1/18. Acute abdomen in mentally retarded patients: role of aerophagia. Report of nine cases. Between 1993 and 1996 nine mentally retarded patients presented because of an acute abdomen. All had the habit of aerophagia, diagnosed previously by a general practitioner. Massive distension of the bowel led to ileus, volvulus, and necrosis. After placement of a percutaneous endoscopic gastrostomy catheter or performing a gastrostomy during laparotomy with the intention to use as a desufflator, no recurrence of the signs and symptoms of an acute abdomen were observed. ( info) |
2/18. Aerophagia as a cause of ineffective phrenic nerve pacing in high tetraplegia: a case report. We report an unusual case of aerophagia after traumatic spinal cord injury (SCI), which shows the profound effects of abdominal distension on respiratory ability in such individuals. In this case, abdominal distension resulting from aerophagia reduced the effectiveness of phrenic nerve pacing on diaphragm function necessitating greater use of positive-pressure ventilatory (PPV) support. Reduction of postprandial gastric air and abdominal distension with insertion of a percutaneous endoscopic gastrostomy tube ameliorated the condition and allowed for more effective phrenic nerve pacing and greater PPV-free breathing. We are unaware of a similar case involving an individual with an SCI. ( info) |
3/18. Abdominal compartment syndrome related to noninvasive ventilation. OBJECTIVE: To study the effects of noninvasive positive pressure ventilation (NIPPV) on intra-abdominal pressure. DESIGN AND SETTING: Single case report from a tertiary teaching hospital. patients AND methods: A 65-year-old man who experienced a sudden respiratory and cardiovascular collapse during NIPPV. This was caused by gastric overdistension due to aerophagia followed by raised intra-abdominal pressure leading to intra-abdominal hypertension and abdominal compartment syndrome. RESULTS: The respiratory and cardiovascular problems resolved immediately after the introduction of a nasogastric tube. This resulted in normalization of IAP. CONCLUSIONS: This is the first case reported of an abdominal compartment syndrome related to NIPPV. Clinicians should be aware of this possible complication while using NIPPV. ( info) |
4/18. air swallowing can be responsible for non-response of heartburn to high-dose proton pump inhibitor. Intraluminal electrical impedance is a novel technique, which is able for the first time to provide a qualitative assessment of refluxed material moving from the stomach to the oesophagus. In other words, the presence of air can be differentiated from that of liquid, because the former is characterised by high and the latter by low impedance compared with baseline. Moreover, the combined measurement of electrical impedance and pH-metry permits to distinguish acid from non-acid liquid reflux. One of the most important clinical applications of this method is to assess the reasons for poor response of GORD patients to high-dose proton pump inhibitors. This case report describes the results of impedance in the evaluation of a young woman, who did not respond to twice-daily doses of rabeprazole. She continued to complain of heartburn as major symptom and impedance allowed us to clarify that it was not related to acid or non-acid reflux, but to air swallowing. Therefore, this technique identified aerophagia to be responsible for persistent heartburn despite high-dose proton pump inhibitor and prevented the adoption of more aggressive, but probably unuseful therapies, such as the surgical one. ( info) |
5/18. Aerophagia and anesthesia: an unusual cause of ventilatory insufficiency in a neonate. We describe a healthy neonate with abdominal distention, inadequate ventilation, and delayed extubation during anesthesia for minor surgery. Following rectal decompression and successful extubation, extreme abdominal distention recurred postoperatively after ingestion of clear fluids. We elicited a history of frequent and excessive flatus from the parents, and abdominal radiography revealed distended loops of small bowel with small lung volumes suggestive of aerophagia. The differential diagnosis of aerophagia is reviewed, the anesthetic implications discussed, and relevant literature pertaining to this condition summarized. ( info) |
6/18. air swallowing caused recurrent ileus in Tourette's syndrome. This report describes an adolescent boy who has Tourette's syndrome and developed a subtle but significant increase in vocal tics after an 8-month respite. The increase in vocal tics was associated with an acute increase in psychological stressors and resulted in recurrent air swallowing, which, in turn, caused abdominal cramping, eructation, and flatus, eventually leading to aeroenteria. air swallowing was recognized only after a second hospital admission for recurrent ileus. air swallowing and associated symptoms were mitigated by reinstitution of psychopharmacologic treatment and an increase in the patient's self-awareness of the air-swallowing behavior. Clinically significant air swallowing has not been described previously in tourette syndrome or a tic disorder. This case is important for pediatricians and pediatric gastroenterologists because either may be the first to evaluate a child or an adolescent with unexplained recurrent ileus. This report also documents the importance of the connection between the brain and the body. ( info) |
7/18. Pathologic childhood aerophagy: an under-diagnosed entity. Three children with pathologic childhood aerophagy are described. This entity is characterized by progressive abdominal distension during the day, non-distended abdomen in the morning, and visible air swallowing. The condition is usually self-limited, and treatment is symptomatic and by reassurance. Early recognition and diagnosis of this condition might help avoid unnecessary and expensive diagnostic investigations. ( info) |
8/18. Behavioral treatment of chronic aerophagia. Effects of various behavioral interventions on stereotyped aerophagic responding by a profoundly mentally retarded, 5-year-old girl were assessed. Aerophagic responding was defined as air swallowing with extreme stomach protrusion, followed by breath-holding. Observations of air swallowing, as well as physiologic measurements related to heart rate and respiratory patterns, were recorded across both baseline and treatment phases of the study. Multiple behavioral interventions were assessed within a laboratory setting using an alternating treatment design format, with the most effective treatment systematically extended to additional settings. Results indicated that a behavior modification treatment package was effective in suppressing the high frequency of this rare stereotyped act to near-zero rates. ( info) |
9/18. Effects of response satiation procedures in the treatment of aerophagia. A contingent response that previously increased self-injurious air-swallowing (aerophagia) by a profoundly mentally retarded woman (Holburn & Dougher, 1985) was shown to decrease her air-swallowing when the response was presented in accord with the response deprivation/satiation hypothesis, which suggests that any free-operant response can serve as a reinforcer or a punisher depending upon specific contigency arrangements. The results offer an explanation for the earlier increase in air-swallowing. ( info) |
10/18. Transverse colon volvulus in a child with pathologic aerophagia. intestinal obstruction secondary to transverse colon volvulus in a 7-year-old girl with previously diagnosed pathologic aerophagia is presented. This unusual combination is not previously described. ( info) |