cqvip:Background: Patients with aerophagia are believed to have excessive belches due to air swallowing. Intraluminal impedance monitoring has made it possible to investigate the validity of this concept. Methods: The authors measured oesophageal pH and electrical impedance before and after a meal in 14 patients with exces sive belching and 14 healthy controls and identified patterns of air transport through the oesophagus. The size of the gastric air bubble was measured radiograp hically. In four patients prolonged oesophageal manometry was performed simultan eously. Results: In all subjects, impedance tracings showed that a significant a mount of air is propulsed in front of about a third of the swallow induced peris taltic waves. Two types of retrograde gas flow through the oesophagus (belch) were observed. In the first type air flowed from the stomach through the oesophagus in oral direction (“gastric belch”). In the second type air entered the oesophagus rapidly from proximal and was expulsed almost immediately in oral directi on (“supragastric belch”). The incidence of air-containing swallows and gastric belches was similar in patients and controls but supragastric belches occurred exclusively in patients. There was no evidence of lower oesophageal sphincter relaxation during supragastric belches. Gastric air bubble sizewas not different between the two groups. Conclusions: In patients with excessive belching the in cidence of gaseous reflux from stomach to oesophagus is similar to that in healthy subjects. Their excess belching activity follows a distinct pattern, characte rised by rapid antegrade and retrograde flow of air in the oesophagus that does not reach the stomach.
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