Gastroesophageal Reflux Characteristics in Supragastric Belching Patients With Positive Versus Negative pH Monitoring: An Evidence of Secondary Gastroesophageal Reflux Disease From Excessive Belching

Abstract

Background/AimsA high prevalence of GERD has been reported in patients with supragastric belching. We aim to evaluate reflux characteristics and explore the temporal relationship between supragastric belches (SGBs) and reflux episodes in GERD patients with excessive belching. MethodsTwenty-four hour esophageal pH-impedance monitoring was analyzed. Reflux episodes were classified into: refluxes preceded by SGBs, followed by SGBs, and lone refluxes. Reflux characteristics were compared between patients with pH-positive (pH+) and pH-negative (pH-). ResultsForty-six patients (34 Female, age 47 ± 13 years) were included. Fifteen patients (32.6%) had pH+. Almost half (48.1 ± 21.0%) of refluxes were preceded by SGBs. The number of SGBs significantly correlated with the number of reflux episodes preceded by SGBs (r = 0.43, P < 0.05) and % time pH < 4 at the distal esophagus (r = 0.41, P < 0.05). Patients with pH+ had significantly more SGBs and reflux episodes preceded by SGBs/day than pH-patients (P < 0.05). The difference in the number of refluxes between pH+ and pH-patients was caused by reflux episodes preceded by SGBs, but not lone refluxes and refluxes followed by SGBs. The proportion of SGBs followed by reflux/total SGBs was similar between patients with pH+ and pH-(P > 0.05). Reflux episodes preceded by SGBs and followed by SGBs extended more proximal and had longer bolus and acid contact time than lone refluxes (P < 0.05). ConclusionsIn patients with GERD and SGB, the number of SGBs positively correlates with the number of reflux episodes preceded by SGBs. Identifying and managing SGB may be beneficial and more likely to improve GERD.

Supragastric belching and rumination syndrome: diagnosis and management

“…This finding is consistent with a study by Kessing et al that showed patients with severe reflux symptoms had a greater frequency of supragastric belches [24]. If there is a causal relationship between reflux events and supragastric belching, using PPIs could help alleviate the behavioral response to the discomfort associated with acid exposure in the esophagus [25 ▪ ].…”

Retrograde Cricopharyngeus Dysfunction: Inability of Belch Due to Upper Esophageal Sphincter Relaxation Failure

“… 1 Belching correlates with supragastric or gastric belching. 1 - 5 However, recent studies have described patients who cannot belch due to failure of the upper esophageal sphincter (UES) to relax. 6 - 8 These patients complained of recurrent chest pain, abdominal bloating, discomfort, or nausea.…”