From the Guidelines
Eructation, also known as belching, is primarily caused by aerophagia, which is the ingestion of air into the esophagus, often due to swallowing air, and can also be caused by gastric belching, where gas is released from the stomach [ 1 ].
Causes of Belching
- Supragastric belching: a voluntary type of belching where air is sucked into the esophagus and then expelled orally [ 1 ]
- Gastric belching: an involuntary type of belching where gas is released from the stomach [ 1 ]
- Aerophagia: the ingestion of air into the esophagus, often due to swallowing air, which can lead to intestinal gas accumulation [ 1 ]
Diagnosis and Management
To diagnose the cause of belching, ambulatory impedance monitoring and high-resolution manometry (HRM) can be used to differentiate between supragastric and gastric belching [ 1 ]. Management of belching may involve lifestyle modifications, such as avoiding carbonated drinks and eating quickly, as well as medications like proton pump inhibitors (PPIs) for cases related to gastroesophageal reflux disease (GERD) [ 1 ]. In some cases, brain-gut behavior therapy may be recommended to help manage symptoms [ 1 ]. It is essential to rule out underlying conditions such as rumination disorder, gastroparesis, and gastroesophageal reflux disease (GERD) to determine the best course of treatment [ 1 ].
From the Research
Causes of Eructation (Belching)
- Belching is a normal physiological function that occurs when ingested air accumulated in the stomach is expelled or when food containing air and gas produced in the gastrointestinal tract is expelled 2
- Excessive belching can be related to various gastrointestinal disorders such as gastroesophageal reflux disease, functional dyspepsia, aerophagia, and rumination syndrome 2, 3, 4
- Supragastric belches are common in patients with excessive belching, and this condition should be treated as a behavioral disorder 3
- Aerophagia, an episodic or chronic disorder in which patients swallow large quantities of air, can also cause abdominal distention and bloating, leading to belching 3
Pathogenic Mechanisms
- The introduction of multichannel intraluminal impedance monitoring has helped elucidate the types and pathogenic mechanisms of belching disorders 2
- Belching disorders can be classified into aerophagia and unspecified belching disorder according to the Rome III criteria 2
- Recent studies have recognized belching disorders and rumination syndrome as disorders of gut-brain interaction (DGBIs) in Rome IV, with excessive supragastric belching and rumination syndrome being behavioral disorders 4
Diagnosis and Treatment
- High-resolution impedance manometry and/or 24-h impedance-pH monitoring can offer an objective diagnosis of belching disorders 4
- Treatment modalities such as behavioral therapy, speech therapy, baclofen, tranquilizers, and proton pump inhibitors can be attempted, but further investigations on the effective treatment of belching disorders are warranted 2, 5
- Cognitive behavioral therapy (CBT) using diaphragmatic breathing is recommended as the first-line therapy for excessive supragastric belching and rumination syndrome 4