The Physiology of Eructation

Abstract

Eructation is composed of three independent phases: gas escape, upper barrier elimination, and gas transport phases. The gas escape phase is the gastro-LES inhibitory reflex that causes transient relaxation of the lower esophageal sphincter, which is activated by distension of stretch receptors of the proximal stomach. The upper barrier elimination phase is the transient relaxation of the upper esophageal sphincter along with airway protection. This phase is activated by stimulation of rapidly adapting mechanoreceptors of the esophageal mucosa. The gas transport phase is esophageal reverse peristalsis mediated by elementary reflexes, and it is theorized that this phase is activated by serosal rapidly adapting tension receptors. Alteration of the receptors which activate the upper barrier elimination phase of eructation by gastro-esophageal reflux of acid may in part contribute to the development of supra-esophageal reflux disease.

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Acknowledgments

This project was supported by NIH P01DK068051; Mechanisms of Upper Gut and Airway Interaction; Project 3: The Physiology of the Pharyngo-Esophageal Junction

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Correspondence to Ivan M. Lang.

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Dr. Lang has no conflicts of interest.

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Lang, I.M. The Physiology of Eructation. Dysphagia 31, 121–133 (2016). https://doi.org/10.1007/s00455-015-9674-6

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Keywords

  • Eructation
  • Belching
  • Esophago-pharyngeal reflux (EPR)
  • Esophageal reverse peristalsis
  • Transient relaxation of the lower esophageal sphincter (TLESR)
  • Transient relaxation of the upper esophageal sphincter (TUESR)
  • Supra-esophageal reflux disease (SERD)