Current Treatment Options in Gastroenterology

, Volume 8, Issue 4, pp 311–318 | Cite as

Bloating and intestinal gas

  • Michael P. Jones
Article

Opinion statement

The most common symptoms associated with intestinal gas are eructation, flatulence, abdominal bloating, and distention. Aerophagia is an uncommon cause of eructation in which repetitive air swallowing results in belching, abdominal distention, and increased flatus. Few therapies have been shown to be effective in treating these symptoms. Eructation can be treated by decreasing excessive air swallowing. Occasionally, behavioral therapy and psychotherapy are employed. Bloating, distention, and other gas-related symptoms are common in functional gastrointestinal disorders; however, their pathophysiology is poorly understood. Additionally, evidence supporting the use of various available therapies in treating gas-related symptoms is either absent or poor. Dietary therapy may be effective in patients with excessive gas production. Excessive gas production, identified by increased flatus, may benefit from a low-carbohydrate diet. Many patients with gas-related symptoms have normal gas production but may have either impaired gas transport or transit through the gut or visceral hypersensitivity. Few studies have addressed the treatment of impaired gas transport.

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References and Recommended Reading

  1. 1.
    Levitt MD: Volume and composition of human intestinal gas determined by means of an intestinal washout technic. N Engl J Med 1971, 284: 1394–1398.PubMedCrossRefGoogle Scholar
  2. 2.
    Serra J, Azpiroz F, Malagelada JR: Intestinal gas dynamics and tolerance in humans. Gastroenterology 1998, 115: 542–550.PubMedCrossRefGoogle Scholar
  3. 3.
    Suarez F, Levitt MD: Intestinal gas. In Sleisenger & Fordtran’s Gastrointestinal and Liver Disease:Pathophysiology/ Diagnosis/Management. Feldman M, Friedman LS, Sleisenger MH, eds. 7th ed. Philadelphia: W.B. Saunders Co, 2002: 155–163.Google Scholar
  4. 4.
    Serra J, Azpiroz F, Malagelada JR: Impaired transit and tolerance of intestinal gas in the irritable bowel syndrome. Gut 2001, 48: 14–19. An elegant study from an experienced group of researchers that builds on their previous work in this area. They demonstrate that gas production is normal in IBS but transit of gas is impaired perhaps due to a motor disorder.PubMedCrossRefGoogle Scholar
  5. 5.
    Maxton DG, Martin DF, Whorwell PJ, Godfrey M: Abdominal distension in female patients with irritable bowel syndrome: exploration of possible mechanisms. Gut 1991, 32: 662–664.PubMedGoogle Scholar
  6. 6.
    Koide A, Yamaguchi T, Odaka T, et al.: Quantitative analysis of bowel gas using plain abdominal radiograph in patients with irritable bowel syndrome. Am J Gastroenterol 2000, 95: 1735–1741.PubMedCrossRefGoogle Scholar
  7. 7.
    Chami TN, Schuster MM, Bohlman ME, et al.: A simple radiologic method to estimate the quantity of bowel gas. Am J Gastroenterol 1991, 86: 599–602.PubMedGoogle Scholar
  8. 8.
    Haderstorfer B, Psycholgin D, Whitehead WE, Schuster MM: Intestinal gas production from bacterial fermentation of undigested carbohydrate in irritable bowel syndrome. Am J Gastroenterol 1989, 84: 375–378.PubMedGoogle Scholar
  9. 9.
    King TS, Elia M, Hunter JO: Abnormal colonic fermentation in irritable bowel syndrome. Lancet 1998, 352: 1187–1189.PubMedCrossRefGoogle Scholar
  10. 10.
    Lasser RB, Bond JH, Levitt MD: The role of intestinal gas in functional abdominal pain. N Engl J Med 1975, 293: 524–526.PubMedCrossRefGoogle Scholar
  11. 11.
