Is constant belching a sign of something serious?

Q I am 20 and I have a healthy body mass index.

However, from a young age, I would feel an urge to burp, usually after meals. And when I do, I regurgitate what I have eaten.

The regurgitation does not taste like vomit. It feels as if the food I had ingested had not entered my stomach.

These days, I sometimes regurgitate about 30minutes to an hour after my meal.

I feel disgusted and embarrassed when this happens.

Am I bulimic? Or do I have rumination syndrome? Are my symptoms a sign of something serious?

A Understandably, you are distressed by your burping and regurgitation.

Belching or burping refers to the release of air from the stomach through the mouth.

Burping is commonly caused by swallowing air. Belching a few times after eating is normal.

During meals, a small amount of air is swallowed along with fluid or food.

More air is swallowed when one is eating or drinking rapidly, when food is not chewed completely or when dentures are poorly fitted.

To reduce the burping, eat and drink slowly and chew your food well. Also avoid chewing gum and sucking hard sweets, and avoid or reduce foods that precipitate the symptoms.

Four out of five patients with functional dyspepsia experience frequent belching.

Functional dyspepsia refers to upper abdominal discomfort in which no significant abnormality is found after investigations.

Compared with healthy people, people with functional dyspepsia swallow air more frequently, which also contributes to unpleasant abdominal sensations.

It is important to note that frequent belching may happen in patients with diseases that cause abdominal discomfort or pain, such as peptic ulcer disease and gall bladder disease, although other symptoms are usually predominant in these conditions.

Regurgitation occurs in a number of conditions such as gastroesophageal reflux disease (Gerd) and movement disorders of the oesophagus.

The oesophagus, also known as the gullet, refers to the food pipe which transmits food from the mouth to the stomach.

Gerd occurs when an excessive amount of gastric juice refluxes into the gullet, causing discomfort.

Belching is one of the most common complaints in patients with Gerd, next to heartburn and regurgitation.

Patients with Gerd may report episodes of symptomatic reflux, including a sour taste in the mouth, heartburn, night-time coughing and voice changes, including hoarseness.

Lifestyle measures which may help relieve reflux symptoms include eating frequent small meals rather than heavy meals, avoiding consuming food within three hours of bedtime, waiting three hours after a meal to lie down, avoiding or reducing intake of alcohol, citrus juice and coffee, elevating the head of the bed, and avoiding bending or stooping positions.

Spontaneous regurgitation between meals or at night, and regurgitation during meals may be caused by movement disorder of the gullet.

The regurgitated fluid and/or food in patients with such conditions is generally not unpleasant in taste.

These patients sometimes complain of chest discomfort, which may be identical to that experienced in Gerd.

Historically, rumination syndrome is seen predominantly in infants, young children and adults with cognitive disabilities.

In recent years, it is being increasingly diagnosed in otherwise healthy adolescents and adults.

Rumination involves the voluntary or involuntary regurgitation and re-chewing of partially digested food that is subsequently re-swallowed or expelled.

Rumination occurs within a few minutes after food is eaten and may last a couple of hours. The regurgitated food does not taste bitter or sour.

This regurgitation may be preceded by a belching sensation, appear effortless and is usually not accompanied by nausea or retching.

Rumination usually happens daily and may continue for several months or years.

Bulimia nervosa is an eating disorder. People with bulimia are often preoccupied with self-image, including body weight and shape. They may secretly binge and then purge in their attempts to get rid of the extra calories in an unhealthy way.

The preliminary brief history that you have given does not appear to be consistent with that of bulimia.

You may wish to consider instituting lifestyle measures first. If that fails, and the symptoms are bothersome, a doctor should be consulted.

A detailed history, possibly with some investigations, will aid in the diagnosis.

Appropriate advice and treatment can then be given.

DR LIM LEE GUAN, consultant at the division of gastroenterology and hepatology at the National University Hospital

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