| Popis: |
Case Report : A 62-year-old man presented to the outpatient clinic for further investigation of excessive belching since one month, sometimes associated with concurrent vomiting, and severely impacting his quality of life. The belching occurred up to ten times a minute, mostly postprandially, while absent during speech or sleep. He denied epigastric pain and heartburn. The patient’s symptoms did not respond to Proton Pump Inhibitor therapy. Previous oropharyngeal examination and radiologic evaluation of the oesophagus were normal. Eradication of Helicobacter pylori based on results from pathology from an otherwise normal upper GI endoscopy did not provide any relief. In order to understand the mechanism of belching, High Resolution oesophageal Impedance Manometry (HRIM) before and after a solid meal was performed. Before the meal, normal oesophageal motility was noted. Multiple episodes of belching and a few episodes of vomiting were recorded postprandially. All episodes shared the same characteristics concordant with supragastric belching (SGB) : decrease of the intrathoracic pressure with ab-orally propagating rise in impedance, followed by a sudden increase of intrathoracic and intra-abdominal pressure, with orally propagating decrease in impedance. Vomiting followed the same pattern but was accompanied by a higher increase of abdominal pressure. As diaphragmatic breathing (DB) remained unsuccessful, baclofen was associated. While sporadic belching reflects normal behaviour, excessive belching becomes bothersome and requires medical care. Uncovering the underlying mechanism with HRIM will direct treatment at an early stage. Despite its benign nature, SGB negatively impacts social interaction and quality of life. Treatment should focus on education and reassurance. Diaphragmatic breathing, behavioural therapy and speech therapy all demonstrated their efficacy, while baclofen should be reserved for refractory cases. |
