Belching is common in gastro-oesophageal reflux disease (GORD). Diaphragmatic breathing can reduce belching and GORD symptoms, but only patients with excessive supra-gastric belching (SGB) responded to this treatment. 24 hour pH-impedance study is the gold standard to diagnose SGB but is expensive and invasive. Our study aimed to identify clinical factors that can predict excessive SGB (>13/day) in GORD patients.Methods
We prospectively analysed patients with a belching visual analogue scale (VAS) score ≥6 and a clinical or endoscopic diagnosis of GORD. All patients underwent 24 hour pH-impedance studies off medications. Patients were given questionnaire on belching symptoms, including belching VAS, belching frequency, repetitive nature of belching and ability to control belching. GORD symptoms were evaluated via Reflux Disease Questionnaire (RDQ), somatization scores via PHQ15 and mood disorders via Hospital Anxiety and Depression Scales (HADS). Statistical analysis via independent t-test and Chi2 test were done for univariate analysis, while logistic regression analysis was used for multivariate analysis of clinical factors most predictive of excessive SGB.Results
We recruited 36 patients between April 2015 and October 2016 (25 women; mean age 45.5±12.7). 32 patients had excessive SGB, while 4 had predominantly gastric belching on pH-impedance studies. Repetitive belching and RDQ regurgitation score ≥2 were significantly more likely in patients with excessive SGB, but only repetitive belching was significant on multivariate analysis. Repetitive belching on questioning has a sensitivity of 93.4% and specificity of 75% for SGB diagnosis, positive predictive value 96.8% and negative predictive value 60.0%.Conclusions
We identified that a simple questioning on the repetitive nature of belching can be used as a screening tool to predict SGB in belching patients, and hence predict response to diaphragmatic breathing exercises.