View source for Bloating

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==Overview==
Bloating is described as a sensation of elevated [[abdominal]] pressure that may or may not be accompanied by objective [[abdominal distension]], i.e. noticeable enlargement of the waist. Bloating and abdominal distension may be symptoms of organic disease and possible causes should be considered first in the differential diagnosis. It is one of the most frequent problems in a wide proportion of patients with gastrointestinal disorders, but the most common cause is [[constipation]]. Bloating also results from [[irritable bowel syndrome]], [[Gastroparesis|gastroparesis,]] [[small intestinal bacterial overgrowth]] and [[Gynecological|gynecological conditions]]. The pathophysiology of bloating is not well understood and suggested underlying causes include [[visceral]] [[hypersensitivity]], behavioral mediated irregular abdominal wall-[[phrenic]] reflexes, the influence of poorly ingested fermentable carbohydrates, and [[microbiome]] modification. Usually, patients are evaluated with a thorough history and physical examination, but organic disorders should be ruled out. The management strategy includes dietary modification, behavioral therapy, microbiome modulation, and medical therapy.

==Historical Perspective==

*Bernheim in 1891 described a woman who said, "I go up and down like an accordion."<ref name="pmid6378725">{{cite journal |vauthors=Schott H |title=[Mesmer, Braid and Bernheim: on the history of the development of hypnotism] |language=German |journal=Gesnerus |volume=41 |issue=1-2 |pages=33–48 |date=1984 |pmid=6378725 |doi= |url=}}</ref> and Later on in 1900 Kaplan, wrote on ventre en accordéon.<ref name="pmid18138437">{{cite journal |vauthors=ALVAREZ WC |title=Hysterical type of nongaseous abdominal bloating |journal=Arch Intern Med (Chic) |volume=84 |issue=2 |pages=217–45 |date=August 1949 |pmid=18138437 |doi=10.1001/archinte.1949.00230020020002 |url=}}</ref>
*Nongaseous form of bloating was first described by Sir James Y. Simpson. <ref name="pmid11978757">{{cite journal |vauthors=Dunn PM |title=Sir James Young Simpson (1811-1870) and obstetric anaesthesia |journal=Arch. Dis. Child. Fetal Neonatal Ed. |volume=86 |issue=3 |pages=F207–9 |date=May 2002 |pmid=11978757 |pmc=1721404 |doi=10.1136/fn.86.3.f207 |url=}}</ref>
*According to Kaplan, in the 19th century in Europe, the intestines of the patient were punctured with a trocar in cases of suspected [[intestinal obstruction]]. In this way, it was discovered that there was no gas involved in cases of hysteric bloating.
*It was also considered a "tumor" that vanished when the patient was anesthetized and returned when they were conscious.<ref name="urlFebruary 1887 - Volume 14 - Issue 2 : The Journal of Nervous and Mental Disease">{{cite web |url=https://journals.lww.com/jonmd/toc/1887/02000 |title=February 1887 - Volume 14 - Issue 2 : The Journal of Nervous and Mental Disease |format= |work= |accessdate=}}</ref>
*[[Lordosis]] association with bloating was described by Krukenberg in 1884. <ref name="pmid18138437">{{cite journal |vauthors=ALVAREZ WC |title=Hysterical type of nongaseous abdominal bloating |journal=Arch Intern Med (Chic) |volume=84 |issue=2 |pages=217–45 |date=August 1949 |pmid=18138437 |doi=10.1001/archinte.1949.00230020020002 |url=}}</ref>
*Bloating was first described by Alvarez of the Mayo Clinic in 1949 in a woman with a psychiatric problem.<ref name="pmid18138437">{{cite journal |vauthors=ALVAREZ WC |title=Hysterical type of nongaseous abdominal bloating |journal=Arch Intern Med (Chic) |volume=84 |issue=2 |pages=217–45 |date=August 1949 |pmid=18138437 |doi=10.1001/archinte.1949.00230020020002 |url=}}</ref>

*

==Classification==
There is no established system for the classification of bloating.

