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The American Journal of Gastroenterology Aug 2017Bloating, as a symptom and abdominal distension, as a sign, are both common functional-type complaints and challenging to manage effectively. Individual patients may... (Review)
Review
Bloating, as a symptom and abdominal distension, as a sign, are both common functional-type complaints and challenging to manage effectively. Individual patients may weight differently the impact of bloating and distension on their well-being. Complaints may range from chronic highly distressing pain to simply annoying and unfashionable protrusion of the abdomen. To avoid mishaps, organic bloating, and distension should always be considered first and appropriated assessed. Functional bloating and distension often present in association with other manifestations of irritable bowel syndrome or functional dyspepsia and in that context patients tend to regard them as most troublesome. A mechanism-based management bloating and distension should be ideal but elucidating key operational mechanisms in individual patients is not always feasible. Some clues may be gathered through a detailed dietary history, by assessing bowel movement frequency and stool consistency and special imaging technique to measure abdominal shape during episodes of distension. In severe, protracted cases it may be appropriate to refer the patient to a specialized center where motility, visceral sensitivity, and abdominal muscle activity in response to intraluminal stimuli may be measured. Therapeutic resources focussed upon presumed or demonstrated pathogenetic mechanism include dietary modification, microbiome modulation, promoting gas evacuation, attenuating visceral perception, and controlling abdominal wall muscle activity via biofeedback.
Topics: Abdominal Wall; Constipation; Dilatation, Pathologic; Dyspepsia; Flatulence; Gastrointestinal Diseases; Humans; Irritable Bowel Syndrome
PubMed: 28508867
DOI: 10.1038/ajg.2017.129 -
World Journal of Gastroenterology Oct 2014Bloating is one of the most common and bothersome symptoms complained by a large proportion of patients. This symptom has been described with various definitions, such... (Review)
Review
Bloating is one of the most common and bothersome symptoms complained by a large proportion of patients. This symptom has been described with various definitions, such as sensation of a distended abdomen or an abdominal tension or even excessive gas in the abdomen, although bloating should probably be defined as the feeling (e.g. a subjective sensation) of increased pressure within the abdomen. It is usually associated with functional gastrointestinal disorders, like irritable bowel syndrome, but when bloating is not part of another functional bowel or gastrointestinal disorder it is included as an independent entity in Rome III criteria named functional bloating. In terms of diagnosis, major difficulties are due to the lack of measurable parameters to assess and grade this symptom. In addition, it is still unclear to what extent the individual patient complaint of subjective bloating correlates with the objective evidence of abdominal distension. In fact, despite its clinical, social and economic relevance, bloating lacks a clear pathophysiology explanation, and an effective management endorsement, turning this common symptom into a true challenge for both patients and clinicians. Different theories on bloating etiology call into questions an increased luminal contents (gas, stools, liquid or fat) and/or an impaired abdominal empting and/or an altered intra-abdominal volume displacement (abdomino-phrenic theory) and/or an increased perception of intestinal stimuli with a subsequent use of empirical treatments (diet modifications, antibiotics and/or probiotics, prokinetic drugs, antispasmodics, gas reducing agents and tricyclic antidepressants). In this review, our aim was to review the latest knowledge on bloating physiopathology and therapeutic options trying to shed lights on those processes where a clinician could intervene to modify disease course.
