Excessive Belching, Burping and Bloating – Causes and Treatment

Causes of Belching and Bloating

Belching is the expulsion of gas from the gut through the mouth (eructations). Bloating may occur due to gas trapped within the gastrointestinal tract and this is often relieved upon belching.

Belching and bloating may be due to food, eating habits, or disorders in the stomach, small intestine or gallbladder. Bloating and gas may not always be expelled or relieved by a belch and other factors and conditions should be considered in cases of excessive bloating and gas.

Belching After Eating – Air Swallowing (Aerophagia)

This may be voluntary or involuntary. Air usually enters the esophagus and is expelled as a belch. It usually does not cause any discomfort or bloating.

Causes of air swallowing:

  • Fast eating or drinking
  • Mouth breathing
  • Nasal blockage
  • Hyperventilation related to anxiety
  • Regular gum chewing
  • Poorly fitted dentures

Treatment is by removing the cause.

Belching After Drinking

Carbonated drinks like soda and beer cause a build up of gas within the stomach and esophagus. This is then expelled as a belch. Certain antacids cause the formation of carbon dioxide as a byproduct to neutralizing stomach acid.

Treatment is by avoiding carbonated drinks and excessive amount of antacids.

How to Burp?

A simple method is to take several short gulps of air. The air should be swallowed partially so that it remains within the esophagus. Once there is sufficient air build up, the air can be regurgitated similar to a burp. This method should not be used excessively immediately after a meal as it can trigger vomiting at times.

How to Burp a Baby?

A baby should be carried upright and supported against the shoulder while a gentle rubbing motion is conducted on the baby’s back. Other methods that may assist is supporting baby in a 45 degree angle between the upright and supine (lying flat) position. Gentle taps on baby’s back may assist in this position to trigger a burp.

There is no set time for a baby to burp. Infants tend to swallow air when drinking so it is advisable that baby should burp within 20 minutes after a feed. However baby may burp well after this period quite naturally.

Hiatus Hernia

Hiatus hernia (Latin : hiatus – opening, hernia – protrusion) is the protrusion of a portion of the stomach into the thoracic (chest) cavity due to a weakening or rupture of the diaphragm. The protrusion and compression of the stomach causes a range of gastrointestinal symptoms.

The exact cause of a hiatal hernia is not known but there are many contributing factors:

  • Obesity
  • Pregnancy
  • Smoking
  • Physical exertion and strain (similar factors that can contribute to an inguinal hernia)
  • Chronic respiratory disorders that involve persistent coughing
  • Surgical procedures affecting the diaphragm
  • Congenital deformities (birth defects)

A person with hiatus hernia may be without symptoms for long periods of time. Acute symptoms include pain or discomfort after eating, sensation of ‘fullness’ after small meals, belching, indigestion, heartburn, acidic taste in mouth. This pain is usually felt in the middle of the abdomen or even cause gastrointestinal chest pain.

A hiatal hernia cannot be seen or felt from the outside. Upon palpation (touching the area with firm pressure), there may be some tenderness in the upper left quadrant of the abdomen. This correlates with the area of the stomach and diaphragm.

Diagnosis. An x-ray is usually sufficient to identify the hernia. Most soft organs and structures in the human body are almost transparent on an x-ray while solid structures, like bone, is opaue. In order to highlight and define semi-transparent organs on an x-ray, radiologically active substances, like barium, needs to be used internally. By drinking a barium solution, the gastrointestinal tract becomes more visible on an x-ray.

Picture of sliding hernia

Picture of para-esophageal hernia

Diet and Remedies in Hiatus Hernia

Carbonated drinks are to be avoided as they may cause expansion of the stomach cavity thereby aggravating the pain and discomfort of a hiatal hernia. Acidic foods and caffeinated drinks may also aggravate your hiatus hernia. Most sufferers note specific foods that aggravate their condition. These foods are often unique to the sufferer and each case should be considered on an individual basis.

Avoiding foods that may aggravate GERD and bloating is recommended.

Treatment of Hiatus Hernia

A paraesophageal hernia can be corrected surgically. More about hiatus hernia.

H. Pylori Infection

Helicobacter pylori is a bacterial species that infects the stomach causing an increase in gastric acid and damaging the lining of the stomach. H.pylori infection may contribute to belching and bloating as the bacteria produces and metabolizes ammonia resulting in the release of carbon dioxide. This production and metabolism of urea by the H.pylori bacteria is the chemical method by which it survives in the gastric acid of the stomach. In chronic infections, the large population of the H.pylori bacteria can contribute to small but significant quantities of carbon dioxide gas within the stomach. H.pylori infection often causes peptic ulcers.

