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Manometry/24 hr Test for Belching

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Posted 1/6/2014 7:48 PM (GMT 0)
Hello! I'm wondering if anybody has any input on this. I just saw a new GI for a 2nd opinion regarding my chronic belching problem I've had the last 4 months (have had normal endoscopy, normal abdominal ultrasound, normal blood work and normal barium swallow/small bowel follow through). This doctor is having me do a breath test for H. Pylori (even though my biopsies were negative, he said it can be missed so he's double checking with the breath test). He says if that is normal, he thinks it would be helpful to do a Manometry with a 24 hour ph Impedance test. I am NOT looking forward to having a tube down my throat for 24 hours, or having it passed through my nose. However, if it really could give me an answer, I would do it. The issue is, I have zero heartburn and no sense of acid. I thought this test was more to determine acid reflux, etc.

Does anybody know if this test could help shine some light on my issue even though all I have is belching? Sometimes I do wonder if I have a weak or malfunctioning muscle/sphincter because I literally have to belch after drinking a sip of anything or even eating something small. It's as though the air can't stay in and has to come right back up...and that makes me wonder if something just isn't working right. But then I think...if something wasn't working right, wouldn't I ALSO be having acid reflux? I'm just very confused and have no idea what to think.

So a few questions...how miserable is this test actually? And, would it be beneficial for my situation of sudden onset of frequent belching for no apparent reason? What could the test results tell me? I really don't want to do it for no reason.

If anybody has any input, I'd really appreciate it!
Posted 1/7/2014 4:33 AM (GMT 0)
Hi dmarie,
You will get a lot of important information from the manometry and 24 hr PH monitor. The manometry will provide information about your swallowing reflex, the strength of your LES, and will provide measurements for placement of the PH monitor.

I've had the manometry twice, and the PH monitor 3 times. It's not fun, but it's very manageable. They have great nurses/technicians to coach you through the procedures. You'll be glad when they're over, but if you're looking for answers, they're worth the effort and discomfort.

You can do it!
Good luck with it all,
Denise
Posted 1/7/2014 4:36 AM (GMT 0)
Hi dencha...thank you for your reply! so this sounds like a test I should do even though I do not have heartburn or signs/feelings of acid reflux (just frequent belching)? All other tests have come back completely normal and I really just want some understanding of what's going on...
Posted 1/7/2014 4:50 AM (GMT 0)
It's your call, but if your GI doc thinks he might get helpful information, it might just be worth the trouble. Nobody likes to do them, but they can provide critical information.

BTW, I had a normal endoscopy as well...if you're on PPIs, your esophagus is likely protected. Silent reflux can occur without you ever realizing it.

