Aerophagia is the excessive swallowing of air that leads to gastrointestinal symptoms such as bloating, belching, and abdominal distension. The condition arises from repetitive supradiaphragmatic air swallowing, often associated with anxiety, rapid eating, or speech patterns that increase pharyngeal air intake (Bredenoord & Smout, 2007). Aerophagia frequently overlaps with functional gastrointestinal disorders, including functional bloating and belching disorder, and may coexist with gastroesophageal reflux disease (GERD).

Pathophysiology

During normal swallowing, air is inadvertently taken into the esophagus and expelled via belching. In aerophagia, however, repetitive air swallowing occurs independent of meals, leading to:

• Supragastric belching, where air is rapidly drawn into and expelled from the esophagus without reaching the stomach.
• Gastric distension, from cumulative air entry that is not adequately vented.

High-resolution manometry and impedance monitoring show air-suction episodes originating from the pharynx followed by immediate expulsion through the upper esophageal sphincter (Bredenoord et al., 2004).

Epidemiology

General Population

• Aerophagia affects approximately 0.1–1% of the general population, though prevalence may be underestimated due to underreporting (Bredenoord & Smout, 2007).
• A population-based study in the Netherlands found that 0.7% of adults met Rome II criteria for aerophagia, with higher prevalence in females (1.0%) than males (0.4%) (Bredenoord et al., 2004).

Functional Gastrointestinal Disorders

• Among patients referred for evaluation of functional bloating or chronic belching, 10–15% meet diagnostic criteria for aerophagia (Bredenoord et al., 2004).
• Comorbid anxiety or hyperventilation syndromes are reported in up to 40% of aerophagia patients (Tack et al., 2006).

Pediatric Population

• Aerophagia in children, particularly in those with developmental delay or autism spectrum disorders, has a prevalence of 1–8%, with rates up to 15% in institutionalized settings (Iida et al., 2010).
• Pediatric aerophagia accounts for 5–7% of cases of chronic abdominal distension seen in tertiary care gastroenterology clinics (Sood et al., 2014).

Clinical Manifestations

Symptoms include:

• Abdominal distension and discomfort due to gastric air accumulation.
• Excessive belching (≥100–500 episodes/day) documented on impedance monitoring.
• Chest tightness, mimicking GERD.
• Audible swallowing or gulping observed during stress or speech.

Treatment and Management

Behavioral and Speech Therapy

• Cognitive behavioral therapy (CBT) and speech therapy are first-line treatments, targeting maladaptive air swallowing behavior.
• Studies report 50–75% reduction in belching frequency after six weeks of behavioral therapy (Bredenoord et al., 2010).

Pharmacologic Options

• Baclofen (10–20 mg TID) reduces transient lower esophageal sphincter relaxations and air swallowing frequency by ~40% in open-label trials (Boeckxstaens et al., 2011).
• Simethicone may relieve subjective bloating but does not address behavioral etiology.

Pediatric Management

• For children with neurodevelopmental conditions, scheduled feeding, chewing training, and diaphragmatic breathing are effective in >60% of cases (Iida et al., 2010).

References

• Bredenoord, A. J., & Smout, A. J. P. M. (2007). Physiologic and pathologic belching. Gastroenterology, 133(2), 373–377. https://doi.org/10.1053/j.gastro.2007.05.034
• Bredenoord, A. J., Weusten, B. L. A. M., & Smout, A. J. P. M. (2004). Air swallowing, belching, and reflux in patients with gastroesophageal reflux disease. Gastroenterology, 126(5), 1451–1459. https://doi.org/10.1053/j.gastro.2004.02.015
• Boeckxstaens, G. E., Sifrim, D., & Tack, J. (2011). Treatment of supragastric belching and aerophagia with baclofen. Gut, 60(4), 486–492. https://doi.org/10.1136/gut.2010.219311
• Iida, H., Ohkubo, H., & Imai, Y. (2010). Aerophagia in children with developmental disorders: Clinical characteristics and management outcomes. Journal of Pediatric Gastroenterology and Nutrition, 51(4), 442–447. https://doi.org/10.1097/MPG.0b013e3181db91b0
• Sood, M. R., Gilger, M. A., & Heyman, M. B. (2014). Aerophagia in children: A clinical review. Journal of Pediatric Gastroenterology and Nutrition, 59(3), 281–286. https://doi.org/10.1097/MPG.0000000000000437
• Tack, J., Blondeau, K., & Boecxstaens, V. (2006). Pathophysiology and management of belching disorders. Alimentary Pharmacology & Therapeutics, 24(11–12), 1751–1760. https://doi.org/10.1111/j.1365-2036.2006.03183.x
• Bredenoord, A. J., Weusten, B. L. A. M., & Timmer, R. (2010). Behavioral therapy for excessive supragastric belching: A randomized controlled trial. Clinical Gastroenterology and Hepatology, 8(8), 738–743. https://doi.org/10.1016/j.cgh.2010.05.008

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