Korean J Gastroenterol.  2014 Jul;64(1):4-9. 10.4166/kjg.2014.64.1.4.

Belching (Eructation)

• Ryu HS
• Choi SC
• Lee JS

• KMID: 1791888
• DOI: http://doi.org/10.4166/kjg.2014.64.1.4

Abstract

Belching is a normal physiological function that may occur when ingested air accumulated in the stomach is expelled or when food containing air and gas produced in the gastrointestinal tract is expelled. Excessive belching can cause patients to complain of abdominal discomfort, disturbed daily life activities, decreased quality of life and may be related to various gastrointestinal disorders such as gastroesophageal reflux disease, functional dyspepsia, aerophagia and rumination syndrome. Belching disorders can be classified into aerophagia and unspecified belching disorder according to the Rome III criteria. Since the introduction of multichannel intraluminal impedance monitoring, efforts are being made to elucidate the types and pathogenic mechanisms of belching disorders. Treatment modalities such as behavioral therapy, speech therapy, baclofen, tranquilizers and proton pump inhibitors can be attempted, but further investigations on the effective treatment of belching disorders are warranted.

Keyword

Eructation; Electric impedance; Lower esophageal sphincter

MeSH Terms

Aerophagy
Behavior Therapy
Eructation/metabolism/*pathology/therapy
Humans
Muscle Relaxants, Central/therapeutic use
Proton Pump Inhibitors/therapeutic use
Quality of Life
Speech Therapy
Muscle Relaxants, Central
Proton Pump Inhibitors

Figure

• 

  Fig. 1. Mechanism of belching. The ingested air during swallowing of food and water accumulates in the proximal stomach. Increased volume in proximal stomach induces transient lower esophageal sphincter relaxation (tLESR), followed by rapid moving of gastric air into the esophagus. Abrupt distension of esophagus by refluxed air induces secondary peristalsis or esophago-UES relaxation reflex, which allows venting of gas. LES, lower esophageal sphincter; UES, upper esophageal sphincter.

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  Fig. 2. Types and mechanisms of belching. (A) Gastric belching. The ingested air that accumulates in the stomach or gas that is generated from food or gastrointestinal tract is expelled during relaxation of the lower esophageal sphincter. (B) Supragastric belching. The ingested air does not enter the stomach but is expelled immediately. (C) Aerophagia. As patients swallow air continuously, some portion of the air is vented by gastric belching and moves to the intestine, causing abdominal distention. (D) Rumination syndrome. The voluntary contraction of the abdominal wall musculature increases intragastric pressure, thereby causing reflux of gastric contents into the esophagus and venting of air simultaneously.

Reference

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