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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?
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Hi there, this is the first time I found this forum.   I have had this 'constant burping' for about 5 months now and I am now ready to see a Gastroentologist (sp?).    I couldn't believe there were so many others with this problem!!!!  :>O   It is driving me crazy (& my family as well).   It came on out of NOWHERE and I haven't a clue what is causing it.   No, I did not suddenly start "swallowing more air" at the ripe age of 51!   Nothing has changed in my life - except this constant belching.    I woke up this morning and the belching started again.    Can't take it anymore!
I too have noticed that when I am out with others or even sitting in the doctor's office of an hour, NOT ONE  BELCH, but the minute I am leaving work and walking home, the belching starts up again. HELP!!!!!!!!!!!!!!    
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Avatar universal
I definitely agree that there are two kinds of burps - the ones that you just can't stop (those to me, tend to be the kinds that are meal/food related and larger/louder) and then there are the ones that can be voluntary and these are the troublesome ones for me.  And yeah, for me too, I feel like there's a bubble or "mass" in my throat - near the base of my neck (does that make any sense?).  I know that I will voluntarily create a burp just to try to release that "bubble" in my throat.  But then there are plenty of burps that I do without thinking and I'm wondering if those are still voluntary, but that my mind/body has gotten so used to trying to release that feeling in my throat that it automatically knows what to do now.

As with the journaling, the only problem I'm finding is that the burps have become so common and ingrained in me that I no longer even notice that I'm burping.  And when I do realize it, I can't even remember how long I've been doing it.  And so far, the only thing that I've noticed that really increased my burping was chocolate...and I'm not giving up chocolate!  

I've also noticed too that if I do say to myself "hey, I'm not burping now" then a few seconds later I'll start burping again.  

So, for me, I'm coming to the conclusion that this weird feeling in my throat and consequent need to burp is always there.  That it's been there so long now - 4 years - that I've gotten so used to it and I can control it to a point, but not so much that it will go away for good.  

I am happy that we have this forum and hopefully, can try to get someone out there to take notice of us and help us out.  Like someone said, it's not a life or death issue, just a quality of life issue.
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Avatar universal
I am now focusing on the carbohydate issue we have identified.  Checking further on the web I found the following:

As stated earlier, intestinal bacteria produce gas from food that is poorly digested and absorbed, particularly carbohydrates and fiber. The most common carbohydrates that are poorly digested are lactose (the carbohydrate in milk), sucrose (the carbohydrate in corn syrup), and sorbitol (a low-calorie sweetener). A reasonable first approach to the problem of excessive gas is the elimination of each of these carbohydrates. Avoidance of the offending carbohydrate should reduce the amount of flatulence and distention. Hydrogen/methane breath tests also can determine accurately which carbohydrates are poorly digested.






Gas accumulates in the stomach and intestines in only one of two ways. The gas is either air that is swallowed or it is produced by intestinal bacteria. Bacteria generates gas from food that is eaten but not digested and absorbed. The gasses produced by the bacteria are primarily hydrogen and methane.

People have excess gas because they have gas-producing bacteria that generate more gas than the bacteria of other people, have more of the gas-producing bacteria than other people, or have the bacteria in their small intestines. (When present in the small intestine, bacteria digest ingested carbohydrates before they can be digested and absorbed by the small intestine.)

What are non-drug treatments for gas?

For the rare person who swallows air to the point of discomfort, techniques are recommended that are supposed to reduce the amount of swallowed air. These methods include chewing particularly well and then swallowing with the mouth closed and sucking liquids only through a straw. It is not known if any of these techniques actually reduce air swallowing.

As stated earlier, intestinal bacteria produce gas from food that is poorly digested and absorbed, particularly carbohydrates and fiber. The most common carbohydrates that are poorly digested are lactose (the carbohydrate in milk), sucrose (the carbohydrate in corn syrup), and sorbitol (a low-calorie sweetener). A reasonable first approach to the problem of excessive gas is the elimination of each of these carbohydrates. Avoidance of the offending carbohydrate should reduce the amount of flatulence and distention. Hydrogen/methane breath tests also can determine accurately which carbohydrates are poorly digested. Another reasonable first approach is a low-fiber diet.

What over-the-counter medicines are there for treating gas?


