Diaphragmatic Breathing Reduces Belching and Proton Pump Inhibitor Refractory Gastroesophageal Reflux Symptoms (original) (raw)
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Breathing could play a role in overall treatment plan of gastroesophageal reflux disease (GERD). A 2011 study published in The American Journal of Gastroenterology indicates diaphragm exercises may have a positive effect on reflux symptoms. Aim: Was to study the effect of practicing deep breathing exercises on improving quality of life of gastroesophageal reflux disease patients. Design: a quasi-experimental study design. Setting: The study was carried out in medical units and outpatient clinics of two hospitals, EL-Hussein and Bab-ELSharia university hospitals, Egypt. Subjects: A convenient sample of 50 adult patients from both genders who agreed to participate in the study according to inclusion criteria. Tools: Three tools were used to collect data include: tool I. Patient socio-demographic characteristics data, tool II. Interview questionnaire sheet, tool III. GERD-Health Related Quality of Life Questionnaire (GERD-HRQD) Pre, post and follow up breathing exercises. Results: total score of study group pre breathing exercise had highly significant correlation with total score of study group post and follow up breathing exercise (P= 0.00,.002). So, the breathing exercise has a positive effect in improving the gastroesophageal reflux disease and patients' quality of life. Conclusion: Considering its safety and cost effectiveness the breathing training exercise could play a crucial role in the management of mild GERD and improvement of health outcomes. Recommendations: Encourage patients of GERD to make lifestyle changes which can play an important role in GERD therapy and education of patients with GERD to do deep breathing exercise, lose weight, quit smoking and eat healthy food can help in managing symptoms. Pay more attention to the importance of identification and management of psychological impact in improving QOL in GERD patients besides physical symptoms of it. Don't replace GERD treatments and apply the breathing exercise as a complementary therapy.
Menoufia Nursing Journal (Print), 2023
Belly breathing recently has an important role in managing GERD symptoms, improving quality of life, medication adherence and sleep quality. Study purpose: to evaluate the belly breathing effectiveness on sleep and life quality among patients with non-erosive gastro esophageal reflux. Design: Quasi-experimental design. Setting: Medical out-patients' clinics of Menoufia University hospital and The National Liver Institute outpatient's clinics at Menoufia Governorate, Egypt. Sample: A purposive sample of 100 patients. Instruments: Five instruments: Structured interview questionnaire, Belly breathing exercises performance checklist & self-reported compliance sheet, GERD clinical symptoms severity and frequency assessment, Pittsburgh Sleep Quality Index and GERD Health-Related Quality of Life Scale. Results: GERD symptoms frequencies were reduced from 26.64 pre-intervention to 17.61 & 9.58 respectively post intervention by 2& 4 months. Also antacid consumption among 34 % of patients preintervention was 7 days / week but reduced to 2% and 0 % postintervention by 2 and 4 months respectively. Moreover good sleeper was 24% preintervention then elevated to 62% and 90% postintervention by 2 and 4 months respectively. Regarding, GERD related quality of life, only 1% were satisfied preintervention but post intervention by 2 and 4 months percent reach 32 and 72 respectively. Conclusion: Belly breathing presenting better therapeutic improvements in all patients' out comes as reduction of GERD symptoms severity and frequencies, little anti acid consumption, better sleep quality and more satisfaction with health-related quality of life. Recommendations: Encourage health care professionals, especially nurses to integrate belly breathing with the treatment protocols of patients with non-erosive GERD.
