Study finds mechanism of improvement of GERD by diaphragatic breathing
According to a recent study, Diaphragmatic Breathing reduces the number of postprandial reflux events pressure by increasing the difference between lower esophageal sphincter (LES) and gastric pressure in patients with upright GERD.The findings have recently been published in The American Journal of Gastroenterology.
Previous results have suggested that diaphragmatic breathing (DB) is effective in gastroesophageal reflux disease (GERD) but the mechanism of action and rigor of proof is lacking.
Researchers undertook this study to determine the effects of DB on reflux, lower esophageal sphincter (LES), and gastric pressures in patients with upright GERD and controls.
As for the study sample,Adult patients with pH proven upright GERD were studied. During a high-resolution impedance manometry, study patients received a standardized pH neutral refluxogenic meal followed by LES challenge maneuvers (Valsalva and abdominal hollowing) while randomized to DB . After that, patients underwent 48 hours of pH-impedance monitoring, with 50% randomization to postprandial DB during the second day.
On data analysis, the following facts emerged.
- On examining 23 patients and 10 controls, postprandial gastric pressure was found to be significantly higher in patients compared with that in controls (12 vs 7 mm Hg, P = 0.018).
- Valsalva maneuver produced reflux in 65.2% of patients compared with 44.4% of controls (P = 0.035).
- LES increased during the inspiratory portion of DB (42.2 vs 23.1 mm Hg, P < 0.001) in patients and healthy persons.
- Postprandial DB reduced the number of postprandial reflux events in patients (0.36 vs 2.60, P < 0.001) and healthy subjects (0.00 vs 1.75, P < 0.001) compared with observation.
- During 48-hour ambulatory study, DB reduced the reflux episodes on day 2 compared with observation on day 1 in both the patient and control groups (P = 0.049).
- In patients, comparing DB with sham, total acid exposure on day 2 was not different (10.2 ± 7.9 vs 9.4 ± 6.2, P = 0.804).
- In patients randomized to DB, esophageal acid exposure in a 2-hour window after the standardized meal on day 1 vs day 2 reduced from 11.8% ±6.4 to 5.2% ± 5.1, P = 0.015.
For full article follow the link: 10.14309/ajg.0000000000000913
Primary source: The American Journal of Gastroenterology