Robert Shmerling, M.D.

Harvard Health Letters

Q. I belch a lot and get a feeling of fullness in the upper abdomen. Is this a common condition? What are the causes and cures? I would prefer natural remedies.

A. Belching and feeling full are normal, everyday experiences. So what makes them "excessive"? There's no precise definition. But if you start belching or feeling full more often than you have in the past, or if belching and fullness are causing you distress and discomfort, then I'd consider that excessive and a problem that you should try to solve.

Every time we swallow we take in a little bit of air. Some of it travels down the esophagus and gets into the upper part of the stomach. When the stomach starts to stretch out, sensors in its wall may trigger a reaction that opens the small ring of muscle, or sphincter, that operates as a valve between the esophagus and the stomach. The air that has built up in the stomach gets vented back up the esophagus and, voila, we belch. So, if it's not excessive, belching is actually a protective mechanism against the stomach getting overinflated.

Sensors in the stomach wall sense fullness, opening the sphincter that separates the stomach from the esophagus so air can escape.

Of course, if you're in public -- and you're not a teenager who thinks belching is hilarious -- you want to do it in a way that isn't too loud or noticeable.

There are also so-called supragastric (above the stomach) belches that come from venting air that only got as far as the esophagus before coming out again. Gastric belches can be smelly because the air has come from the stomach, whereas supragastric belches may not be.

There are many possible explanations for excessive belching and many more for the overly full feeling you say you have. Here are some possibilities:

Air swallowing (aerophagia).

Some people get into a pattern of repeatedly swallowing air and quickly belching it out again, sometimes at a rate of 10 or even 20 belches per minute. Most of those belches are likely to be supragastric.

Food and drink.

Carbonated beverages -- beer, soda, seltzer -- bring a great deal of extra air into the stomach. The way we drink those beverages often compounds the problem: gulping them down or drinking through a straw helps fill the stomach with air. Certain foods -- baked beans, broccoli, cabbage -- are notorious for creating gas during digestion, although that tends to occur more in the small and large intestines than in the stomach.

Gum and hard candy.

When chewing gum, many people swallow air without realizing it. Sucking on hard candies can also lead to inadvertent air swallowing. For some people, sugarless gum or candy cause belching and other forms of gastrointestinal distress because they have difficulty digesting the sweeteners -- sorbitol, for example -- used to replace sugar.

Gastroesophageal reflux disease.

Dutch investigators who've carved out belching as an area of expertise have conducted studies that show that people with gastroesophageal reflux disease sometimes get into a habit of swallowing air.

Irritable bowel syndrome.

For the most part, irritable bowel syndrome seems to be an affliction of the lower part of the gastrointestinal tract, but some people with the condition are bothered by an inordinate amount of belching.

Lactose intolerance.

The inability to digest lactose, the sugar in dairy products, produces abdominal pain and a bloated feeling. Usually flatulence, not belching, is a symptom.

How you go about treating problematic belching or feeling full depends on the cause, and finding it may require evaluation by a doctor. But you can try a few things on your own. Cutting back on carbonated beverages might help. The same goes for chewing gum and sucking hard candies.

Sometimes when fast eaters slow down the pace at which they eat they wind up swallowing less air with their food. You can also experiment with eliminating foods known to cause gassiness from your diet to see if there's a change for the better.

Air swallowing can be a habit that develops apart from any eating or digestion problem. The Dutch group has reported that some people can break the habit with the help of a speech therapist.

Most people with symptoms like yours don't have a serious medical condition. But, there are some circumstances in which you should see a doctor right away. If your abdomen is actually distended -- visibly larger than normal -- you should get evaluated promptly. Blood in your stool, a high fever, sudden weight loss -- they're also good reasons to see a doctor sooner rather than later.

Robert Shmerling, M.D., Beth Israel Deaconess Medical Center, Boston, MA


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