Bloating resident survival guide: Difference between revisions
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==Causes== | ==Causes== | ||
* The [[causes]] of [[abdominal]] [[bloating]] are numerous and are managed according to the underlying [[etiology]]:<ref name="Lacy Gabbard Crowell 2011 pp. 729–39">{{cite journal | last=Lacy | first=BE | last2=Gabbard | first2=SL | last3=Crowell | first3=MD | title=Pathophysiology, evaluation, and treatment of bloating: hope, hype, or hot air? | journal=Gastroenterology & hepatology | volume=7 | issue=11 | year=2011 | issn=1554-7914 | pmid=22298969 | pmc=3264926 | pages=729–39}}</ref><ref name="Malagelada Accarino Azpiroz 2017 pp. 1221–1231">{{cite journal | last=Malagelada | first=Juan R | last2=Accarino | first2=Anna | last3=Azpiroz | first3=Fernando | title=Bloating and Abdominal Distension: Old Misconceptions and Current Knowledge | journal=The American journal of gastroenterology | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=112 | issue=8 | year=2017 | issn=0002-9270 | pmid=28508867 | doi=10.1038/ajg.2017.129 | pages=1221–1231}}</ref> | *The [[causes]] of [[abdominal]] [[bloating]] are numerous and are managed according to the underlying [[etiology]]:<ref name="Lacy Gabbard Crowell 2011 pp. 729–39">{{cite journal | last=Lacy | first=BE | last2=Gabbard | first2=SL | last3=Crowell | first3=MD | title=Pathophysiology, evaluation, and treatment of bloating: hope, hype, or hot air? | journal=Gastroenterology & hepatology | volume=7 | issue=11 | year=2011 | issn=1554-7914 | pmid=22298969 | pmc=3264926 | pages=729–39}}</ref><ref name="Malagelada Accarino Azpiroz 2017 pp. 1221–1231">{{cite journal | last=Malagelada | first=Juan R | last2=Accarino | first2=Anna | last3=Azpiroz | first3=Fernando | title=Bloating and Abdominal Distension: Old Misconceptions and Current Knowledge | journal=The American journal of gastroenterology | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=112 | issue=8 | year=2017 | issn=0002-9270 | pmid=28508867 | doi=10.1038/ajg.2017.129 | pages=1221–1231}}</ref> | ||
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! style="background:#4479BA; color: #FFFFFF;" align="center" + |Misc. | ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Misc. | ||
|- | |- | ||
|[[Adhesions | | | ||
* [[Adhesions]] | |||
[[Scleroderma]] | * [[Malignancy]] | ||
| | |||
Pseudo-obstruction | * [[Diabetes]] | ||
* [[Scleroderma]] | |||
Medications | * Pseudo-[[obstruction]] | ||
|[[Lactose intolerance]] | * [[Medications]] | ||
[[Fructose intolerance]] | | | ||
* [[Lactose intolerance]] | |||
[[Celiac disease]] | * [[Fructose intolerance]] | ||
* [[Celiac disease]] | |||
[[Pancreatic insufficiency]] | * [[Pancreatic insufficiency]] | ||
|[[Small intestinal bacterial overgrowth]] | | | ||
[[Giardiasis]] | * [[Small intestinal bacterial overgrowth]] | ||
|Gas-producing foods | * [[Giardiasis]] | ||
| | |||
|[[Irritable bowel syndrome]] <br /> | * [[Gas]]-producing [[Food|foods]] | ||
* [[FODMAP]]<nowiki/>s | |||
| | |||
* [[Irritable bowel syndrome]] <br /> | |||
|} | |} | ||
Revision as of 19:21, 18 February 2021
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Usman Ali Akbar, M.B.B.S.[2]
Synonyms and keywords:Approach to abdominal bloating, Approach to abdominal belching, Approach to flatulence, Use of FODMAPs.
| Bloating resident survival guide Microchapters |
|---|
| Overview |
| Causes |
| FIRE |
| Diagnosis |
| Treatment |
| Do's |
| Don'ts |
Overview
Bloating is one of the most common gastrointestinal complaints that is attributed by the patient as the subjective sensation of incorrectly perceived excess gas. There are multiple non-functional etiologies of abdominal bloating and distension. Primary functional abdominal distension (FABD) should be diagnosed as a single entity and it doesn't overlap with other functional gastrointestinal disorders. Rome IV diagnostic criteria mentions the co-existence of mild abdominal pain and/or minor bowel movements. FABD can be treated with antispasmodic along with peppermint oil in randomized controlled trials. A stepwise approach is usually needed that includes the dietary interventions, microbiome modulation, and medical therapy in the management of FABD.
