Gastroesophageal Reflux Characteristics in Supragastric Belching Patients With Positive Versus Negative pH Monitoring: An Evidence of Secondary Gastroesophageal Reflux Disease From Excessive Belching

Suriya Keeratichananont; Tanisa Patcharatrakul; Sutep Gonlachanvit

doi:10.5056/jnm22198

Gastroesophageal Reflux Characteristics in Supragastric Belching Patients With Positive Versus Negative pH Monitoring: An Evidence of Secondary Gastroesophageal Reflux Disease From Excessive Belching

J Neurogastroenterol Motil. 2023 Jul 30;29(3):343-351. doi: 10.5056/jnm22198.

Authors

Suriya Keeratichananont^{1

2}, Tanisa Patcharatrakul^{2

3}, Sutep Gonlachanvit^{2

3}

Affiliations

¹ NKC Institute of Gastroenterology and Hepatology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
² Division of Gastroenterology, Department of Medicine, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand.
³ Center of Excellence in Neurogastroenterology and Motility, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

Abstract

Background/aims: A high prevalence of GERD has been reported in patients with supragastric belching. We aim to evaluate reflux characteristics and explore the temporal relationship between supragastric belches (SGBs) and reflux episodes in GERD patients with excessive belching.

Methods: Twenty-four hour esophageal pH-impedance monitoring was analyzed. Reflux episodes were classified into: refluxes preceded by SGBs, followed by SGBs, and lone refluxes. Reflux characteristics were compared between patients with pH-positive (pH+) and pH-negative(pH-).

Results: Forty-six patients (34 Female, age 47 ± 13 years) were included. Fifteen patients (32.6%) had pH+. Almost half (48.1 ± 21.0%) of refluxes were preceded by SGBs. The number of SGBs significantly correlated with the number of reflux episodes preceded by SGBs (r = 0.43, P < 0.05) and % time pH < 4 at the distal esophagus (r = 0.41, P < 0.05). Patients with pH+ had significantly more SGBs and reflux episodes preceded by SGBs/day than pH- patients (P < 0.05). The difference in the number of refluxes between pH+ and pH- patients was caused by reflux episodes preceded by SGBs, but not lone refluxes and refluxes followed by SGBs. The proportion of SGBs followed by reflux/total SGBs was similar between patients with pH+ and pH- (P > 0.05). Reflux episodes preceded by SGBs and followed by SGBs extended more proximal and had longer bolus and acid contact time than lone refluxes (P < 0.05).

Conclusions: In patients with GERD and SGB, the number of SGBs positively correlates with the number of reflux episodes preceded by SGBs. Identifying and managing SGB may be beneficial and more likely to improve GERD.

Keywords: Belching; Esophageal pH monitoring; Esophagus; Gastroesophageal reflux.

Grants and funding

Financial support: This study was supported by the Ratchadapiseksompotch Fund, Chulalongkorn University. They had no roles in the study design or preparation of data, or the manuscript.