==Pathophysiology==
===Abnormal Gut Microbiota===
There is a relationship between the types of gas produced by colonic [[microflora]] and bloating. The role of [[Methanogen|methanogenic flora]] has always been in question when the pathogenesis of bloating is discussed. During the experiments involving ingestion of [[sorbitol]] and fiber, it was determined that there was significant increase in bloating in individuals with low producers of [[methane]] vs high producers. <ref name="pmid8995944">{{cite journal |vauthors=Kajs TM, Fitzgerald JA, Buckner RY, Coyle GA, Stinson BS, Morel JG, Levitt MD |title=Influence of a methanogenic flora on the breath H2 and symptom response to ingestion of sorbitol or oat fiber |journal=Am. J. Gastroenterol. |volume=92 |issue=1 |pages=89–94 |date=January 1997 |pmid=8995944 |doi= |url=}}</ref>

===Small Intestinal Bacterial Overgrowth===
Patients with [[IBS]] who explicitly complain of bloating have been reported to have elevated gas production from bacterial [[fermentation]] due to [[small intestinal bacterial overgrowth]] (SIBO).<ref name="pmid17043337">{{cite journal |vauthors=Pimentel M, Park S, Mirocha J, Kane SV, Kong Y |title=The effect of a nonabsorbed oral antibiotic (rifaximin) on the symptoms of the irritable bowel syndrome: a randomized trial |journal=Ann. Intern. Med. |volume=145 |issue=8 |pages=557–63 |date=October 2006 |pmid=17043337 |doi=10.7326/0003-4819-145-8-200610170-00004 |url=}}</ref>

===Intestinal Gas Accumulation===
Increase levels of intestinal gas has been linked with bloating. After consuming a large meal there is 65% increase in postprandial gas volume in pelvic colon, where as during fasting, GI tract produces about 100ml of gas which spreads between [[liver]], [[small intestine]], [[ascending colon]], [[transverse colon]], [[descending colon]], and distal (pelvic) colon.<ref name="urlSleisenger and Fordtrans Gastrointestinal and Liver Disease- 2 Volume Set - 9th Edition">{{cite web |url=https://www.elsevier.com/books/sleisenger-and-fordtrans-gastrointestinal-and-liver-disease-2-volume-set/feldman/978-1-4160-6189-2 |title=Sleisenger and Fordtran's Gastrointestinal and Liver Disease- 2 Volume Set - 9th Edition |format= |work= |accessdate=}}</ref>

===Altered Gut Motility===
Gut motility is affected in many disorders mainly labeled as Intestinal dysmotility. It affects the evacuation of excessive gas produced in the GI tract during fasting as well as post-prandial. 

===Abnormal Abdominal-diaphragmatic Reflexes===
Mechanism which leads to bloating are not well understood but studies have shown a role of abdominal-diaphragmatic reflexes, which are involves the combination of increase in the anterior wall tone and diaphragm relaxation. These reflexes are abnormal in individuals with bloating.<ref name="pmid19208364">{{cite journal |vauthors=Accarino A, Perez F, Azpiroz F, Quiroga S, Malagelada JR |title=Abdominal distention results from caudo-ventral redistribution of contents |journal=Gastroenterology |volume=136 |issue=5 |pages=1544–51 |date=May 2009 |pmid=19208364 |doi=10.1053/j.gastro.2009.01.067 |url=}}</ref>

===Visceral Hypersensitivity===
The sensation of bloating may originate from abdominal [[viscera]] in patients with a [[functional gastrointestinal disorder]], in whom normal stimuli or small variations of gas content within the gut may be perceived as bloating. The [[autonomic nervous system]] may also contribute to the modulation of [[visceral]] sensitivity and sympathetic activation is known to increase the perception of intestinal distention in these patients.

