Gastroesophageal reflux disease (GERD) is a highly prevalent condition associated with substantial symptom burden and reduced quality of life, resulting from dysfunction of the antireflux barrier, particularly the lower esophageal sphincter (LES) and its diaphragmatic support. Although lifestyle modification and proton pump inhibitor (PPI) therapy remain first-line management, many patients experience persistent symptoms or seek additional nonpharmacologic options. Prior studies suggest osteopathic manipulative treatment (OMT), particularly techniques targeting the diaphragm and thoracoabdominal region, may influence LES pressure and esophageal motility through autonomic and neuromusculoskeletal mechanisms. We present a 53-year-old male with a several-year history of symptomatic GERD despite intermittent PPI therapy who demonstrated recurrent thoracic somatic dysfunction on osteopathic structural examination. The patient received OMT directed at the thoracoabdominal diaphragm, middle thoracic spine, and abdominal restriction using both direct and indirect techniques. Symptom response was assessed using the validated GerdQ questionnaire retrospectively at baseline, immediately post-treatment, and at five-month follow-up. GerdQ improved from 9 at baseline to 0 immediately following treatment. Symptoms gradually returned in the two weeks preceding the five-month follow-up, with GerdQ again measuring 9. During the interim, the patient reported reduced reflux frequency and fewer nocturnal symptoms without medication changes. While alternative causes like functional heartburn or motility disorders cannot be excluded, this case highlights a potential relationship between thoracic somatic dysfunction and GERD symptom burden and supports the physiologic plausibility of OMT as an adjunctive therapy. Limitations include retrospective baseline assessment and single-patient design. The observed temporal relationship supports further prospective studies evaluating OMT in GERD.
