Fast Five Quiz: Belching and Bloating

Sarah El-Nakeep, MD


May 24, 2023

According to a review of existing research, 24-hours ambulatory pH-impedance monitoring is the criterion standard in the diagnosis of belching and can assist clinicians in differentiating between supragastric and gastric belching. Impedance tracks air movement patterns in the esophagus. An increase in impedance level starting in the stomach distally and progressing to the esophagus proximally characterizes gastric belching. Criteria for diagnosis of supragastric belching are rapid antegrade movement and retrograde expulsion of gas (from the distal to the proximal esophagus) to and from baseline impedance level that follow each other. Up to 13 such supragastric events in 24 hours have been demonstrated to be at the upper limit of physiologically normal in asymptomatic patients. Patients with symptomatic supragastric belching had events in 24 hours on average in one study; on 90-minute impedance monitoring, the median number of belching events for patients with gastric belching was 1, compared with 36 for patients with supragastric belching, in another study.

Learn more about impedance monitoring and other GERD imaging.


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