Avatar universal

constant belching...gerd causing aerophagia?

In early March, I started to get really nauseous after eating food.  Then about 2 weeks later, in addition to the nausea, I started producing gurgling-sounding belches which I feel in my chest and throat.  This belching would occur for hours after I ate anything.  I would "belch" every few seconds and it continued for several days, at which point I went to see a doctor.  The doc thought it was due to GERD (even though I hadn't had frequent heartburn) and gave me prilosec.  After using it for 2 weeks, my symptoms hadn't improved, so I had blood tests and stool tests done; the blood tests showed elevated bilirubin but otherwise normal (doc thought it was Gilbert's), and stool was normal.  Then I got referred to a gastroenterologist.  Took Aciphex for 2 weeks, also with no effect on the belching.  I also began to feel pain in my chest a lot and felt some difficulty breathing.  
I had an upper GI done then and it showed no stricture or hiatal hernia, but showed moderate reflux.  
Then he put me on Reglan (5 mg doses) and I got off Aciphex.  Reglan originally helped a bit but got less effective.  After about 2 weeks, the belches started to cause a burning in my throat.  In addition, Reglan caused very painful dry mouth so I stopped using it.
In early May, I went home to see my family doctor.  Then, I got on Protonix and reduced Reglan to 2x/day at most.  Like with Prilosec and Aciphex, I didn't have any heartburn but I still had constant belching, nausea, and feeling of chest tightness.  I don't think the chest tightness is a cardiac problem; I'm 21 years old, non-smoker, 150 lb, plus I had an EKG (normal).  I went to see another GI doc and had several more tests done:

Endoscopy - showed mild inflammation around lower esophagus and in stomach, biopsies were negative.  I'm surprised there was any inflammation because I didn't have any heartburn.
Stomach emptying scan - 86 minute halftime (doc said under 90 min was normal)
Chest x-ray and CT scan of chest and upper abdomen - normal
Esophageal manometry (results aren't in yet)

The belching/chest tightness now occurs all the time.  I belch well over 1000 times a day, even though I eat very little.  The only way to make it stop is to lie down.  The specialist said that since PPIs and Reglan haven't done very much I should consider having stomach surgery to fix it.  I went to get a second opinion and the doc noticed that a large amount of air was going through my esophagus when I breathe (not swallowing!), he said that's the only way I could be belching to such an extent.  Belching doesn't stop even when I breathe through my nose or clench a pencil between my teeth, techniques to control aerophagia.  I'm literally inhaling air into my stomach when I breathe and constantly belching it and I don't know how!  So frustrating!  Why? Does this mean both sphincters are busted?  Would a fundoplication help or would I likely have gas-bloat?  And would stretta or enteryx be effective/safer to try? Advice?
58 Responses
233190 tn?1278549801
You have had a pretty comprehensive evaluation for your symptoms.  The other test I would consider would be a 24-hr pH study to document the severity of the reflux.  If there continues to be reflux despite appropriate medications, then surgery can be pursued stronger.  Regarding the stretta or enteryx procedure, that would be dependent on the severity of the reflux as well as the skill of your physician.  The data regarding these procedures are still emerging, and the long-term efficacy has not yet been established.

Another consideration would be irritable bowel syndrome - which can cause the sensation of increased bloating.  If the 24-hr pH study is non-revealing, you can consider optimizing treatment for IBS - such as antispasmodic agents.

These considerations can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Avatar universal
i had a fundiplication for gerd and had gas bloating for a couple of years - was painful for a couple of months - gas working it's was DOWN and out. Eventuially the LES slackened up enoughto allow belching UP - a great relief. I had to learnt to chew very throuroughly and try not to swallow gas - but things are back to normal now. I would be sure to check out all the risks and side effects of the op before going ahead.
Avatar universal
So sorry to hear of your problems.  I think I can only be empathetic towards you, regarding the lack of the medical professionals to diagnose, and therefore be able to treat you.  

Six weeks ago, I myself have been experiencing trouble in my GI, starting in my throat, where I found it difficult to breath, like I would choke if I tried to eat anything.  I went to an internal medicine MD and he asked me what I went to him for, and have I seen a GI?  He didn't understand anything about not being able to swallow, and difficulty breathing.  All he did was accuse me of being confusing and not telling him what was the matter.

