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 23 June 2018

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News

Standardized protocol increases quality of life in patients with PPI-refractory GERD  

March's issue of Clinical Gastroenterology and Hepatology finds that diaphragmatic breathing reduces belching and proton pump inhibitor refractory gastroesophageal reflux symptoms.

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In patients with gastroesophageal reflux disease (GERD) and excessive belching, most belches are supragastric, and can induce reflux episodes and worsen gastroesophageal reflux disease.

Supragastric belching might be reduced with diaphragmatic breathing exercises.

Dr Andrew Ming-Liang Ong and colleagues of Singapore investigated whether diaphragmatic breathing therapy is effective in reducing belching and proton pump inhibitor-refractory gastroesophageal reflux symptoms.

The researchers performed a prospective study of 36 consecutive patients with gastroesophageal reflux disease refractory to proton pump inhibitor therapy and a belching visual analogue scale score of 6 or more, seen at a gastroenterology clinic at a tertiary hospital in Singapore from 2015 through 2016.

Patients underwent high-resolution manometry and 24-hour pH-impedance studies while they were off proton pump inhibitors.

The team placed 15 patients on a standardized diaphragmatic breathing exercise protocol and completed questionnaires at baseline, after diaphragmatic breathing therapy, and 4 months after the therapy ended.

The researchers placed 21 patients on a waitlist, completed the same questionnaires with an additional questionnaire after their waitlist period, and eventually received diaphragmatic breathing therapy.

The primary outcome was reduction in belching visual analogue scale by 50% or more after treatment.

In the treatment group, the mean belching visual analogue scale score decreased from 7 to 4 after diaphragmatic breathing therapy
Clinical Gastroenterology and Hepatology

The team's secondary outcomes included gastroesophageal reflux disease symptoms and quality of life scores, determined from the Reflux-Qual Short Form and Euroquality of life-visual analogue scale.

Nine of the 15 patients in the treatment group and none of the 21 control subjects achieved the primary outcome.

In the treatment group, the mean belching visual analogue scale score decreased from 7 at baseline to 4 after diaphragmatic breathing therapy; in the control group, the mean visual analogue scale score was 8 at baseline and 7 after the waitlist period.

The researchers found that 80% of patients in the treatment group significantly reduced belching frequency compared with 19% in control subjects.

Treatment significantly reduced symptoms of gastroesophageal reflux disease.

The treatment significantly increased quality of life scores and mean Euroquality of life-visual analogue scale scores.

The team observed that these changes were sustained at 4 months after treatment.

In the end, 20 of the 36 patients who received diaphragmatic breathing therapy, all with excessive Supragastric belching, achieved the primary outcome.

Dr Ming-Liang Ong's team concluded, "In a prospective study, we found a standardized protocol for diaphragmatic breathing to reduce belching and proton pump inhibitor-refractory gastroesophageal reflux symptoms, and increase quality of life in patients with proton pump inhibitor pump inhibitor-refractory gastroesophageal reflux disease with belching—especially those with excessive Supragastric belching."

Clinical Gastroenterology and Hepatology 2018: 16 (3) 407-416 e2
12 March 2018

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