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Belching brings back swallowed atmospheric air. The accumulation of gastric gas results in the relaxation of the lower esophageal sphincter (LES) before belching, creating a common gastroesophageal cavity. Voluntary belching is initiated by an abrupt increase in intra-abdominal pressure, followed by relaxation of the LES, esophageal distention, and subsequent relaxation of the
The initiating event for relaxation of the upper esophageal sphincter is distention of the esophagus rather than relaxation of the LES. Reflux of gas from the stomach to the esophagus probably occurs more frequently than recognized because minor amounts frequently are returned to the stomach by burping.
Occasional belching is a normal and perhaps satisfying event. Of interest are the patients with abdominal bloating who somewhat wistfully say, "If I could only belch." The perceived benefit accruing from belching leads some patients to forcefully swallow air to belch or to drink carbonated beverages to induce belching. These strategies unfortunately are usually ineffective and actually may lead to further increases in gaseous discomfort. Some patients present with pathologic belching, characterized by an extremely loud event that is sure to attract attention. The new onset of belching in an adult should suggest the possibility of underlying organic disease and requires investigation, particularly in patients who fail to respond to empiric measures. Patients may attempt to derive comfort from the distress produced by ulcer disease, reflux esophagitis, malignancy, and other disorders by purposefully swallowing air.
Swallowed air is the common denominator for patients presenting with belching. Attention, therefore, should be directed to those habits that facilitate the swallowing of air.
Dietary features should be explored in patients complaining of belching. The ingestion of carbonated beverages such as soda and beer is an obvious contributor to excess belching.
Many simethicone-containing products have been advertised for the treatment of belching and bloating. There unfortunately have been few convincing studies of their effectiveness. Simethicone is a defrothicant that is used commercially to prevent bubbling of large quantities of liquid mixtures.
Mints often are passed around the table at the conclusion of the meal or are provided at the cashier's counter, creating the perception that the origin of this custom relates to improving one's breath.