Abstract
A sixty year-old woman was admitted to our hospital because of frequent belching. She began to complain of belching with chest pain from 6 months before the hospitalization, when she was stressed by her family. She maximally belched 1000 times per day. Video-analyzed upper gastrointestinal series after the admission revealed sliding esophageal hiatus hernia, gastro-esophageal refiux and turning back phenomenon of esophageal gas. Esophageal manometry showed decreased pressure of the lower esophageal sphincter and decreased amplitude of the esophageal peristalsis. Furthermore, the esophageal contraction amplitude decreased more under mental arithmetic task. Cisapride and clonazepam were administered for regulation of disordered esophageal motility via 5-HT 4 and benzodiazepine receptors. Autogenic training was performed to reduce the sympathetic discharge, which lowered the esophageal contraction amplitude. As a result, the esophegeal contraction pressure tended to increase with concomitant decrease in frequency of belching. Our case suggested that belching might be one of the important signs of esophageal motility disorder. Besides, autonomic dysfunction caused by stress was thought to worsen disordered esophageal motility and to trigger belching. A further study is necessary to clarify the relationship between belching and esophageal motility.