    Serra J, Azpiroz F, Malagelada JR: Mechanisms of intestinal gas retention in humans: impaired propulsion versus obstructed evacuation. Am J Physiol Gastrointest Liver Physiol 2001, 281: G138-G143. Another study from this experienced group demonstrating that retention of intestinal gas in some subjects may be due to impaired evacuation mechanics.PubMedGoogle Scholar
  12. 12.
    Gauderer MW, Halpin TC, Jr., Izant RJ, Jr: Pathologic childhood aerophagia: a recognizable clinical entity. J Pediatr Surg 1981, 16: 301–305.PubMedCrossRefGoogle Scholar
  13. 13.
    Rosenbach Y, Zahavi I, Nitzan M, Dinari G: Pathologic childhood aerophagy: an under-diagnosed entity. Eur J Pediatr 1988, 147: 422–423.PubMedCrossRefGoogle Scholar
  14. 14.
    Zella SJ, Geenens DL, Horst JN: Repetitive eructation as a manifestation of obsessive-compulsive disorder. Psychosomatics 1998, 39: 299–301.PubMedGoogle Scholar
  15. 15.
    D’Mello D: Aerophagia and depression: case report. J Clin Psychiatry 1983, 44: 387–388.PubMedGoogle Scholar
  16. 16.
    Rao SS: Belching, bloating, and flatulence. How to help patients who have troublesome abdominal gas. Postgrad Med 1997, 101: 263–269, 275–278.PubMedCrossRefGoogle Scholar
  17. 17.
    Barrett RP, McGonigle JJ, Ackles PK, Burkhart JE: Behavioral treatment of chronic aerophagia. Am J Ment Defic 1987, 91: 620–625.PubMedGoogle Scholar
  18. 18.
    Calloway SP, Fonagy P, Pounder RE, Morgan MJ: Behavioural techniques in the management of aerophagia in patients with hiatus hernia. J Psychosom Res 1983, 27: 499–502.PubMedCrossRefGoogle Scholar
  19. 19.
    Levitt MD, Furne J, Olsson S: The relation of passage of gas an abdominal bloating to colonic gas production. Ann Intern Med 1996, 124: 422–424.PubMedGoogle Scholar
  20. 20.
    Suarez FL, Springfield J, Levitt MD: Identification of gases responsible for the odour of human flatus and evaluation of a device purported to reduce this odour. Gut 1998, 43: 100–104.PubMedCrossRefGoogle Scholar
  21. 21.
    Di Stefano M, Miceli E, Armellini E, et al.: Probiotics and functional abdominal bloating. J Clin Gastroenterol 2004, 38(Suppl 6):S102-S103.PubMedCrossRefGoogle Scholar
  22. 22.
    Di Stefano M, Strocchi A, Malservisi S, et al.: Non-absorbable antibiotics for managing intestinal gas production and gas-related symptoms. Aliment Pharmacol Ther 2000, 14: 1001–1008.PubMedCrossRefGoogle Scholar
  23. 23.
    Lewis MJ, Reilly B, Houghton LA, Whorwell PJ: Ambulatory abdominal inductance plethysmography: towards objective assessment of abdominal distension in irritable bowel syndrome. Gut 2001, 48: 216–220.PubMedCrossRefGoogle Scholar
  24. 24.
    Azpiroz F, Enck P, Whitehead WE: Anorectal functional testing: review of collective experience. Am J Gastroenterol 2002, 97: 232–240.PubMedGoogle Scholar
  25. 25.
    Hernando-Harder AC, Serra J, Azpiroz F, Malagelada JR: Sites of symptomatic gas retention during intestinal lipid perfusion in healthy subjects. Gut 2004, 53: 661–665. An elegant study expanding on previous observations regarding gas trapping and digestive symptoms. Gas trapping occurs largely in the jejunum and is exacerbated by intraluminal lipid infusion particularly into the ileum.PubMedCrossRefGoogle Scholar
  26. 26.
    Lin HC, Chen JH: Slowing of intestinal transit by fat depends on an ondansetron-sensitive, efferent serotonergic pathway. Neurogastroenterol Motil 2003, 15: 317–322.PubMedCrossRefGoogle Scholar
  27. 27.
    Evans PR, Kellow JE: Physiological modulation of jejunal sensitivity in health and in irritable bowel syndrome. Am J Gastroenterol 1998, 93: 2191–2196.PubMedCrossRefGoogle Scholar
  28. 28.
    Kellow JE, Eckersley CM, Jones MP: Enhanced perception of physiological intestinal motility in the irritable bowel syndrome. Gastroenterology 1991, 101: 1621–1627.PubMedGoogle Scholar
  29. 29.