Diagnosis of H.pylori

H. pylori can be diagnosed with a range of tests using blood, breath and stool samples. Antibodies to H.pylori within your blood sample can indicate a current or previous H.pylori infection. A breath test is more reliable to indicate a current H.pylori infection as the presence of urea in the expelled breath can indicate the presence of the H.pylori bacteria. A stool sample may be useful for antigen testing to identify a current H.pylori infection. A biopsy of the gastric mucosa is one of the most effective methods to identify H.pylori infection but is not often the first choice of testing due to the invasive procedure that has to be conduted in a suitable clinic or hospital.

Diet and Remedies in H. Pylori Infection

Essential oils should be used cautiously and should not be used internally in it original distilled state. Garlic has shown to be fairly effective in treating H.pylori infection when used in conjunction with omeprazole (The Journal of Antimicrobial Chemotherapy).

Treatment of H. pylori with Antibiotics

It is advisable to treat H.pylori infection with antibiotics in combination with proton pump inhibitors like omeprazole. The proton pump inhibitors allow the gastric lining to heal while the antibiotics kill existing bacteria and prevent further growth of the bacterial population.

Treatment is fairly successful but a proton pump inhibitor may have to be used for a period of time after the infection for maximum benefit. The chances of recurrence of the H.pylori infection is high and the case should be constantly monitored.

Antibiotics use may further aggravate the inflammation of the gastric lining and repeated courses may be required. Prolonged antibiotic use can also affect bowel movements and a suitable probiotic may be necessary.


Gastroparesis literally means paralysis of the stomach muscles and this prevents or delays the stomach from emptying its contents into the small intestine. The causative factor may affect the stomach nerve supply to the muscle or the muscle itself.

Causes of Gastroparesis

  • Diabetes (Type I or II)
  • Anorexia nervosa
  • Damage to nerve or muscle due to surgery or other trauma
  • Thyroid disorders
  • Pancreatitis
  • Scleroderma
  • Post-viral syndrome


Symptoms of Gastroparesis

  • feeling ‘full’ quickly or after small meals
  • nausea, vomiting
  • belching (foul odor of rotten eggs)
  • unintentional loss of weight

Diagnosis of Gastroparesis

It is essential to carefully diagnose gastroparesis as it causes similar symptoms to gastrointestinal obstruction due to cancer, pylorostenosis, or bezoar. A gastric emptying study uses radioactive material to monitor the flow of the stomach contents. This is useful in differentiating if the gastroparesis is also affecting the small intestine. An endoscopy may also be useful to verify that there is no obstruction by a tumor in the stomach or intestines.

Diet in Gastroparesis

A liquid or semi-solid diet is advisable and nutritional value should always be considered. Large amounts of fat within the diet is not advisable and fat should be avoided altogether as a precautionary measure. Fat is not well tolerated by the gastrointestinal tract and requires significant intestinal motility (peristalsis) to churn the fatty foods with bile and other lipase enzymes to breakdown the fats. Alcohol is not advisable in gastroparesis as it may further aggravate the delayed gastric emptying.

Home Remedies and OTC Drugs

Gastroparesis should not be managed without professional medical assistance. Immediately consult with your medical practitioner if you suspect that you may be suffering with gastroparesis.

Treatment of Gastroparesis

Treatment of gastroparesis may be through a combination of dietary changes, drugs, electromechanical devices or surgery.

Food Intolerances

Intolerance to certain foods

    may arise from disorders in the digestive or absorption process with the gut.

Lactose intolerance

    arises from the lack of the digestive enzyme lactase. A

hereditary fructose intolerance

    is similar to a lactose intolerance in that there is a hereditary lack of enzymes to metabolize fructose. A

fructose and sorbitol malabsorption

    may result in a reduced absorption of these carbohydrates by the gut thereby allowing intestinal bacteria to consume it. The consumption of the lactose, fructose and sorbitol by intestinal bacteria gives rise to hydrogen gas.

Symptoms of food intolerances and malabsorption are belching, nausea, bloating, abdominal cramps, diarrhea. A rare hereditary fructose intolerance (HFI) may cause more severe symptoms if dietary changes are not implemented. An excessive intake of fructose and/or sorbitol may result in vomiting, jaundice, fatigue, enlarged liver and seizures.

Diagnosis of food intolerances. Colonic bacteria consumes the undigested lactose, fructose and sorbitol producing hydrogen as a byproduct. This hydrogen is detectable by breath tests. A stool sample high in acidity may also assist with diagnosing a food intolerance. A lactose tolerance test may be advisable to establish lactose intolerance.

