Belching in Gastroesophageal Reflux Disease: Literature Review

Abstract

Belching is a common phenomenon. However, it becomes bothersome if excessive. Impedance–pH monitoring can classify the belching into two types: gastric belching and supragastric belching (SGB). The former is a physiological mechanism to vent swallowed air from the stomach, whereas the latter is a behavioral disorder. Gastroesophageal reflux disease (GERD) is the most relevant condition in both types of belching. Recent findings have raised awareness that excessive SGB possibly sheds light on the pathogenesis of a part of proton pump inhibitor (PPI) refractoriness in GERD. SGB could cause typical reflux symptoms such as heartburn, regurgitation or chest pain in two ways: SGB-induced gastroesophageal reflux or SGB-induced esophageal distension. In PPI-refractory GERD, it is important to detect hidden SGB as a cause of reflux symptoms since SGB requires psychological treatment instead of high dose PPIs or pain modulators. In the case of PPI-refractory GERD with excessive SGB, recent studies imply that the combination of a psychological approach and conventional treatment can improve treatment outcome.

Paciente con regurgitación: cómo estudiarla y cuáles son sus principales diagnósticos diferenciales

“…La importancia en la práctica clínica radica en identificar los eructos supragástricos, ya que (como desarrollaremos más adelante) son los que constituyen una potencial causa de refractariedad al tratamiento y presentan un enfoque terapéutico diferente. 17,18 del gas en el esófago, así como su eventual relación con el reflujo y los síntomas. 23 • Eructos gástricos Con cada deglución, ingerimos un volumen variable de aire que es transportado al estómago.…”

“…Si bien los monitoreos de Estos pacientes pueden acudir a la consulta por el eructo en sí (fenómeno audible), mientras que en otros puede manifestarse únicamente con síntomas típicos de reflujo. 18 • Epidemiología…”

“…Gentileza del sector de Neurogastroenterología del Hospital Interzonal General de Agudos General José de San Martín de La Plata Eructo supragástrico B pH-impedanciometría de 24 horas muestran que los pacientes con la ERGE presentan mayor aerofagia y eructos gástricos que los pacientes normales, no se ha podido establecer que estos eventos fuesen la causa de los episodios de reflujo. 18,26 • Eructos supragástricos A diferencia de los eructos gástricos, los supragástricos se consideran un trastorno de la conducta. El paciente succiona el aire, que rápidamente es llevado al esófago y es seguido de su rápida expulsión.…”

What Is the Difference in Characteristics Between Belching Disorder and Gastroesophageal Reflux Disease With Belching? Centering Around Supragastric Belching

“…However, the prevalence of belching in GERD patients varies widely, 4.1-75.6%. 5 A Dutch study revealed that the incidence of SGB was significantly higher in GERD patients with severe belching compared to GERD patients with mild to moderate belching, therefore, they suggested that SGB, and not gastric belching influence the reflux symptoms in patients with GERD. 6 A recent cross-cultural study reported that the prevalence of SGB and its effect on GERD symptoms is significantly lower in Japanese patients compared to British patients.…”

“…Thus far, BD in the Asian population is still not clearly elucidated, there are few studies on BD and GERD patients with belching that have been conducted on an Asian population and especially in Korean patients. A recent review reported that the prevalence of belching in the general population varies from 6.7-28.8%, 5 however most of the studies were conducted in the Western nations.…”