===Food Intolerance and Carbohydrate Malabsorption===
A high FODMAP diet has demonstrated prolonged hydrogen production in the [[intestine]], colonic distension by [[fermentation]], increased colonic fluid delivery by osmotic load within the bowel [[lumen]], and GI symptom generation. <ref name="pmid20102355">{{cite journal |vauthors=Barrett JS, Gearry RB, Muir JG, Irving PM, Rose R, Rosella O, Haines ML, Shepherd SJ, Gibson PR |title=Dietary poorly absorbed, short-chain carbohydrates increase delivery of water and fermentable substrates to the proximal colon |journal=Aliment. Pharmacol. Ther. |volume=31 |issue=8 |pages=874–82 |date=April 2010 |pmid=20102355 |doi=10.1111/j.1365-2036.2010.04237.x |url=}}</ref>

===Hard stool/Constipation===
Distension of the [[rectum]] by retained [[feces]] induces alteration of gut motility and increases bacterial [[Fermentation (biochemistry)|fermentation]].

==Clinical Features==
Some people experience signs of [[irritable bowel syndrome]], [[functional dyspepsia]], [[constipation]], or [[premenstrual syndrome]]. They may have psychiatric or emotional problems, too. Recent weight gain, weak abdominal muscles, and lack of exercise is common. The distention is noticeable to the patient, the family, the friends and the doctor. Patient is typically a woman who complains of occasional abdominal swelling that worsens with large / heavy meals and loosening the belt or changing clothes, burping or [[defecation]] may improve symptoms.

==Causes==
The most common cause of bloating is [[Constipation]], [[Pregnancy]], [[IBS]], [[Celiac disease]], [[Lactose]], [[fructose]], and other carbohydrates intolerance, [[Pancreatic insufficiency]], [[Gastroparesis]], [[Diabetes mellitus]], [[Hypothyroidism]], [[Scleroderma]], Chronic idiopathic [[pseudo-obstruction]], [[Small bowel bacterial overgrowth]], [[Acute gastroenteritis]], [[Gastric malignancy]], [[Ovarian malignancy]], and [[Ascites]].<ref name="pmid30879252">{{cite journal |vauthors=Mari A, Abu Backer F, Mahamid M, Amara H, Carter D, Boltin D, Dickman R |title=Bloating and Abdominal Distension: Clinical Approach and Management |journal=Adv Ther |volume=36 |issue=5 |pages=1075–1084 |date=May 2019 |pmid=30879252 |pmc=6824367 |doi=10.1007/s12325-019-00924-7 |url=}}</ref>

==Differentiating bloating from other Diseases==
Bloating must be differentiated from [[Lactose intolerance]], [[Fructose intolerance]], [[Celiac disease]], [[Pancreatic insufficiency]], [[Irritable bowel syndrome]], [[Functional dyspepsia]], [[Functional bloating|Functional bloating,]] [[Constipation]], [[Diabetes]], [[Scleroderma]], [[Pseudo-obstruction-intestinal|Pseudo-obstruction]]: acute or chronic, [[Gastroparesis]], [[Acute adynamic ileus]], Gastric outlet obstruction, [[Small bowel obstruction]], [[SMA syndrome]], [[Colonic obstruction]], [[Volvulus]], Gastrointestinal/Ovarian [[Malignancy]], [[Ascites]], [[Pregnancy]], and [[Obesity]]/[[adiposity]].<ref name="pmid28316536">{{cite journal |vauthors=Hasler WL |title=Gas and Bloating |journal=Gastroenterol Hepatol (N Y) |volume=2 |issue=9 |pages=654–662 |date=September 2006 |pmid=28316536 |pmc=5350578 |doi= |url=}}</ref>

==Epidemiology and Demographics==

*In the USA, 15-30% of the general population has been reported to experience bloating.<ref name="pmid18477677">{{cite journal |vauthors=Jiang X, Locke GR, Choung RS, Zinsmeister AR, Schleck CD, Talley NJ |title=Prevalence and risk factors for abdominal bloating and visible distention: a population-based study |journal=Gut |volume=57 |issue=6 |pages=756–63 |date=June 2008 |pmid=18477677 |pmc=2581929 |doi=10.1136/gut.2007.142810 |url=}}</ref>