Treatment of food intolerances. A diet excluding these foods is essential. In lactose intolerance, dairy must be discontinued and a strict lactose free diet must be followed. Fructose intolerance and fructose or sorbitol malabsorption also require dietary changes.

Small Intestinal Bacterial Overgrowth (SIBO)

An increased population of intestinal bacteria within the small intestine results in an increased gas production within the gut. The intestinal bacteria are able to consume nutrient laden food which has not as yet been absorbed by the body. Gas is produced as a byproduct resulting in belching and bloating.

Causes of SIBO :

  • Diabetes (Type I or II)
  • Anorexia nervosa
  • Damage to nerve or muscle due to surgery or other trauma
  • Thyroid disorders
  • Pancreatitis
  • Scleroderma
  • Postviral syndroms
  • Intestinal Obstruction
  • Diverticuli

Symptoms of SIBO are belching, bloating, abdominal pain, flatulence, diarrhea, and symptoms of nutritional deficiencies.

Diagnosis. A fluid sample from the small intestine will reveal a large bacterial population in small intestine bacterial overgrowth. A xylose breath test can also assist with diagnosis.

Treatment. Oral antibiotics is usually effective in treating small intestine bacterial overgrowth. Nutritional supplements may be prescribed to treat nutritional deficiencies.

Biliary Stasis and Biliary Reflux

Biliary stasis is the reduction or absence of bile production or secretion into the gut. Bile is essential for the breakdown of fats within the food. Biliary reflux is the back-flow of bile up the small intestine and into the stomach and esophagus.

Causes of Biliary Stasis :

Causes of Biliary Reflux :

  • Dysfunction of the pyloric valve that separates the small intestine from the stomach.
  • Peptic ulcers
  • Cholecystectomy

Symptoms of biliary disease: pain in the upper right quadrant of the abdomen, nausea, vomiting (bile may be regurgitated in biliary reflux), belching, bloating, weight loss, anorexia.

Diagnosis of biliary disease is by endoscopy, blood tests (may reveal elevated enzyme levels), and magnetic resonance imaging.

Treatment is with surgery, drug therapy to increase bile production, drug therapy to reduce gastro-esophageal reflux assists with biliary reflux, discontinue any dietary or lifestyle habits that may be contributing to liver disease including use of drugs and alcohol. For more information on biliary stasis, refer to Cholestasis.

Related Questions and Answers

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  • cb

    I have tested positive for hpylori. My stomach is bloated, no pain. i eat alittle & blow up like I’m pregnant 9 mos. I have gained 80 lbs in 10 years. I drink beer aprox 20 a week, give or take. i eat healthy foods, but alot of animal fat, butter, meat etc. What do u think?

  • Dr. Greg

    Hi CB. Firstly, your beer drinking is a bit excessive. You should seriously consider cutting down to five or less beers in the week. Apart from the gas release in carbonated beverages, alcohol also causes inflammation of the stomach and intestinal lining. This further contributes to bloating. In terms of your extra 80lbs, it is clear that some weight loss is necessary. Overweight and obese people are more likely to experience bloating for a multitude of reasons. Your H.pylori infection is just an additional contributor to the bloating but your lifestyle needs to be addressed immediately.

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  • Dr. Greg

    Hi Byoungwu. Thank you for the feedback on this article. There are a number of contributing factors that can aggravate the symptoms that you report. A little further information would be required. Have you noticed any trigger foods? What is your current weight and height? Have you ever had a hernia?

    I would also advise that you read the article on Gas and Bloating on Healthhype http://www.healthhype.com/causes-of-bloating-and-gas-flatulence.html

  • byoungwu

    This article was very informative and I’m impressed with the thoroughness. I’ve seen a GI specialist and two doctors about my burping/bloating/and nausea over the course of several years and none of them were able to lay out all these issues so clearly. But the problem is that I have still have all those symptoms, and have been tested for all the above things. Now, the doctors have moved on to IBS, but none of the medication is helping (and is actually making me feel sicker, as did all the GERD medicines). Is there anything else that could be causing burping so much? It’s worse when I wake up but is continuous throughout the day. I don’t drink/smoke regularly, and have a fairly healthy, mostly organic, no-processed food diet. I exercise and am otherwise healthy.

  • klingwench

    I’m on Nexium and Cytotec because I take ibuprofen for arthritis. Recently I have been experiencing a feeling of heaviness (a lead cannonball) in my gut after I eat lunch that is relieved by belching. A lot of belching. The heaviness is something I associate with previous bouts of food poisoning. Any ideas?

  • JosephNY

    I have gas and raised liver enzyme levels. A few months ago I was tested and treated for H PiLori and now test negative. Still the symptoms persist. Any thoughts?

