Bloating resident survival guide: Difference between revisions

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{{CMG}} {{AE}} {{Usman Ali Akbar}}
{{CMG}} {{AE}} {{Usman Ali Akbar}}


{{SK}}Approach to abdominal bloating, Approach to abdominal belching, Approach to flatulence, Use of FODMAPs.
{{SK}}Approach to [[abdominal]] [[bloating]], Approach to [[abdominal]] [[belching]], Approach to [[flatulence]], Use of [[FODMAP|FODMAPs]].


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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Treatment|Treatment]]
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Treatment|Treatment]]
|-
|-
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Do's|Do's]]
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Dos|Dos]]
|-
|-
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Don'ts|Don'ts]]
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Don'ts|Don'ts]]
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==Overview==
==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 distention. Primary functional abdominal distention (FABD) should be diagnosed as a single entity and it doesn't overlap with other functional gastrointestinal disorders. Rome IV diagnostic criteria mention 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.
[[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 [[Diagnose|diagnosed]] as a single entity and doesn't overlap with other functional [[gastrointestinal]] [[disorders]]. Rome IV [[diagnostic criteria]] mentions the co-existence of mild [[abdominal pain]] and/or minor [[Bowel movement|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==
==Causes==
The causes of abdominal bloating are numerous and are managed according to the 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]]
|
[[Malignancy]]
*[[Adhesions]]
|[[Diabetes]]


[[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]]
FODMAPs
|
|[[Irritable bowel syndrome]] <br />
*[[Gas]]-producing [[Food|foods]]
*[[FODMAP]]<nowiki/>s
|
*[[Irritable bowel syndrome]] <br />
|}
|}


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==Complete Diagnostic Approach==
==Complete Diagnostic Approach==
Shown below is an algorithm summarizing the diagnosis of abdominal bloating according to American College of Gastroenterology guidelines.<ref name="Foley Burgell Barrett Gibson 2014 pp. 561–571">{{cite journal | last=Foley | first=A | last2=Burgell | first2=R | last3=Barrett | first3=JS | last4=Gibson | first4=PR | title=Management Strategies for Abdominal Bloating and Distension | journal=Gastroenterology & Hepatology | volume=10 | issue=9 | year=2014 | pmid=27551250 | pmc=4991532 | pages=561–571}}</ref><ref name="Lacy Cangemi Vazquez-Roque 2021 pp. 219–231.e1">{{cite journal | last=Lacy | first=Brian E. | last2=Cangemi | first2=David | last3=Vazquez-Roque | first3=Maria | title=Management of Chronic Abdominal Distension and Bloating | journal=Clinical Gastroenterology and Hepatology | publisher=Elsevier BV | volume=19 | issue=2 | year=2021 | issn=1542-3565 | doi=10.1016/j.cgh.2020.03.056 | pages=219–231.e1}}</ref>
 
