Letting the air out
Belching is a normal bodily function, but is it ever a problem?
- Reviewed by Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing
Belching loud and proud was a badge of honor as a kid. But once we're adults, belching (or burping) can be annoying and embarrassing in the company of others.
But people shouldn't be repelled by belching, as it serves an essential purpose. "Belching is a protective mechanism against the stomach getting overinflated from swallowing too much air," says Dr. Kyle Staller, a gastroenterologist at Harvard-affiliated Massachusetts General Hospital. "Think about how great you feel when you have a good belch."
Anatomy of a belch
There are two types of belching: gastric belching and supragastric belching.
Gastric belching is the everyday kind that most people experience. Every time you swallow, you take in a little air, and some of it travels down the esophagus and into the upper part of the stomach. When the stomach begins to stretch out from this air, sensors in its wall send signals to your esophagus. These signals tell the sphincter (the small ring of muscle at the bottom of the esophagus) to open, allowing air that has built up in the stomach to escape up and out as a belch.
A gastric belch often smells. "The air might have the odor of whatever you recently ate," says Dr. Staller. By contrast, with supragastric belching, swallowed air stays in the esophagus and never makes it to the stomach. The air gets quickly expelled in fast and frequent odorless belches.
People can swallow too much air for various reasons. For example:
Eating too fast. "When you eat quickly, you gulp more air, which is why people often feel the urge to belch after eating," says Dr. Staller. The solution is to eat slower so you swallow less air. Try this: At the beginning of your meal, set a timer for 20 minutes. Then pace yourself to make your meal last until the timer goes off. Chew each mouthful 30 times, and put your fork down between bites.
Carbonated beverages. Drinks like beer, soda, and seltzer can bring extra air into the esophagus and stomach. Gulping these drinks or using a straw can also increase air intake. Cutting down on carbonated beverages, drinking slower, and not using a straw can help.
Gum and hard candy. Chewing gum and sucking on hard candies also can lead to inadvertent air swallowing.
What if you can't belch?If you can't belch, you may have a condition called retrograde cricopharyngeus dysfunction (R-CPD), also known as "no burp syndrome." "We still have a lot to learn about R-CPD, as there are limited data on the efficacy of treatment or how to make a true diagnosis," says gastroenterologist Dr. Kyle Staller at Massachusetts General Hospital. R-CPD is believed to occur when the cricopharyngeus muscle, a sphincter muscle that sits at the top of the esophagus, cannot relax and, as a result, does not open to allow air to exit the esophagus. As a result, air accumulates in the stomach, esophagus, and intestines, causing bloating and pressure in the abdomen, chest, and lower neck, and gurgling sounds from the chest and neck. Because the air cannot leave through the esophagus, it instead exits the body as flatulence, which is often excessive. Treatment options for R-CPD include a botulinum toxin injection into the cricopharyngeus muscle or surgery to cut partway through it. Both of these approaches allow the muscle to relax and air to exit the esophagus. |
Sound of trouble
Belching is usually nothing to worry about, says Dr. Staller, but he suggests seeing your doctor if it becomes more frequent and causes distress and discomfort. Excessive belching is a common symptom for digestive disorders like functional dyspepsia (recurring symptoms of an upset stomach with no obvious cause) and gastroesophageal reflux disease (GERD).
"Belching could be a red flag if it accompanies other symptoms like sudden weight loss, difficulty swallowing, or blood in the stool," says Dr. Staller. Problematic belching also could be related to stress or anxiety, and treating these issues with psychotherapy and diaphragmatic breathing techniques often helps.
When you do feel a belch coming, don't try to squelch it. "There is little you can do to stop it," says Dr. Staller. "You can be discreet by muffling a belch or holding it in for a few seconds until you're in a more private setting, but eventually, your body will win."
So, when you must belch, let it out and just say, "Excuse me."
Image: © CSA-Archive/Getty Images
About the Author
Matthew Solan, Executive Editor, Harvard Men's Health Watch
About the Reviewer
Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing
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