Monday, September 01, 2014

Table of Contents

Description

Everyone belches or burps at one time or another to relieve gas buildup in the stomach.

It may often be embarrassing, but for the vast majority of people, occasional belching is not a problem that needs medical attention.

Belching (eructation) is triggered in two ways. First, too much gas is produced in the stomach by eating such foods as bran, raw fruit, vegetables, or by drinking gaseous liquids such as beer, soda, or seltzer. Even apple, grape, and prune juice can lead to belching.

The second cause is swallowing too much air, a condition known as aerophagia in chronic cases. Strange as it may seem, it does not take much effort to swallow air. Gulping one's food, drinking too fast, or talking while eating brings in excessive amounts of air, which can build up in the gastrointestinal tract. Chewing gum, sucking on candy, smoking a pipe or cigarettes, or chewing on a cigar also greatly increase air intake and, with it, belching. Aerophagia occurs normally in small amounts while eating and drinking, but some people unconsciously swallow repeated boluses of air at other times, especially when anxious.

Most swallowed air is subsequently eructated (belched); only a small amount passes into the small bowel, the quantity apparently being influenced by posture. The esophagus empties into the posterior aspect of the stomach. When the person is upright, air rises above the liquid contents of the stomach, comes into contact with the gastroesophageal junction, and is readily belched. When the person is supine (lying on his or her back), air trapped below the fluid tends to be propelled into the duodenum (part of the small intestine).

Excessive salivation may also lead to increased air swallowing and may be associated with various digestive disorders (e.g. peptic ulcer), ill-fitting dentures, or with nausea of any etiology. Belching may be associated with the use of antacids such as baking soda. Attributing the relief of ulcer symptoms to belching rather than antacids, the person continues to belch to relieve distress.

Questions

What is causing the belching?

Is it diet-related?

Is lactose intolerance associated with this condition?

Should the eating habits be modified to minimize discomfort?

Are excessive amounts of air being swallowed?

How can excessive intake of air be avoided?

Do you recommend any medications?

What are the side-effects?

Self-Care

Belching, bloating, and distention are difficult to relieve, since most complaints are due to either unconscious aerophagia or to exaggerated sensitivity to normal amounts of gas. An attempt must be made to reduce aerophagia.

Since aerophagia may be due to excessive salivation, it is important to avoid habits like excessive gum chewing or smoking and to treat digestive diseases (e.g., peptic ulcer) that may cause hypersalivation as well as disorders that may cause nausea and reflex salivation.

It is important to chew food and to eat food slowly. Do not drink through a straw. When belching is associated with use of carbonated beverages or antacids, these should be avoided.

When aerophagia is troublesome, clamping a pencil or other object between the teeth may decrease the amount of involuntary or habit swallowing and break the cycle of aerophagia-discomfort-belch-relief.

In some cases, belching is directly related to lactose intolerance, which is the inability to break down certain sugars found in milk and milk products. A common complaint from people who are diagnosed with lactose intolerance is feeling bloated and gassy.

If belching regularly occurs after drinking milk or eating a milk-based product, a simple lactose intolerance test will confirm if one is missing the enzyme lactase. There are few well-controlled studies that demonstrate clear-cut benefit from any drug. However, simethicone and agents that break up small gas bubbles may be helpful for certain patients.