    Galati JS, McKee DP, Quigley EM: Response to intraluminal gas in irritable bowel syndrome. Motility versus perception. Dig Dis Sci 1995, 40: 1381–1387.PubMedCrossRefGoogle Scholar
  30. 30.
    Dainese R, Serra J, Azpiroz F, Malagelada JR: Influence of body posture on intestinal transit of gas. Gut 2003, 52: 971–974.PubMedCrossRefGoogle Scholar
  31. 31.
    Dainese R, Serra J, Azpiroz F, Malagelada JR: Effects of physical activity on intestinal gas transit and evacuation in healthy subjects. Am J Med 2004, 116: 536–539.PubMedCrossRefGoogle Scholar
  32. 32.
    Gonlachanvit S, Coleski R, Owyang C, Hasler W: Inhibitory actions of a high fibre diet on intestinal gas transit in healthy volunteers. Gut 2004, 53: 1577–1582. Healthy subjects consuming 30g of psyllium daily demonstrated delayed gas transit through the small intestine and colon. Delayed gas transit was attributed to decreased gas expulsion owing to decreased number of gas bolus passages but volume of expelled gas boluses were not changed.PubMedCrossRefGoogle Scholar
  33. 33.
    Suarez FL, Savaiano DA, Levitt MD: A comparison of symptoms after the consumption of milk or lactose-hydrolyzed milk by people with self-reported severe lactose intolerance. N Engl J Med 1995, 333: 1–4.PubMedCrossRefGoogle Scholar
  34. 34.
    Delgado-Aros S, Locke GR, 3rd, Camilleri M, et al.: Obesity is associated with increased risk of gastrointestinal symptoms: a population-based study. Am J Gastroenterol 2004, 99: 1801–1806.PubMedCrossRefGoogle Scholar
  35. 35.
    Talley NJ, Quan C, Jones MP, Horowitz M: Association of upper and lower gastrointestinal tract symptoms with body mass index in an Australian cohort. Neurogastroenterol Motil 2004, 16: 413–419.PubMedCrossRefGoogle Scholar
  36. 36.
    Caldarella MP, Serra J, Azpiroz F, Malagelada JR: Prokinetic effects in patients with intestinal gas retention. Gastroenterology 2002, 122: 1748–1755.PubMedCrossRefGoogle Scholar
  37. 37.
    Johanson JF, Wald A, Tougas G, et al.: Effect of tegaserod in chronic constipation: a randomized, double-blind, controlled trial. Clin Gastroenterol Hepatol 2004, 2: 796–805.PubMedCrossRefGoogle Scholar
  38. 38.
    Muller-Lissner SA, Fumagalli I, Bardhan KD, et al.: Tegaserod, a 5-HT(4) receptor partial agonist, relieves symptoms in irritable bowel syndrome patients with abdominal pain, bloating and constipation. Aliment Pharmacol Ther 2001, 15: 1655–1666.PubMedCrossRefGoogle Scholar
  39. 39.
    Poynard T, Regimbeau C, Benhamou Y: Meta-analysis of smooth muscle relaxants in the treatment of irritable bowel syndrome. Aliment Pharmacol Ther 2001, 15: 355–361.PubMedCrossRefGoogle Scholar
  40. 40.
    Ganiats TG, Norcross WA, Halverson AL, et al.: Does Beano prevent gas? A double-blind crossover study of oral alpha-galactosidase to treat dietary oligosaccharide intolerance. J Fam Pract 1994, 39: 441–445.PubMedGoogle Scholar
  41. 41.
    Rosado JL, Solomons NW, Lisker R, Bourges H: Enzyme replacement therapy for primary adult lactase deficiency. Effective reduction of lactose malabsorption and milk intolerance by direct addition of beta-galactosidase to milk at mealtime. Gastroenterology 1984, 87: 1072–1082.PubMedGoogle Scholar
  42. 42.
    Lisker R, Solomons NW, Perez Briceno R, Ramirez Mata M: Lactase and placebo in the management of the irritable bowel syndrome: a double-blind, cross-over study. Am J Gastroenterol 1989, 84: 756–762.PubMedGoogle Scholar
  43. 43.
    Brecevic L, Bosan-Kilibarda I, Strajnar F: Mechanism of antifoaming action of simethicone. J Appl Toxicol 1994, 14: 207–211.PubMedCrossRefGoogle Scholar
  44. 44.
    Holtmann G, Gschossmann J, Karaus M, et al.: Randomised double-blind comparison of simethicone with cisapride in functional dyspepsia. Aliment Pharmacol Ther 1999, 13: 1459–1465.PubMedCrossRefGoogle Scholar
