Diaphragmatic breathing exercise is one of the most widely used methods in the treatment of chronic diseases, such as chronic obstructive pulmonary disease, asthma, and also gastroesophageal reflux disease (GERD).

Gastroesophageal reflux disease GERD is a chronic medical condition that can reduce the quality of life of sufferers. Management of this disease can be performed through lifestyle modification, administration of drugs, to surgery.

However, even with maximal medical treatment, GERD recurrence can still occur. This recurrence makes the role of lifestyle modification in GERD is enormous, and one method that can be used is diaphragmatic breathing exercises. Diaphragmatic breathing exercises can help improve the function of the anti-reflux mechanism, thereby reducing the symptoms of GERD.

Diaphragmatic Breathing Exercises in Treatment of Gastroesophageal Reflux Disease (GERD)

Mechanisms and Benefits of Diaphragmatic Respiration in Gastroesophageal Reflux

Gastroesophageal reflux disease (GERD) is a condition of the gastric contents returning to the esophagus or gastroesophageal reflux that lasts chronic due to failure of the anti-reflux mechanism. There are several factors, such as exposure to gastric content, esophageal valve/sphincter problems, gastrointestinal motility disorders, esophageal hypersensitivity, Hiatal hernias, and mucosal abnormalities.

Breathing with a diaphragm can help strengthen the diaphragm muscles, decrease the breathing rate, decrease the energy needed to breathe, and reduce the amount of oxygen required.

Exercising diaphragmatic breathing can also strengthen the contraction of the lower esophageal sphincter (LES) muscles. The diaphragm muscle surrounds the LES and can produce positive pressure, which increases intra-abdominal pressure. This mechanism can help prevent reflux from the stomach from re-entering the esophagus, thereby reducing the symptoms of heartburn.

Exercising diaphragmatic breathing can also strengthen the crural parts of the diaphragm, causing actions such as clamps / pinchcock-like when LES to contract. The work of the crural diaphragm can serve as an additional external valve.

Studies also show that diaphragmatic breathing can relieve the symptoms of belching, dyspepsia, sensation of regurgitation, and improve the quality of life in refractory GERD. The success of this mechanism can also help reduce the costs of proton pump medicines for the long term.

Diaphragmatic breathing exercises show promising results. However, current studies do not involve a large number of patients.

One prospective study of 36 patients showed that diaphragmatic breathing exercises could relieve belching symptoms by as much as 50% or more, and improve the quality of life of patients. As many as 80% of patients who get diaphragmatic breathing exercises have decreased symptoms of belching, 60% of them have decreased by more than 50%.

Diaphragmatic breathing exercises also reduced overall GERD symptoms and reduced the GERD questionnaire score by 12.2 points, while patients who did not do diaphragmatic breathing exercises had decreased by 3.3 points. The quality of life of patients also improved by 15.4 points on the EuroQoL-VAS scoring with diaphragmatic breathing exercises. Relieve symptoms and improve the quality of life lasts for 4 months after therapy was carried out. Therapy was carried out one time every week for 4 weeks, where each session was carried out for 30 minutes with physiotherapist guidance.

Another study of 19 patients with non-erosive GERD or esophagitis after therapy showed that diaphragmatic breathing exercises could raise pH levels at pH meters to pH <4.0 (P <0.05). Diaphragmatic breathing exercises also reduce the need for proton pump inhibitor drugs at follow-up after 9 months. The exercise regimen is one hour of exercise with a physiotherapist at the start of therapy, followed by 30 minutes of independent exercise at home for 4 weeks.

A systematic literature study / systematic review of 4 kinds of research shows that diaphragmatic breathing exercises have a significant role in controlling the symptoms of GERD. Patients who got therapy with a physiotherapist 5 days a week for 2 months, with a duration of 30 minutes/session, showed reducing in symptoms of regurgitation and heartburn. Pressure on LES also increased significantly in patients who took 2x40 minutes/day of therapy every day for 8 weeks. This study also showed that there were acid suppression and improvement in the quality of life after one month of undergoing therapy. The use of proton pump inhibitor drugs was also significantly reduced at eight months of follow-up.

Diaphragmatic Respiratory Techniques

Diaphragmatic breathing technique is a technique that must be practiced regularly. In the initial phase, patients will get tired quickly because they need more energy to breathe. However, this tired will decrease, along with more frequent exercises.

Diaphragmatic breathing can be performed in 2 positions, namely the side-lying and sitting positions. Exercise in the side-lying/supine position will make it easier for patients, especially patients who are just starting to use this breathing technique.

Diaphragmatic Breathing Exercises Techniques
Diaphragmatic Breathing Exercises Techniques

  1. In the side-lying position, the patient lies on a flat surface with knees bent around 30-40 degrees. For convenience, patients can use a pillow on the lower side of the knee and head.
  2. Place one hand on the upper chest and 1 other hand on the upper abdomen (parallel to the last rib).
  3. Breathe slowly through the nose while making sure the hands on the stomach move with the breath in, and the hand on the chest stays still.
  4. Tighten the abdominal muscles and exhale through the mouth with lips pursing slightly while making sure the hand on chest remains still.
  5. Over time, patients can try to do this breathing mechanism by sitting on a chair or sofa, with the neck and head in a relaxed position.

Studies show that diaphragmatic breathing exercises of 15 breaths in 10 cycles (30 minutes) every day for 4-8 weeks can be beneficial in reducing the symptoms of GERD.

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