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Objectives: Excessive belching is a common complaint that may be observed alone or with other diseases such as indigestion and reflux. In addition, it has adverse effects on patients’ social life. Due to the insufficient evidence regarding the successful treatment of this disorder, the present study reviewed the medical views of Avicenna in order to find a better solution in this regard. Methods: This literature review was done by searching for "belching" and its MeSH heading term, namely, "eructation" in databases such as Google scholar and Pub Med and their synonyms in Iranian traditional medicine "Josha" in Avicenna’s "Canon of Medicine". Results: The definition of belching in modern medicine was the same as "Josha" but its classifications and treatments were different. Modern scientists have divided excessive belching into gastric and supragastric based on its source although Avicenna classified it into three kinds based on its smell. In recent studies, specialists have come to a link between the brain and the stomach due to the inadequacy of their therapies while Avicenna has along pointed out the relationship between belching and certain organs. He further recommended three main approaches for its treatment, including lifestyle modification, herbal medicines, and physical manipulations. Conclusions: In general, considering the lack of effective treatment for excessive belching, it is important to present a better classification and management. This might be possible with regard to Avicenna’s "Canon of Medicine". Thus, clinical trials are suggested to assess the efficacy of Avicenna’s recommendations as a complementary method.

Background/Aims Belching is the act of expelling gas from the stomach or esophagus noisily through the oral cavity. Although it is a physiological phenomenon, belching may also be a symptom of upper gastrointestinal diseases such as reflux esophagitis and functional dyspepsia (FD). A detailed epidemiology of belching has not yet been reported. The aim of this study is to examine the prevalence and clinical characteristics of clinically significant belching (CSB) in adults. Methods We analyzed 1998 subjects who visited the hospital for annual health checkups. Belching was evaluated by a simple question "Do you burp a lot?" and scored as 0 (never), 1 (occasionally), 2 (sometimes), 3 (often), or 4 (always). Subjects with CSB were defined as having scores ≥ 3. We also collected the clinical parameters, endoscopic findings, and data according to the Athens Insomnia Scale, Rome IV questionnaire, and Hospital Anxiety and Depression Scale (HADS). Results Of the 1998 subjects, 121 (6.1%) had CSB. Subjects with CSB had FD more commonly than reflux esophagitis, but presence of heartburn was high (10.7% vs 3.1%). In addition, the HADS and Athens Insomnia Scale scores in subjects with CSB were significantly higher than those in subjects without CSB. Presence of heartburn (OR, 2.07; 95% CI, 1.05-4.09), presence of FD (OR, 2.12; 95% CI, 1.33-3.36), anxiety/depression (OR, 2.29; 95% CI 1.51-3.45), and sleep disturbances (OR, 1.73; 95% CI, 1.14-2.61) were significantly associated with CSB. Conclusion The detailed epidemiology of belching in the general adult population was clarified. [ABSTRACT FROM AUTHOR]

Background: Supragastric belching (SGB) and aerophagia are behavioral disorders characterized by air induced esophageal distension. SGB is known to be associated with Gastro Esophageal Reflux Disease (GERD). Low Mean Nocturnal Baseline Impedance (MNBI) values support GERD diagnosis. We aimed to assess if chronic esophageal distension by air affects the esophageal mucosa integrity by assessing changes in MNBI., Methods: In a single-center database study, we searched retrospectively for patients with a diagnosis of pathological SGB (n = 146) or aerophagia (n = 34) based on impedance-pH reflux monitoring. During the examined period, patients with a conclusive negative diagnosis of SGB and no evidence of aerophagia were used as a control cohort (n = 191). MNBI at 3, 5, and 17 cm over Lower Esophageal Sphincter (LES) was evaluated. GERD was diagnosed if acid exposure time (AET) >6%. All impedance studies of included patients were prospectively reevaluated., Results: GERD was diagnosed in 31.7% patients with SGB, a rate not different in comparison to patients without SGB (30.8%, p = 0.906). MNBI at 3 and 5 cm above the LES was significantly decreased among patients with SGB. SGB was not correlated with MNBI at 3 cm over the LES, (p: 0.086 OR: 1.000 95% CI: 0.999-1.001) when using multivariate analysis. Moreover no difference was spotted as far as MNBI at 3, 5, and 17 cm over the LES is concerned among patients with or without aerophagia., Conclusion: Even if patients with SGB do show lower MNBI values, esophageal distention due to excessive air movement does not directly lead to impairment of esophageal mucosa integrity., (© 2023 The Authors. Neurogastroenterology & Motility published by John Wiley & Sons Ltd.)

