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Treatment of supragastric belching with cognitive behavioral therapy improves quality of life and reduces acid gastroesophageal reflux

Glasinovic, E, MD1,2; Wynter, E, BSc1; Arguero, J, MD1; Ooi, J, MD1; Nakagawa, K, MD, PhD1; Yazaki, E, PhD1; Hajek, P, MA, PhD; Psych, Clin C3; Woodland, P, MD, PhD1; Sifrim, D, MD, PhD1

American Journal of Gastroenterology: April 2018 - Volume 113 - Issue 4 - p 539–547
doi: 10.1038/ajg.2018.15
ORIGINAL CONTRIBUTIONS: ESOPHAGUS
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OBJECTIVES: Excessive supragastric belching (SGB) manifests as troublesome belching, and can be associated with reflux and significant impact on quality of life (QOL). In some GERD patients, SGB-associated reflux contributes to up to 1/3 of the total esophageal acid exposure. We hypothesized that a cognitive-behavioral intervention (CBT) might reduce SGB, improve QOL, and reduce acid gastroesophageal reflux (GOR). We aimed to assess the effectiveness of CBT in patients with pathological SGB.

METHODS: Patients with SGB were recruited at the Royal London Hospital. Patients attended CBT sessions focused on recognition of warning signals and preventative exercises. Objective outcomes were the number of SGBs, esophageal acid exposure time (AET), and proportion of AET related to SGBs. Subjective evaluation was by patient-reported questionnaires.

RESULTS: Of 51 patients who started treatment, 39 completed the protocol, of whom 31 had a follow-up MII-pH study. The mean number of SGBs decreased significantly after CBT (before: 116 (47–323) vs. after 45 (22–139),P<0.0003). Sixteen of 31 patients were shown to have a reduction in SGB by >50%. In patients with increased AET at baseline, AET after CBT was decreased: 9.0–6.1% (P=0.005). Mean visual analog scale severity scores decreased after CBT (before: 260 (210–320) mm vs. after: 140 (80–210) mm,P<0.0001).

CONCLUSIONS: Cognitive behavioral therapy reduced the number of SGB and improved social and daily activities. Careful analysis of MII-pH allows identification of a subgroup of GERD patients with acid reflux predominantly driven by SGB. In these patients, CBT can reduce esophageal acid exposure.

1Wingate Institute for Neurogastroenterology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK

2Universidad del Desarrollo, Facultad de Medicina, Clínica Alemana de Santiago, Santiago, Chile

3Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK

Correspondence: Dr Daniel Sifrim MD, PhD, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK. E-mail: d.sifrim@qmul.ac.uk

published online 20 February 2018

Received 25 September 2017; accepted 3 January 2018

© The American College of Gastroenterology 2018. All Rights Reserved.
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