title: Effect of sleep on excessive belching: a 24-hour impedance-pH study.
abstract: In patients with repetitive and troublesome belching an organic cause is seldom found, indicating the presence of an acquired abnormal behavior. The aim of our study was to investigate the incidence and pattern of belching during a 24-hour period.
  
  
  METHODS
  Combined 24-hour pH and intraluminal impedance monitoring was performed in 14 patients (9 female; mean age: 43 y) with excessive belching and 10 patients (6 women, mean age 42 y; range 28 to 56) with noncardiac chest pain. Thereafter, we counted the number of belching events and differentiated the number of supragastric and gastric belches.
  
  
  RESULTS
  During the 24-hour study, the hourly rate of belching was 38.7+/-6.0; rate of supragastric belches were significantly higher compared to gastric belches (37.7+/-6.0 vs 1.0+/-0.5, P<0.001). Patients with noncardiac chest pain showed a lower average hourly rate of belching (3.1+/-0.6, P<0.001). Dividing the recording into 2 periods (daily-upright and night-supine), there was a significant decrease in the hourly rate at night (37.8+/-6.1 vs. 0.9+/-0.5, respectively, P<0.001); mostly due to decrease in supragastric belches, where as the rate of gastric belches remained unchanged. None of the patients showed pathological acid reflux and none of the supragastric belches was associated with acid or nonacid reflux events.
  
  
  CONCLUSIONS
  Supragastric belch is the prominent belching pattern in patients with excessive belching. Supragastric belches almost ceased at night suggesting the presence of a behavioral disorder. There were no diurnal changes in the rate of gastric belches.
authors.affiliation: Hepatogastroenterology Unit, 2nd Department of Internal Medicine-Propaedeutic, Attikon University General Hospital, Athens University, Athens, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Karamanolis
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Triantafyllou
authors.forename: Zacharias
authors.initials: Z
authors.lastname: Tsiamoulos
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Polymeros
authors.forename: Theodora
authors.initials: T
authors.lastname: Kalli
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Misailidis
authors.forename: Theodoros
authors.initials: T
authors.lastname: Liakakos
authors.forename: Spiros D
authors.initials: SD
authors.lastname: Ladas
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002637:Chest Pain / Q000209:etiology; D017097:Electric Impedance; D004884:Eructation / Q000209:etiology / Q000503:physiopathology*; D050782:Esophageal pH Monitoring; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D015994:Incidence; D008297:Male; D001523:Mental Disorders / Q000503:physiopathology; D008875:Middle Aged; D012890:Sleep; D055815:Young Adult