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

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Cho: Belching
Special Review
Diagnosis and Treatment of Intractable Digestive Symptoms

The Korean Journal of Gastroenterology 2017; 70(6): 273-277.

Published online: 22 December 2017

DOI: https://doi.org/10.4166/kjg.2017.70.6.273

Belching

Yu Kyung Cho

Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Correspondence to: Yu Kyung Cho, Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea. Tel: +82-2-2258-2064, Fax: +82-2-2258-2055, ykcho@catholic.ac.kr

Received 19 November 2017       Revised 11 December 2017       Accepted 11 December 2017

Copyright © 2017. Korean Society of Gastroenterology

Korean Society of Gastroenterology

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Belching, Impedance, Esophagus

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.

kjg-70-273-g001
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.

kjg-70-273-g002

Notes

Financial support None.

Conflict of interest None.

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