American Journal of Gastroenterology, 2018
Excessive supragastric belching (SGB) manifests as troublesome belching, and can be associated with refl ux and signifi cant impact on quality of life (QOL). In some GERD patients, SGB-associated refl ux contributes to up to 1/3 of the total esophageal acid exposure. We hypothesized that a cognitive-behavioral intervention (CBT) might reduce SGB, improve QOL, and reduce acid gastroesophageal refl ux (GOR). We aimed to assess the effectiveness of CBT in patients with pathological SGB. METHODS: Patients with SGB were recruited at the Royal London Hospital. Patients attended CBT sessions focused on recognition of warning signals and preventative exercises. Objective outcomes were the number of SGBs, esophageal acid exposure time (AET), and proportion of AET related to SGBs. Subjective evaluation was by patient-reported questionnaires. RESULTS: Of 51 patients who started treatment, 39 completed the protocol, of whom 31 had a follow-up MII-pH study. The mean number of SGBs decreased signifi cantly after CBT (before: 116 (47-323) vs. after 45 (22-139), P <0.0003). Sixteen of 31 patients were shown to have a reduction in SGB by >50%. In patients with increased AET at baseline, AET after CBT was decreased: 9.0-6.1% (P =0.005). Mean visual analog scale severity scores decreased after CBT (before: 260 (210-320) mm vs. after: 140 (80-210) mm, P <0.0001). CONCLUSIONS: Cognitive behavioral therapy reduced the number of SGB and improved social and daily activities. Careful analysis of MII-pH allows identifi cation of a subgroup of GERD patients with acid refl ux predominantly driven by SGB. In these patients, CBT can reduce esophageal acid exposure.
Egyptian Journal of Health Care
Background: Gastroesophageal reflux disease (GERD) is a common gastrointestinal illness with symptoms of heartburn, chest pain, and regurgitation. Management of GERD could involve proton pump inhibitor (PPI) medications, lifestyle modifications (healthy diet and diaphragmatic breathing exercises), and surgical intervention depending on the patients` condition. Aim: To evaluate the impact of different management approaches on clinical symptoms among patients with gastroesophageal reflux disease. Research design: Nonequivalent quasi experimental research design was utilized in this study. Study Setting: This study was conducted in gastrointestinal unit at kafrelsheikh University Hospital. Study sample: A convenient sample of 90 patients with gastroesophageal reflux disease were divided randomly into 3 groups receiving Proton pump inhibitor (maximum dose), Proton pump inhibitor (medium dose) with lifestyle modifications, and lifestyle modifications only. Tools: Two tools for data collection were used in this study as follow: tool (I) structured interview questionnaire and tool (II) GERD questionnaire which used to assess patients GERD levels in pre, post intervention and follow up stages. Results: the results showed significant decrease in GERD levels among patients receiving PPI, patients receiving PPI with lifestyle modifications, & patients receiving lifestyle modifications only as (X2=24.471&p= 0.001, X2=27.432&p= 0.001 & X2=5.085&p= 0.278) consequently. In addition, repeated measures one way ANOVA test showed a statistical difference between the total GERD mean scores in relation to time of intervention among patients receiving PPI combined with lifestyle modifications followed by PPI group as (F=17.131&p=<0.05) & (F=4.768 &p=<0.05) accordingly. Conclusion: Combination of pharmacological agent as Omeprazole (PPI) 20 mg/day with non-pharmacological nursing interventions as life style modifications in the form of dietary modifications and diaphragmatic breathing consider as the most effective method to reduce GERD clinical symptoms among patients with GERD. Recommendations: nurses' role as an educator should be continue to teach patients with GERD about lifestyle modifications and its positive effect on reducing the clinical symptoms of the disease. Provide continuous education about the latest modalities in this filed for nurses working with patients with gastrointestinal problems.
