Belching, bloating and flatulence are daily occurrences and usually of little cause for concern. As embarrassing and uncomfortable as it may be, we usually view these body processes as a norm associated with digestion. In some cases however, belching, bloating and flatulence may be a cause of great distress.

The expulsion of gas from the gut can be a loud and socially unacceptable practice but the frequency and nature of these processes may indicate serious pathology. Belching or burping is the common term associated with eructations through the mouth. Belching is a frequent occurrence after meals and consumption of certain drinks. On some occasions, repeated belching may be accompanied by bloating and a feeling of ‘fullness’ known as indigestion (dyspepsia).

What Causes Burping?

Normal gas production in the gut

Some of the common causes of belching involve :

1. Air swallowing (aerophagia) may occur while eating or drinking, prolonged breathing though the mouth especially due to blockage of the nasal passages or in anxiety where hyperventilation may occur. Other causes include regular gum chewing, incorrect fit of dentures and voluntary air swallowing for the purpose of creating noisy eructations. Air that is swallowed does not usually reach the stomach and is expelled from the esophagus through a belch.

2. Carbonated drinks, most commonly beer and soda may also cause belching and bloating. These drinks release their gas into the open air and when consumed, the gas quickly fills the stomach and esophageal cavity. Usually a voluntary or involuntary belch will shortly ensue.

3. Belching and bloating are common symptoms during pregnancy as the growing fetus pushes against the abdominal contents. Gas can be quickly expelled by sudden pressure caused by movement and indigestion bothers most pregnant women. Frequent smaller meals may be advisable to reduce belching and discomfort due to bloating.

4. Normal gut bacteria within the stomach and small intestine can result in gas production as a byproduct. The gas builds up within the stomach cavity and is expelled as a belch.

What causes Excessive Belching?

Conditions that increase gas and belching

Most people will experience belching and bloating associated with indigestion many times in their life. It often passes relatively unnoticed and resolves spontaneously. Simple techniques like a walk after a meal and over the counter products for indigestion can be useful. However recurrent episodes of pain, discomfort, excessive bloating and belching that do not ease spontaneously can be an indication of an upper gastrointestinal disorder.

Certain pathologies may cause excessive belching and bloating which may be initially mistaken for indigestion. There are a myriad of possible causes for repeated episodes of belching and bloating and these are some of the common causative factors.

1. Gastroesophageal reflux disease (GERD) is a common disorder in which belching may be present. The movement of gastric acid up the esophagus may be due to pressure on the abdomen or an increased quantity of gastric contents. GERD is easily treatable and simple dietary changes can improve the condition.

2. Chronic H.pylori infection can affect the lining of the stomach and small intestine causing peptic ulcers. This often results in swelling of the stomach and intestinal lining and partial blockage of the cavity. Food may pass through at a slower rate due to obstruction which often leads to bloating, belching, nausea and vomiting.

3. Slow gut motility and delayed emptying of the stomach contents (gastroparesis) affects the normal movement of food through the gastrointestinal tract (peristalsis). This can result in food spending longer periods of time within the stomach and both bloating and belching may occur. Gastroparesis occurs due to a dysfunction of the normal coordinated gastric movements. Other reasons for slow gut motility should be investigated especially if there is blockage of the gut.

4. Hiatus hernia is a common yet often misdiagnosed cause of belching. A hiatus hernia is the protrusion of a portion of the stomach into the thoracic cavity due to a weakening or rupture of the diaphragm. A host of factors may contribute to a hiatus hernia and it often goes unnoticed. Once the protrusion expands, it can cause a range of symptoms including belching, heartburn, discomfort or pain. A hiatus hernia may require surgical intervention. Conservative measures can assist with reducing the indigestion experienced due to this condition. Smoking, caffeinated beverages such as coffee, tea and certain soft drinks as well as spicy foods aggravate the symptoms of a hiatus hernia. Avoiding these foods and beverages can greatly assist with preventing indigestion. Nevertheless, the hiatus hernia should be attended to by a medical professional.

5. Certain foods may contribute to belching due to the digestive processes. Most food is digested and absorbed within the stomach and small intestine. If any food is not processed, the normal bacterial flora may have the opportunity to digest these foods within the small intestine. Gas produced by the bacteria is often passed off as flatus but can be passed as a belch. Fructose, sorbitol and lactose can contribute to this condition either due to malabsoprtion or inability of the body to digest these compounds.

There are a number of other pathological conditions that may contribute to chronic belching and bloating and it is essential to seek medical advice if this condition persists.

Bloating & Belching

Abdominal bloating is often associated with gas. However, the gut can contain a significant amount of gas without causing any noticeable distension of the abdominal cavity. It should be differentiated whether this abdominal distension is due to gas bloating or swelling due to fluid accumulation (ascites) or a solid mass in the abdominal cavity. The latter may indicate serious underlying pathologies. Always consult with your practitioner if your symptoms are not easing and do not assume that persistent distension may just be gas in the gut. Through the processes of belching and flatus, the body usually passes out gas from the gut quite efficiently.

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