Belching is the expulsion of gas from the gut through the mouth. Bloating may occur due to gas trapped within the gastrointestinal tract and this is often relieved upon belching.

Belching and bloating may be due to food, eating habits, or disorders in the stomach, small intestine or gallbladder.

Air swallowing

Air swallowing commonly known as ‘Belching after eating’ may be a voluntary or involuntary action. When air enters the esophagus it is usually expelled as a belch. In most cases it does not cause any discomfort or bloating.

The causes of air swallowing are many and include; fast eating or drinking, mouth breathing, nasal blockage, hyperventilation related to anxiety, regular gum chewing, and poorly fitted dentures. The only treatment for such cases is by removing the cause.

Belching after drinking

Carbonated drinks like soda and beer cause a build up of gas within the stomach and esophagus. Certain antacids cause the formation of carbon dioxide as a byproduct to neutralising stomach acid.

This is then expelled as a belch. Treatment is by avoiding carbonated drinks and excessive amount of antacids.
Gastro-esophageal reflux disease

Gastro-esophageal reflux disease (GERD) is the back flow of the stomach contents (acid and food) up the esophagus. The esophagus and stomach are usually separated by lower esophageal sphincter, a valve that allows food to enter the stomach.

While the lower esophageal sphincter may spontaneously open and close a few times a day, it usually opens more frequently and stays open for longer in GERD.

Symptoms of GERD are heartburn, belching occasionally with regurgitation, regurgitation, chest pains, ulcers of the esophagus, recurrent sore throats with difficulty swallowing (most aggravated upon waking and lying down), acidic taste in mouth.

Treatment is by medications that reduce gastric acid secretion assist with the closing of the lower esophageal sphincter and lowering the acidity of the stomach. Antacids like tums help only in mild and transient GERD.

Prevention of GERD involves avoiding foods that may increase gastric acid or promote the opening of the lower esophageal sphincter.

This includes foods that are high in caffeine, alcohol, carbonated drinks, spicy foods, acidic foods, fatty foods, dairy and cruciferous foods (’gassy foods’) like beans, onions, brussels sprouts.

Offensive Belch Odor

This is the belching of foul smelling gas usually described as "rotten eggs”. This typical odor is characteristic of the gas hydrogen sulphide which indicates fermentation.

Food that is unable to move rapidly through the gut may start fermenting in the upper gastrointestinal tract due to bacteria and breakdown processes.

Necrosis (cellular death) and decomposition of the intestinal lining may also give rise to hydrogen sulphide within the gut. Necrosis may be indicative of severe underlying pathology.

Causes of offensive belch odor include; Gastroparesis, gut fermentation, intestinal obstruction, dysfunction of the vagus nerve and Necrosis.

For treatment, antibiotics may assist with reducing intestinal bacteria that facilitate decomposition of food. Surgical intervention may be necessary for debridement of necrotc tissue to prevent further spread.

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