Short communication Air swallowing as a tic Rimona S. Weil a, ⁎ , Andrea E. Cavanna a,b , John M.T. Willoughby c , Mary M. Robertson a,d a Institute of Neurology, Queen Square, London, UK b Department of Neurology, Amedeo Avogadro University, Novara, Italy c Lister Hospital, Stevenage, UK d St Georges Hospital Medical School, London, UK Received 9 July 2007; received in revised form 18 December 2007; accepted 1 April 2008 Abstract The authors present a patient with Gilles de la Tourette syndrome who developed abdominal distension and bloating due to air swallowing. We suggest that this air swallowing may have been due to a tic. © 2008 Elsevier Inc. All rights reserved. Keywords: Aerophagy; Air swallowing; Gilles de la Tourette syndrome; Tic Introduction A tic is a brief involuntary movement that can be suppressed by the individual but at the expense of mounting inner tension, often with subsequent rebound [1]. Gilles de la Tourette syndrome (GTS) is a neurodevelopmental disorder characterized by multiple motor tics and one or more vocal tics that usually begin before the age of 18. Estimates of the prevalence of GTS vary. The generally accepted figure was 0.5/1000, but recent research suggests that between 1% and 3% of school children are affected [2,3]. The nature and phenomenology of tics vary widely, even in documented familial cases [4]. They may take the form of a movement, a vocalization (phonic tic), or a complex phenomenon such as an echophenomenon or coprolalia (the inappropriate uttering of obscenities) which is a rare manifestation of GTS. Tics can be increased in conditions of stress, boredom, or fatigue [5,6]. Patients often report that tics are preceded by distinct premonitory feelings or sensations, they are temporarily suppressible, and patients experience relief after the tic has occurred [7]. Tics can also fluctuate in severity and change character within the same person. It is increasingly recognized that tics can be unusual in their manifestations and even self-injurious with reports of teeth grinding [8], vomiting, and retching [9], and other self- injurious behaviors [10]. Aerophagy is a pattern of repetitive air swallowing and troublesome belching that is objectively observed and has been present for the last 3 months with symptom onset at least 6 months before diagnosis [11]. It may be undetected until the patient develops a distended abdomen. It is often associated with abdominal discomfort and distension and patients may present to gastroenterologists with pseudo- obstruction or malabsorption [12], although life-threatening complications are rare [13]. Aerophagy has been described as a cause of irritable bowel syndrome [14] and is frequently reported in association with neurological disorders and learning disabilities, with a high incidence in institutiona- lized patients [13]. In particular, it has been linked with Huntington's disease [15] and Rett syndrome [16] in which it is particularly common and is thought to be due to abnormal feeding patterns during feeding or to specific oropharyngeal problems. Adults with aerophagy have recently been shown to have an increased prevalence of anxiety [17], and anxiety per se has been linked to increased swallowing rates in normal subjects [18], which may suggest a possible precipitating factor in predisposed individuals. Zella et al. [19] reported incessant “eructation” as the presenting Journal of Psychosomatic Research 65 (2008) 497 – 500 ⁎ Corresponding author. Institute of Neurology, 12 Queen Square, London WC1N 3BG, UK. Tel.: +44 0 20 7833 7472. E-mail address: r.weil@fil.ion.ucl.ac.uk (R.S. Weil). 0022-3999/08/$ – see front matter © 2008 Elsevier Inc. All rights reserved. doi:10.1016/j.jpsychores.2008.04.001