Diagnostic and Management Review of Gastric and Supragastric Belching, Aerophagia, and Rumination Syndrome.

Supragastric belching and rumination syndrome are distressing and potentially debilitating gastrointestinal disorders. Though related, these conditions are distinct from aerophagia and excessive gastric belching. Although diagnostic standards and effective treatment strategies are emerging, formal guideline-directed treatment and validated measurement tools to demonstrate efficacy of interventions are lacking. This narrative review synthesizes current evidence in presentation, pathophysiology, diagnosis, and treatment through a systematic search of the literature over the past 2 decades. Supragastric belching, rumination syndrome, excessive gastric belching, and aerophagia have distinct physiologies and vary in symptomatic and psychosocial burden. Although clinical evaluation plays a key role in diagnosis, supragastric belching and rumination syndrome can be objectively confirmed through pH-impedance testing or high-resolution impedance manometry. Supragastric belching and rumination syndrome can be managed effectively with psychoeducation and behavioral treatment strategies. These strategies are underexplored in excessive gastric belching, for which baclofen remains a primary therapy. Aerophagia is rarely symptomatic, and management is comprised of behavioral modifications. Further studies evaluating multidisciplinary behavioral therapy strategies with validated outcome measurement tools are needed to develop management guidelines and improve the lives of patients with these complex conditions. Evaluation for secondary causes is key to well-rounded, effective treatment.