Q I am a 55-year-old man. I have been losing weight over the past year even though I have been eating a lot, as usual.

I have two to three bowls of rice every night. I also eat a lot of fatty meat. I do not like vegetables but I eat oranges every night. I also exercise every day.

After dinner, I tend to burp a lot. I feel quite uncomfortable until I have burped for about half an hour. Is there anything I should be worried about?

A There are a few areas that need to be addressed.

First, weight loss or weight gain is dependent on energy consumption and expenditure.

It is like a bank account - if you eat (put in) more and use (expend) less, you will get a surplus and the body will store this excess energy as fat.

And if you eat less or use more energy, you will lose weight.

If you are losing weight even though your food intake is the same, we will need to know if there has been an increase in your energy expenditure.

For instance, is your exercise regimen new and too strenuous?

We will also ask if there is an imbalance in the body's metabolic system, due to a condition such as diabetes or an overactive thyroid gland. Your family doctor can diagnose these conditions through simple blood tests.

Upper abdominal discomfort, or dyspepsia, should be evaluated to ensure that there are no structural problems in the upper digestive tract.

A gastroscopy, which uses a thin tube with a camera at the tip (called an endoscope), will allow doctors to view the insides of the swallowing tube, stomach and duodenum (first part of the small intestines).

It will also allow us to take biopsies of the abdomen.

Tests to measure the movement and function of the digestive tract may be necessary.

Recurrent burping or belching is a surprisingly common but poorly understood problem.

Belching occurs when there is a build-up of gas in the stomach, which is pushed up the swallowing tube and expelled through the mouth.

This occurs episodically in people and is perfectly normal.

However, if it is excessive, we will need to see if you have gastric or supra-gastric belches.

Gastric belches are sometimes due to an excessive and often imperceptible swallowing of air, a condition known as aerophagia or "air-eating".

Supra-gastric belches are due to "air-swallowing", where air is sucked into the swallowing tube and then expelled.

Supra-gastric belching is important for two reasons. Firstly, it can be distressing and embarrassing, and secondly, it is a known trigger of reflux. It is often due to anxiety and, in many cases, once the patient is aware of it, he can stop belching. In more severe cases, diaphragmatic breathing exercises or psychotherapy will help.

Gastric and supra-gastric belches can be differentiated by performing an esophageal impedance study. A small wire is floated into the swallowing tube to measure the type and frequency of belches, and also to look for any reflux.

Dr Reuben Wong

Dr Wong is a gastroenterologist at gutCARE, a subspeciality digestive medicine group practice. He is also president of the Irritable Bowel Syndrome Support Group and an Adjunct Associate Professor of Medicine.

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