Table 1.
Clinical studies evaluating the effect of respiratory physiotherapy in patients with GERD
| Authors Journal (Year) | Region | Study design | Patients (number/characteristics) | Therapy training/control | Exercises time/follow-up | Parameters | Results |
|---|---|---|---|---|---|---|---|
| Eherer et al. The American Journal of Gastroenterology (2012) | Austria | Prospective randomized controlled study | 19 patients with NERD or healed esophagitis (10 in training group/mean age 48 ± 4 years, mean BMI 22.0 kg/m2; 9 in control group/mean age 55 ± 4 years, mean BMI 24.9 kg/m2) | Abdominal breathing exercises + on-demand PPI/on-demand PPI | 4 weeks training/9 months | pH-metry, QoL, on-demand PPI usage | Significant decrease in pH < 4.0 (9.1 ± 1.3 to 4.7 ± 0.9), significantly improved QoL, and significant decrease in PPI usage after 9 months (98 ± 34 to 25 ± 12 mg/week)—only in study group |
| Da Silva RCV et al. Diseases of the Esophagus (2012) | Brazil | Prospective randomized controlled study | 38 patients (22 in study group/mean age 49.4 ± 15 years, mean BMI 25.7 kg/m2; 16 in placebo group/mean age 50.5 ± 16, mean BMI 23.52 kg/m2) | Osteopathy (diaphragm stretching technique)/placebo technique | ARP and MEP on esophageal manometry before and just after osteopathy | Increase of 9–27% in LES pressure only in study group (9.2% increase in ARP; 21.0% increase in MEP) | |
| Chaves RCM et al. Respiratory Medicine (2012) | Brazil | Prospective study | 29 consecutive patients (20 in study group/mean age 50.1 years; 9 in control group/mean age 51.3 years) | IMT using threshold/respiratory exercises with minimal inspiratory load | 8 weeks | MRP and EEP on esophageal manometry | Significant increase in MRP and EEP in both study group (46.6% and 34.8%, respectively) and control group (26.2% and 15.0%, respectively) |
| Souza MA et al. Am J Physiol Gastrointest Liver Physiol (2013) | Brazil | Prospective study | 12 patients with GERD and 7 healthy volunteers | IMT with threshold | 2 months | Average EGJ pressure, inspiratory EGJ pressure during respiratory maneuvers, assesment of TLESr on manometry, pH-metry, autonomic function | Improved EGJ pressures (19.7 ± 2.4 to 29.5 ± 2.1 mmHg), decreased number and duration of TLESr (8.5 to 7 events/hour, 199.1 ± 23.5 to 156.8 ± 25.9 min), reduced GERD proximal progression, decreased GERD symptoms |
| Sun et al. Diseases of the Esophagus (2016) | China | Prospective randomized controlled study | 40 patients (20 patients in training group/mean age 48.9 ± 2 years, mean BMI 27.9 kg/m2; 20 patients in control group/mean age 50.5 ± 2 years, mean BMI 26.4 kg/m2) | Diaphragm biofeedback training + PPI (Rabeprazole)/Rabeprazole only | 8 weeks/6 months | Consumption of PPI, GERD symptoms, QoL, esophageal motility on HRM | Improved GERD symptoms and QoL at 8 weeks; decreased PPI use at 6 months (82.3% of patients in the study group ceased PPI use; 6.2% of patients in control group ceased PPI use), increased CD pressure (16.81 ± 1.08 to 25.27 ± 1.31 mmHg) and EGJ pressure (23.21 ± 1.28 to 31.76 mmHg), observed only in study group |
| Ong et al. Clinical Gastroenterology and Hepatology (2018) | Singapore | Prospective study | 36 consecutive GERD patients with excessive belching (15 patients in training group/mean age 44.9 ± 15.7 years; 21 patients in control group/mean age 46 ± 10.4 years) | Diaphragmatic breathing exercises/no exercises | 4 weeks/4 months | Belching VAS score, GERD symptoms, QoL | Decreased belching VAS score, reduced GERD symptoms, increased QoL only in study group |
| Moffa et al. Acta Otorrinolaringol Esp. (2019) | Italy, Spain | Prospective study | 21 patients with NERD | Modified inspiratory muscle training | 4 weeks | GERD symptoms, QoL, laryngeal endoscopy | Improved GERD symptoms and QoL, improved laryngeal endoscopy score |
| Martinez-Hurtado et al. Scientific Reports (2019) | Spain | Prospective randomized controlled study | 30 patients with GERD (15 patients in study group/mean age 49.9 ± 14 years, mean BMI 25.6 kg/m2; 15 patients in control group/mean age 46.9 ± 15 years, mean BMI 27.3 kg/m2) | Diaphragmatic MFR techniques/gentle contact techniques | 2 weeks/4 weeks | GERD symptoms, QoL, PPI consumption | Improved GERD symptoms and QoL; reduced PPI usage by week 4 (88 mg/week to 33 mg/week), observed only in study group |
| Eguaras et al. Journal of Clinical Medicine (2019) | Spain | Randomized double-blinded controlled study | 60 patients with GERD (31 patients in experimental group/mean age 48.19 years, mean BMI 24.7 kg/m2; 29 patients in control group/mean age 49.45 years, mean BMI 24.81 kg/m2) | Osteopathic techniques for LES/manual contact mimicked the osteopathic techniques | 1 week/2 weeks | GERD symptoms, CROM, C4 PPTs | Significant improvement in GERD symptoms in 1 week; C4 PPTs and CROM improved in 2 weeks |
| Halland et al. Am J Gastroenterol (2021) | USA | Randomized controlled study | 23 patients with GERD and 10 controls (GERD patients/mean age 58 ± 12 years, BMI 29.98 kg/m2; healthy controls/mean age 44 ± 10 years, mean BMI 28.32 kg/m2) | DBT/no exercises | 2 days | Effect of DBT on reflux (48 h pH-impedance monitoring), LES, and gastric pressure on HRM | Reduced postprandial reflux events on day 2 by increased LES—gastric pressure difference (percentage of acid exposure time decreased from 11.8 ± 6.4 to 5.2 ± 5.1 on day 2) |
| Ahmadi et al. Middle East Journal of Digestive Disease (2021) | Iran | Randomized controlled study | 75 patients with GERD (25 patients in aerobic group/mean age 37 ± 9 years, mean BMI 24 kg/m2; 25 patients in breathing group/mean age 42.6 ± 8 years, mean BMI 23.6 kg/m2; 25 patients in control group/mean age 40.3 ± 7 years, mean BMI 23.43 kg/m2) | AE/DBT/no exercises | 8 weeks | Effect of AE and DBT on QoL and LES pressure | After 8 weeks, DBT had more beneficial effects on LES pressure (16.6 ± 6.29 to 24.3 ± 4.61 mmHg) and QoL than did AE; AE did not change LES pressure, but improved QoL |
NERD nonerosive reflux disease, BMI body mass index, PPI proton pump inhibitor, QoL quality of life, ARP average respiratory pressure, MEP maximum expiratory pressure, LES lower esophageal sphincter, IMT inspiratory muscle training, MRP Mid-respiratory pressure, EEP end expiratory pressure, EGJ esophagogastric junction, TLESr transient lower esophageal sphincter relaxation, GERD gastroesophageal reflux disease, DBT diaphragmatic breathing training, HRM high resolution manometry, CD crural diaphragm, VAS visual analogue Scale, MFR myofascial releas, CROM cervical range of motion, PPT pressure pain threshold, AE aerobic exercise