September/October 2026 Vol 40.5Diaphragmatic Breathing as an Adjunctive Approach in Gastroesophageal Reflux Disease: Narrative Review of Its Mechanistic Basis and Clinical Evidence
Background: Gastroesophageal reflux disease (GERD) is a chronic gastrointestinal condition defined by reflux of stomach contents into the esophagus, leading to cardinal symptoms such as heartburn and regurgitation, thereby negatively impacting patients’ quality of life. Several underlying mechanisms contribute to GERD, with dysfunction of the anti-reflux barrier playing a key role in reflux. Even though proton pump inhibitors are commonly prescribed, a considerable proportion of patients do not achieve symptom relief. Diaphragmatic breathing (DB) has emerged as an adjunct non-pharmacological therapy that may strengthen the anti-reflux barrier by enhancing crural diaphragm function.
Objective: To synthesize the effects of DB in GERD, with a focus on clinical outcomes and underlying mechanisms.
Methodology: PubMed and Scopus databases were searched using predefined keywords “diaphragmatic breathing AND gastroesophageal reflux disease” and “abdominal breathing AND gastroesophageal reflux disease”. 7 clinical trials relevant to our study were retrieved. These trials comprised DB interventions, with measured outcomes such as symptom severity, Quality of life, reflux-associated cough, belching severity, sleep quality, medicine use, and lower esophageal sphincter pressure.
Results: DB has been found to reduce reflux symptoms, improve certain extra-esophageal manifestations, and decrease the use of proton pump inhibitors and antacid demand. It may also reinforce the anti-reflux barrier primarily by improving crural diaphragm function, potentially increasing lower esophageal sphincter pressure. Whereas several individual studies observed improvement in quality of life, these findings were not consistently supported by a recent meta-analysis, likely due to study heterogeneity.
Conclusions: Findings indicate that DB is a safe and inexpensive non-pharmacological intervention for GERD. However, the current evidence is constrained by methodological differences, small sample size, and limited long-term follow-up, highlighting the need for large-scale, well-designed multi-center trials to evaluate its long-term efficacy.
Keywords: Breathing exercises, Complementary therapies, Gastroesophageal reflux, Physical therapy modalities Open Access: Yes Click here for full text
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