Bloating resident survival guide

Revision as of 14:26, 2 February 2021 by Usmanaliakbar (talk | contribs)
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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:

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

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