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Zhongguo Dang Dai Er Ke Za Zhi =... Sep 2020To study the clinical features of aerophagia in children.
OBJECTIVE
To study the clinical features of aerophagia in children.
MEYJODS
A retrospective analysis was performed on the medical data of 46 children with aerophagia who were diagnosed and treated in Children's Hospital Affiliated to Nanjing Medical University from October 2011 to September 2019.
RESULTS
Among these 46 children, 15 (33%) had Tourette syndrome. Abdominal distension was the most common symptom and was observed in 45 children (98%). The 24-hour esophageal multichannel intraluminal impedance monitoring showed a mean number of 341 times of air swallowing and a mean number of 212 times of gas reflux, and 95% of gas refluxes occurred in the upright body position. Compared with those without Tourette syndrome, the children with Tourette syndrome had a significantly higher incidence rate of air swallowing symptoms (67% vs 6%, P<0.001), but there were no significant differences in other symptoms and the results of 24-hour esophageal impedance. Dietary adjustment, psycho-behavioral therapy, and drug intervention significantly improved the scores of clinical symptoms and quality of life, among which psycho-behavioral therapy was an important intervention measure.
CONCLUSIONS
Some children with aerophagia may have Tourette syndrome, and such children are more likely to have air swallowing symptoms. Psycho-behavioral therapy is one of the most important treatment methods, and children with aerophagia tend to have a good prognosis after treatment.
Topics: Aerophagy; Child; Electric Impedance; Gastroesophageal Reflux; Humans; Quality of Life; Retrospective Studies
PubMed: 32933629
DOI: 10.7499/j.issn.1008-8830.2003006 -
Gastroenterologia Y Hepatologia 2017
Topics: Aerophagy; Air; Behavior Therapy; Diagnosis, Differential; Diaphragm; Electric Impedance; Eructation; Esophagus; Female; Gastroesophageal Reflux; Heartburn; Humans; Hydrogen-Ion Concentration; Pharynx; Sleep; Speech; Vomiting
PubMed: 27345533
DOI: 10.1016/j.gastrohep.2016.05.004 -
Neurogastroenterology and Motility Jan 2024The contributions of swallowing and belching to specific gastroesophageal reflux disease (GERD) phenotypes are unclear.
BACKGROUND
The contributions of swallowing and belching to specific gastroesophageal reflux disease (GERD) phenotypes are unclear.
METHODS
This study retrospectively analyzed esophageal pH/impedance studies, comparing reflux events preceded by gastric belching (GB), supragastric belching (SGB), air swallowing, and liquid/solid swallowing based on reflux position, lower esophageal sphincter (LES) pressure, and acid exposure time (AET).
KEY RESULTS
20 GERD patients and 10 controls were studied. Upright GERD patients and controls had a higher proportion of reflux events with a preceding swallow or belch (0.64, 0.64) than the supine group (0.38, p = 0.043). The upright group and controls trended toward a higher proportion of reflux events preceded by overall swallowing (0.61, 0.50) and air swallowing (0.55, 0.48) than the supine group (0.32, 0.31 p = 0.064, p = 0.11), but the three groups had similar rates of liquid/solid swallowing (0.032, 0.024, 0.017, p = 0.69). LES pressure did not correlate with reflux events preceded by swallowing (R = 0.021, p = 0.44). There was a higher rate of events preceded by gastric belching in the control group (0.14) than in the upright (0.032) and supine groups (0.066, p = 0.049). LES pressure did not correlate with the rate of events preceded by belching (R = 0.000093, p = 0.96). Normal AET patients had a higher rate of events preceded by GB (0.12) than those with increased acid exposure (0.030, p = 0.0083), but the two groups had similar rates of preceding air (0.43, 0.47, p = 0.68), liquid/solid (0.018, 0.032, p = 0.30), and overall swallowing (0.44, 0.53, p = 0.38).
CONCLUSIONS AND INFERENCES
Swallowing more than belching is a dominant mechanism for reflux irrespective of GERD position, LES pressure, and AET.
Topics: Humans; Deglutition; Retrospective Studies; Eructation; Aerophagy; Gastroesophageal Reflux; Manometry
PubMed: 37942686
DOI: 10.1111/nmo.14703 -
Revista Paulista de Pediatria : Orgao... 2015To describe an adolescent with pathologic aerophagia, a rare condition caused by excessive and inappropriate swallowing of air and to review its treatment and...
OBJECTIVE:
To describe an adolescent with pathologic aerophagia, a rare condition caused by excessive and inappropriate swallowing of air and to review its treatment and differential diagnoses.
