Mechanisms of gastric and supragastric belching: a study using concurrent high‐resolution manometry and impedance monitoring
- 17 October 2012
- journal article
- Published by Wiley in Neurogastroenterology & Motility
- Vol. 24 (12), e573-e579
- https://doi.org/10.1111/nmo.12024
Abstract
Background Esophageal impedance monitoring has made it possible to distinguish two types of belches, designated gastric and supragastric. We aimed to compare the esophageal pressure characteristics during supragastric belches and gastric belches using combined high-resolution manometry and impedance monitoring. Methods We included 10 patients with severe and frequent belching. Combined high-resolution manometry and impedance monitoring was performed. Key Results Whereas gastric belching was relatively rare in all patients (median incidence 2 per 90-min period), nine of the 10 patients exhibited excessive supragastric belching (36 in 90 min). Supragastric belches were characterized by: (i) movement of the diaphragm in aboral direction and increased esophagogastric junction (EGJ) pressure, (ii) decrease in esophageal pressure, (iii) upper esophageal sphincter (UES) relaxation, (iv) antegrade airflow into the esophagus, and (v) increase in esophageal and gastric pressure leading to expulsion of air out of the esophagus in retrograde direction. In contrast, gastric belches were characterized by: (i) decreased or unchanged EGJ pressure, which was significantly lower than during supragastric belches, (ii) absence of decreased esophageal pressure preceding entrance of air into the esophagus (iii) retrograde airflow into the esophagus, (iv) common cavity phenomenon, and (v) upper esophageal sphincter relaxation after the onset of the retrograde airflow. Conclusions & Inferences In gastric belching UES relaxation is a late event, allowing efflux of air that entered the esophagus from the stomach. In most patients with supragastric belching air is brought into the esophagus by movement of the diaphragm in aboral direction, creation of negative esophageal pressure, and UES relaxatioKeywords
This publication has 17 references indexed in Scilit:
- Review article: the clinical relevance of transient lower oesophageal sphincter relaxations in gastro-oesophageal reflux diseaseAlimentary Pharmacology & Therapeutics, 2011
- Speech therapy in patients with excessive supragastric belching – a pilot studyNeurogastroenterology & Motility, 2009
- Characterization of intraluminal impedance patterns associated with gas reflux in healthy volunteersNeurogastroenterology & Motility, 2009
- Supragastric Belching in Patients With Reflux SymptomsThe American Journal of Gastroenterology, 2009
- Psychological Factors Affect the Frequency of Belching in Patients with AerophagiaThe American Journal of Gastroenterology, 2006
- Aerophagia, gastric, and supragastric belching: a study using intraluminal electrical impedance monitoringGut, 2004
- Esophageal bolus transit imaged by ultrafast computerized tomographyGastroenterology, 1996
- Symptoms in gastro-oesophageal reflux diseaseThe Lancet, 1990
- Abolition of gas reflux and transient lower esophageal sphincter relaxation by vagal blockade in the dogGastroenterology, 1986
- Upper esophageal sphincter function during belchingGastroenterology, 1986