PWE-083 Behavioural Gastro-Oesophageal Reflux Disease Caused by Supragastric Belching

Abstract

Introduction Supragastric belching (SGB) is considered to be a behavioural phenomenon, thus gastro-oesophageal reflux disease (GORD) caused by SGB can be considered as behavioural GORD. Behavioural GORD may necessitate differential treatment to ‘classical’ GORD and therefore requires diagnosis as a distinct clinical entity. This study aims to establish the prevalence of GOR events caused by SGB and evaluate the associated demographic features, symptoms and oesophageal motility abnormalities. Methods The Oesophageal Physiology Laboratory, Guy’s Hospital, patient database was retrospectively searched for patients diagnosed with GORD in whom SGB was observed. Patient demographic information, symptoms and oesophageal motility abnormalities were collected. The 24 hour pH-impedance studies were analysed for SGB. GORD events closely following SGB (within 6 seconds) were quantified and the acid exposure time and acid/non-acid reflux events occurring after a SGB were calculated when upright and recumbent. Results Forty-six patients with a diagnosis of GORD and SGB were identified (48% female, mean age 50.5 years (range: 29–75), male mean age 52.5 years (29–79)). Ninety-five percent of patients reported heartburn and/or epigastric pain, 81.8% suffered from excessive belching, 63.6% reported regurgitation and 54.5% reported dysphagia. Forty-three percent of patients had a hypotensive lower oesophageal sphincter (LOS). SGB preceded 22.7% of all reflux events (24.9% upright and 6.6% recumbent) and 26.5% of acid reflux events. On average, over 24 hours, 16.3 reflux events were associated with SGB (13.0 acid and 4.1 non-acid) corresponding to a mean acid exposure time of 17.8 minutes. In this cohort SGB accounted for 17% of acid exposure time (22% upright and 7.4% recumbent). SGB had no effect on the total number of reflux events or the total acid exposure time in 3 patients and in 3 further patients SGB had no effect on the total acid exposure time. SGB caused ≥50% of the total number of reflux events in 3 patients and ≥50% of the total acid exposure time in 5 patients. Patients with a hypotensive LOS did not have a significantly higher total number of reflux events (p = 0.88) or total acid exposure time (p = 0.86). No relationships were seen between the presence of a hiatus hernia and the total number of reflux events (p = 0.43) or acid exposure time (p = 0.16) associated with SGB. Conclusion SGB induced a considerable proportion of reflux events and acid exposure time. In 8 patients SGB caused ≥50% of the total reflux events or overall acid exposure time, and hence these patients may be considered as having behavioural GORD. Behavioural GORD should be diagnosed and treated separately to ‘classical’ GORD. Further work is required to elucidate the cause and pathophysiology of SGB. Disclosure of Interest None Declared