Topics: Animals; Enteric Nervous System; Gastrointestinal Agents; Gastrointestinal Diseases; Gastrointestinal Motility; Gastrointestinal Tract; Humans; Mechanotransduction, Cellular; Pressure; Sensory Thresholds; Terminology as Topic; Treatment Outcome
PubMed: 25339827
DOI: 10.3748/wjg.v20.i39.14407 -
Journal of Neurogastroenterology and... Oct 2013Abdominal bloating is a very common and troublesome symptom of all ages, but it has not been fully understood to date. Bloating is usually associated with functional... (Review)
Review
Abdominal bloating is a very common and troublesome symptom of all ages, but it has not been fully understood to date. Bloating is usually associated with functional gastrointestinal disorders or organic diseases, but it may also appear alone. The pathophysiology of bloating remains ambiguous, although some evidences support the potential mechanisms, including gut hypersensitivity, impaired gas handling, altered gut microbiota, and abnormal abdominal-phrenic reflexes. Owing to the insufficient understanding of these mechanisms, the available therapeutic options are limited. However, medical treatment with some prokinetics, rifaximin, lubiprostone and linaclotide could be considered in the treatment of bloating. In addition, dietary intervention is important in relieving symptom in patients with bloating.
PubMed: 24199004
DOI: 10.5056/jnm.2013.19.4.433 -
Journal of Clinical Gastroenterology Jul 1994Ten to 25% of healthy persons have bloating at some time or other. It is very common in those with the irritable bowel syndrome, constipation, or anorexia nervosa.... (Review)
Review
Ten to 25% of healthy persons have bloating at some time or other. It is very common in those with the irritable bowel syndrome, constipation, or anorexia nervosa. Although the cause of functional bloating remains unknown, old explanations such as a low diaphragm, exaggerated lumbar lordosis, and psychiatric problems have been disproved. New suggestions on its etiology include recent weight gain, weak abdominal muscles, and retained fluid in loops of small intestine. No treatment is of proven benefit, but treatment by weight loss, exercise, and prokinetics should be studied.
Topics: Abdomen; Colonic Diseases, Functional; Dyspepsia; Female; Gastrointestinal Diseases; Humans; Male; Obesity; Premenstrual Syndrome; Prevalence; Somatoform Disorders
PubMed: 7930428
DOI: 10.1097/00004836-199407000-00007 -
The Veterinary Clinics of North... Mar 2022Gastric dilatation and volvulus (GDV) is an acute, life-threatening syndrome of dogs, particularly large and giant breeds with a deep chest conformation. Rapid diagnosis... (Review)
Review
Gastric dilatation and volvulus (GDV) is an acute, life-threatening syndrome of dogs, particularly large and giant breeds with a deep chest conformation. Rapid diagnosis is important for prompt initiation of stabilization therapy and surgical correction. Negative prognostic factors include hyperlactatemia not responding to fluid therapy, gastric perforation, or need for splenectomy or gastric resection. Gastropexy is essential for all dogs affected by GDV, following correct gastric repositioning. Prophylactic gastropexy for at-risk breeds can be performed via minimally invasive laparoscopic surgery.
Topics: Animals; Dog Diseases; Dogs; Gastric Dilatation; Gastropexy; Intestinal Volvulus; Stomach Volvulus
PubMed: 35082096
DOI: 10.1016/j.cvsm.2021.11.004 -
Gastroenterology Sep 2023Bloating is a common symptom in the general population and among disorders of gut-brain interaction, although its prevalence has not been well characterized. The aim of...
BACKGROUND & AIMS
Bloating is a common symptom in the general population and among disorders of gut-brain interaction, although its prevalence has not been well characterized. The aim of this study was to report the prevalence of bloating as a symptom in the worldwide population and to identify factors associated with this symptom in the general population.
METHODS
Rome Foundation Global Epidemiology Study internet survey data were analyzed. After excluding respondents with potential organic causes of bowel symptoms, the current analysis included 51,425 individuals in 26 countries. Data included diet, medical history, quality of life, and Rome IV diagnostic questions. Presence of bloating was defined as experiencing bloating at least once per week for the last 3 months. Descriptive statistics estimated prevalence by country, region, and disorder of gut-brain interaction diagnosis. Logistic regression evaluated predictors of bloating.
