[Dysphagia] aerophagia

[eripley at yahoo.com (Irene Campbell-Taylor)]

  There are multiple theories about the causes and nature of aerophagia. The only consistent one is that it is associated with GERD. Since there is a very high incidence and prevalence of GERD in the population with developmental disabilities, one would expect aerophagia to be more prominent in this group.
  One of the theories is that it is associated with increased rate of swallowing. This makes a certain sense as GERD produces waterbrash, a thin type of saliva designed to increase swallowing rate in order to promote esophageal motility thereby reducing the risk of reflux. This thin saliva is often mistaken for ?drooling? in persons with DD. If the rate of swallowing is increased, the amount of air in each swallow, it being normal to swallow some air with each bolus, will also be increased. Observation of changes in rate of swallowing may help.
  Other findings/theories can be found at:
   
  http://www.treatment-options.com/article.cfm?PubID=GA04-4-1-07&Type=Article&KeyWords=
   
  And:
   
           
  Gut 2004;53:1561-1565
Aerophagia, gastric, and supragastric belching: a study using intraluminal electrical impedance monitoring 
  A J Bredenoord1, B L A M Weusten1, D Sifrim2, R Timmer1 and A J P M Smout3 
  Background: Patients with aerophagia are believed to have excessive belches due to air swallowing. Intraluminal impedance monitoring has made it possible to investigate the validity of this concept. 
  Methods: The authors measured oesophageal pH and electrical impedance before and after a meal in 14 patients with excessive belching and 14 healthy controls and identified patterns of air transport through the oesophagus. The size of the gastric air bubble was measured radiographically. In four patients prolonged oesophageal manometry was performed simultaneously. 
  Results: In all subjects, impedance tracings showed that a significant amount of air is propulsed in front of about a third of the swallow induced peristaltic waves. Two types of retrograde gas flow through the oesophagus (belch) were observed. In the first type air flowed from the stomach through the oesophagus in oral direction ("gastric belch"). In the second type air entered the oesophagus rapidly from proximal and was expulsed almost immediately in oral direction ("supragastric belch"). The incidence of air-containing swallows and gastric belches was similar in patients and controls but supragastric belches occurred exclusively in patients. There was no evidence of lower oesophageal sphincter relaxation during supragastric belches. Gastric air bubble size was not different between the two groups. 
  Conclusions: In patients with excessive belching the incidence of gaseous reflux from stomach to oesophagus is similar to that in healthy subjects. Their excess belching activity follows a distinct pattern, characterised by rapid antegrade and retrograde flow of air in the oesophagus that does not reach the stomach. 
   
   [input] 1: 
  Swallows, oesophageal and gastric motility in normal subjects and in patients with gastro-oesophageal reflux disease: a 24-h pH-manometric study. Neurogastroenterol Motil. 1998 Apr;10(2):115-21
  Grossi L, Ciccaglione AF, Travaglini N, Marzio L.
  School of Gastroenterology, G.D'Annunzio University, Pescara, Italy.
  BACKGROUND: the motor aspects underlying gastro-oesophageal reflux disease (GORD) are still not completely clear. AIM: to evaluate the relationship between oesophageal and gastric motility in GORD patients. Patients: twelve patients with grade I-II oesophagitis, mean age 45 yr, and 10 healthy subjects, mean age 42 yr, were studied. METHODS: a pH-manometry was performed to analyse oesophageal and gastric motility, swallows and oesophageal pH values for the whole 24-h period, and for the 2-min period before and after each reflux episode. RESULTS: as compared to controls, GORD patients showed in the 24-h period, a greater number of swallows (P < 0.01) and a lower percentage of post deglutitive propagated oesophageal body waves (P < 0.05). The number of migrating motor complexes (MMC) was similar in the two groups, with a lower amplitude of phase III gastric waves in GORD. During MMC reflux episodes were seen only in GORD patients. After refluxes an increase in swallows,
 simultaneous and secondary oesophageal waves were detected in GORD patients, with a reduction of primary peristalsis. Isolated gastric contractions preceded reflux episodes more frequently in GORD patients than in controls. CONCLUSIONS: GORD patients showed an increase in swallows with altered post-deglutitive oesophageal motility and a reduced amplitude of gastric MMC. Moreover small contractions of gastric antrum are present before acid refluxes, suggesting a multifactorial pathogenesis of the disease.
   


Dr I Campbell-Taylor
Clinical Neuroscientist
Exclusive Distributor:
www.interactivetherapy.com