Open Journal of Gastroenterology
The gastroesophageal reflux disease (GERD) represents a major problem for public health because of its high prevalence. The chronic character of the symptoms can have a very important impact on the quality of life (QoL). The purpose of this study is to assess the impact of the GERD on the quality of life of our patients and to determine the main aggravating factors. Patients and Methods: This is a cross-sectional, observational study of 100 patients presenting signs of GERD in the gastroenterology department of the university medical center Hassan II-Fez, for a period of 3 months (October to December 2014). We used the Reflux-Qual short form (RQS ) to evaluate the QoL of our patients. Results: Over the study period, 100 patients were included. The average age of our patients was 47 years [20-75 years] with a sex-ratio F/M in 2.12. Among our patients, 20% (n = 20) were chronic cigarette smokers. The diagnosis of GERD was clinical in 75% of the cases (n = 75) and based on 24-hour pH monitoring in the remaining 25% (n = 25). Approximately 2/3 of the patients were receiving proton pump inhibitors (PPIs) treatment at the time of the questionnaire. The impairment of QoL was moderated to severe (RQS < 16) for 62% of the patients (n = 62). This impairment was associated with elderly (p = 0.01), female sex (p = 0.03) and the frequency of symptoms (p = 0.001). Moreover, patients having a GERD that requiring a daily and continuous administration of PPIs had a lower index of RQS (p = 0.001). The quality of life impairment was not associated with chronic cigarette smoking (p = 0.3). Conclusion: The impairment of the QoL was moderated to severe (RQS < 16) for 2/3 of the patients (n = 62). This impairment was associated with elderly, female sex, frequency and in case of GERD requiring continuous administration of PPIs.
Behavioral Treatment of Chronic Belching Due to Aerophagia in a Normal Adult
Behavior Modification, 2006
Aerophagia, or excessive air swallowing, is a potential cause of belching, flatulence, bloating, and abdominal pain and may contribute to a worsening of gastrointestinal (GI) disorders. A limited number of published reports of aerophagia treatment indicate that behavioral methods may be of benefit. A case report is presented describing the behavioral treatment of chronic belching due to aerophagia in an adult female. The collaborative application of single-participant design research helped identify open-mouth, diaphragmatic breathing and minimized swallowing as an effective intervention. Belching frequency was reduced from an average rate of 18 per 5-min interval during the baseline period to 3 per 5-min period after treatment. Results were maintained at an 18-month follow-up. Recommendations for the use of a brief treatment protocol with adults referred for chronic belching or other GI complaints attributed to aerophagia are discussed.
Inspiratory muscle training improves antireflux barrier in GERD patients
American journal of physiology. Gastrointestinal and liver physiology, 2013
The crural diaphragm (CD) is an essential component of the esophagogastric junction (EGJ), and inspiratory exercises may modify its function. This study's goal is to verify if inspiratory muscle training (IMT) improves EGJ motility and gastroesophageal reflux (GER). Twelve GER disease [GERD; 7 males, 20-47 yr, 9 esophagitis, and 3 nonerosive reflex disease (NERD)] and 7 healthy volunteers (3 males, 20-41 yr) performed esophageal pH monitoring, manometry, and heart rate variability (HRV) studies. A 6-cm sleeve catheter measured average EGJ pressure during resting, peak inspiratory EGJ pressures during sinus arrhythmia maneuver (SAM) and inhalations under 17-, 35-, and 70-cmH2O loads (TH maneuvers), and along 1 h after a meal. GERD patients entered a 5-days-a-week IMT program. One author scored heartburn and regurgitation before and after IMT. IMT increased average EGJ pressure (19.7 ± 2.4 vs. 29.5 ± 2.1 mmHg; P < 0.001) and inspiratory EGJ pressure during SAM (89.6 ± 7.6 vs. 1...