CASE DESCRIPTION:
An 11-year-old mentally impaired blind girl presenting serious behavior problems and severe developmental delay with abdominal distension from the last 8 months. Her past history included a Nissen fundoplication. Abdominal CT and abdominal radiographs showed diffuse gas distension of the small bowel and colon. Hirschsprung's disease was excluded. The distention was minimal at the moment the child awoke and maximal at evening, and persisted after control of constipation. Audible repetitive and frequent movements of air swallowing were observed. The diagnosis of pathologic aerophagia associated to obsessive-compulsive disorder and developmental delay was made, but pharmacological treatment was unsuccessful. The patient was submitted to an endoscopic gastrostomy, permanently opened and elevated relative to the stomach. The distention was resolved, while maintaining oral nutrition.
COMMENTS:
Pathologic aerophagia is a rare self-limiting condition in normal children exposed to high levels of stress and may be a persisting problem in children with psychiatric or neurologic disease. In this last group, the disease may cause serious complications. Pharmacological and behavioral treatments are ill-defined. Severe cases may demand surgical strategies, mainly decompressive gastrostomy.
Topics: Abdomen; Aerophagy; Child; Chronic Disease; Dilatation, Pathologic; Female; Humans
PubMed: 26100594
DOI: 10.1016/j.rpped.2015.01.003 -
Arquivos de Gastroenterologia 2015Eructation is a physiologic event which allows gastric venting of swallowed air and most of the time is not perceived as a symptom. This is called gastric belching....
BACKGROUND
Eructation is a physiologic event which allows gastric venting of swallowed air and most of the time is not perceived as a symptom. This is called gastric belching. Supragastric belching occurs when swallowed air does not reach the stomach and returns by mouth a short time after swallowing. This situation may cause discomfort, life limitations and problems in daily life.
OBJECTIVE
Our objective in this investigation was to evaluate if gum chewing increases the frequency of gastric and/or supragastric belches.
METHODS
Esophageal transit of liquid and gas was evaluated by impedance measurement in 16 patients with complaint of troublesome belching and in 15 controls. The Rome III criteria were used in the diagnosis of troublesome belching. The esophageal transit of liquid and gas was measured at 5 cm, 10 cm, 15 cm and 20 cm from the lower esophageal sphincter. The subjects were evaluated for 1 hour which was divided into three 20-minute periods: (1) while sitting for a 20-minute base period; (2) after the ingestion of yogurt (200 mL, 190 kcal), in which the subjects were evaluated while chewing or not chewing gum; (3) final 20-minute period in which the subjects then inverted the task of chewing or not chewing gum. In gastric belch, the air flowed from the stomach through the esophagus in oral direction and in supragastric belch the air entered the esophagus rapidly from proximal and was expulsed almost immediately in oral direction. Air swallows were characterized by an increase of at least 50% of basal impedance and saliva swallow by a decrease of at least 50% of basal impedance, that progress from proximal to distal esophagus.
RESULTS
In base period, air swallowing was more frequent in patients than in controls and saliva swallowing was more frequent in controls than in patients. There was no difference between the medians of controls and patients in the number of gastric belches and supragastric belches. In six patients, supragastric belches were seen at least once during the 20-minute base period. None of the controls had supragastric belches. In the control group, the ingestion of yogurt caused no significant alteration in the number of air swallows, saliva swallows, gastric belches and supragastric belches. In the patient group, there was an increase in the number of air swallows. If the subjects were chewing gum during this 20-minute period, there was an increase in the number of saliva swallows in both groups, without alterations of the number of air swallow, gastric belches and supragastric belches. There was no alteration in the number of the saliva swallows, air swallows, gastric belches and supragastric belches in both groups for subjects who did not chew gum in the 20-40 minute period after yogurt ingestion. When the subjects were chewing the gum, there was an increase in saliva swallows in the control and patients groups and in air swallows in the patients group.
CONCLUSION
Gum chewing causes an increase in saliva swallowing in both patients with excessive belching and in controls, and an increase in air swallowing in patients with excessive belching 20 minutes after yogurt ingestion. Gum chewing did not increase or decrease the frequency of gastric or supragastric belches.
Topics: Adult; Aerophagy; Case-Control Studies; Chewing Gum; Deglutition; Eructation; Esophagus; Female; Humans; Male; Mastication; Middle Aged; Saliva
PubMed: 26486285
DOI: 10.1590/S0004-28032015000300007 -
Neurogastroenterology and Motility Jul 2023Anxiety may exacerbate GERD and FD symptoms perception and reduce quality of life. As many as 50% of patients with GERD symptoms have incomplete relief with PPI therapy,...
BACKGROUND
Anxiety may exacerbate GERD and FD symptoms perception and reduce quality of life. As many as 50% of patients with GERD symptoms have incomplete relief with PPI therapy, and psychological factors may influence PPI responsiveness.
AIM
The potential relationship between anxiety, excessive air swallowing, and PPI responsiveness was evaluated.
