Burping: why we do it and what can go wrong

Burping refers to the release of excess gas through the mouth. It happens because every time we talk or swallow, we are swallowing air. In fact, research suggests that for every 10 ml of liquid we drink, we swallow 8.3 ml of air. 

If you don’t expel this air, too much gas will build up in your upper digestive tract (small intestine, stomach, oesophagus (gullet) and mouth). To avoid this, your body makes you burp.

Different types of burping

There are two main types of burping: supragastric and gastric. 

Supragastric burping refers to the release of air that you’ve swallowed that remains in your oesophagus and never reaches your stomach. This is usually experienced as a belch. 

Gastric burping refers to the release of gas from your stomach, for example, due to drinking carbonated (fizzy) drinks. 

During gastric burping, gas builds up in your stomach, causing it to expand. This causes a sphincter (a ring of muscle around an opening or tube) at the lower end of your oesophagus to relax, which allows the gas to move up into your oesophagus. This triggers another sphincter at the upper end of your oesophagus to relax, at which point you burp and the gas is expelled through your mouth. 

Supragastric and gastric burping are both normal, healthy processes; however, there are situations where you may burp too much or be unable to burp at all, also known as no burp syndrome. 

Neither excessive burping or no burp syndrome pose any long-term health risks; however, they can make you feel socially awkward or embarrassed, and you may experience uncomfortable or painful symptoms. 

Excessive burping

Burping too much can be caused by both behavioural and medical reasons. 

Behavioural causes include eating or drinking too quickly and talking while eating, which causes you to swallow more air than usual. Drinking and eating with poorly fitting dentures can have the same effect. Other lifestyle habits that increase how much air you swallow include smoking, sucking hard sweets, chewing gum and drinking carbonated drinks.

Medical causes of excessive burping include aerophagia, gastritis, acid reflux, Helicobacter pylori infection and meganblase syndrome. 

Aerophagia refers to swallowing too much air and can be caused by physical problems (eg certain digestive problems), psychological conditions (eg anxiety) or treatment for obstructive sleep apnea, specifically CPAP (continuous positive airway pressure). 

Meganblase syndrome refers to a rare condition where intensive air swallowing occurs after a heavy meal, which causes a large gas bubble to form in your stomach. This leads to an uncomfortable feeling of fullness, shortness of breath and excessive burping; it can also mimic symptoms of a heart attack. 

Treating excessive burping

Treating excessive burping focuses on identifying the underlying cause. If it is a digestive problem, such as acid reflux, proton pump inhibitors and antacids can help. 

If the cause is behavioural, making changes such as eating and drinking more slowly, avoiding fizzy drinks and not talking while eating can help. 

If the cause is psychological (eg anxiety), psychological therapies such as cognitive behavioural therapy (CBT) can help.

No burp syndrome

No burp syndrome is medically known as retrograde cricopharyngeal dysfunction (R-CPD). It is caused by excessive tightness in a muscle in your throat called the cricopharyngeus muscle. This results in a lifelong inability to burp, which consequently can lead to chest pain, back pain, gurgling noises in your chest, excessive bloating, flatulence, painful hiccups and nausea.

What happens during no burp syndrome?

Your cricopharyngeus muscle is a circle-shaped muscle that sits at the junction between your pharynx (the tube that runs from the back of your nose and opens into your oesophagus) and the top of your oesophagus.

It is usually tightly closed to prevent your stomach contents rising up through your oesophagus and into your throat. When you eat, this muscle relaxes so food can pass into your oesophagus and down to your stomach. After you have swallowed, it shuts tight again. When you burp, pressure in your oesophagus also causes this muscle to relax, so you can release the excess gas. 

In no burp syndrome, there is a problem with your cricopharyngeus muscle that prevents it from relaxing specifically in response to increased pressure in your oesophagus that is caused by the build-up of gas. This prevents you from being able to burp, but it doesn’t prevent your cricopharyngeus muscle from relaxing to allow you to swallow when you eat. 

Getting a diagnosis of no burp syndrome

A diagnosis is usually reached through asking about your symptoms and medical history, and thoroughly examining your throat - this will involve having a flexible nasoendoscopy.  

A thin, flexible telescope-like camera with a light on the end (endoscope) will be passed into your throat to check there are no other problems that could be causing your symptoms. 

Treating no burp syndrome

No burp syndrome can be effectively treated with a procedure to relax your cricopharyngeal muscle. 

This involves passing a small surgical tube through your mouth into your throat, through which a special needle can be passed to inject botulinum toxin into your cricopharyngeal muscle. This procedure is performed under a general anaesthetic, so you will be asleep.

It usually takes a few days before the effects of the procedure start to become apparent and after a few weeks, you should be burping normally. This effect usually lasts for a minimum of six to nine months and can be repeated if necessary; however, in some cases, one injection is enough to cure no burp syndrome permanently.