Belching, Air Swallowing, and Hiccups

What about air swallowing?

The inability to belch can cause "gas bloat" symptoms, particularly in patients who have undergone fundoplication for the management of gastric reflux. In many of these patients, the gastric venting process is muted or totally obviated. They can't expel air from the stomach.

True air swallowing (aerophagia) is rare, even though it is often mentioned in discussions about belching. In aerophagia, during impedance manometry, you can see the bolus of air being swallowed with the esophageal contractions. The air bolus registers high impedance in transit because air has higher impedance than liquids.

For a diagnosis of aerophagia, the history should indicate abdominal distention and bloating. Affected patients might experience some belching, but abdominal distention is always present.

Unfortunately, as many as 30% of patients presenting with profound distention undergo exploratory laparotomy to look for an obstruction. Unnecessary surgery can be prevented by looking at the abdominal flat plate, which will show air in the small and large bowel, but no air/fluid levels that would suggest obstruction.

Aerophagia can be associated with certain behavioral disorders or mental impairment. In some patients, air swallowing can be harmful if they become severely distended and results in a volvulus and obstruction.

A speech or behavioral therapist may be able to help patients with aerophagia to reduce the chronic air-swallowing behavior.

In contrast to the patient with supragastric belching, pharmacologic agents might provide some benefit to patients with aerophagia. Surface tension-reducing drugs, such as simethicone, may diminish the gas.