instruction: hello doctor my son took accutane to treat his acne and stop taking the same his acne is gone but he said he started having burping sometime after he took accutane mostly every day in the morning and whenever he eats to prevent his burping he does not eat much he does not feel bloated nor pain in his stomach whenever he burps he does not even feel acid in his throat the burping does not bother him much and the frequency has reduced doctor prescribed pepcid for 30 days but nothing changed he was tested for pyloric which came back negative and all his lab works were fine except his low on vitamin 10 and his a ratio was slightly elevated 5 he drinks water last night before his test and no water since which may or may not explain his slightly elevated a doctor scheduled him for endoscopy and told him to take align probiotics my son does not want to do the endoscopy and will not do it is this endoscopy really a must he just wants to take the supplements no cancer history of the stomach in our family is there any other different and saddle approach for handling this like just take his probiotics and other digestive enzymes for months and wait and see
output: hello thanks for providing a detailed history of your son this excessive burping usually occurs due to aerophagia patient is usually not aware of it and they swallow a lot of air during eating or drinking we normally swallow a little air and we sometimes have one or two burps in routine but those who swallow more air have more burping coming to his lab tests this a ratio is not that significant and his vitamin should be replaced both these tests are not associated with burping he has no alarm sign so endoscopy is not mandatory and he can avoid it his endoscopy report will be most probably normal he needs diaphragmatic exercises to avoid burping the way forward is that after eating or drinking he should hold a pencil in his teeth and take a deep breath via nose and exhale via mouth for about five minutes and it will help out he can take tablet baclofen my three times daily before meals for 10 days and should avoid chewing gums