I had an endoscopy as well, which showed nothing.  Still, I couldn't eat.  So I continued losing more weight.  Everything else was fine-blood pressure/pulse, because I am ordinarily a strong, healthy person.  I dropped 30lbs in 1.5 months.  I was only 160lbs before, so I lost 30lbs of valuable, healthy muscle/body weight.  

Another GI looked at my tests and said, "The tests show nothing abnormal, so what's the matter?"  What a jerk!  That's why I am paying him $400, and I only got 4 minutes with him, before he just said I need more tests.

Now I'm having abdominal pain, yellowing of hands, tingling, which is coming from my losing weight, and not from the original problem.

So, now I have these other issues that have resulted from where  the doctors couldn't find original problem.

Modern medicine, even with all it's advancements, is still run by imperfect, not omniscient people, who most of the time can only treat what they see, and are poor investigators.

I'm just sitting here waiting for a gallbladder attack, or something worse, so the ambulance can get me in the hospital and someone will take seriously what I have been trying to tell them-that something isn't right in me!  

Good luck and God bless you.
Avatar universal
have you been tested for hector pylori bacteria??
you can get a simple breath test in doc office these days.
symptoms for too much acid and too little acid are similar,one happens right after you eat(not enough) and one happens 2 hours after you eat.

Avatar universal
I'm pretty sure that the endoscopy biopsy checked for H pylori, which came up negative.  I haven't done a breath test, but I have tried health foods such as P73 oregano which are effective against many infections including h pylori.
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All I can say is that whoever commented how they can't get an answer could have been me.  I'm in the same bloat.  Extensive bloating, gas, belching has been going on for years and no-one has been able to get to the bottom of it.  I've had gallbladder removed and things are no better or no worse than before I had it removed.
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You guys find the problem yet?  Because i think i have the same thing... i'm also aroudn the same age as you (22)
Avatar universal
My belching started suddenly two years ago.  I am 52.  I have always been extremely fit, running from 40 to 60 miles per week and participating in ultramarathons regularly.  I tried avoiding food allergies, adding enzymes and hcl, changing eating and drinking habits, herbal remedies with little and only temporary relief.  My stomach is almost permantently distended now by gas, which is only relieved by fasting for 24 hours.  It frequently interferes with my running.  After hours of belching after dinner, I sleep normally only to awaken with more massive belching, and a residual feeling of bloated stomach.  If I skip breakfast and lunch, by afternoon the bloating is gone and my stomach is nearly as flat as it was in my late forties. I am sick and tired of hearing about "swallowing air".  I did not suddenly start swallowing air 2 years ago.  Nor did I change my diet.  Nor did I change my lifestyle.  I have never had heartburn or reflux or any sort of pain other than that caused by distension due to gas.  I have never had any surgeries or illness other than a cold every couple of years or so.   I am desperate to regain my normal feeling of health.  Please help.
Avatar universal
I am 36 years old and have been experiencing the bloating, constant belching and (seldom) nausea, for about six years now.  I do not know what it can acutally and truly be attributed to.  It does appear that it occurs when I eat certain types of food or the pace in which I eat.  However, it does occur intermittently with bland or plain food as well.  I got checked out and did a couple of procedures to see what was causing this but never received a straight answer.  It more or less ruled out certain illnesses but did not help my situation.  Tell me more as I am looking for feedback.
Avatar universal
Hi to all

I started 7 years ago (within days after an extreme hard push on my abdomen during a massage) with this vague uncomfortable, pulling-like sensations in my throat from approx.
Avatar universal
Well, this post seems to be pretty popular... I just thought I'd update.  One of the docs I've seen put me on Zelnorm... it's more effective than Reglan for controlling the belching, but it apparently doesn't do much for the aerophagia as I still belch some and get more bloated.  I've tried acupuncture treatments as well but that hasn't really done much.

