Dyspeptic symptoms associated with chronic belching may substantially affect quality of life and can be challenging to manage in clinical practice. We report the case of a 40-year-old nulligravid woman with depressive disorder, bilateral cochlear implants due to deafness, a hiatal hernia, and a previous pulmonary embolism. Her medications included desvenlafaxine, multiple benzodiazepines, mirtazapine, trazodone, and apixaban. She presented with an 18-month history of persistent belching, heartburn, early satiety, and intermittent dry cough, severely impairing her quality of life and leading to social isolation. Additionally, her symptoms intensified during anxiety and depressive episodes. Physical examination was unremarkable, and upper gastrointestinal endoscopy revealed only a small hiatal hernia and mild gastropathy, with no evidence of Helicobacter pylori infection. Despite repeated medical evaluations and multiple therapeutic approaches, including proton pump inhibitors, sucralfate, domperidone, simethicone, and bilastine, symptoms persisted without significant improvement. Functional dyspepsia was therefore suspected, and treatment with baclofen 10 mg twice daily was initiated, resulting in significant clinical improvement and enhanced quality of life. This report highlights the potential benefit of baclofen in patients with persistent belching and dyspeptic symptoms refractory to conventional therapy, particularly in the context of psychiatric comorbidity.

Background: Retrograde cricopharyngeus dysfunction (RCPD) is a recently described upper esophageal sphincter motility disorder caused by the inability of the cricopharyngeus muscle to relax, prohibiting belching. While clinical features and treatment have been reported, early-life experiences remain unclear. This study aimed to explore childhood experiences, comorbidities, and family history in adults reporting symptoms consistent with RCPD. Methods: This cross-sectional survey included adults recruited through an online community focused on RCPD who reported cardinal symptoms consistent with RCPD. The survey collected and descriptively analyzed demographics, symptom profile, family history, neonatal and childhood experiences, psychological factors, and physician visits. Results: Of 225 respondents, 207 met inclusion criteria (mean age 32 years; 69% female). Nearly all experienced abdominal bloating (98%), gurgling noises (98%), flatulence (90%), and inability to belch (100%). Painful hiccupping, a newer described symptom, was reported by 80%. Symptoms began before age 25 in 97%, and 29% reported a first-degree relative affected. Common early-life experiences included emetophobia (39%), anxiety (38%), and difficulty being burped as an infant (20%). No statistically significant crude differences were detected in symptom severity, frequency, gender, or age of onset by presence of experiences. Only 36% felt that any physician understood their condition, and 18% reported their gastroenterologist improved their symptoms. Conclusions: Psychological early-life experiences and family history were common, but exploratory analyses did not detect statistically significant differences in symptom burden by their presence. These findings provide a foundation for future studies investigating the disorder's pathophysiology. Limited physician recognition highlights the need for greater clinical awareness of this emerging esophageal motility disorder.

Semaglutide, a glucagon-like peptide-1 receptor agonist, has demonstrated clinically meaningful weight loss effects in patients with Type 2 diabetes and high BMI, and dental practitioners and physicians are often encountering patients who take these medications. Semaglutide is known to be associated with several systemic side effects, including delayed gastric emptying, belching, reflux and nausea, nutritional changes, and gastrointestinal discomfort. Systemic effects secondarily manifest in the oral cavity, and as a result, patients taking semaglutide may present with xerostomia (dry mouth), halitosis (bad breath), enamel erosion tied to vomiting, altered taste, among other oral signs and symptoms. It is important for dental professionals and physicians to become informed of possible symptoms and corresponding management strategies, given the multiple potential indirect effects on the oral cavity and relevance to dental treatment planning. This article reviews the pharmacodynamics of semaglutide and dives into the current evidence on oral manifestations of the drug family and implications for dental and oral health. It outlines practical management recommendations for dentists and the broader interdisciplinary healthcare team.

