Aerophagia Research Articles

A new and simple approach to air-contrast studies of the stomach and duodenum.

Since the early days of roentgenology many methods of producing double-contrast studies of the stomach and duodenum have been described. These procedures have included the use of effervescent powders and carbonated beverages, the conscious swallowing of air, insufflation and inflation of the stomach by means of inserted tubes, and utilization of the air physiologically present in the stomach. Although the double-contrast examination has proved its value and become routine, currently used technics still have certain limitations and disadvantages. The “Straw Technic” We would like to present the “straw technic” as a new and extremely simple approach to air-contrast studies. This procedure is easily executed and requires no chemicals, no time-consuming instrumentation, no awkward equipment. Technically it affords excellent films. For the “straw technic” the examiner needs only an ordinary drinking straw, either paper or plastic, which has been punctured midway to produce a small perforation. By means of this device one obtains simultaneous aspiration of barium mixture and air when the opaque medium is sipped. The size of the perforation in the straw is an important factor. It must be determined experimentally and depends upon the dilution of the medium employed. The hole should be very small to allow the formation of only tiny air bubbles within the contrast material. This will insure an easily swallowed bolus containing both air and barium. A larger perforation requires excessive effort on the part of the patient, and the end-results are less favorable, as a smaller amount of air actually is swallowed. We have found a through-and-through perforation of the straw made with a very small sewing needle suitable. Puncture of one wall made perpendicularly with a medium-sized safety pin is also adequate with our standard barium medium. Once the size of the perforation has been determined, a supply of straws can be prepared and kept available. It is well to advise a patient that he is drinking through an artificially perforated straw to insure his co-operation. Usually sufficient air will have entered the stomach when the patient in the upright position has ingested 2 to 3 ounces of the medium. This is easily controlled fluoroscopically. In those cases in which a patient is known to have a questionable lesion in the antrum or body of the stomach, the examination is begun in the horizontal left anterior oblique position. After 2 ounces of barium suspension have been sipped through the straw, the patient immediately assumes the right anterior oblique position for demonstration of the lesion by double contrast. In most cases no contrast material will have entered the duodenum and there will be no superimposition of small-bowel shadows. By turning the patient into different obliquities and changing the tilt of the table, it is possible to demonstrate even very minute lesions of the posterior wall (Fig. 1).

EMOTIONAL FACTORS IN THE ETIOLOGY OF COLIC IN INFANTS

There is probably no practicing pediatrician who has not attempted to treat the so-called "colicky" baby. Changes in the formula, the type of nipple used and the size of the nipple hole, attempts at posturing the baby, giving warm water, barley water, fennel tea, sedatives, antihistamine drugs, and antispasmodics—all of these have been tried with varied degrees of success but none with spectacular success. It is obvious from the numerous treatments advised that little is really understood as to the true etiology. Is it a reaction to some gastrointestinal allergy; is it due to poor feeding techniques, with subsequent swallowing of air; is it due to a fat or carbohydrate intolerance, or is it related to something more inherent in the physiological structure or emotional environment of the particular child? It seems evident from the abdominal distention, the flexing of the legs, and the passage of flatus that there is undoubtedly abdominal pain. But what causes colicky babies to develop abdominal pain? If one observes these infants he will note that in almost every instance the child can be categorized as a "hypertonic" baby. Such are the active, keyed-up infants so sharply differentiated from more relaxed and placid infants—often from birth. These hypertonic infants react more acutely to their environment, to their unsatisfied needs or to outward stimulation. They react violently to sudden noises, they vomit and regurgitate easily, and they usually sleep shorter periods and less soundly than other infants. On the assumption that this hypentonicity might be related to the colic, a study was instituted in 1947 in an attempt to determine: 1) if relaxation of the baby would cause a disappearance of the symptoms; 2) if there were unsatisfied emotional or physiological needs of the infant causing the child to react with increased hypertonicity and subsequent colic, and 3) if such needs were satisfied could the symptoms of colic be dispelled without resorting to other means such as formula changes, sedatives, rocking or carrying?

Intestinal obstruction due to swallowing of air: report of a case.

