Belching with air is an involuntary discharge into the oral cavity of a mixture of gases contained in the stomach or intestines. Usually occurs in physically healthy people with food errors or increased intra-abdominal pressure. May indicate damage to the digestive tract, functional disorders. To clarify the causes of belching (eructation) with air, endoscopy, ultrasound, abdominal radiography, a study of gastric secretion, and laboratory tests are used. Belching of gastric gases decreases with diet correction, taking sedative decoctions, herbal remedies, prokinetics and enterosorbents.
Causes of belching air
In most cases, the release of gaseous contents of the stomach is a natural process associated with human eating habits or the characteristics of the digestion of certain foods. Perceptible erection with air occurs up to 2 times a day, and an imperceptible discharge of gastric gases occurs even more often. As a variant of the norm, rapid belching is noted in some physiological conditions. The main prerequisites for a non-pathological release of gas from the stomach are:
- Swallowing air while eating . An increase in the gas bubble in the stomach is facilitated by the rapid eating of food, frequent dry snacks, talking while eating. In such situations, the likelihood of swallowing not only products, but also more air increases, the accumulation of which stimulates the reflex contraction of the gastric wall. The taste and smell of exhaust gases is neutral or tastes like eaten food.
- The use of certain products . Although legumes are more likely to cause flatulence, legumes can increase gas production in the stomach. Due to the presence of phytic acids and protease-inhibiting substances in the composition, the vegetable protein of peas, beans and lentils is worse broken down by pepsin and lingers in the stomach. The use of vegetables with protein foods, especially cabbage, is accompanied by the retention of carbohydrates and their fermentation with the release of gases.
- Drinking highly carbonated drinks . The gastric wall reflexively contracts with the release of excess gaseous contents with a rapid accumulation of carbon dioxide. In addition to the use of carbonated drinks, the accumulation of carbon dioxide is facilitated by drinking alkaline water and taking soda, which enters into a chemical reaction with hydrochloric acid. As a rule, carbon dioxide belching occurs soon after a food error.
- Physical activity . With tension in the abdominal press during sports or performing heavy manual work, an increase in abdominal pressure is noted. Most often, belching is provoked by sharp muscle contractions that squeeze the stomach and contribute to the opening of the cardiac sphincter. The risk of erection with the release of air and part of the chyme increases with physical exertion immediately after eating.
- Pregnancy . Due to the growth of the uterus during gestation, intra-abdominal pressure increases, and the internal organs move towards the diaphragm. Mechanical compression of the stomach facilitates the occurrence of gastroesophageal reflux, additional factors are a change in the natural position of the organ and an increase in acidity. In pregnant women, belching with air often has a sour taste and is combined with heartburn.
- Breastfeeding newborns . Sucking milk is often accompanied by swallowing air, which is belched after feeding. A prerequisite for an easier exit of gastric contents is the age-related immaturity of the cardia. Eructations are facilitated by improper attachment to the breast with insufficient nipple grip, hypogalactia, and non-compliance with the diet. Belching in infants is usually combined with regurgitation.
Belching in bowel disease
The release of gases into the oral cavity in intestinal pathology is associated with a reflex contraction of the stomach wall in response to an increase in intra-abdominal pressure, stagnation of liquid chyme in the small intestine and stool in the large intestine. In severe clinical cases of impaired emptying, a combination of air erection and upward reflux of intestinal contents is possible. The most common causes of pathological belching of gases are:
- Increased gas formation in the intestines . Eructation by air masses in chronic enterocolitis, transversitis and sigmoiditis, especially when combined with dysbacteriosis, usually occurs against the background of flatulence and is reflex in nature. Intraintestinal accumulation of gases increases pressure on the stomach, provokes its contraction and the release of air into the esophagus. Belching is often odorless and tasteless.
- Enteropathy . Dyspeptic disorders are the leading clinical syndrome of typhoid fever with predominant occlusion of the superior mesenteric artery. Violation of the secretory and absorption functions of the small intestine is accompanied by an increase in the volume of intestinal contents, a slowdown in the evacuation of chyme from the duodenum, and then the stomach. Belching gases is combined with flatulence, heartburn, vomiting.
- Slowing down the passage of feces . Reflex belching of air in patients suffering from constipation is a reaction of the stomach to delayed emptying. With the development of intestinal obstruction against the background of pneumatosis of the intestine, polyps and colorectal cancer, the situation is aggravated by the insufficiency of the Bauhinian valve and duodenogastric reflux, which lead to the appearance of putrid belching, and then fecal vomiting.
- parasitic infestations . Dyspeptic belching of air with the smell of hydrogen sulfide (rotten eggs) is characteristic of giardiasis and the acute phase of helminthiases. Its occurrence is caused by an increase in the volume of intestinal contents, a deterioration in the evacuation of chyme, and an increase in abdominal pressure due to flatulence. In addition to erection, patients have non-localized abdominal pain, flatulence, stool instability.
