- What is Belching or Burping?
- How does belching occur?
- Abdominal Bloating
- Causes of Belching and Bloating
- Daily Causes of Belching
- 1. Eating
- 2. Drinking
- 3. Breathing
- 4. Stress or Anxiety
- 5. Wearing of dentures
- Gastrointestinal Causes
- 1. Inflammation
- 2. Obstructive Causes
- 3. Malabsorption Syndromes
- 4. Other Causes
- Symptoms of Belching/Bloating
- Digestive symptoms that may accompany belching
- Other symptoms
- Serious Symptoms that may accompany belching
- Evaluation of Belching/Bloating
- 1. Medical Interview
- 2. Physical Examination
- 3. Diet Trials
- 4. Laboratory tests
- 5. Imaging Studies
- Treatment of Belching and Bloating
- Eating habits/Diet modification
- Lifestyle modification
- Belching in Babies
What is Belching or Burping?
It is a process wherein the gas from the digestive tract, particularly the esophagus and stomach, is released through the mouth. When this occurs, it is usually accompanied with a sound and oftentimes, odor. It is also referred to as ructus, eructation, or burping. 
How does belching occur?
Belching is a normal physiologic process. It results from the build up of air in the upper portion of the stomach. When air becomes stored in the stomach, it leads to its stretching, which stimulates the relaxation of the esophageal sphincter muscle. As the end-result, this allows the release of air up to the esophagus, going out of the mouth . All of this occurs as the body’s response to air being swallowed in the stomach .
Picture 1: Digestive System
Picture 2: Stomach, the location where air is trapped.
Abdominal bloating is the subjective feeling of being full, or having the sensation that the abdomen is enlarged. This occurs as a result of the disturbance in the normal functioning of the digestive system which is caused by an increased amount of gas in the intestine.
The intestinal gas is composed of a mixture of different contents which is due to excess air production, impaired absorption due to obstructive condition, or by swallowing too much air.
By having excess intestinal gas, it results to abdominal bloating, as well as burping, flatulence and even abdominal pain. 
Picture 3: A comparison of the appearance of normal and bloated abdomen
Causes of Belching and Bloating
Daily Causes of Belching
- Consumption of foods with too much fat content: The fat present in the food eaten slows stomach emptying and even enhances the feeling of being full.
- Overeating or rapid eating
- Chewing gum, hard candies, salads, baked beans, cabbage, cauliflower
- Unconscious swallowing of air while eating
- Talking while eating [3, 5, 6]
- Using straw
- Rapid drinking or gulping of drinks
- Drinking sodas or carbonated drinks
- Unconscious swallowing of air while drinking [3, 8]
- Breathing using mouth 
4. Stress or Anxiety
- Nervous habit of air swallowing when talking
- Having emotional stress [3, 7]
5. Wearing of dentures
- Using dentures with poor fit contributes to the cause of belching 
- Gastritis: a condition wherein there is an inflammation of the gastrointestinal lining.
- Reflux Esophagitis/GERD (Gastroesophageal Reflux Disease)
- Megacolon: A parasitic disorder which causes abnormal dilatations of the colon. [3, 4, 7]
2. Obstructive Causes
- Tumors occurring at the digestive tract
- Cancer or tumor of the liver, stomach, or ovaries
- Intestinal Obstruction
- Hiatal Hernia
- Pyloric Obstruction: A condition in which there is an obstruction located between the stomach and small intestine.
- Gastroparesis: A disease in which there is a delayed emptying of the stomach [3, 4]
3. Malabsorption Syndromes
These disorders involve a condition wherein the body lacks certain enzymes to break down and absorb food. Since the body cannot break down and absorb the foods ingested, this produces extra intestinal gas.
- Celiac Disease
- Food Intolerance/Food Allergies
- Lactose Intolerance 
4. Other Causes
- Constipation: Decrease in the frequency of defecating which causes bloating.
- Irritable Bowel Syndrome: A digestive disorder which involves alternating episodes of diarrhea and constipation.
- Menstruation: Bloating is a common occurrence in most women with menstruation.
