Therapeutic assessment as a brief and intensive intervention for avoidant restrictive food intake disorder, belching, and histrionic personality disorder: A case report

A 26-year-old female was hospitalized with complaints of repeated vomiting and weight loss (18 kg in 8 months); and incessant belching and nausea/regurgitation for 30 days subsequent to her COVID-19 treatment. After all the normal medical radiological reports, appropriate psychological and psychiatric evaluations were done. Incessant belching warranted a simple and flexible cognitive psychotherapy for histrionic personality with a therapeutic assessment technique. A total of 6 h of psychotherapy was delivered in three sessions. The belching and vomiting came down by 75% after the first extensive session, and almost 100% after the second session. However, mild belching reappeared, and after the termination-cum-booster session belching subsided till discharge and the first follow-up after 2 weeks

Environmental pollution towards the workplace in the Philippines

Introduction@#Air pollution is an emerging global concern, especially in the Western Pacific and South-East Asia regions; smoke-belching and emissions from vehicles on the road are associated with air pollution. In the Philippines, the Clean Air Act of 1999 was passed to address the growing concern for poor air quality to cover mobile sources such as vehicles. @*Objective@#This study aimed to come up with a descriptive analysis of emissions of vehicles as this has an impact on air pollution and road-environmental safety. @*Methodology@#This study analyzed a secondary database of vehicle emissions violation cases from the Land Transportation Organization (LTO) office in Region 11, the Philippines. The study was retrospective in nature and involved a review of traffic violation cases. The data were encoded and analyzed using the SPSS ver. 23 software program. @*Results@#Two hundred eighty-two vehicle emission standard violations were recorded by the Land Transportation Office (LTO) from 2018 to 2019. Most cases were from 2018 (72.7%), with January (30.9%) recorded the highest number of unsafe vehicle emission standard violation cases. Of the apprehended drivers, the majority (88.3%) were of the driving professional license category. All the drivers (100.0%) were caught due to the violation of smoke-belching (V16). In comparison, a small proportion was also seen as cases of driving without a valid driver’s license or conductor’s permit (1.8%) and failure to carry driver’s license/OR/CR (0.8%). All the violators were caught on daytime working and rush hours, between 6:00 am and 5:00 pm. More than half of the apprehended drivers’ vehicles (55.3%) were classified as for hire, while the remaining (41.8%) were classified as private vehicles. The majority (99.3%) of the vehicles did not pass the first emissions standards. Meanwhile, the most common vehicles caught for unsafe emissions were UV vehicles (n = 239). The vehicles caught for dangerous emissions were more than ten years old, with one-third (35.9%) of the vehicles were between 10 to 19 years old. The mean years of use or age of the vehicle were 15.724 ± 8.553 years. Opacity results for the first emission testing were 6.691 ± 2.404, while the Average Light Absorption (ALA) coefficient for the second emissions testing was 1.102 ± 0.577. @*Conclusion@#This study provided an overview of unsafe vehicle emissions within an urban city and suggested a need for more robust monitoring of vehicle emissions within safe limits. Vehicles that do not meet safety standards should not be allowed on the road, and disposal of old inefficient running vehicles may be beneficial in reducing dangerous air pollution.

Belching on exertion - coronary artery disease

Belching is a ubiquitous symptom in clinical practice. It could be due to gastrointestinal disease or behavioral, functional and physiological causes. It’s association with acute myocardial infarction, more frequently, with inferior myocardial infarction, has been well established. But exertional belching as a cardinal symptom of coronary artery disease is not well documented and its presence is not mentioned in any standard textbooks. It is rarely reported in the literature. Here we present a female diabetic, who presented with exertional belching as a lone complaint. She was confirmed to have significant coronary artery disease necessitating an intervention. So it may be prudent if clinicians are aware of the fact that exertional belching could be of cardiac origin and needs further evaluation and intervention.

