Most people experience belching as a normal phenomenon, often after eating or drinking carbonated drinks in particular. However, separate to this normal physiological phenomenon, some people experience belches that can occur much more frequently (up to 20 times a minute) and are unrelated to eating and drinking. Such patients will frequently seek help from physicians and ENTs, but clinical investigations may fail to elucidate the problem or inform management. The authors of this paper describe an innovative approach for the management of this group of patients supported by data from their therapy intervention. They explain that patients with supragastric belching actively push or suck air into the oesophagus (non-intended but self-induced). This behaviour is often seen in individuals with gastro-oesophageal reflux. Diagnosis of supragastric belching is made by 24hr pH-impedance monitoring and/or careful symptom assessment. The intervention programme makes use of techniques drawn from voice and swallowing therapy. It comprises five main components: 1) patient education about the mechanism of supragastric belching; 2) creating patient awareness and monitoring of air inhalation/injection; 3) exercise for normal abdominal breathing; 4) enhancement of normal function of the lingual-laryngeal-cricopharyngeal complex; and 5) implementation into daily life. The authors performed analysis on 48 patients who received the intervention, with 40 (83%) showing improvement in symptoms, reduction in frequency of belching and improved psychosocial adjustment. This paper presents a useful rehabilitation option for physicians who may encounter this problem in their clinical practice. It also offers useful treatment techniques for speech therapists who receive such referrals.

Speech Therapy as Treatment for Supragastric Belching.
Ten Cate L, Herregods TVK, Dejonckere PH, et al.
DYSPHAGIA
2018;33:707-15.
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CONTRIBUTOR
Roganie Govender

NIHR Doctoral Research Fellow, UCLH, Head and Neck Centre, London, UK.

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