achalasia

Achalasia

Conditions

Achalasia

Achalasia is a rare condition of the esophagus, the tube that connects the mouth to the stomach. It occurs when the muscle at the bottom of the esophagus (the lower esophageal sphincter) fails to relax properly, making it difficult for food and liquid to pass into the stomach.

Symptoms of achalasia can include difficulty swallowing, regurgitation of food, chest pain, and weight loss. The exact cause of achalasia is not known, but it is believed to be related to a problem with the nerve supply to the lower esophageal sphincter.

Diagnosis of achalasia may involve a series of tests, including X-rays, a barium swallow test, and an esophageal manometry test to measure the pressure in the lower esophageal sphincter.

Treatment for achalasia typically involves procedures to relax the lower esophageal sphincter and improve the passage of food into the stomach. This can include medications, dilation of the esophagus with a balloon, or surgical procedures to cut the muscle at the bottom of the esophagus. In some cases, dietary modifications and lifestyle changes may also be recommended to manage symptoms.

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belching burping

Belching and burping

Symptoms

Belching and burping

Belching and burping arise due to the presence of excessive air within the oesophagus that is expelled through the mouth. The underlying cause is commonly linked to dietary intake or rapid ingestion. However, persistent occurrences may signify an underlying issue in the upper digestive tract, such as acid reflux. We recommend scheduling an appointment with one of our medical professionals for a thorough examination and diagnosis.

Related Symptoms

What’s the difference between burping and belching?

  • - Acid reflux (heartburn) and indigestion
  • - Chest pain and discomfort
  • - Abdominal pain
  • - Bloating

Belching and burping are synonymous in meaning, referring to the act of expelling gas from the mouth, with some regarding belching as producing a more audible sound. An alternative term for this process is eructation.

While typically a natural bodily function, it is only a cause for concern when coupled with other symptoms. If excessive belching and burping persist, we recommend seeking guidance from a medical professional.

As well as trouble swallowing, signs of dysphagia include:

When to seek emergency help

Burping and belching rarely require emergency care, though seek urgent treatment if you experience the following symptoms.

  • - Tarry or black stools
  • - Severe abdominal pain
  • - Sudden difficulty swallowing
  • - Blood in your poo (stools) or vomit
  • - Vomit that resembles coffee grounds

The manifestation of abrupt swallowing difficulties may indicate an allergic response. Additionally, the presence of blood in vomit or stool may signify internal bleeding within the digestive system.

Causes of burping and belching

Transient episodes of excessive belching may be triggered by the ingestion of specific foods and beverages, including carbonated beverages, curry, chewing gum, and dairy products. Furthermore, temporary burping may also accompany gastrointestinal distress. Nevertheless, persistent belching and burping warrant further evaluation as they could signify an underlying gastrointestinal (GI) ailment requiring medical attention.

Conditions linked to belching and burping

Outlined below are several medical conditions that may give rise to belching and burping, alongside their typical symptoms.

  • - Peptic ulcers – also cause blood in your poo
  • - Gastritis – can also cause nausea and vomiting
  • - Functional or non-ulcer dyspepsia – also causes indigestion
  • - H. Pylori – also causes abdominal pain and bloating
  • - Gastroparesis – can also cause unintended weight loss
  • - Aerophagia – you may experience air gulping and flatulence
  • - Food intolerance – symptoms may occur after specific foods
  • - Hiatal hernia – may cause bad breath, heartburn and acid reflux
  • - Gastro-oesophageal reflux disease (GORD) – frequent acid reflux
  • - Irritable bowel syndrome (IBS) – also causes diarrhoea and constipation

Should you present with any of the aforementioned symptoms, we advise seeking guidance from our specialist team to obtain a comprehensive diagnosis.

Diagnosis

The diagnostic approach to identifying the underlying cause of your belching and burping hinges upon the presence of accompanying symptoms. During your consultation, our medical professionals will conduct a thorough evaluation of any additional symptoms, their duration, and possible triggers.

Furthermore, we will delve into your medical history, both personal and familial, to help establish a probable cause for your symptoms. For enhanced visualisation of your digestive system, our specialist may conduct various gastrointestinal (GI) tests.

