Constant Nausea and Burping: 9 Causes, Gastroenterologist Explains.
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1. GERD (chronic acid reflux).
The acid inside your stomach can regurgitate back to the esophagus. It causes irritation and inflammation of the esophagus lining.
GERD or chronic acid reflux is very common. The estimated prevalence of GERD in the USA is between 18.1% to 27.8% of the population (reference).
GERD is one of the most common causes of constant nausea and burping.
Symptoms suggestive for GERD:
- Heartburn: a burning sensation in the chest and upper stomach area, especially after eating.
- Regurgitation: stomach contents reflux back to the mouth or throat. You typically feel a bitter (acidic) material with small amounts of undigested food.
- Nausea: it can be constant in severe cases.
- Burping (bleaching).
- Sometimes, vomiting also occurs.
- Difficulty swallowing food (dysphagia).
- Recurrent sore throat.
- Cough and shortness of breath.
- Chest pain while swallowing.
- Increased saliva inside your mouth (water brush).
- Badmouth odor and teeth problems.
Interestingly, some studies suggest unexplained constant nausea can be the only sign of GERD (reference).
2. Hiatal Hernia.
Hiatal (or hiatus) hernia is the upward herniation of your abdominal contents (usually a part of the stomach) into your chest cavity. The herniation is through the esophageal opening (hiatus) in the diaphragm.
Hiatus hernia can be asymptomatic or have mild symptoms such as nausea and burping. Also, hiatal hernia is considered one of the causes of GERD (acid reflux).
Symptoms suggesting you have hiatal hernia:
- It can present with symptoms of GERD (as heartburn and regurgitation).
- Nausea (it can be constant in severe cases).
- Vomiting also can develop and can be persistent.
- Burping (bleching).
- Dysphagia (difficulty swallowing).
- Chest pain.
3. Bad eating habits and food intolerance.
Faulty food habits can result in constant nausea and burping. For example:
- Eating too fast leading to excessive swallowing of air during eating.
- Taking while eating.
- Binge eating.
- Over-consumption of foods that cause burping and nausea, such as alcohol and caffeine.
- Habitual drinking of carbonated beverages.
Also, Some may have an intolerance to certain types of food. Food intolerance is a widespread condition. And it may present with a more severe type of reaction called (food allergy).
Bad eating habits, food intolerance, and food allergy can cause constant nausea and burping.
The symptoms and differences between food intolerance and food allergy are illustrated in the table below.
|Food intolerance||Food allergy|
|Affects 15-20% of the population||Affects nearly 2-5% of adults|
|Difficulty digesting certain types of food (not immune-mediated allergy).||An immune-mediated reaction to certain foods or food components.|
|Causes “acute” or “chronic” diarrhea, nausea, burping, and abdominal pain attacks.||Usually causes acute attacks related to the ingestion of offending food.|
|Intestinal symptoms: diarrhea, extensive gas, bloating, and abdominal pain, nausea, burping.||Intestinal symptoms are the same (including nausea and burping).|
|No extra-intestinal symptoms||Extraintestinal symptoms like rashes, urticaria, swollen lips, face, or severe life-threatening allergic reactions.|
|The severity of your symptoms is proportional to the amount you eat from the offending food.||Even trace amounts of the offending food can produce severe symptoms.|
|Common offending foods:||Common offending foods: (examples)|
4. Gastritis and peptic ulcer disease.
Gastritis is the inflammation your stomach lining. Severe and chronic forms of gastritis may lead to Ulceration in your stomach or duodenum.
The 2 most common causes of gastritis and peptic ulcer disease are Drugs (as Non-steroidal antiinflammatory drugs) and a stomach bug called (h. pylori).
- Pain in the upper part of your stomach. The pain can be sharp, burning, or gnawing.
- Related to meals: especially heavy fatty or spicy meals.
- Associated with nausea or vomiting.
- In severe cases, an ulcer can develop, and it can bleed (vomiting of blood, passage of dark stool).
- Having H. pylori infection, recent use of analgesics, caffeine abuse, or alcohol abuse increases the risk of gastritis.
5. Functional dyspepsia.
Functional dyspepsia is common. About 5 to 11% of the people suffer from it (reference).
According to ROME IV criteria for the diagnosis of functional dyspepsia, the presence of one or more of the following symptoms (after excluding the organic diseases of your gut) indicates FD.
