Bloating resident survival guide

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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: 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.