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

Why clinicians should know about it

• Picked for Hepatology (top studies of the week, 26 July 2026).
• Picked for Gastroenterology (paper of the day, 23 July 2026).
• Picked for Psychiatry and Mental Health (paper of the day, 23 July 2026).

Abstract

BACKGROUND & AIMS: Supragastric belching significantly impairs quality of life. Although diaphragmatic breathing is recommended as a first-line intervention in clinical guidelines, some patients perceive it as monotonous. This superiority trial investigated structured singing therapy as a potentially more engaging intervention that may better target psychophysiological mechanisms, symptom-related anxiety, and depressive responses in supragastric belching. METHODS: In this randomized controlled trial, 72 patients with supragastric belching diagnosed according to Rome IV criteria were randomly assigned (1:1) to structured singing therapy or diaphragmatic breathing at 2 tertiary gastroenterology centers in China between October 2024 and April 2025. The primary outcome was the treatment response, defined as ≥50% reduction in belching visual analog scale scores. Secondary outcomes included quality of life (EuroQoL visual analog scale), anxiety, depression, and gastrointestinal symptom severity. Outcomes were assessed at baseline, immediately post-treatment (1 week), and at 1-month follow-up. RESULTS: After 1 week, singing therapy demonstrated a significantly higher response rate than diaphragmatic breathing both immediately postintervention (72.2% vs 38.9%; P = .004) and at 1-month follow-up (50.0% vs 30.6%; P = .032). Although both groups demonstrated sustained improvements in secondary outcomes, singing produced greater relief in belching symptoms and larger improvements in quality of life at treatment completion. Importantly, its superiority in alleviating belching was maintained at follow-up. Responders reported higher treatment acceptability than nonresponders. Logistic regression confirmed singing therapy, older age, and higher baseline belching visual analog scale scores as key predictors of response. CONCLUSIONS: Singing therapy is superior to diaphragmatic breathing for supragastric belching, particularly in older patients with severe symptoms. This trial was registered at the Chinese Clinical Trial Registry (ChiCTR2400090799).

Abstract as published, via PubMed.