Eructation

ERUCTATION (eructation, ructus), the expulsion through the mouth of air contained in the stomach or esophagus, accompanied by a characteristic sound. The amount of air expelled is usually small, not exceeding 50 cm³, although in individual cases the expulsion of larger amounts of it (up to 750 cm³) has been observed. In its composition, the eructated air is close to atmospheric air, differing from it by a higher carbon dioxide content. Stagnation and decomposition of the gastric contents can noticeably alter its composition: carbohydrate fermentation leads to an increase in the amount of carbon dioxide, and protein decomposition leads to the appearance of hydrogen sulfide, ammonia, hydrocarbons, and so on. The frequency of eructation can be very variable. Rare, seemingly accidental eructation is a normal phenomenon observed with a full stomach, the introduction of carbonated liquid, or food in a combination that favors gas formation. Eructation is a frequent complaint of patients with various organic diseases of the stomach, especially with a violation of its evacuation function. In anacid gastritis, eructation is a very frequent symptom; in these cases, it is caused by the patients' habit of swallowing air, with which they try to weaken the distressing sensation of pressure in the cardiac region of the stomach. The development of a bacterial flora in the stomach causing fermentation processes also plays a role. In ulcer of the stomach or duodenum and in pyloric gastritis, eructation can be a consequence of pylorospasm and increased motor excitability of the stomach, being as it were a companion or equivalent of the vomiting impulse. Eructation of the same origin is observed in diseases of the gallbladder, peritonitis, and other processes causing reflex pylorospasm. With prolonged pylorospasm, stagnation and decomposition of gastric contents can cause eructation with the smell of hydrogen sulfide, "rotten eggs"; the putrid smell of eructation is a frequent symptom of organic pyloric stenosis. The stagnation of gastric contents in these cases leads to the release of gaseous products of putrefaction and fermentation, sometimes capable of ignition (burns when lighting a cigarette). In decomposing gastric cancer, eructation has a pungent, sometimes fetid odor. Sometimes the putrid odor of eructation is due to intestinal gases, for example, in habitual constipation and colitis. Often patients complain of sour (or bitter) eructation, which is explained by the entry into the mouth along with gases of small portions of liquid gastric contents. At the same time, sour eructation should by no means be associated exclusively with hypersecretion or increased acidity: it can also take place in the complete absence of hydrochloric acid thanks to fermentation acids. True eructation should be distinguished from false eructation, which is a noisy swallowing of air. Such false eructation is observed in hysterical reactions in the form of attacks of spasmodic aerophagia (tic aerophagique according to Bouveret). During such an attack, the patient emits a series of sounds of various strengths and timbres, representing false eructation and ending with louder sounds of true eructation. Eructation is a common companion of simple aerophagia (see)—the accumulation of air in the stomach cavity due to its frequent swallowing with saliva (or aspiration). The mechanism of the act of eructation itself is apparently as follows: the cardiac orifice opens under the pressure of the gastric bubble with the simultaneous contraction of the muscles of the stomach; the simultaneous participation of the abdominal muscles and the diaphragm is also likely. Eructation is not accompanied by peristaltic movements of the esophagus.