J Neurogastroenterol Motil  https://doi.org/10.5056/jnm20114
Characteristics of symptomatic belching in patients with belching disorder and patients who exhibit gastroesophageal reflux disease with belching
Shin Ok Jeong,1 Joon Seong Lee,1* Tae Hee Lee,1 Su Jin Hong,2 Young Sin Cho,3 Junseok Park,1 Seong Ran Jeon,1 Hyun Gun Kim,1 and Jin-Oh Kim1
1Institute for Digestive Research, Digestive Disease Center Soonchunhyang University College of Medicine, Seoul, Korea; 2Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Gyeonggi-do, Korea; and 3Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine. Cheonan, Chungcheongnam-do, Korea
Correspondence to: Joon Seong Lee, MD
Institute for Digestive Research, Soonchunhyang University College of Medicine, 59 Daesagwan-ro, Yongsan-gu, Seoul 140-743, Korea
Tel: +82-2-709-9691, Fax: +82-2-709-9696, E-mail: joonlee@schmc.ac.k
Received: May 22, 2020; Revised: August 2, 2020; Accepted: August 16, 2020; Published online: January 11, 2021.
© The Korean Society of Neurogastroenterology and Motility. All rights reserved.

Abstract
Background/Aims
Belching disorder (BD) is clinically distinct from gastroesophageal reflux disease (GERD) with belching. Supragastric belching (SGB) is closely associated with reflux episodes. This study investigates belch characteristics in association with reflux, compared between patients with BD and those who had GERD with belching.
Methods
Impedance pH monitoring data from 10 patients with BD and 10 patients with GERD who exhibited belching were retrospectively analyzed. Belches were considered “isolated“ or “reflux-related” and acidic/non-acidic. Belch characteristics were compared between patients with BD and those with GERD.
Results
Symptomatic belches were more frequent in patients with BD than in patients with GERD (median, 160.5 vs 56.0, P < 0.05). SGB was the most common type in both groups; common subtypes comprised “isolated“ in patients with BD and “isolated during the reflux period” in patients with GERD. Reflux-related SGB was more common in patients with GERD than in BD (78.3% vs 45.2%, P < 0.005). Both “preceding belching” including the reflux period and acidic SGB were more common in patients with GERD than in BD (31.8% vs 8.6% and 38.1% vs 8.9%, both P < 0.05). Supragastric belch number positively correlated with all reflux episodes in patients with GERD (adjusted R2 = 0.572, P = 0.007).
Conclusions
BD is characterized by more belching, compared to GERD. SGB is more frequently associated with reflux in GERD than in BD; acidity may be related to GERD. In BD, SGB is typically non-acidic and unrelated to reflux. Distinct SGB characteristics may reflect different pathogenic mechanisms of reflux and associated symptoms.
Keywords: Electric impedance; Esophageal pH monitorings; Eructation; Gastroesophageal reflux

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