Since I seem to have stumped the medical field I contacted a "medical intuitive" who said that my problem is exacerbated by part of my thoracic spine being out of place which is pinching/disrupting nerve flow... she recommended seeing a chiropractor and this might help my problem.  I haven't tried it yet but I plan to... I just thought I'd post this for everyone who is struggling with this problem because it might be worth a look... if you go on chiropractic information websites you'll find that spine misalignments can cause digestive problems like heartburn and dyspepsia (maybe has something to do with reduced nerve flow causing the lower sphincter to weaken?)
Avatar universal
As you're puzzled by the way aerophagia, some of my thoughts on that. I know little to nothing about how about HH or GERD indirectly or directly causes belching, so I have to be very modest and careful on that.

But apart from these in some patients being the cause of their belching, I'm rather skeptical about the fact that many people are diagnozed with aerophagia as the cause. Just read the threads on belching in this forum... Recent research showed that patients with bloating symptoms often have retention of gas in the small bowel, and even possibly reflux from gas in stomach. So, personally I think this could in many people be a cause of gas related symptoms.

I also have this chest tightness, increasingly after meals. When I inhale very deeply through my nose, it induces a belch, yes. Obviously I'm not literally swallowing air then, but there's a theory that while inhaling, air is sucked into the esophagus and into the stomach and is expelled immediately as a belch again. If I breathe in the same way many times after another, at some point there's usually no more belches coming... So, why suddenly no more? And there's relief of chest tightness/discomfort. For me I'm sure that this theory doesn't apply in my case.

In my case at some point it became very clear the belching was type of food dependent (carbohydrates and fats worse than veggies and proteines). I did a diet for a week and the belching was significantly less. This strengtened me in that it is not aerophagia.

Sometimes an up going movement of the larynx just before a belch is said to be an act of air swallowing. But each belch reflex is preceded by a rising of the larynx. That's part of the reflex because it makes the way clear for the up going content. Look in the mirror or put one hand on the larynx, and observe on what exactly happens in the here-and-now, without influencing... Then you'll observe it's a reflex and no strange maneuver or act of swallowing. The larynx goes up with swallowing, but also with belching, vomiting etc. (a cow is an animal, but not all animals are cows). Moreover, a swallow is much less ml than a burp.

I experience involuntary burps induced by many daily movements of my body or reflexes (bending forward, lifting my arms above my head, after coughing, after sneezing, pushing on my navel area etc.). By that I found out it has to be something with my abdomenal area. So no air swallowing or strange maneuvers that cause the belching, just involuntary reflexes in my case...

I hope this can help you in getting more clearity where the cause of your belching lies.
Avatar universal
This was certainly an interesting site to come across.  I have been dealing with the same excessive belching issue on and off for the past  6 years or so.  I have episodes 2-3 times a year that last 1-3 months. The most recent has been on since April.  When it first happened I had a range of tests like the rest of you- upper and lower GI, pelvic ultrasound, tested for H. pylori.  In the past Prevacid has helped but this time around it does not seem to be doing much.  Last the person in the last entry my condition is worsened by bending over or lifting. This makes me think there is something mechanical going on, i.e. not just chemical (digestive).  Also, if it was just about swallowing air why would lying down curb the symptoms?  Interestingly, I will have a day or here and there where it seems like things are back to normal and then the next day it starts up again.

I have a few questions for people who are experiencing this:

Does anyone believe any of this is stress-induced?

Is it postural for everyone? i.e. goes away when lying down and worse with a lot of bending?

Have people tried to omit coffee and does that help?

Avatar universal
I was very glad to find this site.  I have been belching for 2 weeks and am so frustrated.  I too have acid reflux and am on Protonix.  For some reason this started 2 weeks ago, and like some of you I have been belching non stop.  I can relate to the person who said they belch 1000 a day.  

Please everyone keep posting what the doctors discover for you.  I was a little take back to hear some of you have had this problem for years.

Tomorow I am going to call my dr and get a change for the medication.  I am alergic to aciphex.
Avatar universal
I am 61 years old. My symptoms started about a year ago. I always feel as if I just ate a very large meal and my stomach is uncomfortably full, even when I wake up in the morning. One cup of coffee produces instant belching.  

I've always had a flat, muscular stomach, but since the onset of my symproms I look like I have a "beer-belly". I've always been a breakfast eater but nowdays I have no interest in eating breakfast or lunch. I eat dinner not because I feel hungry but because I know I need the nourishment.

