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Belching: dyspepsia or gastroesophageal reflux disease?
Am J Gastroenterol. 2003 Oct; 98(10):2139-45.AJ

Abstract

OBJECTIVES

Eructation (belching) is a common symptom seen in clinical practice. Because either belching or heartburn may result from transient lower esophageal sphincter relaxations, it has been proposed that belching may be a manifestation of gastroesophageal reflux disease (GERD). In this retrospective study we evaluated the prevalence of belching in dyspepsia and GERD and the relation of belching to acid reflux events documented by pH monitoring.

METHODS

We examined the prevalence, frequency, and severity of belching and other GERD symptoms by use of standardized questionnaires in 180 GERD patients (group A) and 78 dyspeptic controls (group B) referred for evaluation at our institution. GERD was defined as either endoscopic esophagitis (or Barrett's esophagus) or positive DeMeester score (>14.2) on pH monitoring or both. Dyspeptic patients had normal endoscopy and pH studies. We also analyzed the relationship of belching to acid reflux events during the 24-h period of pH studies.

RESULTS

Of 180 GERD patients, 132 (70%) reported belching during pH monitoring, versus 63 of 78 dyspeptic patients (80%) (p = ns). Similarly, 163 of 180 GERD patients (90%) reported heartburn versus 64 of 78 of dyspeptic patients (82%) (p = ns). Review of symptom questionnaires revealed no significant difference in belching severity between groups. However, heartburn and acid regurgitation were significantly more severe among GERD patients. There was a significantly higher correlation of both heartburn and belching with acid events in patients with GERD compared with patients with dyspepsia. In addition, although both belching and heartburn were significantly improved in patients with GERD, belching scores remained unchanged after proton pump inhibitor (PPI) therapy in patients with dyspepsia.

CONCLUSIONS

Belching is as common and as severe in patients with dyspepsia as it is in patients with GERD. Belching and heartburn in GERD patients are more likely correlated with episodes of pathological acid reflux. Because belching cannot be clinically used as a discriminatory symptom, ambulatory pH monitoring should be considered to elucidate the relationship of belching to acid reflux in patients with dyspepsia or GERD.

Authors+Show Affiliations

Gastroenterology Section, Veterans Affairs Medical Center Palo Alto, and Division of Gastroenterology and Hepatology, Stanford University, Stanford, California 94304, USA.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

14572558

Citation

Lin, Mona, and George Triadafilopoulos. "Belching: Dyspepsia or Gastroesophageal Reflux Disease?" The American Journal of Gastroenterology, vol. 98, no. 10, 2003, pp. 2139-45.
Lin M, Triadafilopoulos G. Belching: dyspepsia or gastroesophageal reflux disease? Am J Gastroenterol. 2003;98(10):2139-45.
Lin, M., & Triadafilopoulos, G. (2003). Belching: dyspepsia or gastroesophageal reflux disease? The American Journal of Gastroenterology, 98(10), 2139-45.
Lin M, Triadafilopoulos G. Belching: Dyspepsia or Gastroesophageal Reflux Disease. Am J Gastroenterol. 2003;98(10):2139-45. PubMed PMID: 14572558.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Belching: dyspepsia or gastroesophageal reflux disease? AU - Lin,Mona, AU - Triadafilopoulos,George, PY - 2003/10/24/pubmed PY - 2003/12/3/medline PY - 2003/10/24/entrez SP - 2139 EP - 45 JF - The American journal of gastroenterology JO - Am J Gastroenterol VL - 98 IS - 10 N2 - OBJECTIVES: Eructation (belching) is a common symptom seen in clinical practice. Because either belching or heartburn may result from transient lower esophageal sphincter relaxations, it has been proposed that belching may be a manifestation of gastroesophageal reflux disease (GERD). In this retrospective study we evaluated the prevalence of belching in dyspepsia and GERD and the relation of belching to acid reflux events documented by pH monitoring. METHODS: We examined the prevalence, frequency, and severity of belching and other GERD symptoms by use of standardized questionnaires in 180 GERD patients (group A) and 78 dyspeptic controls (group B) referred for evaluation at our institution. GERD was defined as either endoscopic esophagitis (or Barrett's esophagus) or positive DeMeester score (>14.2) on pH monitoring or both. Dyspeptic patients had normal endoscopy and pH studies. We also analyzed the relationship of belching to acid reflux events during the 24-h period of pH studies. RESULTS: Of 180 GERD patients, 132 (70%) reported belching during pH monitoring, versus 63 of 78 dyspeptic patients (80%) (p = ns). Similarly, 163 of 180 GERD patients (90%) reported heartburn versus 64 of 78 of dyspeptic patients (82%) (p = ns). Review of symptom questionnaires revealed no significant difference in belching severity between groups. However, heartburn and acid regurgitation were significantly more severe among GERD patients. There was a significantly higher correlation of both heartburn and belching with acid events in patients with GERD compared with patients with dyspepsia. In addition, although both belching and heartburn were significantly improved in patients with GERD, belching scores remained unchanged after proton pump inhibitor (PPI) therapy in patients with dyspepsia. CONCLUSIONS: Belching is as common and as severe in patients with dyspepsia as it is in patients with GERD. Belching and heartburn in GERD patients are more likely correlated with episodes of pathological acid reflux. Because belching cannot be clinically used as a discriminatory symptom, ambulatory pH monitoring should be considered to elucidate the relationship of belching to acid reflux in patients with dyspepsia or GERD. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/14572558/Belching:_dyspepsia_or_gastroesophageal_reflux_disease L2 - https://doi.org/10.1111/j.1572-0241.2003.07627.x DB - PRIME DP - Unbound Medicine ER -