Good luck with your decision!
Take care,
Denise
Posted 1/7/2014 8:44 AM (GMT 0)
Hi dmarie,
I also have issues with burpingand belching (not my only symptom though as I've also had a bad cough and voice problems and used to have trouble swallowing). I never had any heartburn (maybe three or four times in my life!).
Like you I had a normal endoscopy/colonoscopy, normal barium swallow and normal blood work. Manometry was also normal, according to my GI my LES works normal (I have my doubts about this, but what can you do...). It was only the PH study that revealed that something was not right: I have significant non-acidic and weakly-acidic reflux. I was relieved to find out that my symptoms were not just in my head (something my former GP told me, needless to say that I changed GPs after my diagnosis).
At least I know now that something is causing my reflux, although I haven't figured out what. I went wheat-free, lactose-free and sugar-free for 6 weeks to see if it made a difference, but my symptoms did not improve during that time, I could only pin point problems with certain fats and high-fat dairy products after re-introducing foods in my diet (and onions, citrus, chocolate and anything acidic, but I knew that already anyhow).
I have improved about 80% through lifestyle changes and medication, but I still don't know why I'm burping so often.Currenlty weaning myself of PPI, so will see how I feel without acid suppressants. Like you, I belch every time I eat and drink anything, especially after drinking, and I only drink water and herbal tea.
Anyhow, good luck with the tests, I'd go for it if I were you. They are not exactly pleasant, but I'd rather do manometry and the PH study again than another barium swallow, which totally messed me up so I had to go to A&E the night after. Horrible experience!
Good luck!
Posted 1/7/2014 3:16 PM (GMT 0)
Hi IDAD...thanks for sharing your experience. I imagine I will do the testing since my dr is suggesting it. I was just a little confused since my only symptom is belching. I really just want an answer as to what could be causing this. How did yours start? I literally didn't have a belching problem one day, and then the next day half way through the day I started belching and it hasn't stopped since (it's been over 4 months now). It feels like I'm just burping air, but who knows. I don't know where all that air is coming from...I'm sure I'm swallowing some of it, but I can't be swallowing all of it suddenly after never doing that before. It's very frustrating and for me worrisome. I've been worrying the last 4 months about every possible illness I could have that would cause this because I just get no answers from any test. I've heard swallowing air, anxiety and "it's just happening". What's so hard to understand is I can't even take a sip of water without belching. What on earth could cause that?? I'm hoping the manometry or ph test could maybe give me an understanding? Did your dr say in your case the belching was from your reflux? Just curious...any more input would be great!
Posted 1/7/2014 8:56 PM (GMT 0)
Mine just started one night after I ate chocolate. Just like that, and it hasn't stopped ever since. I asked my doctor about it as well, but he only told me it could be due to me swallowing too much air, just like they told you. I have no clue how I just started to swallow too much air overnight, but there you go :-)
Mind you, it's a lot less than about a year ago, but I'm still belching every day.
I'm a bit more relaxed about the whole thing by now, I've had it for over a year, I guess they would have found something if it was due to something sinister. For a while I thought it might have been caused by chewing a lot of gum since it helps with any throat discomfort, but I didn't chew gum when I was going sugar-free for a while (wasn't sure about artificial sweeteners) and was still belching during hat time.
So I have no clue were it came from and how to stop it. Getting used to it now, as bad as that sounds...
Posted 1/9/2014 6:59 PM (GMT 0)
hi idad...

thanks for your replies. i'm so frustrated with this belching and the fact that nobody can give me an answer as to what started it and is causing it to persist. how can i suddenly have to belch just from a sip of ANYTHING to drink? i wonder if the body can just change, and suddenly the stomach can't hold/tolerate as much air as it used to? or something isn't functioning properly? did your doctors ever give you any other insight into the belching other than "swallowing air"? i keep doing these tests which give me no answers, and am still so scared it's something serious. nobody seems concerned except myself :(

how often are you belching? is it only with eating or drinking, or all the time?

i hate this! i wish i could at least relax about it and not worry so much...
Posted 1/9/2014 7:10 PM (GMT 0)
Hi

I started with severe belching suddenly out of the blue. To cut a long story short it turned out I had a hiatus hernia

Maria
Posted 1/9/2014 7:19 PM (GMT 0)
Hi mcedge...no hernia for me. It didn't show up on an endoscopy or barium swallow so I'm pretty certain I don't have one...
Posted 1/10/2014 2:17 PM (GMT 0)
Hi dmarie725

I had an endoscopy too and my hernia wasn't seen. I asked for a barium swallow because I was convinced that I had a hernia. On the day of the swallow the doctor performing it said that there was no hernia - I was really down because I had convinced myself that I had a hernia.

I was having the fundoplication the following week and the surgeon said that a hernia had been seen on the barium swallow. I said that I had been told that one wasn't seen on the day. He said that they look at the images in more detail and I had a slight hernia.

Well one was definitely there and I had to have 3 stitches in the diaphragm to make the hiatus smaller to stop the stomach from protruding through again.

I know of lady on another forum who had all the tests and was told there was no hernia but again when they operated one was found.

So bare in mind just because they don't see them on the tests doesn't mean that there isn't one.

I was also told by a doctor that I was swallowing air because on my 24 ph test I was burping a lot. I have since found out that burping can be a sign of a hernia.

For me the 24 hour impedance test was the one that proved I had acid reflux so that's why I opted for surgery. My surgeon agreed to the surgery before we knew about the hernia. I asked the surgeon after my surgery about this and he said that 99% of the time reflux is caused by a hernia.

Go for all of the tests that you can to find out what's causing the problems. The Manometry and the 24 hour tests are not difficult and they may give you vital information on what's causing your symptoms.

