Journal List > Korean J Gastroenterol > v.70(6) > 1007713

Cho: Belching

Abstract

Supragastric belching is the most important factor in the etiology of excessive belching complaints. Supragastric belching is a belching disorder with a behavioral origin. The standard diagnosis is made by monitoring the esophageal impedance. Supragastric belching has been shown to be associated with globus, as well as reflux symptoms in proton pump inhibitor non-responders in gastroesophageal reflux disease; however, the pathophysiology of supragastric belching in patients with gastroesophageal reflux disease or functional dyspepsia has not been clarified. Patient education with behavioral therapy is the treatment of choice in isolated supragastric belching. On the other hand, the best management of supragastric belching associated with globus, gastroesophageal reflux disease, and dyspepsia remains to be studied.

Figures and Tables

Fig. 1

Patterns of gas movement shown in patients complaining of belching in impedance monitoring. (A) Gastric belch, there is unidirectional movement of air from the distal to the proximal esophagus. (B) Supragastric belch, air enters the proximal esophagus and travels downward rapidly, which corresponds to a rapid antegrade rise in impedance from the proximal to the distal channels. This is followed by a rapid return to the baseline impedance in the reverse direction, corresponding to the retrograde expulsion of gas. (C) Two episodes of supragastric belch occur subsequently.

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Fig. 2

Supragastric belch occurring seconds after the onset of an episode of acid reflux. Arrowheads indicate the change of pH. At the point of arrowhead, esophageal pH decreases below 4. Arrows indicates the direction of movement. Esophageal impedance shows retrograde movemet of bolus. Therefore, the change of pH and bolus movement mean acid reflux.

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Notes

Financial support None.

Conflict of interest None.

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