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Belching disorders are not uncommon in clinical practice, posing a significant burden on patients. Adequate history taking and clinical observation can identify the subtype of excessive belching and the presence of concomitant gastrointestinal (GI) disorders. Supragastric belching (SGB) can be diagnosed clinically as frequent and repetitive belches, with further investigations tailored to the patient’s associated symptoms and depending on the response to therapy. 24-hour pH-impedance measurement and high-resolution manometry with impedance (HRiM) provide insight into underlying mechanisms for excessive belching. Increased awareness of an impaired ability to belch has led to the clinical suspicion in many patients based on the presence of cardinal symptoms, and recently, HRiM with belch provocation test has been validated as a confirmatory test. Besides management of concomitant (functional) GI disorders, behavioural therapy is the mainstay of treatment for SGB. Medical treatment with baclofen or surgical management with (partial) fundoplication has failed to show benefit for patients with SGB. For inability to belch, the only established treatment to date is botulinum toxin injection in the upper oesophageal sphincter, with evidence for its effectiveness derived exclusively from open-label cohort studies. Further research is needed to establish effective treatment options for patients presenting with excessive belching, or a dysfunction of the belching reflex.