Diaphragmatic Breathing Reduces Belching and GERD Symptoms

An article in Clinical Gastroenterology and Hepatology showed that diaphragmatic breathing training reduced belching frequency in 80% of the study participants, and significantly reduced symptoms of acid reflux.

Written by David Rakel MD, FAAFP
Diaphragmatic Breathing for Belching-Inducing GERD

Many things that we use PPIs for should not be treated with acid suppression therapy. One of these is excessive belching, which is produced by micro-spasms of the diaphragm, resulting in negative airway pressure and excessive air swallowing. The mechanism of belching can then cause disruption of the lower esophageal barrier, leading to reflux symptoms. To address the root of the problem, the wise clinician will improve diaphragm function so treating the reflux will not be necessary.

In this small study of 36 patients with excessive belching and PPI-refractory GERD, 15 were taught diaphragmatic breathing (DB) once weekly for 4 weeks vs a wait-list control. The wait-list control was also taught the DB after their waiting was complete. Out of the whole study group, 73% were able to come off their PPIs. Of the DB group, 80% had improvement in belching and GERD vs 19% in the wait-list control group. The benefits lasted 4 months after the intervention. This was a small study and needs to be replicated. But it is promoting an intervention that is low-cost, low-harm, and always available to the patient. It also helps us reduce the use of a medicine (PPI) that has growing concerns with long-term use.

How to Belly Breathe

While sitting in a chair or lying down, place one hand on the abdomen and one on the chest. Slowly inhale for a count of 3 to 4. With each inhalation, the belly hand should expand more than the chest hand. When the belly expands, the diaphragm is contracting, taking up more room and pushing the abdominal contents outward. This diaphragmatic contraction also stimulates the vagus nerve and the parasympathetic branch of the autonomic nervous system. Some imagine filling up a balloon located in the abdomen. Exhale for a count of 6 to 7. Exhalation is generally twice as long as inhalation. The autonomic nervous system is brought under balance with one in-and-out breath every 10 seconds, or 6 breaths per minute. During these breathing exercises, the mind should focus on one thing, such as the present moment, the in and out flow of the breath, or a calming word.

Encourage 30 belly breaths three times daily. With practice, the body starts to breathe like this normally.

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