METHODS
GERD patients with concomitant FD were prospectively evaluated. Validated structured questionnaires were used to evaluate anxiety, GERD, and FD symptoms. All patients were treated, within the previous year, with at least 8 weeks of standard dose PPI therapy.
RESULTS
One hundred sixty-one patients were included. Frequency of non-responders in patients with moderate/severe anxiety was significantly higher compared to patients with mild anxiety (62.7% vs. 37.3%, p < 0.01). Patients with moderate/severe anxiety displayed a significantly higher mean FD symptoms score value compared to patients with mild anxiety. A significantly higher mean number of air swallows were observed in patients with moderate/severe anxiety. At ROC analysis, air swallows and mixed reflux episodes were significantly associated with the presence of PPI refractoriness (AUC: 0.725, 95% CI: 0.645-0.805 and 0.768, 0.692-0.843). According to univariate analysis, an abnormal number of air swallows, mixed reflux episodes and presence of moderate/severe anxiety was significantly associated with PPI refractoriness.
CONCLUSION
Our results, if confirmed in in a larger, prospective clinical and therapeutic study, demonstrate the usefulness of an up-front evaluation with anxiety questionnaire and esophageal testing in patients with a broad spectrum of upper gastrointestinal symptoms who fail to respond to PPI treatment, supporting the option of alternative treatment modalities.
Topics: Humans; Dyspepsia; Prospective Studies; Proton Pump Inhibitors; Aerophagy; Quality of Life; Gastroesophageal Reflux; Anxiety
PubMed: 36786093
DOI: 10.1111/nmo.14550 -
European Review For Medical and... Sep 2021Functional gastrointestinal disorders are common gastrointestinal diseases. The pathophysiology is multifactorial and psychosocial distress worsens symptoms severity....
OBJECTIVE
Functional gastrointestinal disorders are common gastrointestinal diseases. The pathophysiology is multifactorial and psychosocial distress worsens symptoms severity. Since the end of 2019 the world has been facing COVID-19 pandemic. The associated control measures have affected the psychological health of people. The aim of the present study is to evaluate the impact of the COVID-19 pandemic on the prevalence of functional gastrointestinal disorders among Italian children and adolescents.
PATIENTS AND METHODS
The study sample is composed of 407 patients (187 males, 220 females), aged from 10 to 17 years. The mean age is 14.27 ± 2.24 years. The study was conducted through the Italian version of the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III Version. The prevalence of each disorder has been calculated as the ratio of affected subjects for each disease and the total number of effective cases for that specific disease.
RESULTS
The study demonstrates that the prevalence of Functional Gastrointestinal Disorder in Italian children, during the COVD-19 pandemic, is higher, compared with the one reported in the previous studies. The most frequent disorders are Abdominal Migraine and Irritable Bowel Syndrome.
CONCLUSIONS
Our study is the first one which provides data of the prevalence of Functional gastrointestinal disorders in sample of Italian adolescents, during the COVID-19 pandemic. The study underlines the need to focus on stress management, in order to reduce the effects of the lockdown on the psychological wellness of the youngest.
Topics: Abdominal Pain; Adolescent; Aerophagy; COVID-19; Child; Constipation; Dyspepsia; Fecal Incontinence; Female; Gastrointestinal Diseases; Humans; Irritable Bowel Syndrome; Italy; Male; Migraine Disorders; Prevalence; Quarantine; Rumination Syndrome; Social Isolation; Stress, Psychological; Surveys and Questionnaires; Vomiting
PubMed: 34604975
DOI: 10.26355/eurrev_202109_26802 -
Neurogastroenterology and Motility Mar 2018Aerophagia is a common childhood functional gastrointestinal disorder. We studied the association between adverse life events (ALEs), psychological maladjustment,...
BACKGROUND
Aerophagia is a common childhood functional gastrointestinal disorder. We studied the association between adverse life events (ALEs), psychological maladjustment, somatization, and aerophagia (AP) in adolescents. We also assessed the impact of AP on their health-related quality of life (HRQoL).
METHODS
A cross-sectional survey was conducted on 2500 subjects of 13-18 years in 8 randomly selected schools in Sri Lanka. Translated, validated, and self-administered questionnaires were used to collect data. Aerophagia was diagnosed using Rome III criteria.
KEY RESULTS
A total of 2453 questionnaires were analyzed (males 1200 [48.9%], mean age 14.8 years, SD 1.6 years). Of them, 371 adolescents had AP (15.1%). Aerophagia was associated with exposure to physical abuse (20.4% vs. 12.7% in controls, P < .0001), emotional abuse (20.3% vs. 8.2% in controls, P < .0001), and other ALEs (22% vs. 10.2% in controls, P < .001). One hundred and ninety (51.2%) adolescents with AP and 775 (37.2%) controls had a personality score above the international cutoff value of 105, indicating psychological maladjustment (odds ratio 1.77, 95% confidence interval 1.42-2.21, P < .0001). Those with AP had higher somatization (16.4 vs. 8.9) and lower overall HRQoL scores (77.0 vs. 85.1, P < .0001). HRQoL scores of adolescents with AP were lower in all domains, namely, physical (80.6 vs. 86.9), emotional (69.1 vs. 80.3), social (83.8 vs. 90.5), and school (72.6 vs. 82.5) functioning (P < .0001).
