belching (eructation)
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Etiology
- aerophagia (swallowing air)
- generally does NOT occur from excess gas production in the stomach
Pathology
- most swallowed air generally passes only part way down the esophagus, then is regurgitated (belching)
- because belching may provide temporary relief, a viscious cycle of aerophagia & belching may occur
- inability to belch may occur after surgical repair of a hiatal hernia
Diagnostic procedures
- impedance pH monitoring can help to differentiate between gastric & supragastric belching.
- upper GI endoscopy with small bowel biopsy
- confirm celiac disease
- worsening symptoms
Radiology
- abdominal imaging as indicated
Management
- supragastric belching
- brain-gut behavioral therapies, either separately or in combination
- cognitive behavioral therapy
- diaphragmatic breathing
- speech therapy
- central neuromodulators
- brain-gut behavioral therapies, either separately or in combination
- gastric belching
- low FODMAP diet with GI dietician oversight
More general terms
Additional terms
References
- ↑ Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 234
- ↑ American Gastroenterological Association Clinical practice update focuses on belching, bloating, distension. https://gastroenterology.acponline.org/archives/2023/07/28/1.htm
Moshiree B, Drossman D, Shaukat A. AGA Clinical Practice Update on Evaluation and Management of Belching, Abdominal Bloating, and Distension: Expert Review. Gastroenterology. 2023. July 13 PMID: https://www.ncbi.nlm.nih.gov/pubmed/37452811 Free article Review. https://www.gastrojournal.org/article/S0016-5085(23)00823-5/fulltext