An article intended for practitioners of Chinese medicine:

I used to know that belching (meaning burping, as opposed to hiccups, which are something completely different) is caused by swallowing air, and then a patient came to me complaining of belching that had been going on for hours every day (!) for over ten years.

As I delved deeper into his problem, I realized that he was not swallowing air and discovered that there is an interesting (Western) differential diagnosis between types of belching, and it also affects us as caregivers.

From a Western perspective, belching is divided into two types: gastric belching and abdominal belching.

In stomach belching, we swallow air with our food and drink. The air reaches the stomach and is later expelled.

In gastric belching (which manifests itself in frequent and repetitive belching), the air comes from the pharynx, not the stomach, and is not related to food and drink.

In the background, there is also a phenomenon called aerophagia - swallowing air, but it does not have to come with belching, meaning the air we swallow does not have to be expelled out of the mouth. It can also go down the digestive system and cause discomfort and bloating in the abdomen.

The types of belching can be distinguished by esophageal manometry.

Why is it important for us as caregivers to know whether the burp is gastric or on the stomach?

In case of gastric belching (air swallowing), it is important for us to instruct the patient to avoid carbonated drinks and chewing gum, not to eat when distracted (say, while driving or talking), to eat slowly and chew food thoroughly.

I would also give the same instructions to a patient who suffers from abdominal bloating, because it is possible that the air he swallowed is accumulating in his stomach.

For belching on the stomach, the suggested treatment is CBT - cognitive behavioral therapy, but if we decide to treat such a patient, we will work much more on his mental calmness and much less on the nutritional guidelines for swallowing air.

That's it for today... I hope I've added something new :)

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