Belching

J.G.S. Breed, MD PhDConsultant 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