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Belching

Belching. J.G.S. Breed, MD PhD Consultant endoscopist Internal medicine. Learning/lecture objectives. To understand anatomy and physiology of the oesophagus. Learning/lecture objectives. To understand anatomy and physiology of the oesophagus To understand different types of belching.

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Belching

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  1. Belching J.G.S. Breed, MD PhD Consultant endoscopist Internalmedicine

  2. Learning/lecture objectives • To understand anatomy and physiology of the oesophagus

  3. Learning/lecture objectives • To understand anatomy and physiology of the oesophagus • To understand different types of belching

  4. Learning/lecture objectives • To understand anatomy and physiology of the oesophagus • To understand different types of belching • To give appropriate advice to patient and family

  5. Belching=eructation • Occurs 25-30 times a day • Is a physiological proces • Each 10 ml fluid goes with 8-32ml of air • Occurs involuntarely • No difference in air bubble size

  6. Two types: • Gastric belching • Supra-gastric belching.

  7. Gastric belching

  8. Gastric belching Gas accumulation Stretchingreceptors Opening of the LES (TLESR) Gastricdecompression Opening of the UES Sound

  9. Supragastric belching • Expulsion of recently suctioned air. • Not swallowed air! • Subsequent expulsion using straining • Result of human behaviour • Initially induced consciously, later • uncontrolled

  10. Gastric vs supergastric belching

  11. Excessive belching • Sometimes up to 20/min • Always supra-gastric • Never during sleep • Never associated with organic complaints

  12. Functional supragastric belching

  13. Therefor: • Dimethicon and simethicon useless

  14. Therapy excessive supragastric belching • Explaining, creating awareness of mechanism • Speech therapist

  15. Belching and GERD • Belching and GERD have same mechanisme • Patients with GERD belch more • Belching does not cause GERD

  16. Inabillity to belch

  17. Inabillity to belch

  18. Take home messages: • Belching is a normal physiologic phenomenon • Excessive belching is a behaviour disorder • Seldomly associated with organic disease. • So refrain from medication or endoscopy • Hetero-anamnesis will give you the clue

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