What is the treatment for belching (burping)?

From the Guidelines

Burping does not always require treatment, but when it does, Brain-Gut Behavior Therapy is a recommended approach for excessive belching with reduced quality of life, as per the latest guidelines from 2023 1. When considering treatment for burping, it's essential to differentiate between supragastric belching, gastric belching, and aerophagia.

• Supragastric belching is characterized by the voluntary influx of air into the esophagus, which is then expelled orally through the pharynx prior to reaching the stomach.
• Gastric belching, on the other hand, occurs less frequently and with greater force than supragastric belching.
• Aerophagia is considered if manometry shows an influx of air into the esophagus with swallowing, causing intestinal gas accumulation on abdominal X-rays 1. To manage burping, the following steps can be taken:
• Rule out rumination disorder using HRM with impedance, and consider PPI therapy if related to GERD.
• Communicate findings to the patient through psychoeducation, and consider fundoplication if severe pathologic GERD is present.
• For patients with nausea and vomiting, rule out gastroparesis, and consider Baclofen if related to excess TRLES.
• Ambulatory impedance monitoring, preferably for 24 hours, can help differentiate between the two types of belching 1. It's also important to note that dietary restrictions, such as avoiding fructans, can help alleviate symptoms of bloating, and breath testing can be used to diagnose food intolerances like lactose, fructose, or sucrose intolerance 1.

From the FDA Drug Label

• for up to 4 weeks to treat heartburn and other symptoms that happen with gastroesophageal reflux disease (GERD). GERD happens when acid in your stomach backs up into the tube (esophagus) that connects your mouth to your stomach This may cause a burning feeling in your chest or throat, sour taste, or burping. The treatment for burping is related to the treatment of GERD and other acid-related symptoms, and omeprazole delayed-release capsules may be used for up to 4 weeks to treat these symptoms 2.

• Omeprazole delayed-release capsules reduce the amount of acid in the stomach, which may help alleviate burping and other symptoms associated with GERD.
• It is essential to take omeprazole delayed-release capsules exactly as prescribed by the doctor, at the lowest dose possible, and for the shortest time needed 2.

From the Research

Treatment Options for Burping

• The treatment for burping, which can be a symptom of functional dyspepsia, often involves lifestyle modifications and dietary changes, such as eating frequent small meals, a low-fat diet, and avoiding certain aggravating foods 3.
• Antacids and over-the-counter histamine type 2 receptor antagonists may be helpful as an "on-demand" therapy for intermittent symptoms of functional dyspepsia, including burping 3.
• If the predominant symptom is epigastric pain, histamine-2 receptor antagonists or proton pump inhibitors are the initial treatment of choice, which may also help alleviate burping symptoms 3.

Pharmacological Management

• Proton pump inhibitors (PPIs) remain the first-choice therapy in the treatment of gastro-esophageal reflux disease (GERD), which can also cause burping, but a consistent proportion of patients continue to experience symptoms despite PPI intake 4.
• Recent studies suggest that tricyclic antidepressant therapy may be effective in functional dyspepsia, which can include burping as a symptom 5.
• A new prokinetic, acotiamide, has been shown to reduce dyspepsia symptoms, including burping, in functional dyspepsia patients 5.

Comparison of Treatment Strategies

• A study comparing an omeprazole versus an antacid-alginate/ranitidine management strategy found that the omeprazole treatment strategy was superior in providing relief of acid-related dyspepsia symptoms, including burping, after 16 weeks 6.
• The effects of proton pump inhibitors on gastric emptying, which can be related to burping, have been found to be variable, with a consistent delaying effect on gastric emptying of solid meals, but an inconsistent effect on the emptying of liquids 7.