Burping in Gastritis: Prevalence and Mechanisms
Yes, burping (eructation) remains a common symptom in individuals with gastritis, occurring in more than 50% of patients with upper gastrointestinal symptoms including gastritis. 1
Mechanisms of Burping in Gastritis
Gastric belching is physiologically normal and involves spontaneous transient relaxation of the lower esophageal sphincter followed by air transport from the stomach through the esophagus, with subsequent relaxation of the upper esophageal sphincter allowing air to be expelled orally 2
In patients with gastritis, particularly when associated with GERD, gastric belching has been reported in up to 50% of cases 2
Structural causes that may contribute to belching in gastritis patients include hiatal hernias and paraesophageal hernias 2
Gastric belching is different from supragastric belching, which is more commonly associated with anxiety and involves air being drawn into the esophagus and immediately expelled before reaching the stomach 2
Types of Belching Related to Gastritis
Gastric belching: More commonly associated with organic conditions like gastritis and GERD, involving air expelled from the stomach 2
Supragastric belching: Less commonly associated with gastritis, more often related to psychological factors and behavioral conditioning 2
Aerophagia: Excessive swallowing of air that increases intragastric gas, leading to symptoms of bloating and distention, and sometimes belching in gastritis patients 2
Prevalence and Clinical Significance
Belching and bloating are present in more than 50% of patients with upper gastrointestinal complaints, regardless of H. pylori status 1
In chronic gastritis, especially when progressing to atrophic gastritis, changes in gastric acid production can affect digestive processes and potentially contribute to gas-related symptoms 3
The prevalence of belching disorders according to Rome IV criteria is approximately 1% in the general population, but is higher in those with upper GI conditions like gastritis 2
Diagnostic Considerations
High-resolution esophageal manometry combined with impedance monitoring can differentiate between gastric and supragastric belching in patients with persistent symptoms 2
When evaluating a patient with gastritis and belching, it's important to consider whether the belching is directly related to the gastritis or represents a separate functional disorder 4
Belching in gastritis patients may be associated with other symptoms like epigastric pain, bloating, and heartburn 1
Management Approaches
For gastritis patients with belching associated with GERD, proton pump inhibitor therapy may be effective 4
For supragastric belching not associated with reflux episodes, PPIs are typically ineffective as the reflux episodes are usually non-acidic 4
Behavioral strategies, including diaphragmatic breathing, can be effective for managing belching symptoms, particularly for supragastric belching 2
Addressing underlying gastritis through appropriate treatment (such as H. pylori eradication when applicable) may help reduce associated belching symptoms 5
Important Clinical Considerations
The presence of belching does not differentiate between H. pylori-positive and H. pylori-negative gastritis patients, as the symptom is common in both groups 1
Severe forms of atrophic gastritis may lead to an acid-free stomach, which can affect digestion and potentially contribute to gas-related symptoms 3
When belching is excessive and significantly impacts quality of life, it should be evaluated as a potential disorder of gut-brain interaction rather than simply a symptom of gastritis 2