*Shown below is an [[algorithm]] summarizing the [[diagnosis]] of [[abdominal]] [[bloating]] according to the [[American College of Gastroenterology Guidelines]]:<ref name="Foley Burgell Barrett Gibson 2014 pp. 561–571">{{cite journal | last=Foley | first=A | last2=Burgell | first2=R | last3=Barrett | first3=JS | last4=Gibson | first4=PR | title=Management Strategies for Abdominal Bloating and Distension | journal=Gastroenterology & Hepatology | volume=10 | issue=9 | year=2014 | pmid=27551250 | pmc=4991532 | pages=561–571}}</ref><ref name="Lacy Cangemi Vazquez-Roque 2021 pp. 219–231.e1">{{cite journal | last=Lacy | first=Brian E. | last2=Cangemi | first2=David | last3=Vazquez-Roque | first3=Maria | title=Management of Chronic Abdominal Distension and Bloating | journal=Clinical Gastroenterology and Hepatology | publisher=Elsevier BV | volume=19 | issue=2 | year=2021 | issn=1542-3565 | doi=10.1016/j.cgh.2020.03.056 | pages=219–231.e1}}</ref>
{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree | | | | A01 | | | A01= Patient with abdominal bloating and Distention }}
{{familytree | | | | A01 | | | A01= [[Patient]] with [[abdominal]] [[bloating]] and [[distension]] }}
{{familytree | | | | |!| | | | }}
{{familytree | | | | |!| | | | }}
{{familytree | | | | B01 | | | B01= Look for the <br>
{{familytree | | | | B01 | | | B01= Look for the <br>
* Alarm signs
*Warning signs
*Overlapping functional gastrointestinal disorders
*Overlapping functional [[gastrointestinal]] [[disorders]]
*[[Bacterial overgrowth]] (Small intestine bacterial overgrowth)
*[[Bacterial overgrowth]] (Small intestine bacterial overgrowth)
* Dietary intolerances
*[[Dietary]] intolerances
*[[Celiac Disease]]
*[[Celiac Disease]]
* Weight gain  
*[[Weight gain]]
*[[Constipation]]  
*[[Constipation]]  
*[[Hydrogen breath test]]  
*[[Hydrogen breath test]]  
*Any pyschological comorbidities}}
*Any [[psychological]] [[comorbidities]]}}
{{familytree | | |,|-|^|-|.| | }}
{{familytree | | |,|-|^|-|.| | }}
{{familytree | | C01 | | C02 | C01= Yes | C02=No}}
{{familytree | | C01 | | C02 | C01= Yes | C02=No}}
{{familytree | | |!| | | |!| | }}
{{familytree | | |!| | | |!| | }}
{{familytree | | C01 | | C02 | C01=
{{familytree | | C01 | | C02 | C01=
* Reassurance the patient, recommend [[diaphragmatic breathing]]
*[[Reassure]] the [[patient]], recommend [[diaphragmatic breathing]]
*Diet intervention: Low FODMAP (fermentable oligo-, di-, mono-saccharides and polyols) diet  
*[[Diet]] [[intervention]]: Low FODMAP (fermentable oligo-, di-, [[monosaccharides]], and [[polyols]]) [[diet]]
*Iniate sympotmatic treatment such as [[peppermint oil]] or [[Simethicone]]  | C02= Treat Accordingly}}
*Initiate [[symptomatic]] treatment such as [[peppermint oil]] or [[Simethicone]]  | C02= Treat Accordingly}}
{{familytree | | |!| | | | | | }}
{{familytree | | |!| | | | | | }}
{{familytree | | C01 | | | C01= *Trial of [[Rifaximin]]/[[Probiotics]] }}
{{familytree | | C01 | | | C01= Trial of [[Rifaximin]]/[[Probiotics]] }}
{{familytree | | |!| | | | | | }}
{{familytree | | |!| | | | | | }}
{{familytree | | C01 | | | C01= No Response }}
{{familytree | | C01 | | | C01= No Response }}
{{familytree | | |!| | | | | | }}
{{familytree | | |!| | | | | | }}
{{familytree | | C01 | | | C01= [[Antidepressants]]
{{familytree | | C01 | | | C01= [[Antidepressants]]
*[[Psychological therapy]]
*[[Psychological]] [[therapy]]
*Hypnotherapy, [[Cognitive behavioral therapy]] (CBT)}}
*[[Hypnotherapy]], [[Cognitive behavioral therapy]] ([[CBT]])}}
{{familytree | | |!| | | | | | }}
{{familytree | | |!| | | | | | }}
{{familytree | | C01 | | | C01= No Response }}
{{familytree | | C01 | | | C01= No Response }}
{{familytree | | |!| | | | | | }}
{{familytree | | |!| | | | | | }}
{{familytree | | C01 | | | C01=  
{{familytree | | C01 | | | C01=  
*Referral to specialized Neurogastroenterology center  
*Referral to specialized [[Neurogastroenterology]] center  
*Referral for the CT/MRI [[Electromyography]]
*Referral for the [[CT]]/[[MRI]] [[Electromyography]]
*Referral for the abdominal biofeedback therapy)}}
*Referral for the [[abdominal]] [[biofeedback]] [[therapy]]}}
{{familytree/end}}
{{familytree/end}}


