TO THE EDITOR: We would like to report our ob-.
servations upon a new gastrointestinal syndrome,
which we shall refer to by the acronym HAFE
(high altitude flatus expulsion). This phenomenon
was most recently witnessed by us during an expedition
in the San Juan Mountains of southwestern
Colorado, with similar experiences during excursions
past. The syndrome is strictly associated
with ascent, and is characterized by an increase in
both the volume and the frequency of the passage
of flatus, which spontaneously occurs while climbing
to altitudes of 11,000 feet or greater. The
eructations (known to veteran back-packers as
"Rocky Mountain barking spiders") do not appear
to vary with exercise, but may well be closely
linked to diet.' The fact that the syndrome invariably
abated on descent leads us to postulate a
mechanism whereby the victim is afflicted by the
expansion of colonic gas at the decreased atmospheric
pressure of high altitude. This is somewhat
analogous to the rapid intravascular expansion of
nitrogen which afflicts deep-sea divers and triggers
decompression illness.
While not as catastrophic as barotrauma nor
as debilitating as HAPE (high altitude pulmonary
edema), HAFE nonetheless represents a significant
inconvenience to those who prefer to hike in company.
Some experience from recent Everest expeditions
suggests that the use of digestive enzymes
and simethicone may minimize the hazard.
At present, we can advise victims that the offense
is more sociologic than physiologic.
HAFE should be added to the growing list of
medical disorders that are associated with exposure
to high altitude. We are planning a prospective
study for the summer of 1981.
PAUL AUERBACH, MD
Assistant Professor of Medicine
Attending Physician, Emergency Services
Temple University Hospital
Philadelphia
YORK E. MILLER, MD
Research Fellow
Pulmonary Division
Department of Medicine
University of Colorado Health Sciences Center
Denver
(Published in the Feb 1981 issue of the Western Journal of Medicine)
servations upon a new gastrointestinal syndrome,
which we shall refer to by the acronym HAFE
(high altitude flatus expulsion). This phenomenon
was most recently witnessed by us during an expedition
in the San Juan Mountains of southwestern
Colorado, with similar experiences during excursions
past. The syndrome is strictly associated
with ascent, and is characterized by an increase in
both the volume and the frequency of the passage
of flatus, which spontaneously occurs while climbing
to altitudes of 11,000 feet or greater. The
eructations (known to veteran back-packers as
"Rocky Mountain barking spiders") do not appear
to vary with exercise, but may well be closely
linked to diet.' The fact that the syndrome invariably
abated on descent leads us to postulate a
mechanism whereby the victim is afflicted by the
expansion of colonic gas at the decreased atmospheric
pressure of high altitude. This is somewhat
analogous to the rapid intravascular expansion of
nitrogen which afflicts deep-sea divers and triggers
decompression illness.
While not as catastrophic as barotrauma nor
as debilitating as HAPE (high altitude pulmonary
edema), HAFE nonetheless represents a significant
inconvenience to those who prefer to hike in company.
Some experience from recent Everest expeditions
suggests that the use of digestive enzymes
and simethicone may minimize the hazard.
At present, we can advise victims that the offense
is more sociologic than physiologic.
HAFE should be added to the growing list of
medical disorders that are associated with exposure
to high altitude. We are planning a prospective
study for the summer of 1981.
PAUL AUERBACH, MD
Assistant Professor of Medicine
Attending Physician, Emergency Services
Temple University Hospital
Philadelphia
YORK E. MILLER, MD
Research Fellow
Pulmonary Division
Department of Medicine
University of Colorado Health Sciences Center
Denver
(Published in the Feb 1981 issue of the Western Journal of Medicine)
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