Alpha-galactosidase: Alpha-galactosidase is a rather recent and novel approach to the problem of excess gas. Alpha-galactosidase (Beano) is an enzyme that breaks down carbohydrates and fiber. It is derived from a mold and is taken as a tablet or as drops added to food (after the food has cooled since heat inactivates the enzyme). By assisting with the digestion of carbohydrates and fiber, there is less for the bacteria to digest and convert to gas. Diabetics should use alpha-galactosidase with care since the carbohydrate digested by the enzyme is absorbed into the body and may increase blood sugar levels. Patients with galactosemia, a genetic disease in which blood levels of galactose (a carbohydrate) are elevated, should not use alpha-galactosidase because galactose may be formed by the enzyme in the intestine and then absorbed. This may further increase the levels of galactose in the blood. There is the potential for allergic reactions to alpha-galactosidase among patients allergic to molds.
http://www.medicinenet.com/script/main/art.asp?articlekey=10521


I have purchased and tried the Beano and with a very limited experience I can say it seems to be working.  You must take the supplement right before you eat and take it each time you eat.  I agree that the name of the supplement (Beano) is a bit off-putting but the rationale makes sense.  If you find it works it could get expensive so I found an internet site where you can buy a generic version.  Here is the link:http://www.bean-zyme.com/?referrer=Google.

Give it a try and let me know your experience.
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Avatar universal
To burpmaestro
I also experience quite often the need to belch in public and have to suppress it. But what I tried to say was that because you're e.g. very busy talking, your consciousness generally notices it later (than at home alone) that the gas is building up and with its uncomfortable feelings and the need to belch/burp... But at some point the you are experiencing the strong need to belch, and then (if in company) you suppress it... So I completely recognize what you write about belching in the bathroom, a few dozen belches, that - when I would have been alone - in my case have come out sooner already; not only because social reasons, but because of experiencing the sensations! BTW I don't have any stool changes like you describe, and in my case taking additional pancreas enzymes didn't have any effect... But I think it's true from what I've read and heard that a deficit of these pancreatic enzymes can be one of the causes of (bad digestion?) and burping.

To bizzy
It seems obvious, now... But it took me a long time, because literature and what gastro MDs say in daily practice or write about this is definitely 'not always' correct (this is an understatement). But I accept it is difficult because it's on the border of involuntary and voluntary. Normal illnesses are just there, although you perhaps can influence it with your mind. Anyhow, the fact that your burps are mostly voluntary (as with me) doesn't make the problem less real or 'in our head'. I'm 100% certain I have a gas problem (most probably in the direction of what I wrote in Comment 21) and not imaginary thing in my head.
Interesting other fact in this context: I noticed over the years that, immediately after experiencing strong pulling, nausea-like uncomfortable sensation in my throat, there's sometimes an extra involuntary reflexive inhalation, immediately followed by an explosive belch (like throwing up)... This is not sucking in air into the stomach while inhaling, as is suggested sometimes! I found a source (more neurologic/reflexive process description of gastrointestinal matters) which describes exactly what happens when you vomit, and e.g. food is transported back up in intestine (if not from the stomach) etc. Part of that reflexive process is a deep inhalation, which probably does a 'clearing-up' or so in the intestine when there's something 'stuck' there or has to come up out. Wonderful stuff isn't it, but complicated...

To bizzy & burpmaestro: I'm quite surprised you also seem to have more problems with the carbs, like me an only a few others reported in the threads I have seen here in this forum. That's interesting and hope giving! Because we share a common thing... I read your 'entire night on the couch last Thursday night' respectively 'definite a quality of life issue'.. Same here with me, so this is not a minor issue for us.

A guy NeverGivingUpNever - who posted some comments in the thread 'burping' in this forum - and myself, we both feel we have to start up something, to join hands, to get together. Like to share personal experiences and provide moral support, to share sources of information, and perhaps to formalize an association of patients with this same or similar problem, that might help us to obtain formal medical help in the future. We will probably coming up with some ideas shortly.

I hope we can stay in touch via this thread, or even if at some point this thread closes for comments. My email address is in a previous comment.

Take care, Ted

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Avatar universal
You are very correct.  Now that you state the facts, it seems obvious. It is mostly voluntary.  When I an occupied I do not focus on the discomfort and therefore no belching unlike when I am alone, in the car, etc.  

I have only started to keep a journal but based on just a 24 hr observation, I feel carbs (particularly, sugars) are a trigger but it may be too early to be stating that.  