Causes
- The causes of abdominal bloating are numerous and are managed according to the underlying etiology:[1][2]
| Intestinal Disorders | Motility Disorders | Malabsorption disorders | Infectious causes | Dietary causes | Misc. |
|---|---|---|---|---|---|
Complete Diagnostic Approach
Shown below is an algorithm summarizing the diagnosis of abdominal bloating according to American College of Gastroenterology guidelines.[3][4]
| Patient with abdominal bloating and Distention | |||||||||||||||||
Look for the
| |||||||||||||||||
| Yes | No | ||||||||||||||||
* Reassurance the patient, recommend diaphragmatic breathing
| Treat Accordingly | ||||||||||||||||
| *Trial of Rifaximin/Probiotics | |||||||||||||||||
| No Response | |||||||||||||||||
Antidepressants
| |||||||||||||||||
| No Response | |||||||||||||||||
*Referral to specialized Neurogastroenterology center
| |||||||||||||||||
Treatment
Shown below is an algorithm summarizing the treatment of abdominal bloating according the the American College of Gastroenterology guidelines.[5]
| Treatment of bloating is based on etiology of bloating. | |||||||||||||||||||||||||||||||||||||||
Dietary changes are suggested for bloating
Are any warning signs present?
| |||||||||||||||||||||||||||||||||||||||
| Yes | No | ||||||||||||||||||||||||||||||||||||||
Treat accordingly
| Functional? | ||||||||||||||||||||||||||||||||||||||
| Constipation | Functional dyspepsia | Non-constipation IBS | Bloating alone | ||||||||||||||||||||||||||||||||||||
Lifestyle and nonspecific dietary advice.
| |||||||||||||||||||||||||||||||||||||||
Do's
- Use of probiotics can help reduce bloating.
- Antidepressants can help to reduce the symptoms of IBS but the data is unclear over the reduction of bloating.[7]
- Hypnotherapy has been reported to be useful in reducing symptoms of bloating.
- Bowel training and diaphragmatic breathing have been useful in the management of bloating however the data is unclear.
Don'ts
- Artificial sweeteners containing sorbitol, mannitol, xylitol should be avoided.[8]
- Medications (anticholinergics, opiates, calcium channel blockers, antidepressants) should also be avoided as they have an effect on bloating.[9]
- 20% of carbohydrates in baked beans and 7–10% in wheat, oats, potatoes, and corn, and 1% in white rice are not absorbed well in the intestine and they can predispose to bloating.
References
- ↑ Lacy, BE; Gabbard, SL; Crowell, MD (2011). "Pathophysiology, evaluation, and treatment of bloating: hope, hype, or hot air?". Gastroenterology & hepatology. 7 (11): 729–39. ISSN 1554-7914. PMC 3264926. PMID 22298969.
- ↑ Malagelada, Juan R; Accarino, Anna; Azpiroz, Fernando (2017). "Bloating and Abdominal Distension: Old Misconceptions and Current Knowledge". The American journal of gastroenterology. Ovid Technologies (Wolters Kluwer Health). 112 (8): 1221–1231. doi:10.1038/ajg.2017.129. ISSN 0002-9270. PMID 28508867.
- ↑ Foley, A; Burgell, R; Barrett, JS; Gibson, PR (2014). "Management Strategies for Abdominal Bloating and Distension". Gastroenterology & Hepatology. 10 (9): 561–571. PMC 4991532. PMID 27551250.
- ↑ Lacy, Brian E.; Cangemi, David; Vazquez-Roque, Maria (2021). "Management of Chronic Abdominal Distension and Bloating". Clinical Gastroenterology and Hepatology. Elsevier BV. 19 (2): 219–231.e1. doi:10.1016/j.cgh.2020.03.056. ISSN 1542-3565.
- ↑ Schmulson, M.; Chang, L. (2011-03-29). "Review article: the treatment of functional abdominal bloating and distension". Alimentary Pharmacology & Therapeutics. Wiley. 33 (10): 1071–1086. doi:10.1111/j.1365-2036.2011.04637.x. ISSN 0269-2813.
- ↑ Altobelli, Emma; Del Negro, Valerio; Angeletti, Paolo; Latella, Giovanni (2017-08-26). "Low-FODMAP Diet Improves Irritable Bowel Syndrome Symptoms: A Meta-Analysis". Nutrients. MDPI AG. 9 (9): 940. doi:10.3390/nu9090940. ISSN 2072-6643.
- ↑ Seo, A Young; Kim, Nayoung; Oh, Dong Hyun (2013-10-31). "Abdominal Bloating: Pathophysiology and Treatment". Journal of Neurogastroenterology and Motility. The Korean Society of Neurogastroenterology and Motility. 19 (4): 433–453. doi:10.5056/jnm.2013.19.4.433. ISSN 2093-0879.
- ↑ Kamphuis, Jasper B.J.; Guiard, Bruno; Leveque, Mathilde; Olier, Maiwenn; Jouanin, Isabelle; Yvon, Sophie; Tondereau, Valerie; Rivière, Pauline; Guéraud, Françoise; Chevolleau, Sylvie; Noguer-Meireles, Maria-Helena; Martin, Jean- François; Debrauwer, Laurent; Eutamène, Helene; Theodorou, Vassilia (2020). "Lactose and Fructo-oligosaccharides Increase Visceral Sensitivity in Mice via Glycation Processes, Increasing Mast Cell Density in Colonic Mucosa". Gastroenterology. Elsevier BV. 158 (3): 652–663.e6. doi:10.1053/j.gastro.2019.10.037. ISSN 0016-5085.
- ↑ Mari, Amir; Abu Backer, Fadi; Mahamid, Mahmud; Amara, Hana; Carter, Dan; Boltin, Doron; Dickman, Ram (2019-03-16). "Bloating and Abdominal Distension: Clinical Approach and Management". Advances in Therapy. Springer Science and Business Media LLC. 36 (5): 1075–1084. doi:10.1007/s12325-019-00924-7. ISSN 0741-238X.