Speech therapy in patients with excessive supragastric belching - A pilot study

Department of Gastroenterology, Sint Antonius Hospital, Nieuwegein, The Netherlands.
Neurogastroenterology and Motility (Impact Factor: 3.59). 08/2009; 22(1):24-8, e2-3. DOI: 10.1111/j.1365-2982.2009.01371.x
Source: PubMed


In patients whose main symptom is excessive belching, supragastric belching appears to be the predominant mechanism. This belch pattern is characterized by a rapid influx of air into the oesophagus, immediately followed by rapid air expulsion. The rate at which supragastric belching occurs is influenced by attention and distraction, suggesting a behavioural disorder and speech therapy may be of benefit to these patients. In 17 consecutive patients with excessive belching, concurrent impedance monitoring and high-resolution manometry were performed to ascertain the mechanism of belching. Patients with supragastric belches were referred to a speech therapist, who was familiar with the concept of supragastric belching. Before and after treatment by the speech therapist, patients filled out a VAS scale regarding the severity of their symptoms. In all patients, supragastric belches were identified with impedance monitoring. Eleven patients were referred to a speech therapist, six patients were not able or willing to undergo repetitive treatments. Eleven patients completed treatment by the speech therapist consisting of 10 (8-10) sessions. Overall, the VAS scales showed a significant improvement of the severity of symptoms (P < 0.05). Six of the 11 patients reported a large decrease (>30%) in their symptoms and four patients reported a modest decrease (<30%). In one patient, the VAS scores indicated an increase in symptoms. Speech therapy performed by a well-informed speech pathologist leads to a significant symptom reduction in patients with excessive supragastric belching. This is the first study indicating benefit of a treatment for excessive belching.

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    • "Bredenoord et al. demonstrated that these patients are characterized by an increased frequency of supragastric belches but not of gastric belches [42]. Moreover, a pilot study in patients with excessive supragastric belching revealed that speech therapy could decrease the severity of belching symptoms [43]. "
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    ABSTRACT: Esophageal impedance monitoring and high-resolution manometry (HRM) are useful tools in the diagnostic work-up of patients with upper gastrointestinal complaints. Impedance monitoring increases the diagnostic yield for gastroesophageal reflux disease in adults and children and has become the gold standard in the diagnostic work-up of reflux symptoms. Its role in the work-up for belching disorders and rumination seems promising. HRM is superior to other diagnostic tools for the evaluation of achalasia and contributes to a more specific classification of esophageal disorders in patients with non-obstructive dysphagia. The role of HRM in patients with dysphagia after laparoscopic placement of an adjustable gastric band seems promising. Future studies will further determine the clinical implications of the new insights which have been acquired with these techniques. This review aims to describe the clinical applications of impedance monitoring and HRM.
    Current Gastroenterology Reports 02/2012; 14(3):197-205. DOI:10.1007/s11894-012-0253-9
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    ABSTRACT: Background - Eructation is a physiologic event which allows gastric venting of swallowed air and most of the time is not perceived as a symptom. This is called gastric belching. Supragastric belching occurs when swallowed air does not reach the stomach and returns by mouth a short time after swallowing. This situation may cause discomfort, life limitations and problems in daily life. Objective - Our objective in this investigation was to evaluate if gum chewing increases the frequency of gastric and/or supragastric belches. Methods - Esophageal transit of liquid and gas was evaluated by impedance measurement in 16 patients with complaint of troublesome belching and in 15 controls. The Rome III criteria were used in the diagnosis of troublesome belching. The esophageal transit of liquid and gas was measured at 5 cm, 10 cm, 15 cm and 20 cm from the lower esophageal sphincter. The subjects were eval­uated for 1 hour which was divided into three 20-minute periods: (1) while sitting for a 20-minute base period; (2) after the ingestion of yogurt (200 mL, 190 kcal), in which the subjects were evaluated while chewing or not chewing gum; (3) final 20-minute period in which the subjects then inverted the task of chewing or not chewing gum. In gastric belch, the air flowed from the stomach through the esophagus in oral direction and in supragastric belch the air entered the esophagus rapidly from proximal and was expulsed almost immediately in oral direction. Air swallows were characterized by an increase of at least 50% of basal impedance and saliva swallow by a decrease of at least 50% of basal impedance, that progress from proximal to distal esophagus. Results - In base period, air swallowing was more frequent in patients than in controls and saliva swallowing was more frequent in controls than in patients. There was no difference between the medians of controls and patients in the number of gastric belches and supragastric belches. In six patients, supragastric belches were seen at least once during the 20-minute base period. None of the controls had supragastric belches. In the control group, the ingestion of yogurt caused no significant alteration in the number of air swallows, saliva swallows, gastric belches and supragastric belches. In the patient group, there was an increase in the number of air swallows. If the subjects were chewing gum during this 20-minute period, there was an increase in the number of saliva swallows in both groups, without alterations of the number of air swallow, gastric belches and supragastric belches. There was no alteration in the number of the saliva swallows, air swallows, gastric belches and supragastric belches in both groups for subjects who did not chew gum in the 20-40 minute period after yogurt ingestion. When the subjects were chewing the gum, there was an increase in saliva swallows in the control and patients groups and in air swallows in the patients group. Conclusion - Gum chewing causes an increase in saliva swallowing in both patients with excessive belching and in controls, and an increase in air swallowing in patients with excessive belching 20 minutes after yogurt ingestion. Gum chewing did not increase or decrease the frequency of gastric or supragastric belches. © 2015, IBEPEGE - Inst. Bras. Estudos Pesquisas Gastroent. All rights reserved.
    Arquivos de gastroenterologia 09/2015; 52(3):190-194. DOI:10.1590/S0004-28032015000300007
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    ABSTRACT: Belching is physiological venting of excessive gastric air. Excessive and bothersome belching is a common symptom, which is often seen in patients with functional dyspepsia and gastroesophageal reflux disease. Other symptoms are usually predominant. However, a small group of patients complain of isolated excessive belching, with a frequency of several belches per minute. In these patients, the eructated air does not originate from the stomach but is sucked or injected in the esophagus from the pharynx and expelled immediately afterward in oral direction. This behavior is called supragastric belching because the air does not originate from the stomach and does not reach the stomach either. Excessive belching can be treated by speech therapy or behavior therapy. The term aerophagia should be reserved for those patients where there is evidence that they swallow air too frequently and in too large quantities. These patients have excessive amounts of intestinal gas visualized on a plain abdominal radiogram and their primary symptoms are bloating and abdominal distension and they belch only to a lesser degree. Aerophagia and excessive supragastric belching are thus two distinct disorders.
    Diseases of the Esophagus 05/2010; 23(4):347-52. DOI:10.1111/j.1442-2050.2009.01038.x · 1.78 Impact Factor
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