Help! My wife can’t stop her burping

QFOR the past four years, my wife, who’s 76, has suffered from non-stop burping, except when she’s asleep. She has tried just about every medication and has seen various doctors, but nobody can suggest a solution. I have heard of a procedure called a LINX band, but when I’ve mentioned this to various experts, they’ve told me it’s not available and probably wouldn’t work. What’s your opinion?

APeter Wigfall, by email. This has been a considerable puzzle, and no doubt a source of anxiety for you both. You would be surprised how often patients visit GPs about burping or other gastrointestinal complaints, such as bloating, abdominal pain and flatulence. Typically, the patient believes the problem is excessive gas in the abdomen, yet rarely is that the case.

scientific studies have shown that the total volume of gas in the intestines is quite small — only about 200ml, a fraction of the amount found in an average party balloon — even in patients who are complaining of distension (bloating).

in your longer letter, you say your wife also has a small hiatus hernia (where the stomach, or part of it, bulges up into the chest where the oesophagus comes through the diaphragm) and two diverticuli (small pouches that form in the wall of the large intestine). Although these can both cause discomfort, i think they are unlikely to be connected to the burping.

Repetitive burping is often assumed to be a sign of some underlying gastrointestinal disorder, but more often than not, it’s caused by aerophagia — swallowing excessive air. The fact that your wife has seen various doctors who seem unable to find any other cause suggests that aerophagia is the issue.

Typically, when we swallow throughout the day, we take in a teaspoonful or so of air — and more when food is gulped down. But someone with aerophagia may take in a great deal more, which can lead to considerable discomfort and burping. in a study involving 80 patients with aerophagia, more than 50 per cent complained of excessive belching, 30 per cent of abdominal pain and 20 per cent from distension.

The researchers found that patients with excessive recurrent burping were expelling swallowed air that had been taken into only the oesophagus, and then immediately released — in other words, the air never reached the stomach at all.

The Linx system you mention is not appropriate for your wife’s case because it’s designed to prevent reflux of stomach contents into the oesophagus, a condition known as gastroesophageal reflux disease. As well as burping, this usually causes pain.

The Linx system is a bracelet of magnetic beads surgically implanted around the valve at the bottom of the oesophagus, which allows food to go down, but keeps contents from rising up. This would not be of any benefit to your wife.

What will help is finding a way to ease the aerophagia. normally, it’s linked to stress or anxiety, though chewing gum or eating too quickly can also contribute to it.

The first step must be to reassure your wife that the burping is a benign condition; there is no sinister, undiscovered disease driving it — it is a subconscious habit.

i suspect that none of the experts your wife has consulted has confronted the psychological aspects of the burping, only telling her what is not wrong with her.

i suggest she talks to her doctor about the possibility of referring her for behaviour modification therapy, such as cognitive behavioural therapy, a form of talking therapy that may prove beneficial in undoing this habit.

QMY DAUGHTER has just been diagnosed with Parkinson’s disease at the age of 50. But how can a neurologist come to such a devastating result after just one appointment? She had only some slight limping in one leg and slight shaking now and again. The neurologist is arranging a brain scan and has given her tablets called Azirest. Earlier in the year, she felt depressed and her doctor prescribed sertraline, which she took for a few weeks. Should we seek a second opinion?

AName and address supplied. MY feeLinG is that this diagnosis sounds correct — Parkinson’s is a progressive neurodegenerative disease, which means the symptoms will increase over time, and the progression in this case does sound typical.

A diagnosis is made after taking a history of symptoms and a physical examination. The classic signs the specialist will have looked for are: bradykinesia, or general slowness of movement, a tremor at rest, rigidity when moving the limb and unstable posture (though that tends to occur later).

Unfortunately, there are no blood tests for Parkinson’s, and scanning — whether by CT or MRi (magnetic resonance imaging) — is carried out only to exclude other causes, for instance lesions linked to a tumour, as Parkinson’s does not cause structural changes.

The rigidity, tremor and slowness often begin on one side, eventually progressing to both sides, and although Parkinson’s has always been thought of as a movement disorder, it is now understood to be a complex condition with other manifestations, the most common of these being depression, affecting about 50 per cent of patients.

Depression is also often the initial symptom — others may include fatigue, anxiety, apathy and sleep disturbance. Loss of the sense of smell is also common.

The symptoms stem from a loss of nerve cells that secrete the chemical messenger dopamine in parts of the brain associated with movement control. The drug your daughter has been put on, Azirest, aims to increase dopamine levels.

i do not feel this is the right time for seeking a second opinion, as the specialist is scheduled to see your daughter to explain the results of the brain scan and assess the benefit or otherwise of the Azirest. if this isn’t helping, there are other treatments that work in slightly different ways, such as levodopa.

My advice would be that if treatment shows no benefit after some months, that might be the time for your daughter to request referral for a second opinion.

But from the information you have given, i do not see any fault in the diagnosis so far.