Belly Breathing After Meals for Daytime Reflux: What a Mayo Clinic Trial Measured

Heartburn that starts an hour after lunch, while you sit at your desk, is a different pattern from heartburn that wakes you at two in the morning. Doctors call the first kind upright reflux. Researchers at Mayo Clinic in Rochester, here in Minnesota, carried out a small trial to see if a breathing exercise could reduce it. The trial was published in 2021, and the AANP news digest circulated it again in October.

Photo: Sydney Moore / Unsplash

What the Mayo Clinic breathing trial found

The lower esophageal sphincter (LES) is a ring of muscle at the bottom of the esophagus that keeps stomach contents in the stomach. Part of the diaphragm, the main breathing muscle, wraps around that ring and adds to its squeeze. The Mayo team wanted to find out if training that part of the diaphragm could strengthen the barrier [1].

They studied 23 adults whose reflux was confirmed by pH testing and happened mostly while upright, along with 10 healthy volunteers [1]. Participants ate a standardized meal designed to provoke reflux while sensors measured pressures in the esophagus and stomach, and each was randomly assigned to diaphragmatic breathing or a sham breathing exercise. After that, the patients wore a reflux monitor for 48 hours, and half of them were randomly assigned to do diaphragmatic breathing after meals on the second day [1].

During the in-breath of diaphragmatic breathing, pressure at the LES rose from about 23 to about 42 mmHg [1]. The abbreviation mmHg means millimeters of mercury, the same unit used for blood pressure. After the test meal, people with reflux had an average of 2.6 reflux events while simply sitting and 0.36 while doing the breathing [1]. In the patients assigned to breathing, acid exposure in the two hours after the standardized meal fell from 11.8% of the time on day one to 5.2% on day two. Total acid exposure across the whole second day, however, was no different between breathing and sham [1]. This was a short study in 23 people, built to measure pressures and reflux events, and symptoms were not its main outcome.

What other breathing trials have found

A meta-analysis published this year combined the results of 10 randomized trials, 476 participants in all, and analyzed them as one larger group. Sessions averaged about 20 minutes, done over roughly five weeks [2]. Diaphragmatic breathing improved reflux symptom scores by a moderate amount on average. The results varied a great deal from trial to trial, quality of life did not improve significantly, and several trials had problems with how they randomized people or reported outcomes [2]. The authors concluded that the research so far is not strong enough for firm clinical recommendations [2].

The trials in the meta-analysis scored symptoms, whereas researchers in a 2025 study measured the barrier itself. They checked esophageal pressures in 53 people with reflux symptoms before and after at least three months of breathing training. Average LES pressure rose from 25.6 to 29.1 mmHg, and the esophagus contracted more strongly, though the size of a hiatal hernia did not change [3]. A hiatal hernia is when the top of the stomach pushes up through the opening in the diaphragm where the esophagus passes. That study had no comparison group, so some of the change could have come from other things that happened over those months.

A muscle you breathe with is also part of your reflux barrier

This research fits the way I think about digestion. Reflux is usually treated as a pure acid problem, yet the barrier that keeps acid down is made partly of a muscle you can train. A 2025 panel of ten gastroenterology, primary care, and psychology experts wrote that when reflux-like symptoms continue on acid-suppressing medication, factors like anxiety, attention to symptoms, and behavior can play a major role [4]. They recommended an individualized approach that includes education about the gut-brain connection, diet and lifestyle changes, weight loss, and diaphragmatic breathing, with acid suppression as one tool among several [4].

The diaphragm is involved in other digestive complaints too. Mayo Clinic gastroenterologists list abdomino-phrenic dyssynergia as one of five common causes of bloating and distension [5]. Abdomino-phrenic dyssynergia is a coordination problem between the diaphragm and the abdominal wall. Unlike most of what goes on in digestion, breathing is something you can change on purpose. The authors of a 2026 review described diaphragmatic breathing as safe and inexpensive [6].

Should you try belly breathing after meals?

Belly breathing after meals costs nothing to try, and a few details from these studies can help you set it up the way it was tested:

1. Timing was part of the Mayo design. The participants did their breathing right after eating, which is when upright reflux happens [1]. In the pooled trials, sessions averaged about 20 minutes [2].

2. A trained provider can check your technique. Diaphragmatic breathing means breathing so that your belly rises more than your chest. A physical therapist or another trained provider can watch you breathe and confirm that the movement comes from the diaphragm and not from your neck and shoulders.

3. The established habits still count. A 2025 review found the most consistent support for weight loss, two to three hours between your last meal and bedtime, raising the head of the bed, sleeping on your left side, quitting smoking, and light activity after meals [7]. How much coffee, chocolate, tomato, and other common triggers bother someone varies a lot from person to person, so the same review favored individual adjustments over blanket bans [7].

4. Breathing was studied as an add-on to care. If you take acid-suppressing medication, add the breathing on top of it, and ask the clinician who prescribed the medication before you lower the dose or stop it [6].

Trouble swallowing, food sticking, unexplained weight loss, vomiting, or black stools are signs that call for a prompt medical evaluation, whatever else you are trying.

References

1. Halland M, Bharucha AE, Crowell MD, Ravi K, Katzka DA. Effects of diaphragmatic breathing on the pathophysiology and treatment of upright gastroesophageal reflux: a randomized controlled trial. Am J Gastroenterol. 2021;116(1):86-94. PMID: 33009052. doi:10.14309/ajg.0000000000000913 (original article linked in the AANP digest: https://journals.lww.com/ajg/abstract/10.14309/ajg.0000000000000913~effects-of-diaphragmatic-breathing-on-the-pathophysiology?redirectionsource=fulltextview)

2. Abureesh, Qaqish, Abu-Shaban, et al. Efficacy and safety of diaphragmatic breathing exercises for gastroesophageal reflux disease: a systematic review and meta-analysis. J Clin Med. 2026;15(9):3406. PMID: 42123139. doi:10.3390/jcm15093406

3. Zdrhova, Bitnar, Friedl, et al. Effect of diaphragmatic breathing training on the esophagogastric junction and esophageal motility in patients with reflux symptoms. Neurogastroenterol Motil. 2025;37(12):e70172. PMID: 40984704. doi:10.1111/nmo.70172

4. Kahrilas PJ, Keefer L, Yadlapati R, et al. Review article: individualised management of reflux-like symptoms: strategies beyond acid suppression. Aliment Pharmacol Ther. 2025;61(9):1437-1446. PMID: 40166851. doi:10.1111/apt.70115

5. Cangemi DJ, Lacy BE. A practical approach to the diagnosis and treatment of abdominal bloating and distension. Gastroenterol Hepatol (N Y). 2022;18(2):75-84. PMID: 35505814. (Yggdrasil abstract library)

6. Semwal, Jha, Kumar, et al. Diaphragmatic breathing as an adjunctive approach in gastroesophageal reflux disease: narrative review of its mechanistic basis and clinical evidence. Adv Mind Body Med. 2026;40(5):43-47. PMID: 42735091.

7. Lee, Kim, Shin, et al. [Gastroesophageal reflux disease]. Korean J Gastroenterol. 2025;85(4):440-450. PMID: 41132014. doi:10.4166/kjg.2025.115

This post is for education only and is not medical advice. Reflux has many possible causes, and persistent symptoms deserve an evaluation by your own provider. Please do not stop or change a prescribed medication without talking to the clinician who prescribes it.

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