Aerophagia

Aerophagia is a functional indigestion characterized by ingestion of air. Normally, without swallowing, the upper esophageal sphincter is closed. During food, it opens, and together with food, a certain amount of air is always swallowed (to each sip about 2-3 cm ^{3 of} air). In this regard, in the stomach there is normally up to 200 ml of air ("air", "gas" bubble), which then enters the intestines and is absorbed there.

In a healthy person, gas is mainly contained in the stomach and large intestine. The intestine contains on average 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 when the digestive juices are neutralized with bicarbonates.

With aerophagia, the amount of air in the stomach and intestines increases significantly, as air is swallowed up both during eating and outside eating.

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Causes of aerophagy

The causes of aerophagy are as follows:

• psychogenic factors, psychoemotional stressful situations; in this case, aerophagy arises as a reaction to various nervous shocks, fear, grief, etc. Often, aerophagia is a manifestation of hysteria;
• respiratory tract diseases that impede nasal breathing;
• hasty fast food, loud champing at meal time;
• hypersalivation (during smoking, sucking candies, chewing gum);
• organic or functional diseases, accompanied by a feeling of pressure and overfilling in the epigastrium (for example, chronic gastritis with secretory deficiency);
• diseases or operations that violate the function of cardia (diaphragmatic hernia, etc.).

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Symptoms of aerophagia

The main clinical manifestations of aerophagy are as follows:

• loud belching of the air, especially with a nervous breakdown, arousal. Often, burping worries patients regardless of food intake, sometimes involuntarily;
• feeling of fullness, pressure, bloating in the epigastrium shortly after eating; these subjective manifestations are due to the stretching of the stomach by air and food and decrease after belching with air;
• palpitations, interruptions, a feeling of lack of air, shortness of breath, pain or burning sensation in the area of the heart after eating, decreasing after belching with air. Pains in the heart caused by aerophagia are called pseudo-anginal syndrome and require differential diagnosis with angina pectoris;
• frequent hiccough;
• bloating, especially in the upper part;
• "High" tympanitis in the left hypochondrium (with percussion of the left hypochondrium tympanic sound is determined, the zone of which extends high up to the IV intercostal space, which makes it difficult even to determine the left border of the heart).

When X-ray examination determines the high standing of the diaphragm (mainly the left dome), you see a large gas bubble of the stomach, in the left bend of the colon reveals a large amount of gas.

Clinical symptoms of aerophagia should be differentiated from coronary artery disease, diaphragmatic hernia, stomach cancer, pancreas, large intestine, peptic ulcer disease, stenosis of the pylorus, dyskinesia of the intestine and bile ducts. For this purpose, ECG, PHAGS, ultrasound of the abdominal cavity organs are used for differential diagnostics.

Aerophagy promotes stretching of the lower esophageal sphincter, its weakening and development of hernia of the esophageal opening of the diaphragm.

Aerophagy must also be differentiated with psychogenic enlargement of the abdomen (Alvarez syndrome). This syndrome develops usually in nervous, hysterical women, sometimes it simulates pregnancy ("false pregnancy"). The psychogenic increase in the abdomen is due to the contraction of the muscles of the posterior abdominal wall and a sharp relaxation - the anterior one. An excessive lumbar lordosis is formed, the diaphragm is shortened, the contents of the abdominal cavity are shifted forward and downward. Breathing becomes superficial, rapid. The increase in the abdomen usually develops slowly and is most pronounced in the afternoon, during sleep the stomach can take the usual form.

In aerophagy, in contrast to the Alvarez syndrome, there is no such dramatic increase in the abdomen. Alvarez syndrome is not characterized by loud belching of air. It should also be noted that the psychogenic increase in the abdomen disappears at night during sleep, and this is not associated with defecation or escaping of gases.