The Australian Department of Climate Change and Energy Efficiency announced that a camel produces methane equivalent to one ton of carbon dioxide a year, making the animal one of the country’s biggest greenhouse gases emitters. In order to stop pollution, a plan was proposed to shoot the camels from a helicopter or round them up and send them to the slaughterhouse. As scientists working on camel physiology and human beings dealing with animal welfare and protection, we developed a trial to measure camel methane emissions and compared them to dairy cattle receiving the same amount of feed. Seven Holstein cows (average weight 350 kg) and seven she-camels (average weight 330 kg) were used in this study. All animals were not pregnant and are in the latest stage of lactation with very limited milk production. Animals were housed in boxes and fed individually the same ration composed of 3 kg of barley and 2 kg of lucerne hay daily at 9 a.m. After eating, methane emissions measurements were carried out for 2 hours on several periods per day by using a face mask open circuit system. The results showed that the camel eliminated most of the methane by eructation with an average of 18 (eructations) emission cycles per hour. In cattle, the number of emission cycles averaged 54 eructations per hour. Methane emission from the camel was estimated to average 67 liters per day corresponding to 15.2 liters per kg of dry matter intake while dairy cattle methane emissions was estimated to average 194 liters per day corresponding to 42.2 liters per kg of dry matter intake. The present study showed clearly that dairy cattle produced three times more methane than camel when the two species received the same diet. Some digestive and metabolic particularities of each species may explain the difference. Other solutions to reduce the greenhouse gases should be proposed other than the eradication of the camel population of Australia.

Chronic gastrointestinal disorders are disruptive to patients physically and psychologically, and benefit from multidisciplinary care, including targeted psychological interventions. This case study details a case of a 42-year-old Caucasian female with idiopathic eructation, who was identified as having psychological contributors to her 3-year history of GI symptoms. Following extensive medical testing, she was diagnosed with excessive, likely supragastric belching and referred for psychological care. She noted initial reticence to psychological approaches but was offered psychoeducation and CBT interventions targeting eructation disorder and anxiety. Although the patient paused treatment after only a single session of psychological contact (including assessment and brief intervention), her GI symptoms effectively resolved with application of anxiolytic breathing, psychoeducation, and other cognitive behavioral techniques, suggesting rapid efficacy of CBT interventions, when diligently applied. [ABSTRACT FROM AUTHOR]

Objectives: Excessive belching is a common complaint that may be observed alone or with other diseases such as indigestion and reflux. In addition, it has adverse effects on patients' social life. Due to the insufficient evidence regarding the successful treatment of this disorder, the present study reviewed the medical views of Avicenna in order to find a better solution in this regard. Methods: This literature review was done by searching for "belching" and its MeSH heading term, namely, "eructation" in databases such as Google scholar and Pub Med and their synonyms in Iranian traditional medicine "Josha" in Avicenna's "Canon of Medicine". Results: The definition of belching in modern medicine was the same as "Josha" but its classifications and treatments were different. Modern scientists have divided excessive belching into gastric and supragastric based on its source although Avicenna classified it into three kinds based on its smell. In recent studies, specialists have come to a link between the brain and the stomach due to the inadequacy of their therapies while Avicenna has along pointed out the relationship between belching and certain organs. He further recommended three main approaches for its treatment, including lifestyle modification, herbal medicines, and physical manipulations. Conclusions: In general, considering the lack of effective treatment for excessive belching, it is important to present a better classification and management. This might be possible with regard to Avicenna's "Canon of Medicine". Thus, clinical trials are suggested to assess the efficacy of Avicenna's recommendations as a complementary method. [ABSTRACT FROM AUTHOR]

Background: Retrograde cricopharyngeus dysfunction (R-CPD), a condition first detailed in 1987 and termed in 2019, refers to the cricopharyngeal muscle's inability to relax to allow the retrograde passage of gas. Limited research exists on the fundamental characteristics of this condition, including its impact on one's life. The purpose of this study is to characterize R-CPD and how the inability to burp affects the social lives of people who suffer from it., Methods: A Qualtrics survey was distributed on the subreddit "r/noburp," a community of 26,000 individuals sharing information about R-CPD. Adults aged 18-89 experiencing R-CPD symptoms were invited to participate. Participants reported on their experiences with R-CPD and its effects on social life on a 4-point Likert scale (1 = strongly disagree to 4 = strongly agree). Data was analyzed using descriptive statistics., Key Results: Among the 199 respondents, the mean age was 30.9, and gender identity was 74%/25% female/male. 99% reported inability to burp, 98% reported abdominal bloating, 93% reported socially awkward gurgling noises, 89% reported excessive flatulence, and 55% reported difficulty vomiting. Only half discussed their symptoms with their primary care provider (PCP), and 90% disagreed with receiving adequate help. Average Likert scores indicated embarrassment (3.4), anxiety/depression (3.1), negative impact on relationships (2.6), and work disruption (2.7) due to R-CPD., Conclusions & Inferences: R-CPD is unfamiliar to many healthcare providers, leaving patients underserved. It not only affects daily life but also personal and professional relationships. Raising awareness by understanding disease basic features may increase diagnosis and treatment rates, improving quality of life., (© 2023 The Authors. Neurogastroenterology & Motility published by John Wiley & Sons Ltd.)

