Supragastric belching: Evaluating the efficacy of short-term Ryle's tube placement and diaphragmatic breathing...

Supragastric belching (SGB) is a behavioral disorder involving rapid air influx into the esophagus through a transiently relaxed upper esophageal sphincter, followed by immediate expulsion. Unlike gastric belching, it is not related to lower esophageal sphincter (LES) dysfunction or gastroesophageal reflux disease (GERD). Often associated with psychological stress, SGB can significantly impair quality of life and some patients remain refractory to conventional therapies.

In this retrospective study, clinical records of patients diagnosed with refractory supragastric belching were systematically analyzed. Extracted data included detailed clinical history and upper gastrointestinal endoscopy findings; high-resolution esophageal manometry (HREM) was performed using Herbert's 16-channel water perfusion system, with interpretation of esophageal motility patterns based on the Chicago Classification version 3.0 and perceived stress levels assessed using the PSS-10 questionnaire. All patients underwent a standardized intervention protocol consisting of nasogastric tube insertion followed by structured diaphragmatic breathing training (Yellapu Technique), aimed at behavioral modulation of belching. Follow-up evaluations included symptom assessment and perceived stress scores over a three-month period to determine therapeutic response.

Total 56 patients were analyzed (40 females and 16 males, mean age of 45.6 ± 10.0 years). Upper gastrointestinal endoscopy and HREM findings were within normal limits in all patients. Endoscopy showed normal mucosal findings. HREM demonstrated normal esophageal motility and sphincter function, with a baseline esophagogastric junction (EGJ) pressure of 33.75 ± 6.45 mmHg and an integrated relaxation pressure (IRP) of 10.90 ± 2.8 mmHg, both within physiological limits. Complete resolution of supragastric belching was observed in 55 patients. The paired mean Perceived Stress Scale (PSS) score showed a statistically significant reduction, decreasing from 33 ± 3.65 at baseline to 22.92 ± 2.34 at one month (p < 0.001). No recurrence of symptoms was reported during the follow-up period.

In conclusion, the Yellapu Technique appears to offer a practical and innovative therapeutic approach for the management of refractory supragastric belching. By combining mechanical interruption with behavioral modification, it was associated with immediate symptom relief as well as sustained improvement. These findings suggest that this technique may represent a promising adjunct or alternative to existing therapies, warranting further validation through well-designed prospective controlled studies.