==Treatment==
==Treatment==
Shown below is an algorithm summarizing the treatment of abdominal bloating according the the American College of Gastroenterology guidelines.<ref name="Schmulson Chang pp. 1071–1086">{{cite journal | last=Schmulson | first=M. | last2=Chang | first2=L. | title=Review article: the treatment of functional abdominal bloating and distension | journal=Alimentary Pharmacology & Therapeutics | publisher=Wiley | volume=33 | issue=10 | date=2011-03-29 | issn=0269-2813 | doi=10.1111/j.1365-2036.2011.04637.x | pages=1071–1086}}</ref>
* Shown below is an [[algorithm]] summarizing the [[treatment]] of [[abdominal]] [[bloating]] according the the [[American College of Gastroenterology Guidelines]]:<ref name="Schmulson Chang pp. 1071–1086">{{cite journal | last=Schmulson | first=M. | last2=Chang | first2=L. | title=Review article: the treatment of functional abdominal bloating and distension | journal=Alimentary Pharmacology & Therapeutics | publisher=Wiley | volume=33 | issue=10 | date=2011-03-29 | issn=0269-2813 | doi=10.1111/j.1365-2036.2011.04637.x | pages=1071–1086}}</ref>
{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree | | | | | | | | A01 |A01= Treatment of bloating is based on etiology of bloating.}}  
{{familytree | | | | | | | | A01 |A01= [[Treatment]] of [[bloating]] is based on the underlying [[etiology]] of [[bloating]]}}  
{{familytree | | | | | | | | |!| | | | | |}}
{{familytree | | | | | | | | |!| | | | | |}}
{{familytree | | | | | | | |C01| | | | | |C01= Dietary changes are suggested for bloating  
{{familytree | | | | | | | |C01| | | | | |C01= [[Dietary]] changes are suggested for [[bloating]]
*Diet
*[[Diet]]
*[[Exercise]] and [[posture]]
*[[Exercise]] and [[posture]]
*Over-the-counter medications
*Over-the-counter [[medications]]
*[[Probiotics]]
*[[Probiotics]]
*[[Antibiotics]]
*[[Antibiotics]]
*Smooth muscle [[antispasmodics]]
*[[Smooth muscle]] [[antispasmodics]]
*Osmotic laxatives
*[[Osmotic]] [[laxatives]]
*Prokinetic agents
*[[Prokinetic]] agents
*Chloride channel activators
*[[Chloride channel]] activators
*[[Tricyclic antidepressants]]
*[[Tricyclic antidepressants]]


Are any warning signs present?
Are any warning signs present?
*anemia,GI bleeding, weight loss>10% of the body weight, and family history of GI malignancy. }}
*[[Anemia]], [[GI bleeding]], [[weight loss]] >10% of the [[body weight]], and [[family history]] of [[GI]] [[malignancy]]}}
{{familytree | | | | | | | | |!| | | | | | }}
{{familytree | | | | | | | | |!| | | | | | }}
{{Family tree | | | | | |,|-|-|^|-|-|.| | }}
{{Family tree | | | | | |,|-|-|^|-|-|.| | }}
Line 131: Line 135:
*Labs
*Labs
*[[Endoscopy]]
*[[Endoscopy]]
*Imaging|F02=Functional?}}
*[[Imaging]]|F02=Functional?}}
{{familytree | | | | | | | | | | | | |!| | | }}
{{familytree | | | | | | | | | | | | |!| | | }}
{{familytree | | | | | | | | | | | | |!| | | | | | | }}
{{familytree | | | | | | | | | | | | |!| | | | | | | }}
{{familytree | | | |,|-|-|-|v|-|-|-|-|+|-|.| | }}
{{familytree | | | |,|-|-|-|v|-|-|-|-|+|-|.| | }}
{{familytree | | | |!| | | |!| | | | |!| |!| | }}
{{familytree | | | |!| | | |!| | | | |!| |!| | }}
{{familytree | | | D01 | | D02 | | D03 | | D04 | |D01=[[Constipation]]|D02=Functional dyspepsia|D03=Non-constipation IBS|D04=Bloating alone}}
{{familytree | | | D01 | | D02 | | D03 | | D04 | |D01=[[Constipation]]|D02=Functional [[dyspepsia]]|D03=Non-[[constipation]] [[IBS]]|D04=[[Bloating]] alone}}
{{familytree | | | |`|-|-|-|^|-|-|+|-|-|-|-|-|'|}}
{{familytree | | | |`|-|-|-|^|-|-|+|-|-|-|-|-|'|}}
{{familytree | | | | | | | | | | |!| | | | | | | | | }}
{{familytree | | | | | | | | | | |!| | | | | | | | | }}
{{familytree | | | | | | | | | | A02 | | | | | |A02= Lifestyle and nonspecific dietary advice.<br>
{{familytree | | | | | | | | | | A02 | | | | | |A02= *[[Lifestyle]] and nonspecific [[dietary]] advice<br>
*Education about low FODMAP diet <br><ref name="Altobelli Del Negro Angeletti Latella p=940">{{cite journal | last=Altobelli | first=Emma | last2=Del Negro | first2=Valerio | last3=Angeletti | first3=Paolo | last4=Latella | first4=Giovanni | title=Low-FODMAP Diet Improves Irritable Bowel Syndrome Symptoms: A Meta-Analysis | journal=Nutrients | publisher=MDPI AG | volume=9 | issue=9 | date=2017-08-26 | issn=2072-6643 | doi=10.3390/nu9090940 | page=940}}</ref>
*[[Education]] about low [[FODMAP]] [[diet]]<ref name="Altobelli Del Negro Angeletti Latella p=940">{{cite journal | last=Altobelli | first=Emma | last2=Del Negro | first2=Valerio | last3=Angeletti | first3=Paolo | last4=Latella | first4=Giovanni | title=Low-FODMAP Diet Improves Irritable Bowel Syndrome Symptoms: A Meta-Analysis | journal=Nutrients | publisher=MDPI AG | volume=9 | issue=9 | date=2017-08-26 | issn=2072-6643 | doi=10.3390/nu9090940 | page=940}}</ref>
* Treat constipation aggressively and minimize bowel distention<br>
* Treat [[constipation]] aggressively and minimize [[bowel]] [[distension]]<br>
*Consider the use of [[Rifaximin]]
*Consider the use of [[Rifaximin]]
*Consider probiotics, Psychological therapy, [[CBT]], and/or [[antidepressants]]<br>
*Consider [[Probiotics]], [[Psychological]] [[therapy]], [[CBT]], and/or [[Antidepressants]]<br>
*Consider Biodfeedback neuromodulation }}
*Consider Biofeedback [[neuromodulation]] }}
{{familytree/end}}
{{familytree/end}}


