In this episode we dive into the causes and treatment for aerophagia – one of the most unrecognized factors behind burping and bloating. Aerophagia is a condition where people swallow large amounts of air unintentionally and without realizing it. It’s often misdiagnosed as acid reflux, ulcers, gallstones, or SIBO – small intestinal bacterial overgrowth. I frequently see patients who have been put on acid blockers or treated for ulcers that they don’t have, or sometimes even had their gallbladder removed, and they’re still not better. And that’s because their aerophagia has not been diagnosed.
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This GI condition can make you go up 2 whole pants sizes in a day and is one of the commonest but most underdiagnosed causes of burping and bloating.
On today’s show, years ago when I was full-time faculty at Georgetown Hospital, I had a patient who was a pastor in one of the local churches in Washington DC, and he had a major GI problem. His problem was that he had severe burping. And I’m not just talking about an occasional burp here and there, I’m talking about off the charts pathological burping. He wanted to make sure I really understood how much of a problem this was, so he left me a five-minute voice mail of himself burping. After listening to the voice mail, I immediately called my colleague Dr. Susan Miller, who has a PhD in speech pathology and was an expert at diagnosing and treating the condition my patient was suffering from.
Susan carefully evaluated the pastor, analyzing his breathing, speaking, eating, and drinking patterns. She discovered that an undiagnosed deviated septum was causing him to breathe almost exclusively through his mouth. Breath holding was also a contributing factor—during his sermons he would speak loudly for long periods of time without taking a breath and then gasp for air in between sentences. Much of that air that he was taking in was being swallowed – it wasn’t all going down into his lungs; some of it was ending up in his stomach, so by the end of the sermon he was looking and feeling like the Michelin man. His story has a good ending though: he had surgery to fix his deviated septum and Susan helped him retrain his speech and breathing patterns and the combination put an end to his burping – and the bloating that the air swallowing was causing.
Burping is a normal bodily function, but when it happens excessively, like with my patient, that is not normal. When we come back we’re going to get into the causes and treatment for air swallowing – otherwise known as aerophagia – the condition my patient was suffering from, and one of the commonest, but also one of the most unrecognized factors behind burping and bloating.
OK let’s start with the definition of aerophagia – this is a condition where people swallow large amounts of air unintentionally and without realizing it. It’s an incredibly common cause of bloating and it’s often misdiagnosed as acid reflux, ulcers, gallstones, or SIBO – small intestinal bacterial overgrowth. And I will frequently see patients who have been put on acid blockers or treated for ulcers that they don’t have, or sometimes even had their gallbladder removed, and they’re still not better. And that’s because their aerophagia has not been diagnosed.
Most of us swallow a little bit of air when we eat or drink, and we may take in extra gas bubbles with carbonated beverages like seltzer, beer, soda, or champagne. But people with aerophagia swallow large amounts of air that can lead to a significant buildup of gas in their GI tract. What causes them to do that? If you have chronic sinus problems, a deviated septum, or a history of allergies or asthma, you are at risk for aerophagia because you might be mouth breathing, which predisposes you to air swallowing. What else causes it? Chewing gum, sucking on hard candy, smoking, eating too quickly, talking while eating, drinking liquids with meals, or loose dentures can all cause aerophagia.
Most people with aerophagia come in complaining of three things: bloating, burping, and abdominal discomfort. If you have aerophagia, your stomach may feel tight like a drum and very distended because of the high pressure caused by all the air you’ve swallowed. I’ve had patients say they wish I could stick them with a pin to deflate them. Eventually most of that swallowed air gets burped up or makes its way through your GI tract and exits through the other end, but it can cause a lot of discomfort in between.
Some people with aerophagia swallow small amounts of air and force up burps repetitively as part of an anxiety syndrome. It’s a nervous habit, like biting your fingernails or playing with your hair, and although it’s a voluntary action, the person is usually unaware that he or she is doing it. One of my patients more recently burped repetitively every ten or twenty seconds during the visit, but when I distracted her, it stopped completely. Biofeedback using deep breathing techniques and guided visualization eventually improved her burping. She still burps a lot when she’s nervous, but she’s much more aware of it and she now has the tools to control it.
After the break, my go-to Gutbliss solutions for aerophagia
If you’re bloated and burping and having abdominal discomfort and think you may have aerophagia, try these tips:
- Spit out the gum.
- Don’t suck on hard candy.
- Eat slowly.
- Don’t talk on the phone while eating.
- Drink liquids at the beginning or end of the meal, not in between.
- Choose flat, not bubbly drinks.
- Meditate a little if you feel anxious.
- Practice taking deep breaths that expand your lungs not your stomach.
I want to leave you with 3 takeaways about air swallowing:
1. If you are having that combination of bloating, burping and abdominal discomfort, you may have aerophagia
2. Aerophagia is really common, but it’s also really under-diagnosed because it often goes unrecognized by physicians.
3. If you’ve had a GI evaluation for symptoms that include frequent burping and everything has been negative, ask for a referral to a speech pathologist who may be able to help you identify if the problem is related to your breathing, speech, or swallowing patterns.
So that’s it for this week’s episode of the Gutbliss Podcast on aerophagia – otherwise known as air swallowing.
