by Sam Treadway MSc, Clinical Scientist, The Functional Gut Clinic
Belching, or ‘burping’ is a common feature of daily life and affects some people more than others. Aside from the social connotations – most of us consider belching in public to be poor manners, we generally disregard it and certainly do not think of it as a health problem.
In reality though, if you belch a lot it can be a sign of an underlying health condition, and in this article, I explain the various causes of belching.
Belching is a physiological process, defined as the audible expulsion of air from the stomach or oesophagus into the pharynx. Although this is a normal bodily function, it can cause embarrassment for the belcher or those people in their presence.
When belching becomes excessive or is accompanied by other gastrointestinal symptoms, it has the potential to become highly intrusive and severely impact on a person’s quality of life.
The causes of excessive belching can be often attributed to lifestyle choices, gastrointestinal disease, behavioural causes or a combination of these factors. Determining the exact reason for excessive belching on an individual basis is important not only in treating this troublesome symptom, but also to help restore a better quality of life for the patient.
Belching presents in two distinct patterns, depending on the origin of the gas:
In order to guide treatment, the correct belching pattern must be identified, and this may not be clear on clinical assessment alone. We use Intra-luminal oesophageal impedance monitoring to accurately determine the belching pattern.
For gastric belching, excessive air swallowing (aerophagia) is a likely cause. Initially, the excess of air produces bloating and distension, but if the gas escapes the abdomen and enters the LOS, then belching can occur. Lifestyle modifications often help to reduce this cause of belching – behavioural adaptations such as taking time when eating meals, avoiding fizzy drinks and ceasing chewing gum can all assist with reducing the volume of air swallowed.
Supragastric belching treatment relies on medication and behavioural techniques. The drug baclofen has been shown to reduce the symptoms of SGB, and a combination of baclofen and pregabalin produced a 90% reduction in SGB events.
In addition, speech therapy centred around making the patient aware of their behaviour is efficacious, while cognitive behavioural therapy has also been shown to significantly reduce belching and improve quality of life in patients with pathological SGB.
At The Functional Gut Clinic, we often help patients with ‘biofeedback therapy’ which helps them to understand their pattern of belching by observing pressure and gas patterns of the computer screen whilst we are performing an oesophageal manometry test. We can try tricks like diaphragmatic breathing, exhaling before swallowing and even placing a pencil between patients teeth to show how air swallowing behaviour can be reduced.
When excessive belching is not accompanied by excessive air swallowing or SGB, a likely culprit could be gastrointestinal disease. Premature fermentation of ingested food and drink may lead to the overgrowth of bacteria in the gut and produce an excess of gas. Hydrogen and methane breath tests can reveal if this is the cause.
In the case of a positive diagnosis, treating bacterial overgrowth with antibiotic therapy may reduce belching.
Excessive belching may often present as a primary complaint or be associated with other gastrointestinal symptoms. Physiological testing is key in determining the cause of belching on an individual patient basis.