Published online May 1, 2006
PEDIATRICS Vol. 117 No. 6 June 2006, pp. e1249-e1252 (doi:10.1542/peds.2005-2914)
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EXPERIENCE AND REASON

Air Swallowing Caused Recurrent Ileus in Tourette's Syndrome

Richard E. Frye, MD, PhD, FAAPa and Elizabeth J. Hait, MDb

a Department of Pediatrics, University of Florida, Gainesville, Florida
b Department of Gastroenterology, Children's Hospital Boston, Boston, Massachusetts

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.

Key Words: abdominal pain • aerophagia • air swallowing • Tourette's syndrome • ileus

Abbreviations: TS, Tourette's syndrome • OCD, obsessive-compulsive disorder • ED, emergency department

Accepted Dec 22, 2005.