Background: The contributions of swallowing and belching to specific gastroesophageal reflux disease (GERD) phenotypes are unclear., Methods: This study retrospectively analyzed esophageal pH/impedance studies, comparing reflux events preceded by gastric belching (GB), supragastric belching (SGB), air swallowing, and liquid/solid swallowing based on reflux position, lower esophageal sphincter (LES) pressure, and acid exposure time (AET)., Key Results: 20 GERD patients and 10 controls were studied. Upright GERD patients and controls had a higher proportion of reflux events with a preceding swallow or belch (0.64, 0.64) than the supine group (0.38, p = 0.043). The upright group and controls trended toward a higher proportion of reflux events preceded by overall swallowing (0.61, 0.50) and air swallowing (0.55, 0.48) than the supine group (0.32, 0.31 p = 0.064, p = 0.11), but the three groups had similar rates of liquid/solid swallowing (0.032, 0.024, 0.017, p = 0.69). LES pressure did not correlate with reflux events preceded by swallowing (R 2  = 0.021, p = 0.44). There was a higher rate of events preceded by gastric belching in the control group (0.14) than in the upright (0.032) and supine groups (0.066, p = 0.049). LES pressure did not correlate with the rate of events preceded by belching (R 2  = 0.000093, p = 0.96). Normal AET patients had a higher rate of events preceded by GB (0.12) than those with increased acid exposure (0.030, p = 0.0083), but the two groups had similar rates of preceding air (0.43, 0.47, p = 0.68), liquid/solid (0.018, 0.032, p = 0.30), and overall swallowing (0.44, 0.53, p = 0.38)., Conclusions and Inferences: Swallowing more than belching is a dominant mechanism for reflux irrespective of GERD position, LES pressure, and AET., (© 2023 John Wiley & Sons Ltd.)

Recent interest in greenhouse gas emissions from ruminants, such as cattle, has spawned a need for affordable, precise, and accurate methods for the measurement of gaseous emissions arising from enteric fermentation. A new head hood system for cattle designed to capture and quantify emissions was recently developed at the University of California, Davis. The system consists of two head hoods, two vacuum pumps, and an instrumentation cabinet housing the required data collection equipment. This system has the capability of measuring carbon dioxide, methane, ethanol, methanol, water vapor, nitrous oxide, acetic acid emissions and oxygen consumption in real-time. A unique aspect of the hoods is the front, back, and sides are made of clear polycarbonate sheeting allowing the cattle a full range of vision during gas sampling. Recovery rates for these slightly negative pressure chambers were measured ranging from 97.6 to 99.3 percent. This system can capture high quality data for use in improving emission inventories and evaluating gaseous emission mitigation strategies.

Symptoms of angina pectoris can present with the typical specific symptoms, which are easy to recognize, or vague symptoms like chills, nausea, dizziness, belching and mild chest pain. Both the typical and atypical forms of angina symptoms may rarely be associated with or masked by predominantly extra cardiac manifestations, which are occasionally referred to the abdomen. We report here an unusual presentation of angina. A 62 years old male who had been healthy all his life, presented at Sultan Qaboos University, Oman, with a two month history of belching episodes as the chief and the only complaint. He was found to have angina pectoris, although there were no classical symptoms or signs to suggest it. He was treated successfully by surgery. It is concluded that belching can be a presenting symptom of angina.

Eructation is composed of three independent phases: gas escape, upper barrier elimination, and gas transport phases. The gas escape phase is the gastro-LES inhibitory reflex that causes transient relaxation of the lower esophageal sphincter, which is activated by distension of stretch receptors of the proximal stomach. The upper barrier elimination phase is the transient relaxation of the upper esophageal sphincter along with airway protection. This phase is activated by stimulation of rapidly adapting mechanoreceptors of the esophageal mucosa. The gas transport phase is esophageal reverse peristalsis mediated by elementary reflexes, and it is theorized that this phase is activated by serosal rapidly adapting tension receptors. Alteration of the receptors which activate the upper barrier elimination phase of eructation by gastro-esophageal reflux of acid may in part contribute to the development of supra-esophageal reflux disease. [ABSTRACT FROM AUTHOR]

The prevalence and localizing value of ictal belching are yet unknown. We present the case of a patient with medically refractory focal epilepsy with simple and complex partial seizures, as well as generalized seizures. One presumed seizure type comprised frequent episodes of repetitive belching. Video-EEG monitoring during these attacks showed no ictal changes. The belching episodes were inducible and terminable through suggestion. The diagnosis of excessive supragastric belching, a previously described psychogenic condition, was made.

