Air Swallowing and Breathing Exercises Reduce the Severity of Acute Gastroesophageal Reflux Symptoms and Give a Clue into the Role of Oxygen in Digestion: A Case Report with Extended Discussion

Abstract

A case is reported where a patient, after using a tooth whitening gel containing the active ingredient hydrogen peroxide over 2 days, found that the expected onset of postprandial gastroesophageal reflux symptoms (RS) did not occur. Oxygen in air dissolves in water contained in the gut lumen to form hydrogen peroxide, and so the role of oxygen, rather than potentially toxic hydrogen peroxide, was investigated as a treatment for RS. Air swallowing can provide oxygen to the gut lumen, and breathing exercises can supply oxygen from the blood to the gut epithelium. Air swallowing and breathing exercises (ASBE) were performed as required over 34 days, and it was found that a single ASBE session (3-8 ASBE episodes over 30 seconds) brought temporary relief from RS over 1-2 hours. Up to 3 sessions of ASBE were required and resolved RS over 74% of days, reducing the need to take antacid tablets. To understand the impact oxygen could have on RS, the oxidation potential for oxygen, calculated as mmol electrons/100 ml (2-3 breaths) of swallowed air, was calculated and compared to the reported values for the antioxidant content of various foods. It was found that 100 ml of swallowed air has the potential to oxidize 1 serving of coffee, red wine, or orange juice, known refluxogenic or trigger foods that can cause RS. Based on the finding that ASBE can reduce RS and a brief review of the role oxygen plays in digestion, a hypothetical oxygen model for digestive reflux was proposed. For the model, the reflux of digesting food to the more oxygenated esophageal regions is triggered by refluxogenic foods high in antioxidants that react with oxygen in the lumen to create an inadequate supply necessary for aerobic digestion, resulting in gastroesophageal reflux. As the ASBE did not resolve all RS, with ≈26% remaining unresolved, the oxygen supply was considered only a part of the complex digestive reflux mechanism.