Anatomy of a BU

It may be embarrassing, but belching typically isn’t a health issue. Here’s what you need to know.

When we were little, we burped on command to impress our siblings and friends or to annoy our parents. As the years have gone by, we may have belched now and again after sipping a glass of sparkling water or eating a large meal. What causes all that burping? Is it normal? We asked the experts to give us the scoop.

WHAT’S HAPPENING WHEN YOU BURP?

Belching is the forcible removal or expelling of air, usually up the esophagus and through the mouth, says Gil Weitzman, M.D., a gastroenterology specialist in New York City. When there is air in the stomach, the ring valve that separates the esophagus and stomach (the lower esophageal sphincter) relaxes.

“It opens up and the air from the stomach comes back up into the esophagus and then is erupted out,” says Scott Gabbard, M.D., a gastroenterologist at Cleveland Clinic.

WHAT ARE THE CAUSES?

You’ve swallowed air Normal belching can occur for lots of reasons, one of them being the process of eating. “We swallow air when we swallow food,” explains Weitzman. Eating may then trigger your body to let out a burp in order to release some of that excess air. And the larger the meal, the more you may need to belch. “If your stomach couldn’t vent, it would get very large and uncomfortable,” Gabbard says. So the natural response to eating large meals is that the valve releases, allowing you to belch. Eating soup, where you swallow air with each bite, also can be a burp booster.

You’re eating something fatty

Studies show that meals high in fat can make the bottom valve of the esophagus relax and allow air to come back up. “Meals that contain 20 grams of fat or higher, like cheeseburgers and fries or a big steak,” can be a culprit, Gabbard says.

You’re eating something very dry. One example: “If you bite into a peanut butter sandwich without a beverage to wash it down, you start swallowing a few times to help it go down. And then air follows,” Gabbard says.

You’re eating on the go or in a hurry. Eating too quickly can cause you to swallow more air and activate a belch. Chewing gum can trigger the same reaction.

You’re swallowing bubbles. Drinking carbonated beverages, like a

can of so`a or flavore`

seltzer, may result in you belching out carbon dioxide.

ARE ALL BURPS NORMAL?

Burps are not all created equal. Belching also can be caused by stomach ulcers, gastroesophageal reflux `isease (GERD), small intestinal bacteria overgrowth (SIBO), asthma, lactose intolerance, hiatal hernia or an H. pylori bacterial infection. Talk with your doctor if you suspect your belching is more than just the everyday release of air, if your burping is affecting your quality of life or if you’re exhibiting additional symptoms, such as abdominal pain, nausea, vomiting, trouble swallowing, weight loss or black stools. Many of these conditions can be treated with over-the-counter medications.

Patients with chronic burping might have what is called supragastric belching, says Joan Chen, M.D., a University of Michigan gastroenterologist who specializes in the upper GI tract and esophagus. “That occurs when people either behaviorally or subconsciously suck in air and, without air even reaching the stomach, expel the air. These patients can have 20 belches in a minute or more,” she says. This is often a behavioral condition and can be treated with cognitive behavioral therapy.