Most of us give little thought to the natural process of burping (belching). It occurs several times in a day, often after eating, and does not pose a problem. However, there are instances when burping becomes excessive to the point that it needs to be medically investigated and treated accordingly. It is first important to understand how gas builds up in the upper gut and is eventually expelled as a burp or belch.
Gas in the Upper Gut
The alimentary tract, commonly referred to as the gut, is a hollow cavity that is prone to gas build up. The reasons being is that it has two orifices that are open into the air-filled external environment. Furthermore the processes that occur within the gut also leads to production of gas and accumulation within the gut.
The upper gut runs from the mouth to the first half of the small intestine. Any gas that enters this part of the gut or is produced within these sections tend to pass out of the gut as a burp or belch. This is commonly referred to as an eructation. Most of the gas expelled as a burp (belch) is made up of air. It is actually air that is swallowed which constitutes the main cause of belching.
However, gas may also be sourced from aerated drinks, like the carbonated beverages (sodas) which are so common in the modern lifestyle. Gas that is eventually passed out as a burp is very rarely the result of chemical reactions within the gut, gas passing from the bloodstream into the gut or from bacteria within the upper gut. These latter sources of gas in the gut are however, the main reasons for flatus – expelling has from the rectum.
Normal Reasons for Excessive Burping
There are some reasons for excessive burping that cannot be attributed to diseases. These “normal” everyday causes are often termed as physiological. The main reason for physiological causes of excessive burping is due to an air swallowing. While it is normal for every person to swallow some air especially during eating and drinking, and sometimes during speaking, in some cases this is excessive.
The medical term for air swallowing is aerophagia. Air that enters the mouth has two possible routes that it can travel. It can enter the airways and pass to the lung as occurs with mouth breathing. Alternatively, if the epiglottis to the airways is closed, air can be pushed into the esophagus. Essentially air has to be swallowed to enter the esophagus.
Aerophagia is not a disease. It is a consequence of various factors, many of which are lifestyle factors, but in some cases aerophagia can stem from diseases of the mouth and airways. A person is more likely to swallow air in the following instances :
- Eating or drinking too fast
- Talking excessively
- Chewing gum
- Mouth breathing (habitual, due to nasal congestion or with labored breathing).
- Cigarette smoking
- Persistent coughing (deep breaths prior to coughing may lead to some air being swallowing)
- Missing teeth or incorrectly fitting dental appliances, like dentures
- Episodes of rapid breathing with anxiety (hyperventilation), in anemia (likely cause in pregnancy) and heart, lung or blood problems
Foods and Drinks
There are certain foods and drinks that are considered to be “gassy”. This means that consuming these foods and drinks increases the likelihood of gas buildup in the gut. In most cases however, these gassy foods are responsible for excessive flatulence (flatus or “farting”). It is only when these foods are chemically digested and acted upon by bacteria in the gut that the gas is released. By the it is too low down in the gut to be expelled as a burp.
However, this is different with beverages, particularly carbonated or aerated beverages. Soda pop (soft drinks), club soda and certain alcoholic beverages like beer are laden with gases such as carbon dioxide. The gas either improves the taste of the drink or arises as part of the manufacturing process. Gas within these drinks can accumulate within the upper gut until it the pressure forces it to be expelled as a burp.
Causes of Excessive Burping
The diseases that causes excessive burping can vary but usually involves conditions that affect the stomach, first part of the small intestine (duodenum), gallbladder and esophagus. However, it is important to not that most cases of excessive burping are not due to diseases but air swallowing and food and drinks as mentioned above. Therefore diseases causing excessive burping are collectively referred to as pathological causes, while air swallowing, lifestyle and dietary factors are known as physiological causes.
In this condition a portion of the stomach extends into the chest cavity through the esophageal hiatus (hole in the diaphragm). This affects the movement of food into the stomach and the normal mechanisms that prevent backward flow of stomach acid and enzymes into the esophagus. Belching is a major symptom of hiatal hernia. It is usually present after eating and only at certain times as sometimes the upper portion of the stomach may slide back into its normal position.
Some bacteria can live and thrive within the stomach. These bacteria may produce and release gas which could contribute to belching. However, the gas produced in these conditions is very small. Bacteria like H.pylori (Helicobacter pylori) are the main cause of stomach infection. Apart from producing gas, these bacteria also increases the stomach acidity. This also contributes to gas build up within the upper gut.
Food Intolerance or Malabsorption
When food is not digested or absorbed as it should, there remains a sufficient amount of nutrients in the gut for bacteria to consume. These bacteria produce gas as a byproduct which can contribute to excessive belching. The more common food intolerances and malabsorption includes :
- Lactose intolerance – milk sugars
- Gluten intolerance – wheat
- Fructose malabsorption – fruit sugar
- Sorbitol malabsorption – artificial sweeteners
Small Intestine Bacterial Overgrowth
There are very small populations of bacteria in the upper gut like the stomach and small intestine compared to the bacteria teaming in the colon. Apart from H.pylori, few other types of bacteria can exist in the stomach for prolonged periods. The small intestine is sometimes prone to an overgrowth of bacteria. This condition is known as small intestine bacterial overgrowth (SIBO). The large population of bacteria in the duodenum (first part of the small intestine) can produce excessive gas in the upper gut. This presents as excessive burping.
The pancreas is the main source of digestive enzymes that chemically break down different types of foods. If the pancreas is unable to secrete sufficient quantities of digestive enzymes then the food may serve as a major source of residual nutrition for bowel bacteria, similar to food intolerances and malabsorption syndromes. This may be seen with bile duct stones, pancreatitis and in rare cases pancreatic cancer.
Excessive Burping in Babies
Excessive gas in the upper gut leading to burping is frequently seen in babies. In fact babies need to be burped by parents and caregivers as their ability to expel the gas voluntarily is not the same as with an adult. Babies are more likely to develop excessive burping for the following reasons :
- Prolonged and repeated bouts of crying
- Drinking too fast
- Bottle feeding
- Impaired suckling reflex
Most of these conditions lead to air swallowing. Food intolerance and malabsorption syndrome may be congenital meaning that it is present from birth. It may therefore be evident in evidents as excessive burping.
Treatment and Prevention
There is no specific treatment for preventing excessive burping without conclusively identifying the cause. Excessive burping is a symptom and not a disease on its own and therefore treatment may vary.
- Simethicone may help to reduce the pain and discomfort associated with excessive gas.
- Effervescent fruit salts may increase gas in the upper gut but is sometimes used to relieve bloating and discomfort.
- Eating and drinking slowly, talking at an appropriate speed and avoiding cigarette smoking can significantly ease excessive burping.
- Carbonated beverages should be avoided altogether, and this includes beer.
- Foods that tend to exacerbate the burping should be avoided or consumed in moderation.
- Some probiotics like those containing Saccharomyces boulardii and Lactobacillus casei may be useful to some degree.