  45. 45.
    Holtmann G, Gschossmann J, Mayr P, Talley NJ: A randomized placebo-controlled trial of simethicone and cisapride for the treatment of patients with functional dyspepsia. Aliment Pharmacol Ther 2002, 16: 1641–1648.PubMedCrossRefGoogle Scholar
  46. 46.
    Suarez FL, Furne J, Springfield J, Levitt MD: Failure of activated charcoal to reduce the release of gases produced by the colonic flora. Am J Gastroenterol 1999, 94: 208–212.PubMedCrossRefGoogle Scholar
  47. 47.
    Hills JM, Aaronson PI: The mechanism of action of peppermint oil on gastrointestinal smooth muscle. An analysis using patch clamp electrophysiology and isolated tissue pharmacology in rabbit and guinea pig. Gastroenterology 1991, 101: 55–65.PubMedGoogle Scholar
  48. 48.
    Spanier JA, Howden CW, Jones MP: A systematic review of alternative therapies in the irritable bowel syndrome. Arch Intern Med 2003, 163: 265–274.PubMedCrossRefGoogle Scholar
  49. 49.
    Liu JH, Chen GH, Yeh HZ, et al.: Enteric-coated peppermint-oil capsules in the treatment of irritable bowel syndrome: a prospective, randomized trial. J Gastroenterol 1997, 32: 765–768.PubMedCrossRefGoogle Scholar
  50. 50.
    Sen S, Mullan MM, Parker TJ, et al.: Effect of Lactobacillus plantarum 299v on colonic fermentation and symptoms of irritable bowel syndrome. Dig Dis Sci 2002, 47: 2615–2620.PubMedCrossRefGoogle Scholar
  51. 51.
    Nobaek S, Johansson ML, Molin G, et al.: Alteration of intestinal microflora is associated with reduction in abdominal bloating and pain in patients with irritable bowel syndrome. Am J Gastroenterol 2000, 95: 1231–1238.PubMedCrossRefGoogle Scholar
  52. 52.
    Kim HJ, Camilleri M, McKinzie S, et al.: A randomized controlled trial of a probiotic, VSL#3, on gut transit and symptoms in diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther 2003, 17: 895–904.PubMedCrossRefGoogle Scholar
  53. 53.
    Pimentel M, Chow EJ, Lin HC: Eradication of small intestinal bacterial overgrowth reduces symptoms of irritable bowel syndrome. Am J Gastroenterol 2000, 95: 3503–3506.PubMedCrossRefGoogle Scholar
  54. 54.
    Pimentel M, Chow EJ, Lin HC: Normalization of lactulose breath testing correlates with symptom improvement in irritable bowel syndrome. a double-blind, randomized, placebo-controlled study. Am J Gastroenterol 2003, 98: 412–419.PubMedGoogle Scholar
  55. 55.
    Di Stefano M, Malservisi S, Veneto G, et al.: Rifaximin versus chlortetracycline in the short-term treatment of small intestinal bacterial overgrowth. Aliment Pharmacol Ther 2000, 14: 551–556.PubMedCrossRefGoogle Scholar
  56. 56.
    Lea R, Houghton LA, Calvert EL, et al.: Gut-focused hypnotherapy normalizes disordered rectal sensitivity in patients with irritable bowel syndrome. Aliment Pharmacol Ther 2003, 17: 635–642.PubMedCrossRefGoogle Scholar
  57. 57.
    Houghton LA, Calvert EL, Jackson NA, et al.: Visceral sensation and emotion: a study using hypnosis. Gut 2002, 51: 701–704. Hypnotic suggestion was used to induce states of relaxation, anger or happiness in patients with IBS. Relaxation improved tolerance to rectal distension while anger decreased it. No changes in tone or compliance were seen. This interesting study highlights the importance of emotion as both an important variable and a therapeutic tool in th evaluation and treatment of patients with functional disorders.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2005

Authors and Affiliations

  • Michael P. Jones
    • 1
  1. 1.Division of GastroenterologyNorthwestern University Feinberg School of MedicineChicagoUSA

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