Three Part Question
In [patients with chest pain] is [belching a useful discriminatory symptom] of [myocardial ischaemia]?
A 60 year old man attends the emergency department with chest pain. He also gives a history of belching since the onset of the pain. His initial ECG is normal. You wonder if the symptom of belching has any prognostic value in the diagnosis of cardiac chest pain, or is more suggestive of a gastrointestinal cause.
Medline 1966 to 08/01 using the OVID interface.
[(exp myocardial infarction OR myocardial infarction.mp. OR MI.mp OR exp myocardial ischemia OR myocardial ischemia.mp OR myocardial ischaemia.mp OR exp angina pectoris) AND (exp eructation OR eructation.mp OR belching.mp OR eructonesius.mp)] LIMIT to human and english.
7 articles of which 5 were irrelevant or of insufficient quality. The two remaining papers are shown in the table.
|Author, date and country
||Study type (level of evidence)
|108 consecutive patients presenting to CCU||Questionnaire||Belching as a symptom in patients with confirmed inferior myocardial infarction||Sensitivity 69%, specificity 84% (no p value given)||Possible bias from direct questioning.|
|Logan RL et al,|
|227 consecutive patients presenting to CCU||Questionnaire||Belching as a symptom in patients with confirmed cardiac ischaemia||Positive predictive value of 72% (no p value given)||Possible bias from population chosen i.e. CCU admissions.|
There are no randomised trials that address the question. The best evidence would appear to come from two questionnaire studies, which show that belching is a symptom of myocardial ischaemia or infarction in a significant number of patients. It should not be assumed, therefore, that patients who have both chest pain and belching are more likely to be suffering from a non-cardiac cause.
Clinical Bottom Line
Belching is a recognised symptom of myocardial ischaemia or infarction.
- Darsee JR. Eructonesius with inferior myocardial infarction. N Engl J Med. 1978;298(4):221-2.
- Logan RL, Wong F, Barclay J. Symptoms associated with myocardial infarction: are they of diagnostic value? NZ Med J. 1986;99(800):276-8.