Neonatal Aerophagia Dilemma – A Gastrointestinal Functional Disorder: Role of Imaging Studies.

Aerophagia is excessive swallowing of air which goes to stomach through oesophagus and causes abdominal distention. This may alert the parents of pediatric age group especially neonates and causes anxiety. Although it’s a functional condition, the clinical presentation can suggest malabsorption or obstruction, leading to unnecessary tests and investigations. We present a 15 days -old neonate who was brought to the pediatric surgical emergency with one such condition and was managed conservatively after imaging studies ruled out any underlying pathology. The case was discharged without any surgical intervention.

The role of esophageal multichannel intraluminal impedance monitoring for 24 hours in diagnosis of aerophagia / 中华实用儿科临床杂志

Objective To investigate the clinical characteristics of aerophagia in children,and to evaluate the effect of 24 hours esophageal multichannel intraluminal impedance monitoring in diagnosis of aerophagia.Methods The clinical data of 30 children with aerophagia hospitalized in Department of Digestive Disease,Nanjing Children's Hospital Affiliated to Nanjing Medical University from July 2005 to June 2013 were reviewed.The 24 hours esophageal multichannel intraluminal impedance monitoring was performed in 8 cases of aerophagia.The treatment of these patients normally included psychological counseling,dietary adjustment,Iactulose,Domperidone and vitamins,while Simethicone was given to the patients if normal treatment was invalid.Results Of the 30 patients,aged 2 to 13 years,averaged (8.6 ± 4.5) years,the chief complaints were abdominal distention in 30 cases (100.00％),visible or audible air swallowing in 28 cases (93.33％),repetitive belching in 27 cases (90.00％),reduced appetite in 25 cases (83.33％),constipation in 22 cases (73.33％),psychological stresses in 15 cases (50.00％),recurrent abdominal pain syndrome in 10 cases(33.33％),chronic diarrhea in 3 cases(10.00％) and acute abdominal pain in 3 cases(10.00％).Among the 30 patients,24 hours esophageal multichannel intraluminal impedance monitoring was performed in 8 cases,averaging 149.63 (47-553)times of air swallowing were recorded.In the 30 patients,24 cases (80.00％) were relieved after being treated with psychological counseling,dietary adjustment,lactulose,domperidone and vitamins,and only 6 cases(20.00％) were invalid for normal treatment but well responeded to Simethicone.Conclusions Aerophagia is a kind of functional gastrointestinal disorders in children.Abdominal distention,air swallowing,repetitive belching,reduced appetite,constipation and pain are common symptoms.It can be cured through psychological counseling management,diet modification,laxatives,propulsives and vitamins.24 hours esophageal multichannel intraluminal impedance monitoring is a useful technology in the diagnosis of aerophagia children.

Aerophagia in children / 国际儿科学杂志

Children aerophagia is a relatively rare functional gastrointestinal disease.Its main clinical manifestations are swallowing air,chronic bloating,belching and increased anal exhaust.Since lack of understanding of children aerophagia in pediatricians,it can be very easily missed or misdiagnosed in clinic.Understanding of the research status about children aerophagia means to pediatric clinical guidance.This review summarizes the causes,clinical manifestation,diagnosis and treatment of children aerophagia.

Clinical Approach to Functional Gastrointestinal Disorders in Children: Revolve Around on Cyclic Vomiting Syndrome and Aerophagia / 대한소아소화기영양학회지

Functional gaonic or recurrent gastrointestinal symptoms not explained by structural or biochemical abnormalities. The Rome II pediatric criteria for FGIDs were announced in 1999. The Rome III criteria, update and revise the pediatric criteria, included FGIDs criteria of infant and toddler to child and adolescent (aged 4 to 18 years). The aerophagia was classified into abdominal pain-related FGIDs in the ROME II criteria. However, cyclic vomiting syndrome and aerophagia, both were classified into vomiting and aerophagia part in the ROME III criteria. We describe the clinical features, diagnostic criteria, and treatments of cyclic vomiting syndrome and aerophaiga among pediatrstrointestinal disorders (FGIDs) are defined as a chric FGIDs

Clonazepam Treatment of Pathologic Childhood Aerophagia with Psychological Stresses

The treatment of pathologic aerophagia has rarely been discussed in the literature. In this retrospective study, the authors investigated the effects of clonazepam on the management of pathologic childhood aerophagia (PCA) with psychological stresses (PS), but not with mental retardation. Data from 22 consecutive PCA patients with PS (aged 2 to 10 yr), who had been followed up for over 1 yr, were reviewed. On the basis of videolaryngoscopic views, the authors observed that the pathology of aerophagia was the result of reflex-induced swallowing with paroxysmal openings of the upper esophageal sphincter due to unknown factors and also observed that these reflex-induced openings were subsided after intravenous low dose benzodiazepine administration. Hence, clonazepam was administered to treat paroxysmal openings in these PCA patients with PS. Remission positivity was defined as symptom-free for a consecutive 1 month within 6 months of treatment. The results of treatment in 22 PCA patients with PS were analyzed. A remission positive state was documented in 14.3% of PCA patients managed by reassurance, and in 66.7% of PCA patients treated with clonazepam (p=0.032). Thus, clonazepam may produce positive results in PCA with PS. Future studies by randomized and placebo-controlled trials are needed to confirm the favorable effect of clonazepam in PCA.

A Case of Pathologic Aerophagia with Mental Retardation Managed by Percutaneous Endoscopic Gastrostomy / 대한소아소화기영양학회지

We experienced a case of pathologic aerophagia in a 10-year-old girl who has mental retardation. It was observed that the abdomen was non-distended in the morning and became maximally distended in the evening. Increased passage of flatus, but normal eructation, was noted. Roentgenographic examination showed 'esophageal air sign', abnormal air shadow on proximal esophagus adjacent to the trachea, in simple chest X-ray and visible air swallowing fluoroscopically. We tried a percutaneous endoscopic gastrostomy (PEG) to decompress swallowed air in stomach. We suggest that placement of a PEG catheter in early life, especially in mentally retarded patients, that can be used as desufflator, can prevent the complications of aerophagia. 'Esophageal air sign' may be very helpful for early detection of pathologic aerophagia.