Background: Pathologic aerophagia (PA) is characterised by excessive swallowing of air resulting in significant abdominal distension or belching. This is a relatively rare condition in general population but has been reported in up to 8.8% of institutionalised patients with intellectual disability. In severe cases, this can cause volvulus and ileus, and even intestinal perforation. Currently, there is limited information on this potentially life-threatening condition, particularly for people with intellectual disability. In this study, we aim to present a literature of diagnosis and management of PA and describe a case of PA in an adult with intellectual disability and autism. Methods: A literature search of electronic database was performed using specific keywords. Results: Apart from a few small controlled trials on pharmacotherapy, most of the studies were case series or uncontrolled studies. The understanding on pathophysiology is incomplete but is thought to involve a reflex-induced movement of upper oesophageal sphincter and may be associated with anxiety or stress. A comprehensive history and physical examination as well as an abdominal radiograph may be helpful in diagnosis. Medications that are helpful include antacids, anti-reflux drugs and benzodiazepines. Surgical treatment may be required in severe cases. A case of an adult patient with intellectual disability and PA is discussed to highlight the challenges in diagnosis and management. Conclusions: PA is not uncommon in people with intellectual disability and can pose challenges in the assessment and management. Further studies are necessary to provide evidence-based treatment guidelines for the management of this condition particularly in patients with intellectual disability.