IN some cultures, burping is considered a sign that the guest enjoyed the food served. This is especially so in South Asian homes.
However, in some European countries, it could be seen as a rude gesture.
Belching or also called burping, happens when the stomach or oesophagus fills with air. The escape of air from the stomach after eating with a few burps is normal.
However, when ingesting excessive air into the oesophagus, aerophagia can happen. Aerophagia can happen when talking and eating at the same time, eating or drinking in a hurry, chewing gum, drinking using a straw, smoking cigarettes and a few other medical reasons.
Repeated swallowing of air into the oesophagus and then belching to release it is called habitual aerophagia.
In aerophagia the patient may also complain of excessive belching, bloating of the abdomen, gas and excess flatulence.
Belching may occur many times, up to 20 to 30 times in a few minutes.
There are also other conditions that can cause excessive belching. This includes acid reflux or Gastro-oesophageal reflux disease (GERD), functional dyspepsia where the patient complains of additional symptoms like pain over the upper abdomen or feeling of fullness after eating a normal sized meal, slowdown in stomach emptying which is called gastroparesis, as well as mechanical blockage of the intestine.
Management of excessive belching includes avoiding habits like talking and eating at the same time, chewing gum and sucking candies and stopping smoking.
Anyone with excessive belching should see a doctor if there are symptoms suggestive of habitual aerophagia such as weight loss, heartburn or regurgitation, difficulty in swallowing, and if the belching is troublesome and does not respond to lifestyle changes as outlined earlier.
Bloating refers to a sensation of fullness in the abdomen and flatulence refers to the passage of rectal gas.
Some people who complain of abdominal bloating do not have excess gas compared to others. However, they seem to be more sensitive to even normal amounts of gas compared to others.
Some people have weak abdominal muscles and appear to be bloated especially after pregnancy. They think it is gas, but the distension disappears when they lie flat, so it is due to weak abdominal muscles rather than gas.
There are several causes of bloating due to gas and increased flatulence which include swallowing of too much air while eating or drinking, dietary reasons such as a high FODMAP diet or consuming a diet rich in fatty foods, too much fibre in the diet and many other causes that the doctor may discover.
If symptoms of gas and bloating occur less than 30 minutes after eating the problem is usually from the stomach and can be due to functional dyspepsia or a slow- down in stomach emptying called gastroparesis.
If symptoms of gas and bloating occur 30 minutes after eating, the problem is usually from the small intestine and can be due to FODMAP foods, celiac disease, small intestine bacterial overgrowth and irritable bowel syndrome.
To manage your symptoms try to avoid swallowing too much air, take a low FODMAP diet, reduce the intake of fatty foods, modify your fibre intake, exercise and consume probiotics for one month. Most importantly, consult a doctor and dietitian.
By Dr Madhav Kudva (Gastroenterologist) – NST