Retrograde cricopharyngeal dysfunction was recently described by Bastian in 2019 and is characterized by an inability to belch, abdominal or chest pressure, odd gurgling noises, and occasional difficulty vomiting. Symptoms tend to worsen with carbonated beverages. Currently, the recommended treatment is cricopharyngeus muscle botulinum toxin injections. Prior studies have included few pediatric patients within larger datasets comprised primarily of adults. We describe our preliminary experience in pediatric patients, including presenting symptoms, treatment approach, and post-treatment outcomes. Retrospective chart review of pediatric patients (aged <18 years) diagnosed with retrograde cricopharyngeal dysfunction based on clinical history by the senior author. Medical records were reviewed for presenting symptoms, prior testing and treatment, details of treatment, and postoperative outcomes. Five patients with average age of 14 ± 4 (3 females, 2 males) were included. Presenting symptoms included lifelong or nearly lifelong inability to burp (n = 5), bloating (n = 5), awkward gurgling noises (n = 3), and worsening of symptoms with carbonated beverages (n = 5). Two patients had prior normal upper endoscopy. All patients underwent cricopharyngeal botulinum toxin injection under general anesthesia, with 25–50 units of botulinum toxin injected to the posterior cricopharyngeus across 4–5 locations. All patients had resolution of symptoms with follow-up of 1.5–10 months. Retrograde cricopharyngeal dysfunction may be underdiagnosed due to lack of awareness of the condition. Now that the phenomenon of inability to belch has a name and is being reported in the literature, we will likely see more adult and pediatric patients with these symptoms. Pediatric patients may respond similarly to adults. Larger studies with longer-term follow-up and targeted patient-reported outcome measures are needed to characterize disease presentation and treatment outcomes. [ABSTRACT FROM AUTHOR]

Background/Aims: Supragastric belching (SGB) is a phenomenon during which air is sucked into the esophagus and then rapidly expelled through the mouth. Patients often complain of severely impaired quality of life. Our objective was to establish the prevalence of excessive SGB within a high-volume gastrointestinal physiology unit, and evaluate its association with symptoms, esophageal motility and gastresophageal reflux disease. Methods: We established normal values for SGB by analyzing 24-hour pH-impedance in 40 healthy asymptomatic volunteers. We searched 2950 consecutive patient reports from our upper GI Physiology Unit (from 2010-2013) for SGB. Symptoms were recorded by a standardized questionnaire evaluating for reflux, dysphagia, and dyspepsia symptoms. We reviewed the predom - inant symptoms, 24-hour pH-impedance and high-resolution esophageal manometry results. Results: Excessive SGB was defined as > 13 per 24 hours. We identified 100 patients with excessive SGB. Ninety-five percent of these patients suffered from typical reflux symptoms, 86% reported excessive belching, and 65% reported dysphagia. Forty-one percent of patients with excessive SGB had pathological acid reflux. Compared to the patients with normal acid exposure these patients trended towards a higher number of SGB episodes. Forty-four percent of patients had esophageal hypomotility. Patients with hypomotility had a significantly higher frequency of SGB compared to those with normal motility (118.3 ± 106.1 vs 80.6 ± 75.7, P = 0.020). Conclusions: Increased belching is rarely a symptom in isolation. Pathological acid exposure and hypomotility are associated with more SGB frequency. Whether SGB is a disordered response to other esophageal symptoms or their cause is unclear. [ABSTRACT FROM AUTHOR]

The hand-held laser methane detector (LMD) technique has been suggested as an alternative method for measuring methane (CH4) emissions from enteric fermentation of ruminants in the field. This study aimed to establish a standard procedure for using LMD to assess CH4 production in cattle and evaluate the efficacy of the protocol to detect differences in CH4 emissions from cattle fed with diets of different forage-to-concentrate (FC) ratios. Experiment 1 was conducted with four Hanwoo steers (584 ± 57.4 kg body weight [BW]) individually housed in metabolic cages. The LMD was installed on a tripod aimed at the animal's nostril, and the CH4 concentration in the exhaled gas was measured for 6 min every hour for 2 consecutive days. For the data processing, the CH4 concentration peaks were identified by the automatic multi-scale peak detection algorithm. The peaks were then separated into those from respiration and eructation by fitting combinations of two of the four distribution functions (normal, log-normal, gamma, and Weibull) using the mixdist R package. In addition, the most appropriate time and number of consecutive measurements to represent the daily average CH4 concentration were determined. In experiment 2, 30 Hanwoo growing steers (343 ± 24.6 kg BW), blocked by BW, were randomly divided into three groups. Three different diets were provided to each group: high FC ratio (35:65) with low-energy concentrate (HFC-LEC), high FC ratio with high-energy concentrate (HFC-HEC), and low FC ratio (25:75) with high-energy concentrate (LFC-HEC). After 10 d of feeding the diets, the CH4 concentrations for all steers were measured and analyzed in duplicate according to the protocol established in experiment 1. In experiment 1, the mean correlation coefficient between the CH4 concentration from respiration and eructation was highest when a combination of two normal distributions was assumed (r = 0.79). The most appropriate measurement times were as follows: 2 h and 1 h before, and 1 h and 2 h after morning feeding. Compared with LFC-HEC, HFC-LEC showed 49% and 57% higher CH4 concentrations in exhaled gas from respiration and eructation (P < 0.01). In conclusion, the LMD method can be applied to evaluate differences in CH4 emissions in cattle using the protocol established in this study., (© The Author(s) 2022. Published by Oxford University Press on behalf of the American Society of Animal Science. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Aerophagia is a common functional gastrointestinal disorder among children. The disease leads to symptoms related to air in the intestine leading to burping, abdominal distension, and excessive flatus. We aimed to perform a systematic review and a meta-analysis to assess the epidemiology of aerophagia in children., Methods: We conducted a thorough electronic databases (MEDLINE, EMBASE, PsycINFO and Web of Science) search for all epidemiological surveys conducted in children on aerophagia. All selected studies were assessed for their scientific quality and the extracted data were pooled to create a pooled prevalence of aerophagia., Results: The initial search identified 76 titles. After screening and in depth reviewing, 19 studies representing data from 21 countries with 40129 children and adolescents were included in the meta-analysis. All studies have used standard Rome definitions to diagnose aerophagia. The pooled prevalence of aerophagia was 3.66% (95% Confidence interval 2.44-5.12). There was significant heterogeneity between studies [I2 98.06% with 95% Confidence interval 97.70-98.37). There was no gender difference in prevalence of aerophagia in children. The pooled prevalence of aerophagia was highest in Asia (5.13%) compared to other geographical regions., Conclusion: In this systematic review and meta-analysis, we found aerophagia has a significant prevalence across the world., Competing Interests: The authors have declared that no competing interests exist.