Respiratory Care, 2012
BACKGROUND: Patients with COPD and patients with bronchiectasis undertake airway clearance therapy and exercise as part of management, but the effect of these activities on gastroesophageal acid exposure is unknown. This study aimed to determine if positive expiratory pressure (PEP) therapy and standardized exercise tasks were associated with increased gastroesophageal reflux. METHODS: During dual-probe 24 hour esophageal pH monitoring, all participants undertook a single session of PEP therapy, a measure of submaximal exercise capacity (6-min walk test [6MWT]), and a functional upper limb task (grocery shelving task [GST]). The number of reflux episodes and fractional reflux time (reflux index [RI]) were recorded during each intervention and compared to equivalent background time (BGT). RESULTS: Fifty-seven participants (30 with bronchiectasis, 27 with COPD, mean ؎ SD age 61 ؎ 13 y, FEV 1 61.2 ؎ 24.6% predicted) completed the study. Episodes of isolated distal esophageal reflux occurred in 30% of participants during PEP therapy, 22% during the 6MWT, and 20% during the GST. However, there was no significant difference in distal RI during 6MWT or PEP therapy, compared to BGT (all P > .05). The number of reflux episodes was decreased, compared to BGT during the GST (P ؍ .001) and 6MWT (P ؍ .001), but not during PEP therapy (P ؍ .71). CONCLUSIONS: Episodes of gastroesophageal reflux may occur during physiotherapy tasks, including airway clearance therapy using mouthpiece PEP, the 6MWT, and a measure of upper limb movement. However, as these activities did not increase the frequency of these events, no modifications to these tasks to minimize the occurrence of gastroesophageal reflux are necessary.
World Journal of Gastroenterology
AIM To evaluate the psychometric properties of a newly developed questionnaire, known as the gastroesophageal reflux and dyspepsia therapeutic efficacy and satisfaction test (GERD-TEST), in patients with GERD. METHODS Japanese patients with predominant GERD symptoms recruited according to the Montreal definition were treated for 4 wk using a standard dose of proton pump inhibitor (PPI). The GERD-TEST and the Medical Outcome Study Short Form-8 Health Survey (SF-8) were administered at baseline and after 4 wk of treatment. The GERD-TEST contains three domains: the severity of GERD and functional dyspepsia (FD) symptoms (5 items), the level of dissatisfaction with daily life (DS) (4 items), and the therapeutic efficacy as assessed by the patients and medication compliance (4 items). RESULTS A total of 290 patients were eligible at baseline; 198 of these patients completed 4 wk of PPI therapy. The internal consistency reliability as evaluated using the Cronbach's α values for the GERD, FD and DS subscales ranged from 0.75 to 0.82. The scores for the GERD, FD and DS items/subscales were significantly correlated with the physical and mental component summary scores of the SF-8. After 4 wk of PPI treatment, the scores for the GERD items/subscales were greatly reduced, ranging in value from 1.51 to 1.87 and with a large effect size (P < 0.0001, Cohen's d ; 1.29-1.63). Statistically significant differences in the changes in the scores for the GERD items/subscales were observed between treatment responders and non-responders (P < 0.0001). CONCLUSION The GERD-TEST has a good reliability, a good convergent and concurrent validity, and is responsive to the effects of treatment. The GERD-TEST is a simple, easy to understand, and multifaceted PRO instrument applicable to both clinical trials and the primary care of GERD patients.
American Journal of Respiratory and Critical Care Medicine, 2001
This study evaluated the prevalence of upper respiratory symptoms (URS) among patients with symptomatic gastroesophageal reflux disease (GERD). Seventy-four subjects with heartburn completed a URS questionnaire before dual-probe, 24-h esophageal pH monitoring. The URS questionnaire was also completed by 74 normal volunteers without previous or current symptoms of GERD. Esophageal pH monitoring results were classified as normal, distal, or proximal and distal gastroesophageal reflux using standardized criteria. Mean URS scores (Ϯ SD) were 8.31 Ϯ 3.98 in the 52 subjects with GERD and 4.57 Ϯ 3.57 in the 22 subjects with negative pH probe studies, p ϭ 0.02. Subjects with negative pH probe studies and normal volunteers scored similarly on the URS questionnaire. Reflux episodes/24 h correlated with URS scores, r ϭ 0.47, p ϭ 0.0001. Seventy-five percent of subjects with upper reflux, 68% of subjects with lower reflux, 36% of subjects with normal esophageal pH studies, and 9% of normal volunteers reported laryngeal symptoms for at least 5 d/mo. Sixty-nine percent of subjects with upper reflux, 50% of subjects with lower reflux, 31% of subjects with normal pH studies, and 14% of normal volunteers reported nasal symptoms for at least 5 d/mo. URS are frequent among subjects with GERD.