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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?
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?
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?
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?
I find social situations do seem to inhibit the belching, and that getting in the car can bring it on - roads that are a bit bumpy make me worse. I've had this condition for 4 yrs now, since my last child was born. (I was very disappointed to find that the indigestion didn't end when the pregnancy did!)When I mentioned it to my GP she basically advised me to go away and eat bland, low fibre food for the rest of my life. But I think its time to have some tests done and see if there's a simple cause.
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!
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!
I'd like to make a suggestion...I'm sure some of you have already done this but I think it would be helpful if we keep journals for a few weeks that document everything we eat, when the burping starts, when it stops, our activities, etc. Then perhaps we can find a common link among us. Anyone in?
From what I've read on this post, it seems that going to the doctor will only lead to a slate of pointless and negative tests or plain confusion on the doctor's part. But maybe we'll be able to solve this puzzle on our own...this is frustrating!
From what I've read on this post, it seems that going to the doctor will only lead to a slate of pointless and negative tests or plain confusion on the doctor's part. But maybe we'll be able to solve this puzzle on our own...this is frustrating!
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.
I just read your comment that the burping stops when you are in a group and I have to say that is the same for me too. I have no explanation but it does suggest that there is something conscious about the burping. I can be in a meeting for 2 hr and not burp but get in my car to go someplace else and burp 20 times. I have tried to pay attention to whether or not the burping actually makes me feel better i.e. relieves gas and it does. So, it makes sense there is a conscious component. Unfortunately, that does not answer the question about what is underlying the behavior to begin with.
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