*A telephone [[Survey sampling|survey]] reported a [[prevalence]] of 16% in US adults who were asked about bloating or distention during the last month.<ref name="pmid10877233">{{cite journal |vauthors=Sandler RS, Stewart WF, Liberman JN, Ricci JA, Zorich NL |title=Abdominal pain, bloating, and diarrhea in the United States: prevalence and impact |journal=Dig. Dis. Sci. |volume=45 |issue=6 |pages=1166–71 |date=June 2000 |pmid=10877233 |doi=10.1023/a:1005554103531 |url=}}</ref>

*Women were more likely than men to report bloating.<ref name="pmid18477677">{{cite journal |vauthors=Jiang X, Locke GR, Choung RS, Zinsmeister AR, Schleck CD, Talley NJ |title=Prevalence and risk factors for abdominal bloating and visible distention: a population-based study |journal=Gut |volume=57 |issue=6 |pages=756–63 |date=June 2008 |pmid=18477677 |pmc=2581929 |doi=10.1136/gut.2007.142810 |url=}}</ref>

*There is no racial predilection to bloating.<ref name="pmid9772037">{{cite journal |vauthors=Ho KY, Kang JY, Seow A |title=Prevalence of gastrointestinal symptoms in a multiracial Asian population, with particular reference to reflux-type symptoms |journal=Am. J. Gastroenterol. |volume=93 |issue=10 |pages=1816–22 |date=October 1998 |pmid=9772037 |doi=10.1111/j.1572-0241.1998.00526.x |url=}}</ref>

==Risk Factors==
Risk factors include chewing gum, hard candy, and carbonated beverages such as soda or beer. Foods that can produce excess bowel gas include leafy greens, beans, and bran foods. Dairy products can lead to [[bloating]] and [[flatulence]] in people who are [[lactose intolerant]].

==Screening==
There is insufficient evidence to recommend routine screening for bloating.

==Natural History, Complications, and Prognosis==
The sensation of abdominal bloating is often attributed to excessive gas in patients. However, the relationship between the volume of intestinal gas and the effects is not clear. Patients with chronic complaints of bloating and distension have heightened sensitivity to gaseous distension or exaggerated motor response to normal amounts of gas. Pains that are due to bloating will feel sharp and cause the [[stomach]] to cramp. These pains may occur anywhere in the body and can change locations quickly.

Bloating is typically [[benign]], although it can be due to severe conditions such as [[intestinal obstruction]] and [[Malignancy|malignancy.]]

Patients with mild functional bloating may need merely reassurance that the condition is benign. <ref name="pmid30879252">{{cite journal |vauthors=Mari A, Abu Backer F, Mahamid M, Amara H, Carter D, Boltin D, Dickman R |title=Bloating and Abdominal Distension: Clinical Approach and Management |journal=Adv Ther |volume=36 |issue=5 |pages=1075–1084 |date=May 2019 |pmid=30879252 |pmc=6824367 |doi=10.1007/s12325-019-00924-7 |url=}}</ref>

==Diagnosis==
===Diagnostic Study of Choice===
[[Rome IV criteria]] for establishing the diagnosis of functional bloating include both of the following (for at least three months with symptom onset at least six months prior to diagnosis).<ref name="pmid27144627">{{cite journal |vauthors=Mearin F, Lacy BE, Chang L, Chey WD, Lembo AJ, Simren M, Spiller R |title=Bowel Disorders |journal=Gastroenterology |volume= |issue= |pages= |date=February 2016 |pmid=27144627 |doi=10.1053/j.gastro.2016.02.031 |url=}}</ref>

●Recurrent bloating or distension, on average, at least one day per week; abdominal bloating and/or distension predominates over other symptoms

