title: Clinical features of pathologic childhood aerophagia: early recognition and essential diagnostic criteria.
abstract: OBJECTIVE
  This study investigated the early recognition and diagnosis of pathologic childhood aerophagia to avoid unnecessary diagnostic approaches and serious complications.
  
  
  METHODS
  Between 1995 and 2003, data from 42 consecutive patients with pathologic childhood aerophagia, aged 2 to 16 years, were reviewed. An esophageal air sign was defined as an abnormal air shadow on the proximal esophagus adjacent to the trachea on a full-inflated chest radiograph.
  
  
  RESULTS
  Of the 42 patients, the chief complaints were abdominal distention (52.4%), recurrent abdominal pain syndrome (21.4%), chronic diarrhea (11.9%), acute abdominal pain (7.1%) and others (7.2%). Mean symptom duration before diagnosis was 10.6 months (range, 1 to 60 months), and it exceeded 12 months for 16 (38.1%) patients. The clinical features common to all patients were abdominal distention that increased progressively during the day, increased flatus on sleep, increased bowel sound on auscultation and an air-distended stomach with increased gas in the small and large bowel by radiography. Visible or audible air swallowing (26.2%) and repetitive belching (9.5%) were also noted. Esophageal air sign was observed in 76.2% of the patients and in 9.7% of the controls (P=0.0001). The subgroups of pathologic childhood aerophagia divided by underlying associations were pathologic childhood aerophagia without severe mental retardation (76.2%), which consisted of psychological stresses and uncertain condition, and pathologic childhood aerophagia with severe mental retardation (23.8%).
  
  
  CONCLUSIONS
  The common manifestations of pathologic childhood aerophagia may be its essential diagnostic criteria, and esophageal air sign may be useful for the early recognition of pathologic childhood aerophagia. Our observations show that the diagnostic clinical profiles suggested by Rome II criteria should be detailed and made clearer if they are to serve as diagnostic criteria for pathologic childhood aerophagia.
authors.affiliation: Division of Pediatric Gastroenterology & Nutrition, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea. pedgi@korea.com
authors.forename: Jin-Bok
authors.initials: JB
authors.lastname: Hwang
authors.forename: Won Joung
authors.initials: WJ
authors.lastname: Choi
authors.forename: Jun Sik
authors.initials: JS
authors.lastname: Kim
authors.forename: Sang Yun
authors.initials: SY
authors.lastname: Lee
authors.forename: Chul-Ho
authors.initials: CH
authors.lastname: Jung
authors.forename: Young Hwan
authors.initials: YH
authors.lastname: Lee
authors.forename: Sin
authors.initials: S
authors.lastname: Kam
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D000334:Aerophagy / Q000175:diagnosis* / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004884:Eructation / Q000209:etiology; D005260:Female; D005414:Flatulence / Q000209:etiology; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D011860:Radiography, Abdominal; D012189:Retrospective Studies