Testing may involve

  • - H. pylori test
  • - Maldigestion tests
  • - A blood or stool test
  • - Hydrogen and methane breath tests
  • - Gastroscopy (if we suspect it is GORD)
  • - Abdominal scans, such as MRI, CT, or ultrasound scans

Treatment

Prior to seeking professional guidance, there are several lifestyle modifications that you may consider implementing to alleviate belching. Digestive disruptions, including belching, can arise due to poor gut health and heightened stress levels. 

If your symptoms cause discomfort, we suggest consulting with a specialist at the earliest convenience. Maintaining a symptom tracker and food diary may prove beneficial in providing our team with an accurate depiction of your condition during your appointment.

After identifying the underlying cause of your symptoms, our specialists will recommend the most suitable course of treatment. In the event that we diagnose a gastrointestinal (GI) ailment, follow-up testing, medication, or surgery may be necessary.

Lifestyle changes to prevent belching and burping

  • - Quit smoking
  • - Don’t drink through a straw
  • - Avoid eating or drinking quickly
  • - Eat less fatty or high-fibre foods
  • - Try taking a short walk after eating
  • - Stop chewing gum or similar products
  • - Limit carbonated drinks, such as beer
  • - Avoid certain other foods, such as mushrooms, beans, cabbage, broccoli, lentils, onions, and some fruits.

Over-the-counter medications

Some over-the-counter medications may alleviate your symptoms, such as antacids. Your local pharmacist can advise you on the medicines that may help.

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Swallowing-Problems

Swallowing Problems

Symptoms

Swallowing Problems (Dysphagia)

Occasionally, food can become lodged in the throat or oesophagus for a brief period. However, if this becomes a frequent occurrence, lasts longer than a few seconds or causes pain when swallowing, it is advisable to seek medical attention.

Dysphagia is the medical term for difficulty swallowing, which can result in difficulties swallowing certain foods or liquids, or an inability to swallow altogether. If you are experiencing any of these symptoms, it is recommended that you consult with one of our specialists.

Further information on the symptoms, causes, diagnosis and treatment for swallowing problems is detailed below.

Related Symptoms

  • - Cough and throat clearing
  • - Hoarseness of voice

Symptoms of dysphagia

As well as trouble swallowing, signs of dysphagia include:

  • - Choking or coughing when eating
  • - Bringing food back up
  • - Feeling like food is stuck in your throat or behind your chest bone
  • - Excess salivation
  • - Trouble chewing food

Left untreated, dysphagia can cause weight loss and chest infections.

Causes

The following health conditions can cause swallowing problems: 

  • - Eosinophilic oesophagitis (EoE)
  • - Gastro-oesophageal reflux disease (GORD)
  • - Achalasia
  • - Oesophageal cancer

The narrowing of the oesophagus, which can lead to difficulty swallowing, can be caused by various digestive health conditions. Additionally, neurological conditions like stroke and multiple sclerosis can also contribute to dysphagia. If you are experiencing difficulty swallowing and have one of these conditions, it is recommended to consult with our specialists to better understand the impact on your swallowing ability.

Diagnosis

If your doctor suspects that your difficulty in swallowing is due to a digestive health issue, they may refer you to one of our gastroenterologists for further consultation. To diagnose the underlying condition, we may conduct one or more of the following tests :

  • - Gastroscopy
  • - Barium swallow
  • - High-resolution oesophageal manometry
  • - 24 hour pH impedance
  • - 96 hour pH capsule (BRAVO or Alpha)

Treatment

The optimal treatment for dysphagia varies based on its root cause. Endoscopic dilation is a viable treatment option for eosinophilic oesophagitis (EoE) and achalasia. Additionally, other potential treatment options for EoE include:

  • - 6 food elimination diet
  • - Proton pump inhibitors (PPIs) medications
  • - Topical swallowed steroids (Budesonide)

We can treat GORD with:

  • - Medications to suppress or counteract acid
  • - Lifestyle modifications (diet, weight loss, exercise)
  • - Anti-reflux procedures (Stretta, transoral incisionless fundoplication (TIF), LINX)
  • - Anti-reflux surgery (laparoscopic/keyhole Nissen fundoplication)

The treatment for oesophageal cancer varies depending on the stage of the disease. For early stages, endoscopic resection (ER) and HALO radiofrequency ablation (RFA) may be appropriate. However, more advanced stages require surgical intervention, such as an oesophagectomy to remove the affected part of the oesophagus. Other treatments, such as chemotherapy or radiotherapy, may also be considered.

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23 Widegate Street, City of London, London, E1 7HP, United Kingdom

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