What causes frequent eructation (belching)?

From the Guidelines

Frequent burping is most commonly caused by swallowing excess air, a condition known as aerophagia, or by underlying digestive issues such as gastroesophageal reflux disease (GERD), functional dyspepsia (FD), or gastroparesis, as noted in the 2023 study published in Gastroenterology 1.

Causes of Frequent Burping

The causes of frequent burping can be multifaceted, including:

• Swallowing excess air while eating or drinking, which can happen when eating too quickly, drinking carbonated beverages, chewing gum, smoking, or using straws.
• Digestive issues like acid reflux, GERD, lactose intolerance, or irritable bowel syndrome.
• Structural causes such as hiatal and paraesophageal hernias, and impaired gastric accommodation, especially in patients post-Nissen fundoplication 1.
• Belching can also be subdivided into supragastric belching from the esophagus and gastric belching from the stomach, with supragastric belching being more commonly associated with anxiety 1.

Management and Treatment

To reduce frequent burping, the following strategies can be employed:

• Eating more slowly and avoiding carbonated drinks.
• Limiting gum chewing and reducing consumption of gas-producing foods like beans, cabbage, and onions.
• For acid reflux-related burping, over-the-counter antacids like Tums or Rolaids can provide relief, while H2 blockers (ranitidine, famotidine) or proton pump inhibitors (omeprazole) may help for persistent symptoms, as suggested by the 2023 study in Gastroenterology 1.
• Simethicone products like Gas-X can specifically target excess gas.
• Behavioral strategies, including diaphragmatic breathing and cognitive behavioral therapy (CBT), have been shown to be effective in treating supragastric belching, improving quality of life (QOL) 1.
• In cases of functional dyspepsia (FD), regular exercise, lifestyle changes, and medications such as neuromodulators can help manage symptoms, according to the 2022 guidelines from the British Society of Gastroenterology 1.

Importance of Medical Evaluation

If burping is accompanied by severe pain, difficulty swallowing, weight loss, or persistent vomiting, it is crucial to consult a healthcare provider, as these could indicate more serious conditions requiring medical attention. Burping itself is a normal bodily function, but when excessive, addressing the underlying cause can provide relief.

From the Research

Causes of Frequent Burping

• Frequent burping can be caused by various factors, including gastroesophageal reflux disease (GERD), functional dyspepsia, and irritable bowel syndrome (IBS) 2, 3, 4, 5, 6
• GERD, functional dyspepsia, and IBS are common overlapping gastrointestinal disorders, and the overlap between these conditions can contribute to frequent burping 5, 6
• The use of proton pump inhibitors (PPIs) can also affect gastric emptying, leading to frequent burping 2
• Abnormal gastric emptying, which can be caused by PPIs, GERD, or other conditions, can lead to frequent burping 2, 4

Relationship Between GERD, Functional Dyspepsia, and IBS

• There is a significant overlap between GERD, functional dyspepsia, and IBS, with up to 79% of IBS patients reporting GERD symptoms, and up to 71% of GERD patients reporting IBS symptoms 4
• The overlap between these conditions can make diagnosis and treatment challenging, and physicians should consider the possibility of multiple conditions when diagnosing patients with GERD, functional dyspepsia, or IBS 6
• The relationship between GERD, functional dyspepsia, and IBS is complex, and further research is needed to understand the underlying mechanisms and to develop effective treatments for these conditions 3, 5