The Application of the Rome IV Criteria to Functional Esophagogastroduodenal Disorders in Asia

The Rome criteria were amended as Rome IV. For functional esophageal disorders, the exclusion criteria have been more specifically revised based on further understanding of other esophageal disorders, including eosinophilic esophagitis and spastic and hypercontractile motor disorders. Another revised point is the more restrictive definition of gastroesophageal reflux disease, indicating that sensitivity to a physiological reflux burden may be placed more firmly within the functional group. For functional dyspepsia (FD), only minor changes were introduced, mainly to improve specificity. Among the major symptoms of FD, not only postprandial fullness, but also epigastric pain, epigastric burning, and early satiation should be “bothersome.” Investigation on the effect of meal ingestion on symptom generation has indicated that not only postprandial fullness and early satiety, but also epigastric pain, epigastric burning sensation and nausea (not vomiting) may increase after meals. Helicobacter pylori infection is considered a possible cause of dyspepsia if successful eradication leads to sustained resolution of symptoms for more than 6 months, and such status can be termed as “H. pylori–associated dyspepsia.” Prompt esophagogastroduodenoscopy and H. pylori testing and treatment would be more beneficial, especially in Asia, which has a high prevalence of gastric cancer. Acotiamide, tandospirone, and rikkunshito are the newly listed as treatment options for FD. For further therapeutic development, clinical studies based on the strict Rome IV criteria should be performed.

Belching in Irritable Bowel Syndrome: An Impedance Study

BACKGROUND/AIMS: There are limited data about the relation between belching and irritable bowel syndrome (IBS). We aim to evaluate belching in patients with IBS. METHODS: Twenty-five patients with IBS and 12 healthy volunteers were enrolled in the study. IBS was diagnosed in accordance with the Rome III criteria. All patients were questioned about the presence of symptoms for belching, gastroesophageal reflux disease, and dyspepsia. Esophageal manometry and 24-hour pH-impedance were performed in all patients and healthy volunteers. Each of the patients with IBS underwent gastroscopy and colonoscopy. RESULTS: Demographic features were similar in both groups (P > 0.05). The belching rate was 32% in patients with IBS. The mean DeMeester score was significantly higher in IBS patients (13.80 ± 14.40 vs 6.04 ± 5.60, P = 0.027) and 24% of patients had pathologic acid reflux (DeMeester score > 14). Gastroscopy was normal in all patients. Symptom association probability positivity was detected in 24% of patients in the impedance study. The rate of weak acid reflux was also significantly higher in patients with IBS (97.00 ± 56.20 vs 58.20 ± 29.30, P = 0.025). The number of supine gas reflux (7.50 ± 6.40 vs 2.42 ± 2.80, P = 0.001) and supragastric belches was significantly higher in patients with IBS (51.20 ± 41.20 vs 25.08 ± 15.20, P = 0.035). Although the number of gastric belching was higher in controls, the difference did not reach statistical significance (12.10 ± 17.60 vs 4.90 ± 3.80, P = 0.575). We did not find any correlation between belching and any symptoms of IBS. CONCLUSIONS: Belching is frequent in patients with IBS. Non-erosive reflux disease is frequent in IBS, which may be related to supragastric belching.

Belching / 대한소화기학회지

Supragastric belching is the most important factor in the etiology of excessive belching complaints. Supragastric belching is a belching disorder with a behavioral origin. The standard diagnosis is made by monitoring the esophageal impedance. Supragastric belching has been shown to be associated with globus, as well as reflux symptoms in proton pump inhibitor non-responders in gastroesophageal reflux disease; however, the pathophysiology of supragastric belching in patients with gastroesophageal reflux disease or functional dyspepsia has not been clarified. Patient education with behavioral therapy is the treatment of choice in isolated supragastric belching. On the other hand, the best management of supragastric belching associated with globus, gastroesophageal reflux disease, and dyspepsia remains to be studied.

Lidocaine spray on an endoscope immediately before insertion improves patient tolerance to endoscopy: A single center, clinical observational study