==Do's==
==Dos==


*Use of [[probiotics]] can help reduce [[bloating]].
*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.<ref name="Seo Kim Oh pp. 433–453">{{cite journal | last=Seo | first=A Young | last2=Kim | first2=Nayoung | last3=Oh | first3=Dong Hyun | title=Abdominal Bloating: Pathophysiology and Treatment | journal=Journal of Neurogastroenterology and Motility | publisher=The Korean Society of Neurogastroenterology and Motility | volume=19 | issue=4 | date=2013-10-31 | issn=2093-0879 | doi=10.5056/jnm.2013.19.4.433 | pages=433–453}}</ref>
*[[Antidepressants]] can help to [[Reduced|reduce]] the [[symptoms]] of [[IBS]] but the [[data]] is unclear over the [[reduction]] of [[bloating]].<ref name="Seo Kim Oh pp. 433–453">{{cite journal | last=Seo | first=A Young | last2=Kim | first2=Nayoung | last3=Oh | first3=Dong Hyun | title=Abdominal Bloating: Pathophysiology and Treatment | journal=Journal of Neurogastroenterology and Motility | publisher=The Korean Society of Neurogastroenterology and Motility | volume=19 | issue=4 | date=2013-10-31 | issn=2093-0879 | doi=10.5056/jnm.2013.19.4.433 | pages=433–453}}</ref>
*[[Hypnotherapy]] has been reported to be useful in reducing symptoms of bloating.
*[[Hypnotherapy]] has been reported to be useful in [[Reduction|reducing]] the [[symptoms]] of [[bloating]].
*Bowel training and [[diaphragmatic breathing]] have been useful in the management of [[bloating]] however the data is unclear.
*[[Bowel training problem|Bowel training]] and [[diaphragmatic breathing]] have been useful in the management of [[bloating]], however the [[data]] is unclear.


