Kessing Boudewijn F, Bredenoord Albert J, Smout André J P M
Department of Gastroenterology and Hepatology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
Am J Gastroenterol. 2014 Aug;109(8):1196-203); (Quiz) 1204. doi: 10.1038/ajg.2014.165. Epub 2014 Jul 8.
Excessive belching is a commonly observed complaint in clinical practice that can occur not only as an isolated symptom but also as a concomitant symptom in patients with gastroesophageal reflux disease (GERD) or functional dyspepsia. Impedance monitoring has revealed that there are two mechanisms through which belching can occur: the gastric belch and the supragastric belch. The gastric belch is the result of a vagally mediated reflex leading to relaxation of the lower esophageal sphincter and venting of gastric air. The supragastric belch is a behavioral peculiarity. During this type of belch, pharyngeal air is sucked or injected into the esophagus, after which it is immediately expulsed before it has reached the stomach. Patients who belch excessively invariably exhibit an increased incidence of supragastric, not of gastric belches. Moreover, supragastric belches can elicit regurgitation episodes in patients with the rumination syndrome and sometimes appear to induce reflux episodes as well. Behavioral therapy has been proven to decrease belching complaints in patients with isolated excessive belching, but its effect is unknown in frequently belching patients with GERD, functional dyspepsia or rumination.
嗳气过多是临床实践中常见的主诉，它不仅可作为孤立症状出现，也可作为胃食管反流病（GERD）或功能性消化不良患者的伴随症状。阻抗监测显示，嗳气可通过两种机制发生：胃源性嗳气和胃上源性嗳气。胃源性嗳气是迷走神经介导的反射导致食管下括约肌松弛和胃内气体排出的结果。胃上源性嗳气是一种行为特点。在这种类型的嗳气过程中，咽部空气被吸入或注入食管，之后在空气到达胃部之前立即被排出。嗳气过多的患者胃上源性嗳气的发生率总是增加，而不是胃源性嗳气。此外，胃上源性嗳气可引发反刍综合征患者的反流发作，有时似乎也会诱发反流发作。行为疗法已被证明可减少孤立性嗳气过多患者的嗳气主诉，但其对GERD、功能性消化不良或反刍的频繁嗳气患者的效果尚不清楚。