My doctor suspected I was infected by H Pylori and an Endoscopy revealed that he was correct. After four rounds of various antibiotics another Endoscopy revealed that the H Pylori is finally gone. But, I still have the constant bloated feeling.  Eating yogurt is helping to reduce the bloated feeling slightly.

The last round of antibiotics I had was two months ago and I've yet to notice any improvement in my condition.  Very annoying indeed! If anyone finds a magic cure please let the rest of us know about it.

Avatar universal
In my case it's digestive I think. It's just that using the abdominal muscles (while lifting, bending) pushes on the intestine where gas has accumulated. Normally, in healthy subjects, any gas should be absorbed in small intestine or propulsed rather quickly towards large intestine (and evacuated). That's why healthy person can bend and lift normally, and doesn't burp... Even if one would swallow somewhat more air than normal, the gas should be transported and/or absorbed through intestine. Only swallowing air can sometimes leads to increased flatulence. More and more I'm convinced that, if people not swallow air in an extreme way, any symptoms like bloating, belching etc. could point to an intestinal disorder of impaired handling of normal amounts of gas. There is research on that.

At least I don't observe any variation with stress. I wish it did, so I could work with that. I practise meditation for 2o years, live non-stressful life etc. etc. Personally, in my case I think it is not stress-induced.

Omiting coffee doesn't give any relief either.
Avatar universal
tears are swelling up in my eyes.  i thought that i was the one person who was experiencing the belching drama.  i am in my 6 years of trying to determine what is going on with me.  i've tried it all (diet, meds, chiropractor, meditation, accupunture), so I am waiting in my belching mode for relief that I am hoping will come from this forum.
Avatar universal
Most people in this discussion seem to be on some proton blocker (Prevacid, Nexium, etc).  One thing that appears to be effective is to take the pill first thing in the morning and then wait for at least an hour before you eat anything. I used to cut corners and only wait 15 or 30 min but I think giving it a chance to work without diluting it by food really helps.

Let me know if you try this and it work- as it appears we all have to work out our own treatment plan for this annoyance.
Avatar universal
Well, this is certainly interesting.  Sorry to hear you are all suffering from the same or similar thing I have been for about 4 years now but it's nice to know I'm not alone.  In my case, endoscopic exam showed evidence of hiatal hernia and mild acid reflux damage.  Doctor prescribed Prevacid but the problem isn't that I have an acid problem and I have since had my gall bladder removed as testing showed it to be 90% clogged - no help though.  My condition began with pain and fullness followed by a belching fit a couple of hours after meals and has deteriorated over the last four years to extreme muscle spasm on the left side of my chest [you'd swear you're having a heart attack!] and I can literally belch for hours now.  This appears to be some sort of diaphramatic spasm that results in literally inhaling air into my stomach.  I'm wondering if the catalyst wasn't the hiatal hernia in my case.  It is aggravated by carbs and starches - not so much by veggies and meats.  Sad thing is that I use to swim a mile Tues/Thur and lift weights Mon/Wed/Fri but I had to give it all up because upper body exertion aggravates the **** out of this bizarre condition too.  At times it gets so severe that I develop a really bad case of malaise.  I'm considering seeking out a laproscopic hiatus surgeon at this point.
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In my case for 7 years I
Avatar universal
For me, this just started last evening.  We were out to dinner and after having a roll, I started coughing.  I thought perhaps something might have gone down the wrong way.  Once we got home, I started belching but everytime I belched, some of the food would come up as if I was throwing up.

I woke up this morning and my throat felt awful.  I belched and instead of food coming up, I had heartburn.  I took two Rolaids.  Then I ate a bagel for breakfast and now I'm belching again and the bagel is coming up with each belch.  I have to work today and I can't imagine what I'm going to do all day as I belch and have food in my mouth that I will immediately have to spit out.

Please help if anyone has ever had this part of it.
Avatar universal
Yeah, food comes up for me too... taking Reglan helps a "small" amount with the regurgitation but not significantly.  Although I've heard it's worked well for other people, you might ask your doc about Reglan.

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