EpistemisSour belches
Specialty: Gastrointestinal.
Why it occurs
- Non-erosive or severe erosive gastroesophageal reflux disease (GERD)
- Sliding or paraesophageal hiatus hernia with alteration of the antireflux barrier
- Slowed gastric emptying or initial diabetic gastroparesis
- Benign or malignant pyloric stenosis with stasis and acid fermentation of gastric fluids.
Initial workup
Upper digestive endoscopy (EDA) to rule out esophagitis, hiatal hernia or tumor lesions | 24-hour esophageal pH-metry with or without impedanciometry (to correlate sour belching with the drop in intraesophageal pH below 4) | Double contrast esophagram to assess the anatomy of the gastroesophageal junction | High resolution esophageal manometry.
red flags
Recurrent vomiting with remains of digested food or fresh blood, progressive dysphagia, significant weight loss of unexplained cause, oppressive retrosternal pain that radiates to the jaw or left arm, recent onset anemia.
Standard management
- Proton pump inhibitors — omeprazole 20-40 mg, pantoprazole 40 mg or rabeprazole 20 mg daily, administered 30 minutes before breakfast to effectively suppress the acidity of regurgitated gastric contents
- Sodium alginate plus potassium bicarbonate — 10 ml or one sachet administered 30 minutes after main meals and at bedtime, forming a physical barrier of alginate gel ("raft") floating on the gastric contents
- Histamine H2 receptor antagonists — famotidine 20-40 mg at night in case of refractory nocturnal acid leak
- Prokinetics (itopride 50 mg three times a day to accelerate gastric clearance).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Gastrointestinal
- Listed causes
- 4
- Treatment options
- 4