A case of chronic psychogenic belching, responded to ECTs -? Masked depression

Belching is expulsion of air from the upper gastrointestinal tract. It’s a physiological process in which the ingested air is expelled out through mouth to relieve the distention. An average rate of 30 belches/24 hours is considered normal.1 Some patients present with excessive belching that markedly affects their day-to-day life and out of those 50% have symptoms of dyspepsia.2 Belching can be of two types, gastric and supra-gastric belching. The physiological belching in which the ingested air originating from the stomach is expelled out, is called gastric belching. On the other hand, when air is expelled out before reaching the stomach, it is called supra-gastric belch.3 It has been implied that supra-gastric belching begins as a voluntary attempt to relieve any upper GI discomfort and eventually becomes a learned behavior.4 It has also been demonstrated that the frequency reduces when patient is distracted and disappears during sleep, implying that there might be a psychological factor associated.5 Belching, sometimes is the primary presenting complain in patients, who may become resistant to treatment and are difficult to treat. This case has been reported to present the challenges faced while managing one such patient.