What causes frequent eructation (belching)?

From the Guidelines

Frequent belching is primarily caused by swallowing excess air, a condition known as aerophagia, as well as other factors such as digestive issues, anxiety, and stress, as supported by the most recent study 1.

Causes of Frequent Belching

The causes of frequent belching can be multifaceted, including:

• Aerophagia, which is the swallowing of excess air, often occurring during eating or drinking too quickly, chewing gum, smoking, or drinking carbonated beverages 1
• Digestive issues such as acid reflux, gastroparesis, or irritable bowel syndrome, which can contribute to excessive belching as the body attempts to relieve pressure in the digestive tract 1
• Anxiety and stress, which can worsen this condition by leading to unconscious air swallowing 1
• Certain habits like talking while eating, using straws, or consuming foods that produce gas, such as beans, cabbage, and onions 1

Diagnosis and Management

To diagnose and manage frequent belching, the following steps can be taken:

• Rule out rumination disorder using HRM with impedance, and consider PPI therapy if related to GERD 1
• Consider fundoplication if severe pathologic GERD is present, and consider Baclofen if related to excess TRLES 1
• Use ambulatory impedance monitoring +/- high resolution manometry (HRM) to differentiate between types of belching, such as gastric belching, supragastric belching, and aerophagia 1
• Implement lifestyle changes, such as eating slowly, avoiding carbonated drinks, chewing with your mouth closed, limiting gum chewing, and managing stress 1

Treatment Options

If belching persists despite lifestyle changes, the following treatment options can be considered:

• Medications like simethicone to help break up gas bubbles, while acid-reducing medications such as omeprazole (20mg daily) or ranitidine (150mg twice daily) may help if acid reflux is the underlying cause 1
• Brain-Gut Behavior Therapy, which can help improve quality of life and reduce symptoms of belching 1
• Probiotics and medical foods, although their use is not recommended for bloating or distention due to insufficient data supporting their efficacy 1

From the Research

Causes of Frequent Belching

• Excessive belching can occur as an isolated symptom or as a concomitant symptom in patients with gastroesophageal reflux disease (GERD) or functional dyspepsia 2
• There are two mechanisms through which belching can occur: the gastric belch and the supragastric belch 2
• The gastric belch is the result of a vagally mediated reflex leading to relaxation of the lower esophageal sphincter and venting of gastric air 2
• The supragastric belch is a behavioral peculiarity, where pharyngeal air is sucked or injected into the esophagus, after which it is immediately expulsed before it has reached the stomach 2
• Patients who belch excessively invariably exhibit an increased incidence of supragastric, not of gastric belches 2
• Functional gastrointestinal disorders, such as functional dyspepsia, irritable bowel syndrome, and chronic idiopathic constipation, are common causes of gas, bloating, and belching 3
• Disordered motility and visceral hypersensitivity, often worsened by psychological distress, are characteristic of functional gastrointestinal disorders 3

Related Conditions

• Gastroesophageal reflux disease (GERD) can contribute to frequent belching 2, 3
• Functional dyspepsia is a common cause of belching disorders 2, 3
• Irritable bowel syndrome can also cause belching, bloating, and gas 3
• Chronic idiopathic constipation can lead to bloating and belching 3

Treatment and Management

• Behavioral therapy has been proven to decrease belching complaints in patients with isolated excessive belching 2
• Antacids can be used to neutralize stomach acid and relieve heartburn and bloating symptoms 4, 5, 6
• Acid suppression with proton pump inhibitors can be effective for functional dyspepsia 3
• Empiric therapy, such as antispasmodics for irritable bowel syndrome and osmotic laxatives for chronic idiopathic constipation, can be a reasonable initial approach to functional gastrointestinal disorders 3