●Insufficient criteria for a diagnosis of IBS, functional [[constipation]], functional [[diarrhea]], or postprandial distress syndrome

===History and Symptoms===
History includes the onset of symptoms, the relationship to diet (eg, wheat, dairy, fructose, fiber, non absorbable sugars) diurnal variation, and the presence of symptoms suggestive of other functional gastrointestinal disorders, including [[constipation]], diarrhea, and abdominal pain or postprandial fullness. Functional bloating usually has a [[diurnal]] pattern which may accompanies the consumption of such foods, frequently accompanied by excessive [[burping]] or flattening. Patients may complain about deteriorating symptoms as the day progresses, particularly after meals, but they may be relieved overnight.<ref name="pmid16678560">{{cite journal |vauthors=Tack J, Talley NJ, Camilleri M, Holtmann G, Hu P, Malagelada JR, Stanghellini V |title=Functional gastroduodenal disorders |journal=Gastroenterology |volume=130 |issue=5 |pages=1466–79 |date=April 2006 |pmid=16678560 |doi=10.1053/j.gastro.2005.11.059 |url=}}</ref>

===Physical Examination===
Common physical examination findings of bloating include abdominal distention with or without altered [[bowel sounds]]. However, if [[Occult Blood|occult fecal blood]], cutaneous findings [[Sclerodactyly|(sclerodactyly]] with [[scleroderma]], [[dermatitis herpetiformis]] in [[celiac disease]]), peripheral or autonomic [[neuropathy]], [[cachexia]], [[jaundice]], or palpable masses is present then it suggests underlying organic disease. <ref name="pmid28316536">{{cite journal |vauthors=Hasler WL |title=Gas and Bloating |journal=Gastroenterol Hepatol (N Y) |volume=2 |issue=9 |pages=654–662 |date=September 2006 |pmid=28316536 |pmc=5350578 |doi= |url=}}</ref>

===Laboratory Findings===
====Complete blood count====
To evaluate for [[anemia]] 

====Serologies for Celiac Sprue<ref name="pmid308792522">{{cite journal |vauthors=Mari A, Abu Backer F, Mahamid M, Amara H, Carter D, Boltin D, Dickman R |title=Bloating and Abdominal Distension: Clinical Approach and Management |journal=Adv Ther |volume=36 |issue=5 |pages=1075–1084 |date=May 2019 |pmid=30879252 |pmc=6824367 |doi=10.1007/s12325-019-00924-7 |url=}}</ref>====

*anti-tissue transglutaminase (tTG) antibodies
*endomysial antibodies (EMA)
*deamidated gliadin peptide (DGP) antibodies

====Hydrogen Breath Test====
For the evaluation of [[small intestinal bacterial overgrowth]] and [[lactose intolerance]].

====Thyroid Function tests<ref name="pmid308792523">{{cite journal |vauthors=Mari A, Abu Backer F, Mahamid M, Amara H, Carter D, Boltin D, Dickman R |title=Bloating and Abdominal Distension: Clinical Approach and Management |journal=Adv Ther |volume=36 |issue=5 |pages=1075–1084 |date=May 2019 |pmid=30879252 |pmc=6824367 |doi=10.1007/s12325-019-00924-7 |url=}}</ref>====

====Fasting Cortisol Levels<ref name="pmid308792524">{{cite journal |vauthors=Mari A, Abu Backer F, Mahamid M, Amara H, Carter D, Boltin D, Dickman R |title=Bloating and Abdominal Distension: Clinical Approach and Management |journal=Adv Ther |volume=36 |issue=5 |pages=1075–1084 |date=May 2019 |pmid=30879252 |pmc=6824367 |doi=10.1007/s12325-019-00924-7 |url=}}</ref>====

