title: Psychological factors affect the frequency of belching in patients with aerophagia.
abstract: BACKGROUND
  In patients with aerophagia and excessive belching an organic cause is seldom found and a psychogenic cause is often suspected.
  
  
  OBJECTIVE
  To investigate the effects of attention and distraction on the frequency of belching in patients with aerophagia.
  
  
  METHODS
  In 10 patients with aerophagia, combined esophageal manometry and impedance monitoring was performed for 2 h, consisting of four 30-minute recording periods. Period I: patient unaware that recording had commenced. Period II: patient informed of recording in progress. Period III: distraction by filling in questionnaires. Period IV: no distraction.
  
  
  RESULTS
  A total of 1,258 belches was measured, 51 of which were the result of air that escaped from the stomach (gastric belches). A total of 1,207 belches (96%) were events during which air was expelled in the oral direction almost immediately after entering the esophagus from there (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 periods. In contrast, the incidence of supragastric belches increased significantly from 0 (0-32) in period I to 30 (18-60) in period II, after patients were told that recording was started. During period III (questionnaires) the incidence of supragastric belches decreased to 14 (4-30). In period IV the incidence of supragastric belches increased to 21 (10-49).
  
  
  CONCLUSIONS
  When patients with excessive belching are unaware that they are being studied or when they are distracted, the incidence of belching is significantly reduced. These findings underline the importance of psychological factors and provide rationale for behavioral therapy.
authors.affiliation: Department of Gastroenterology, Sint Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Albert J
authors.initials: AJ
authors.lastname: Bredenoord
authors.forename: Bas L A M
authors.initials: BL
authors.lastname: Weusten
authors.forename: Robin
authors.initials: R
authors.lastname: Timmer
authors.forename: André J P M
authors.initials: AJ
authors.lastname: Smout
mesh_terms: D000328:Adult; D000334:Aerophagy / Q000503:physiopathology / Q000523:psychology*; D000368:Aged; D001288:Attention; D001364:Awareness; D017097:Electric Impedance; D004884:Eructation / Q000503:physiopathology / Q000523:psychology*; D004947:Esophagus / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D013270:Stomach / Q000503:physiopathology