The frequent expulsion of gas from the stomach through the mouth is known as eructation or belching. While this condition may accompany the most varied affections of the stomach, it may also occur alone and is then considered as a neurosis. It is characteristic of the latter that the gas expelled has no particular odor and consists principally of air. The eructations of gas may appear in the form of attacks lasting half an hour to an hour or much longer. The intervals between the eructations during an attack are sometimes very short, so that there may occur two or three belching spells in one minute. Sometimes the expelled gas does not come from the stomach, but merely from the oesophagus, and consists of air which has just been swallowed previous to the belching. Some people are able to produce this kind of belching voluntarily. Ewald states that he can belch at will from the oesophagus. By auscultating himself to the ensiform process, he became convinced that the air voluntarily eructated did not come from his stomach, as no sound whatever was audible at the ensiform process.

In view of this fact and of the importance of swallowing of air in the production of belching, Bouveret1 proposed to designate this condition as aero-phayia (eating of air). I am inclined to think that the frequent eructations from the oesophagus, which are always preceded by acts of deglutition and accompanied by loud sounds, are identical with singultus, and result from a condition of irritation of the phrenic nerves. Attacks of singultus of short duration (ten to fifteen minutes) are of frequent occurrence, while attacks lasting several days without interruption are quite rare. The latter occur either accompanying very grave conditions (cancer of the stomach and some cases of peritonitis) or again as a primary neurosis. Nervous belching may either last several days or exist for years. The patients are never disturbed by the act of belching during sleep, but in the daytime the trouble may sometimes be so annoying as to keep them away from society or even from business. The act of belching is ascribed by some to an increased peristaltic action of the stomach, by some to a decreased contraction or a relaxation of the cardia, and by some to both of these conditions together.

Etiology

Nervous belching is frequently found in hysterical and neurasthenic persons, but also in people not otherwise showing any neurotic symptoms whatever. It sometimes appears after great mental worry or excitement, or also as a sequel of an acute gastric catarrh.

1 Bouveret: l. c., p. 611.

Treatment

In persons with a weakened constitution, in neurasthenics and hysterical persons, this primary trouble must be treated as such. If the condition is idiopathic, the administration of the bromide salts is very valuable. The faradic current applied intraventricularly has given me very good results in this class of cases. Diet does not seem to have much influence upon the affection. I deem it very important to tell the patient to try and suppress the belching as often as he can. Very frequently this measure alone suffices to effect a cure.