A Case of Psychogenic Belching (P4.065)

OBJECTIVE: To describe a case of rhythmic and persistent belching that began suddenly following an argument in a patient with a history of dysautonomia, hypertension, fibromyalgia, and GERD. BACKGROUND: Belching may be a primary presenting complaint that is socially debilitating and difficult to treat. Attention has been found to modify belching frequency (Bredenoord et al., 2006), suggesting that some cases may be psychogenic. DESIGN/METHODS: A 53 year old man with a history of dysautonomia, hypertension, fibromyalgia, and GERD developed sudden belching during a stressful argument with his wife four years ago. It has persisted since then whenever the patient is awake and stops with sleep. The belching frequency varies and can increase up to nearly 1 Hz. It is triggered by water, bananas, grapes, the smell of chlorine, physical exercise, and mental stress. The belching can be stopped by putting his hands behind his head and by lying on his right side. RESULTS: Video-esophagram showed esophageal contractions correlating with belching. Cine-esophagopharyngogram showed a small sliding hiatal hernia and repetitive downward movement of the left and upward movement of the right hemidiaphragm during belching. Examination found entrainment of belching frequency to the frequency of the examiner’s tapping hand. There was a slight postural side to side (abduction/adduction) tremor in the right upper extremity. The tremor was variable and stopped with distraction. CONCLUSIONS: The sudden onset during a stressful situation, variability in frequency as a function of physical and mental stress, and entrainment of belching frequency support the diagnosis of a psychogenic (functional) movement disorder. The patient’s arm tremor also appears to be psychogenic because it stops with distraction. Psychiatric counseling with cognitive behavioral therapy is the general treatment for psychogenic movement disorders. Spiegel (1996) reports a case of successful treatment of belching with hypnosis. Study Supported by: NIH/NINDS intramural program Disclosure: Dr. Paine has nothing to disclose. Dr. Hallett has received personal compensation for activities with Neurotoxin Institute, Cambridge University Press, Oxford University Press, Wiley-Blackwell, Springer, Wolters Kluwer, and Elsevier. Dr. Hallett has received royalty payments from the National Institutes of Health. Dr. Hallett9s institute has received research support from BCN Peptides and Manhattan Pharmaceuticals.