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Aerophagia and Eructation
Aerophagia is characterized by excessive swallowing of air that results in repeated belching. Air may be swallowed unconsciously by the patient; when it results in repeated eructation, it becomes a clinical problem ( Fig. 23.1 ).
Aerophagia and Eructation.
Patients with aerophagia report frequent, uncontrollable belching, or eructation, which often is loud and disturbs family or coworkers. The condition may be acute in onset, but careful history usually reveals it is slow in developing but increases in severity until the patient seeks medical attention. It has been noted in children and may occur at any age. To fulfill the criteria of a functional gastrointestinal (GI) disorder, the condition should have been noted for at least 12 weeks in the year preceding the onset of troublesome, repetitive belching.
Pathophysiology and Diagnosis
Eructation is normal during or after a meal, occurring two to six times without significance. Early in life, infants are made to burp with a change of position and then are able to resume a meal interrupted because of stomach distention caused by air swallowed during feeding. Frequent eructation by adults may become a habit.
In the act of belching, the glottis is closed, and the diaphragm and thoracic muscles contract. When the increased intraabdominal pressure transmitted to the stomach is sufficient to overcome the resistance of the lower esophageal sphincter, the swallowed air is eructated.
No diagnostic tests demonstrate normal or abnormal belching. However, in a patient with any symptom associated with belching, the history might indicate that the esophagus or stomach should be evaluated. Patients who are uncomfortable from mild upper abdominal distress may swallow a great amount of air and may have frequent eructation. Upper endoscopy to evaluate for organic disease is important with this symptom complex. The diagnosis is established by observing either the air swallowing or the frequent belching.
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