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Gastroenterologie
a hepatologie

Gastroenterology and Hepatology

Gastroent Hepatol 2019; 73(4): 308–312. doi:10.14735/amgh2019308.

The role of pH impedance in patients with excessive supragastric belching

Michal Prokopič1, Martin Ďuriček2, Peter Bánovčin Jr2, Rudolf Hyrdel2

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Summary

Background: Excessive supragastric belching is is a functional esophageal disorder defined by the Rome IV criteria as frequent, repetitive, and bothersome belching from the esophagus that is sufficiently severe to affect usual activities. Some patients experience up to several hundred episodes of belching per day, which negatively affects their quality of life. Diagnosis is based on 24 hour multichannel, intraluminal impedance pH monitoring (24-MII-pH), which allows the gaseous bolus in the esophagus to be accurately followed. Patients and methods: A prospectively collected group of patients with excessive supragastric belching was retrospectively analyzed. Clinical characteristics, associated esophageal and non-esophageal symptoms, effect of treatment, and high-resolution manometry (HRM) and 24-MII-pH records were evaluated. Results: During the study period, we identified eight patients with excessive supragastric belching. The most common esophageal symptoms were regurgitation and heartburn followed by dysphagia and non-cardiac chest pain. The majority of patients exhibited a motility disorder on HRM characterized by ineffective esophageal motility or the absent contractility. The number of belches ranged from 15 to 250 per hour during the day, with within normal range in most patients during the night. The acid exposure time was increased in three patients. The number of reflux episodes was in the normal range for most patients. Proton pump inhibitors, prokinetics, and antireflux surgery did not improve belching or quality of life. Conclusion: Excessive supragastric belching is a functional disorder that can be diagnosed by 24-MII-pH monitoring based on clearly defined diagnostic criteria. Patients have refractory symptoms that significantly affect their quality of life and are resistant to conventional treatment. 24-MII-pH monitoring in conjunction with appropriate patient education significantly contributes to management of patients. At present, cognitive-behavioral therapy is the gold standard of treatment and leads to a significant improvement in quality of life.

Keywords

electric impedance, eructation, gastrooesophageal reflux, esophagus, manometry, esophageal motility disorders

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Literature

1. Wyman JB, Dent J, Heddle R et al. Control of belching by the lower oesophageal sphincter. Gut 1990; 31 (6): 639–646. doi: 10.1136/gut.31.6.639.
2. Stanghellini V, Chan FK, Hasler WL et al. Gastroduodenal disorders. Gastroenterology 2016; 150 (6): 1380–1392. doi: 10.1053/j.gastro.2016.02.011.
3. Koukias N, Woodland P, Yazaki E et al. Supragastric belching: prevalence and association with gastroesophageal reflux disease and esophageal hypomotility. J Neurogastroenterol Motil 2015; 21 (3): 398–403. doi: 10.5056/jnm15002.
4. Hobbs P, Gyawali CP. The role of esophageal pH-impedance testing in clinical practice. Curr Opin Gastroenterol 2018; 34 (4): 249–257. doi: 10.1097/MOG.0000000000000441.
5. Bredenoord AJ, Weusten BL, Sifrim D et al. Aerophagia, gastric, and supragastric belching: a study using intraluminal electrical impedance monitoring. Gut 2004; 53 (11): 1561–1565. doi: 10.1136/gut.2004.042945.
6. Ooi JL, Vardar R, Sifrim D. Supragastric belching. Curr Opin Gastroenterol 2016; 32 (4): 302–309. doi: 10.1097/MOG.0000000000000276.
7. Glasinovic E, Wynter E, Arguero J et al. Treatment of supragastric belching with cognitive behavioral therapy improves quality of life and reduces acid gastroesophageal reflux. Am J Gastroenterol 2018; 113 (4): 539–547. doi: 10.1038/ajg.2018.15.
8. Duricek M, Banovcin P, Halickova T et al. Acid-ic pharyngeal reflux does not correlate with symptoms and laryngeal injury attributed to laryngopharyngeal reflux. Dig Dis Sci 2019; 64 (5): 1270–1280. doi: 10.1007/s10620-018-53 72-1.
9. Broeders JA, Bredenoord AJ, Hazebroek EJ et al. Effects of anti-reflux surgery on weakly acidic reflux and belching. Gut 2011; 60 (4): 435–441. doi: 10.1136/gut.2010.224824.
10. Kessing BF, Broeders JA, Vinke N et al. Gas-related symptoms after antireflux surgery. Surg Endosc 2013; 27 (10): 3739–3747. doi: 10.1007/s00464-013-2959-7.
11. Blondeau K, Boecxstaens V, Rommel N et al. Baclofen improves symptoms and reduces postprandial flow events in patients with rumination and supragastric belching. Clin Gastroenterol Hepatol 2012; 10 (4): 379–384. doi: 10.1016/j.cgh.2011.10.042.
12. Kunte H, Kronenberg G, Fink K et al. Successful treatment of excessive supragastric belching by combination of pregabalin and baclofen. Psychiatry Clin Neurosci 2015; 69 (2): 124–125. doi: 10.1111/pcn.12223.
13. Riehl ME, Kinsinger S, Kahrilas PJ et al. Role of a health psychologist in the management of functional esophageal complaints. Dis Esophagus 2015; 28 (5): 428–436. doi: 10.1111/dote.12219.
14. Karamanolis G, Triantafyllou K, Tsiamoulos Z et al. Effect of sleep on excessive belching: a 24-hour impedance-pH study. J Clin Gastroenterol 2010; 44 (5): 332–334. doi: 10.1097/MCG.0b013e3181bd885e.
15. Bredenoord AJ. Management of belching, hiccups, and aerophagia. Clin Gastroenterol Hepatol 2013; 11 (1): 6–12. doi: 10.1016/j.cgh.2012.09.006.

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