Background: The relationship between bothersome symptoms and gastric pressure or CO2 injection volumes in drug-resistant functional dyspepsia (FD) patients remains unknown; therefore, this relationship was examined in drug-resistant FD and non-FD patients., Methods: Thirty drug-resistant FD patients and 30 non-FD patients were recruited. Gastric pressure was assessed using an external pressure transducer, and the CO2 injection volume was measured using an endoscopic CO2-supplied device and flow meter. The following variables were examined: gastric pressure at baseline and gastric pressure and the CO2 injection volume when patients initially felt abdominal tension and bothersome symptoms following the CO2 injection. The relationship between belching and bothersome symptoms was also investigated., Results: No significant differences were observed in basal gastric pressure between the groups. Initial and bothersome symptoms in the upper abdomen in drug-resistant FD patients developed at a significantly lower gastric pressure and significantly smaller CO2 injection volume than in non-FD patients. The frequency of belching was significantly lower in the drug-resistant FD group than in the non-FD group., Conclusion: Bothersome symptoms in drug-resistant FD patients develop at a lower gastric pressure and smaller CO2 injection volume than in non-FD patients. These patients also had difficulties with belching., Competing Interests: The authors have declared that no competing interests exist.

This report offers the first detailed description of repetitive eructation (belching) in a patient with bulimia nervosa. The case was a man in his 30's with bulimia nervosa characterized by daily bingeing and purging behavior. Detailed assessment revealed repetitive eructation which was construed as a learned behavior precipitated and maintained by aerophagia (air swallowing) secondary to regular binge-eating. Eructation was associated with a strong sense of 'relief' that shared a common phenomenology with other purging behaviors. Repetitive eructation was addressed as part of outpatient treatment using a cognitive-therapy approach. Eructation became less frequent during outpatient treatment but the patient disengaged after six sessions. We define a new term 'eructophilia' where repetitive eructation takes on an ego-syntonic, self-contained, and autonomous quality which serves as a reinforcing stimulus in itself. Issues of phenomenology and motivating factors are further discussed. © 2011 by Wiley Periodicals, Inc. (Int J Eat Disord 2012) [ABSTRACT FROM AUTHOR]

Recent interest in greenhouse gas emissions from ruminants, such as cattle, has spawned a need for affordable, precise, and accurate methods for the measurement of gaseous emissions arising from enteric fermentation. A new head hood system for cattle designed to capture and quantify emissions was recently developed at the University of California, Davis. The system consists of two head hoods, two vacuum pumps, and an instrumentation cabinet housing the required data collection equipment. This system has the capability of measuring carbon dioxide, methane, ethanol, methanol, water vapor, nitrous oxide, acetic acid emissions and oxygen consumption in real-time. A unique aspect of the hoods is the front, back, and sides are made of clear polycarbonate sheeting allowing the cattle a full range of vision during gas sampling. Recovery rates for these slightly negative pressure chambers were measured ranging from 97.6 to 99.3 percent. This system can capture high quality data for use in improving emission inventories and evaluating gaseous emission mitigation strategies. [ABSTRACT FROM AUTHOR]

