Disclosures: Zachary A. Satin, MD: No financial relationships or conflicts of interest

Case Diagnosis: A 59-year-old female presenting 6 months following a motor vehicle collision with persistent neck pain and recurrent belching.

Case Description or Program Description: The patient endorsed a pulling sensation in the right posterior neck radiating to the right shoulder and recurrent involuntary belching with movement of or pressure to her neck, both aggravated by bilateral cervical rotation and lateral flexion. She reported experiencing milder neck pain and occasional belching following a MVC 8 years prior which self-resolved. Work-up including MRI brain, MRA head/neck, cervical-spine x-ray, EGD, laryngoscopy, and neck ultrasound was unremarkable. Acetaminophen, ibuprofen, antacids, and acupuncture did not offer significant relief. Physical exam demonstrated pain with forward cervical flexion; pain and belching with bilateral cervical flexion; right-sided paravertebral and upper trapezius tenderness; and reproduction of belching with pressure to right-posterior neck.

Setting: Academic outpatient physiatry clinic

Assessment/Results: Without an identifiable cause for this patient’s belching, the authors focused on pain relief. For muscular strain and myofascial pain, they prescribed topical diclofenac gel off-label for trapezius and cervical region pain and recommended continuing physical and speech therapy. She returned 1 month later reporting pain relief and near-complete resolution of belching. She continued diclofenac gel as needed, speech therapy, and home exercises.

Discussion (relevance): Belching is a physiological response to gastric and duodenal air distension, yet pathological repetitive belching can occur. Cases of isolated, repetitive belching secondary to neuropathic or musculoskeletal damage do not currently exist in the literature. The authors postulate this patient’s repetitive belching may have resulted from inflammation or injury within the right posterior neck following MVC, potentially irritating the phrenic or vagus nerve given their roles in belching, thereby exacerbating symptoms with local pressure or muscle contraction. However, a functional disorder could not be ruled out.

Conclusions: Traumatic accidents can elicit unique symptoms and cause significant debility. Careful evaluation for behavioral components is paramount when caring for patients following traumatic injury.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/chronic-belching-related-to-cervical-injury-after-a-motor-vehicle-collision-a-case-report/