Belching with gastroduodenal pathology
Although eructation of liquid contents is more typical for diseases of the stomach and duodenum, their initial symptom is sometimes belching of gases with a characteristic aftertaste. In the early stages of Zollinger-Ellison syndrome, antral gastritis and other pathologies that occur with an increase in the secretory function of the stomach, an acidic taste is often felt in the mouth during erection with air. With incipient achlorhydria and atrophic gastritis, belching with the smell of rotten eggs is possible, which is subsequently aggravated by regurgitation of putrefactive contents.
A large amount of air, and then food, burps when chyme stagnates in the upper gastrointestinal tract. With atony of the stomach, duodenostasis and duodenal stenosis, fermentation and putrefactive processes quickly develop. In such patients, belching is rotten accompanied by heaviness, colicky pain in the epigastrium, heartburn, and vomiting. If duodenogastric reflux occurs, especially in combination with cholecystitis, biliary dyskinesia, and other hepato-biliary pathology, after belching, a taste of bitterness may remain in the mouth.
Belching in functional disorders
One of the frequent inorganic pathologies of the gastrointestinal tract, manifested by strong and persistent erection, is gastroneurosis with aerophagia. Due to unconscious reflex swallowing of air, the volume of the gas bubble constantly remains increased, the stomach reflexively contracts. In some of these patients, gastric belching is combined with supragastric (esophageal). In severe neurotic disorders, erection stops only during sleep. Often it is accompanied by severe flatulence caused by the flow of excess gases into the intestines.
Neurogenic eructation with neutral air can be observed during panic attacks, neurasthenia. A diagnostically complex autonomic disorder that occurs against the background of vagal dysfunction with gastric overflow is gastrocardial syndrome. His clinical picture is dominated by cardiosymptomatics (rhythm disturbances, retrosternal pain like angina pectoris, increased blood pressure), which develops after eating and disappears without medical correction after regurgitation of excess air, and sometimes vomiting.
Diagnostic search to establish the causes of eructation of gastric gases begins with the exclusion of diseases of the gastrointestinal tract. The patient is assigned a comprehensive examination, which allows assessing the functional viability of the digestive system and identifying possible morphological changes in organs. The most valuable for diagnosis are:
- Endoscopic methods . During gastroscopy (EFGS), the mucous membrane of the esophagus, stomach, duodenum is examined, inflammatory and ulcerative-destructive changes, deformations, volumetric neoplasms are detected. If necessary, a biopsy is performed for histological examination of the material. Patients with suspected bowel disease undergo a colonoscopy.
- X-ray studies . If a lesion of a particular section of the gastrointestinal tract is suspected, an x-ray of the relevant organs (stomach, esophagus, study of the passage of barium through the small and large intestines) is performed. To study the features of the pancreato-biliary zone, retrograde cholangiopancreatography is performed. With the help of mesentericography, the condition of the mesenteric vessels is assessed.
- Examination of gastric secretion . In case of possible acid-dependent diseases with increased or insufficient production of hydrochloric acid, intragastric pH-metry and gastric sounding are recommended. To detect gastroesophageal reflux, intraesophageal pH-metry is performed. Additionally, the levels of pepsinogens and gastrin are determined in the blood.
- Fecal analysis . Digestive disorders that provoke belching with air leakage are often accompanied by changes in the coprogram. Pathological inclusions and impurities (undigested food, muscle fibers, mucus, etc.) can be found in the feces. Often, the study is supplemented with an analysis of feces for occult blood and helminth eggs, sowing for dysbacteriosis.
Abdominal ultrasound is recommended as a non-invasive screening method for patients with air belching, and, if indicated, sonography of individual organs. After the exclusion of organic prerequisites for regurgitation of gases, an examination is prescribed to establish possible functional disorders (consultation of a neurologist, a psychiatrist, a comprehensive psychological study).
When belching air, first of all, correction of eating habits and diet is carried out.
Episodic erection does not require treatment. To reduce the severity of physiological belching with air, correction of eating habits and diet is sufficient. Frequent fractional consumption of food (up to 5-6 times a day) with a decrease in the volume of individual portions, thorough, slow chewing of products is effective. To reduce gas formation in the stomach, it is necessary to limit or completely eliminate legumes and dairy products, highly carbonated drinks, cruciferous vegetables from the diet, and stop using chewing gum.
Gastric gases are more easily removed into the intestines after small walks, which improve the evacuation function of the stomach after eating. Effective non-drug ways to reduce intra-abdominal pressure are wearing loose clothing without tight belts, limiting the amount of exercise for the abdominal muscles during exercise or training. Calm imperceptible removal of gases from the gastric cavity is facilitated by sleeping on a high pillow.
An increase in the duration of belching for more than an hour, its occurrence for several days in a row, the discharge of a large volume of air, the appearance of a sour, bitter or rotten taste, and other dyspeptic disorders are indications for contacting a gastroenterologist. Until an accurate diagnosis is established, herbal decoctions, sedative herbal remedies, agents that improve gastrointestinal motility, and enterosorbents are used to stop constant erection.