Barrett's esophagus (BE) is reported to be infrequent in Asians, with no data from India regarding its prevalence and risk factors. We investigated the frequency and risk factors of columnar mucosa with or without specialized intestinal metaplasia (SIM) in Indian patients with gastroesophageal reflux disease (GERD). A total of 278 GERD patients over 2 years underwent gastroscopy and completed a questionnaire for possible BE risk factors. Patients with columnar mucosa on endoscopy underwent four-quadrant biopsy; BE was histologically defined as columnar mucosa with or without SIM. Patients without columnar mucosa at endoscopy were considered as controls and compared to patients with BE and those with SIM. Forty-six patients with GERD had columnar mucosa on histology (16.54%); 25 (8.99%) of these had SIM. The risk factors for BE were the presence of hiatus hernia (odds ratio [OR]: 3.14; 95% confidence interval [CI]: 1.2-8.17) and a history of eructation (OR: 2.28; CI: 1.11-4.66). The risk factors for SIM were age ≥ 45 years (OR: 2.63; CI: 1.03-6.71), hiatus hernia (OR: 3.95; CI: 1.24-12.56), and a history of eructation (OR: 3.41; CI: 1.19-9.78). Sex, severity of symptoms, dietary factors, tobacco or alcohol use, and body mass index were not associated with BE. The median circumferential segment length was 2 (1-10) cm, and the maximal length was 3 (2-11) cm in both groups. BE is not an uncommon finding among Indian GERD patients. Age ≥ 45 years, history of eructation, and the presence of hiatus hernia are associated with SIM. [ABSTRACT FROM AUTHOR]

It was the aim of this study to characterize rumination behaviour, eructation and oesophageal motility in camels to identify similarities and differences between camels and domestic ruminants. Recordings were carried out in five camels fed on a hay-based diet. On an average, the duration of rumination, feeding and resting was 8.3, 5.6 and 10.1 h per 24 h, respectively. Rumination activity peaked in the morning between 9:00 and 11:00 and in the night between 02:00 and 04:00 a.m. During rumination periods, on an average 67 boluses were regurgitated per hour. Each bolus was chewed for an average of 45 s with 68 chews per min. The pause between two rumination cycles lasted on an average 9 s. Hay intake took 61 min/kg dry matter (DM), rumination lasted 71 min/kg DM of hay consumed. The regurgitation of a bolus started with a contraction of cranial compartment 1 (C 1) during a B-sequence, followed by a deep inspiration with closed glottis. Digesta enters the oesophagus, and an antiperistaltic wave transported the bolus orally. Eructation starts with a contraction of the caudal C1 during a B-sequence when the cranial C1 is relaxed. After entering the oesophagus, a rapid antiperistaltic wave transports the gas orally. Results revealed that the parameter values obtained in the camels were remarkably similar to those in domestic ruminants despite profound morphological differences and different patterns of forestomach motility. [ABSTRACT FROM AUTHOR]

Introduction: Although inability to belch has previously been linked to dysfunction of the upper esophageal sphincter (UES), its underlying pathogenesis remains unclear. Our aim was to study mechanisms underlying inability to belch and the effect of UES botulinum toxin (botox) injections in these patients., Methods: We prospectively enrolled consecutive patients with symptoms of inability to belch. Patients underwent stationary high-resolution impedance manometry (HRIM) with belch provocation and ambulatory 24-h pH-impedance monitoring before and 3 months after UES botox injection., Results: Eight patients (four males, age 18-37 years) were included. Complete and normal UES relaxation occurred in response to deglutition in all patients. A median number of 33(15-64) gastroesophageal gas reflux episodes were observed. Despite the subsequent increase in esophageal pressure (from -4.0 [-7.7-4.2] to 8 [3.3-16.1] mmHg; p < 0.012), none of the gastroesophageal gas reflux events resulted in UES relaxation. Periods of continuous high impedance levels, indicating air entrapment (median air presence time 10.5% [0-43]), were observed during 24-h impedance monitoring. UES botox reduced UES basal pressure (from 95.7[41.2-154.0] to 29.2 [16.7-45.6] mmHg; p < 0.02) and restored belching capacity in all patients. As a result, esophageal air presence time decreased from 10.5% (0-43.4) to 0.7% (0.1-18.6; p < 0.02) and esophageal symptoms improved in all patients (VAS 6.0 [1.0-7.9] to 1.0 [0.0-2.5]; p < 0.012)., Conclusion: The results of this study underpin the existence of a syndrome characterized by an inability to belch and support the hypothesis that ineffective UES relaxation, with subsequent esophageal air entrapment, may lead to esophageal symptoms., (© 2021 The Authors. Neurogastroenterology & Motility published by John Wiley & Sons Ltd.)

