Table 5

Investigation and management of belching/burping

InvestigationsPotential resultsClinical management plan
Actions from history, medication and dietary assessment
History findingsAerophagia (excessive swallowing of air)Eat slowly.
Reduce chewing gum and temperature of hot drinks.
Carbohydrate sensitivityAssess for carbohydrate malabsorption (p. 26).
Psychological support.
Medication findingsUse of effervescent medicationsDiscuss alternatives available.
Sedatives, eg, temazepamDiscuss alternatives available.
MetforminChange to long-acting preparation.
Dietary findingsExcessive use of carbonated drinksAdvise regarding reducing carbonated drinks intake.
Eating/drinking too much in one sittingEat/drink little and often.
First line
OGD and SI aspirate (p. 25)Malignancy/tumour recurrenceRefer to appropriate MDT requesting an appointment within 2 weeks.
SIBOManagement of SIBO (p. 27).
Stricture formationDilatation of anastomosis (p. 25)±dilatation of pylorus (if evidence of delayed gastric emptying) with careful biopsy.
Glucose hydrogen methane breath testSIBOManagement of SIBO (p. 27).
Second line
If normal investigations/no response to intervention
  • Refer to dietitian for trial of low FODMAPs diet.

  • Reassure.

  • FODMAPs, fermentable oligo-di-monosaccharides and polyols; MDT, multidisciplinary team; OGD, upper GI endoscopy (oesophago-gastroduodenoscopy); SI, small intestine; SIBO, small intestinal bacterial overgrowth