Gastric Reflux, often abbreviated as GERD/GORD (Gastroesophageal Reflux Disease), is a common condition that gives you a feeling of heart-burn, chest pain, difficulty swallowing or feeling very full and bloated after eating. Some people can have reflux without these symptoms, but they may have bitter taste in the mouth, chronic cough, frequent clearing of the throat,  increased awareness of swallowing, and hoarseness. Having a hiatus hernia, where part of the stomach moves up into the thorax where the lungs are, increases the chances you will have gastric reflux. The diagnosis of this would be done through your general practitioner and imaging tests. You will often be prescribed medication by your general practitioner to reduce the acidity in your stomach such as H2 blocers, protein pump inhibitors (PPI) or antacids, which helps to reduce the burning in your oesophagus. General practitioners are less aware of using breathing, diaphragm strengthening exericses and visceral manipulation to improve and control gastric reflux.

Physiotherapy can help with GERD/GORD. Breathing exercises to strengthen your diaphragm can help to reduce reflux as the diaphragm works with the lower oesophageal sphincter (LES) to reduce reflux. Up to 85% of reflux  control is from the diaphragm in conjunction with the sphincter. Eguaras et. al  (2019) showed that visceral manipulation can also help to reduce reflux, although it is more likely to help patients with less severe, rather than severe reflux. Visceral manipulation involves manual therapy in the abdomen and to the diaphragm to help reduce restriction, improve the ease of breathing, and increase blood flow for better digestive function. By releasing tension in the diaphragm and stomach, it may be possible to partly reduce a hiatus hernia and hence reduce reflux. Advice on exercise and weight loss may also help as being overweight is a risk factor for developing gasstric reflux.

References: 

Eguaras N, Rodríguez-López ES, Lopez-Dicastillo O, Franco-Sierra MÁ, Ricard F, Oliva-Pascual-Vaca Á. Effects of Osteopathic Visceral Treatment in Patients with Gastroesophageal Reflux: A Randomized Controlled Trial. J Clin Med. 2019 Oct 19;8(10):1738. doi: 10.3390/jcm8101738. PMID: 31635110; PMCID: PMC6832476.

Kahrilas PJ, Mittal RK, Bor S, Kohn GP, Lenglinger J, Mittal SK, Pandolfino JE, Serra J, Tatum R, Yadlapati R. Chicago Classification update (v4.0): Technical review of high-resolution manometry metrics for EGJ barrier function. Neurogastroenterol Motil. 2021;33:e14113. 10.1111/nmo.14113.

Zdrhova, L., Bitnar, P., Balihar, K. et al. Breathing Exercises in Gastroesophageal Reflux Disease: A Systematic Review. Dysphagia 38, 609–621 (2023). https://doi.org/10.1007/s00455-022-10494-6