Scientific letter
Supragastric belches. An entity to know
Eructos supragástricos. Una entidad a conocer
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Una entidad a conocer" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "396" "paginaFinal" => "397" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Supragastric belches. An entity to know" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1049 "Ancho" => 1664 "Tamanyo" => 152480 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Ejemplo de trazado de pH-impedancia mostrando un eructo supragástrico, definido como un rápida subida en la impedanciometría (≥<span class="elsevierStyleHsp" style=""></span>1.000<span class="elsevierStyleHsp" style=""></span>Ω), moviéndose distalmente, seguido de un retorno a la línea basal previa, moviéndose en dirección proximal. 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An entity to know" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "396" "paginaFinal" => "397" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Jose C. Salazar Quero, M. José Moya Jiménez, María Rubio Murillo, Sebastián Roldán Pérez, Alejandro Rodríguez Martínez, Justo Valverde Fernández" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Jose C." "apellidos" => "Salazar Quero" "email" => array:1 [ 0 => "josec.salazar.sspa@juntadeandalucia.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M. José" "apellidos" => "Moya Jiménez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "María" "apellidos" => "Rubio Murillo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Sebastián" "apellidos" => "Roldán Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Alejandro" "apellidos" => "Rodríguez Martínez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Justo" "apellidos" => "Valverde Fernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad de Gestión Clínica de Pediatría, Unidad de Digestivo Infantil, Hospital Universitario Virgen del Rocío, Sevilla, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Gestión Clínica de Cirugía Infantil, Hospital Universitario Virgen del Rocío, Sevilla, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Eructos supragástricos. Una entidad a conocer" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1049 "Ancho" => 1664 "Tamanyo" => 153055 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Example of a pH-impedance trace showing a supragastric belch, identified as a rapid rise in impedance (≥1000<span class="elsevierStyleHsp" style=""></span>Ω), moving distally, followed by a return to baseline, moving proximally. Supragastric belches less than 5<span class="elsevierStyleHsp" style=""></span>s apart were considered a single episode.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Belching may be defined as audible or silent oral expulsion of boluses of gas from the upper gastrointestinal tract.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1–3</span></a> It is a normal phenomenon in most individuals, but may represent a medical problem if it is excessive or hard to control.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Physiologically, belching relieves the accumulation of gas inside the stomach. The air accumulated in the stomach is expelled towards the oesophagus, due to spontaneous relaxation of the lower oesophageal sphincter (LOS), which allows the air to pass into the oesophagus. There, it stimulates secondary relaxation of the upper oesophageal sphincter (UOS), thereby allowing the air to pass into the mouth.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,3</span></a> In supragastric belching, air is swallowed and belched immediately without reaching the stomach, or originating from it. There are 2 reported mechanisms by which it may occur<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1–3</span></a>:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">−</span><p id="par0015" class="elsevierStylePara elsevierViewall">“Air suction”. This is the more common mechanism. In it, the diaphragm generates increased negative intrathoracic pressure, which, together with a relaxation of the UOS, causes the air to pass towards the oesophagus and be expelled immediately, resulting in a belch.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">−</span><p id="par0020" class="elsevierStylePara elsevierViewall">An increased pressure in the pharynx together with a decreased pressure in the oesophagus. This is due to contractions of the base of the tongue, which cause a contraction of the pharynx without a simultaneous contraction of the oesophagus.</p></li></ul></p><p id="par0025" class="elsevierStylePara elsevierViewall">It has been suggested that supragastric belching may be due to an involuntary response to different feelings of discomfort for the patient (abdominal distension/bloating), which end up becoming uncontrolled. It has been demonstrated that it does not occur during sleep and that the patient belches less if distracted. Consequently, supragastric belching may be a learned behaviour.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,2</span></a> Other studies have postulated that a certain amount of supragastric belching may be considered normal, and that excessive supragastric belching is usually associated with gastro-oesophageal reflux disease (GORD) and sometimes associated with oesophageal hypomotility.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Supragastric belching has been demonstrated in patients with GORD or rumination syndrome, and should be distinguished from aerophagia, in which the gas swallowed goes to the stomach.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,2</span></a> It may be accompanied by a feeling of reflux and pyrosis, especially with fluids.