Introduction Supragastric belching (SGB) is characterised by rapid antegrade and retrograde flow of air in the oesophagus that does not reach the stomach.* Whilst proactive SGB is a behavioural phenomenon, reactive SGB occurs in response to a particular stimulus. Currently treatment for SGB is behavioural therapy however this may not be the most appropriate treatment for patients with reactive SGB. In this study we aimed to ascertain prevalence of proactive versus reactive SGB in response to a certain pathological stimulus i.e. GOR.
Methods The database of the Oesophageal Physiology Laboratory at Guy’s Hospital London were retrospectively searched (November 2014 – present) for patients diagnosed with SGB (>13 SGBs within 24 hrs). The 24 hour pH-impedance studies were analysed to differentiate proactive SGB from reactive (proactive SGB being an SGB without preceding reflux event (or preceding event lasting <1 second), and reactive SGB being an SGB with preceding reflux event (> 1 second)). A patient was then labelled as having predominantly reactive SGB (PR-SGB) if >60% of their SGB was reactive and having predominantly proactive SGB (PP-SGB) if >60% of their SGB was proactive. Reflux Diseases Questionnaire (RDQ) score was obtained for all patients. P value <0.05 was considered significant.
Results 28 patients identified for this study (14 males (M), 14 females (F), mean age 51 [27–75]). 82% of patients had PP-SGB events, 11% PR-SGB and 7% had the same number of proactive and reactive SGB. The most common symptoms in patients with PR-SGB were: heartburn 66.6%, belching 66.6% and throat burning sensation 66.6% and, in patients with PP- SGB: belching 68%, heartburn 39% and regurgitation 21%. In total, in all 28 patients, proactive SGBs accounted for 1124 and reactive 216 of SGB events (19.22% of all SGBs being reactive). The 3 patients with PR- SGB had an average RDQ of 3.53, whilst the average RDQ for the patients with PP- SGB was significantly lower 2.36 (p = 0.00004). There was 1 patient with 100% proactive SGB and no patient with purely reactive SGB. The median presentation of reactive SGB was 15.38%.
Conclusion Treating GORD may resolve SGB in a small group of patients and ameliorate potential psychological stress caused by a behavioural therapy referral. Whether the remaining SGB events are purely behavioural or in reaction to other types of stimuli other than GOR requires further investigation. Having a high RDQ score may help in identifying patients with PR-SGB.
Reference * Bredenoord AJ, et al. Aerophagia, gastric, and supragastric belching: a study using intraluminal electrical impedance monitoring. Gut 2004:53(11),1561–1565.
Disclosure of Interest None Declared