- Ascites: This is a condition wherein there is fluid accumulation within the abdominal cavity. [3, 4]
Symptoms of Belching/Bloating
Digestive symptoms that may accompany belching
- Appearance of distended or swollen abdomen
- Change in the bowel habits: Diarrhea/Constipation
- Nausea which may occur with or without vomiting
Increased frequency of belching may be related to the other body systems. Other symptoms include:
- Emotional Stress
Serious Symptoms that may accompany belching
Belching is usually a normal body process. However, there are times wherein belching may indicate a possible condition which may threaten life. It is important to notice these symptoms as soon as possible and seek for emergency help. These symptoms are:
- High Fever
- Severe Abdominal Pain
- Blood in the vomitus or in stool
- Chest pain or pressure
- Breathing difficulty, wheezing, choking 
Evaluation of Belching/Bloating
1. Medical Interview
The doctor would most likely ask questions regarding:
- Diet of the patient
- Length of time bloating has been experienced
- Any medications taken
- Symptoms accompanying belching or bloating
- Patient’s medical history
- For females, questions regarding menstrual cycle are asked. 
2. Physical Examination
- After the medical history of the patient has been obtained, physical examination of the abdomen will be done. The doctor will do assessment of the abdomen through inspection, palpation, and percussion of the abdomen.
- Also, the doctor will be using the stethoscope to listen to the bowel sounds. This will help in evaluating if there is a presence of obstruction.
- Lastly, the doctor may do a rectal examination to the patient. 
Picture 4: Assessment of the Abdomen
3. Diet Trials
- In order for the doctor to determine if the food consumed is the culprit for the abdominal bloating, diet trials may be performed. Here, the patient will be asked to try foods such as dairy products or wheat. 
4. Laboratory tests
- Urine Analysis: This is to determine the presence of blood in the urine which may be related to tumors in the kidney or bladder.
- Complete Blood Count: An increase in the level of white blood cells indicates infection or malignancy.
- Urea and electrolytes: This is for evaluating electrolyte imbalances or renal dysfunctions that may be linked to bowel obstruction.
- Liver Function Tests
- Pregnancy tests 
5. Imaging Studies
- Abdominal X-rays: Using this can determine if there is a blockage at the digestive tract.
- Colonospcopy: This is the visualization of the intestine by inserting a tube with a camera into the rectum. This is useful in assessing for presence of tumors.
- Barium Enema
- Ultrasound/CT Scans: This is ordered by the doctor if presence of ascites or mass is suspected. 
Treatment of Belching and Bloating
Eating habits/Diet modification
1. Avoid eating and drinking too fast.
2. Refrain from talking while eating
3. Know the foods to avoid:
- Fatty foods: Foods with high content of fats are slowly digested and tends to cause frequent belching.
- High fiber foods: Though high fiber is advised for better digestion, it also produces too much intestinal gas. Products such as Beano can be added to high fiber foods to reduce the gas they produce.
- Carbonated drinks and beer
- Beans, onions, broccoli, cauliflower, bananas, salads, lentils, peas, and whole wheat bread
- If the dairy products are the culprit for frequent belching, cut off these foods. 
4. Food Additives
- A brand of food additive particularly Sorbitol relieves the GI tract irritation that causes cramps, abdominal pain, and diarrhea.
- Fibre supplements: Some fiber supplements can aggravate the bloating experienced by a patient. Be sure to consult the doctor or a pharmacist before using it. 
5. Do not use straws in drinking. 
- Brisk walking/Exercising: In order to eliminate excessive intestinal gas, try exercising or doing brisk walks. Performing exercises can enhance digestion and helps the intestine to function more effectively.
- Positioning: If brisk walking does not become effective, try laying on the left side and curl knees toward the chest. This position can aid in the release of intestinal gas.
- Quit Smoking: Accompanying the cigarette smoke is the air swallowed going directly to the stomach. [5, 6]
- Lactaid/Dairy Ease: Helps in relieving belching by enhancing the digestion of lactose
- Simethicone: Breaks down the bubbles present in intestinal gas
- Antacids: Another helpful remedy for treating mild heartburn 
Belching in Babies
Babies most commonly experience gas accumulation in the stomach. This usually happens during their feeding. Abdominal bloating results in agitation and discomfort of the child. The easiest remedy to relieve belching in babies is to make them burp.
In order to burp a baby, place the infant in a position which promotes gas expulsion. This is done by holding the infant to the level of the adult’s shoulder, as if the baby is hugged. Make sure that the stomach of the infant rests on the chest of the adult. Then, gently pat the lower back of the infant, until he/she burps. Also, prepare a burp pad or burp cloth, because infants may vomit as a result of burping them. 
Picture 5: How to burp a baby