  • Silversky

    Hello. Recently, I have been experiencing severe wind problems. This episode has been going for over 1 month now. A few months back, I had another severe episode, and Gaviscon Double Action seemed to help and enjoyed good health. I tried to chew my food better and cut down on the amount at a time I eat, as I didn’t have the best of habits regarding both. I’m 23, 6’2″ and was about 12 stone 6 pounds, but I’m now 11 stone 4 pounds after 5 weeks. The Gaviscons and other shelf medicines to do with indigestion didn’t have any effect. I don’t seem able to handle food in much volume, I suffer severe wind, can go on for hours on end, all night sometimes. Some days it doesn’t stop, others days it isn’t so bad, until it comes to lying down in bed. When I wake up, I’m very bloated and have to clear a backlog. All this depite regularly seeing my Doctor. I have been on Omeprzole (2x20mg a day for a month so far) and Metoclopramide (up to 3x10mg a day). Also have a Peptac liquid to take a few times a day (1-2 teaspoons at a time), which is meant to help with the symptoms. They seem to have limited effect, and I’m still 3 weeks away from an edoscopy at my hospital. I’ve been off work, but don’t have much sick leave available to me, am not sleeping very well at all. I’m at my wits end sometimes. Any information you could offer please?

  • Silversky

    Just wanted to add, I have been blood tested for Helicobacter, and that came back negative.

  • Jan Modric

    @ klingwench
    Belching usually arises from the stomach or duodenum problems.
    -H. pylori infection of the stomach may go (not necessary) with nausea, heartburn, or eraly satiety. H. pylori also can cause either stomach or duodenal ulcer with pain in upper middle abdomen – where ribs met. Diagnosis is with a breath test (made by gastroenterologist).

    In gastroparesis – slow stomach emptying – food stays in the stomach for several hours. This often goes with a bad breath and constipation. Diagnosis is with stomach emttying test.

    Next: fructose malabsorption goes with gas (flatulence), belching, cramps, diarrhea…after eating excesive amount of fruits, honey or foods cpontaining high fructose corn syrup. Problems may last for few days after such a meal. Diagnosis is with another breath test. Fructose malabsorption almost always goes with some diarrhea.

  • Jan Modric


    blood test for H. pylori is not 100% reliable. Additional H. pylori test can be made during endoscopy.

    Beside H. pylori, common reasons for belching are gastroparesis, small intestinal bacterial overgrowth (SIBO), and fructose malabsorption.

    For the later two, a diet trial exists. Avoiding table sugar for at least 2-3 days (including sweets) can help in SIBO.

    Avoiding all fruits, honey, onions, foods with sorbitol or xylitol (“sugar free” chewing gum, “low calorie” foods), and HFCS (high fructose corn syrup) for at least 4 days should stop belching/gas in fructose malabsorption.

    To get a reliable diagnosis, a serial of breath tests (for H. pylori, fructose malabsorption, SIBO and lactose intolerance) might be necessary.

  • gemma

    I have a client who starts excessive burping whenever I massage her back and neck She is overweight but otherwise healthy and active. Any ideas?

  • Jan Modric

    To gemma:

    This gas obviously comes from the stomach. When she lies on the stomach, pressure is put upon it, and air comes out.

    Now the question is, if this is
    – the air she eats,
    – gas produced by Helycobacter pylori chronic infection that may go totally without symptoms
    – food, decomposing in the stomach and staying there for long time due to gastroparesis (this usualy goes with some bloating).

    If there is quite some amount of this gas, you can recommend her having a test for H. pylori (done by gastroenterologist). H.pylori on long term can cause gastric ulcer.

  • Rory

    I recently ate some Thai fishcakes and very soon suffered excesses of belching and hiccups. That was three days ago. Mostly, the belches act as hiccups, unable to free themselves, and is exacerbated now whenever I eat. The hiccupping dies off when I do manage to belch, but soon regains intensity. Visits to the loo/john to defecate have also decreased.

  • Jan Modric


    two common reasons for belching after eating are:
    1. Stomach infection with bacterium H. pylori
    2. Obstruction of outflow of the food from the stomach (condition is called gastroparesis)

    Both conditions can be checked by gastroenterologists. THere are two tests for this, in either case you get a special drink, and after a while gases in your expired air are measured, and diagnosis made from the results.

  • Ollewis

    6 months ago I started getting chest pains when I swallowed food. It was in the upper right chest area, above the breast.
    I still have it now, but find much of the time it is relieved with multiple belches. I can also get t now spontaneously, with no eating at all.
    I am on prevacid, and have had a history of GERD.

    Any ideas?

  • Jan Modric

    my first two thoughts are chronic H.pylori infection of the stomach, or gastroparesis. In both cases gases are produced and distension is releaved by belching.