BACKGROUND: Topical pharyngeal anesthesia reduces discomfort during upper gastrointestinal endoscopy (UGIE) but may not increase tolerance to the procedure. This case-control study was performed to assess whether lidocaine spray on the endoscope in addition to pharyngeal anesthesia improves patient tolerance to endoscopy we performed. METHODS: Patients who underwent UGIE were assigned to either the case group where the endoscope was treated with 2 sprays of 10% lidocaine before insertion or the control group given only conventional pharyngeal anesthesia. And we compared the frequency of belching and retching during endoscopy. RESULTS: Among 497 eligible patients, 262 were assigned to the case group and 235 to the control group. There were significant differences between the two groups in belching (odds ratio [OR] = 0.15, 95% confidence interval [CI] = 0.09-0.24, P < 0.01) and retching (OR = 0.22, 95% CI = 0.15-0.34, P = 0.01) during endoscopy using multivariate analysis. Younger patients (OR = 0.96, 95% CI = 0.94-0.98, P < 0.01) and female patients (OR = 2.16, 95% CI = 1.40-3.33, P = 0.01) had belching more frequently than older patients and male patients, respectively. Retching was more frequent in sedated patients (OR = 0.39, 95% CI = 0.25-0.61, P = 0.01) and those with gastro-esophageal reflux disease (OR = 1.48, 95% CI = 1.00-2.21, P = 0.06). CONCLUSIONS: Use of lidocaine spray on the endoscope improves patient tolerance during UGIE compared to only conventional pharyngeal anesthesia.

Patients in whom metoclopramide effectively relieved discomfort associated with gastrointestinal obstruction-related belching insufficiency

<b>Case 1</b>: A female, aged 81 years, with cardiac stomach cancer. Air retention in the digestive tract aggravated discomfort of the epigastric region, but belching relieved the symptom. As belching insufficiency persisted, the continuous subcutaneous injection of metoclopramide was started. Belching was promoted, and swelling of the upper abdomen was relieved. <b>Case 2</b>: A male aged 57 years. Gastrointestinal obstruction related to pancreatic head cancer was observed. He complained of discomfort of the upper abdomen with abdominal swelling. Belching reduced these symptoms. The continuous subcutaneous injection of metoclopramide facilitated belching, and relieved discomfort of the upper abdomen.<b>Discussion</b>： The results suggest that the continuous administration of metoclopramide is a useful option for belching insufficiency associated with cancer-related gastrointestinal obstruction. In the presence of gastrointestinal obstruction,gas retained in the stomach may be elevated/regurgitated through the peristalsis-promoting actions of metoclopramide,promoting belching.

A Psychiatric Approach to a Patient with Excessive Belching / 신경정신의학

Belching is the audible escape of air from the esophagus into the pharynx. It is considered a disorder when the symptom is very frequent and causes significant distress to the patients. Excessive belching can be divided according to excessive supragastric and gastric belching. Gastric belching is usually physiological. In contrast, supragastric belching can be considered learned behavior. In addition, many psychiatric conditions, including anxiety, have been described in patients with supragastric belching and some patients have reported that their symptoms increased during stressful events. We report on a case of supragastric belching in a depressive patient and discuss its management through psychiatric approaches.

A Psychiatric Approach to a Patient with Excessive Belching / 신경정신의학

Belching is the audible escape of air from the esophagus into the pharynx. It is considered a disorder when the symptom is very frequent and causes significant distress to the patients. Excessive belching can be divided according to excessive supragastric and gastric belching. Gastric belching is usually physiological. In contrast, supragastric belching can be considered learned behavior. In addition, many psychiatric conditions, including anxiety, have been described in patients with supragastric belching and some patients have reported that their symptoms increased during stressful events. We report on a case of supragastric belching in a depressive patient and discuss its management through psychiatric approaches.

Therapeutic Observation of Salt-partitioned Moxibustion for Belching Due to Chemotherapy / 上海针灸杂志

Objective To observe the effect of salt-partitioned moxibustion at Zhongwan (CV12) in treating belching due to chemotherapy.Method Subjects with chemotherapy-induced belching were randomized into an observation group and a control group, 30 in each group. The control group was intervened by intramuscular injection with Ritalin 20 mg, while the observation group was by salt-partitioned moxibustion at Zhongwan for 30 min in addition to the intramuscular injection.Result The total effective rate was 93.3% in the observation group versus 76.7% in the control group, and the difference was statistically significant (P＜0.05); the action latency in the observation group was (1.7±1.8)min in the observation group versus (15.6±4.2)min, and the difference was statistically significant (P＜0.01).Conclusion Salt-partitioned moxibustion at Zhongwan is significantly effective in treating chemotherapy-induced belching, and it’s easy-to-operate, efficient, and safe.