Effect of Sleep on Excessive Belching

Karamanolis, George; Triantafyllou, Konstantinos; Tsiamoulos, Zacharias P.; Polymeros, Dimitrios; Kalli, Theodora; Misailidis, Nikolaos; Liakakos, Theodore; Ladas, Spiros D.

doi:10.1097/mcg.0b013e3181bd885e

Cited by 33 publications

(22 citation statements)

References 14 publications

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“…The patients who did respond also gave a specific history of belching, such that it was chronic, generally persisted throughout the day without relation to eating, resolved during sleep, and improved during exercise. These patients do not typically belch during sleep because of lack of swallowing. In contrast, a lack of belching during exercise most likely results from the need for concentrated open mouth breathing during exercise that both inhibits and does not allow time for swallowing.…”

Section: Discussionmentioning

confidence: 99%

Simple office-based behavioral approach to patients with chronic belching

Katzka

2012

Dis Esophagus

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Chronic belching can be a difficult and socially disabling symptom often attributed to reflux with poor response to therapy. In patients where aerophagia is identified as a clear cause, treatment with baclofen may not be tolerated, and biofeedback therapy is time-intensive and may still not be effective. In this pilot study, an office-based easy-to-perform method based on sustained glottal opening was used in five patients with chronic belching, in whom reflux and other causes had been excluded. Treatment consisted of having the patient breathe slowly and diaphragmatically with his or her mouth open during supine, then sitting periods to prevent belching. When this was successful, patients were then counseled on continuing this breathing with mouth slightly ajar as an outpatient using this persistently. Wide mouth opening was used for rescue therapy of belching attacks. All five patients responded to the office-based therapy with complete cessation of belching during the visit. At 1-month follow up, four patients remained asymptomatic. One patient was asymptomatic but for two breakthrough attacks easily managed with the protocol. A simple office-based procedure based on complete glottal opening can be curative for a subset of patients with chronic eructation secondary to repetitive air swallowing.

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Section: Discussionmentioning

confidence: 99%

Simple office-based behavioral approach to patients with chronic belching

Katzka

2012

Dis Esophagus

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“…Th is suggests that in the majority of patients markedly excessive belching is likely related to supragastric belching ( 71 ). Identifi cation of supragastric belching with intraluminal impedance has also allowed for the development of eff ective therapies, most notably baclofen and diaphragmatic breathing (72)(73)(74).…”

Section: Intraluminal Impedance In Belching and Rumination Syndromementioning

confidence: 98%

Esophageal Impedance Monitoring: Clinical Pearls and Pitfalls

Ravi

Katzka

2016

American Journal of Gastroenterology

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The development of intraluminal esophageal impedance monitoring has improved our ability to detect and measure gastroesophageal reflux without dependence on acid content. This ability to detect previously unrecognized weak or nonacid reflux episodes has had important clinical implications in the diagnosis and management of gastroesophageal reflux disease (GERD). In addition, with the ability to assess bolus transit within the esophageal lumen, impedance monitoring has enhanced the recognition and characterization of esophageal motility disorders in patients with nonobstructive dysphagia. The assessment of the intraluminal movement of gas and liquid has also been proven to be of diagnostic value in conditions such as rumination syndrome and excessive belching. Further, alternative applications of impedance monitoring, such as the measurement of mucosal impedance, have provided novel insights into assessing esophageal mucosal integrity changes as a consequence of inflammatory change. Future applications for esophageal impedance monitoring also hold promise in esophageal conditions other than GERD. However, despite all of the clinical benefits afforded by esophageal impedance monitoring, important clinical and technical shortcomings limit its diagnostic value and must be considered when interpreting study results. Overinterpretation of studies or application of impedance monitoring in patients can have deleterious clinical implications. This review will highlight the clinical benefits and limitations of esophageal impedance monitoring and provide clinical pearls and pitfalls associated with this technology.

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“…Recession of SGB during sleep, speech and distraction, as well as the type of muscles that are included in its pathogenesis are suggestive of the behavioural nature of the disease. 7,9 Hence, interest is mainly focused in behavioural therapies. Speech therapy has been applied in a recent pilot study with 11 patients and showed positive results.…”

Section: Discussionmentioning

confidence: 99%

Supragastric Belching: Prevalence and Association With Gastroesophageal Reflux Disease and Esophageal Hypomotility

Koukias

Woodland

Yazaki

et al. 2015

J Neurogastroenterol Motil

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Background/AimsSupragastric belching (SGB) is a phenomenon during which air is sucked into the esophagus and then rapidly expelled through the mouth. Patients often complain of severely impaired quality of life. Our objective was to establish the prevalence of excessive SGB within a high-volume gastrointestinal physiology unit, and evaluate its association with symptoms, esophageal motility and gastresophageal reflux disease. MethodsWe established normal values for SGB by analyzing 24-hour pH-impedance in 40 healthy asymptomatic volunteers. We searched 2950 consecutive patient reports from our upper GI Physiology Unit (from 2010-2013) for SGB. Symptoms were recorded by a standardized questionnaire evaluating for reflux, dysphagia, and dyspepsia symptoms. We reviewed the predominant symptoms, 24-hour pH-impedance and high-resolution esophageal manometry results. ResultsExcessive SGB was defined as ＞ 13 per 24 hours. We identified 100 patients with excessive SGB. Ninety-five percent of these patients suffered from typical reflux symptoms, 86% reported excessive belching, and 65% reported dysphagia. Forty-one percent of patients with excessive SGB had pathological acid reflux. Compared to the patients with normal acid exposure these patients trended towards a higher number of SGB episodes. Forty-four percent of patients had esophageal hypomotility. Patients with hypomotility had a significantly higher frequency of SGB compared to those with normal motility (118.3 ± 106.1 vs 80.6 ± 75.7, P = 0.020). ConclusionsIncreased belching is rarely a symptom in isolation. Pathological acid exposure and hypomotility are associated with more SGB frequency. Whether SGB is a disordered response to other esophageal symptoms or their cause is unclear.

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Effect of Sleep on Excessive Belching

Abstract: Supragastric belch is the prominent belching pattern in patients with excessive belching. Supragastric belches almost ceased at night suggesting the presence of a behavioral disorder. There were no diurnal changes in the rate of gastric belches.

Cited by 33 publications

References 14 publications

Simple office-based behavioral approach to patients with chronic belching

Simple office-based behavioral approach to patients with chronic belching

Esophageal Impedance Monitoring: Clinical Pearls and Pitfalls

Supragastric Belching: Prevalence and Association With Gastroesophageal Reflux Disease and Esophageal Hypomotility

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