CONCLUSIONS AND INFERENCES
Aerophagia was associated with exposure to ALEs and psychological maladjustment. Affected teenagers suffer from more somatic symptoms and has a poor HRQoL.
Topics: Adolescent; Adverse Childhood Experiences; Aerophagy; Cross-Sectional Studies; Female; Humans; Male; Personality; Personality Inventory; Quality of Life; Somatoform Disorders
PubMed: 28971549
DOI: 10.1111/nmo.13224 -
Journal of Clinical GastroenterologyThe present study was aimed at evaluating the possible role of air swallowing in the association between gastroesophageal reflux disease (GERD) symptoms and concomitant...
GOALS
The present study was aimed at evaluating the possible role of air swallowing in the association between gastroesophageal reflux disease (GERD) symptoms and concomitant functional dyspepsia (FD) and their role in GERD symptom persistence despite proton pump inhibitor (PPI) therapy.
BACKGROUND
It has been shown that individuals with excessive air swallowing experience FD. It has been also demonstrated that a consistent group of GERD patients not responding to PPI therapy swallow more air during mealtime and also have more mixed refluxes.
MATERIALS AND METHODS
Multichannel intraluminal impedance-pH tracings from consecutive patients were retrospectively evaluated. A validated structured questionnaire was used to evaluate GERD and concomitant FD symptoms. All patients were treated, within the previous year, with at least 8 weeks of standard-dose PPI therapy.
RESULTS
A total of 35 patients with conclusive GERD, 35 patients with reflux hypersensitivity, and 35 with functional heartburn were studied. A direct relationship was observed between the number of air swallows and of mixed refluxes ( R =0.64). At receiver operating characteristic curve analysis, air swallows and mixed refluxes were significantly associated to the presence of FD and PPI refractoriness. An air swallow cutoff of 107 episodes/24 hours was identified to discriminate patients with and without FD (sensitivity: 87%, specificity: 82.8%). A mixed reflux cutoff of 34 episodes/24 hours was identified to discriminate PPI responders from nonresponders (sensitivity: 84.8%, specificity: 69%). At multivariate analysis, an abnormal number of air swallows and of mixed refluxes were significantly associated to FD and PPI refractoriness.
CONCLUSION
Our study highlights the relevant role of excessive air swallowing in eliciting both dyspepsia and refractoriness of typical GERD symptoms to PPI therapy.
Topics: Humans; Dyspepsia; Retrospective Studies; Aerophagy; Proton Pump Inhibitors; Gastroesophageal Reflux; Esophageal pH Monitoring
PubMed: 35648971
DOI: 10.1097/MCG.0000000000001728 -
Pediatric Gastroenterology, Hepatology... Dec 2014Pathologic aerophagia (PA) may lead to bowel perforation or volvulus in mentally retarded patients. The authors investigated the effects of clonazepam on the management...
PURPOSE
Pathologic aerophagia (PA) may lead to bowel perforation or volvulus in mentally retarded patients. The authors investigated the effects of clonazepam on the management of PA in children with severe to profound mental retardation (MR).
METHODS
This study was undertaken as a retrospective case analysis of 21 PA patients with MR who were followed for over 12 months and diagnosed as having PA. Patients were assigned to two management groups, that is, to a clonazepam randomized open-labeled, treatment group or a reassurance group. The following were recorded and analyzed; age, response, remission rate to clonazepam treatment, and the side effect of clonazepam. It was defined positive response (response+) as being symptom-free for a whole week within 1 month of commencing treatment and remission(+) as being symptom-free for a whole month within 6 months of treatment.
RESULTS
The average age of the 21 PA children with MR was 10 years and 13 patients were female. Symptom duration before diagnosis of PA was 7 months. Clinical features of the clonazepam-trial group (n=11) and the reassurance group (n=10) were non-significantly different. Response(+) was achieved by 2 patients (18.2%) in the clonazepam-trial group and by no patient in the reassurance group. Remission(+) was achieved by 6 patients (54.5%) in the clonazepam-trial group and by one patient (10%) in the reassurance group (p=0.040).
CONCLUSION
When PA children with MR with severe bowel distention are considered for surgical treatment to prevent acute abdomen, a trial of clonazepam could be recommended.
PubMed: 25587520
DOI: 10.5223/pghn.2014.17.4.209