S1087 The Prevalence and Predictive Factors for Silent Peptic Ulcer Disease in a Cohort of Unselected Patients Underwent Screening EGD

Abstract

In patients with repetitive and troublesome belching an organic cause is seldom found and excessive air swallowing is considered the primary event. Previous study using combined impedance and pH monitoring (MII-pH) showed two patterns of retrograde gas flow through the esophagus, supragastric and gastric belching. The aim of our study was to investigate the incidence and pattern of belching during a 24 hrs period and to evaluate the effectiveness of chewing gum use in patients with belching by Rome III. Methods: Combined 24hrs MIIpH monitoring was performed in 12 patients (7 female; mean age: 46 yrs); in 6 of these patients with the distinct supragastric pattern of belching, a second MII-pH monitoring was performed, while the patients were ordered to chew a gum. Data presented as mean ± SEM. Results: During the study, the average rate of belching was 49.6 ± 14.7 per hour. The vast majority of belches (96%) were supragastric. Dividing the recording into 2 periods (daily and nocturnal), there was a significant difference between the daily and the nocturnal average rate (46.5 ± 14.1 vs. 1.9 ± 0.7, p<0.001). During monitoring with the use of chewing gum, a significant decrease in the rate of daily supragastric belches (11.3 ± 3.7 vs. 45.9 ± 13.7, p<0.001) was observed. None of the patients showed pathological acid reflux (% of time with pH<4: 2.9±0.5) and none of the supragastric belches was associated with acid or nonacid reflux events. Conclusions: Supragastric belches were the predominant belch pattern in patients with belching by Rome III. They mainly occurred in the daily upright position underlying the importance of psychological factors. The use of chewing gum, as a putative distracting mechanism, decreased the incidence of supragastric belches and seems to be effective in these patients.