Aerophagia among school children: epidemiological patterns and symptom characteristics

Abstract

BACKGROUND: Aerophagia is a functional gastrointestinal disease characterized by repetitive air swallowing, abdominal distension, belching and flatulence. In severe cases, it can lead to pneumoperitonium, volvulus and intestinal perforation. Little is known about the epidemiology and clinical profile of affected children. The main objective of this study was to assess the epidemiology of aerophagia in Sri Lankan children and adolescents. METHODS: This cross sectional survey was conducted in 10–16 years old children in 8 randomly selected schools of 4 randomly selected provinces in Sri Lanka. Data were collected using a self-administered questionnaire Questionnaire on Pediatric Gastrointestinal Symptoms - Rome III version, which is translated into native language and pretested for Sri Lankan children). It was distributed in an examination setting and collected on the same day. Trained research assistants were present during the answering of the questionnaire, for any required clarification. Aerophagia was diagnosed using Rome III criteria. RESULTS: In this study, aerophagia was seen in 163 (7.5%), of the 2163 children evaluated. The prevalence was higher in older children (10.5% in 15-year-olds). No gender difference was observed (boys 8.2% vs. girls 6.8%, p>0.05). Other intestinal-related (abdominal pain, nausea and anorexia) and extraintestinal symptoms (headache, limb pain, sleeping difficulty, photophobia and lightheadedness) were more prevalent among affected children ( p<0.05). Out of 163 children with aerophagia, 18 (11%) had difficulty in sleeping and 31 (19.0%) had missed school because of symptoms. Both entities were significantly commoner among children with aerophagia than in controls ( p<0.05). A higher percentage of affected children were found to be exposed to recent stressful life events when compared to controls ( p=0.01). CONCLUSIONS: This study highlights the high prevalence of aerophagia among Sri Lankan children and adolescents. Other intestinal-related and extraintestinal somatic symptoms are frequently seen in affected children. Furthermore, aerophagia has a significant impact on daily activities, such as sleep and schooling, of 10–20% of affected children. This condition is more commonly seen in children exposed to emotional stress