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Can Belly Breathing Reduce Burping from GERD?

by Melissa Caravella

Vocalists use it to improve their singing. Athletes use it to improve their performance. And now, science has found that diaphragmatic breathing—also called belly breathing—may help those who suffer from gastroesophageal reflux disease (GERD) to reduce burping.

Beyond the burp

GERD occurs when the stomach’s contents flow back (reflux) into the esophagus, inflaming the linings of the throat and esophagus. Most cases of GERD are a result of a weakened lower esophageal sphincter (LES). The LES is a ring of muscle that normally blocks the reflux of stomach contents. If the LES doesn’t stay tightly shut, stomach contents can back up, causing heartburn.

Nearly half of people who have GERD report belching as a primary symptom. Often these burps are “supragastric”—meaning that they’re accompanied by acid reflux in the back of the throat—which makes them particularly unpleasant. Many patients turn to proton pump inhibitors (PPIs) for symptom relief. While PPIs are an effective remedy for symptoms, their long-term use has been associated with an increased risk of health issues such as kidney disease, bone loss, pneumonia, and Clostridium difficile infection. Even so, PPIs’ benefits outweigh the potential risks for many patients. But in 2015, the American Geriatrics Society recommended that older adults use PPIs for no longer than eight weeks as a precaution, unless otherwise advised by their doctor.

PPIs don’t do the job for people who suffer from PPI-refractory GERD. This group of patients could benefit from other ways to relieve symptoms, especially hard-to-treat belching—which isn’t always related to GERD. Enter belly breathing.

The science of belly breathing

Researchers previously thought the excessive burping that GERD sufferers experience resulted from swallowing too much air, but newer studies have shown that involuntary contractions of the diaphragm may be a culprit. This finding prompted researchers in Singapore to hypothesize that breathing exercises could help control diaphragm contractions, thus reducing supragastric belching and improving other GERD symptoms.

In the study, published online in December 2017 in Clinical Gastroenterology and Hepatology, scientists recruited 36 adults with PPI-refractory GERD. All had heartburn but no evidence of esophageal lining inflammation from acid reflux. The participants, who ranged in age from 29 to 60, had been taking PPIs twice a day for 12 weeks with no improvement in heartburn, regurgitation, and excessive belching. On average, they belched 46 times over each 24-hour period.

How to Perform Diaphragmatic Breathing

You might recognize belly breathing from yoga classes. It is safe, costs nothing, and is easy to do, but it takes some practice. Here’s how to start.

The participants were taught, over four weekly sessions, how to perform the belly-breathing technique. After that time, more than 93 percent achieved a reduction in excessive burping and an increase in quality of life, with 60 percent reporting their overall GERD symptoms were reduced by half or more. The researchers suspected that the improvement in heartburn and regurgitation was in part due to a decrease in supragastric belching. They also say that belly breathing’s ability to impart relaxation might have served to distract GERD sufferers from belching while reducing their anxiety.

Because of the study’s very small size and short-term nature, a larger, more diverse randomized controlled trial is needed to confirm the findings.

Other belly-breathing benefits

Studies have shown that diaphragmatic breathing may provide an array of health benefits, such as lowering blood pressure, making breathing easier for people with chronic lung conditions, controlling hot flashes, reducing stress and anxiety, and improving attention and focus.

This article first appeared in the April 2018 issue ofUC Berkeley Health After 50.

Also see Do You Need Breathing Lessons?