Clonazepam Treatment of Pathologic Aerophagia in Children with Mental Retardation

Abstract

PurposePathologic aerophagia (PA) may lead to bowel perforation or volvulus in mentally retarded patients. The authors investigated the effects of clonazepam on the management of PA in children with severe to profound mental retardation (MR).MethodsThis study was undertaken as a retrospective case analysis of 21 PA patients with MR who were followed for over 12 months and diagnosed as having PA. Patients were assigned to two management groups, that is, to a clonazepam randomized open-labeled, treatment group or a reassurance group. The following were recorded and analyzed; age, response, remission rate to clonazepam treatment, and the side effect of clonazepam. It was defined positive response (response+) as being symptom-free for a whole week within 1 month of commencing treatment and remission(+) as being symptom-free for a whole month within 6 months of treatment.ResultsThe average age of the 21 PA children with MR was 10 years and 13 patients were female. Symptom duration before diagnosis of PA was 7 months. Clinical features of the clonazepam-trial group (n=11) and the reassurance group (n=10) were non-significantly different. Response(+) was achieved by 2 patients (18.2%) in the clonazepam-trial group and by no patient in the reassurance group. Remission(+) was achieved by 6 patients (54.5%) in the clonazepam-trial group and by one patient (10%) in the reassurance group (p=0.040).ConclusionWhen PA children with MR with severe bowel distention are considered for surgical treatment to prevent acute abdomen, a trial of clonazepam could be recommended.

Pathologic aerophagia: a rare but important medical condition in people with intellectual disabilities

“…No other aetiological factors were identified. Although there are reports of beneficial effects of clonazepam in PA in patients with intellectual disability (Lee et al ., ), our patient did not show any improvement. Behavioural or psychological interventions were impractical because of his severe cognitive impairment and communication difficulties.…”

“…It has also been suggested that PA may originate from a reflex‐induced swallowing due to unknown factors (Hwang et al ., ). It may occur as a result of involuntary paroxysmal cricopharyngeal sphincter openings of the oesophagus, like myoclonus (Hwang et al ., ) which may explain the benefits observed with clonazepam (Lee et al ., ). PA has also been reported in patients with autism, Rett syndrome and Tourette's syndrome (Frye & Hait, ; Hwang et al ., ; Van der Kolk et al ., ; Weil et al ., ).…”

“…Antidepressant and anxiolytics have been used to treat underlying depression and anxiety in PA associated with psychological symptoms (Chitkara et al ., ,b). The only controlled study in PA was performed by Lee et al ., () using clonazepam; in a randomised open label study, 21 children with intellectual disability who were diagnosed with PA were assigned to clonazepam(treatment) group ( n = 11) and a reassurance group ( n = 10); remission of symptoms for at least 1 month within 6 months of treatment was documented in six patients (54.5%) from the treatment group compared to one patient in the reassurance group (10%).…”

Adverse effects of antiepileptics potentially serious in individuals with severe motor and intellectual disabilities

“…The presence of such vicious cycle and the risk of acute abdomen in patients with SMID, in whom abdominal distension is merely recognized as "constipation", should be noted. Venting gas through a nasogastric tube or via a gastrostomy, use of a mouthpiece to inhibit deglutition, and benzodiazepines have been reported to be effective for the reduction of aerophagia [31][32][33]. However, air venting via the gastrostomy was not effective in patient 1.…”