Respiratory Training Improves Anti-Reflux Barrier in Non-Erosive Gastro-Esophageal Respiratory Diseases (GERD) Patients - A Narrative Review of Current Literature

Background: Gastroesophageal reflux disease (GERD) is characterized by impaired lower esophageal sphincter (LES) pressure and diaphragmatic dysfunction. Conventional pharmacological therapy often fails to fully control symptoms, prompting interest in physiotherapy-based interventions. Objectives: To review clinical evidence on inspiratory muscle training (IMT), modified IMT, diaphragmatic breathing exercises (DBE), biofeedback training, myofascial release (MFR), and aerobic exercise in GERD management. Methodology: The literature review was drafted using Preferred Reporting Items for Systematic Reviews and Meta analysis protocols with appropriate modifications for purposes of narrative review. For this review all relevant information was identified using Google Scholar, PubMed, Science Direct, Cochrane library and Scopus. A literate review was performed. Search words were GERD, respiratory training, diaphragm, anti-reflux. Total 7 articles were included in this literature review. Randomized controlled trials and comparative studies published between 2012 and 2021 were analyzed. Sample sizes ranged from 30 to 50 participants, with outcomes measured via LES manometry, GERD symptom scores, and quality of life indices. Results: Inspiratory muscle increased LES pressure and reduced transient relaxations. Diaphragmatic breathing exercise and biofeedback training improved reflux symptoms and reduced belching. Diaphragm myofascial release enhanced GERD symptom scores. Aerobic exercise improved overall quality of life, while Diaphragmatic breathing more effectively increased LES pressure (Ahmadi, 2021). Conclusion: Physiotherapy interventions targeting diaphragmatic function consistently demonstrate improvements in LES competence, reflux symptoms, and patient-reported outcomes. These approaches are safe, low-cost adjuncts to pharmacological therapy. Larger multicenter RCTs are needed to confirm long-term efficacy.