How can I stop frequent eructation?

How to Stop Burping (Eructation)

The most effective approach to stopping frequent burping depends on identifying whether you have gastric belching (involuntary air venting from the stomach) or supragastric belching (a behavioral disorder where air is sucked into the esophagus and immediately expelled), with supragastric belching requiring brain-gut behavioral therapy as first-line treatment rather than medications. 1

Understanding the Type of Belching

The critical first step is determining which type of belching you have, as this fundamentally changes treatment:

Gastric Belching (Involuntary)

• Occurs less frequently and with greater force 1
• Represents physiological venting of swallowed air from the stomach 2, 3
• Often associated with GERD or functional dyspepsia 2, 4

Supragastric Belching (Voluntary/Behavioral)

• Occurs very frequently, potentially up to 20 times per minute 4
• Air is sucked or injected into the esophagus from the pharynx and expelled immediately without reaching the stomach 3, 5
• This is a behavioral disorder, not a physiological problem 3, 4

Treatment Algorithm

For Supragastric Belching (Most Common Cause of Excessive Burping)

Brain-gut behavioral therapy is the first-line treatment and should be prioritized over medications. 1

Specific behavioral interventions include:

• Cognitive behavioral therapy (CBT) using diaphragmatic breathing to stop the complex muscle contractions that generate supragastric belching 5, 6
• Speech therapy focused on breathing patterns and swallowing mechanics 1, 4, 6
• Psychoeducation: Simply communicating the findings to the patient that they are unconsciously creating the belches can be therapeutic 1

These behavioral approaches have shown promise in recent studies and directly address the underlying mechanism 6.

For Gastric Belching

If your belching is truly gastric in origin (less frequent, more forceful), treatment targets the underlying cause:

GERD-Related Gastric Belching:

• Start PPI therapy (proton pump inhibitor) and lifestyle modifications for reflux 1
• Consider fundoplication if severe pathologic GERD is present 1
• Consider Baclofen if related to excessive transient relaxations of the lower esophageal sphincter 1

Rule out other causes:

• Gastroparesis in patients with associated nausea and vomiting 1
• Rumination disorder using high-resolution manometry with impedance 1

Diagnostic Considerations

If belching is excessive and impacting quality of life, consider diagnostic testing to differentiate the types: 1

• Ambulatory impedance monitoring ± high-resolution manometry (for at least 90 minutes; 24-hour impedance preferred) 1
• High-resolution manometry shows distinct patterns: upper esophageal relaxation with air flowing into esophagus then expelled orally through pharynx before reaching stomach in supragastric belching 1

Important Clinical Pitfalls

Common mistakes to avoid:

• Don't assume all excessive belching requires acid suppression therapy - supragastric belching will not respond to PPIs and requires behavioral treatment instead 2, 5
• Don't overlook the behavioral component - supragastric belching is often misdiagnosed as PPI-refractory GERD, leading to inappropriate escalation of acid suppression 2, 5
• Consider associated conditions - belching disorders commonly overlap with anxiety, obsessive-compulsive disorder, functional dyspepsia, and IBS 5, 6

When Behavioral and Medical Treatments Should Be Combined

In PPI-refractory GERD with excessive supragastric belching, recent studies suggest combining psychological approaches with conventional treatment can improve outcomes. 2 This is particularly relevant when:

• Reflux symptoms persist despite adequate acid suppression 2
• Supragastric belching is causing esophageal distension or inducing gastroesophageal reflux 2
• There is overlap with eating disorders or other functional GI disorders 5

Additional Considerations for Bloating vs. Belching

If your primary symptom is bloating rather than belching, consider food intolerances (lactose, fructose, artificial sweeteners) with a 2-week dietary restriction trial as the simplest diagnostic approach 1.