P1554 - When Air Turns Harmful: A Consequence of Aerophagia in Clinical Case

Hari Movva, MD, Eric Margulies, MD, Gurinder Luthra, DO
University of Texas Medical Branch, Galveston, TX

Introduction: Aerophagia is a functional/pathological disorder of the upper gastrointestinal tract caused by excessive and inappropriate swallowing of air. Although more common in children, aerophagia is rare in adults, especially when presenting with lower rather than upper intestinal tract symptoms. Individuals with stressful situations, severe psychiatric and/or neurologic problems are more prone to this condition. We report a case of aerophagia in an adult presenting with lower intestinal symptoms.

Case Description/Methods: A 30-year-old male with non-verbal autism presents with poor oral intake, acute abdominal pain, and abdominal distension. He had a similar episode about one year ago, which was diagnosed as ileus. Since that time, the patient has had irregular bowel movements, every 3-4 days on average, and progressive abdominal distention with discomfort. On presentation, patient was observed intermittently swallowing air, with severe abdominal distention on examination. Lab work showed leukocytosis, and abdominal radiograph revealed significant dilatation of the large bowel measuring up 10.1 cm and rectum. CT abdomen/pelvis then showed gaseous distension of the esophagus, stomach, small intestine, and colon, without obstruction. During the hospitalization, serial abdominal examinations were benign and daily abdominal radiographs showed unchanged distention. Patient continued to pass flatus and had bowel movements with initiation of polyethylene glycol daily and glycerin suppositories BID. The patient was discharged with a likely diagnosis of aerophagia based on observations during physical examination and diffuse gastrointestinal tract distention on CT that is atypical for colonic pseudoobstruction or ileus.

Discussion: Pathological aerophagia is a gastrointestinal disorder due to repetitive air swallowing resulting in abdominal distension, reduced appetite, belching, and flatulence. It affects about 3.66% of the population, predominantly children, with no gender preference. Diagnosis relies on a thorough history with minimal diagnostic testing. While aerophagia is more common in children, adult-onset cases are rare due to symptom management without medical intervention. Treatment options are limited, with surgery reserved for severe cases linked to psychiatric or neurological conditions. This case highlights the need for increased awareness among both patients and healthcare providers to ensure early identification and appropriate management, enhancing patient well-being.



Disclosures:


Hari Movva, MD, Eric Margulies, MD, Gurinder Luthra, DO. P1554 - When Air Turns Harmful: A Consequence of Aerophagia in Clinical Case, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.