RESULTS
Nearly 18% of the global study population reported bloating (ranging from 11% in East Asia to 20% in Latin America). Prevalence decreased with age and women were approximately twice as likely as men to report bloating. More than one-half of respondents who reported weekly epigastric pain (71.39%), nausea (59.7%), or abdominal pain (61.69%) also reported bloating at least once per week. In logistic regression, the strongest associations were with abdominal pain (odds ratio, 2.90) and epigastric pain (odds ratio, 2.07).
CONCLUSIONS
Bloating is common throughout the world. Nearly 18% of the general population experience bloating at least once per week. Reported bloating prevalence is lower in older age groups, most common in women, and strongly associated with abdominal pain.
Topics: Male; Humans; Female; Aged; Irritable Bowel Syndrome; Constipation; Prevalence; Quality of Life; Rome; Abdominal Pain; Flatulence; Surveys and Questionnaires
PubMed: 37315866
DOI: 10.1053/j.gastro.2023.05.049 -
Singapore Medical Journal Sep 2016Irritable bowel syndrome (IBS) is a common functional bowel disorder. Up to 96% of IBS patients experience bloating, resulting in poor response to conventional therapies... (Review)
Review
Irritable bowel syndrome (IBS) is a common functional bowel disorder. Up to 96% of IBS patients experience bloating, resulting in poor response to conventional therapies and high consultation rates. Many IBS patients report that food triggers symptoms, particularly diets with poorly absorbed, short-chain carbohydrates, and restrict intake of certain foods to control their symptoms. IBS patients are especially susceptible to an attack due to visceral hypersensitivity. An emerging therapeutic strategy excludes fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) from the diet. There is evidence supporting the efficacy of a low FODMAP diet in improving symptoms of bloating in IBS patients. Individualised, structured dietary guidance may benefit those with persistent troublesome symptoms despite traditional therapies. In view of the multifactorial aetiology of the condition, it is probably best to use a multipronged approach, involving combination therapies, to address bloating in IBS patients.
Topics: Diet; Disaccharides; Fermentation; Humans; Irritable Bowel Syndrome; Monosaccharides; Nutrition Policy; Oligosaccharides; Polymers; Quality of Life; Severity of Illness Index
PubMed: 27664186
DOI: 10.11622/smedj.2016152 -
Alimentary Pharmacology & Therapeutics Nov 2002Bloating is a frequently reported symptom in functional bowel disorders. It usually occurs in combination with other symptoms, but may also occur in isolation. The... (Review)
Review
Bloating is a frequently reported symptom in functional bowel disorders. It usually occurs in combination with other symptoms, but may also occur in isolation. The severity of bloating tends to worsen during the course of the day and improves overnight. Although frequently considered to be a subjective phenomenon, recent studies have shown that bloating is associated with a measurable increase in abdominal girth. The pathophysiology of bloating remains elusive, but the evidence supports a sensorimotor dysfunction of the bowel. The possible mechanisms include abnormal gas trapping, fluid retention, food intolerance and altered gut microbial flora. Further studies are needed to define the sensorimotor abnormalities associated with bloating, which might be segmental and transient rather than generalized and persistent. The lack of understanding of this symptom is paralleled by a limited availability of therapeutic options. Conventional medications used in functional bowel disorders are not helpful and may indeed worsen the symptoms. In future, new drugs with activity against serotonin and kappa receptors, or novel approaches such as the use of exclusion diets, probiotics and hypnotherapy, may prove to be useful.
Topics: Abdomen; Colonic Diseases, Functional; Gases; Gastrointestinal Motility; Humans; Intestines
PubMed: 12390095
DOI: 10.1046/j.1365-2036.2002.01369.x -
Alimentary Pharmacology & Therapeutics Jul 2021Although bloating is a highly prevalent and troublesome symptom in irritable bowel syndrome with constipation (IBS-C), treatment is empirical with no specific guidelines... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Although bloating is a highly prevalent and troublesome symptom in irritable bowel syndrome with constipation (IBS-C), treatment is empirical with no specific guidelines for its management.