The goal of this study was to evaluate alternative phenotypes for methane emissions in dairy cattle and to estimate their genetic relationships with productive traits. Methane (CH4) and carbon dioxide (CO2) concentration in exhaled breath and eructation events were measured with sniffers from 2,961 dairy cows across 34 commercial farms in 5 Spanish regions between 2018 and 2023. Records for CO2 concentrations were available for 23 farms. Traits derived included the average of CH4 concentration, area under the curve of CH4 concentration from eructation events, average maximum values of CH4 concentration in eructation events, number of eructation events per minute, average of CO2 concentration, CH4:CO2 ratio from average gas concentrations, and 2 methane production traits (g/d) derived from ratio. A Bayesian approach was used to estimate variance components and genetic correlations. Heritability estimates for methane phenotypes ranged from 0.07 (Highest Posterior Density interval, HPD = 0.03: 0.11) to 0.12 (HPD = 0.06: 0.17), with moderate-to-high repeatability (0.49-0.58). The number of eructation events per minute showed higher heritability (0.30; HPD = 0.24: 0.37) and repeatability (0.75; HPD = 0.73: 0.76). The phenotypic and genetic correlations between methane concentrations traits were high, ranging from 0.78 to 0.99, except for the number of eructation events per minute, which correlated positively with peak-based traits at the phenotypic level, but lowly or even negatively at the genetic level with most methane phenotypes. The phenotypic and genetic correlation between ratio and other methane concentration traits was moderate (0.46; HPD = 0.13: 0.73) to high (0.94; HPD = 0.85: 0.99), while strong and positive (0.92; HPD = 0.84: 0.98, or 0.99; HPD = 0.98: 0.99) with methane production. Methane production traits showed high phenotypic correlation (0.56-0.74) and moderate (0.44; HPD = 0.07: 0.79) to high (0.99; HPD = 0.98: 0.99) genetic correlation with methane concentration traits. The genetic correlation estimates with productive traits were low (0.12; HPD = -0.06: 0.42) to high (0.78; HPD = 0.47: 0.98) for all methane and carbon dioxide traits, with stronger associations observed with fat yield. Sniffer devices provide robust methane phenotypes under commercial conditions, enabling accurate genetic parameter estimation. We show strong correlations among methane traits, positive links with production traits, and highlight a new methane production phenotype that avoids bias in genetic correlation estimates when productive traits are used in the conversion from ppm to g/d. These results support the inclusion of methane traits in breeding programs to balance productivity with environmental sustainability.

Chronic refractory hiccups significantly impair quality of life, especially with prolonged symptom duration. This case highlights the therapeutic potential of a combined interventional approach in managing chronic refractory hiccups, particularly in patients with prolonged symptom duration unresponsive to conventional treatments. A 52-year-old man presented with a 20-year history of persistent, debilitating hiccups, often triggered after meals and resistant to pharmacological therapy. His symptoms had worsened in recent years, occasionally accompanied by reflux and vomiting, with minimal relief from anti-reflux medications and neural supplements. Further evaluation revealed pathological acid reflux and excessive supra-gastric belching, suggesting gastroesophageal reflux disease (GERD) as a contributing factor. After comprehensive assessment and informed consent, the patient underwent a series of ultrasound-guided interventions, including bilateral stellate ganglion blocks (SGBs) and phrenic nerve blocks. Although initial symptom relief was achieved, hiccups partially recurred, prompting the use of pulsed radiofrequency modulation (PNRF) of the phrenic nerve in combination with targeted analgesic injections. Following treatment, the patient experienced a significant and sustained reduction in hiccup frequency and severity, with only occasional brief relapses. Continued follow-up and additional sessions of phrenic nerve modulation resulted in further symptom control. This case underscores the effectiveness of integrating sympathetic and somatic nerve modulation, particularly ultrasound-guided SGB and PNRF, in cases of intractable hiccups. Such a multimodal, image-guided strategy may offer meaningful relief for patients suffering from chronic, treatment-resistant hiccups and demonstrates the value of personalized, interventional pain management in complex functional disorders.