MDCalc

Rome IV Diagnostic Criteria for Belching Disorders

Official Rome IV criteria for the diagnosis of excessive supragastric or gastric belching.

Use in patients with symptoms suggestive of a belching disorder, such as bothersome belching from the esophagus or stomach more than 3 days per week for at least 6 months.

Patients with any of the following features must be evaluated clinically for other diagnoses even though a belching disorder may be present: 

  • Signs or symptoms of GI bleeding.

  • Unexplained iron deficiency anemia.

  • Unintentional weight loss.

  • Palpable abdominal mass or lymphadenopathy on exam.

  • Family history of gastric cancer and no recent upper endoscopy.

  • Dysphagia.

  • Persistent vomiting.

Must have the following:

For 3 months prior with symptom onset ≥6 months ago

Diagnostic Result

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Advice

If diagnostic criteria are not met (negative):

Symptoms are unlikely to be caused by a belching disorder. Consider further assessment for other diseases, or a different functional GI disorder.

If meets diagnosis (positive):

Symptoms are likely due to a belching disorder. Provide reassurance and explanation of symptoms to the patient.

Management

Management of belching disorders should be based on the subcategorization.

For supragastric belching:

  • Speech therapy.

  • Diaphragmatic breathing.

  • Behavioral therapy (e.g. cognitive behavioral therapy, hypnosis).

For gastric belching:

  • Avoidance of carbonated beverages.

  • Speech therapy.

  • Diaphragmatic breathing.

  • Simethicone.

  • Baclofen.

Critical Actions

  • This calculator should only be used in patients after appropriate organic, systemic, and metabolic causes have been ruled out after careful investigation.

  • Note: Other GI conditions, such as GERD, may coexist with belching disorders.