Aerophagy

Aerophagia is a functional disorder of the stomach characterized by swallowing air. Normally, the upper esophageal sphincter is closed outside of swallowing. During eating, it opens, and a certain amount of air is always swallowed with the food (about 2-3 cm3 of air with each swallow ⁾. In this regard, the stomach normally contains up to 200 ml of air (an "air", "gas" bubble), which then enters the intestine and is absorbed there.

In a healthy person, gas is contained mainly in the stomach and large intestine. The intestine contains an average of 199+30 cm3 of gas. About 70% of the gas contained in the gastrointestinal tract is swallowed air, the rest of the gas is formed by intestinal bacteria and by neutralizing digestive juices with bicarbonates.

With aerophagia, the amount of air in the stomach and intestines increases significantly, since air is swallowed both during and outside of meals.

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Causes of Aerophagia

The causes of aerophagia are as follows:

• psychogenic factors, psychoemotional stress situations; in this case, aerophagia occurs as a reaction to various nervous shocks, fear, grief, etc. Aerophagia is often a manifestation of hysteria;
• respiratory diseases that make nasal breathing difficult;
• hasty, fast eating, loud slurping while eating;
• hypersalivation (during smoking, sucking on lollipops, chewing gum);
• organic or functional diseases accompanied by a feeling of pressure and fullness in the epigastrium (for example, chronic gastritis with secretory insufficiency);
• diseases or operations that disrupt the function of the cardia (diaphragmatic hernia, etc.).

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Symptoms of Aerophagia

The main clinical manifestations of aerophagia are the following:

• loud belching of air, especially during nervous disorders, excitement. Belching often bothers patients regardless of food intake, sometimes involuntarily;
• a feeling of fullness, pressure, and bloating in the epigastrium shortly after eating; these subjective manifestations are caused by the stretching of the stomach by air and food and are reduced after belching air;
• heart palpitations, interruptions, feeling of lack of air, shortness of breath, pain or burning sensation in the heart area after eating, decreasing after belching air. Pain in the heart area caused by aerophagia is called pseudoanginal syndrome and requires differential diagnosis with angina pectoris;
• frequent hiccups;
• bloating, especially in the upper abdomen;
• "high" tympanitis in the left hypochondrium (when percussing the left hypochondrium, a tympanic sound is detected, the zone of which extends high up to the fourth intercostal space, which makes it difficult to even determine the left border of the heart).

An X-ray examination reveals a high position of the diaphragm (mainly the left dome), a large gas bubble in the stomach is visible, and a large amount of gas is detected in the left flexure of the colon.

The clinical symptoms of aerophagia should be differentiated from ischemic heart disease, diaphragmatic hernia, stomach cancer, pancreatic cancer, colon cancer, gastric ulcer, pyloric stenosis, intestinal dyskinesia and biliary tract. For this purpose, ECG, FGDS, and ultrasound of the abdominal organs are used for differential diagnostics.

Aerophagia contributes to the stretching of the lower esophageal sphincter, its weakening and the development of a hernia of the esophageal opening of the diaphragm.

Aerophagia should also be differentiated from psychogenic abdominal enlargement (Alvarez syndrome). This syndrome usually develops in nervous, hysterical women, sometimes it simulates pregnancy ("false pregnancy"). Psychogenic abdominal enlargement is caused by contraction of the muscles of the posterior abdominal wall and a sharp relaxation of the anterior one. Excessive lumbar lordosis is formed, the diaphragm contracts, the contents of the abdominal cavity shift forward and downward. Breathing becomes shallow and rapid. Abdominal enlargement usually develops slowly and is most pronounced in the afternoon; during sleep, the abdomen may take on its normal shape.

Aerophagia, unlike Alvarez syndrome, does not involve such a sharp increase in the abdomen. Alvarez syndrome is not characterized by loud belching of air. It should also be noted that psychogenic abdominal enlargement disappears at night during sleep, and this is not associated with defecation or gas discharge.