Bloating resident survival guide: Difference between revisions
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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]] | ||
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide# | ! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Bloating resident survival guide#Dos|Dos]] | ||
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! 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 [[distension]]. Primary functional [[abdominal distension]] (FABD) should be [[Diagnose|diagnosed]] as a single entity and | [[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== | ||
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*[[Lactose intolerance]] | *[[Lactose intolerance]] | ||
*[[Fructose intolerance]] | *[[Fructose intolerance]] | ||
*[[Celiac | *[[Celiac Disease]] | ||
*[[Pancreatic insufficiency]] | *[[Pancreatic insufficiency]] | ||
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{{familytree | | | | |!| | | | }} | {{familytree | | | | |!| | | | }} | ||
{{familytree | | | | B01 | | | B01= Look for the <br> | {{familytree | | | | B01 | | | B01= Look for the <br> | ||
* | *Warning signs | ||
*Overlapping functional [[gastrointestinal]] [[disorders]] | *Overlapping functional [[gastrointestinal]] [[disorders]] | ||
*[[Bacterial overgrowth]] (Small intestine bacterial overgrowth) | *[[Bacterial overgrowth]] (Small intestine bacterial overgrowth) | ||
| Line 148: | Line 148: | ||
*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 | *Consider Biofeedback [[neuromodulation]] }} | ||
{{familytree/end}} | {{familytree/end}} | ||
== | ==Dos== | ||
*Use of [[probiotics]] can help reduce [[bloating]]. | *Use of [[probiotics]] can help reduce [[bloating]]. | ||
*[[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> | *[[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 [[Reduction|reducing]] the [[symptoms]] of [[bloating]]. | *[[Hypnotherapy]] has been reported to be useful in [[Reduction|reducing]] the [[symptoms]] of [[bloating]]. | ||
*[[Bowel training problem|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== | ||
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[[Category:Resident survival guide]] | [[Category:Resident survival guide]] | ||
[[Category:Gastroenterology]] | [[Category:Gastroenterology]] | ||
[[Category: | [[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
- 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 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
- 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 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
- 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, hence it is advisable to avoid them in the patients with increased complaints of 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.