Singing Therapy May Help Reduce Excessive Belching, Study Finds

People with supragastric belching, a rare disorder that causes frequent and disruptive belching, may benefit from an unexpected treatment: singing therapy.

New research suggests that structured singing may reduce belching more effectively than standard diaphragmatic breathing, also known as abdominal breathing.

Diaphragmatic breathing involves taking slow, deep breaths using the diaphragm rather than the muscles in the chest. The technique is commonly used to help people control excessive belching before it occurs. Because singing also relies on controlled breathing and diaphragm movement, researchers wanted to determine whether it could provide similar or greater benefits in a more engaging format.

“Singing also involves diaphragmatic breathing,” the researchers noted. Their findings suggest that singing-based breathing exercises may offer an effective behavioral treatment for some people with excessive belching.

What Is Supragastric Belching?

Supragastric belching does not involve the normal release of air from the stomach. Instead, a person rapidly draws air into the esophagus and then expels it, creating a repetitive belching sound.

“That’s why it’s called a belch, because it’s not a belch from the stomach,” said Dr. Daniel Sifrim, a gastroenterologist at Queen Mary University of London who specializes in esophageal diseases and was not involved in the study.

Supragastric belching is considered a behavioral disorder because the pattern can develop as a learned response. It may begin when a person experiences abdominal discomfort, acid reflux or another digestive symptom and discovers that belching temporarily provides relief. Over time, the behavior may become habitual.

Although supragastric belching is relatively uncommon in the general population, it may occur more often in people with reflux disease and other digestive disorders. Frequent belching can cause significant distress and negatively affect quality of life.

Treatment often combines breathing exercises with behavioral approaches such as cognitive behavioral therapy. These approaches aim to address both the physical breathing pattern and the thoughts, sensations and triggers associated with excessive belching.

How the Singing Therapy Study Worked

The study, published July 22 in Clinical Gastroenterology and Hepatology, included 72 people diagnosed with supragastric belching at two hospitals in China.

Researchers used established diagnostic criteria to evaluate participants and rule out other possible causes of their symptoms. They also assessed belching severity, quality of life, anxiety and depression.

Participants were randomly assigned to one of two groups: a structured singing therapy program or diaphragmatic breathing exercises. The singing program consisted of five-minute sessions performed three times daily for seven days. Participants sang one of four Chinese folk songs with instrumental accompaniment and could complete an additional five-minute session if they wished.

The breathing group performed guided diaphragmatic breathing exercises. These included visualizing the movement of the diaphragm and placing a hand on the abdomen to monitor breathing. Both groups were asked to reach a sound level of approximately 80 decibels while singing or performing the breathing exercises—about as loud as a food blender.

Singing Therapy Reduced Belching Frequency

Researchers reassessed participants one week and one month after treatment. After one week, approximately 72% of people in the singing group had reduced their belching frequency by at least half. In comparison, 39% of participants in the diaphragmatic breathing group achieved the same result.

The improvement continued at the one-month follow-up. About 50% of participants in the singing group still met the study’s definition of treatment success, compared with 31% in the breathing group.

Participants who received singing therapy also reported greater immediate relief from belching and significantly improved quality of life compared with those who performed diaphragmatic breathing exercises.

Why More Research Is Needed

Despite the promising results, experts say the study has important limitations. Dr. Sifrim questioned whether all 72 participants had been definitively diagnosed with supragastric belching.

Some belching disorders can be difficult to distinguish based on symptoms alone. Doctors may use esophageal impedance monitoring to track air movement and distinguish between belching that originates in the stomach and air drawn into the esophagus. This objective testing was not included in the study, raising questions about how participants were diagnosed.

Dr. Sifrim also cautioned that singing therapy may address only the behavioral part of the disorder. Excessive belching can involve both behavioral and cognitive components, including the thoughts, sensations and emotional triggers that reinforce the behavior.

“There are two components to treatment,” Sifrim said. “One is a cognitive component and the other is a behavioral component. Singing only has a behavioral component by changing the diaphragm.”

In clinical practice, cognitive behavioral therapy is often combined with diaphragmatic breathing to address the underlying causes of excessive belching. The new study did not directly examine the cognitive aspects of either treatment.

Although larger studies are needed, the findings suggest that structured singing may be a useful addition to treatment options for people with supragastric belching. Anyone experiencing frequent or distressing belching should speak with a qualified health care professional for an accurate diagnosis and personalized treatment plan.