How can I stop sour, vomit-like burps caused by gastro‑oesophageal reflux?

How to Stop Sour, Vomit-Like Burps from Gastro-Oesophageal Reflux

Start with a proton pump inhibitor (PPI) taken 30 minutes before meals, combined with lifestyle modifications including weight loss if overweight, avoiding trigger foods, and elevating the head of your bed. 1

Understanding Your Symptoms

The sour, vomit-like taste in your burps is caused by gastric acid refluxing from your stomach into your esophagus and throat. 2 This occurs when the lower esophageal sphincter relaxes inappropriately, allowing stomach contents to move upward. 1

First-Line Treatment Approach

Lifestyle Modifications (Start Immediately)

• Weight loss if overweight or obese – Obesity is strongly associated with reflux, with one study showing an odds ratio of 7.6 in patients with elevated body mass index. 1
• Avoid trigger foods – Identify and eliminate foods that worsen your symptoms. 1
• Chew sugarless gum – This can help reduce symptoms in older children and adolescents. 1
• Avoid smoking and alcohol – Both worsen reflux symptoms. 1
• Elevate the head of your bed – Keep your upper body elevated during sleep. 2

Pharmacologic Treatment

Proton pump inhibitors (PPIs) are the most potent acid suppressants and superior to H2 antagonists for treating GERD. 1, 3

Critical dosing detail: Take your PPI approximately 30 minutes before meals for maximum effectiveness. 1 The timing is essential because PPIs work best when taken before acid production is stimulated by food. 4

If PPIs provide partial relief but you still have breakthrough symptoms, you may need dose adjustment or twice-daily dosing rather than switching medications. 5

When Belching is the Primary Problem

If excessive belching accompanies your reflux symptoms, the treatment approach differs slightly:

• Gastric belching (from stomach) responds well to PPI therapy combined with diaphragmatic breathing exercises. 1
• Supragastric belching (behavioral) requires behavioral strategies including cognitive behavioral therapy, diaphragmatic breathing, and patient education about the mechanism. 1
• Important distinction: Supragastric belching that occurs before reflux episodes does not respond to PPIs, but belching that occurs after reflux episodes does respond to acid suppression. 1

If Initial Treatment Fails

If you have no response to PPIs after 4-8 weeks, the diagnosis may not be GERD. 5, 3 Consider:

• Upper endoscopy with biopsy to evaluate for erosive esophagitis, eosinophilic esophagitis, or other conditions that mimic GERD. 1
• 24-hour pH monitoring to confirm pathologic acid reflux and establish a temporal relationship between symptoms and reflux episodes. 1

Critical Pitfalls to Avoid

• Do not use prokinetic agents like metoclopramide – These have a black box warning and cause adverse effects in 11-34% of patients, including drowsiness, restlessness, and extrapyramidal reactions. 1
• Do not use chronic antacid therapy – This is generally not recommended due to risks. 1
• Do not continue ineffective treatment – If PPIs don't work after an adequate trial, reassess the diagnosis rather than continuing or escalating therapy. 5, 3

Long-Term Considerations

Be aware of PPI risks with long-term use: These include increased risk of bone fractures (hip, wrist, spine), kidney problems, severe diarrhea from Clostridium difficile, community-acquired pneumonia, and certain types of lupus. 1, 4, 6

Use the lowest effective dose for the shortest time needed. 4 Once symptoms are controlled for 8-12 weeks, attempt to taper to the minimum dose that maintains symptom control. 1

When to Consider Surgery

Fundoplication surgery is reserved for carefully selected patients who have failed pharmacologic treatment or have severe risk of aspiration. 1 However, if acid suppression with PPIs is ineffective, surgery may not produce optimal results, and the diagnosis should be reassessed first. 1