From the Guidelines
To stop belching, the most effective approach is to combine behavioral strategies, such as diaphragmatic breathing, with dietary changes and stress management techniques, as recommended by the American Gastroenterological Association (AGA) in their 2023 clinical practice update 1.
Key Recommendations
- Eat and drink slowly to reduce air swallowing
- Avoid carbonated beverages, chewing gum, and smoking
- Limit foods that may cause gas, such as beans, onions, and high-fiber foods
- Try over-the-counter antacids containing simethicone, like Gas-X or Mylanta, to break up gas bubbles in the stomach
- Practice deep breathing exercises, such as diaphragmatic breathing, to reduce stress and increase vagal tone
- Consider stress management techniques, such as relaxation training and gut-directed hypnotherapy, to reduce supragastric belching episodes and improve quality of life
Important Considerations
- Belching can be a symptom of an underlying condition, such as acid reflux, gastroparesis, or a functional gastrointestinal disorder, and severe or persistent belching should be evaluated by a healthcare provider 1
- Supragastric belching, which occurs in up to 3.4% of patients with upper gastrointestinal symptoms, is more commonly associated with anxiety and may require specific treatment, such as behavioral strategies and central neuromodulators 1
- The AGA clinical practice update provides best practice advice for clinicians on the evaluation and management of belching, abdominal bloating, and distention, based on both controlled trials and observational data 1
From the Research
Types of Belching
- Gastric belching: a physiological mechanism to vent swallowed air from the stomach 2
- Supragastric belching (SGB): a behavioral disorder, where pharyngeal air is sucked or injected into the esophagus and immediately expulsed before it reaches the stomach 3, 4
Causes of Excessive Belching
- Gastroesophageal reflux disease (GERD) 2, 4
- Functional disorders of the gastrointestinal tract 5
- Behavioral disorders like anxiety and obsessive-compulsive disorder 5
- Learned abnormal behaviors in response to unpleasant feelings in the abdomen 6
Diagnosis of Belching Disorders
- Impedance-pH monitoring can classify belching into gastric and supragastric belching 2, 6
- Multichannel intraluminal impedance and pH testing can provide a more definitive diagnosis and estimate the frequency of belching episodes 5
Treatment of Belching Disorders
- Behavioral therapy, such as speech therapy, cognitive-behavioral therapy, and diaphragmatic breathing, has shown promise in managing excessive belching 5, 6
- Addressing underlying behavioral disorders and learned abnormal behaviors is crucial in managing excessive belching 6
- Combination of psychological approach and conventional treatment can improve treatment outcome in PPI-refractory GERD with excessive SGB 2