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