OESOPHAGUS

Aerophagia, gastric, and supragastric belching: a study using intraluminal electrical impedance monitoring

A J Bredenoord¹, B L A M Weusten¹, D Sifrim², R Timmer¹, A J P M Smout³

¹ Department of Gastroenterology, Sint Antonius Hospital, Nieuwegein, the Netherlands
² Center for Gastroenterology Research, Catholic University of Leuven, Leuven, Belgium
³ Gastrointestinal Research Unit, University Medical Center, Utrecht, the Netherlands

Correspondence to:
Correspondence to:
Dr A J Bredenoord
Department of Gastroenterology, St. Antonius Hospital, PO Box 2500, 3430 EM Nieuwegein, the Netherlands; a.bredenoord{at}antonius.net

Background: Patients with aerophagia are believed to have excessive belches due to air swallowing. Intraluminal impedance monitoring has made it possible to investigate the validity of this concept.

Methods: The authors measured oesophageal pH and electrical impedance before and after a meal in 14 patients with excessive belching and 14 healthy controls and identified patterns of air transport through the oesophagus. The size of the gastric air bubble was measured radiographically. In four patients prolonged oesophageal manometry was performed simultaneously.

Results: In all subjects, impedance tracings showed that a significant amount of air is propulsed in front of about a third of the swallow induced peristaltic waves. Two types of retrograde gas flow through the oesophagus (belch) were observed. In the first type air flowed from the stomach through the oesophagus in oral direction ("gastric belch"). In the second type air entered the oesophagus rapidly from proximal and was expulsed almost immediately in oral direction ("supragastric belch"). The incidence of air-containing swallows and gastric belches was similar in patients and controls but supragastric belches occurred exclusively in patients. There was no evidence of lower oesophageal sphincter relaxation during supragastric belches. Gastric air bubble size was not different between the two groups.

Conclusions: In patients with excessive belching the incidence of gaseous reflux from stomach to oesophagus is similar to that in healthy subjects. Their excess belching activity follows a distinct pattern, characterised by rapid antegrade and retrograde flow of air in the oesophagus that does not reach the stomach.

Abbreviations: LOS, lower oesophageal sphincter

Keywords: aerophagia; belching; oesophageal motility; functional gastrointestinal disorders; electrical impedance

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

Digest

Robin Spiller
Gut 2004 53: 1549. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• (2005). A Tale of Two Belches. JWatch Gastroenterology 2005: 4-4 [Full Text]  
• Marcovitch, H. (2004). What's new this month in BMJ Journals. BMJ 329: 1368-1368 [Full Text]