Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
Digestion. 2024;105(1):18-25. doi: 10.1159/000534092. Epub 2023 Oct 16.
Belching disorders and rumination syndrome (RS) are disorders of gut-brain interaction (DGBIs) in Rome IV. Belching disorders are composed of excessive gastric belching (GB) and supragastric belching (SGB). Excessive GB is related to physiological phenomenon whereas excessive SGB and RS are behavioral disorders.
A recent large internet survey found that prevalence of belching disorders and RS were 1% and 2.8%, respectively. It has been recognized that not a few patients with two behavioral disorders, excessive SGB and RS, could be misdiagnosed as proton pump inhibitors (PPI)-refractory gastroesophageal reflux disease (GERD). In patients with reflux symptoms, distinguishing these conditions is essential because they need psychological treatment (i.e., cognitive behavioral therapy (CBT) rather than acid suppressants. Clinicians should take a medical history meticulously first to identify possible excessive SGB and/or RS. High-resolution impedance manometry and/or 24-h impedance-pH monitoring can offer an objective diagnosis of the disorders. Several therapeutic options are available for excessive SGB and RS. The first-line therapy should be CBT using diaphragmatic breathing that can stop the behaviors involving complex muscle contraction (e.g., abdominal straining) to generate SGB or rumination. Overlap with eating disorders and/or other DGBIs such as functional dyspepsia can make management of the behavioral disorders challenging since such coexisting conditions often require additional treatments.
Excessive SGB and RS are not unusual conditions. It is important to raise awareness of the behavioral disorders for appropriate management.
呃逆障碍和反刍综合征（RS）是罗马 IV 中肠-脑相互作用障碍（DGBI）的组成部分。呃逆障碍由过度胃呃逆（GB）和胃上呃逆（SGB）组成。过度 GB 与生理现象有关，而过度 SGB 和 RS 则是行为障碍。
最近一项大型互联网调查发现，呃逆障碍和 RS 的患病率分别为 1%和 2.8%。人们已经认识到，相当多的两种行为障碍，即过度 SGB 和 RS 的患者可能被误诊为质子泵抑制剂（PPI）难治性胃食管反流病（GERD）。在有反流症状的患者中，区分这些情况至关重要，因为他们需要心理治疗（即认知行为疗法（CBT）而不是酸抑制剂。临床医生应首先仔细询问病史，以确定是否存在过度 SGB 和/或 RS。高分辨率阻抗测压和/或 24 小时阻抗-pH 监测可提供这些疾病的客观诊断。过度 SGB 和 RS 有几种治疗选择。一线治疗应是使用膈式呼吸的 CBT，这可以阻止涉及复杂肌肉收缩（例如腹部用力）的行为，从而停止 SGB 或反刍。与饮食失调和/或其他 DGBI（如功能性消化不良）的重叠会使行为障碍的管理变得具有挑战性，因为这些共存情况通常需要额外的治疗。
过度 SGB 和 RS 并不罕见。提高对这些行为障碍的认识，以便进行适当的管理非常重要。
