Definition

Aerophagia is derived from the Greek words "aero" (air) and "phagia" (eating). This word refers to the medical condition of excessive intake of air during the process of swallowing. Individuals involuntarily ingest air while speaking, consuming food or beverages, or laughing. People commonly swallow over two liters of air daily from eating and drinking. Approximately 50% of the air is ejected through burping, while the remaining air enters the digestive system and is released through flatulence.  This should not be a problem in most situations. People with aerophagia swallow too much air, leading to distressing symptoms in the digestive system, such as chronic burping, abdominal pain or bloating, loss of hunger, and excessive gas.

Aerophagia can manifest as either chronic (long-term) or acute (short-term). It can be attributed to physical reasons, such as an underlying medical condition, as well as psychological factors, such as anxiety and depression.

Causes

Aerophagia may indicate some underlying problem or disease resulting from bad eating habits or lifestyle. Some of the behaviors that might lead to excessive air swallowing include the following:

• Eating too fast
• Talking while eating
• Chewing on some candy
• Using a straw to drink
• Smoking
• Breathing through the mouth
• Excessive exercise
• Consuming carbonated beverages.
• Wearing incorrect prosthetic teeth, resulting in the presence of spaces between the teeth

The following are some of the other factors that might lead to aerophagia:

• Obstructive sleep apnea (OSA)

A sleep disorder in which the airways get obstructed or blocked while a person is sleeping is referred to as obstructive sleep apnea (OSA). This medical condition is why those suffering from it require a device that assists them in breathing. Disorders of the throat muscles are the most common cause of airway obstruction. People with sleep apnea frequently use a Continuous Positive Airway Pressure (CPAP) machine to aid in breathing while asleep. The user will probably swallow more air when using this device because it will blow air into the nose and mouth through a mask or tube. This is especially true in the beginning stages of utilizing the machine.

A study reported that approximately 50% of individuals with CPAP are encountering at least one indication of aerophagia. In addition to sleep apnea, individuals with diseases such as COPD (chronic obstructive pulmonary disease) and heart failure may require respiratory assistance.

• Psychological disorders

Mental retardation, anxiety, and depression are a few examples of psychological illnesses that can cause aerophagia. Several studies have found that aerophagia coincides with anxiety. According to some experts, aerophagia could potentially serve as a coping mechanism for anxiety. People with anxiety have rapid and irregular breathing patterns and tend to swallow air excessively.

• Breathing through the mouth

Several conditions, including allergic rhinitis, sinusitis, and swollen tonsils in children, are common conditions that make children breathe through the mouth.

Risk factor

Aerophagia is experienced by approximately 25% of adults and around 7% of children. Aerophagia is more prevalent in individuals with mental stress, as they frequently suffer from feelings of despair or worry. Emotional stress alters the nervous system-digestive system interaction, causing gas retention in the digestive system.  Aerophagia is more common among children with Autism Spectrum Disorder (ASD), learning disabilities, Rett Syndrome (a hereditary condition that impacts brain development), and other developmental abnormalities.

Due to the undigested carbohydrates in the small intestine, some diets—mainly vegetarian diets—might make gas buildup in the digestive tract worse. Large intestinal microorganisms digest these carbohydrates when they enter the large intestine, producing the gases hydrogen and carbon dioxide. These foods include Bran, cabbage, cauliflower, broccoli, and nuts.

Symptoms

The predominant symptoms of aerophagia include:

• The most typical symptom of aerophagia is excessive belching. The gas is released involuntarily during the night; therefore, the sensation of flatulence is strongest in the morning. If you're experiencing gas, it will get worse throughout the day, particularly in the evening.
• Abdominal pain
• Gastric noises
• Elevated occurrence of flatulence
• Insomnia

These symptoms resemble those of stomach acid reflux, gastric mucosal irritation, food allergies (including lactose intolerance), constipation, intestinal blockage, and irritable bowel syndrome. However, the disease above causes vomiting, nausea, feeling full after eating little meals, and weight loss. The symptoms distinguish aerophagia from other gastrointestinal disorders.

Diagnosis

Aerophagia can only be diagnosed if there have been no other underlying causes or symptoms for 12 weeks (not necessarily continuously) in the last 12 months. The ROME III criteria for aerophagia require at least two symptoms: excessive air swallowing, flatulence, and excessive belching or gas.

Before examining the abdomen, the doctor will ask about symptoms, diet, and lifestyle. The doctor may also perform imaging tests like abdominal X-rays to confirm excessive gas in the digestive tract.

Management

There is no medication or treatment for aerophagia; however, several lifestyle changes may decrease the symptoms. 

• Speech therapy to help you control your breathing while speaking.
• Avoid eating too fast, talking while eating, and chewing too much candy. Chewing smaller quantities for longer with your mouth closed is strongly advised. Drinking with straws should also be avoided.
• Stop smoking
• Stop drinking carbonated beverages
• Repairing incomplete or perforated teeth
• Avoid gas-causing vegetables, such as broccoli, cabbage, cauliflower, and beans.
• Stress reduction, psychotherapy, and breathing exercises
• For CPAP users, talk to your doctor to control the airflow
• If stomach acid reflux causes you to swallow too much air, antacids may help.

Simethicone and dimethicone are two examples of medications that can reduce the symptoms of aerophagia. Both of these medications effectively inhibit the production of gas in the stomach.

Complications

Most cases of aerophagia are mild and not dangerous. However, aerophagia can lead to digestive tract problems like intestinal twisting (volvulus), perforations in the small intestine, and pneumoperitoneum (gas in the abdomen from air leaking from the digestive tract)

When to see a doctor?

Consult your doctor for further evaluation and treatment if the lifestyle modifications have not successfully reduced the symptoms.