What causes belching with a sulfur odor?

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Last updated: April 12, 2025View editorial policy

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Differential Diagnosis for Burps Smelling like Sulfur

  • Single most likely diagnosis:
    • Gastroesophageal Reflux Disease (GERD) - This condition involves the reflux of stomach acid into the esophagus, which can cause burps that smell like sulfur due to the presence of hydrogen sulfide gas in the stomach.
  • Other Likely diagnoses:
    • Lactose intolerance - Inability to digest lactose can lead to the production of sulfur-containing gases during digestion, resulting in sulfur-smelling burps.
    • Fructose malabsorption - Similar to lactose intolerance, the incomplete absorption of fructose can lead to the production of sulfur-containing gases.
    • Small Intestine Bacterial Overgrowth (SIBO) - An overgrowth of bacteria in the small intestine can produce sulfur-containing gases, leading to sulfur-smelling burps.
    • Food intolerance (e.g., gluten, high-sulfur foods) - Consuming foods that are not well-tolerated can lead to the production of sulfur-containing gases.
  • Do Not Miss diagnoses:
    • Peptic ulcer disease - Although less common, peptic ulcers can cause sulfur-smelling burps due to the infection with Helicobacter pylori, which produces enzymes that break down sulfur-containing compounds.
    • Gastric cancer - A rare but potentially life-threatening condition that can cause changes in digestion and gas production, leading to sulfur-smelling burps.
  • Rare diagnoses:
    • Wilson's disease - A rare genetic disorder that affects copper metabolism, leading to the accumulation of sulfur-containing compounds in the body.
    • Sulfur amino acid metabolism disorders (e.g., homocystinuria) - Rare genetic disorders that affect the metabolism of sulfur-containing amino acids, potentially leading to the production of sulfur-containing gases.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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