Help from habit reversal for supragastric belching.

Supragastric belching differs from common gastric belching. It can be detected by 24-hour intra-esophageal impedance monitoring. Belching is seldom the only symptom: reflux symptom is present in 95% and dysphagia in 65% of the patients. In supragastric belching, the air does not come from the stomach but instead from the esophagus. Belching is caused by the patient him/herself swallowing air into the esophagus. This voluntary but unconscious symptom is treated by therapy in which explaining the mechanism of belching for the patient and learning of correct diaphragmatic breathing technique play a central role. Habit reversal is utilized for teaching the patient to react correctly to preemptive symptoms.

Belching, regurgitation, chest tightness and dyspnea: not gastroesophageal reflux disease but asthma.

Belching is a common symptom of gastroesophageal reflux disease. If the symptoms are not relieved after anti-reflux treatment, another etiology should be considered. Here, we report a case of a 43-year-old man who presented with belching, regurgitation, chest tightness and dyspnea for 18 mo, which became gradually more severe. Gastroscopic examination suggested superficial gastritis. Twenty-four-hour esophageal pH monitoring showed that the Demeester score was 11.4, in the normal range. High-resolution manometry showed that integrated relaxation pressure and intrabolus pressure were higher than normal (20 mmHg and 22.4 mmHg, respectively), indicating gastroesophageal junction outflow tract obstruction. Pulmonary function test showed severe obstructive ventilation dysfunction [forced expiratory volume in 1 second (FEV1)/forced vital capacity 32%, FEV1 was 1.21 L, occupying 35% predicted value after salbuterol inhalation], and positive bronchial dilation test (∆FEV1 260 mL, ∆FEV1% 27%). Skin prick test showed Dermatophagoides farinae (++), house dust mite (++++), and shrimp protein (++). Fractional exhaled nitric oxide measurement was 76 ppb. All the symptoms were alleviated completely and pulmonary function increased after combination therapy with corticosteroids and long-acting ß2-agonist. Bronchial asthma was eventually diagnosed by laboratory tests and the effect of anti-asthmatic treatment, therefore, physicians, especially the Gastrointestinal physicians, should pay attention to the belching symptoms of asthma.

Glucose-fructose likely improves gastrointestinal comfort and endurance running performance relative to glucose-only.

This study aimed to determine whether glucose-fructose (GF) ingestion, relative to glucose-only, would alter performance, metabolism, gastrointestinal (GI) symptoms, and psychological affect during prolonged running. On two occasions, 20 runners (14 men) completed a 120-min submaximal run followed by a 4-mile time trial (TT). Participants consumed glucose-only (G) or GF (1.2:1 ratio) beverages, which supplied ∼ 1.3 g/min of carbohydrate. Substrate use, blood lactate, psychological affect [Feeling Scale (FS)], and GI distress were measured. Differences between conditions were assessed using magnitude-based inferential statistics. Participants completed the TT 1.9% (-1.9; -4.2, 0.4) faster with GF, representing a likely benefit. FS ratings were possibly higher and GI symptoms were possibly-to-likely lower with GF during the submaximal period and TT. Effect sizes for GI distress and FS ratings were relatively small (Cohen's d = ∼0.2 to 0.4). GF resulted in possibly higher fat oxidation during the submaximal period. No clear differences in lactate were observed. In conclusion, GF ingestion - compared with glucose-only - likely improves TT performance after 2 h of submaximal running, and GI distress and psychological affect are likely mechanisms. These results apply to runners consuming fluid at 500-600 mL/h and carbohydrate at 1.0-1.3 g/min during running at 60-70% VO2peak .

Simple office-based behavioral approach to patients with chronic belching.

Chronic belching can be a difficult and socially disabling symptom often attributed to reflux with poor response to therapy. In patients where aerophagia is identified as a clear cause, treatment with baclofen may not be tolerated, and biofeedback therapy is time-intensive and may still not be effective. In this pilot study, an office-based easy-to-perform method based on sustained glottal opening was used in five patients with chronic belching, in whom reflux and other causes had been excluded. Treatment consisted of having the patient breathe slowly and diaphragmatically with his or her mouth open during supine, then sitting periods to prevent belching. When this was successful, patients were then counseled on continuing this breathing with mouth slightly ajar as an outpatient using this persistently. Wide mouth opening was used for rescue therapy of belching attacks. All five patients responded to the office-based therapy with complete cessation of belching during the visit. At 1-month follow up, four patients remained asymptomatic. One patient was asymptomatic but for two breakthrough attacks easily managed with the protocol. A simple office-based procedure based on complete glottal opening can be curative for a subset of patients with chronic eructation secondary to repetitive air swallowing.

