The Physiology of Eructation

• Published in: Dysphagia Vol. 31; no. 2; pp. 121 - 133
• Main Author: Lang, Ivan M.
• Format: Journal Article Book Review
• Language: English
• Published: New York Springer US 01.04.2016; Springer; Springer Nature B.V
• Subjects: Eructation - etiology; Eructation - physiopathology; Esophageal Mucosa - physiology; Esophageal Sphincter, Lower - physiology; Esophageal Sphincter, Upper - physiology; Gases; Gastroenterology; Gastroesophageal Reflux - complications; Gastroesophageal Reflux - physiopathology; Hepatology; Humans; Imaging; Mechanoreceptors - physiology; Mediation; Medicine; Medicine & Public Health; Otorhinolaryngology; Peristalsis - physiology; Physiological aspects; Radiology; Review Paper; Stomach - physiology; Transient relaxation of the lower esophageal sphincter (TLESR); Belching; Esophago-pharyngeal reflux (EPR); Eructation; Transient relaxation of the upper esophageal sphincter (TUESR); Supra-esophageal reflux disease (SERD); Esophageal reverse peristalsis
• ISSN: 0179-051X; 1432-0460
• DOI: 10.1007/s00455-015-9674-6

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.