Effect of Breathing Training on Symptoms of Gastroesophageal Reflux Disease

Официальное название

Effect of Breathing Training on Symptoms of Gastroesophageal Reflux Disease: A Parallel Randomized Controlled Trial

Обзор

The goal of this clinical trial is to evaluate whether two types of breathing training can improve symptoms of gastroesophageal reflux disease (GERD) in adults. The main research questions are: * Do volume-oriented incentive spirometry (VIS) or diaphragmatic breathing exercise (DBE) improve GERD symptoms compared with usual care? * Do these breathing exercises reduce the symptoms of GERD? * Does volume-oriented incentive spirometry (VIS) produce greater improvement in GERD symptoms compared with DBE? * Do these exercises increase the strength of the lower esophageal sphincter (LES)? Researchers will compare VIS training, DBE training, and usual care to determine whether breathing training can serve as a safe and effective non-pharmacological treatment option for GERD. Participants will: * Be randomly assigned to VIS training, DBE training, or usual care * Perform their assigned breathing training (if in the intervention group) twice daily for 6 weeks * Attend study visits at baseline and at week 7 for questionnaires and esophageal function tests * Keep a diary of their symptoms and breathing practice

Подробное описание

Gastroesophageal reflux disease (GERD) is a prevalent gastrointestinal disorder resulting from dysfunction of the lower esophageal sphincter (LES) and impaired anti-reflux barrier mechanisms. While proton pump inhibitors (PPIs) are effective in reducing gastric acid secretion, up to 30-40% of patients report persistent symptoms despite optimized medical therapy. Non-pharmacological interventions are therefore of growing clinical interest.

Diaphragmatic breathing exercise (DBE) targets abdominal breathing patterns to enhance diaphragmatic tone and coordination. This may improve the esophagogastric junction competence and reduce transient LES relaxations. Volume-oriented incentive spirometry (VIS), a device providing visual feedback during sustained deep inspiration, has been demonstrated to facilitate diaphragmatic recruitment and strengthen inspiratory effort. VIS has shown benefits in perioperative recovery, pulmonary rehabilitation, and post-COVID-19 recovery, but has not yet been systematically studied in GERD populations.

This randomized controlled trial adopts a parallel three-arm design, comparing VIS training, DBE training, and a usual care control group. Participants in the intervention arms will be instructed to perform their assigned breathing training twice daily for six weeks. Standardized protocols will be applied: VIS training will target 80-90% of predicted inspiratory capacity with 3-5 seconds of breath-hold at peak inspiration, while DBE will emphasize abdominal expansion and controlled diaphragmatic contraction.

Objective outcome measures include high-resolution manometry (HRM) to assess LES basal pressure and 24-hour pH-impedance monitoring to quantify esophageal acid exposure time (AET) and reflux episodes. GERD symptom severity will be evaluated using validated questionnaires (GERDQ). Assessments are scheduled at baseline and week 7 following the intervention.

The primary hypothesis is that both VIS and DBE will improve GERD symptoms compared with usual care, with VIS expected to demonstrate superior enhancement of diaphragmatic activation and LES pressure. Secondary outcomes will explore physiological changes in esophageal acid exposure, symptom-reflux association, and intervention feasibility.

This trial is expected to generate evidence supporting safe, low-cost, and accessible non-pharmacological strategies for GERD management, complementing or potentially reducing the need for long-term pharmacotherapy.

Вмешательства

• Устройство Volume-Oriented Incentive Spirometer
  Participants in the experimental group will perform volume-oriented incentive spirometry training twice daily (morning and evening) for 6 weeks. Each session consists of 10 deep inspirations using the spirometer, with the target volume initially set according to the participant's predicted maximum inspiratory capacity and increased by approximately 5% each week starting from week 2. For each breath, participants inhale to reach the target volume, hold their breath for 3-5 seconds, and then exhal
• Поведенческое Diaphragmatic Breathing Exercise (DBE)
  Participants in the control group will perform diaphragmatic breathing exercises twice daily (morning and evening) for 6 weeks. During weeks 1-2, each session consists of 10 breaths per set; from week 3 to week 6, each session consists of 15 breaths per set. The exercise is performed without devices and includes the following sequence: slow inspiration through the nose with abdominal expansion, holding the breath for 5 seconds, followed by exhalation through the mouth with visible abdominal cont
• Поведенческое Usual Care and Education
  Participants in the control group will receive usual clinical care for gastroesophageal reflux disease (GERD) without structured breathing training. At study entry, participants are provided with standardized patient education regarding GERD and lifestyle modification strategies, along with an educational leaflet. No specific posture or breathing exercises are required during the study period.

Первичные конечные точки

• Change in lower esophageal sphincter (LES) pressure [Срок оценки: Baseline and Week 7]

Вторичные конечные точки (4)

• Change in GERD symptom severity measured by GERDQ [Срок оценки: Baseline and Week 7]
• Change in the number of reflux episodes within 24 hours [Срок оценки: Baseline and Week 7]
• Change in esophageal acid exposure time (AET) [Срок оценки: Baseline and Week 7]
• Change in the number of effective esophageal peristalsis events [Срок оценки: Baseline and Week 7]

Критерии участия

Критерии включения

• Adults aged 20 to 80 years
• Endoscopic finding of reflux esophagitis (LA grade A) with proton pump inhibitor (PPI) use > 2 months, or 24-hour pH monitoring showing acid exposure time (AET) > 6%, or endoscopic diagnosis of reflux esophagitis LA grade B or higher
• Willingness to comply with the full training and follow-up protocol

Критерии исключения

• Pregnant or breastfeeding women
• History of anti-reflux surgery
• Severe cardiopulmonary dysfunction or respiratory disease
• Inability to perform the training exercises or attend follow-up visits

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Рандомизированное

Модель

Параллельные группы

Маскирование

Простое слепое

Основная цель

Лечение

Центры проведения

Список центров уточняется — проверьте первичный протокол.

Идентификаторы

NCT: NCT07179250 · CCH-IRB-250618 · CCH-IRB-250618

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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