Bitter eructation is an involuntary throwing of air and liquid contents into the oral cavity due to contraction of the smooth muscles of the gastrointestinal tract, after which the patient feels the taste of bitterness in the mouth. Episodic erection may be associated with nutritional errors, but more often regurgitation is observed in diseases of the biliary system and duodenal-pancreatic zone. To determine the cause of the symptom, X-ray, endoscopic, ultrasound and laboratory studies are carried out. To stop belching, prokinetics, antispasmodics and choleretic agents are used.
In most cases, erection with a taste of bitterness develops due to functional disorders or organic damage to the digestive tract, biliary pathology. Periodic belching without any other warning signs often has a physiological nature. Bitterness in the mouth associated with nutritional errors occurs after excessive consumption of nuts, seeds, and other fat-rich foods. The unpleasant taste is due to the presence of underoxidized fats in the belched gastric contents.
The cause of bitter eructation against the background of violations of the contractile function of the bile ducts and gallbladder is the uneven flow of bile into the duodenum and the periodic throwing of intestinal contents into the stomach. Violation of the digestion of chyme with dyskinesia causes overstretching of smooth muscle fibers, their reflex contraction with the release of gases and liquid chyme with impurities of bile acids onto the oral mucosa. An increase in belching is observed with the addition of duodeno-gastric reflux.
For functional disorders of the motility of the biliary tract, a combination of bitter erection with other signs of dyspepsia is characteristic, the severity of which depends on the variant of the change in contractility. With the hyperkinetic type, there are sharp pains and spasms on the right in the hypochondrium, nausea, vomiting, and flatulence. For hypokinetic dyskinesia, dull pulling pain in the epigastrium and right hypochondrium, abdominal distention, stool instability with frequent constipation are typical.
The appearance of a bitter eructation in cholelithiasis is more typical for the interictal period, when the biliary tract remains open. The taste of bitterness that patients feel after erection is associated with the throwing of bile into the stomach, esophagus and oral cavity. Frequent regurgitation is due to stretching of the walls of the stomach and a reflex reaction to periodic stagnation of chyme in the proximal intestine. Belching is usually accompanied by pain and discomfort in the right hypochondrium, nausea, stool disorder with a predominance of diarrhea.
Any pathology that affects the biliary tract and liver can lead to belching with an unpleasant bitter taste. In inflammatory processes in the biliary system, the mechanism of regulation of bile ejection is disrupted, the general visceral innervation provokes concomitant functional pathology of the gastroduodenal zone. The symptom is potentiated by the periodic gaping of the pylorus and the throwing of duodenal chyme with a large amount of concentrated bile into the overlying sections of the gastrointestinal tract. The main hepatobiliary diseases with a symptom of bitter belching are:
Diseases of the pancreas and duodenum are accompanied by disorders of bile secretion, since the common bile duct, together with the pancreatic duct, opens in the middle part of the duodenum. With a decrease in the synthesis of digestive enzymes, a violation of parietal and abdominal digestion, chyme stagnates in the intestine. Duodeno-gastric reflux and reflex stretching of the muscular apparatus of the stomach provide the release of liquid contents with bile impurities into the mouth. Belching can be provoked by diseases such as:
The development of bitter belching in pregnant women is primarily caused by hormonal changes. With an increase in the level of estrogens, the composition of bile changes: the mass fraction of cholesterol increases, an imbalance of the main bile acids occurs. An additional factor is an increase in progesterone effects with a decrease in the motor function of the biliary tract, a violation of the enterohepatic circulation of individual bile components. With cholestasis of pregnancy, the symptom is accompanied by skin itching, stool disorders and yellowing of the skin.
Sometimes belching of bitter gastrointestinal contents occurs without organic pathologies of the digestive organs. In functional diseases, dysregulation of the autonomic nervous system is observed, which disrupts the normal motility of the gastrointestinal tract, leads to the appearance of reverse peristalsis with the reflux of aggressive contents from the duodenal lumen into the stomach. Belching and other dyspeptic disorders (heaviness in the abdomen, flatulence, nausea) are variable and are combined with emotional lability, psychasthenia.
Belching of gastric contents with a bitter taste is sometimes found in parasitic invasions and intestinal helminthiases, which occur with a predominant lesion of the organs of the duodenal and biliary zone. Often, bitter erection occurs with giardiasis, opisthorchiasis, and the intestinal form of strongyloidiasis. Belching bitterness is accompanied by other dyspeptic disorders: giardiasis is characterized by diarrhea with the release of foamy feces, with opisthorchiasis and strongyloidiasis, dull pains are observed in the hypochondrium on the right, nausea, alternating constipation and diarrhea.
Diagnostic search is aimed at a comprehensive assessment of the functional and morphological state of the gastrointestinal tract. Examination of patients with bitter erection is carried out by a gastroenterologist. Particular attention is paid to the study of the hepatobiliary system. To establish the root cause of belching with an unpleasant aftertaste, a complex of laboratory and instrumental methods is recommended, the most informative of which are:
As additional research methods, a biochemical blood test is used to determine the level of bilirubin fractions, the concentration of alkaline phosphatase, ALT and AST, and serological tests to detect antibodies to intestinal parasites. According to indications, in complex and doubtful cases, scintigraphy of the biliary tract and liver is performed.
duodenal sounding
If the symptom is observed quite rarely and is not accompanied by other unpleasant signs on the part of the gastrointestinal tract, belching can be dealt with with the help of non-drug remedies. The main factor is the normalization of eating habits: the rejection of fatty, smoked and fried foods, limiting alcohol and carbonated drinks that cause stomach distension and gas formation. You need to eat food 4-5 times a day in small portions, after eating you can not bend over, do hard physical work.
Bitter eructation, which lasts more than 5 days, is a sign of a disease of the digestive or biliary system, requires a visit to a specialist. Before undergoing a complete examination and making a clinical diagnosis, medications can be used to reduce unpleasant manifestations: prokinetics to improve gastrointestinal motility and prevent the contents of the duodenum from being thrown into the stomach cavity, choleretic drugs to normalize the rhythm of bile secretion. With concomitant pain syndrome, antispasmodics are used.