Upper esophageal sphincter (UES) function has been extensively studied in the context of swallowing and antegrade bolus transit, but relatively little attention has been paid to its retrograde function to facilitate belching. Indeed, prior to 2019, there were only three case reports in the world literature of individuals with a physiologically demonstrated inability to belch due to failure of the UES to relax after gas venting from the stomach and ensuing low-pressure esophageal distention. In this minireview, that disorder is termed retrograde UES dysfunction (R-UESD). The associated symptom complex includes some combination of chest pain, gurgling noises in the chest, bloating, nausea, hiccups, and flatulence. The obscurity of R-UESD has recently been challenged by two large series published in the ENT literature of circumstantially demonstrated R-UESD that was resolved by botulinum toxin (BT) injection to the cricopharyngeus. The field has now further advanced with the publication in this issue of the Journal by Oude Nijhuis et al. of 8 cases of R-UESD demonstrated by high-resolution impedance manometry (HRIM) with a provocative challenge of carbonated water. These individuals were also treated with BT and at 3-month follow-up had both an encouraging symptomatic response and HRIM demonstrated resolution of R-UESD., (© 2022 John Wiley & Sons Ltd.)

Background/aims: Belching is the act of expelling gas from the stomach or esophagus noisily through the oral cavity. Although it is a physiological phenomenon, belching may also be a symptom of upper gastrointestinal diseases such as reflux esophagitis and functional dyspepsia (FD). A detailed epidemiology of belching has not yet been reported. The aim of this study is to examine the prevalence and clinical characteristics of clinically significant belching (CSB) in adults., Methods: We analyzed 1998 subjects who visited the hospital for annual health checkups. Belching was evaluated by a simple question "Do you burp a lot?" and scored as 0 (never), 1 (occasionally), 2 (sometimes), 3 (often), or 4 (always). Subjects with CSB were defined as having scores ≥ 3. We also collected the clinical parameters, endoscopic findings, and data according to the Athens Insomnia Scale, Rome IV questionnaire, and Hospital Anxiety and Depression Scale (HADS)., Results: Of the 1998 subjects, 121 (6.1%) had CSB. Subjects with CSB had FD more commonly than reflux esophagitis, but presence of heartburn was high (10.7% vs 3.1%). In addition, the HADS and Athens Insomnia Scale scores in subjects with CSB were significantly higher than those in subjects without CSB. Presence of heartburn (OR, 2.07; 95% CI, 1.05-4.09), presence of FD (OR, 2.12; 95% CI, 1.33-3.36), anxiety/depression (OR, 2.29; 95% CI 1.51-3.45), and sleep disturbances (OR, 1.73; 95% CI, 1.14-2.61) were significantly associated with CSB., Conclusion: The detailed epidemiology of belching in the general adult population was clarified.

Background and Aims: Gastric bypass surgery effectively treats obesity; however, its association with belching, which occurs in other bariatric surgeries, remains unclear. Hence, we aimed to evaluate belching occurrence after gastric bypass surgery., Methods: We enrolled 12 healthy volunteers and 17 patients (12 and 5 underwent Roux-en-Y gastric bypass and mini-gastric bypass surgeries 24 (18-54) months prior, respectively). Gastrointestinal symptoms were assessed. Gastroscopy was performed, followed by the 24-hour pH-impedance analysis., Results: Age and sex were not statistically different between the two groups (P > 0.05). Patients had a significantly higher mean DeMeester score than the healthy controls (9.11 ± 19.40 vs. 6.04 ± 5.60, P = 0.048), but the pathologic acid reflux (DeMeester score > 14) rate was similar in both groups (11.8% vs. 8.3%). Regarding the impedance, symptom-association probability was positive in 11.8% of patients. The patients also had higher alkaline reflux rates (6% vs. 0%); additionally, 50% of them experienced belching based on the questionnaire, and 25% had esophagitis based on gastroscopy. Furthermore, patients had a significantly higher number of gas reflux (123.24 ± 80 vs. 37.2 ± 21.5, P = 0.001) and supragastric/ gastric belches (182 ± 64/228 ± 66.69 vs. 25.08 ± 15.20/12.17 ± 17.65, P = 0.001). Supragastric belching was more frequent than gastric belching in the controls, whereas gastric belching was more frequent in the patients., Conclusion: Belching increases after gastric bypass surgery in a long-term period. Gastric belching was more frequent than supragastric belching in these patients., Competing Interests: The authors declare that they have no conflict of interest, (© Acta Gastro-Enterologica Belgica.)

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Background/aims: Belching disorder (BD) is clinically distinct from gastroesophageal reflux disease (GERD) with belching. Supragastric belching (SGB) is closely associated with reflux episodes. This study investigates belch characteristics in association with reflux, compared between patients with BD and those who had GERD with belching., Methods: Impedance pH monitoring data from 10 patients with BD and 10 patients with GERD who exhibited belching were retrospectively analyzed. Belches were considered "isolated" or "reflux-related" and acidic/non-acidic. Belch characteristics were compared between patients with BD and those with GERD., Results: Symptomatic belches were more frequent in patients with BD than in patients with GERD (median, 160.5 vs 56.0, P < 0.05). SGB was the most common type in both groups; common subtypes comprised "isolated" in patients with BD and "isolated during the reflux period" in patients with GERD. Reflux-related SGB was more common in patients with GERD than in BD (78.3% vs 45.2%, P < 0.005). Both "preceding belching" including the reflux period and acidic SGB were more common in patients with GERD than in BD (31.8% vs 8.6% and 38.1% vs 8.9%, both P < 0.05). Supragastric belch number positively correlated with all reflux episodes in patients with GERD (adjusted R 2 = 0.572, P = 0.007)., Conclusions: BD is characterized by more belching, compared to GERD. SGB is more frequently associated with reflux in GERD than in BD; acidity may be related to GERD. In BD, SGB is typically non-acidic and unrelated to reflux. Distinct SGB characteristics may reflect different pathogenic mechanisms of reflux and associated symptoms.

