From the Guidelines
Persistent eructation (belching) is typically caused by excessive air swallowing (aerophagia), digestive issues, or certain dietary habits, and can be managed by addressing the underlying cause, such as eating slowly, avoiding carbonated drinks and gas-producing foods, and managing stress, as recommended by the most recent study 1. The causes of persistent eructation can be divided into several categories, including:
- Aerophagia, which is the swallowing of excessive air, leading to an increase in intragastric and intestinal gas, and resulting in symptoms of bloating, distention, and belching 1
- Digestive issues, such as gastroesophageal reflux disease (GERD), functional dyspepsia (FD), and gastroparesis (GP) 1
- Dietary habits, such as eating or drinking too quickly, chewing gum, smoking, and consuming gas-producing foods like beans, cabbage, and onions 1
- Other medical conditions, such as lactose intolerance, and small intestinal bacterial overgrowth (SIBO) 1
- Psychological factors, such as anxiety and stress, which can contribute to unconscious air swallowing and exacerbate symptoms 1 To manage persistent eructation, it is essential to identify and address the underlying cause. This can be achieved by:
- Eating slowly and avoiding carbonated drinks and gas-producing foods
- Managing stress and anxiety through relaxation techniques, such as meditation or deep breathing
- Using over-the-counter remedies, such as simethicone (Gas-X, Mylicon) at 40-125mg after meals, to help break up gas bubbles
- Considering antacids, such as Tums or Rolaids, if acid reflux is the underlying cause
- Consulting a healthcare provider if symptoms persist or are accompanied by other symptoms, such as abdominal pain, weight loss, or difficulty swallowing, as it could indicate a more serious condition requiring specific treatment 1
From the Research
Causes of Persistent Eructation (Belching)
- Excessive belching can be caused by various factors, including gastroesophageal reflux disease (GERD) and functional dyspepsia 2, 3, 4
- Supragastric belching, a behavioral disorder, is a common cause of excessive belching, where air is sucked or injected into the esophagus and expelled immediately 2, 5, 3, 4, 6
- Aerophagia, a condition where patients swallow large quantities of air, can also lead to excessive belching, although it is a distinct disorder from supragastric belching 2, 5, 3
- Gastric belching, a physiological mechanism to vent swallowed air from the stomach, can also contribute to excessive belching 4, 6
- In some cases, persistent belching can be a symptom of an underlying condition, such as rumination syndrome, and may require extensive diagnostic testing 5, 4
Mechanisms of Belching
- Gastric belching occurs through a vagally mediated reflex, leading to relaxation of the lower esophageal sphincter and venting of gastric air 4
- Supragastric belching occurs through a behavioral mechanism, where pharyngeal air is sucked or injected into the esophagus and expelled immediately 4, 6
- Impedance monitoring can help distinguish between gastric and supragastric belching 4, 6