Abstract
A four-year-old boy who presented with abdominal pain and upper abdominal distension was referred to our hospital. His mental state was normal. Plain abdominal radiography demonstrated an extremely distended stomach with a dilated small intestine. There was no sign of mechanical obstruction with full investigations. He was diagnosed with aerophagia from the clinical feature that abdominal distension progressively increased in the daytime and decreased during sleep. Since clinical symptoms did not change after medication with famotidine and the herbal medicine Dai-Kenchu-To, we decided to retain a nasogastric tube for persistent gastric decompression. We started to administer itopride hydrochloride and mosapride citrate in order to accelerate gastric emptying; however, clinical symptoms remained unchanged one month after administration. A pediatrician could not completely rule out involvement of psychological stress, but medication with ethyl loflazepate was also ineffective. Finally, we started to use the herbal medicine Rikkunshi-To two months after the initiation of therapy, which gradually reduced the abdominal distension in two weeks, and nasogastric decompression was discontinued after the two months. It was considered that Rikkunshi-To was effective not only on the gastric emptying but also on the gastric adaptive relaxation and gastric antiarrythmic effect in this case.
