Managing GERD: Can Breathing Exercises Help Reduce Acid Reflux?

Gastroesophageal reflux disease (GERD) is one of the most common digestive disorders worldwide, with cases rising steadily. It occurs when stomach acid frequently flows back into the esophagus, causing discomfort, inflammation, and potential damage to the esophageal lining. Symptoms often include heartburn, regurgitation, chest pain, and difficulty swallowing. While medications like proton pump inhibitors (PPIs) are commonly prescribed for GERD, concerns about their long-term use have sparked interest in alternative treatment options—including breathing exercises.

Understanding GERD and the Anti-Reflux Barrier

The human body has a natural defense mechanism to prevent acid reflux. At the junction between the esophagus and stomach, a combination of structures forms the anti-reflux barrier. This includes the lower esophageal sphincter (LES), the crural diaphragm (CD), and other supportive tissues. When this barrier is weakened—due to obesity, overeating, delayed gastric emptying, or muscle dysfunction—acid can escape from the stomach and irritate the esophagus.

Limitations of Long-Term PPI Use

PPIs are the first-line treatment for GERD as they effectively reduce stomach acid production. However, they do not address the root cause of acid reflux, and symptoms often return once the medication is stopped. Long-term PPI use has also been linked to side effects, including an increased risk of nutrient deficiencies, bone fractures, kidney disease, and infections. Additionally, some individuals experience "refractory GERD," meaning their symptoms persist despite medication. These factors have led researchers to explore non-pharmacological approaches, including lifestyle modifications and breathing exercises.

The Role of Breathing Exercises in GERD Management

Recent studies suggest that specific breathing techniques can strengthen the diaphragm, particularly the crural diaphragm, which plays a key role in maintaining the anti-reflux barrier. By improving diaphragm function, breathing exercises may help reduce acid reflux episodes and enhance overall digestive health.

1. Reduction in GERD Symptoms

Breathing exercises have been found to provide short-term relief from acid reflux symptoms such as heartburn, belching, and regurgitation. They can also improve quality of life by reducing discomfort. However, some studies suggest that long-term adherence to breathing exercises can be challenging, which may impact their effectiveness.

2. Lower Dependence on Acid-Suppressing Medication

GERD patients often rely on PPIs to manage symptoms, but some research indicates that consistent breathing exercises may help reduce the need for acid-suppressing medication. One study found that long-term breathing exercises were more effective in decreasing medication use compared to short-term interventions.

3. Strengthening the Anti-Reflux Barrier

The crural diaphragm is a muscle that can be trained like other skeletal muscles. Breathing exercises may enhance its function, increasing pressure at the lower esophageal sphincter and improving its ability to prevent acid reflux. While evidence supports the role of breathing exercises in improving diaphragm function, their effect on strengthening the LES remains debated.

Additional Benefits of Breathing Exercises

Aside from their impact on acid reflux, breathing exercises may offer other health benefits for GERD patients:

• Reduced Stress and Anxiety: GERD symptoms can be worsened by stress, and many patients experience anxiety related to their condition. Controlled breathing can promote relaxation and reduce stress-induced acid reflux episodes.
• Improved Gastric Emptying: Some evidence suggests that breathing exercises may help speed up the movement of food from the stomach to the small intestine, preventing excessive stomach pressure that contributes to reflux.
• Fewer Transient Lower Esophageal Sphincter Relaxations (TLESRs): These are brief moments when the LES opens, allowing stomach contents to move into the esophagus. Breathing exercises may help reduce the frequency of these relaxations.

The Need for Further Research

Although breathing exercises show promise as a complementary therapy for GERD, more large-scale studies are needed to determine their long-term effectiveness and specific mechanisms. Research suggests that they can enhance diaphragm function and potentially reduce acid reflux, but their impact on the lower esophageal sphincter remains inconclusive.

Conclusion

Breathing exercises offer a natural, low-risk strategy for managing GERD, particularly for individuals looking to reduce their dependence on medication. By strengthening the diaphragm and improving anti-reflux mechanisms, these exercises may help alleviate symptoms and enhance overall digestive health. While they should not replace medical treatment, incorporating them into a broader GERD management plan—including dietary changes, weight management, and stress reduction—may offer meaningful benefits. As research continues, breathing exercises could become a valuable tool in the fight against acid reflux.

Reference: https://pubmed.ncbi.nlm.nih.gov/32233626/