In any case, I am finding this dialog provides me good moral support.  Though the situation certainly is not life threatening, it is a definite quality of life issue.
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Avatar universal
In my case, it's not a matter that I don't need to belch in public; I simply consciously suppress the belching in public because it's disgusting.  The bloating will build though until I literally have to go to the bathroom at work, sit in the stall, and have a few dozen belches.  I just spent the entire night out on the couch last Thursday night propped up on 3 pillows on my left side belching.  All I had for dinner that evening was about a half cup of beef stew, a couple of bites of potato casserole and a biscuit.  I'm 6' tall, weigh 180 lbs., and I don't tend to eat junk. Acid reducers only help from the standpoint of keeping acid down so when I belch there's less reflux to cause more problems.  I've had my gall bladder removed but still occasionally have the same pains that I had when I had the plugged gall bladder.  Journaling is always good but, aside from knowing that carbs will exacerbate the problem more than meats and veggies, I have found no particular food catalyst.  Eliminating carbs, dairy, or caffeine does not eliminate the problem.  Curious: Does anyone out there have yellowish bowel movements after you've had a really bad belching day/night?  I've read this can mean the pancreas is not functioning properly.  If that's true, then you wouldn't properly digest your food, and the food sits there and rots.  Sad thing is that when I share all this with doctors I get that "you're an engineer aren't you?" look followed by the "how's your stress level?" speech.  I know this is physiological though.  Problem is, how to prove it?  Or maybe my mother didn't breast feed me long enough when I was a baby so, now at the age of 46, I have chronic belching :>).
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Avatar universal
My thoughts on the burping: conscious act or not? From what I have read and my own introspection. Correct me if necessary...

Burps are either involuntary or voluntary.

When I feel an uncomfortable sensation in my throat or in my abdomen, by an act of will power I can induce a burp, trying to get rid of the uncomfortable feeling. In my case this helps and relieves me of gas in my (as I recently discovered) in the intestine. This burp is called a voluntary burp, it's in fact a manoever, something done by an act of will power.

But quite often burps come out 'spontaneously' are a reflex. In some cases it happens so fast and strongly that you can't stop that belch. In other cases you feel/observe it happening, you could even surpress it if you would like... But it is still a reflex and not a conscious act of will to induce a burp!!! These kinds are all involuntary burps. It's like with sneezing: sometimes you sneeze very loud and forceful, you couldn't stop it... Other times you feel the itching and the sneeze getting on its way etc. If you wanted you perhaps could supress it, but that doesn't mean it's not an involuntary reflex. It's a chain of sensations, reflexes, but not a manoever by an act of will power.

I've seen many gastro MDs who don't distinguish and think all burps are voluntary. This is definitely not true/correct.

What happens when I'm with friends or teaching and with all my attention and very busy talking/teaching/explaining? Then there is no space to consciously feel the discomfort or sensations that I normally, when I'm alone, would feel - but without influencing it or inducing it - and that would lead to an involuntary burp, a reflex. Same would be with the sneezing. But if it would be very strong it can sometimes break through, and even when you're with others can lead to a burp.

Are you experiencing it in the same way?
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Avatar universal
jpc
I'm going to keep notes too.
btw I'm 42, pretty close to my proper weight, and am fit and healthy (apart from this problem). I don't get heartburn very often, unless I eat very unwisely and lie down too soon afterwards. Mostly I just belch furtively, even on an empty stomach. But certain foods definately make it worse for me. Also, someone else mentioned giving up swimming - I used to swim in a squad for an hour twice a week and had to stop because I'd get such bad stitches, even though I was careful not to eat for hours beforehand. Now I do brisk walking and workout on the weights machines at the gym, and both of these are ok.
I'm going to cut back on the things they say are bad for you if you have a weakened lower oesophageal sphincter (LES). This is what my doctor thought I have, based on my symptoms and the way it came on after my fourth pregnancy.
here's a quote from a web site on gastroesophageal reflux (GERD) "Eating foods or drinking beverages flavored with spearmint, peppermint, or other spices with strong aromatic oils causes relaxation of the LES and can contribute to symptoms in people with GERD. Chocolate also relaxes the LES and can cause heartburn.Acidic beverages like juices, coffee, and tea have also been linked to increased heartburn pain, as have carbonated drinks, alcohol, and milk."
Out of that list, its the coffee, tea and chocolate that I really resent having to give up!
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Avatar universal
I am in on our suggestion to keep a journal. I will start today. I think we need to pay attention to: when it starts, stops, what we eat, medications, also relation to physical activity.
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