    Both conditions can be treated, but first, you need diagnosis by gastroenterologist.

    Bacterium H.pylori causes GERD, and also produces gas.

    Raw garlic was proven to act against H.pylori.

  • tjlonecowboy

    I been sick with bloating for past two months now. When I take clora instential it causes more berping and gas. Also when I lay on my stomach it causes my gas problems. I had a cat scan and sonar done with no gallstones found. I do not know what is causing the gas to be bleching please help

  • annie54

    I have an old gastric bypass from 1977. I have GERD. I am miserable. I throw up almost every day last 15 years. The staples pull and hurt. I now have copd. I think its more aspirated food. Also have apnea. Train wreck!! Your thoughts please.

  • Jan Modric

    common causes of belching are H. pylori infection, hiatus hernia, gastroparesis, and fructose malabsorption. Most of these causes are hard to determine from symptoms alone, so I suggest you to visit gastroenterologist that may order appropriate tests.

  • Ina

    I am 20 years old. I have very good health, exept excessive burping. I take care of my diet, i maintain nutrition food, my fat is at level of 22-24%, which is excellent to good. I noticed, when i take little carbohydrate, i have this excessive burping, and i’m uncomfortable with it. but after eating carbo diet like rice and breads, i dont burp at all. what is happening? tq

  • Jan Modric

    if I get you right, you burp after eating sugars. Avoid sugary sodas, sweets,…
    Do you also burp after fruits? Read about fructose malabsorption:

    You might also check if you have H.pylori infection of the stomach (common) – gastroenterologist will do it.

  • Cyfanfor

    I hit upon this site on a Google search for a combination of Belching and Massage. I noticed someone mentioned a massage client with belching resulting from back and neck massages, and the response was that the stomach was being pressed. Well, there’s definitely more to it, at least in my case, and here’s why.

    I have been dealing with a lousy stomach for a while now, latest misdiagnosis being IBS. But the most mysterious aspect, I seem to inherit from my mother, which only adds to the curiousness.

    A back or neck massage ALWAYS triggers off belching. Sitting up. Sometimes, massaging an arm will do it. And an upset stomach causes generalized body pain.

    What is this?

  • Jan Modric

    Cyfanfor, when food reaches the pharynx, a reflex peristaltic wave goes down along esophagus and opens the cardia (stomach entrance). This is called swallowing reflex. During neck massage the same (or resembling) reflex may be triggered, and when stomach entrance is opened, the gas is released from it.

    So, like you’ve said, neck massage can trigger, but not really cause belching. You need some gas built up to belch.

    What do you think you have inherited: belching or “lousy stomach”?

    H. pylori infection runs in families, and causes chronic gastritis. This is probably contracted rather than inherited. Breath test for H. pylori is the first thing I recommend. It’s done by gastroenterologist.

    To say more, I’d need more info about what symptoms you have. What is hidden under “IBS” it’s usually a combination of stress and irritation by certain food(s). If lactose intolerance and celiac disease were excluded, the next to think is fructose malabsorption.
    Here are details:

    If low-fructose diet doesn’t help, you might want to try an eliminiting diet. There are at least two ways how to do it; either you start with few days of fasting and than slowly add foods one by one to see which one you can tolerate. The other way is to exclude foods (food groups) one by one from your current diet. If you have any underlying health problems, this should be done under doctor’s supervision.

  • whiterabbit

    Hi there ~ I’ve recently had a bad chest infection and was on a five day cause of antibiotics. After a week or so I started to pick up but one night I started going hot and cold, uncontrollably so and felt just awful like flu like symptons.
    The next day I woke up and had this dire need to burp which lasted all day long. I am also gluten-sensitive so I am on a gluten free diet which I started on early in March. I also experienced extremely bad heart burn after a meal the other night of simply lamb chops, potatoes and coleslaw (everything was gluten free) and immediately after consuming the last mouthful of food I got it and that is so not me.
    Since then, when I wake up in the morning and I have this gas that builds up over night and I need to get rid of it to ease off the pressure in my chest area. I only get this gas sensation first thing in the morning and I come right during the day. I am still recouperating after this chest infection which was a nasty one.
    One other thing concerns me is that I am still losing weight even though I am eating reasonable meals. I have lost 3.3 kg’s in just a month since I have been sick and even though I’m not a rake, I am only 54.6 kg’s and don’t want to lose any more weight if I can help it and yet I don’t know what else I can do. I started on a probiotic a few days ago thinking that maybe I need to put back some good bacteria into my gut through taking the antibiotics but am just wondering when you might think I will notice a change – will the burping simply go on its own.
    I don’t drink soda drinks, only tea with milk, don’t eat sugars really and recently (after the burping started) drinking promegrante juice. Any advice much welcomed as I’m not looking forward to having to go back to my doctor ‘yet again’ on another sympton which to them is like a needle in the haystack.
    Thanks for listening,


  • Jan Modric

    Burping comes from stomach or upper intestine. It sound like Stomach/intestinal infection.

