Belching
J.G.S. Breed, MD PhD
Consultant endoscopist
Internal medicine
Learning/lecture objectives
• To understand anatomy and physiology of the
oesophagus
Learning/lecture objectives
• To understand anatomy and physiology of the
oesophagus
• To understand different types of belching
Learning/lecture objectives
• To understand anatomy and physiology of the
oesophagus
• To understand different types of belching
• To give appropriate advice to patient and
family
Belching=eructation
• Occurs 25-30 times a day
• Is a physiological proces
• Each 10 ml fluid goes with 8-32ml of air
• Occurs involuntarely
• No difference in air bubble size
Two types:
• Gastric belching
• Supra-gastric belching.
Gastric belching
Gastric belching
Gas accumulation
Stretching receptors
Opening of the LES (TLESR)
Gastric decompression
Opening of the UES
Sound
Supragastric belching
• Expulsion of recently suctioned air.
• Not swallowed air!
• Subsequent expulsion using straining
• Result of human behaviour
• Initially induced consciously, later
• uncontrolled
Gastric vs supergastric belching
Excessive belching
• Sometimes up to 20/min
• Always supra-gastric
• Never during sleep
• Never associated with organic complaints
Functional supragastric belching
Therefor:
• Dimethicon and simethicon useless
Therapy excessive
supragastric belching
• Explaining, creating awareness of mechanism
• Speech therapist
Belching and GERD
• Belching and GERD have same mechanisme
• Patients with GERD belch more
• Belching does not cause GERD
Inabillity to belch
Inabillity to belch
Take home messages:
• Belching is a normal physiologic phenomenon
• Excessive belching is a behaviour disorder
• Seldomly associated with organic disease.
• So refrain from medication or endoscopy
• Hetero-anamnesis will give you the clue