Standard-dose lansoprazole is more effective than high-dose ranitidine in achieving endoscopic healing and symptom relief in patients with moderately severe reflux oesophagitis. The Dutch Lansoprazole Study Group.

BACKGROUND: In the treatment of reflux oesophagitis, H2-receptor antagonists are still widely used in spite of the apparent higher efficacy of proton pump inhibitors. In an attempt to compensate for the lower efficacy, H2-receptor antagonists are now increasingly being used at a higher dose. OBJECTIVE: To assess whether or not standard-dose lansoprazole (30 mg o.d.) is more effective than high-dose ranitidine (300 mg b.d.) in moderately severe reflux oesophagitis (grades II-III). METHODS: Lansoprazole or ranitidine was given to 133 patients for 4-8 weeks in a double-blind, randomized, parallel group, multicentre trial. RESULTS: The percentage of patients with endoscopically-verified healing was significantly higher on lansoprazole than on ranitidine both after 4 weeks (79% vs. 42%) and 8 weeks (91% vs. 66%), though smoking had a negative impact on oesophagitis healing with lansoprazole. Heartburn, retrosternal pain and belching improved significantly better with lansoprazole than with ranitidine, as did the patient-rated overall symptom severity. Relief of heartburn appeared somewhat faster with ranitidine, but was more pronounced with lansoprazole. The number of patients with adverse events was similar in both treatment groups. CONCLUSION: Standard-dose lansoprazole is better than high-dose ranitidine in moderately severe reflux oesophagitis.

Cisapride compared with ranitidine in the treatment of functional dyspepsia.

OBJECTIVE: To compare the efficacy of the prokinetic drug cisapride and the antisecretory agent ranitidine in relieving symptoms of functional dyspepsia, as well as their effect on the recurrence of symptoms after the discontinuation of treatment. DESIGN: A randomized double-blind parallel-group trial of cisapride 30 mg daily and ranitidine 300 mg daily given for 2, 4 or 8 weeks, followed by a 4-week drug-free follow-up of the patients with a good or excellent response. Rescue antacid tablets were allowed only if pain was unbearable. PATIENTS: A total of 203 patients (99 cisapride, 104 ranitidine) with symptoms of functional dyspepsia for more than 4 weeks, after the exclusion of organic disease by endoscopy and sonography or radiology. RESULTS: Cisapride and ranitidine improved the symptoms of diffuse epigastric pain, postprandial epigastric fullness, epigastric distension, belching, heartburn, regurgitation, and nausea when compared with baseline. Pain at night and gastric discomfort also greatly improved. Cisapride produced a greater reduction in epigastric pain (P = 0.07) and epigastric distension (P = 0.03) scores than ranitidine. Both drugs were equally effective in reducing the concomitant reflux-like symptoms of heartburn and regurgitation. At week 8, 87% of cisapride patients versus 61% of ranitidine patients had an excellent or good result. The deterioration of symptoms during the follow-up phase was limited in both groups. However, after the withdrawal of medication there was a greater reduction in scores in the cisapride group than in the ranitidine group for diffuse epigastric pain (P = 0.05), epigastric distension (P = 0.002), the cluster of six symptoms of epigastric discomfort (P = 0.05), and the cluster of all nine upper gastrointestinal symptoms (P = 0.06). Adverse events occurred in 15 cisapride patients and 18 ranitidine patients, and two of the ranitidine patients were withdrawn from treatment. CONCLUSIONS: Although cisapride and ranitidine both improved the symptoms of functional dyspepsia, cisapride was superior to ranitidine, particularly on the combined evaluation of the response to treatment and the recurrence of symptoms.

[Roentgenmorphology of the upper stomach after prophylactic reflux surgery (author's transl)]. / Röntgenmorphologie des Mageneingangs nach operativer Refluxprophylaxe.

The combination of vagotomy, of proximal and of total gastrectomy with antireflux-surgery can lead to a characteristic roentgenmorphology of the lower esophagus and the upper stomach. The fundoplication or hemifundoplication may have a tumorlike shape, may open up or may slide down. The knowledge of the preceding operation and of the symptoms allows a correct interpretation of the x-ray findings in most cases.