Bloating resident survival guide: Difference between revisions
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==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 | *[[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 | *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]]. | ||
==References== | ==References== |
Revision as of 19:27, 18 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 |
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Overview |
Causes |
FIRE |
Diagnosis |
Treatment |
Do's |
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 it 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
- The causes of abdominal bloating are numerous and are managed according to the underlying etiology:[1][2]
Intestinal Disorders | Motility Disorders | Malabsorption disorders | Infectious causes | Dietary causes | Misc. |
---|---|---|---|---|---|
Complete Diagnostic Approach
- Shown below is an algorithm summarizing the diagnosis of abdominal bloating according to the American College of Gastroenterology Guidelines:[3][4]
Patient with abdominal bloating and Distention | |||||||||||||||||
Look for the
| |||||||||||||||||
Yes | No | ||||||||||||||||
* Reassurance the patient, recommend diaphragmatic breathing
| Treat Accordingly | ||||||||||||||||
*Trial of Rifaximin/Probiotics | |||||||||||||||||
No Response | |||||||||||||||||
Antidepressants
| |||||||||||||||||
No Response | |||||||||||||||||
*Referral to specialized Neurogastroenterology center
| |||||||||||||||||
Treatment
Shown below is an algorithm summarizing the treatment of abdominal bloating according the the American College of Gastroenterology guidelines.[5]
Treatment of bloating is based on 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.
| |||||||||||||||||||||||||||||||||||||||
Do's
- 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.[7]
- Hypnotherapy has been reported to be useful in reducing the symptoms of bloating.
- Bowel training and diaphragmatic breathing have been useful in the management of bloating however the data is unclear.
Don'ts
- Artificial sweeteners containing sorbitol, mannitol, and xylitol should be avoided.[8]
- Medications such as anticholinergics, opiates, calcium channel blockers, and antidepressants should also be avoided as they have an effect on bloating.[9]
- 20% of carbohydrates in baked beans, 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.
References
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.