Bitter belching is an involuntary throwing of air and liquid contents into the oral cavity due to the contraction of the smooth muscles of the gastrointestinal tract, after which the patient feels the taste of bitterness in the mouth. Episodic eructation may be associated with nutritional errors, but regurgitation is more often observed in diseases of the biliary system and duodenal pancreatic zone. To determine the cause of the symptom, X-ray, endoscopic, ultrasound and laboratory tests are performed. To stop belching, prokinetics, antispasmodics and choleretics are used.
Causes of bitter belching
In most cases, eructation with a taste of bitterness develops due to functional disorders or organic damage to the digestive tract, biliary pathology. Periodic burping without any other alarming signs often has a physiological nature. Bitterness in the mouth associated with nutritional errors occurs after excessive consumption of nuts, seeds, and other fat-rich foods. The unpleasant taste is due to the presence of under-oxidized fats in the regurgitated gastric contents.
Biliary dyskinesia
The cause of bitter belching against the background of violations of the contractile function of the bile ducts and gallbladder is an uneven flow of bile into the duodenum and periodic throwing of intestinal contents into the stomach. Violation of the digestion of chyme in dyskinesia causes overgrowth of smooth muscle fibers, their reflex contraction with the release of gases and liquid chyme with impurities of bile acids on the oral mucosa. An increase in belching is observed with the addition of duodenoastric reflux.
Functional disorders of the biliary tract motility are characterized by a combination of bitter eructation with other signs of dyspepsia, the severity of which depends on the variant of changes in contractility. With the hyperkinetic type, sharp pains and spasms appear on the right side of the hypochondrium, nausea, vomiting, flatulence. Hypokinetic dyskinesia is characterized by dull pulling pain in the epigastrium and right hypochondrium, bloating, instability of the stool with frequent constipation.
Cholelithiasis
The appearance of bitter belching in the gastrointestinal tract is more characteristic of the intercalary period, when the patency of the biliary tract persists. The taste of bitterness that patients feel after eructation is associated with the throwing of bile into the stomach, esophagus and oral cavity. Frequent regurgitation is caused by stretching of the walls of the stomach and a reflex reaction to periodic stagnation of chyme in the proximal part of the intestine. Regurgitation is usually accompanied by pain and discomfort in the right hypochondrium, nausea, stool disorder with a predominance of diarrhea.
Other hepatobiliary diseases
Any pathology affecting the bile ducts and liver can lead to belching with an unpleasant bitter taste. With inflammatory processes in the biliary system, the mechanism of regulation of bile discharge is disrupted, general visceral innervation provokes concomitant functional pathology of the gastroduodenal zone. The symptom is potentiated by the periodic gaping of the gatekeeper and the throwing of duodenal chyme with a large amount of concentrated bile into the overlying gastrointestinal tract. The main hepatobiliary diseases with the symptom of bitter belching are:
- Cholecystitis. Regurgitation with bitterness can occur not only with GI, but also with stone-free cholecystitis. Exacerbation of symptoms is most often associated with errors in the diet (intake of fatty or smoked foods). Patients complain of discomfort and soreness in the area of the projection of the gallbladder, nausea, single vomiting, which does not bring relief. More rare signs are constipation, dysphagia, flatulence.
- Postcholecystectomy syndrome. Eructation with a taste of bitterness is noted with pathological bile circulation in the intestine, secondary changes in the motor function of the digestive tract. In addition to bitter belching, there is an intense pain syndrome with localization in the right hypochondrium, which is determined in 70% of patients. Concomitant malabsorption syndrome causes weight loss, beriberi, stomatitis.
- Cholangitis. For inflammation of the bile ducts, regurgitation of the contents with a bitter taste is pathognomonic in combination with a triad of symptoms — intense pain, jaundice of the skin and mucous membranes, intermittent febrile fever. Due to increased pressure in the ductal system, normal bile production is disrupted with bile entering the pancreas and biliary pancreatitis.
- Hepatitis. Dyspeptic syndrome associated with digestive disorders due to insufficient production of enzymes and bile acids is considered one of the leading ones in the clinical picture of hepatitis. In addition to bitter belching, appetite decreases, diarrhea is noted, an unpleasant taste in the mouth. Signs of possible hepatitis are pains of varying intensity localized in the hypochondrium on the right, subfebrile fever.
Pathology of the duodenoancreatic zone
Diseases of the pancreas and duodenum 12 are accompanied by disorders of bile secretion, since the common bile duct together with the pancreatic duct open in the middle part of the duodenum. With a decrease in the synthesis of digestive enzymes, violation of parietal and abdominal digestion, chyme stagnates in the intestine. Duodenoastric reflux and reflex stretching of the muscular apparatus of the stomach ensure the release of liquid contents with impurities of bile into the mouth. Belching can provoke diseases such as:
- Duodenite. The appearance of bitter eructation is characteristic of a cholecyst-like variant of duodenal inflammation. Regurgitation of chyme with a bitter taste is combined with other symptoms: nausea, frequent defecation with the release of liquid fetid feces, pain in the epigastric region. When the condition is aggravated by a local violation of bile secretion, jaundice staining of the skin and mucous membranes is detected.
- Duodenostasis. With stagnation in the lumen of the duodenum of partially digested food, the pressure in the upper gastrointestinal tract increases, provoking reflex muscle contraction and the occurrence of bitter belching. Also, patients are concerned about spastic pain after eating, the intensity of which decreases after vomiting. With duodenostasis, there is constant flatulence, rumbling in the stomach. It is possible to delay the stool up to partial intestinal obstruction.
