Wingate Institute for Neurogastroenterology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
Universidad del Desarrollo, Facultad de Medicina, Clínica Alemana de Santiago, Santiago, Chile.
Am J Gastroenterol. 2018 Apr;113(4):539-547. doi: 10.1038/ajg.2018.15. Epub 2018 Feb 20.
Excessive supragastric belching (SGB) manifests as troublesome belching, and can be associated with reflux and significant impact on quality of life (QOL). In some GERD patients, SGB-associated reflux contributes to up to 1/3 of the total esophageal acid exposure. We hypothesized that a cognitive-behavioral intervention (CBT) might reduce SGB, improve QOL, and reduce acid gastroesophageal reflux (GOR). We aimed to assess the effectiveness of CBT in patients with pathological SGB.
Patients with SGB were recruited at the Royal London Hospital. Patients attended CBT sessions focused on recognition of warning signals and preventative exercises. Objective outcomes were the number of SGBs, esophageal acid exposure time (AET), and proportion of AET related to SGBs. Subjective evaluation was by patient-reported questionnaires.
Of 51 patients who started treatment, 39 completed the protocol, of whom 31 had a follow-up MII-pH study. The mean number of SGBs decreased significantly after CBT (before: 116 (47-323) vs. after 45 (22-139), P<0.0003). Sixteen of 31 patients were shown to have a reduction in SGB by >50%. In patients with increased AET at baseline, AET after CBT was decreased: 9.0-6.1% (P=0.005). Mean visual analog scale severity scores decreased after CBT (before: 260 (210-320) mm vs. after: 140 (80-210) mm, P<0.0001).
Cognitive behavioral therapy reduced the number of SGB and improved social and daily activities. Careful analysis of MII-pH allows identification of a subgroup of GERD patients with acid reflux predominantly driven by SGB. In these patients, CBT can reduce esophageal acid exposure.
过度的胃食管上逆（SGB）表现为令人困扰的呃逆，可能与反流相关，并对生活质量（QOL）产生重大影响。在一些 GERD 患者中，SGB 相关的反流可导致总食管酸暴露的 1/3 左右。我们假设认知行为干预（CBT）可能减少 SGB、改善 QOL 和减少酸胃食管反流（GOR）。我们旨在评估 CBT 在病理性 SGB 患者中的有效性。
在伦敦皇家医院招募 SGB 患者。患者参加了 CBT 课程，重点是识别预警信号和预防措施。客观结果是 SGB 次数、食管酸暴露时间（AET）和与 SGB 相关的 AET 比例。主观评估通过患者报告的问卷进行。
51 名开始治疗的患者中，有 39 名完成了方案，其中 31 名进行了后续的 MII-pH 研究。CBT 后 SGB 次数明显减少（治疗前：116（47-323）vs. 治疗后：45（22-139），P<0.0003）。31 名患者中有 16 名 SGB 减少>50%。基线时 AET 增加的患者，CBT 后 AET 减少：9.0-6.1%（P=0.005）。CBT 后平均视觉模拟量表严重程度评分降低（治疗前：260（210-320）mm vs. 治疗后：140（80-210）mm，P<0.0001）。
认知行为疗法减少了 SGB 次数，改善了社会和日常活动。仔细分析 MII-pH 可识别出一组主要由 SGB 驱动的 GERD 患者的酸反流。在这些患者中，CBT 可减少食管酸暴露。
