Belching, Air Swallowing, and Hiccups

Slide 3.

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That being said, it is not necessarily an easy problem to take care of because some of these people are very fixated by the behavior. Sometimes the belching is exacerbated by stress, and there may be other behavioral components that you can identify. We have seen this in some eating disorders -- that there are psychological components that must be explored.

How do you deal with it? The surface tension-reducing agents, such as simethicone, won't work for this type of belching.

Pharmacologic agents may be most effective in managing the neurocognitive symptoms if any psychiatric disturbances are identified. If so, the patient should be referred to a psychiatrist. Some patients will identify a specific crisis during which the belching behavior began. Counseling, cognitive-behavioral therapy, or a neuropsychiatric evaluation might be necessary.

There may also be a strong role for a speech pathologist. The belching is not being induced by swallowing air, but rather by sucking air into the esophagus. Postlaryngectomy patients are taught by speech therapists to use eructation to phonate after their surgery, so they may also be able to use this knowledge to help repetitive supragastric belchers to unlearn this behavior. There are no good controlled data yet on this, but it is how I manage refractory patients.

Other treatments that have been tried include hypnotherapy (although there are no controlled data on this) and sedatives; however, I prefer not to sedate patients to treat supragastric belching. Few diagnostic tests are helpful.