Air Swallowing, Belching, Acid and Non-acid Reflux With Dyspepsia
Air Swallowing, Belching, Acid and Non-acid Reflux With Dyspepsia
Background: Frequent belching is a common symptom in patients with functional dyspepsia with a reported incidence up to 80%. We hypothesized that patients with functional dyspepsia possibly have a higher frequency of belching than healthy subjects secondary to frequent air swallowing.
Aim: To assess air swallowing, belching, acid and non-acid reflux patterns of patients with functional dyspepsia.
Methods: Combined 24-h oesophageal impedance and pH monitoring was performed in 10 functional dyspepsia patients and 10 controls. Analysis of the impedance-pH signals included incidence of air swallows, belching, acid and non-acid reflux.
Results: The incidence of air swallows in functional dyspepsia patients were significantly higher compared with controls (153 ± 15 vs. 79 ± 10, P < 0.001), while the incidence of liquid-only swallows were not significantly increased. The proportions of gas-containing reflux episodes (belches) and non-acid reflux episodes in functional dyspepsia patients were significantly higher when compared with controls (66.4 vs. 44.4%, P = 0.04 and 70.1 vs. 45.9%, P = 0.009, respectively).
Conclusion: Patients with functional dyspepsia swallow air more frequently than controls and this is associated with an increased incidence of non-acid gaseous gastro-oesophageal reflux.
Functional dyspepsia (FD) is a clinical syndrome defined by persistent or recurrent pain or discomfort centered in the upper abdomen without evidence of organic disease likely to explain the symptoms. Discomfort refers to unpleasant sensations that the subject does not interpret as pain and which may be characterized by upper abdominal fullness, early satiety, bloating, belching or nausea.
Belching is the physiological mechanism of expelling ingested gas from the stomach and a common symptom in patients with FD with a reported incidence up to 80%. Troublesome repetitive belching that is objectively observed is defined as aerophagia.
Recently, intraluminal impedance measurement has been introduced as a technique to investigate bolus transport in the oesophagus and duodenum. This technique makes it possible to distinguish movements of even small volumes of gas through the oesophagus in oral and aboral direction. Combined pH and intraluminal impedance monitoring allows detection of all reflux events regarding acidity (acid and non-acid) and composition (liquid, gas and mixed). Using this technique Bredenoord et al. have shown that in both healthy subjects and gastro-oesophageal reflux disease (GERD) patients, air swallowing promotes belching but does not facilitate acid reflux. In patients with FD air swallowing, belching and non-acid reflux patterns have not yet been studied.
We hypothesize that patients with FD possibly have a higher frequency of belching than healthy subjects secondary to frequent air swallowing. The aim of the present study was to test that hypothesis using combined intraluminal impedance and pH monitoring.
Summary and Introduction
Summary
Background: Frequent belching is a common symptom in patients with functional dyspepsia with a reported incidence up to 80%. We hypothesized that patients with functional dyspepsia possibly have a higher frequency of belching than healthy subjects secondary to frequent air swallowing.
Aim: To assess air swallowing, belching, acid and non-acid reflux patterns of patients with functional dyspepsia.
Methods: Combined 24-h oesophageal impedance and pH monitoring was performed in 10 functional dyspepsia patients and 10 controls. Analysis of the impedance-pH signals included incidence of air swallows, belching, acid and non-acid reflux.
Results: The incidence of air swallows in functional dyspepsia patients were significantly higher compared with controls (153 ± 15 vs. 79 ± 10, P < 0.001), while the incidence of liquid-only swallows were not significantly increased. The proportions of gas-containing reflux episodes (belches) and non-acid reflux episodes in functional dyspepsia patients were significantly higher when compared with controls (66.4 vs. 44.4%, P = 0.04 and 70.1 vs. 45.9%, P = 0.009, respectively).
Conclusion: Patients with functional dyspepsia swallow air more frequently than controls and this is associated with an increased incidence of non-acid gaseous gastro-oesophageal reflux.
Introduction
Functional dyspepsia (FD) is a clinical syndrome defined by persistent or recurrent pain or discomfort centered in the upper abdomen without evidence of organic disease likely to explain the symptoms. Discomfort refers to unpleasant sensations that the subject does not interpret as pain and which may be characterized by upper abdominal fullness, early satiety, bloating, belching or nausea.
Belching is the physiological mechanism of expelling ingested gas from the stomach and a common symptom in patients with FD with a reported incidence up to 80%. Troublesome repetitive belching that is objectively observed is defined as aerophagia.
Recently, intraluminal impedance measurement has been introduced as a technique to investigate bolus transport in the oesophagus and duodenum. This technique makes it possible to distinguish movements of even small volumes of gas through the oesophagus in oral and aboral direction. Combined pH and intraluminal impedance monitoring allows detection of all reflux events regarding acidity (acid and non-acid) and composition (liquid, gas and mixed). Using this technique Bredenoord et al. have shown that in both healthy subjects and gastro-oesophageal reflux disease (GERD) patients, air swallowing promotes belching but does not facilitate acid reflux. In patients with FD air swallowing, belching and non-acid reflux patterns have not yet been studied.
We hypothesize that patients with FD possibly have a higher frequency of belching than healthy subjects secondary to frequent air swallowing. The aim of the present study was to test that hypothesis using combined intraluminal impedance and pH monitoring.
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