Ask an answerable question (PICO)：
Proton pump inhibitor (PPI) is the primary treatment to relieve symptoms of gastroesophageal reflux disease (GERD). Despite of intervention of drug, some patients can’t relieve the symptoms. Thus, patients try to inquire other non-drug treatments. Diaphragmatic breathing exercise is the way to evaluate lower esophageal sphincter pressure and empty stomach more quickly. Therefore, the authors were motivated to discuss the effect of diaphragmatic breathing exercise on improving symptoms of patients with GERD.
The Method and Analysis of Literature Review：
The search of literatures was using EBM PICO method. "Can diaphragmatic breathing exercise decrease symptoms of patient with gastroesophageal reflux disease?" was asked as an answerable question. The keywords were included Patients as “Gastroesophageal reflux disease, GERD”, Interventions as “Diaphragmatic breathing, Breathing, Exercise, Training”, and Outcomes as “Low esophageal sphincter pressure, Regurgitation, Heartburn”. The databases of literatures were conducted from PubMed, CINAHL, Medline and Cochrane Library. The search strategies by using the Boolean logic “AND, OR, and NOT” were implemented. “Humans” subjects, the research design of "Randomized Controlled Trial and Systematic Review", language as "English", searching years from 2016 to 2021 were limited. And the exclusion criteria were (1) non- Gastroesophageal reflux disease, (2) non-18 years Adults, (3) non-breathing exercise or other exercise therapies. After exclusion of irrelevant or repeated papers, one systematic review with meta-analyses and two RCT were finally included.
Critical Appraisal：
The Systematic Review Appraisal Sheet (2019) and the Cochrane Risk of Bias Tool were accorded to appraise the quality of study in systematic review and randomized controlled trial respectively. The OCEBM Levels of Evidence table (2011) was used to rank the level of evidence body of study. The results of the first study of systematic review showed that diaphragmatic breathing exercise can evaluate pressure generated by the lower esophageal sphincter (WMD = 1.36, 95% CI: (0.82, 1.91), p < .01). The results of the second study of randomized controlled trial showed that diaphragmatic breathing exercise had effective in improving lower esophageal sphincter pressure, reducing acid reflux times and acid exposure time (p < .05).
Results, Conclusions and Recommendations：
Diaphragmatic breathing exercise improve lower esophageal sphincter pressure, strengthen the anti-reflux barrier function. Additionally, it is a non-drug, non-invasive treatment, suitable for use in the daily life of patients, and can be done anytime, anywhere. Although patients will have different perceptions of breathing exercise steps or training interrupted due to symptoms of discomfort, through one-on-one teaching by professional physicians, physiotherapists, also via videos, pictures to reduce mistakes of the exercise movement. Therefore, doing diaphragmatic breathing exercise for 10-30 minutes twice a day more than 4 weeks can decrease symptoms of patient with gastroesophageal reflux disease.
