Efficacy and Safety of Diaphragmatic Breathing Exercises for Gastroesophageal Reflux Disease: A Systematic Review and Meta-Analysis

Abstract

Background: Gastroesophageal reflux disease (GERD) is a highly prevalent gastrointestinal disorder worldwide. Management strategies include lifestyle modification, pharmacologic therapy, and surgical interventions. Diaphragmatic breathing exercises have been proposed as a non-pharmacological treatment aimed at improving lower esophageal sphincter function and reducing reflux episodes. Methods: A systematic search of PubMed/MEDLINE, Scopus, ScienceDirect, Google Scholar, and ClinicalTrials.gov was conducted from database inception to 10 March 2026 to identify randomized controlled trials evaluating diaphragmatic breathing in patients with GERD. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Cochrane Risk of Bias 2.0 tool. Random-effects meta-analyses were performed to estimate pooled mean differences for symptom scores and quality-of-life outcomes. Results: Ten randomized controlled trials including 476 patients were analyzed (mean age: 39.9 ± 11.3 years). Diaphragmatic breathing interventions were performed in 229 participants, with an average duration of 20.36 min per session over approximately 5.1 weeks. Meta-analysis demonstrated a modest improvement in GERD symptom scores favoring diaphragmatic breathing (SMD −0.74; 95% CI −1.36 to −0.12; p = 0.019), with substantial heterogeneity (I2 = 79.7%). Subgroup analyses comparing breathing with medication and sham breathing controls produced similar trends. Quality-of-life outcomes did not demonstrate statistically significant improvement (MD −2.35; 95% CI −6.35 to 1.65; p = 0.25) and showed considerable heterogeneity (I2 = 85.3%). Risk-of-bias assessment revealed “some concerns” in several studies, primarily related to randomization procedures and outcome reporting. Conclusions: Although pooled results demonstrated a statistically significant reduction in GERD symptom scores favoring diaphragmatic breathing, this finding must be interpreted with considerable caution given the substantial heterogeneity observed. The current evidence remains limited by methodological heterogeneity, and inconsistent outcome assessment is insufficient to support definitive clinical recommendations, and the observed benefit may not be generalizable across patient populations or clinical settings. Larger standardized randomized trials are required to determine the clinical role of diaphragmatic breathing in GERD management.