Maria
Posted 1/10/2014 11:05 PM (GMT 0)
Hi Maria,

Thanks for your response. I'm glad you were at least able to find the cause of your burping issue. I'm upset because I feel like I'll never know the cause. I suppose even though a hernia wasn't seen on my endoscopy or barium swallow, there is a chance I still have one...but I'll probably never know for sure because I'm not having surgery, and according to my dr. there is no hernia. So I don't know how else I'd find out.

What's also mind-boggling to me is the fact that I always have a huge belch after just drinking a small amount of water. You'd think that would be from swallowing air with the water, but that never used to happen to me in 30 years, so what could cause that suddenly? I don't know if I should be scared or not. I definitely am VERY scared and concerned something serious is wrong, though all my tests have been normal.

I do not want to have the 24 hour test only to have them say "you're swallowing a lot and burping a lot" because I already know that. I want to know WHY. What could have possibly started this after 31 years...I've already gotten 2 different GI opinions and don't know what else I can do. I feel like I'm running out of ways to find an answer, and not sure how to accept that this just "developed". My doctor (aside from swallowing air) told me that when all tests come back normal, sometimes these conditions just develop. Well does that mean my stomach can't hold as much air anymore? Is my LES (or something else) simply not as strong as it used to be? Is something malfunctioning? Could it possibly be something non-GI related causing a GI symptom? It sounds far-fetched but no GI can help me find a cause or answer.

What do you think??
Posted 1/11/2014 9:02 AM (GMT 0)
Hi dmarie

I'm not sure what else you can do other than have the 24 ph test. If the burping isn't causing any pain then maybe just leave well alone and see if it subsides on its own. Do you burp only after you've eaten and drunk or do you burp all the time all day ?

Maria
Posted 1/11/2014 1:55 PM (GMT 0)
Hi dmarie,

You don't mention what else you have tried, so I will suggest a common remedy for belching/bloating.

You'll need both:

1. Pro biotic
2. Digestive enzymes

The pro biotic can be dairy based(yogurt or acidophilous supplements), or if you have problems with lactose, vegetable based (Saccharomyces Boulardii). The advantage of the vegetable based is that it does not have to be kept refrigerated. The digestive enzyme supplement I just started taking is called Digest Gold. It has reduced, but not entirely eliminated, my belching. This week I am going to up the dose from one pill to two, to see if it works better.

Good luck.
Posted 1/11/2014 5:05 PM (GMT 0)
dmarie-

The manometry would show how your LES is working and if you have developed any swallowing issues. They usually do this right before a wired 24hr PH study.

Take care,
Bill
Posted 1/11/2014 7:59 PM (GMT 0)
Hi everyone....to answer questions:

Mcedge....no, the burping isn't causing any pain (just causing me to worry because I don't understand what's causing it). I do burp on and off throughout the day (even on an empty stomach, or when exercising, anything really), but it is significantly worse when eating or drinking. Very soon after eating or drinking (like minutes), I am belching. Which makes me feel like my stomach is just full and can't hold it, but that never has happened before in my life. What's even stranger is the drinking...just one sip of something to drink (never anything carbonated) will cause me to belch.

rjdriver...the only things I've tried was Prilosec when this all started about 4 months ago. Even though I didn't have heartburn or acid reflux my dr. put me on a trial of Prilosec, which did not make any difference whatsoever. I don't really have any bloating, just the belching. I have not tried probiotics or anything like that. Would this be a digestion issue if the belching is happening so soon after eating or drinking (minutes) or would that be occurring later?

opnwhl4...regarding the manometry...would a problem with the LES cause belching even without reflux or heartburn? I do notice that occasionally when I belch, if I'm in a certain position, I can feel a little acid/something else coming up, but I'd say 99% of the time it's just air.

I know it seems I'm overreacting about this burping. After all, it is just burping. It's not the actual burping that scares me, it's whatever caused it to start and to persist for so long that worries me and keeps me wondering what it is. My doctor is sort of at the point of besides telling me I'm "swallowing air" that sometimes these things just "develop" for no reason. Could that really be true? I guess if there was some explanation as to what physically made it develop, I'd understand. I also feel occasional mild nausea which scares me, but at the same time all my GI tests are coming back normal...so I just don't know.