    Probiotics themselves are bacteria, they eat some nutrients from the gut and yield gas, so I’m not sure if this is appropriate for you, if you burp a lot.

    One thought is H. pylori infection that is treated with a special combination of antibiotics and Prevacide. Some people report that oregano oil, broccoli, or garlic helped to treat them H. pylori, but I can’t say how reliable this information is.

    Another thought is – food poisoning – it goes with nausea and diarrhea. This usually goes away by its own in few days.

    If it’s H. pylori, it won’t go away by itself. It’s a gastroenterologist who can give you reliable diagnosis and treatment for this or whatever it is.

  • annie54

    annie54 I have an old gastric bypass from 1977. I have GERD. I am miserable. I throw up almost every day last 15 years. The staples pull and hurt. I now have copd. I think its more aspirated food. Also have apnea. Train wreck!! Your thoughts please.

  • kellyc

    I was in a car accident about three weeks ago, hit head on by a drunk driver. I was in the driver’s seat. Main problem afterwards was my knees, no real noticeable issue with my chest/stomach, areas where my seatbelt was. However, after the wreck I had constipation and increased gas, released primarily through belching, followed by diarrhea which has remained fairly constant. At best my stool has been soft and foul smelling, at worst watery diarrhea. And it pretty much always contains undigested food. Any ideas?

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  • Dr. Greg

    Hi Kelly

    It is difficult to say what may have caused your symptoms or whether it is even related to your accident. Constipation and increased acidity in the stomach resulting in increased gas can occur due to shock or anxiety. Being hit head on most definitely qualifies as shock and I am sure it is still upsetting to recall. Do you have a history of irritable bowel syndrome (IBS)? Undigested food may indicate rapid movement through the gut or even a problem with your good bowel bacteria. Are you on any medication (anti-inflammatory, pain killers, etc) after your accident?

  • AlexP

    I’m struggling to find possible causes for frequent belching which occurs after eating, sometimes even after drinking water. Often times the belching or gas will get trapped in the throat or upper esophagus area causing discomfort. I’ve had an upper endoscopy which showed some abrasions in the stomach (H. Pylori negative and they’re not ulcers either) but am on PPI drugs. I’ve also had an esophagram which was normal. 24 hour pH study which didn’t reveal anything and a manometry test which didn’t show a motility problem. Any idea what could be the likely cause or causes?


  • Dr. Pravith

    Hi AlexP

    It is difficult to conclusively say what may be causing this condition in your case. One possible cause in cases like yours is a hiatal hernia which should have been evident upon diagnostic investigation. Your diet may be a contributing factor along with air swallowing especially if you are a fast eater or mouth breather. If you are overweight, fat deposits around the mouth and neck may cause a slight constriction of the mouth and associated cavities. This may causes air to get trapped within the throat or upper esophagus area.

  • Jenna

    I’ve had problems with chronic nausea, bloating, burping, heartburn/reflux, headaches, etc. for many years.

    I’ve had an endoscopy done, H-pylori tests, gallbladder scan, full abdominal ultrasound, gastric emptying study, and probably several other tests that slip my mind at the moment. Endoscopy showed inflammation, nothing else.

    I’m not overweight (the nausea has actually made me underweight), I don’t eat spicy/fatty foods. I’ve been on Proton pump inhibitors, antacids, Reglan, anti-nausea meds, nothing helps.

    Any advice is appreciated. My own Gastro dr. has given up, and I’m close to throwing in the towel as well.

  • Dr. Pravith

    Hi Jenna
    Your gastroenterologist would have gone through all the necessary tests and excluded his differential diagnosis. If he has “thrown in the towel”, it would be difficult for us to assess your condition online. However we will try our best to assist you. How are your bowel movements? Do you notice any foods that may aggravate your condition further? Any alcohol or drug (medicinal) use?

  • Jenna

    Thank you for the response, Dr. Pravith.

    My bowel movements are normal (x1 daily) for the most part. I do have bouts of diarrhea at least once a month though.

    It’s hard to say which foods make it worse, since about the only thing I can keep down currently is toast and bland eggs. Spicy, fatty, fried, and salty foods were the first to bother me though.

    I’ve never drank alcohol, and I’m not on any drugs currently. (As I posted before, I’ve tried many many types of antacids and over the counter stomach remedies, but stopped them when it was apparent they weren’t helping.)

