- Definition of Terms
- Belching or Burping Definition
- Bloating Definition
- Flatulence Definition
- How this happens?
- Causes of Excessive Gas
- Gastro esophageal Reflux Disease (GERD)
- Incomplete Protein Digestion
- Inability to Break Down Sugars
- Gallbladder Stones
- Trigger Foods and Drinks
- Chewing gum and hard candy
- Medical Conditions
- How is it Evaluated?
- Management, Treatment and Remedies
Belching or burping can be experienced by anyone. In some Southeast Asian cultures, belching is somewhat acceptable and is even linked as a sign of satisfaction from the meal being provided. While in others, especially on the Western cultures, belching is socially inappropriate and is considered as a bad manner.
Belching or burping as well as passing of gas (flatulence) are normal habits for some to relieve the bloated feeling that they might be experiencing after a meal or anytime of the day.But if belching or burping and bloating became excessive in nature and affects your daily activities, then it should be explored and given the prompt management.
Definition of Terms
Belching or Burping Definition
Belching or burping is medically known as eructation. It happens when excess air or gas from the gastrointestinal tract travels through the esophagus and is expulsed through the mouth. Oftentimes, it could be accompanied by an odor or a sound due to the vibration of the air. 
Bloating is a feeling of abdominal fullness secondary to accumulation of gas in the abdomen and is sometimes used interchangeably with abdominal distention though there is a difference between the two. Bloating is a subjective (reported) feeling of distention but do not necessarily means that the abdomen is distended when measured. 
Also known as farting, it shares the same principle with belching. But instead of passing the gas through the mouth, it is passed through the anus. Gas builds up in the intestines causing uncomfortable feeling of fullness or bloating. And to relieve this discomfort, passing of gas is the most effective way.
Figure 1: Abdominal Gas
How this happens?
- People may think that it is a simple act, but several coordinated activities will be required during the process.
A closed larynx is needed to make sure that any food particles or liquid that might be returning with the air coming from the stomach won’t be able to get inside the lungs as it will lead to aspiration. A closed larynx can be accomplished by swallowing (it will voluntarily raise the larynx).
- When the larynx is raised, a relaxed upper and lower esophageal sphincter will result allowing the excess air to pass through from the stomach up to the esophagus then expulsed through the mouth.
- While these are simultaneously occurring, the diaphragm descends (as if you take a deep breath, increasing the abdominal pressure whilst decreasing the chest pressure.
- The shift of pressure between the diaphragm and the chest will then result to the promotion of the flow of the excess air from the stomach and then to the esophagus exiting through the mouth. 
Figure 2: Flatulence
Causes of Excessive Gas
A myriad of things can cause belching or burping and bloating. It might be influenced by a meal, by whatever medications you take or by the physiologic changes inside your body. And since the topic is broad, the collective causes for excessive gas accumulation that lead to belching, bloating and also flatulence are listed below.
It is a disorder wherein a person swallows large quantity of air so frequently that symptoms arises. 
Gastro esophageal Reflux Disease (GERD)
Belching is one of the symptoms most reported by patients with GERD, next to regurgitation and heartburn. It is because sufferers from GERD tend to swallow large amount of air more often to relieve the unpleasant sensation brought about by heartburn. 
Figure 3: Gastro esophageal Reflux Disease (GERD)
Some people use swallowing to ease the anxiety they are experiencing, thus belching is a strange anxiety symptom. 
Incomplete Protein Digestion
Since a lot of stomach acid will be required by protein to be properly broken down, an alkaline intestinal environment won’t be able to do this job effectively. The incompletely digested proteins will then ferment and release gas in the gastrointestinal tract.
Inability to Break Down Sugars
Like the principle involved with protein digestion, some sugar compounds cannot be broken down by your system properly. That’s why while its stay in the gastrointestinal tract is lengthening, it will ferment and release excess gas that will lead to bloated feeling.
The gallbladder is a sac under the liver that is responsible in storing and regulating the bile. Bile on the other hand is a fluid substance made by the liver to aid in digesting fat. As fatty food from the stomach passes through the duodenum towards the small intestine, the gallbladder will release a proper amount of bile needed to aid in an effective fat digestion. But severe uncomfortable bloating will be experienced after eating if the gallbladder happens to be clogged with stones. 
Trigger Foods and Drinks
- Beer and carbonated beverages – this are loaded with bubbles made by carbon dioxide.
- Onions, beans, asparagus
- Soy products (tofu, soy milk)
- Dairy products (cheese, milk, butter)
- Processed food
- Cruciferous vegetables (broccoli, cauliflower, cabbage)
- Sprouts (alfalfa, brussels)
- Whole grains 
- Fruits (peaches, apples and pears)
Smoking makes you inhale and swallow excess air.
Chewing gum and hard candy
When sucking hard candy or chewing your gum, swallowing occurs more often than the usual and part of what you swallow in is air. 
- Metformin and Byetta – this are common drugs for diabetes that causes excess air especially when in higher doses.
- Antibiotics – when antibiotic therapy is initiated, some of the good bacteria inside the gastrointestinal tract can also be affected. This can make the bad bacteria (usually gas forming type of bacteria) outnumber the good bacteria.
- Irritable bowel syndrome (IBS)
- Lactose intolerance
- Gastric dumping syndrome
- Celiac disease – a condition wherein the intestines were not able to absorb and digest certain food components.
- Polycystic ovarian syndrome
- Ovarian cysts
- Intestinal parasites 
- Bowel obstruction
- Crohn’s disease 
- Tumors or cancers (arising from the liver, ovary, stomach or uterus) 
How is it Evaluated?
- Simple abdominal x rays (abdominal or intestinal) – large amounts of air can be easily seen in the intestine and the stomach.
- Gastric emptying studies – a radioactive substance will be eaten by the patient while a counter like device is placed over the abdomen and this will measure how rapid is the ability of the stomach to empty its content.
- Ultrasound, CT scans and MRI – this is far more advance and more defined than x-rays. 
Management, Treatment and Remedies
- Eating and drinking slowly. When you take your time during eating and drinking, lesser air will be swallowed.
- Avoid drinking from straw, use a glass instead.
- Skip hard candy and chewing gum as much as possible.
- Avoid the trigger foods and drinks (carbonated beverages and gas forming food).
- Stop smoking.
- Checking you dentures. Swallowing of excess air during eating and drinking can also be caused by ill fitting dentures. 
- Being active.
- Over the counter remedy like Simethicone. 
- Breathing habits and drinking some sips of water when experiencing anxiety. 
- Using natural ways.
- Charcoal supplements – taken before meals to prevent abdominal distention.
- Parsley – Dried or fresh, it helps in cutting down the problems on excess gas the natural way. 
- When the gas is not passed yet, you can find relief by doing the knees to chest position or by simply lying on your side.
- Cooling hot drinks before drinking. 
Episodes of excess belching, bloating and flatulence may often be transient and will resolve in time but if it feels troublesome and has other accompanying symptoms, it is better to seek a professional help from a doctor. 
These symptoms may include but are not limited to change in appetite, bouts of constipation or diarrhea, nausea or vomiting, abdominal pain (severe and recurrent), bloody stools, fever, weight loss and chest pain. Though oftentimes that abdominal symptom are labeled as something embarrassing, you should never let it from keeping you to get help because these might be signals of underlying serious medical condition.
Treatments are always available and you have the right to get one.