OVERVIEW
Aerophagia in children is a relatively rare functional or behavioral manifestation of the disease characterized by frequent gulping of air, chronic abdominal distension, belching, and increased anal defecation. The etiology of the disease is still unclear.
Etiology
The etiology of aerophagia in children is still unknown. It is considered to be a functional or behavioral disorder, and is often seen as a comorbidity of other diseases.
1. Diseases related to the digestive system
(1)Functional constipation Because long-term constipation is prone to anxiety, irritability and other negative emotions, children are prone to excessive aerophagia, coupled with the slow peristalsis of these children, defecation and exhaustion is inhibited, so it is easy to abdominal distension suddenly aggravated and other discomforts.
(2) Functional abdominal pain The pathogenesis of this type of children is not clear, early adverse life events and psychosocial stress can make this type of children more prone to pain, depression and other negative emotions will aggravate the condition. Negative emotions such as depression can aggravate the condition. Excessive gas swallowing is easy to occur when in pain, causing gastrointestinal distension and aggravating abdominal pain and other discomforts.
(3) Gastroesophageal Reflux Disease (GERD) In order to remove the reflux material in the esophagus, this type of children often have to do swallowing, and at the same time, the stimulation of the reflux material also leads to an increase in the number of times that the child swallows. Frequent swallowing results in a large amount of gas being swallowed into the esophagus and the gastrointestinal tract, and the child develops symptoms such as abdominal distension, abdominal pain, postprandial fullness, and anal discharge.
(4) Irritable bowel syndrome Patients with irritable bowel syndrome have symptoms such as abdominal distension, hyperactive bowel sounds, increased anal discharge and frequent belching. These symptoms make the quality of life of patients significantly reduced, and frequent belching is likely to be the key factor leading to the aggravation of abdominal distension in patients with irritable bowel syndrome.
2. Neuropsychiatric disorders
Children with mental retardation, Reye’s syndrome, etc. are often associated with aerophagia. Psychological factors such as anxiety and depression may also increase the frequency of swallowing, leading to increased intestinal gas.
3. Other causes
Such as sleep apnea, these children are often treated with continuous positive airway pressure, in which case the gas is pushed into the gastrointestinal tract by the positive pressure triggering a series of manifestations related to aerophagia, resulting in abdominal distension, belching and other discomforts, and even affecting the application of the ventilator.
Symptoms
1. Frequent air swallowing
The behavior of air swallowing is widespread and usually unconscious. It often occurs when people eat, drink and swallow saliva. In infants and toddlers, air swallowing is common when children cry, suck on a pacifier, or are not fed properly. In older children, air swallowing is common when drinking liquids through a straw or chewing gum. At other times, however, children with aerophagia continue to have recurrent episodes of gas swallowing.
2. Bloating
Aerophagia children suffer from recurrent abdominal distention due to swallowing large amounts of gas. Abdominal distention is characterized as follows: when the child wakes up in the morning, the abdominal circumference is the smallest and the abdominal distention is the lightest; during the day, the abdominal circumference gradually increases and the abdominal distention is gradually aggravated; the abdominal distention is the most serious when the child goes to sleep in the evening; the abdominal distention gradually decreases during the night, which is characterized by the feature of “light in the morning and heavy at night”.
3. Repeated belching
Due to excessive swallowing behavior, the stomach of children with pneumonias is always in a dilated state, causing repeated belching.
4. Increased anal discharge
Under normal circumstances, people have about 20 transient gastrointestinal flatulence per day, and the volume of gas per hour is usually not more than 100 ml. Due to the excessive swallowing of gas, children with aerophagia have more frequent anal discharge than normal children. Due to the increase in gas emission during sleep and the absorption of some of the gas by the gastrointestinal tract, abdominal distension gradually decreases during the night and is lightest or even disappears when the child wakes up in the morning.
Examination
1. Physical examination
The abdomen is obviously bulging, soft to touch, no pressure pain, no mass, drum sound on percussion, no mobile turbid sound, active or hyperactive bowel sounds on auscultation.
2. Imaging
The gastrointestinal tract is filled with a large amount of gas and there is no liquid plane.
3. Laboratory tests
Blood, urine and feces routine, stool culture, enterovirus test, blood biochemistry and tuberculin test.
Diagnosis
Currently, the recognized diagnostic criteria for aerophagia is the Rome III criteria, which includes: (1) frequent gas swallowing; (2) abdominal distension due to gastrointestinal flatulence; (3) recurrent belching or increase in anal discharge. Under the premise of exclusion of other illnesses, the diagnosis is made when there are two manifestations of aerophagia and the course of the disease has lasted for more than 2 months.
However, the clinical diagnosis of aerophagia is made more difficult by the inability of parents to provide an accurate and detailed history because they are not aware that their child is swallowing gas. Early recognition and diagnosis of the disease is important to reduce parental or child anxiety, control the progression of the disease, and prevent unnecessary investigations and therapeutic measures.
Treatment
1. Parental guidance
The first step in the treatment of childhood aerophagia is to make parents understand what aerophagia is, be aware of the existence of aerophagia in children, and pay attention to the observation of the child in normal times and remind and discourage this behavior in a timely manner. For infant air swallowing behavior, parents can use warm towels to gently rub the abdomen, avoid crying when breastfeeding the baby, hold the baby upright after breastfeeding and pat the back so that the swallowed air can be discharged as soon as possible.
2. Dietary regulation
Some special conditions, such as lactose intolerance or high-fiber, difficult-to-digest meals, etc., will lead to increased intestinal gas production, thus aggravating bloating. In addition, you should try not to drink carbonated beverages or chew gum, and do not drink from straws or sippy cups.
3. Psychological and behavioral treatment
Psychological interventions and behavioral modification therapy are often used to improve the condition of aerophagia in children with mental retardation.
4. Medication
The best treatment for Aerophagia is still unclear. Simethicone, activated charcoal, aluminum hydroxide, omeprazole, and gastroretentive are commonly used to relieve symptoms. In addition, stimulant laxatives such as senna can help stimulate the increase of intestinal excretion, and clonazepam can effectively relieve the symptoms of children with aerophagia accompanied by psychological stress.
5. Other treatments
For patients with acute and severe aerophagia, immediate nasogastric tube decompression is needed when dyspnea occurs, or percutaneous endoscopic gastrostomy is performed promptly to prevent abdominal distension when it worsens.