My doctor said he'd order a CT scan just so I could have a complete picture of everything in my abdomen. My ultlrasound was fine, so I'm pretty sure the CT scan would be as well, though it's just more detailed with the pancreas (and my doctor said we shouldn't be worrying about my pancreas anyways).

Obviously I'm grasping at straws trying to think of things this could be. I've even wondered if maybe it's something not even GI-related and that's why they can't find a reason. Not sure what that could be...some infection, bacteria, mysterious rare disease, who knows (I'm negative for H. Pylori through biopsy AND breath test so it's not that). At my worst I was belching over 100 times a day. It's probably about half of that now...I guess the fact that it started so out of the blue and so excessively just concerns me. Am I completely over-reacting? I don't do well not understanding why something physical is occurring.

Well, any other thoughts or input would be greatly appreciated. Thanks for putting up with me :)
Posted 1/12/2014 10:49 AM (GMT 0)
dmarie-

Yes you could have a LES or HH issue and not actually feel heartburn. Everyone has some reflux, but there is a normal range. I suspect a manometry and PH study will show something is off. Whether it's a permanent problem or something that may work itself out is the big question.

With my reflux, it pretty much started all at once or at least how I sensed it. It did get worse over time, but my symptoms came out of the blue. Mine may actually have a cause because it showed up after I returned from the Gulf War and was exposed to chemicals there, but it did gradually get worse after I noticed symptoms. IIRC my 1st symptoms were excessive belching.

Take care,
Bill
Posted 1/12/2014 2:11 PM (GMT 0)
dmarie,

There can be many causes for burping and belching. It could be as simple as the way you chew and swallow, or as complicated as an exotic bacteria or malfunction of the UES, LEW, Pyloric valve, liver, gall bladder, or your proton pumps that make the stomach acid.

After bouncing from doctor to doctor, test to test, followup this, followup that, it could end up taking years to figure it out. Too bad miraculous diagnosis doesn't happen in a week or two like it does on the TV show House. In the real world we are at the mercy of a medical system with many flaws and long waits.

I mention suplemenation with probiotics and digestive enzymes not necessarily as a cure, but as an inexpensive diagnostic test you can do on your own. If it doesn't help, then you move on to something else. If it does.....?

Post Edited (rjdriver) : 1/12/2014 9:57:21 AM (GMT-7)

Posted 1/12/2014 6:48 PM (GMT 0)
Hi rj...what do you mean an exotic bacteria that could cause belching? I haven't been anywhere other than Illinois for years so I don't know if I could've picked anything up. As for my liver, with my normal liver function blood tests and normal liver ultrasound my liver is most likely fine don't you think? I know I don't have gallstones although maybe the gallbladder isn't functioning well. Also what is the pyloric valve? I know I have no blockages after my endoscopy and barium swallow with the intestinal follow through. Any thoughts?? Oh also I'm not on any PPIs anymore because they didn't help. I belch within a minute of drinking anything which makes me feel like maybe something isn't working right? Just trying to clarify the things you mentioned....let me know what you think!
Posted 1/12/2014 8:14 PM (GMT 0)
Hello, Marie. I have the same exact problem as you are describing, I have just recently developed the never ending burping condition. It starts as soon as I wake up in the morning and goes on throughout the day. This belching began about 2 weeks ago, but before it started 1 week prior I had this nausea feeling that lasted 2 days and I felt like I wanted to throw up but could not. So about a week after this constant belching began, and it's pretty much the same as you described. I really wish we had answers to our embarrassing and annoying problem.

I did some research online and this is all I could find in regards to constant belching:
1. H. Pylori
2. GERD
3. Low Enzyme Levels
4. Gallbladder problem
5. Gerdia


It has honestly made me a bitdepressed, I would love to go to a doctor to see if they can help, but I don't have insurance. And it seems they could find an answer for you, which is even more depressing. I really hope we get our issue resolved.



Good luck to both of us.
Posted 1/13/2014 10:45 PM (GMT 0)
Opnwlh...quick question. When you had excessive belching as your first symptom, how long did you have that before you noticed other symptoms. I'm over 4 months now of just belching. We're you having this all the time, just with eating, etc? Also was wondering if nausea is ever related to reflux? I feel as though the belching began with some nausea that I occasionally still feel. Very confusing...
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