Reduction in supragastric belching seen with cognitive-behavioral therapy

Last Updated: 2018-03-19

By Lorraine L. Janeczko

NEW YORK (Reuters Health) - Receiving cognitive-behavioral therapy (CBT) is associated with reduced supragastric belching (SGB) and acid gastroesophageal reflux, and improved quality of life (QOL), new research shows.

"Cognitive behavioral therapy ameliorated SGB in patients who completed treatment. It reduced the number of belches and improved social and daily activities in 50% of patients," write Dr. Daniel Sifrim of Queen Mary University of London and colleagues in the American Journal of Gastroenterology, online February 20.

The researchers recruited patients with SGB at one hospital. The participants, all between 20 and 72 years of age, attended an initial assessment with a gastroenterologist and a psychologist followed by four CBT sessions. Of the 51 patients who started treatment, 31 had a follow-up multichannel intraluminal impedance-pH study.

Participants attended CBT sessions that helped them recognize warning signals and learn preventive exercises. Before and after CBT treatment, they completed a Short Form Health Survey (SF-36) to assess personality traits, hypervigilance, and health-related QOL, and they used a four-item visual analog scale (VAS) to assess belching severity.

The mean number of SGBs dropped from 116 before CBT to 45 after four sessions (P<0.0003). In 16 of the 31 patients who completed the study, SGB decreased by over 50%.

After CBT treatment, the SF-36 scores related to general health, physical function, social function and vitality improved significantly (P<0.05). The mean VAS scale severity scores decreased from 260 mm before CBT to 140 mm after treatment (P<0.0001).

Dr. Jeffrey M. Lackner, who directs the Behavioral Medicine Clinic at the University at Buffalo School of Medicine in Buffalo, New York, told Reuters Health by email, "This is a relatively small but very innovative, creative study. We now understand more about how the brain and gut interact. Just as the brain can generate symptoms, patients can learn strategies that can relieve those symptoms."

"Excessive belching is a very common problem. It is a frequent symptom in patients with some of the most common functional gastrointestinal disorders and it's not well understood," added Dr. Lackner, who was not involved in the study. "So anything we can do to help patients gain control of their symptoms can not only help them reduce their day-to-day burden of these symptoms but can also improve the quality of their lives and help physicians manage them."

Dr. Timothy McGorisk, a gastroenterologist at the University of Illinois at Chicago, told Reuters Health by email, "Cognitive-behavioral therapy has been shown to benefit many functional gastrointestinal disorders, including irritable bowel syndrome."

"If you are a provider with a patient who is suffering from excessive supragastric belching, you can confidently recommend cognitive-behavioral therapy as a treatment option," Dr. McGorisk, who was not involved in the study, told Reuters Health by email.

"This study raises the possibility that supragastric belching is associated with GERD, and that correcting SGB has the potential to decrease the number of reflux events," he noted. "With the growing number of concerns associated with proton pump inhibitors, it is important to try to impact GERD with lifestyle and behavioral modifications when possible."

To establish longer-term efficacy, the research team is planning to follow the participants out to one year.

Dr. Sifrim did not respond to requests for comments.

SOURCE: http://bit.ly/2IB1X1B

Am J Gastroenterol 2018.