© 2004 by BMJ Publishing Group Ltd & British Society of Gastroenterology
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Patients who constantly belch prove something of a mystery to most clinicians. Standard tests for reflux reveal few abnormalities, but as reported by Bredenoord et al, the new technique of impedance monitoring clarifies the matter considerably. The rate of gastro-oesophageal reflux and swallowing both liquid and air was equal between controls and patients with aerophagy, as was the frequency of air moving from stomach to proximal oesophagus (a normal or gastric belch). However, the patients also showed a unique pattern, the supragastric belch with air passing down as far as, but not beyond, the lower oesophageal sphincter and then returning proximally. The air enters the oesophagus in two ways, either by being sucked in by negative oesophageal pressure or being pushed in by positive pharyngeal pressure. Treatment must be behavioural and explaining the origin of the belch to the patient may well help in this process.
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