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


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 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
*Reassure the patient, recommend diaphragmatic breathing
Treat Accordingly
Trial of Rifaximin/Probiotics
No Response
No Response
*Referral to specialized Neurogastroenterology center


Treatment of bloating is based on the underlying etiology of bloating
Dietary changes are suggested for bloating

Are any warning signs present?

Treat accordingly
Functional dyspepsia
Non-constipation IBS
Bloating alone
*Lifestyle and nonspecific dietary advice




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