- Bulbit. With a limited erosive lesion of the duodenal bulb, the functioning of the common bile duct, which opens in the bulbar section, is always disrupted. Bitter eructation is combined with indistinct abdominal pains, which are aggravated on an empty stomach, nausea. Also, with bulbitis, various variants of violation of stool frequency and stool consistency are noted, with a prolonged course of the disease, patients lose weight.
- Pancreatitis. The appearance of belching with an aftertaste of bitterness is possible with chronic inflammation of the pancreas. The symptom is provoked by disorders of digestion of food, which increases the pressure in the intestines and reflexively contracts the muscles of the stomach. Patients complain of constant pain in the left hypochondrium of varying intensity, combined with steatorrhea, nausea, vomiting, bloating and rumbling in the abdomen.
Pregnancy
The development of bitter belching in pregnant women is primarily caused by hormonal restructuring. With an increase in the level of estrogens, the composition of bile changes: the mass fraction of cholesterol increases, an imbalance of the main bile acids occurs. An additional factor is an increase in progesterone effects with a decrease in the motor function of the biliary tract, a violation of the enterohepatic circulation of individual bile components. With cholestasis of pregnant women, the symptom is accompanied by itching, stool disorders and yellowing of the skin.
Functional digestive disorders
Sometimes regurgitation of bitter gastrointestinal contents occurs even without organic pathologies of the digestive organs. In functional diseases, dysregulation of the autonomic nervous system is observed, which disrupts the normal motility of the gastrointestinal tract, leads to the appearance of reverse peristalsis with the throwing of aggressive contents from the duodenal lumen into the stomach. Belching and other dyspeptic disorders (heaviness in the abdomen, flatulence, nausea) are variable and combined with emotional lability, psychasthenia.
Intestinal infections
Belching with gastric contents with a bitter taste is sometimes found in parasitic infestations and intestinal helminthiasis, which occur with a predominant lesion of the organs of the duodenal and biliary zones. Often bitter eructation occurs with giardiasis, opisthorchiasis, intestinal form of strongyloidosis. Regurgitation with bitterness is accompanied by other dyspeptic disorders: giardiasis is characterized by diarrhea with the release of foamy feces, with opisthorchiasis and strongyloidosis, dull pains in the subcostal region on the right, nausea, alternation of constipation and diarrhea are observed.
Diagnostics
The diagnostic search is aimed at a comprehensive assessment of the functional and morphological state of the gastrointestinal tract. A gastroenterologist is engaged in the examination of patients with bitter eructation. Special attention is paid to the study of the hepatobiliary system. To establish the root cause of belching with an unpleasant taste, a complex of laboratory and instrumental methods is recommended, the most informative of which are:
- Radiography. For a detailed study of the gallbladder, biliary tract, percutaneous cholangiopancreatography is used. Studies allow us to assess the degree of violation of contractile function, visualize concretions, signs of the inflammatory process. In order to exclude gastrointestinal pathology, radiography with oral contrast is performed.
- Endoscopy. Since belching can be associated with damage to the duodenal zone, patients are shown EGD, visualizing the mucous membrane of the upper digestive tract and revealing signs of various organic diseases. If necessary, a biopsy of pathologically altered areas with histological analysis of the material is performed to clarify the diagnosis.
- Duodenal probing. Sequential sampling of several portions of bile on an empty stomach and after administration of drugs that stimulate bile secretion is a valuable method for detecting pathologies of the biliary tract. The doctor evaluates the amount of bile secretions obtained, studies its microscopic and biochemical composition. If necessary, bacteriological sowing is carried out.
- Ultrasound examination. Ultrasound of the abdominal cavity is used as a non-invasive screening method that provides rapid scanning and determination of pathology of individual organs. Targeted sonography of the gallbladder and bile ducts allows you to identify concretions, signs of inflammation and suppuration of the organ.
- Analysis of feces. For pathologies manifested by bitter eructation, changes in the coprogram are typical, so all patients are prescribed macroscopic and microscopic analysis of bowel movements. If the patient has signs of a probable infectious process, bacteriological sowing is performed. Additionally, Gregersen’s reaction to latent blood is carried out.
As additional research methods, a biochemical blood test is used to determine the level of bilirubin fractions, the concentration of alkaline phosphatase, ALT and AST, serological tests to detect antibodies to intestinal parasites. According to indications, in difficult and doubtful cases, scintigraphy of the biliary tract and liver is performed.
Treatment
If the symptom is observed quite rarely and is not accompanied by other unpleasant signs on the part of the gastrointestinal tract, belching can be managed with the help of non-medicinal means. The main factor is the normalization of food habits: the rejection of fatty, smoked and fried foods, the restriction of alcohol and carbonated drinks that cause stomach distension and gas formation. You need to eat 4-5 times a day in small portions, after eating you can not bend over, do heavy physical work.
Bitter belching, which lasts more than 5 days, is a sign of a disease of the digestive or biliary system, requires contacting a specialist. Before undergoing a full examination and making a clinical diagnosis, medications can be used to reduce unpleasant manifestations: prokinetics to improve gastrointestinal motility and prevent the contents of the duodenum from being thrown into the stomach cavity, choleretic drugs to normalize the rhythm of bile secretion. With concomitant pain syndrome, antispasmodics are used.