    Again, thank you for the response.

  • Dr. Pravith

    Hi Jenna

    Your condition is baffling. The fact that your symptoms are so severe, isolated to the upper gastrointestinal tract, with little or no signs and symptoms of the lower gut and has persisted for so long definitely warrants further investigation. Since H.pylori and hyperacidity have been excluded as possible causes, I think you should take a look at small intestine bacterial overgrowth (SIBO) above. Take note of the causes of SIBO.

    Here are some points to consider for future reference :
    – Fluctuations of the blood sugar levels may be a cause of the nausea
    – Is it ‘nausea’ or burning in the ‘pit of the stomach’? Both symptoms can be quite subjective and often confused.
    – You mentioned your foods but not what you drink. Tea? Coffee? Soft drinks? Any with artificial sweeteners?

    I advise that you seek a second opinion from another gastroenterologist. The symptoms you are experiencing could be due to a multitude of other conditions, some of which may not even be directly related to the gastrointestinal system. I would not like to comment on this further and create any paranoia about possible causes of your symptoms. Rather let a professional investigate and diagnose or exclude other possible causes.

    Sorry, any further attempt to diagnose online would just be irresponsible on my part. 🙂

    Good luck.

  • AlexP

    Thanks Dr. Pravith. If it is a hiatal hernia what does that mean or what can be done to correct it. Also most of the chronic belching occurs after eating or drinking something, so what tests can I do to look into possible digestive disorders causing my symptoms?

    Lastly I’ve noticed that I cannot seem to digest sugar properly. Any food or drink with high sugar content causes significant belching. What does this signify? Again blood tests were normal except slightly elevated amylase levels.

  • Dr. Pravith

    Hi AlexP

    An elevated amylase MAY signify a pancreatic disorder depending on the extent and duration of the elevation. It may also cause some GIT symptoms although you have not reported any of these. Consult with your doctor for more information or further investigation.

    A hiatal hernia is when a portion of the stomach gets constricted by the diaphragm. It should show up on an x-ray or barium study and can be corrected surgically. However this is just a consideration and not a definite diagnosis.

    Based on the information have provided, I would advise investigating your pancreas further as well as focusing on fructose malabsorption (although sugar is sucrose) as well as conditions like small intestine bacterial overgrowth (SIBO). You can search for more information on these topics on this website.

    Once again, I must stress that you should consult with your medical practitioner with regards to your symptoms.

    Good luck.



  • Dr. Pravith

    Hi Shorty

    It seems that you are lactose intolerant and it must be noted that if you are lactose intolerant, you may not always have severe reactions to all dairy products. Milk usually is the biggest trigger even in small quantities, although very large amounts of processed products like cheese and ice cream will also trigger GIT symptoms. Your diarrhea and abdominal pain which is likely due to intestinal cramps is very likely linked to your lactose intolerance and means that you should control your dairy intake or even discontinue if possible.

    With regards to the second part of your question, it would not be possible to “guess” what may be causing your gas and burping with bouts of diarrhea and constipation unless you had further diagnostic investigation performed by a medical practitioner. There are many causes including IBS (irritable bowel syndrome). There are articles on IBS on this website, take a look at them and see if they fit in with what you may be experiencing.

  • AlexP

    I appreciate that Dr. Pravith. Almost six years ago was diagnosed with a small reducible hiatal hernia, however upon manometry testing they couldn’t find one. How can that be?

    Aside from fructose malabsorption and SIBO what other tests can reveal useful digestive information? To look into intestinal health or gut permeability, what diagnostics are available?

    As for GIT symptoms, mainly bloating and distension occasionally after meals. Primary issue is the chronic belching and trapped gas in throat.


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  • greenmint


    I am 24yr/female. Have had chronic nausea for over a year now. Most recently, it’s gone from nausea to vomiting. I am nauseous everyday. I am not throwing up anything coffee ground like, but there may be blood – usually throwing up bile like substances with red traces. Also belching a lot (upwards of 40x/day), and I never did before. And (sorry for grossness) diarrhea. I’ve lost 10 pounds total, which doesn’t seem like a lot… but I am not overweight at 140 pounds/5’10”.

    Been to the ER several times for passing out and severe dehydration (10% total dehydration) and also chronic kidney infection/UTI.

    Feeling tired ALL the time. Have had heart and kidneys checked – all fine. Blood comes back normal except for high cholesterol and high ANA.

    Help. 🙁

  • Dr. Pravith

    Hi greenmint

    Your symptoms are indicative of many conditions relating to the gastrointestinal tract or associated systems. Since an ANA came back with a high reading, this could possibly be due to some systemic cause like an autoimmune condition. Seek specialist treatment to rule out a number of conditions including HIV infection and gallbladder disorders.

