School of Medical Sciences & Research, Sharda University, Greater Noida, Department of Psychiatry: Poster Presentation: Psychogenic Belching: Mystery, Nature and Treatment: A case report

Belching is defined as the act of expelling air from the stomach through the mouth and it is a physiological act that occurs occasionally in everyone and usually not related to a disease or gastrointestinal pathology. Persistent and uncontrollable belching is benign in origin, but can be distressing in its psychosocial consequences. There have been case reports where the patient may belch up to 20 times a minute. A high prevalence of anxiety disorders and major depression has been described in relation to persistent belching and these symptoms increase due to an ongoing stressor. Many patients stop belching during speaking and it has been shown that distraction also reduces the frequency of belching whereas putting attention to their belching behaviour usually results in an increase in belching frequency. Treatment ususally requires a combination of both pharmacotherapy and sessions of psychotherapy though it often becomes challenging at times. We report herewith a case of persistent psychogenic belching in a female patient that responded to a combination of multiple medications. A 35 year old female patient reported to the opd with complaints of repeated belching through out the day from last 2 years. She had already consulted many physicians and surgeons and all her investigations were normal. After rapport building, and serial mental status examination, stressors mainly in the form of marital discord, disturbed sexual relations were elicited and direct relation with worsening of symptoms whenever there would be increase in stress was observed. Both pharmacotherapy in the form of ssri and non pharmacological intervention in the form of individual psychotherapy, individual & couple therapy, relaxation techniques were adviced and the patient improved significantly. A consultation liaison approach to eliminate organic causes in these cases is prudent before considering a pure psychological and psychosocial etiology. Clinicians must be aware that persistent psychogenic belching though rare needs a team based approach in its management and elimination of patient distress is the key to success.