Singing Therapy versus Diaphragmatic Breathing for Supragastric Belching: A Multicenter Randomized Controlled Trial: GI Signals

Motility rct · n=72 · Jul 22, 2026 · Clin Gastro Hep · IF 16.2

Singing Therapy versus Diaphragmatic Breathing for Supragastric Belching: A Multicenter Randomized Controlled Trial.

New evidence

Clinical takeawayIn motivated patients, particularly older patients with severe baseline symptoms, singing therapy may be considered as an alternative to first-line diaphragmatic breathing, pending validation in broader practice settings and with longer follow-up. Diaphragmatic breathing remains guideline-recommended first-line care; singing therapy's delivery model (individual, group, self-directed) and feasibility outside research centers require clarification.

What it foundSinging therapy achieved 72.2% response rate (≥50% reduction in belching visual analog scale) versus 38.9% with diaphragmatic breathing at 1 week (P=0.004); superiority was maintained at 1-month follow-up (50.0% vs 30.6%, P=0.032), with greater quality-of-life improvements in the singing group. Follow-up beyond 1 month was not reported.

ContextDiaphragmatic breathing is currently recommended as first-line in clinical guidelines for supragastric belching. This single-center trial (two tertiary centers in China, October 2024-April 2025) demonstrated superior response rates for singing therapy at 1 month; validation in diverse practice settings and longer follow-up are needed to determine if this evidence warrants updating guideline recommendations.

Refinessuggested applicable standard· Rome Foundation (Stanghellini V, Chan FKL, Hasler WL, Malagelada JR, Suzuki H, Tack J, Talley NJ), "Gastroduodenal Disorders," Gastroenterology, 2016

Decision at stakeoptimal first-line behavioral technique for functional esophageal regurgitation syndromes

… First-line treatment is diaphragmatic breathing therapy, supplemented by behavioral health/gut-directed CBT and management of coexisting anxiety or eating disorder; baclofen 10 mg TID is an off-label option. …

From our summary of this standard, unedited — the part the paper bears on. … marks omitted text. Our wording, not the guideline's; read the source for its own text.

Our full summary of this standard

Confirm rumination syndrome by Rome IV clinical criteria, persistent or recurrent regurgitation of recently ingested food into the mouth with subsequent spitting or remastication and swallowing, not preceded by retching, with symptoms present for the last 3 months and onset at least 6 months before diagnosis; supportive (non-mandatory) features include effortless post-meal regurgitation within minutes, regurgitation usually not preceded by nausea, and a non-bilious/non-sour (non-acidic) regurgitant, supported when needed by high-resolution manometry-impedance showing abdominal strain with simultaneous gastric pressure rise and retrograde flow. First-line treatment is diaphragmatic breathing therapy, supplemented by behavioral health/gut-directed CBT and management of coexisting anxiety or eating disorder; baclofen 10 mg TID is an off-label option. Red-flag features (weight loss, hematemesis/bilious vomiting, dysphagia) warrant workup for organic disease, and failure of diaphragmatic breathing prompts motility specialist referral.

Rome Foundation (Stanghellini V, Chan FKL, Hasler WL, Malagelada JR, Suzuki H, Tack J, Talley NJ), "Gastroduodenal Disorders," Gastroenterology, 2016 · reviewed 2026-07-23 ↗

Shang H … Hou X · Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association · IF 16.2 · PubMed ↗Permalink