Where can I find therapy for excessive burping?

Where to Find Therapy for Excessive Burping

Therapy for excessive burping should be sought from a gastroenterologist who can perform specialized esophageal testing to differentiate the type of belching, followed by referral to a speech therapist or behavioral therapist for treatment of supragastric belching, which is the most common cause of excessive burping. 1

Initial Evaluation: Gastroenterology

Start with a gastroenterologist for diagnostic workup, as excessive belching requires specialized testing that primary care cannot provide. 1

• High-resolution esophageal manometry combined with impedance monitoring differentiates between gastric belching (from the stomach) and supragastric belching (from the esophagus), which have completely different treatments. 1
• Impedance pH monitoring can identify if GERD is contributing to the belching symptoms. 1
• Most patients with isolated excessive belching (several times per minute) have supragastric belching, which is a behavioral disorder where air is sucked into the esophagus and immediately expelled. 2, 3

Primary Treatment Location: Speech Therapy or Behavioral Therapy

Once supragastric belching is diagnosed, the primary treatment location shifts to speech therapy or cognitive behavioral therapy (CBT), not continued gastroenterology care. 3, 4

Speech Therapy

• Speech therapists can teach diaphragmatic breathing techniques that stop the involuntary muscle contractions causing supragastric belching. 3
• This is considered first-line therapy for behavioral belching disorders. 2, 5

Behavioral Therapy/CBT

• Cognitive behavioral therapy using diaphragmatic breathing is the evidence-based treatment for supragastric belching. 3
• Brain-gut behavioral therapists specialize in treating disorders of gut-brain interaction, including excessive belching. 6
• These therapists can address underlying anxiety, which is commonly associated with supragastric belching. 1

When to Stay with Gastroenterology

Continue gastroenterology management only if testing reveals gastric belching associated with GERD or other structural problems. 1, 7

• If gastric belching is related to GERD, PPI therapy (such as omeprazole 20 mg daily) combined with diaphragmatic breathing may be effective. 7, 8
• Structural causes like hiatal hernias or post-fundoplication complications require ongoing gastroenterology management. 1
• If belching occurs with other symptoms like bloating or dyspepsia, integrated care with gastroenterology dietitians may be needed. 6

Common Pitfall to Avoid

Do not continue PPI therapy indefinitely for isolated excessive belching without proper testing. Many patients with supragastric belching are misdiagnosed as having PPI-refractory GERD and receive unnecessary long-term acid suppression when they actually need behavioral therapy. 3 PPIs are ineffective for supragastric belching because the reflux episodes are typically non-acidic. 7

Practical Algorithm for Finding Care

1. Schedule with gastroenterology for impedance manometry testing to diagnose the belching type. 1
2. If supragastric belching is confirmed, request referral to speech therapy or a therapist trained in CBT with diaphragmatic breathing. 3
3. If gastric belching with GERD is confirmed, continue with gastroenterology for PPI therapy and consider adjunctive behavioral therapy for breathing exercises. 7
4. If refractory or complex, seek integrated care involving gastroenterology, dietitians, and brain-gut behavioral therapists. 6