Hello,
Supragastric belching with repetitive throat movements is usually a behavioral/neuromuscular issue, not stomach gas.
In your case, it is very likely related to medication-induced dyskinesia or a tic, especially with clozapine and amisulpride.
The most effective treatments are speech therapy–based behavioral therapy, medication review by your psychiatrist, and sometimes low-dose medications for dyskinesia.
🛑🛑This is treatable and reducible, but it requires coordinated care with a psychiatrist and speech therapist.
I trust this helps Thank you
Supragastric belching, particularly if related to repetitive throat movements or a tic disorder, can be quite distressing and difficult to manage. The key is addressing the underlying causes. Given that you have treatment-resistant schizophrenia and are taking amisulpride and clozapine, it’s important to consider that these medications, especially clozapine, can have side effects that affect muscle control and movement, potentially contributing to dyskinesias or abnormal swallowing patterns. Discussing this with your psychiatrist or prescribing physician could be crucial, as they can evaluate whether the medication regimen might be contributing to your symptoms and consider if an adjustment is possible.
For immediate management, behavioral therapy techniques, such as those used in speech therapy, could be beneficial. These may help you develop strategies to control throat and swallowing movements more consciously. Techniques like diaphragmatic breathing or mindfulness-based stress reduction might also help reduce the frequency of belching by calming the nervous system and changing your focus. Exploring cognitive-behavioral therapy (CBT) with a psychologist experienced in treating tic disorders might provide strategies to manage these involuntary movements.
It’s also imperative to rule out any gastrointestinal causes, such as GERD, that could exacerbate your symptoms. A consultation with a gastroenterologist could lead to treatments that specifically reduce belching and improve quality of life. Keep thorough notes of your symptoms, frequency, and any patterns, as this information can be vital for your healthcare providers in forming an accurate diagnosis. Remember, involving a multidisciplinary team, including your psychiatrist, gastroenterologist, and possibly a speech therapist, can offer comprehensive approaches to manage the symptoms more effectively.
Your symptoms are most consistent with supragastric belching associated with a tic-like swallowing behavior and possible medication-related movement disorder (tardive dyskinesia or oropharyngeal dyskinesia). This condition is functional and behavioral, not due to excess stomach gas, and is commonly worsened by anxiety and certain psychiatric medications, including antipsychotics.
Supragastric belching occurs when air is rapidly sucked into the esophagus and expelled, often unconsciously, which explains the belching every few seconds. The repetitive gulping of saliva suggests a motor tic or dyskinesia, which can occur in patients taking long-term antipsychotic therapy, even when these medications are necessary.
Key points:
Acid-reducing medicines usually do not help supragastric belching
This condition is treatable but requires a combined approach
It is not dangerous, but it can be extremely distressing
What helps most:
Behavioral therapy (especially speech therapy or CBT focused on belching control) — this is the most effective treatment
Breathing retraining (slow diaphragmatic nasal breathing)
Habit-reversal therapy for the swallowing tic
Review of medications by your psychiatrist to assess for tardive dyskinesia and consider treatments such as VMAT-2 inhibitors if appropriate
Important next steps:
Consult a psychiatrist and gastroenterologist together
Request evaluation for antipsychotic-induced dyskinesia
Ask specifically about supragastric belching behavioral therapy
Overall conclusion:
Your condition is real, recognized, and manageable, but it requires specialized behavioral treatment and medication review, not just stomach medicines. With proper care, symptoms can be significantly reduced, even if they do not disappear completely.
Hello Rishabh Thank you for sharing your situation—dealing with supragastric belching and frequent swallowing can be really distressing, especially alongside schizophrenia and the medications you’re on.
Here’s what’s likely happening:
- Supragastric belching is often a learned or habitual behavior, not caused by excess stomach gas but by air being sucked into the esophagus and quickly expelled.
- Frequent swallowing/gulping can be a tic or a form of tardive dyskinesia (a movement disorder sometimes caused by antipsychotic medications like amisulpride and clozapine).
- Both can be worsened by anxiety, stress, or as a side effect of your medications.
What you can do:
1. Discuss with your psychiatrist:
- Since you’re on clozapine and amisulpride, and have a possible tic or dyskinesia, your psychiatrist needs to know. Sometimes, adjusting medication or adding a treatment for movement disorders can help.
- Do not stop or change your medicines on your own.
2. Behavioral therapy:
- Speech and behavioral therapy (like cognitive-behavioral therapy or habit reversal training) can help reduce supragastric belching and tics.
- Relaxation techniques and mindfulness may also help reduce the frequency.
3. Lifestyle tips:
- Try to avoid carbonated drinks, chewing gum, or eating too quickly, as these can increase air swallowing.
- Practice slow, deep breathing when you feel the urge to belch or swallow.
4. Medical review:
- If you haven’t already, get checked for reflux or other gastrointestinal issues, but supragastric belching is rarely due to a physical stomach problem.
What to expect:
- These symptoms can improve with the right combination of medication management and behavioral therapy, but it may take time and patience.
- There’s no instant cure, but with support from your psychiatrist and possibly a speech therapist, you can see improvement.
Thank you
Hello Rishabh, Thank you for explaining your problem so clearly. What you are describing sounds very distressing, and it can be managed. Here is my advise -
1. Get a psychiatry review - You must not stop or change medications yourself, but please discuss with your psychiatrist regarding current medicines and your gastric problems.
2. Behavioral therapy: Speech therapy / Behavioral therapy is the gold standard for supragastric belching. Techniques include: Diaphragmatic breathing. Suppressing air-swallowing reflex. Habit reversal training. This works even when medicines fail.
3. Practice slow diaphragmatic breathing. Avoid frequent throat clearing. Sip water instead of gulping saliva. Reduce caffeine and smoking (if any). Observe if symptoms disappear during sleep (important diagnostic clue).
4. Red flags (seek urgent care if): Difficulty swallowing food. Choking. Progressive worsening movements. Tongue or jaw movements. Voice changes.
5. This condition is real, common in psychiatric patients, and treatable. It is not life-threatening, but it needs proper diagnosis and targeted therapy, not trial-and-error. Please consult your psychiatrist + a gastroenterologist.
Feel free to reach out again.
Regards, Dr. Nirav Jain MBBS, DNB D.Fam.Medicine
I’m really sorry you’re dealing with this—supragastric belching with constant saliva gulping can be extremely distressing, especially alongside treatment-resistant schizophrenia.
Supragastric belching is often a behavioral/functional condition (air is swallowed subconsciously and released immediately) and it commonly overlaps with tic disorders or tardive dyskinesia, which can be triggered or worsened by antipsychotics like clozapine and amisulpride. The most effective treatment is behavioral therapy, especially speech therapy or diaphragmatic breathing training, along with a psychiatrist reviewing your medications (sometimes dose adjustment or adding medicines like clonazepam, propranolol, or VMAT-2–related strategies helps dyskinesia).
Please consult a psychiatrist (movement-disorder aware) and a gastroenterologist together, and specifically ask for evaluation of tardive dyskinesia vs tic disorder and supragastric belching—this condition is treatable, and many patients improve significantly with the right combination of therapy and medication adjustment.
