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Functional gastroduodenal disorders / Belching disorders
Belching disorders
A positive diagnosis of aerophagia is based on a careful history and observation of air swallowing. In typical cases, no further investigation is required(1). ]
Excessive belching may also accompany GERD, and in difficult cases, pH monitoring or empirical acid suppressive therapy may be considered. Belching is also often reported in dyspepsia in which it does not respond to acid suppressive therapy. In FD, belching is associated with hypersensitivity to gastric distension, which supports the concept that belching is induced to relieve upper abdominal discomfort. It may be important to screen for psychiatric diseases, but there is no evidence of excess psychopathology in aerophagia or in functional dyspepsia with symptoms of belching(6).
Explanation of the symptoms and reassurance to the patient is very important. The habit can sometimes be inhibited by showing chest expansion and air ingestion as the patient belches. Dietary modifications as avoiding sucking candies or chewing gum and drinking carbonated beverages, as well as dietetic habits as eating slowly and encouraging small swallows are recommended but have not been rigorously tested. Behavioural therapy seems helpful in some cases, but no proven evidence from clinical trials is available as also lack studies investigating drug therapy specifically in aerophagia(1).
Belching disorders comprise aerophagia (troublesome repetitive belching with observed excessive air swallowing) and unspecified belching (no evidence of excessive air swallowing)(1).
Air swallowing during eating and drinking is a normal physiological event and so is venting of the ingested air during transient relaxations of the lower esophageal sphincter. Hence, belching can only be considered a disorder when it becomes troublesome(1).
The committee distinguishes aerophagia from unspecified excessive belching. In the previous Rome II classification, aerophagia was described as an unusual disorder with excessive belching due to air swallowing. The committee decided to expand the category based on consensus that excessive belching is a presenting symptom and based on recent evidence - obtained with intraluminal impedance measurement of air transport in the esophagus - which confirms that different mechanisms of excessive belching occur(1).
Rome III diagnostic Criteria* for Aerophagia(1):
| Must include all of the following: | |
| 1. | Troublesome repetitive belching at least several times a week |
| 2. | Air swallowing that is objectively observed or measured |
* Criteria fulfilled for the last 3 months with symptom onset at least 6 months before diagnosis.
Rome III diagnostic Criteria* for "Unspecified Excessive Belching"(1)
| Must include all of the following: | |
| 1. | Troublesome repetitive belching at least several times a week |
| 2. | No evidence that excessive air swallowing underlies the symptom |
* Criteria fulfilled for the last 3 months with symptom onset at least 6 months before diagnosis.
Belching is usually an unconscious act, and the motility patterns of belching are quite similar to those found in gastroesophageal reflux. A recent study performed by using intraluminal impedance measurement in aerophagia patients revealed swallowing of air that enters the esophagus very rapidly and is expulsed almost immediately in the oral direction. This phenomenon of "supragastric belching" , clearly distinct from "gastric" belching, is not accompanied by transient relaxation of the lower esophageal sphincter and is only observed in aerophagia(21).
26. Bredenoord A.J., Weusten B.L., Sifrim D. Belching disorders, gastric, and supragastric belching: a study using intraluminal electrical impedance monitoring. Gut 2004; 53: 1561-1565.