Diaphragmatic breathing was found to lower the number of postprandial reflux events in patients experiencing upright gastroesophageal reflux disease (GERD) by creating a greater difference between lower esophageal sphincter (LES) and gastric pressure, according to the results of a study published in the American Journal of Gastroenterology.

A team of investigators from the Mayo Clinic, in Rochester, Minnesota, conducted a study to determine the effectiveness of diaphragmatic breathing on reflux and LES and gastric pressures in both patients with upright GERD as well as healthy control participants. Adult patients with upright GERD were recruited for the study from March 2017 to February 2019. Before participating in the study, the researchers asked patients to discontinue the use of proton pump inhibitor (PPI) therapy for at least 7 days.  

During high-resolution impedance manometry, the investigators gave participants a standardized, pH-neutral refluxogenic meal succeeded by LES challenge maneuvers (Valsalva and abdominal hollowing) while they were randomly assigned to diaphragmatic breathing or sham. On the second day, patients underwent 48 hours of pH-impedance monitoring, with 50% randomization to postprandial diaphragmatic breathing.

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A total of 33 patients participated in the study: 23 with upright GERD and 10 healthy control participants. The investigators found that postprandial gastric pressure was much higher in patients with upright GERD in comparison with the control participants (12 vs 7 mm Hg; P =.018).Valsalva maneuver produced reflux in 65.2% of patients with GERD and in 44.4% of control participants (P = .035). The researchers found that LES pressure increased during the inspiratory part of diaphragmatic breathing (42.2 vs 23.1 mm Hg; P <.001) in both patients with GERD as well as in healthy individuals.

Postprandial diaphragmatic breathing reduced the number of postprandial reflux events in patients with upright GERD (0.36 vs 2.6; P <.001) and in healthy participants (0 vs 1.75; P <.001) in comparison with observation. Diaphragmatic breathing reduced the reflux episodes on day 2 compared with observation on day 1 in both patients with GERD as well as in the healthy control group (P =.049) during the 48-hour ambulatory study.

In addition, a comparison of diaphragmatic breathing with sham showed that mean total acid exposure on day 2 was indistinguishable among the 2 groups (10.2±7.9 vs 9.4±6.2; P =.804). For patients practicing diaphragmatic breathing, mean percentage esophageal acid exposure in a 2-hour window after the standardized meal on day 1 vs day 2 was found to be reduced from 11.8±6.4 to 5.2±5.1; P =.015.

This study was limited by failure to demonstrate a significant decrease in esophageal acid exposure in relation to diaphragmatic breathing, the relatively small size of the study population, symptoms not evaluated, and only having 1 education visit, which could have possibly had a detrimental effect on patient adherence to the technique.

The researchers determined that diaphragmatic breathing may have the potential to be an effective treatment for certain patients with GERD. These findings suggest that additional research is needed to confirm whether diaphragmatic breathing can reduce symptoms in patients with GERD and, if so, what forms of GERD will benefit most from this therapy.    


Halland M, Bharucha AE, Crowell MD, Ravi K, Katzka DA. Effects of diaphragmatic breathing on the pathophysiology and treatment of upright gastroesophageal reflux: a randomized controlled trial. Am J Gastroenterol. 2020;116(1):86-94. doi:10.14309/ajg.0000000000000913