AIM
To conduct a pairwise and network meta-analysis, using a frequentist approach, of Food and Drug Administration-licensed drugs for IBS-C comparing their efficacy for abdominal bloating as a specific endpoint.
METHODS
We searched the medical literature through December 2020 to identify randomised controlled trials (RCTs) in IBS-C, with abdominal bloating reported as a dichotomous assessment. Efficacy of each drug was reported as a pooled relative risk (RR) with 95% confidence intervals (CIs) to summarise effect of each comparison tested. Treatments were ranked according to their P-score.
RESULTS
We identified 13 eligible RCTs, containing 10 091 patients. Linaclotide 290 µg o.d., lubiprostone 8 µg b.d., tenapanor 50 mg b.d. and tegaserod 6 mg b.d. were all superior to placebo for abdominal bloating in patients with IBS-C, in both pairwise and the network meta-analyses. Linaclotide demonstrated the greatest improvement in abdominal bloating in both pairwise and network meta-analysis (RR of failure to achieve an improvement in abdominal bloating = 0.78; 95% CI 0.74-0.83, number needed to treat = 7, P-score 0.97). Indirect comparison revealed no significant differences between individual drugs.
CONCLUSIONS
We found all licensed drugs for IBS-C to be superior to placebo for abdominal bloating. Linaclotide appeared to be the most efficacious at relieving abdominal bloating. Further research is needed to assess long-term efficacy of these agents and to better understand the precise mechanism of improving bloating.
Topics: Constipation; Flatulence; Humans; Irritable Bowel Syndrome; Lubiprostone; Pharmaceutical Preparations; Treatment Outcome
PubMed: 34114657
DOI: 10.1111/apt.16437 -
Alimentary Pharmacology & Therapeutics May 2011Abdominal bloating and distension are common symptoms in patients with functional gastrointestinal disorders (FGIDs), however, relatively little is known about their... (Review)
Review
BACKGROUND
Abdominal bloating and distension are common symptoms in patients with functional gastrointestinal disorders (FGIDs), however, relatively little is known about their treatment.
AIM
To review the treatment trials for abdominal bloating and distension.
METHODS
A literature review in Medline for English-language publications through February 2010 of randomised, controlled treatment trials in adults. Study quality was assessed according to Jadad's score.
RESULTS
Of the 89 studies reviewed, 18% evaluated patients with functional dyspepsia, 61% with irritable bowel syndrome (IBS), 10% with chronic constipation and 10% with other FGIDs. No studies were conducted in patients diagnosed with functional abdominal bloating. The majority of trials investigated the efficacy of prokinetics or probiotics, although studies are heterogeneous with respect to diagnostic criteria and outcome measures. In general, bloating and/or distension were evaluated as secondary endpoints or as individual symptoms as part of a composite score rather than as primary endpoints. A greater proportion of IBS patients with constipation reported improvement in bloating with tegaserod vs. placebo (51% vs. 40%, P<0.0001) and lubiprostone (P<0.001). A greater proportion of nonconstipating IBS patients reported adequate relief of bloating with rifaximin vs. placebo (40% vs. 30%, P<0.001). Bloating was significantly reduced with the probiotics, Bifidobacterium infantis 35624 (1×10(8) dose vs. placebo: -0.71 vs. -0.44, P<0.05) and B. animalis (live vs. heat-killed: -0.56±1.01 vs. -0.31±0.87, P=0.03).
CONCLUSIONS
Prokinetics, lubiprostone, antibiotics and probiotics demonstrate efficacy for the treatment of bloating and/or distension in certain FGIDs, but other agents have either not been studied adequately or have shown conflicting results.
Topics: Abdomen; Dilatation, Pathologic; Flatulence; Gases; Gastric Dilatation; Gastrointestinal Agents; Gastrointestinal Transit; Humans; Probiotics; Randomized Controlled Trials as Topic
PubMed: 21488913
DOI: 10.1111/j.1365-2036.2011.04637.x