====Antinuclear antibodies and Scleroderma antibodies<ref name="pmid308792525">{{cite journal |vauthors=Mari A, Abu Backer F, Mahamid M, Amara H, Carter D, Boltin D, Dickman R |title=Bloating and Abdominal Distension: Clinical Approach and Management |journal=Adv Ther |volume=36 |issue=5 |pages=1075–1084 |date=May 2019 |pmid=30879252 |pmc=6824367 |doi=10.1007/s12325-019-00924-7 |url=}}</ref>====
To evaluate for [[collagen]] [[vascular]] disease

====Antinuclear neuronal antibodies<ref name="pmid308792526">{{cite journal |vauthors=Mari A, Abu Backer F, Mahamid M, Amara H, Carter D, Boltin D, Dickman R |title=Bloating and Abdominal Distension: Clinical Approach and Management |journal=Adv Ther |volume=36 |issue=5 |pages=1075–1084 |date=May 2019 |pmid=30879252 |pmc=6824367 |doi=10.1007/s12325-019-00924-7 |url=}}</ref>====
To screen for [[Paraneoplastic syndrome|paraneoplastic]] [[visceral]] [[neuropathy]]

====Stool analysis====
Antigen testing for ''[[Giardia lamblia|Giardia]]''

===Electrocardiogram===
There are no ECG findings associated with bloating.

===X-ray===
An abdominal x-ray may be helpful to rule out [[Intestinal obstruction|intestinal obstruction.]]

===Echocardiography or Ultrasound===
Abdominal/Pelvic Ultrasound to look for [[ascites]] and rule out [[Ovarian cancer|ovarian cancer.]]

===CT scan===
There are no CT scan findings associated with bloating. However, it can be used to rule out [[Intestinal obstruction|intestinal obstruction.]]

===MRI===
There are no MRI findings associated with bloating.

===Other Imaging Findings===
====Upper GI Endoscopy====
The presence of alarm features including [[weight loss]], abdominal pain, [[dysphagia]], [[heartburn]], and [[regurgitation]] are an indication for a diagnostic evaluation with upper [[endoscopy]].

===Other Diagnostic Studies===
There are no other diagnostic studies associated with bloating.

==Treatment==
===Medical Therapy===
====Education, treatment of associated disorders, and behavioral therapy====
Management requires instruction to minimize air swallowing and reassurance that belching is a [[benign]] condition. Relevant behavioural interventions include the avoidance of gum chewing, smoking, consuming carbonated drinks, and gulping of food and liquids. Treatment should be started in people with persistent [[depression]] or [[anxiety]].<ref name="pmid288397572">{{cite journal |vauthors=Disney B, Trudgill N |title=Managing a patient with excessive belching |journal=Frontline Gastroenterol |volume=5 |issue=2 |pages=79–83 |date=April 2014 |pmid=28839757 |pmc=5369716 |doi=10.1136/flgastro-2013-100355 |url=}}</ref> Patients with co-existing acid reflux may need an acid reduction treatment for the control of [[GERD]].

Effective management with excessive belching by a therapist (e.g. cognitive behavioral therapy or speech therapist)<ref name="pmid19650772">{{cite journal |vauthors=Hemmink GJ, Ten Cate L, Bredenoord AJ, Timmer R, Weusten BL, Smout AJ |title=Speech therapy in patients with excessive supragastric belching--a pilot study |journal=Neurogastroenterol. Motil. |volume=22 |issue=1 |pages=24–8, e2–3 |date=January 2010 |pmid=19650772 |doi=10.1111/j.1365-2982.2009.01371.x |url=}}</ref> with specific experience of diaphragmatic relaxation exercises has been linked with a decrease of symptoms.   [[Diaphragmatic breathing|Diaphragmatic]] breathing decreases postprandial intragastric pressure and raises the pressure of the esophagogastric junction region, restoring the gradient of the gastroesophageal pressure.

