Persistent Nausea and Burping: Gastrointestinal Issues

Belching and nausea?

Hello Dr.
Lee: For the past two months, I have been experiencing nausea and a sensation of something stuck in my throat after meals, which is quite uncomfortable.
I find that I need to burp continuously to relieve the discomfort.
In the past two weeks, the symptoms have worsened, and I even find myself burping frequently in the morning on an empty stomach.
Sometimes, I can't help but dry heave several times.
I have seen a doctor and underwent an endoscopy, but the doctor said that everything from the esophagus to the duodenum appears normal.
The doctor prescribed medication to aid digestion, but despite taking several medications over the past two months and visiting the hospital multiple times, following the doctor's advice to eat small, frequent meals, the symptoms persist.
They even occur in the morning when I haven't eaten anything.
I am puzzled about where all this air is coming from.
Therefore, I would like to ask Dr.
Lee what I should do in this situation and what possible conditions I might have.
Should I consider further examinations, such as an abdominal ultrasound? Thank you for taking the time to respond.

Chris Lee, 20~29 year old female. Ask Date: 2011/10/03

Dr. Li Yongming reply Gastroenterology and Hepatology

Hello, based on your symptoms, it appears you may be experiencing a sensation of a lump in the throat (globus sensation).
Medically, there is no specific etiology or mechanism that can directly explain this condition.
When the symptoms occur, there may be increased pressure in the upper esophageal sphincter or abnormal movements in the pharynx.
Possible causes include gastroesophageal reflux or sensations related to emotional responses (such as anxiety) that lead to repeated swallowing or dry mouth.
Many medical conditions can present similar symptoms, such as diffuse esophageal spasm, neuromuscular disorders (like myasthenia gravis), or symptoms caused by masses in the mediastinum or neck compressing the esophagus.
If you experience any of the following warning symptoms, please consult a physician for further evaluation: 1.
Pain in the neck or throat.
2.
Unexplained weight loss of more than 10 kilograms within three months.
3.
New onset of globus sensation in individuals over 50 years of age.
4.
Difficulty swallowing or frequent choking.
5.
Regurgitation of food.
6.
Muscle weakness.
7.
Palpable or visible masses.
8.
Persistent and worsening globus sensation.
Further evaluations may include: 1.
Chest X-ray (with particular attention to the mediastinum and diaphragm).
2.
Upper gastrointestinal examination (endoscopy, upper GI series).
3.
Otolaryngology examination (laryngoscopy).
4.
Esophageal manometry (to measure esophageal sphincter pressure and peristaltic waveforms).
(This is a specialized test that only a few medical centers in the country can perform.) Regarding the abdominal ultrasound you mentioned, it can be considered to evaluate or rule out diaphragmatic tumors, as it is a cost-effective method.
As for pharmacological treatment, there are currently no specific medications (if there is no organic disease), and most treatment focuses on symptom management.
For symptoms related to emotional issues, you may seek assistance from a psychiatrist.
This condition spans multiple specialties, which can indeed be challenging for diagnosis and treatment.
Please seek care from gastroenterology, otolaryngology, neurology, or psychiatry clinics based on your specific situation.
Wishing you a speedy recovery!

Reply Date: 2011/10/03

More Info

Persistent nausea and burping can be quite distressing and may stem from various gastrointestinal issues. Based on your description, it seems that you've been experiencing significant discomfort after meals, with symptoms worsening over the past month. The sensation of having something stuck in your throat, along with the need to burp frequently, suggests that there may be underlying issues related to your digestive system.

Firstly, it's important to consider the possibility of gastroesophageal reflux disease (GERD), which can cause symptoms such as nausea, burping, and a sensation of fullness or obstruction in the throat. GERD occurs when stomach acid flows back into the esophagus, leading to irritation and discomfort. Although your endoscopy showed normal findings from the esophagus to the duodenum, it is still possible to have GERD, as it can sometimes be diagnosed based on symptoms alone.

Another potential cause of your symptoms could be functional dyspepsia, a condition characterized by chronic or recurrent pain or discomfort in the upper abdomen. This condition can lead to feelings of fullness, nausea, and burping, especially after meals. It is often related to abnormal motility of the stomach and intestines, which can affect how food is digested and moved through the gastrointestinal tract.

Additionally, the sensation of having something stuck in your throat could be related to a condition known as globus sensation, which is often associated with anxiety or stress but can also occur in the context of gastrointestinal disorders. This sensation can be exacerbated by reflux or esophageal motility disorders.

Given that you have already undergone an endoscopy and received medications to aid digestion, it may be beneficial to explore other diagnostic avenues. An abdominal ultrasound could be useful to rule out any structural abnormalities in the gallbladder or liver that might be contributing to your symptoms. Furthermore, if you have not yet been evaluated for motility disorders, a test such as esophageal manometry could provide insights into how well your esophagus is functioning.

In terms of management, continuing to follow a diet that minimizes irritants is crucial. This includes avoiding spicy, fatty, or acidic foods, as well as caffeine and alcohol. Eating smaller, more frequent meals can also help reduce symptoms. Additionally, consider keeping a food diary to identify any specific triggers that may exacerbate your nausea and burping.

If your symptoms persist despite these measures, it may be worthwhile to consult with a gastroenterologist for further evaluation. They may recommend additional tests or a different approach to treatment, such as adjusting your current medications or exploring other therapeutic options.

In summary, while your symptoms are concerning, they can often be managed effectively with the right approach. It is essential to maintain open communication with your healthcare provider and advocate for further testing if necessary. Your quality of life is important, and finding the underlying cause of your symptoms will be key to achieving relief.

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