Published online Feb 7, 2015. doi: 10.3748/wjg.v21.i5.1680
Peer-review started: August 14, 2014
First decision: August 29, 2014
Revised: September 9, 2014
Accepted: October 15, 2014
Article in press: October 15, 2014
Published online: February 7, 2015
Processing time: 179 Days and 18.8 Hours
Belching is a common symptom of gastroesophageal reflux disease. If the symptoms are not relieved after anti-reflux treatment, another etiology should be considered. Here, we report a case of a 43-year-old man who presented with belching, regurgitation, chest tightness and dyspnea for 18 mo, which became gradually more severe. Gastroscopic examination suggested superficial gastritis. Twenty-four-hour esophageal pH monitoring showed that the Demeester score was 11.4, in the normal range. High-resolution manometry showed that integrated relaxation pressure and intrabolus pressure were higher than normal (20 mmHg and 22.4 mmHg, respectively), indicating gastroesophageal junction outflow tract obstruction. Pulmonary function test showed severe obstructive ventilation dysfunction [forced expiratory volume in 1 second (FEV1)/forced vital capacity 32%, FEV1 was 1.21 L, occupying 35% predicted value after salbuterol inhalation], and positive bronchial dilation test (∆FEV1 260 mL, ∆FEV1% 27%). Skin prick test showed Dermatophagoides farinae (++), house dust mite (++++), and shrimp protein (++). Fractional exhaled nitric oxide measurement was 76 ppb. All the symptoms were alleviated completely and pulmonary function increased after combination therapy with corticosteroids and long-acting β2-agonist. Bronchial asthma was eventually diagnosed by laboratory tests and the effect of anti-asthmatic treatment, therefore, physicians, especially the Gastrointestinal physicians, should pay attention to the belching symptoms of asthma.
Core tip: Belching is a common symptom of gastroesophageal reflux disease. If the symptoms are not relieved after anti-reflux treatment, bronchial asthma needs to be considered when the patient is accompanied by respiratory symptoms. Combination of multiple tests including pulmonary function, fractional exhaled nitric oxide, and allergen skin prick test, except for specific gastroenterological examinations, is helpful to make a correct diagnosis. Corticosteroids are the most effective medication for asthma-induced belching. This case suggests that physicians, especially the gastrointestinal physicians, should pay attention to the belching symptoms of asthma.