- Postprandial fullness: a feeling of fullness or tight band around your stomac. It usually starts during or soon after eating.
- Early satiety: You cannot complete your meal because of the fullness or the tight band that develops around your stomach.
- Epigastric discomfort, pain, or burning: that develops after eating.
Functional dyspepsia is commonly associated with constant nausea and maybe burping after eating.
Also, some patients may suffer from heartburn and vomiting.
Gastroparesis occurs when your stomach takes more time to empty its content. The slow stomach leads to accumulation of food for longer periods inside it.
Gastroparesis is very common in patients with diabetes mellitus. However, many cases of gastroparesis are of unknown causes.
Slow stomach (gastroparesis) often causes constant nausea and fullness after eating. Burping after eating is also frequent.
Symptoms of gastroparesis:
- Abdominal discomfort or pain: at the upper middle stomach area (epigastric area).
- Nausea and vomiting are more common with gastroparesis than functional dyspepsia.
- Early satiety.
- Bloating and fullness after meals.
- Weight loss in severe cases.
- Shortness of breath.
7. Early pregnancy.
Nausea is one of the most common complaints during pregnancy. Around 70% of pregnant women feel nauseous at some point during pregnancy (ref).
Increased pregnancy hormones (progesterone, estrogen, and human chorionic gonadotropin) plays a major role in such case.
In severe cases, nausea can be associated with vomiting or even burping.
Nausea (and vomiting) of pregnancy are more common in the morning (morning sickness).
Fun Fact: researchers found that women who have nausea with pregnancy are at LOWER risk of miscarriage (reference).
Nausea (& vomiting) of pregnancy is more common with (reference) :
- Younger women.
- First-time pregnancy.
- Obese women.
- Women with a previous history of motion sickness.
- Women with a history of nausea due to oral contraceptive pills (ref).
A long list of medication can lead to nausea (and burping). Check your list of medication for any offending drugs.
The table below illustrates the most common drugs leading to nausea.
|Medications causing nausea||Examples|
|1- Analgesics: medications used to treat headache and pain||Aspirin.Other NSAIDs such as Ibuprofen, ketoprofen.Anti-gout medications.|
|2- Drugs for heart diseases:||Digoxin (especially over-dose).Beta-blockers (such as bisoprolol).Calcium channel blockers (as Amlodipine).Other antihypertensives and anti-arrhythmia medications.Diuretics|
|3- over-use of vitamin supplements (hypervitaminosis).||Vitamin D overdose.Vitamin A overdose.|
|4- Cancer chemotherapy.||Severe nausea and vomiting, especially with: Cisplatinum.Dacarbazine.Nitrogen mustard. Others cause moderate to mild nausea: Methotrexate.Cytarabine.Etoposide.Fluorouracil.Tamoxifen.|
|5- Hormonal preparations/therapies||Oral contraceptives.Anti-diabetic drugs.|
|6- Antibiotics / Antivirals||Erythromycin.Tetracycline.SulfonamidesAnti-TB drugs.Acyclovir.|
|7- IBD (Crohn’s & Ulcerative Colitis) medications||Sulfasalazine.Azathioprine.|
|8- CNS drugs:||Antiparkinsonian drugs.Anticonvulsants (& epilepsy) drugs.|
|9- Anti-asthma drugs:||Theophylline|
- Gastroenteritis (stomach bugs) and food poisoning.
- Gallbladder diseases such as gallstones, acute cholecystitis, and others.
- Painful conditions: such as bone fractures, cancer pain, etc.
- Psychological stress and anxiety: is also an essential factor and it can be the only cause of constant nausea and burping. Nausea and burping are frequent in patients with anxiety.
- Ear Problems.
- Irritable bowel Syndrome: IBS is a common functional disease of the bowel. Nausea is one of the commonly associated symptoms of IBS.
- Neurological diseases such as brain tumors, migraine, seizure diseases (epilepsy), brain irradiation.
- Kidney failure.
- Endocrinal diseases Such as hyperparathyroidism, hyperparathyroidism, hyperthyroidism, Addison’s disease, etc.
- Heart disease as heart failure and angina pectoris.
- Radiation therapy.
- Stomach and esophageal cancers.
- Enlargement of an abdominal organ such as splenomegaly or hepatomegaly.
- Chronic pancreatitis.