The case to be reported of obstruction of the descending colon as a result of swallowing of air is of interest as I have been unable to find mention of a similar case in the world literature. Partial obstruction of the descending colon after swallowing of air by the patient over a period of several days was proved by roentgen-ray study with a barium enema. A total laryngectomy had been performed on this patient for cancer four years previously and, in order to speak, the patient used an esophageal voice necessitating the swallowing of quantities of air to be eructated so that the sound could be converted into speech by the lips, teeth, tongue, and palate. The mechanism of the obstruction can probably be explained by the fact that, owing to increasing distension of the proximal descending colon, the sigmoid folded over on itself near its peritoneal attachment, thus completing

The Comparative Ethology of Vertebrate Breathing

The ascent through water to the surface in order to breathe, in animals which spend much time under water, is regarded as an instinct whose consummatory act is the filling of the lungs. The behaviour of Triturus cristatus is different according as it is on land, or floating because its lungs are distended, or supported on a solid object below the water because it is heavier than water. The frequency of ascent to breathe is diminished when oxygen is breathed or dissolved in the water, and increased when nitrogen is substituted for air. It is also sharply increased when the lungs are partially collapsed by increasing the water pressure. Intention movements, and the interaction of breathing and courting movements, are described. A phylogeny of breathing behaviour is suggested: accidental swallowing of air; evolution of an instinct involving rising to seek it; evolution of organs to exploit it for respiration or buoyancy. The appetitive behaviour of this instinct led to land-living forms; development of a skin impermeable to carbon dioxide necessitated regulation by chemical stimuli. These, unlike the physical stimuli asssociated with the older appetitive phase, have an associated psychic component in man only in exceptional environments. In land animals appetitive behaviour is not seen, but may reappear when evoked by the environment, either exceptionally as in men or mice, or integrated with other instinctive activities such as sleep or reproduction, as in the aquatic mammals. It is associated with regulation of buoyancy. In man the consummatory act has lost a fixed action pattern and acquired the ontogenetic plasticity which seems common among mammalian movements. Vocalization is considered as a ritualization of breathing. The phylogenetically complementary drive to obtain water is discussed. If this is defined as an attempt to keep the internal salinity relatively constant, even among mammals it can have another appetitive behaviour, the seeking of air with a preferred humidity. This, including immersion of the whole body in water, seems the phylogenetically older, and drinking does not occur in amphibia. If this drive is called thirst, it is pointed out that it is one of the drives responsible of fish migration. Thirst and air hunger belong to a class of drives amenable to experiment, and easy to discuss from the standpoint of evolution, but whose corresponding sign stimuli are provided by the inanimate environment, and are therefore difficult to present to an animal artificially. A propos of the other class of drives whose sign stimuli are provided by the living environment and can be presented by dummies, we discuss the relation between chemical stimuli evoking the drives in the central nervous system and peripheral chemical sensation.

Essentials of Infant Feeding for Physicians.

This monograph was written with the express intention of presenting the principles of infant feeding in the simplest possible terms and a manner which would make those principles easily and practically applicable. As the author remarks, the number of preparations currently available is so great as to make infant feeding seem complex, whereas actually the subject is fundamentally simple. As the title implies, an attempt is made to present the essentials of infant feeding. In this respect, no deficiencies can be found in the subject matter. No practicing physician would ask for more information than is supplied. After brief chapters on the history of infant feeding and breast feeding, the chemical principles involved are discussed. After each section—fats, proteins, carbohydrates—there is a brief summary of these principles. Mechanisms of infant feeding, mainly prevention of air swallowing, are briefly but adequately considered. There is a short chapter on complemental or mixed

Talking with the Gullet

THE removal of the larynx is a drastic operation, but the use of sulphonamide and penicillin have made it possible to prevent the sepsis which formerly hindered recovery (Lancet, March 2, p. 312) The operation involves loss of normal speech, and it is good to learn that remarkable progress has been made in teaching people who have lost the larynx to speak with the œsophagus. Speech can be produced by a stream of air which comes up through the œsophagus instead of through the trachea. The subject must first learn to swallow air. It is not essential that he should do this before the operation, but it is better if he does so. A week or so before the larynx is removed, he is taught to close the glottis and the lips and to expand the chest as he swallows, so that air is aspirated ; this can then be brought up again in a noisy belch. When the operation wound has healed, the swallowing of air and belching is resumed. The trick of this may be learned more easily if a boiled sweet is sucked or if the subject takes acid and alkaline powders which give off gas in the stomach. Very soon it becomes possible to convert the belching of wind into something like speech. Consonants such as sh and ch are usually the first to be practised. Vowels are then added to them and words like church and scrub are made. When such explosive consonants as p, d and k have been learnt, other words are added. Before long, several syllables, or one long word, can be spoken with each intake of air, and attempts are then made at short sentences. Pauses for the intake of air cause abnormal grouping of words, and this difficulty is only slowly overcome.

