What is Aerophagia?
Aerophagia is a disorder characterized by excessive swallowing of air that increases intragastric and intestinal gas, leading primarily to symptoms of bloating, abdominal distention, and flatulence—with belching being less prominent than in other belching disorders. 1
Key Distinguishing Features
Aerophagia differs fundamentally from belching disorders in where the swallowed air travels and what symptoms predominate:
- Air moves distally to the intestines and colon rather than being immediately expelled from the esophagus or stomach 1
- Flatulence is the predominant gas-related symptom, not belching 1
- Bloating and abdominal distention are the main manifestations rather than excessive belching alone 1
Physiologic Mechanism
The pathophysiology involves a specific sequence of events that can be identified on esophageal testing:
- Air enters the esophagus through swallowing, causing the upper esophageal sphincter (UES) to open 1
- As air clears the esophagus via peristalsis, the lower esophageal sphincter relaxes 1
- Air then enters the stomach and progresses to the intestines 1
- This repetitive air swallowing results in accumulation of gas throughout the gastrointestinal tract 2, 3
Clinical Presentation
Aerophagia presents as an episodic or chronic disorder affecting both children and adults:
- Repetitive air swallowing with consequent belching, flatulence, and abdominal distention 2, 4
- Abdominal bloating as the primary complaint 5, 6
- Can cause serious medical problems if severe 4
- May occur in both children and adults 2, 3
Diagnostic Approach
High-resolution esophageal manometry combined with impedance monitoring and impedance pH monitoring can definitively differentiate aerophagia from gastric and supragastric belching 1. This testing reveals the characteristic pattern of air entering through swallowing, clearing via peristalsis, and progressing into the stomach.
Important Clinical Pitfalls
Do not perform exploratory laparotomy on patients with aerophagia, as they do not have ileus despite significant abdominal distention 3. The distention is from swallowed air, not mechanical obstruction.
Treatment Considerations
Aerophagia is primarily a behavioral disorder requiring behavioral interventions:
- Diaphragmatic breathing techniques to reduce air swallowing 5, 7
- Open-mouth, diaphragmatic breathing with minimized swallowing has shown effectiveness in reducing symptoms 8
- Brain-gut behavioral therapies such as cognitive behavioral therapy may be beneficial 1, 7
- Psychotherapy may be employed in select cases 2, 6
PPIs are not effective for aerophagia unless there is coexisting GERD 5. The mechanism of aerophagia does not involve acid-related pathology, so acid suppression provides no benefit for the primary disorder.