Rare belching disorder could be treated with singing, study hints — but not everyone is convinced

People with a rare disorder that causes excessive burping may benefit from an unlikely treatment: singing therapy.

A new study suggests that this singing approach could offer a more engaging alternative to diaphragmatic breathing, or belly breathing, which involves engaging the diaphragm muscle to take very deep breaths. This is commonly used to help patients stop burps before they happen.

As singing also involves diaphragmatic breathing, researchers wanted to determine if singing might be more engaging for patients while offering the same benefits. Their results suggest it may actually offer superior benefits to the breathing exercises.

When it comes to singing, however, one expert told Live Science that the approach doesn't address the entire underlying issue behind the disorder, adding that the study had significant limitations.

No ordinary burps

The burping disorder, called supragastric belching, doesn't involve ordinary burps. Instead of releasing air that has collected in the stomach, people with the condition rapidly pull air out of their esophagus and then push it back out as a sort of belch.

"That is why it's called supragastric belching, because it's not gastric," said Dr. Daniel Sifrim, a gastroenterologist at Queen Mary University of London who specializes in esophageal disorders and was not involved in the study. (The prefix "supra" here means "above," meaning supragastric belching occurs above the stomach.)

Supragastric belching is considered a behavioral disorder, as the action is typically a learned response. It may start when someone is feeling discomfort in the abdomen or experiencing symptoms of reflux and discovers that belching can help relieve the discomfort. The person then repeats the movement until it becomes habitual, Sifrim explained.

Supragastric belching is considered pathological when it becomes "excessive" and causes significant distress to a person's quality of life. While rare in the general population, the behavior is more common in people with reflux and other digestive disorders. To treat the condition, doctors often combine breathing techniques with therapy, such as cognitive behavioral therapy, aimed at addressing the underlying mental triggers behind the behavior.

The new study, published July 22 in the journal Clinical Gastroenterology and Hepatology, involved 72 people diagnosed with supragastric belching at two hospitals in China. The researchers used established criteria to diagnose the condition, assessing each person's symptoms to rule out other causes. They also surveyed the patients to assess the severity of their symptoms, their overall quality of life, and feelings of sadness or anxiousness.

The researchers randomly assigned the participants to one week of either structured singing therapy or diaphragmatic breathing. The singing therapy involved five-minute sessions, repeated three times a day for seven days, in which the patient would sing one of four Chinese folk songs accompanied by musical instruments. Patients were allowed to add more five-minute sessions, if desired.

The breathing therapy included guided breathing exercises that involved visualizing the diaphragm's movements and putting a hand on the belly to feel the breath. In both treatment groups, patients worked to hit a target volume of 80 decibels with either their singing or deep breathing — that's roughly the same volume as a food blender.

The researchers checked the patients' symptoms one week after their treatment and again a month later. After one week of treatment, roughly 72% of the people in the singing group had cut their belching frequency by at least half, compared with only 39% of people in the breathing group. This advantage continued at the one-month checkup: 50% of people in the singing group still met the study's definition of a successful treatment, compared with 31% of those in the breathing group.

The singing group also reported a larger boost in quality of life and greater relief from belching immediately after the treatment than the breathing group did.

Questions remain

However, Sifrim was not convinced by these findings.

He questioned whether all 72 participants had been definitively diagnosed with supragastric belching, which is just one of several belching disorders. It can be difficult to distinguish supragastric belches from gastric belches, he explained, because the former diagnosis is made by asking patients about their symptoms.

"The only way to be sure is to measure it with impedance technique," he explained. Esophageal impedance monitoring measures acidic and nonacidic reflux from the stomach into the esophagus and can help doctors determine whether a belch originates in the stomach or involves air being sucked into the esophagus. This objective measurement was missing, "so I am concerned about the way they made a diagnosis," he said.

He also cautioned that the singing therapy does not necessarily address the underlying problem: the cognitive trigger that causes a person to belch excessively to begin with.

"There are two components of the treatment," Sifrim said. "One is a cognitive component, and the other is a behavioral component. The singing is doing only the behavioral component by modifying the diaphragm."

In his experience, the cognitive aspect is most important, he said. With his own patients, he applies techniques like cognitive behavioral therapy to address the cause of the belching.

This is a common treatment course combined with diaphragmatic breathing. But notably, the current study didn't address the cognitive aspect in either treatment group; it looked at each physical treatment in isolation and compared the two head-to-head, finding singing to be more helpful.

While further investigation is needed, the researchers say that their study points to a potential new avenue to explore in future research about this rare condition.