Background & Aims: Reflux hypersensitivity (RH), a functional esophageal disorder, is detected in 14%-20% of patients who present with typical esophageal symptoms. As many as 40% of patients with RH do not respond to treatment with pain modulators or proton pump inhibitors (PPIs); behavior disorders might contribute to lack of treatment efficacy. We aimed to assess the prevalence of behavioral disorders and their effects on typical reflux symptoms in patients with RH., Methods: We performed a retrospective study of 542 patients with PPI-refractory esophageal symptoms (heartburn, regurgitation, or chest pain) or with symptoms that responded to PPI therapy, evaluated for anti-reflux surgery from January 2016 through August 2019 at a single center in London, United Kingdom. We collected data on symptoms, motility, and impedance-pH monitoring and assigned patients to categories of RH (n = 116), functional heartburn (n = 126), or non-erosive reflux disease (n = 300)., Results: Of the 116 patients with a diagnosis of RH, 59 had only hypersensitivity, whereas 57 patients (49.2%) had either excessive supragastric belching (SGB, 39.7%), based on 24-hour impedance-pH monitoring, or rumination (9.5%), based on postprandial manometry combined with impedance. The prevalence of SGB and rumination in patients with RH was significantly higher than in patients with functional heartburn (22%; P < .001). Patients with RH and rumination were significantly younger (P = .005) and had the largest number of non-acid reflux episodes (P = .023). In patients with RH with SGB, SGB episodes were associated with 40.6% of marked reflux symptoms (heartburn, regurgitation, or chest pain), based on impedance-pH monitoring. In patients with RH and rumination, 40% of reflux-related symptoms (mostly regurgitation) were due to possible rumination episodes., Conclusions: Almost half of patients with a diagnosis of RH have behavior disorders, including excessive SGB or rumination. Episodes of SGB or rumination are associated with typical reflux symptoms. Segregation of patients with diagnosis of RH into those with vs without behavioral disorders might have important therapeutic implications., (Copyright © 2021 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Background: Functional dyspepsia (FD), belching disorders (BD) and functional heartburn (FH) are the three most common upper functional gastrointestinal disorders (FGID) in IBS patients. FD is known to exert deleterious effects on health-related quality of life (HRQoL) and the psychological status of IBS patients; however, the impact of overlapping BD and FH on anxiety, depression and HRQoL of IBS patients remains unknown. This cross-sectional study was conducted to investigate the impact of overlapping FD, BD and FH on anxiety, depression and HRQoL in patients with IBS., Methods: This study enrolled 319 consecutive outpatients with IBS from 2 tertiary hospitals in Beijing and Shijiazhuang of China. IBS, FD, BD and FH were diagnosed using the Rome III Criteria. Hospital Anxiety and Depression Scale and a 36-item Short-Form Health Survey (SF-36) were used to assess the psychological distress and HRQoL of patients respectively., Results: Among the 319 patients with IBS, the IBS subtypes were diarrhoea (67%), constipation (16%), unsubtyped (12%) and mixed (5%). These IBS patients were further classified into IBS + FD, IBS + BD/FH (BD and/or FH), IBS + FD + BD/FH, or IBS only according to the patients' overlapping upper GI symptoms. IBS+FD patients reported higher levels of anxiety than IBS+BD/FH and elevated depression scores than IBS only patients (P< 0.05). The latter observation remained consistent after confounder-adjustment. The IBS + FD and IBS + FD + BD/FH groups exhibited statistically significant impairment in most of SF-36 scales, while the IBS + BD/FH group only showed lower HRQoL results in general health, when compared to the IBS only group. Multiple linear regression analysis demonstrated IBS + FD + BD/FH was linked to worse mental, physical and global HRQoL. Furthermore, IBS + FD was a strong predictor of poorer physical and global HRQoL compared to IBS only., Conclusions: Among the diarrhoea-prevalent IBS patients, those with concomitant FD experienced more psychological distress and demonstrated poorer physical HRQoL. Overlapping FD + BD/FH is a significant predictor of worse mental and physical HRQoL for IBS patients. The impact of concomitant BD and FH on the psychological status and HRQoL of IBS patients was limited. These findings implied that the overlapping upper FGIDs in IBS might be treated distinctively when developing comprehensive management strategies for IBS treatment.