Effect of Diaphragmatic Breathing Training on the Esophagogastric Junction and Esophageal Motility in Patients With Reflux Symptoms

Background Diaphragmatic breathing training (DBT) improves symptoms in patients with gastroesophageal reflux disease; however, the effect of DBT on the anti‐reflux barrier and esophageal motility is unclear. This study aimed to evaluate the changes in specific parameters of EGJ function and esophageal motility before and after DBT using high‐resolution manometry (HRM) in patients with reflux symptoms. Methods Prospectively collected data from adult patients with persistent reflux symptoms who underwent initial and follow‐up HRM after at least 3 months of DBT were analyzed. Esophagogastric junction (EGJ) function was assessed using basal lower esophageal sphincter (LES) pressure (LESP), the EGJ contractile integral (EGJ‐CI), and integrated relaxation pressure (IRP). Esophageal motility was assessed using the distal contractile integral (DCI) and percentage of ineffective esophageal motility (IEM). Key Results Data from 53 patients with a median age of 45 years (range 25–77) were analyzed. LES pressure increased after DBT (mean LES pressure 25.6 [SE 1.3] vs. 29.1 [SE 1.4] mmHg after DBT; p = 0.02). This effect was also observed in patients with an initially hypotensive LES, but no effect was found on the size of hiatus hernia. There was a trend to increased EGJ‐CI (mean EGJ‐CI 52.8 [SE 3.7] vs. 59.9 [SE 4.3] mmHg·cm after DBT, p = 0.07). Esophageal contractility improved (mean DCI 1046.6 [SE 112] vs. 1264.1 [SE 137] mmHg·s·cm after DBT; p < 0.01) with the prevalence of IEM reduced from 38.0% [SE 5] to 29.2% [SE 4] after DBT; p = 0.03. Conclusion and Inferences Diaphragmatic breathing training increased LES pressure and esophageal peristaltic vigor in patients with reflux symptoms.