Significant Temporal Association of Esophageal Air Events (Supragastric Belches, Air Swallows, and Gastric Belches) With Hiccups: A Case Study in an Adolescent

We previously reported our ability to objectively assess the strength of temporal relationships between gastroesophageal reflux (GER) disease-like symptoms with esophageal air events (EAEs) (air swallows, gastric belching, and supragastric belching) using impedance-pH monitoring. Recently, we similarly evaluated an adolescent female who presented to our clinic with symptoms of recurrent hiccups and with what appeared to be numerous EAEs. Hiccups were associated with GER (symptom association probability [SAP] = 100%), air swallows (SAP = 99.7%), supragastric belches (SAP = 100%), and gastric belches (SAP = 100%), with almost twice as many of the supragastric belches preceding a hiccup than any of the other 3 esophageal disturbance types (EDs) (P < 0.00001). Our data showing a significant temporal association between EAEs and hiccups support a previous report in which belching was suspected of being associated with hiccups in an adult male. Reports such as this underscore the importance of considering the assessment of temporal relationships between extra-esophageal symptoms and EDs that include not only GER, but also EAEs, such as air swallows, gastric belches and supragastric belches, when devising strategies for clinical management of patients with hiccups.

Supragastric belch may be related to globus symptom - a prospective clinical study

BACKGROUND

The etiology of globus is poorly understood. It is controversial, whether gastroesophageal reflux disease (GERD) has a role in globus. To investigate the possible esophageal background of this symptom, we performed transnasal esophagoscopy (TNE), high-resolution manometry (HRM), and 24-h multichannel intraluminal impedance (MII) and pH monitoring on globus patients.

METHODS

Thirty consecutive patients were referred to Helsinki University Hospital, Department of Otorhinolaryngology - Head and Neck Surgery for treatment of globus; 24 consecutive patients with difficult reflux symptoms from the Department of Surgery served as controls. We compared the results of the patient groups in endoscopies, HRM, and 24-h MII-pH monitoring.

KEY RESULTS

In MII monitoring, globus patients had supragastric belch (6/20, 30% vs 1/24, 4%; p = 0.038) more often than controls. Total reflux time was higher in controls (p = 0.004), and they had more acid reflux events (p = 0.002) in MII, but between groups, the number of non-acid reflux events was similar. In pH monitoring, DeMeester score and total pH <4 time were higher in controls (P < 0.001). In HRM, the upper esophageal sphincter (UES) mean basal and residual pressures did not differ.

CONCLUSIONS & INFERENCES

Supragastric belch was more common in globus patients, suggesting the possible role of this condition in globus sensation. However, globus patients in this series had no acid or non-acid GERD or elevated UES pressure.