Belching (Eructation)

Key Features

• Belching (eructation) is defined as the involuntary or voluntary release of gas from the stomach or esophagus

• A normal reflex, it does not itself denote gastrointestinal dysfunction

• Occurs most frequently after meals when gastric distention results in transient lower esophageal sphincter relaxations

• When chronic and excessive, almost always caused by supragastric belching or aerophagia, both of which are common in those with anxiety or psychiatric disorders

Clinical Findings

• Virtually all stomach gas comes from swallowed air

• Distention, flatulence, and abdominal pain may result when excessive amounts of air is ingested (eg, with carbonated beverages, rapid eating, gum chewing, and smoking)

Diagnosis

• Evaluation should be restricted to patients with other complaints such as dysphagia, heartburn, early satiety, or vomiting

Treatment

• Referral to behavioral or speech therapist may be beneficial since most patients suffer from behavioral disorder (eg, aerophagia from causes listed above)