    Endoscopic investigation may be advisable to diagnose other gastrointestinal conditions. Based on your case history, your doctor should consider further investigation however if you have different attending physicians, they may not be realizing the entirety of the situation since they are not aware of your history. Consult with a doctor or gastroenterologist and follow through on any series of tests that he/she may require to confirm a diagnosis.

  • greenmint

    Thank you, Dr. Pravith.

    Just a few more questions, if I may. Does it sound like HIV?? Or is that just something to rule out as a precaution?

    My family has a long history of autoimmune conditions, dating back several generations. Which autoimmune should I look at specifically?

  • Ruth

    Dear Dr Pravith,
    My life has become miserable. After the evening meal the belching starts until 2 or 3 in the morning when I take No-gas and a sleeping pill. The next day I am tired and irritable (I work a full day). Every night it starts again. Funny enough it does not happen during the day. I skip breakfast and do not get time to eat much at work. I use a coffee creamer in my coffee, have started eliminating coffee, switched to Horlicks – belching became worse because of increased coffeecreamer (white powdery stuff to use instead of milk (non dairy). My belches are most unladylike, explosions almost, I am not overweight, no alcohol smoking or medicine. Always been healthy. Now I have a dreadful pain under my left breast like trapped wind. I have a heart murmur. Have sometimes been anaemic therefore I changed to meat eating after 20 years of being a healthy vegetarian. Is it the meat? Have been for Breath test- still awaiting result. Funny thing – this can go away for weeks, then come back for weeks to plague me again. Mystery. Will start eliminating sugar and coffeecreamer as well as all refined floury substances this week. Thanks.

  • Dr. Pravith

    Hi Ruth

    You obviously seem to be in great distress about this problem. It would be difficult to conclusively say what may be the cause of your belching until further investigation has been undertaken.

    Skipping meals is not advisable. Ensure that you eat regular meals, even small meals, as hunger and increased gastric acidity can cause belching. The pain under your left breast may be indicative of a number of conditions but I would suggest you consider a hiatal hernia or hyperacidity as a possible diagnosis. A hiatal hernia may explain a number of the symptoms that you are experiencing but your doctor will undertake the necessary investigations to confirm or exclude these conditions. Several foods and lifestyle factors can aggravate the symptoms associated with a hiatal hernia beyond just stimulants like caffeine, nicotine or alcohol. Spicy foods and other irritants (possibly coffee creamer although it is not common) could be aggravating your condition.

    In terms of meat eating, it should not really be a problem but your diet should be abundant with fresh fruit and vegetables. Your anemia could be related to your vegetarian diet but may also be indicative of a malabsorption syndrome.

    Adopt as wait and see approach to your condition. Continue excluding foods as you are doing. Consult with your doctor about your test result and any further investigation he/she may deem fit. And start eating regular meals. Mild exercise is known to relieve some of the symptoms of hiatal hernia so consider this as well. However, if it is a hiatal hernia, surgery will most likely be necessary.

    Please note that this advice does not constitute a medical consultation and any comments provided is solely for assisting with a possible diagnosis. However your medical doctor and test results will be the deciding factor.

  • Serena


    I had an ENT look at my throat with an endoscope because I was having some sensation and irritation. He noticed that he saw some acid there. He told me to take Nexium 40mg mornings and another PPI called Pantoprazole 40mg in the evenings. Is it alright to take two different PPI drugs each day?

    Also what else can be done to help heal the acid in the throat? Why did this happen if I was already taking Pantoprazole 40mg once daily? Is it possible I’m hypersecreting acid? What test determines this?

    Thanks for the help!

  • Dr. Chris

    Hi Serena

    Yes, it is alright to take 2 PPI’s if your ENT prescribed it as he had made his decision based on his findings. However long term use can be a problem as research has shown that acid reflux often returns and aggravates after long term use of PPI’s. It is not entirely a matter of hypersecreting acid although this is possibly. Reflux may occur for a number of reasons apart from increased acid production. The gastroesophageal sphincter which prevents the gastric contents from rising to the throat may be malfunctioning, thereby allowing acid to up the espohagus. When sleeping, this can easily reach the throat and cause irritation due to its prolonged stay in this area.

    If necessary, your doctor will conduct stomach acid tests to monitor the pH of your gastric acid and quantity of gastric acid secretion. This is not always necessary if acid has been noted at the back of the throat or if you are experiencing regular sore throats upon waking in the morning. You ENT may refer you to a gastroenterologist for further investigation if necessary.