constant belching...gerd causing aerophagia?

[wassupwassabi]

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?

[kimo78]

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.

[raul1]

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.

[djtrackie]

You guys find the problem yet?  Because i think i have the same thing... i'm also aroudn the same age as you (22)

[gasburger]

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.

[yoshi]

yyy

[Kevin Pho, MD]

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.
http://www.straightfromthedoc.com