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Belching, also known as erucation, is often a troublesome symptom that frequently responds poorly, or not at all to currently available pharmacological intervention. This reflects the drivers of this symptom. Belching describes the expulsion of air from the stomach or oesophagus, usually in the context of repeated air swallowing. This often takes place without the patient being aware that they are swallowing air. As such it is often challenging to  treat. Often the habit of sub-consciously swallowing air begins following an initial trigger, which may be an episode of reflux or a change in emotional context (a such as a life event). It seems that in response to intial irritation within the oesophagus patients swallow in an attempt to clear the irritation, this may then lead to repeated swallows and consequent aerophagia (air swallowing), which then leads to repeated belching and often further symptoms. Sometimes belching may be secondary to overgrowth of bacteria within the small bowel (SIBO)

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