Reduction of Proton Pump Inhibitor Dependence in Gastroesophageal Reflux Disease Following Isometric Diaphragmatic Resistance Training With a Novel Respiratory Muscle Training Device: An Autobiographical Case Report

Gastroesophageal reflux disease (GERD) has been associated with transient lower esophageal sphincter relaxations (TLESRs), which are considered a predominant mechanism of reflux and are modulated in part by the crural diaphragm. Long-term proton pump inhibitor (PPI) therapy remains the standard of care but is associated with drug dependency and systemic adverse effects. Strengthening the crural diaphragm through resistive respiratory training represents a mechanistically plausible non-pharmacological approach. We report a case in which a 14-day isometric diaphragmatic resistance training protocol using a novel prototype device substantially reduced PPI requirement and GERD symptom burden in a patient with over a decade of PPI-dependent GERD. A 38-year-old male physician with a more than 10-year history of GERD, refractory to multiple prior acid-suppressive agents and maintained on dexlansoprazole 60 mg daily, voluntarily discontinued his morning PPI. Immediate and consistent nocturnal symptoms, heartburn, regurgitation, and sleep disturbance, emerged upon discontinuation, necessitating nightly rescue dexlansoprazole use. Following a five-day informal observation period and two days of structured formal baseline recording (evening binary GerdQ score 4/6 on both days), a 14-day diaphragmatic resistance training protocol was initiated using a novel prototype respiratory muscle training device incorporating a safety algorithm to limit inspiratory negative pressure below the reflux induction threshold. The protocol comprised three sets of 10 repetitions daily with 2-second isometric inspiratory and expiratory holds and 3-minute inter-set rest periods. Over 14 days, the mean evening GerdQ score decreased to 1.1/6 (71% reduction from baseline), PRN dexlansoprazole was required on only 3 of 14 days (21%), and sleep disturbance was recorded on a single occasion (Day 3 only). This case demonstrates that isometric diaphragmatic resistance training was associated with marked reduction in PPI requirement and GERD symptom burden in a patient with longstanding PPI-dependent disease. The findings support crural diaphragm strengthening as a viable non-pharmacological target in GERD management, warranting controlled trials with objective esophageal endpoints.