A case of excessive burping

It all started with burping

My first hint of stomach cancer did not involve the classic symptoms of heartburn, upper abdominal pain, or swallowing difficulty. At first, I noticed increased burping between meals, progressing to round-the-clock burping that happened even on an empty stomach in the middle of the night, over the course of a few months. At its peak I counted 1 burp every 10 to 15 minutes. Was I ever concerned about a sinister process developing? No. Excessive burping happens for a variety of reasons, with causes including acid reflux, certain types of foods, and benign “belching disorders” that are of no consequence.

Then the burping became painful

The new pain I experienced with each burp made me think of acid reflux, a common phenomenon which classically manifests as burning pain in the middle of the chest occurring with or after meals. Yet my pain had nothing to do with how big of a meal I ate, or whether I had even eaten. Something wasn’t right, but no alarm sounds yet. I decided to try pantoprazole, a medication which suppresses stomach acid, in an attempt to control my symptoms. While it did nothing to reduce my burping, it did help decrease the chest pain, which led me to think that perhaps I had a simple case of acid reflux manifesting in an unusual way.

Then the swallowing became difficult

Dysphagia, otherwise known as difficulty swallowing, is generally not a good sign. Dysphagia to solid foods, progressing to both solid and liquid foods, is an easily recognized sign (among the medical community) of an obstruction in the esophagus, such as a stricture or a mass. In my case, I did experience some dysphagia, although oddly enough, it happened only at the beginning of every meal, and was promptly relieved when burping. At the time, I had downplayed the gravity of this symptom and attributed it to my stomach being full of gas which needed to be burped out, before food could pass down.

Then came the iron deficiency

Well-nourished, non-vegetarian men shouldn’t have iron deficiency. If it happens, it generally means bleeding in the gastrointestinal tract. My routine bloodwork revealed an iron level low enough to raise a red flag. Perhaps I had developed gastritis, an irritation of the stomach associated with stress, or perhaps I had an ulcer. At no point was I concerned about stomach cancer, but I knew it was serious enough to warrant having a gastroscopy, AKA a camera going down the mouth into the stomach, to see what was going on. Sounds painful, but it’s not. They give you a cocktail of medication, generally fentanyl and midazolam, that keeps you sedated and pain-free, and you have no recollection of the procedure. All I remember that day is being surrounded by smiling faces right before receiving sedation, to waking up surrounded by faces which were no longer smiling. That’s when I was told there was a concerning mass in my stomach. Two days later, the diagnosis of gastric adenocarcinoma, in other words stomach cancer, was confirmed by the biopsy samples taking during my earlier gastroscopy.

The elephant in the room (or rather in the stomach)

The tumour was located in the stomach fundus (the top part of the stomach), involving the gastroesophageal junction (the part where the stomach joins the esophagus), as well as the esophagus. It had a necrotic centre (tissue that starts dying and decomposing after outgrowing its own blood supply), which explained the excessive burping via gas production from the tumour. The surface looked friable and bleeding was visible, which explained the iron deficiency. The mass was causing a partial obstruction at the gastroesophageal junction, which explained why I had chest discomfort every time I burped, given the limited ability of the esophagus to be distended when gas was passing through. Everything started making sense.

What a normal stomach should look like (source: http://www.gastrointestinalatlas.com)

Picture taken from my gastroscopy revealing a necrotic, bleeding tumour, partially blocking the entrance to the stomach.

Within seconds of arriving at these explanations, the Eureka realization turned to disbelief and despair. This is how my stomach cancer journey began.