Flatulence and Burping/Belching and Bad Breath (Halitosis)

Gas in stomach

Gas is naturally expelled out from the body through either burping (via the mouth) or flatulence (via the anus)

The gas that is expelled out via the mouth is known as Burping or Belching. Burping or Belching is usually a result of air swallowed during eating, drinking or talking. In addition, carbonated drinks also result in air being expelled out through the mouth. The amount and frequency of burping varies from individual to individual and also from time to time depending on what activities are being carried out.

Sometimes, the gas that is expelled out can be foul smelling, a phenomenon known as Bad Breath or Halitosis. Bad breath per se does not necessarily signify an underlying problem as it can be purely due the food and drinks that have been consumed giving rise to a characteristic smell. However, Halitosis can certainly be a sign of an underlying problem such as Gastroesophageal Reflux (Acid reflux), poor oral hygiene or even rare conditions like a Esophageal or Pharyngeal pouch. Individuals who breath through the mouth or who snore a lot will tend to dry out the oral cavity and lead to bacterial overgrowth and resultant bad breath

The gas that is expelled out through the anus is known as Flatulence. The production of Flatus is a much more complex process and involves an interplay between the food we eat, the composition of the gut bacteria and the length of time the faeces spends in the colon. Certain foods are common culprits of excessive flatus production. These include vegetables especially broccoli, cabbage, and onions, dairy products, beans, fruits, wholegrain foods, soft carbonated and fruit drinks. However, it is not a given that every person produces the same amount of gas from eating the same foods. Again, flatus production is very much up to the individual’s body. Smelly flatulence does not usually signify a serious underlying medical condition.

Gastroesophageal Reflux Disease (GERD)

Gastroesophageal reflux disease (GERD) is characterised by reflux of gastric contents from the stomach into the lower esophagus. In more severe cases, the reflux can occur up till the level of the throat or the mouth (oral cavity). As the gastric contents include partially digested food, the deposition of these residual food material in the mouth and throat can in turn lead to bad breath or halitosis.

Esophageal or Pharyngeal pouch

Pouches, as the name suggests, refers to an outward (external) protrusion of part of the wall of the esophagus or pharynx (throat). As a result of the protrusion, there is a dead space that allows food material to accumulate in it instead of going down the esophagus. As a result of that, the food material undergoes partial digestion and breakdown in the pouch and this results in noxious gases being produced, resulting in bad breath

Irritable Bowel Syndrome (IBS)

Irritable Bowel Syndrome (IBS) is a condition that afflicts the entire gastrointestinal tract and comprises of abnormal intestinal contractions coupled with increased sensitivity of the intestines to pain and gaseous distension.

In patients with IBS, they can experience a feeling of abdominal bloatedness with obvious distension of the abdomen. They can also experience frequent flatulence. Accelerated intestinal transit results in frequent passage of flatuence while retarted transit allows more time for faeces to be fermented and broken down in the intestines

Peptic Ulcers

Peptic ulcers is the collective term used to refer to stomach or duodenal ulcers. In cases of ulcer bleeding, the blood undergoes digestion in the colon and the end result is black and tarry faeces with a characteristic foul smell. This may lead to smelly flatulence.

Lactose Intolerance

According to the US National Institutes of Health, over 90% of East Asians are lactose intolerant to a certain degree. This is because many Asians are short of lactase, an enzyme in the small intestine needed to break down lactose – a sugar commonly found in dairy products. Undigested lactose gets fermented by bacteria, resulting in diarrhoea and potentially a characteristic smelly flatulence.


With constipation, faeces spends a longer time in the digestive tract, particularly the colon and rectum. As a result, the faeces gets acted on by the gut bacteria for a longer period time and this can result in production of excessive flatulence that may have a characteristic smell.

When should I seek help?

Frequent belching/burping or flatulence is not a problem per se. Medical attention is warranted when the patient is very bothered by the symptoms. In such cases, a food diary may prove helpful in pin pointing the inciting foods.

Halitosis is more likely to point to an underlying problem. As such, any acute halitosis or worsening halitosis may signify a need for medical attention.

The presence of associated symptoms such as uncomfortable abdominal distension or bloatedness or diarrhoea or black stools will warrant medical attention.

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