==Don'ts==
==Don'ts==


*Artificial sweeteners containing [[sorbitol]], [[mannitol]], [[xylitol]] should be avoided.<ref name="Kamphuis Guiard Leveque Olier 2020 pp. 652–663.e6">{{cite journal | last=Kamphuis | first=Jasper B.J. | last2=Guiard | first2=Bruno | last3=Leveque | first3=Mathilde | last4=Olier | first4=Maiwenn | last5=Jouanin | first5=Isabelle | last6=Yvon | first6=Sophie | last7=Tondereau | first7=Valerie | last8=Rivière | first8=Pauline | last9=Guéraud | first9=Françoise | last10=Chevolleau | first10=Sylvie | last11=Noguer-Meireles | first11=Maria-Helena | last12=Martin | first12=Jean- François | last13=Debrauwer | first13=Laurent | last14=Eutamène | first14=Helene | last15=Theodorou | first15=Vassilia | title=Lactose and Fructo-oligosaccharides Increase Visceral Sensitivity in Mice via Glycation Processes, Increasing Mast Cell Density in Colonic Mucosa | journal=Gastroenterology | publisher=Elsevier BV | volume=158 | issue=3 | year=2020 | issn=0016-5085 | doi=10.1053/j.gastro.2019.10.037 | pages=652–663.e6}}</ref>
*[[Artificial sweetener|Artificial sweeteners]] containing [[sorbitol]], [[mannitol]], and [[xylitol]] should be avoided.<ref name="Kamphuis Guiard Leveque Olier 2020 pp. 652–663.e6">{{cite journal | last=Kamphuis | first=Jasper B.J. | last2=Guiard | first2=Bruno | last3=Leveque | first3=Mathilde | last4=Olier | first4=Maiwenn | last5=Jouanin | first5=Isabelle | last6=Yvon | first6=Sophie | last7=Tondereau | first7=Valerie | last8=Rivière | first8=Pauline | last9=Guéraud | first9=Françoise | last10=Chevolleau | first10=Sylvie | last11=Noguer-Meireles | first11=Maria-Helena | last12=Martin | first12=Jean- François | last13=Debrauwer | first13=Laurent | last14=Eutamène | first14=Helene | last15=Theodorou | first15=Vassilia | title=Lactose and Fructo-oligosaccharides Increase Visceral Sensitivity in Mice via Glycation Processes, Increasing Mast Cell Density in Colonic Mucosa | journal=Gastroenterology | publisher=Elsevier BV | volume=158 | issue=3 | year=2020 | issn=0016-5085 | doi=10.1053/j.gastro.2019.10.037 | pages=652–663.e6}}</ref>
*Medications ([[anticholinergics]], [[opiates]], [[calcium channel blockers]], antidepressants) should also be avoided as they have an effect on [[bloating]].<ref name="Mari Abu Backer Mahamid Amara pp. 1075–1084">{{cite journal | last=Mari | first=Amir | last2=Abu Backer | first2=Fadi | last3=Mahamid | first3=Mahmud | last4=Amara | first4=Hana | last5=Carter | first5=Dan | last6=Boltin | first6=Doron | last7=Dickman | first7=Ram | title=Bloating and Abdominal Distension: Clinical Approach and Management | journal=Advances in Therapy | publisher=Springer Science and Business Media LLC | volume=36 | issue=5 | date=2019-03-16 | issn=0741-238X | doi=10.1007/s12325-019-00924-7 | pages=1075–1084}}</ref>
*[[Medications]] such as [[anticholinergics]], [[opiates]], [[calcium channel blockers]], and [[antidepressants]] should also be avoided as they have an [[Effect size|effect]] on [[bloating]].<ref name="Mari Abu Backer Mahamid Amara pp. 1075–1084">{{cite journal | last=Mari | first=Amir | last2=Abu Backer | first2=Fadi | last3=Mahamid | first3=Mahmud | last4=Amara | first4=Hana | last5=Carter | first5=Dan | last6=Boltin | first6=Doron | last7=Dickman | first7=Ram | title=Bloating and Abdominal Distension: Clinical Approach and Management | journal=Advances in Therapy | publisher=Springer Science and Business Media LLC | volume=36 | issue=5 | date=2019-03-16 | issn=0741-238X | doi=10.1007/s12325-019-00924-7 | pages=1075–1084}}</ref>
*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]].
*20% of [[carbohydrates]] in baked [[beans]], 7–10% in [[wheat]], [[Oat|oats]], [[Potato|potatoes]], and [[Corn oil|corn]], and 1% in white rice are not [[Absorbed dose|absorbed]] well in the [[intestine]] and they can [[Predisposition|predispose]] to [[bloating]], hence it is advisable to avoid them in the [[patients]] with increased complaints of [[bloating]].


==References==
==References==
Line 166: Line 170:
[[Category:Resident survival guide]]
[[Category:Resident survival guide]]
[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Up-To-Date]]

Latest revision as of 18:58, 19 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
Dos
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 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

Causes of Abdominal Bloating
Intestinal Disorders Motility Disorders Malabsorption disorders Infectious causes Dietary causes Misc.

Complete Diagnostic Approach

 
 
 
Patient with abdominal bloating and distension
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Look for the
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
No
 
 
 
 
 
 
 
 
 
 
 
 
*Reassure the patient, recommend diaphragmatic breathing
 
Treat Accordingly
 
 
 
 
 
 
 
 
 
 
 
Trial of Rifaximin/Probiotics
 
 
 
 
 
 
 
 
 
 
 
 
 
No Response
 
 
 
 
 
 
 
 
 
 
 
 
 
Antidepressants
 
 
 
 
 
 
 
 
 
 
 
 
 
No Response
 
 
 
 
 
 
 
 
 
 
 
 
 
*Referral to specialized Neurogastroenterology center
 
 

Treatment

 
 
 
 
 
 
 
Treatment of bloating is based on the underlying 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
 
 
 
 
 

Dos

Don'ts

References

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. 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.