T1927 Psychological Factors

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T1927
Psychological Factors Affect the Frequency of Belching in Patients with Aerophagia
Albert J Bredenoord,1 Bas L Weusten,1 Robin Timmer,1 Andre J Smout2
(1) Gastroenterology, St Antonius Hospital, Nieuwegein, Netherlands, (2) Gastrointestinal Research Unit, University Medical Center, Utrecht, Netherlands
Abstract Body: Background and aim: In patients with excessive belching (aerophagia) an organic cause is seldomly found and a psychogenic cause is often suspected. Aim of this study was to investigate the effects of attention and distraction on the frequency of belching and to investigate the mechanism of belching in these patients. Methods: In 10 patients with aerophagia combined esophageal manometry, pH and impedance monitoring was performed for 2 hours. These 2 hours consisted of 4 30-min recording periods. Period 1: patient under the impression that recording had not yet commenced. Period 2: patient informed of recording in progress. Period 3: patient being distracted by having him/her filling in questionnaires. Period 4: patient not being distracted. Data are presented as median (iqr). The study was approved by the local IRB. Results: One patient stopped belching immediately after introduction of the catheters and was excluded from further analysis. In the remaining 9 patients, a total of 1258 belches was measured, 51 of which were the result of air that escaped from the stomach (gastric belches). The remaining 1207 belches (96%) were events during which air was expelled in oral direction almost immediately after entering the esophagus, before reaching the stomach (supragastric belches). Gastric belches were distributed equally over the first (1.5 (0.5-2.0)), second (1.5 (0.5-2.0)), third (1.0 (0-2.0)) and fourth (1.0 (0-2.0)) recording period. In contrast, the incidence of supragastric belches increased significantly (p<0.05) from 0 (0-32) in the first period to 30 (18-60) in the second period, after patients were told that recording was started. During the questionnaires the incidence of supragastric belches decreased (p<0.05) to 14 (4-30). In the fourth period the incidence of supragastric belches increased (p<0.05) to 21 (10-49). Supragastric belches were initiated either by sucking air into the esophagus by a negative thoracic pressure (8 patients) or by injecting air into the esophagus by a pharyngeal contraction (2 patients). Conclusions: The vast majority of belches in patients with aerophagia is due to supragastric belching. When patients are unaware that they are being studied or when they are distracted the incidence of belching is significantly reduced. These findings confirm that a psychological factor is important in this disorder, which supports treatments such as behavioral therapy. The mechanisms the patients use to fill their esophagus with air during supragastric belching are similar to the techniques described for facilitation of esophageal speech in laryngectomized patients, which suggests that logopedic therapy might also be helpful.
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