What Is Aerophagia and How Is It Treated?

We swallow about 2 quarts of air a day just eating and drinking. We burp out about half of that. The rest travels through the small intestine and out the rectum in the form of flatulence. Most of us do not have a problem processing and expelling this gas. People with aerophagia, who take in a lot of air, experience some uncomfortable symptoms.

One study published by Alimentary Pharmacology and Therapeutics found that 56 percent of subjects with aerophagia complained of belching, 27 percent of bloating, and 19 percent of both abdominal pain and distension. Research published in the journal Case Reports in Gastroenterologyfound that this distension tends to be less in the morning (probably due to gas being unconsciously expelled during the night through the anus), and progresses throughout the day. Other symptoms include audible air gulping and flatulence.

The Merck Manual reports that we pass gas through our anus on average about 13 to 21 times a day, although that number is increased in people with aerophagia.

While aerophagia shares many of the same symptoms with indigestion — primarily upper abdominal discomfort — they are two distinct disorders. In the Alimentary Pharmacology and Therapeutics study, those with indigestion were more apt to report the following symptoms than those who had aerophagia:

• nausea
• vomiting
• feelings of fullness without eating large amounts
• weight loss

Taking in the appropriate amount of air seems simple enough, but for a number of reasons, things can go awry. Aerophagia can be caused by issues with any of the following:

Mechanics

How we breathe, eat, and drink play key roles in the formation of aerophagia. Some things that lead to excessive air swallowing include:

• eating quickly (for example, taking a second bite before the first one is fully chewed and swallowed)
• talking while eating
• chewing gum
• drinking through a straw (sucking draws in more air)
• smoking (again, due to the sucking action)
• mouth breathing
• vigorously exercising
• drinking carbonated beverages
• wearing loose-fitting dentures

Medical

People with certain medical conditions who use machines to help them breathe are more prone to have aerophagia.

One example is noninvasive ventilation (NIV). This is any type of respiratory support that falls short of inserting a tube into a person’s nose or mouth.

One common form of NIV is the continuous positive airway pressure (CPAP) machine used to treat people with obstructive sleep apnea. Sleep apnea is a condition in which the airways become blocked while you’re sleeping. This blockage — which happens because of slack or improperly functioning muscles located at the back of the throat — restricts airflow and interrupts sleep.

A CPAP machine provides continuous air pressure through a mask or tube. If the pressure isn’t set correctly, or the wearer has some congestion, too much air can be swallowed. This results in aerophagia.

In one study, researchers found that 50 percent of subjects using a CPAP machine had at least one aerophagia symptom.

Other people who might need assisted breathing and run a higher risk of aerophagia include those with chronic obstructive pulmonary disease (COPD) and people with certain types of heart failure.

Mental

In one study comparing adults with aerophagia to adults with indigestion, researchers found that 19 percent of those with aerophagia had anxiety versus just 6 percent of those with indigestion. The connection between anxiety and aerophagia was seen in another study published in the American Journal of Gastroenterology.When subjects with excessive belching were unaware they were being studied, their burps were significantly fewer than when they knew they were being observed. Experts theorize that aerophagia may be a learned behavior used by those with anxiety to cope with stress.

Because aerophagia shares some of the same symptoms with common digestive disorders like gastroesophageal reflux disease (GERD), food allergies, and bowel blockages, your doctor may first test for these conditions. If no physical cause of your intestinal issues is found, and your symptoms are persistent, your doctor may make the diagnosis of aerophagia.

While some doctors may prescribe drugs such as simethicone and dimethicone to reduce the formation of gas in the bowel, there’s not a lot in the way of drug therapy to treat aerophagia.

Most experts advise speech therapy to improve breathing while talking. They also recommend behavior modification therapy to:

• become conscious of air gulping
• practice slow breathing
• learn effective ways of dealing with stress and anxiety

A study published in the journal Behavior Modificationhighlighted the experiences of a woman with chronic belching. Behavior therapy that focused on breathing and swallowing helped her reduce her belches during a 5-minute period from 18 to just 3. At an 18-month follow-up, the results still held.

Reducing — and even eliminating — aerophagia symptoms requires preparation and mindfulness, but it can be done. Experts advise:

• taking small bites and chewing food thoroughly before taking another one
• modifying how you swallow food or liquids
• eating with your mouth closed
• breathing slowly and deeply
• being mindful of open-mouth breathing
• quitting aerophagia-producing behaviors, such as smoking, drinking carbonated beverages, and chewing gum
• getting a better fit on dentures and CPAP machines.
• treating any underlying conditions, such as anxiety, that may be contributing to aerophagia

There’s no need to live with aerophagia and its bothersome symptoms. While the condition can take its toll on the quality of your life, there are highly effective treatments to limit its effects, if not banish the condition altogether. Talk to your healthcare professional about what remedies might work well for you.