====Reflux inhibitors for refractory symptoms====
[[Baclofen]] (10 mg three times daily) by reducing transient lower [[esophageal]] [[sphincter]] relaxations and centrally suppressing the swallowing rate, may decrease both supragastric and gastric [[belching]]. <ref name="pmid22079512">{{cite journal |vauthors=Blondeau K, Boecxstaens V, Rommel N, Farré R, Depeyper S, Holvoet L, Boeckxstaens G, Tack JF |title=Baclofen improves symptoms and reduces postprandial flow events in patients with rumination and supragastric belching |journal=Clin. Gastroenterol. Hepatol. |volume=10 |issue=4 |pages=379–84 |date=April 2012 |pmid=22079512 |doi=10.1016/j.cgh.2011.10.042 |url=}}</ref>


{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree | | | | | | | | A01 |A01='''Abdominal Bloating <br> and <br> Distension''' <ref name="pmid30879252">{{cite journal |vauthors=Mari A, Abu Backer F, Mahamid M, Amara H, Carter D, Boltin D, Dickman R |title=Bloating and Abdominal Distension: Clinical Approach and Management |journal=Adv Ther |volume=36 |issue=5 |pages=1075–1084 |date=May 2019 |pmid=30879252 |pmc=6824367 |doi=10.1007/s12325-019-00924-7 |url=}}</ref> }} 
{{familytree | | | | | | | | |!| | | | | | }}
{{familytree | | | | | | | | A'01| | | | | | A'01= Evaluate for: <br> ●Alarm Signs <br> ●Overlapping FGID <br> (FG,FD,IBS) <br> ●[[Bacterial Overgrowth]] <br> ●Dietary Intolerance <br> [[Celiac Disease]] <br> ●Recent Weight Gain <br> [[Constipation]] <br> ●Psychological disorder  }}
{{familytree | | | | |,|-|-|-|^|-|-|-|-|.| | | }}
{{familytree | | | B01 | | | | | | | | B02 | | |B01=No  |B02=Yes }}
{{familytree | | | |!| | | | | | | | | |!| }}
{{familytree | | | D01 | | | | | | | | D02 |D01= ●Reassurance <br> ●Recommend <br> [[Diaphragmatic]] <br> Breathing <br> ●Diet Intervention: <br> Low FODMAP diet <br> ●Symptomatic <br> medical therapy: <br> [[Peppermint oil]], <br> Simethicone etc   |D02= Treat <br> Accordingly }}
{{familytree | | | |!| | | | | | | | | | | | | }}
{{familytree | | | E01 | | | | | | | | | | | | |E01= '''''No Response''''' }}
{{familytree | | | |!| | | | | | | | | | | | | }}
{{familytree | | | E02 | | | | | | | | | | | | |E02= ●Trial of <br> [[Rifixamin]]/[[Probiotics]]  }}
{{familytree | | | |!| | | | | | | | | | | | | }}
{{familytree | | | F01 | | | | | | | | | | | | |F01= '''''No Response''''' }}
{{familytree | | | |!| | | | | | | | | | | | | }}
{{familytree | | | G01 | | | | | | | | | | | | |G01= ●Antidepressants <br> ●Psychological therapy <br> ●[[Hypnotherapy]], <br> [[CBT]] }}
{{familytree | | | |!| | | | | | | | | | | | | }}
{{familytree | | | F02 | | | | | | | | | | | | |F02= '''''No Response''''' }}
{{familytree | | | |!| | | | | | | | | | | | | }}
{{familytree | | | H01 | | | | | | | | | | | | |H01= ●Refer to <br> [[Neurogastroenterology]] <br> center <br> ●Refer to [[CT]] <br> or <br> [[MRI]] [[Electromyography]] <br> ●Refer to Abdominal <br> Biofeedback <br> therapy }}
{{familytree/end}}

===Surgery===
Surgical intervention is not recommended for the management of bloating.

===Primary Prevention===
There are no established measures for the primary prevention of bloating.

===Secondary Prevention===
There are no established measures for the secondary prevention of bloating.

==References==
{{Reflist|2}}


{{Symptoms and signs}}

[[Category:Digestive disease symptoms]]
[[Category:Gastroenterology]]


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