Bloating resident survival guide

Bloating resident survival guide Microchapters
Overview
Causes
FIRE
Diagnosis
Treatment
Do's
Don'ts

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:

Overview

Bloating is one of the most common gastrointestinal complaint that is attributed by the patient as subjective sensation of incorrectly perceived excess gas. There are multiple non-functional etiologies of abdominal bloating and distention. Primary functional abdominal distention (FABD) should be diagnosed as single entity and it doesn't overlap with other functional gastro-intestinal 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 counter 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 etiology.

Causes of Abdominal Bloating
Intestinal Disorders	Motility Disorders	Malabsorption disorders	Infectious causes	Dietary causes	Misc.
Adhesions Malignancy	Diabetes Scleroderma Pseudo-obstruction Medications	Lactose intolerance Fructose intolerance Celiac disease Pancreatic insufficiency	Small intestinal bacterial overgrowth Giardiasis	Gas-producing foods FODMAPs	Irritable bowel syndrome

Complete Diagnostic Approach

Shown below is an algorithm summarizing the diagnosis of [[disease name]] according [...] guidelines.

Patient with abdominal bloating and Distention

Look for the

Alarm signs
Overlapping functional gastrointestinal disorders
Bacterial overgrowth (Small intestine bacterial overgrowth)
Dietary intolerances
Celiac Disease
Weight gain
Constipation
Any pyschological comorbidities

Yes

No

* Reassurance the patient, recommend diaphragmatic breathing

Diet intervention: Low FODMAP diet
Iniate sympotmatic treatment such as peppermint oil or Simethicone

Treat Accordingly

*Trial of Rifaximin/Probiotics

No Response

Antidepressants

Psychological therapy
Hypnotherapy, Cognitive behavioral therapy (CBT)

No Response

*Referral to specialized Neurogastroenterology center

Referral for the CT/MRI Electromyography
Referral for the abdominal biofeedback therapy)

Treatment

Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.

Do's

The content in this section is in bullet points.

Don'ts

The content in this section is in bullet points.

References