Burping (belching) is a normal bodily behaviour – if not always socially acceptable in some cultures or settings! – but if it happens frequently and persistently, there could be a problem.

Excessive burping can even start to impair quality of life. According to the Rome IV diagnostic criteria, there is a belching disorder when someone experiences bothersome belching (severe enough to impact lifestyles) more than three days a week.

Burping is usually caused by swallowing air when eating or drinking and subsequently expelling it. Its posher name is ‘eructation’.

In medical terminology, burping is often described in the following ways:

  • Gastric belching – a physiological mechanism to expel swallowed air from the stomach
  • Supragastric belching – when air is swallowed or sucked down into the oesophagus and subsequently expelled through the pharynx (throat)

Many people assume that excessive belching is a direct consequence of aerophagia (excessive swallowing of air into the stomach).

Reflux and burping

It has now been suggested that belching may be a manifestation of gastroesophageal reflux disease (GERD). This is because the lower oesophageal sphincter has been weakened and doesn’t stay closed or close properly.

In addition to stomach contents rising up into the oesophagus, gas can also escape and exit the mouth as a belch.

But is supragastic belching the cause or the consequence of reflux episodes?

Some researchers suggest the relation between supragastric belching and GERD is bidirectional.

One study found 40 per cent of patients with excessive supragastric belching have pathological oesophageal acid exposure, while one third of reflux episodes seem to be induced by supragastric belching.

Another hypothesis is that supragastric belching is a response to an unpleasant oesophageal sensation. This hypothesis is supported by the observation that supragastric belching occurs more often in patients with ineffective oesophageal motility.

Burping and PPIs

When reflux disease has been diagnosed, patients are often treated with medication called proton pump inhibitors in order to reduce the production of stomach acid.

PPIs are considered effective in reducing the number of belches in some studies.

However, in some of cases, GERD persists even with the PPI treatment – called proton pump inhibitor refractory GERD – leading to an increase in supragastric belching.

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