Techniques in Coloproctology

, Volume 17, Issue 4, pp 405–410 | Cite as

Colonic gas transit in patients with bloating: the effect of an electromechanical stimulator of the abdominal wall

  • F. Tremolaterra
  • A. Pascariello
  • S. Gallotta
  • C. Ciacci
  • P. Iovino
Original Article



The aim of our study was to evaluate gas retention, abdominal symptoms and changes in girth circumference in females with bloating using an active or sham abdominal wall mechanical stimulation.


In 14 female patients, complaining of bloating (11 with irritable bowel syndrome and 3 with functional bloating according to the Rome III criteria) a gas mixture was continuously infused into the colon for 1 h (accommodation period). Abdominal perception and girth were measured. At the beginning of the 30-min period of free rectal gas evacuation (clearance period), an electromechanical device was positioned on the abdominal wall of all patients. The patients were randomly assigned to an active or a sham stimulation protocol group. Gas retention, perception and abdominal distension were measured at the end of the clearance period.


All patients tolerated the volume (1,440 ml) of gas infused into the colon. Abdominal perception and girth measurements was similar in both groups during the accommodation period. At the end of the clearance, the perception score and the girth changes in the active and sham stimulation groups were similar (2.8 ± 2.0 vs. 1.4 ± 1.2, p = 0.2 and 4.9 ± 4.5 vs. 2.8 ± 2.3 mm, p = 0.3 active vs. sham, respectively). Furthermore, the mechanical stimulation of the abdominal wall did not significantly reduce gas retention (495 ± 101 ml vs. 566 ± 55, active vs. sham, p = 0.1).


An external mechanical massage of the abdominal wall did not improve intestinal gas transit, abdominal perception and abdominal distension in our female patients complaining of functional bloating.


Irritable bowel syndrome Intestinal gas Functional bowel disorders Functional bloating Colon function Physiopathology Rome III criteria 


Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Whorwell PJ (2000) The problem of gas in the irritable bowel syndrome. Am J Gastroenterol 95:1618–1619PubMedCrossRefGoogle Scholar
  2. 2.
    Chang L, Lee OY, Naliboff B, Schmulson M, Mayer LA (2001) Sensation of bloating and visible abdominal distension in patients with irritable bowel syndrome. Am J Gastroenterol 96:3341–3347PubMedCrossRefGoogle Scholar
  3. 3.
    Hungin AP, Whorwell PJ, Tack J, Mearin F (2003) The prevalence, patterns and impact of irritable bowel syndrome: an international survey of 40,000 subjects. Aliment Pharmacol Ther 17:643–650PubMedCrossRefGoogle Scholar
  4. 4.
    Caldarella MP, Serra J, Azpiroz F, Malagelada JR (2002) Prokinetic effects of neostigmine in patients with intestinal gas retention. Gastroenterology 122:1748–1755PubMedCrossRefGoogle Scholar
  5. 5.
    Serra J, Azpiroz F, Malagelada JR (2001) Impaired transit and tolerance of intestinal gas in the irritable bowel syndrome. Gut 48:14–19PubMedCrossRefGoogle Scholar
  6. 6.
    Salvioli B, Serra J, Azpiroz F et al (2005) Origin of gas retention and symptoms in patients with bloating. Gastroenterology 128:574–579PubMedCrossRefGoogle Scholar
  7. 7.
    Hernando-Harder AC, Serra J, Azpiroz F et al (2010) Colonic responses to gas loads in subgroups of patients with abdominal bloating. Am J Gastroenterol 105:876–882PubMedCrossRefGoogle Scholar
  8. 8.
    Tremolaterra F, Villoria A, Azpiroz F, Serra J, Aguadé S, Malagelada JR (2006) Impaired viscerosomatic reflexes and abdominal wall dystony associated with bloating. Gastroenterology 130:1062–1068PubMedCrossRefGoogle Scholar
  9. 9.
    Villoria A, Azpiroz F, Burri E, Cisternas D, Soldevilla A, Malagelada JR (2011) Abdomino-phrenic dyssynergia in patients with abdominal bloating and distension. Am J Gastroenterol 106:815–819PubMedCrossRefGoogle Scholar
  10. 10.
    Accarino A, Perez F, Azpiroz F, Quiroga S, Malagelada JR (2009) Abdominal distension results from caudo-ventral redistribution of contents. Gastroenterology 136:1544–1551PubMedCrossRefGoogle Scholar
  11. 11.
    Coleski R, Owyang C, Hasler WL (2006) Modulation of intestinal gas dynamics in healthy human volunteers by the 5-HT receptor agonist tegaserod. Am J Gastroenterol 101:1858–1865PubMedCrossRefGoogle Scholar
  12. 12.
    Dainese R, Serra J, Azpiroz F, Malagelada JR (2004) Effects of physical activity on intestinal gas transit and evacuation in healthy subject. Am J Med 116:536–539PubMedCrossRefGoogle Scholar
  13. 13.
    Villoria A, Serra J, Azpiroz F, Malagelada JR (2006) Physical activity and intestinal gas clearance in patients with bloating. Am J Gastroenterol 101:2552–2557PubMedCrossRefGoogle Scholar
  14. 14.
    Keeling WF, Martin BJ (1987) Gastrointestinal transit during mild exercise. J Appl Physiol 63:978–981PubMedGoogle Scholar
  15. 15.
    Oettle GJ (1991) Effect of moderate exercise on bowel habit. Gut 32:941–944PubMedCrossRefGoogle Scholar
  16. 16.
    Cheskin LJ, Crowell MD, Kamal N, Rosen B, Schuster MM, Whitehead WE (1992) The effects of acute exercise on colonic motility. Neurogastroenterol Motil 4:173–177CrossRefGoogle Scholar
  17. 17.
    Rao SS, Beaty J, Chamberlain MJ, Lambert PG, Gisolfi C (1999) Effects of acute graded exercise on human colonic motility. Am J Physiol 276:G1221–G1226PubMedGoogle Scholar
  18. 18.
    Mimidis K, Galinsky D, Rimon E, Papadopoulo V, Zickerman Y, Oreopolous D (2005) Use of a device that applies external kneading-like force on the abdomen for treatment of constipation. World J Gastroenterol 11:1971–1975PubMedGoogle Scholar
  19. 19.
    Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC (2006) Functional bowel disorders. Gastroenterology 130:1480–1491PubMedCrossRefGoogle Scholar
  20. 20.
    Foster RE (1968) Physiological basis of gas exchange in the gut. Ann N Y Acad Sci 150:4–12CrossRefGoogle Scholar
  21. 21.
    Pogrund RS, Steggerda FR (1948) Influence of gaseous transfer between the colon and blood stream on percentage gas compositions of intestinal flatus in man. Am J Physiol 153:475–482PubMedGoogle Scholar
  22. 22.
    Iovino P, Tremolaterra F, Boccia G, Miele E, Ruju FM, Staiano A (2009) Irritable bowel syndrome in childhood: visceral hypersensitivity and psychosocial aspects. Neurogastroenterol Motil 21:940–974PubMedCrossRefGoogle Scholar
  23. 23.
    Serra J, Azpiroz F, Malagelada JR (1998) Intestinal gas dynamics and tolerance in humans. Gastroenterology 115:542–550PubMedCrossRefGoogle Scholar
  24. 24.
    Passos MC, Serra J, Azpiroz F, Tremolaterra F, Malagelada JR (2005) Impaired reflex control of intestinal gas transit in patients with abdominal bloating. Gut 54:344–348PubMedCrossRefGoogle Scholar
  25. 25.
    Salvioli B, Serra J, Azpiroz F, Malagelada JR (2006) Impaired small bowel gas propulsion in patients with bloating during intestinal lipid infusion. Am J Gastroenterol 101:1853–1857PubMedCrossRefGoogle Scholar
  26. 26.
    Serra J, Azpiroz F, Malagelada JR (2001) Mechanisms of intestinal gas retention in humans: impaired propulsion versus obstructed evacuation. Am J Physiol 281:G138–G143Google Scholar
  27. 27.
    Dainese R, Serra J, Azpiroz F, Malagelada JR (2003) Influence of body posture on intestinal transit of gas. Gut 52:971–974PubMedCrossRefGoogle Scholar
  28. 28.
    Tremolaterra F, Villoria A, Serra J, Azpiroz F, Malagelada JR (2006) Intestinal tone and gas motion. Neurogastroenterol Motil 18:905–910PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2012

Authors and Affiliations

  • F. Tremolaterra
    • 1
  • A. Pascariello
    • 2
  • S. Gallotta
    • 3
  • C. Ciacci
    • 3
  • P. Iovino
    • 3
  1. 1.IRCCSCentro di Riferimento Oncologico di BasilicataRionero in VultureItaly
  2. 2.Department of General SurgeryFederico II University of NaplesNaplesItaly
  3. 3.Department of Medicine and Surgery, Gastrointestinal UnitUniversity of SalernoBaronissiItaly

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