OMPHALOCELE WITH CONGENITAL OBSTRUCTION

Omphalocele, or exocelom, is a true congenital umbilical hernia containing intestine or abdominal organs. This condition is said to occur once in 5,000 to 6,000 newborn infants.1 The presence of Meckel's diverticulum in an omphalocele has been reported only twice in the English literature.2 In the present case the intestines could not be reduced until the infant was anesthetized. One of us (H. J. M.) observed the size of the omphalocele increase from that of a lemon (approximately 6 cm. in diameter) to that of a medium-sized grapefruit (approximately 12 cm. in diameter) within five minutes after birth. This occurred through the swallowing of air when the infant began to cry. The intestines became distended, and this hindered any reduction. This was a most interesting physiologic observation. The infant was operated on when 80 minutes of age. Convalescence was uneventful, and at the age of 14 weeks she weighed 12

On the Importance of Aerophagia for Infantile Meteorism.

On the Importance of Aerophagia for Infantile Meteorism.

SOME CLINICAL FEATURES OF AIR SWALLOWING

The origin of the gases in the gastro-intestinal tract, their passage, absorption and expulsion, are large themes and will not be presented here. One phase, viz., air swallowing, or aerophagy, will be discussed with particular reference to the clinical features. Air swallowing is an extremely common occurrence. At least 60 per cent of patients with functional or organic disease of the gastro-intestinal tract are belchers or have symptoms of one sort or another referable to aerophagy. The French and Germans have written considerably on the subject, but the American and English literature contains few references to it. In one extensive bibliography, of 130 references, 1 only ten are American and four English. It is certainly a symptom of importance. While most frequently a functional disturbance, often it signifies organic disease. One recalls its frequency in cardiac disease. Elderly patients with hypertension are aerophagic almost as a rule. Neurotic individuals may

GAVAGE FEEDING OF INFANTS

It is my impression that this is a subject which has been very lightly dealt with, judging from the scarcity of information to be found concerning it in any of the books that deal with methods pertaining to the care of infants. It is difficult to understand why such is the case, since it is a procedure which, in many instances, saves a baby's life. In connection with gavage feeding, we think first of the premature infant who is too frail to nurse or even to make an effort to swallow, when food is placed in the mouth by a dropper. This infant is best fed by gavage until it gradually becomes vigorous enough to take its food from the bottle or to be nursed at the breast. The second class is that of the decomposition baby who comes under our care so starved, so emaciated, and so feeble, that he cannot make the effort to take food. In extreme cases, it means life to this baby to conserve its strength, so he is fed by gavage, and in a few days' time he has gained so much that when, as a trial experiment, he is offered the bottle, he rewards us by draining every drop and, in his way, asking for more. It is best not to change all at once to the bottle feeding, for it is easy to overestimate the baby's strength, but give it first one bottle a day, then two, and so on, until he is entirely off the gavage method of feeding. The third class is comprised of babies who are acutely ill and persistently refuse food, until the depletion of strength and loss of weight are so great that it becomes necessary to force the food,then as the baby grows better and its appetite returns, the gavage feeding is discontinued. The fourth class is made up of the hare-lip and cleft-palate babies. These are all eventually subjected to operation. Even if they are able to take food through a nipple, it is necessary to accustom them to some other method, since the nipple cannot be used after operation until the lip is healed and the tenderness gone. Feeding with a spoon is not satisfactory, because so much of the food is lost; the dropper method is the one most often employed,-but in a number of instances it has been found that these babies do not take the feeding without a considerable amount of trouble attending, caused chiefly by the swallowing of air with the food, and the resulting discomfort. This is eliminated by the use of the gavage method. The fifth and last class is that of the baby who vomits persistently.

A Case of Air-Swallowing

A Case of Air-Swallowing