Deep breathing can help reduce acid reflux and belching: Study

IF MEDICATIONS to reduce gastric fluid acidity or its secretion don’t work for those with hard-to-treat acid reflux and belching symptoms, a form of deep breathing may be a viable optional treatment.

Known as diaphragmatic or belly breathing, the technique has been used by speech therapists to help people with speech and voice disorders. But a team from Singapore General Hospital (SGH) has found that the technique can also help those patients whose belching and gastro-esophageal reflux disease (GERD) symptoms don’t respond to standard treatment.

“Patients’ heartburn and regurgitation symptoms were reduced while their ability to control their belching, along with their belching severity, also improved,” said Dr Andrew Ong, Associate Consultant, Department of Gastroenterology and Hepatology, SGH, and the first author of the study.

“We also showed that their quality of life improved at the end of treatment. These benefits were sustainable even four months after treatment was completed, and the majority of patients did not require medications to control their symptoms.”

GERD is a digestive disorder that occurs when the ring of muscle between the oesophagus (the tube connecting the mouth and stomach) and stomach, known as the lower oesophageal sphincter, relaxes at inappropriate moments. This allows stomach acid to travel back up the oesophagus. Belching, said Dr Ong, is also common in people with GERD, although it may be the result or cause of their GERD symptoms.

Besides helping to reduce belching and regurgitation, diaphragmatic breathing can also ease stress and anxiety. “Since it is a form of relaxation therapy, the sensitivity of the nerves within the oesophagus may as a result be reduced, and so will the symptoms,” said Dr Ong.

Besides heartburn and/or regurgitation, throat pain, a hoarse voice and chronic cough are other signs of GERD. However, these symptoms are only linked to GERD if they occur with heartburn and regurgitation, not in isolation.

Diaphragmatic breathing has become a standard treatment at SGH for patients with difficultto-treat GERD and belching. SGH has published the benefits of the breathing treatment for this group of patients, and received queries from many international centres.

This condition is expected to affect more and more people, in part because of rising obesity, especially among younger Singaporeans. No current data is available on the percentage with this condition, but research 20 years ago noted a 10 per cent prevalence in Singapore, said Dr Ong.

“GERD contributes to about 20 per cent of our outpatient workload at SGH, and there are likely a lot more patients in primary healthcare,” he added.

GERD is a long-term condition that can be helped by lifestyle changes such as losing weight if obese, medications such as antacids to reduce the acidity of gastric fluid, and proton pump inhibitors or PPI to lower the secretion and acidity of gastric fluids.

The Diaphragmatic Breathing Reduces Belching and Proton Pump Inhibitor Refractory Gastroesophageal Reflux Symptoms study was published in the peerreviewed medical journal Clinical Gastroenterology and Hepatology late last year. In addition to Dr Ong, other members of the study team include Drs Christopher Khor Jen-Lock, Ravishankar Asokkumar, Vikneswaran Namasivayam and Wang YuTien from the Department of Gastroenterology and Hepatology, and Ms Laura Chua Teng Teng from the Physiotherapy Department. • This story was first published in Singapore Health, Nov - Dec 2018 issue.

Patients’ heartburn and regurgitation symptoms were reduced while their ability to control their belching, along with their belching severity, also improved. We also showed that their quality of life improved at the end of treatment. These benefits were sustainable even four months after treatment was completed, and the majority of patients did not require medications to control their symptoms. Dr Andrew Ong, Associate Consultant

SGH Senior Speech Therapist Laura Chua (demonstrating diaphragmatic breathing on a colleague) first gets him to lie down, placing one hand on his chest and the other on the abdomen above the navel. He then slowly breathes in through the nose and out with the mouth open.The abdomen should rise while the chest and shoulders remain still.As the technique becomes more familiar, the person can do it while in a sitting or standing position and (right) Dr Andrew Ong was the first author of the study into the benefits of diaphragmatic breathing for patients whose GERD symptoms did not respond to standard treatment.

Dr Andrew Ong