Chronic Burping | Why It Happens & How to Treat It

Understanding Chronic Belching

Belching, or burping, is a normal bodily function that helps release excess air from the stomach. However, when belching becomes frequent, persistent, and bothersome, it may indicate an underlying disorder. Chronic belching is often linked to two main conditions: Aerophagia and Excessive Supragastric Belching (ESB).

Both conditions involve excessive swallowing of air that is then expelled as burps. While some medical literature distinguishes between these terms, many use them interchangeably. The key takeaway is that chronic belching is a Disorder of the Gut-Brain Interaction (DGBI), meaning it is driven by the complex relationship between the digestive system and the nervous system. Importantly, this does not mean the condition is "all in your head"—rather, it reflects how deeply interconnected gut function and mental health are.

For further reading this paper ( The Pathophysiology, Diagnosis and Treatment of Excessive Belching Symptoms) does an excellent job of explaining the main components of what causes ESB.  As it explains, ESB is a behavioral disorder, behavioral therapy is the therapy of choice.  Air swallowing is a habit that got learned, so it can often be unlearned to a large degree.

How to Treat Chronic Belching

Because ESB and aerophagia are behavioral in nature, the most effective treatments focus on changing learned air-swallowing habits. Here are the top evidence-based treatment approaches:

1. Cognitive Behavioral Therapy (CBT)

CBT is the gold standard for treating ESB. Research has shown that targeted cognitive and behavioral interventions significantly reduce symptoms and improve quality of life.

Key components of CBT for belching include:

• Increasing awareness of air-swallowing behaviors

• Teaching strategies to modify these behaviors

• Addressing underlying stress and anxiety contributing to the cycle

CBT is a common type of therapy, so you won’t have any issue finding a CBT therapist BUT the tricky part is that it would be ideal to work with someone who has been trained specifically to use CBT for health issues.  This is called health psychology.  The best case scenario is finding a therapist that trained & experienced in working specifically with GI disorders (a form of health psychology called psychogastroenterology or just GI psychology).

1 | The best place to start would be to look through this directory of therapists in the Gastro Psych Directory.  These are people trained in GI psychology.

2 | If there aren’t good options there you can try a popular therapist directory on the website Psychology Today.  On here you can apply the following filters to narrow down your choices:

• Under ‘Issues’ select chronic illness

• Under ‘Types of Therapy’ select Cognitive Behavioral (CBT)

• Under ‘Insurance’ select your insurance (though you may be able to work with other therapists not in this list using your insurance ‘out-of-network’ benefits

You would want to ask these therapists if they would be able to use CBT with you & to follow the protocols outlined in the articles linked above.

For further reading on CBR, you can learn about the two main components of what this treatment will look like in these articles

• Treatment of supragastric belching with cognitive behavioral therapy improves quality of life and reduces acid gastroesophageal reflux

• Simple office-based behavioral approach to patients with chronic belching

• Management of supragastric belching with cognitive behavioural therapy: factors determining success and follow‐up outcomes at 6‐12 months post‐therapy

2. Speech Therapy

Speech-language pathologists (SLPs) with experience in treating ESB can help retrain swallowing and breathing patterns. If considering this option, ensure the therapist has specific experience with supragastric belching.

Here’s an article to read to be informed about what to ask for when interacting with a speech therapist - Speech Therapy as Treatment for Supragastric Belching.

3. Biofeedback Training

Biofeedback helps train the body to regulate physiological functions, including breathing and swallowing patterns. If CBT or speech therapy is unavailable, biofeedback can be an excellent alternative.

Here is a directory to search for a provider in your area.  Note - you would want to get biofeedback, not neurofeedback for this issue.  

Look for the providers with the credential BCB (Board Certified in Biofeedback). Biofeedback is the preferred approach for ESB over neurofeedback.

Addressing Stress and Psychological Factors

Chronic belching is often linked to stress and anxiety. If the distress of uncontrolled belching contributes to broader mental health concerns such as Generalized Anxiety Disorder (GAD), therapy focused on emotional regulation can be beneficial.

Because Disorder of the Gut-Brain Interaction involve both biological and psychological factors, comprehensive treatment includes addressing both the behavioral and emotional aspects. Chronic stress can create a feedback loop, where stress worsens symptoms, and symptoms increase stress.

Lifestyle Adjustments That May Help

While professional treatment is the most effective approach, some behavioral and dietary changes can help reduce belching episodes:

• Dietary Adjustments: Avoid chewing gum, sucking candies, and carbonated beverages.

• Eating Habits: Eat slowly, take smaller bites, and avoid gulping air while drinking.

• Breathing Techniques: Learning & regularly practicing diaphragmatic breathing is often a key component of effective behavioral treatment for Aerophagia and ESB. The Rest & Digest podcast associated with this website is an easy way to get started without waiting to see a professional first.