According to a preliminary trial, massaging the connective tissue surrounding the diaphragm could significantly reduce acid reflux for people with gastroesophageal reflux disease (GERD).

In this era of antibiotic resistance and opioid addiction, finding alternatives to drugs is of growing interest to scientists, doctors, and the public at large. A group of researchers recently investigated a drug-free way to alleviate GERD, or acid reflux.

Hailing from the Departments of Physical Therapy, Medicine, and Surgery of the Universidad CEU Cardenal Herrera of Valencia in Spain, they recently published their findings in the journal Scientific Reports.

The scientists focused their study on people with GERD, a common condition that affects around 18.1%–27.8% of adults in the United States. Gastroesophageal reflux occurs when the contents of the stomach, including stomach acid, travel up into the esophagus. This can cause the unpleasant burning sensation that many people call heartburn.

For people with GERD, gastroesophageal reflux can be a regular occurrence that significantly impacts their quality of life. Current treatment options generally involve the long-term use of proton pump inhibitors (PPIs). Although these drugs are effective, they can cause adverse events in some people and may increase the risk of chronic kidney disease. The scientists involved in the most recent study investigated whether a type of massage called myofascial release (MFR) might relieve the symptoms of GERD.

What is MFR?

MFR focuses on the fascia. Professor María Dolores Arguisuela, research co-director, explains that "the fascia is a tissue of the body that wraps around all structures—muscles, bones, vessels, organs—and has the function of supporting or sustaining, transmitting tensions, and sliding between planes."

According to the authors of a review of MFR, the technique is a "manual therapy that involves the application of a low load, long duration stretch to the myofascial complex, intended to restore optimal length, decrease pain, and improve function."

The researchers wanted to understand whether MFR could reduce gastroesophageal reflux, improve quality of life, and minimize the number of PPIs that people needed to take. They explain that the MFR intervention they designed to use in this study aimed to "stretch the diaphragm muscle fibers."

The diaphragm is a muscular barrier that separates the abdomen from the chest. The scientists focused on massaging the fascia around the diaphragm because it sits just above the stomach and plays an important role in stopping stomach acid from traveling into the esophagus.

Massage vs reflux

To investigate, they recruited 30 people, aged 18–80, with GERD. Half of the participants received MFR from a highly experienced physical therapist, and the other half received a sham procedure. Each participant received four 25-minute sessions at a cadence of twice per week for 2 weeks.

During the MFR sessions, the therapist used six techniques that targeted the fascia of the diaphragm; the sham treatment involved similar techniques, but the practitioner did not apply pressure to the fascia. The scientists assessed the impact of MFR using three measures:

• Severity and frequency of GERD symptoms, measured using a 12-item questionnaire
• Quality of life, assessed using a 36-item questionnaire
• PPI usage, measured in milligrams of drugs the participants took

The researchers assessed these measures before the first MFR session, after 1 week of MFR, and at the 4-week mark (2 weeks after the final MFR session).

Compared with those in the sham group, at the 4-week mark, those in the experimental group had a significant improvement in symptoms and self-rated quality of life. Similarly, participants in the MFR group needed to take significantly fewer PPIs. The study authors explain:

"These preliminary findings indicate that the application of the MFR protocol we used in this study decreased the symptoms and PPIs usage and increased the quality of life of patients with non-erosive GERD up to 4 weeks after the end of the treatment."

Limitations and concerns

This was only a small preliminary trial, so scientists will need to investigate this effect using many more participants. The authors also note that their study did not take any physical measurements to assess whether the diaphragm was, indeed, blocking the esophagus more effectively.

They also note the challenges of studying a manual therapy, because as the practitioner responds to the needs of each person's body, every therapy session is different; on this note, they write, "In this sense, the use of manual therapy is itself a study limitation."

Another shortfall is the limited follow-up; it would be interesting to measure how long the benefits of MFR can last. However, despite the limitations, the results are encouraging. The researchers write:

"[T]reatment with MFR techniques has no side effects and could become a therapeutic alternative or complement in patients requiring long-term PPIs use or who want or need to avoid PPI medications because of their possible side effects."