Unifying Concepts

Rome IV Diagnostic Criteria for Belching Disorders

Gas, bloating, and belching are associated with a variety of conditions but are most commonly caused by functional gastrointestinal disorders. These disorders are characterized by disordered motility and visceral hypersensitivity that are often worsened by psychological distress.

Rome IV Diagnostic Criteria for Belching Disorders

Must include all of the following:

Bothersome (ie, severe enough to impact on usual activities) belching from the esophagus or stomach more than 3 days a week

2a: Excessive supragastric belching (from esophagus)
2b: Excessive gastric belching (from stomach).

Supportive remarks

  • Supragastric belching is supported by observing frequent, repetitive belching
  • Gastric belching has no established clinical correlate
  • Objective intraluminal impedance measurement can be used to distinguish supragastric from gastric belching.

Criteria fulfilled for the last 3 months with symptom onset at least 6 months before diagnosis.



  1. Wilkinson JM, Cozine EW, Loftus CG. Gas, Bloating, and Belching: Approach to Evaluation and Management. Am Fam Physician. 2019 Mar 1;99(5):301-309. [Medline]
  2. Stanghellini V, Chan FK, Hasler WL, Malagelada JR, Suzuki H, Tack J, Talley NJ. Gastroduodenal Disorders. Gastroenterology. 2016 May;150(6):1380-92. [Medline]


Created Aug 27, 2021.

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