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">We present the case of a patient who was admitted to our hospital, transferred from another hospital where she was admitted due to signs and symptoms of continuous belching for the last 2 months which had been increasing. Her signs and symptoms started following an episode of uncontrollable vomiting for several days. It was sometimes accompanied by vomiting after eating and pyrosis. The situation limited the patient's daily activities, since she could not control the belching. She had undergone an oesophagogastroduodenal transit study; upper gastrointestinal endoscopy; and oesophageal, antral and duodenal biopsies. These were normal. Her laboratory testing with a complete blood count, thyroid profile, IgA, ATG, total IgA and iron metabolism was normal. She had received treatment with omeprazole, H2 antagonists, prokinetics, antacids, diazepam, haloperidol, clorazepate dipotassium and antiflatulents with no improvement.</p><p id="par0040" class="elsevierStylePara elsevierViewall">While she was admitted, the patient was found to have no belching while sleeping or speaking, and to belch less when distracted and more when stressed. She was examined using a head CT scan, a hydrogen breath test for lactose and fructose, gastric emptying scintigraphy, and impedancemetry. The results of the head CT scan, hydrogen breath tests, and scintigraphy were normal. Impedancemetry demonstrated supragastric belching (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">A diagnosis of supragastric belching should be suspected in patients with repetitive belching that ceases when they are speaking and decreases when they are distracted.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> It may be associated with pyrosis, abdominal or chest pain, dysphagia, or a feeling of distension.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> The leading test that enables diagnosis is impedancemetry, which has a typical pattern in which there is an increase in impedance that starts at the proximal channel and advances towards the most distal channel, followed by a return to baseline from the distal channel to the proximal channel.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Treatment is based on different steps: (1) explaining the nature of the symptoms to the patient, (2) addressing it as a behaviour disorder using behaviour therapy and (3) ensuring that the patient has speech therapy in which he or she learns exercises to control the entry of air into the oesophagus.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,3,5</span></a> The use of medication is not recommended, with the exception of baclofen, which may be useful in selected cases.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> In our case, the patient was referred to the children's mental health and rehabilitation unit to address her existing behaviour disorder.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Salazar Quero JC, Moya Jiménez MJ, Rubio Murillo M, Roldán Pérez S, Rodríguez Martínez A, Valverde Fernández J. Eructos supragástricos. Una entidad a conocer. Gastroenterol Hepatol. 2017;40:396–397.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1049 "Ancho" => 1664 "Tamanyo" => 153055 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Example of a pH-impedance trace showing a supragastric belch, identified as a rapid rise in impedance (≥1000<span class="elsevierStyleHsp" style=""></span>Ω), moving distally, followed by a return to baseline, moving proximally. Supragastric belches less than 5<span class="elsevierStyleHsp" style=""></span>s apart were considered a single episode.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "(Quiz) 204" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The pathophysiology, diagnosis and treatment of excessive belching symptoms" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B.F. Kessing" 1 => "A.J. Bredenoord" 2 => "A.J. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 101 | 5 | 106 |
| 2024 September | 255 | 10 | 265 |
| 2024 August | 164 | 19 | 183 |
| 2024 July | 199 | 8 | 207 |
| 2024 June | 202 | 8 | 210 |
| 2024 May | 287 | 10 | 297 |
| 2024 April | 234 | 10 | 244 |
| 2024 March | 286 | 23 | 309 |
| 2024 February | 323 | 17 | 340 |
| 2024 January | 329 | 4 | 333 |
| 2023 December | 289 | 10 | 299 |
| 2023 November | 386 | 18 | 404 |
| 2023 October | 294 | 43 | 337 |
| 2023 September | 201 | 27 | 228 |
| 2023 August | 216 | 20 | 236 |
| 2023 July | 218 | 22 | 240 |
| 2023 June | 247 | 18 | 265 |
| 2023 May | 317 | 23 | 340 |
| 2023 April | 296 | 16 | 312 |
| 2023 March | 230 | 31 | 261 |
| 2023 February | 175 | 22 | 197 |
| 2023 January | 197 | 36 | 233 |
| 2022 December | 192 | 30 | 222 |
| 2022 November | 192 | 13 | 205 |
| 2022 October | 261 | 20 | 281 |
| 2022 September | 143 | 24 | 167 |
| 2022 August | 184 | 24 | 208 |
| 2022 July | 137 | 20 | 157 |
| 2022 June | 120 | 17 | 137 |
| 2022 May | 177 | 22 | 199 |
| 2022 April | 156 | 22 | 178 |
| 2022 March | 195 | 39 | 234 |
| 2022 February | 208 | 16 | 224 |
| 2022 January | 280 | 12 | 292 |
| 2021 December | 203 | 15 | 218 |
| 2021 November | 226 | 26 | 252 |
| 2021 October | 267 | 32 | 299 |
| 2021 September | 222 | 25 | 247 |
| 2021 August | 183 | 15 | 198 |
| 2021 July | 223 | 15 | 238 |
| 2021 June | 150 | 8 | 158 |
| 2021 May | 248 | 13 | 261 |
| 2021 April | 567 | 28 | 595 |
| 2021 March | 406 | 19 | 425 |
| 2021 February | 364 | 20 | 384 |
| 2021 January | 340 | 20 | 360 |
| 2020 December | 379 | 13 | 392 |
| 2020 November | 356 | 19 | 375 |
| 2020 October | 248 | 13 | 261 |
| 2020 September | 440 | 14 | 454 |
| 2020 August | 529 | 7 | 536 |
| 2020 July | 522 | 9 | 531 |
| 2020 June | 525 | 26 | 551 |
| 2020 May | 486 | 29 | 515 |
| 2020 April | 431 | 13 | 444 |
| 2020 March | 299 | 18 | 317 |
| 2020 February | 301 | 9 | 310 |
| 2020 January | 249 | 7 | 256 |
| 2019 December | 118 | 17 | 135 |
| 2019 November | 83 | 7 | 90 |
| 2019 October | 57 | 6 | 63 |
| 2019 September | 25 | 4 | 29 |
| 2019 August | 11 | 8 | 19 |
| 2019 July | 21 | 8 | 29 |
| 2019 June | 20 | 4 | 24 |
| 2017 June | 1 | 0 | 1 |
Show all
