BELCHING OR ERUCTATION

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Dr. Minocha is a practicing gastroenterologist and author of "Natural Stomach Care: Treating and Preventing Digestive Disorders with Best of Eastern and Western Therapies".

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Dictionaries describe eructation as "the voiding of gas or of a small quantity of acid fluid from the stomach through the mouth".

Normally the air in stomach is passed downstream into the intestines. Belching occurs when the stomach air, instead of going down, goes up into the esophagus and is expelled though the mouth. As in gastroesophageal reflux disease (GERD) or heartburn, this process requires that the one way valve between esophagus and stomach (lower esophageal sphincter or LES) relax and allow the regurgitation of air upward into the esophagus and then out through the mouth making a sound.

Belching after a meal, especially a big meal, may be normal. It occurs as a result of air being swallowed while eating. In addition, a lot of swallowed air accumulates in stomach in between meals. The food once it reaches the stomach, displaces the air already present there.

The upward expulsion of air is facilitated by relaxation of the LES especially by foods like onions, mints, tomatoes and alcohol. Cultural acceptance of the belching varies. While considered to be uncouth in the western society, a belch after a hearty meal is considered to be a compliment for the chef in some eastern cultures.

Aerophagia means swallowing of air. It primarily occurs while eating, drinking, chewing gum and smoking. Aerophagia increases exponentially during anxiety.

Belching in anxious persons is an extension of "normal" aerophagia and belching. While breathing in, they suck air into the food pipe in addition to the wind pipe (trachea).

Chronic belching is generally not due any disease. Rather, it is a learned process, albeit subconsciously. In most cases, air is swallowed into the esophagus as described above, but is promptly expelled out as a belch before it has had a chance to reach the stomach. This develops into a habit and occurs in anxious persons.

Many a times, patients believe that the belching indicates that there is something wrong with the digestion. Frequently, they ascribe relief of their digestive symptoms caused by other conditions to belching.

Measures to decrease aerophagia, e.g. eating slowly, not chewing gum, avoiding carbonated beverages, mind, onions, chocolates, alcohol are frequently prescribed in chronic belching but may be of limited benefit. Stress reduction and relaxation is the key.

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MAGENBLASE SYNDROME

This poorly defined disorder involves increased fullness and bloating after a meal as described above. The symptoms resolve after patient belches.

GAS-BLOAT SYNDROME

This occurs in patients who have been operated for gastroesophageal reflux disease (GERD) or heartburn. The most common operation is (Nissen's fundoplication). This procedure involves wrapping stomach around the valve at the junction of esophagus and stomach (LES) so as to make it tighter and prevent upward flow of acid.

A natural consequence of that is that the tightened valve does not allow for upward expulsion of air either, thus preventing belching. Patients feel full of gas and bloated especially after a meal. They develop discomfort because of their inability to belch and get rid of that gas. Not only do they develop abdominal cramps, but may also pass large amounts of flatus resulting in socially embarrassing situations.

This syndrome occurs in 25-50% of patients after the fundoplication surgery, but symptoms resolve over time in most cases. Revision surgery may rarely be to correct the problem.

Gas-Bloat syndrome may also occur in patients who are learning to use their upper food pipe (esophagus) for their speech after their voice box (larynx) has been surgically removed due to cancer etc. This new form of speech involves sucking air into esophagus, and then expelling it immediately in the form of words. Increased aerophagia into the stomach may occur in these patients.

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Authored by: Anil Minocha M.D.; FACP; FACG, Chief of Gastroenterology, S.I.U. School of Medicine, Springfield, IL. , Author of Natural Stomach Care and How to Stop Heart Burn

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