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Breathing exercises may help soothe heartburn

By Amy Norton

NEW YORK (Reuters Health) - People with milder heartburn problems might find some relief from deep breathing exercises, a small clinical trial suggests.

The study, of 19 adults with mild gastroesophageal reflux disease, or GERD, found that "belly breathing" exercises seemed to help reduce people's acid reflux, and eventually lessen their need for acid-suppressing medication.

The findings, reported in the American Journal of Gastroenterology, hint that some people might be able to breathe their way to greater heartburn relief. But whether that's truly the case requires more research.

"I'm not sure what to think of the results because it's such a small study," said Dr. Neil Toribara, a gastroenterologist and professor of medicine at National Jewish Health in Denver.

But if the breathing exercises are proven to help some people with GERD, it would be a welcome addition to the heartburn arsenal, said Toribara, who was not involved in the study.

"We wouldn't have to worry about side effects," he noted in an interview. And anything that can help people curb their reliance on medication -- which can have side effects -- "would be a good thing," Toribara said.

GERD occurs when stomach acids move up into the esophagus, the passageway that connects the throat to the stomach. That leads to the familiar burning sensation in the chest known as heartburn.

The problem is thought to rest in the ring of muscle at the bottom of the esophagus -- namely, that it opens when it shouldn't and allows stomach acid to back up.

So it's possible that deep abdominal breathing might help with GERD by strengthening the surrounding muscles of the diaphragm, according to Dr. Karl Martin Hoffmann, the senior researcher on the study.

To study the question, Hoffmann and his colleagues at Medical University Graz, in Austria, recruited 19 men and women with milder GERD -- milder in that they had no erosive damage to the esophagus.

But their heartburn was bad enough that they were using acid-suppressing proton-pump inhibitors, which include medications like omeprazole (Prilosec), lansoprazole (Prevacid) and esomeprazole (Nexium).

Hoffmann's team randomly assigned the patients into two groups. In one, people learned abdominal breathing exercises from a physical therapist, and were told to perform them daily for 30 minutes. The other group served as a "control" and did not learn the exercises.

The researchers used a tiny catheter threaded through the nose and into the esophagus to take measurements of how much acid was getting into each participant's esophagus.

After one month, the study found, people in the breathing-exercise group showed a drop, on average, in the amount of acid reaching the esophagus. They also reported improvements in their quality of life, which includes heartburn symptoms.

After that first month, the rest of the study participants learned the breathing exercises. And nine months later, patients who'd stuck with the therapy were using medication less often -- cutting down to about one-quarter of their weekly dose at the study's start, the researchers found.

One issue, though, was that only 11 out of the 19 patients actually stuck with the exercises. Some said they just preferred to take medication, some said they lacked the time for the exercises, and some admitted to being "too lazy."

Both Hoffmann and Toribara said that breathing exercises are likely to have limited appeal.

"This method is definitely not 'the easy way out' for GERD patients if they want to try to control their symptoms," Hoffmann told Reuters Health in an email. "Swallowing anti-reflux pills is of course still very effective and much easier to do."

Toribara said there are a number of non-drug ways to help soothe heartburn -- from diet changes, to quitting smoking, to losing excess pounds. But they all take effort.

"We know weight loss helps," Toribara noted. "But how many people actually do it?"

So even if breathing exercises are proven useful in larger studies, Toribara said, it's not clear how popular the approach will become. "It's not something that would work immediately," he pointed out. "And we are a society that likes instantaneous results."

In general, frequent heartburn (two or more times per week) is considered a sign of GERD. Many people have heartburn more sporadically: in the U.S., it's estimated that 60 million people have heartburn at least once a month, while 15 million have it daily.

The cost of all those pills to treat it can add up. Prilosec and Prevacid cost about 50 cents per pill, while Nexium -- available only by prescription -- is more expensive, at more than $200 a month.

SOURCE: http://bit.ly/uqq85Y American Journal of Gastroenterology, online December 6, 2011.

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