From the Guidelines
Bloating can be effectively managed with a low-FODMAP diet, as recommended by the most recent and highest quality study 1. This approach involves restricting fermentable oligosaccharides, disaccharides, and monosaccharides, and polyols for a period of 4-6 weeks, followed by reintroduction of these foods to assess tolerance. The low-FODMAP diet has been shown to significantly reduce global symptoms, abdominal pain, and bloating in patients with irritable bowel syndrome (IBS) 1. In addition to dietary changes, other management options for bloating include:
- Physical activity to promote gut motility
- Stress reduction techniques like meditation to help manage symptoms
- Avoiding gas-producing foods and carbonated beverages
- Eating small, frequent meals to reduce bloating
- Considering central neuromodulators, such as antidepressants, to reduce visceral sensations and improve psychological comorbidities 1
- Gut-related medications, such as secretagogues and 5-hydroxytryptamine 4 receptor agonists, to treat constipation and improve bloating symptoms 1 It is essential to note that the implementation of a low-FODMAP diet should be done under the guidance of a trained gastroenterology dietitian or provider to avoid potential negative impacts on the gut microbiome and to ensure proper reintroduction of FODMAPs 1. Furthermore, probiotics and medical foods are not recommended for bloating or distention due to insufficient evidence supporting their use 1. Anorectal biofeedback therapy may also be beneficial for patients with bloating and distention, particularly those with dyssynergic defecation 1. Overall, a comprehensive approach to managing bloating should consider dietary changes, lifestyle modifications, and medical therapies, with a focus on improving symptoms and quality of life.
From the FDA Drug Label
Use for the relief of pressure and bloating commonly referred to as gas The management option for bloating is the use of simethicone (PO), which is indicated for the relief of pressure and bloating commonly referred to as gas 2.
From the Research
Management Options for Bloating
- The management of bloating can involve various treatment options, including medications and probiotics 3, 4, 5, 6, 7.
- A study comparing the efficacy and safety of APT036 (xyloglucan plus tyndallized Lactobacillus reuteri and Bifidobacterium brevis) and simethicone in treating functional bloating found that both treatments were well tolerated, but APT036 was superior in relieving symptoms of functional bloating 3.
- Another study evaluating the efficacy of pinaverium bromide plus simethicone in patients with irritable bowel syndrome (IBS) found that the combination was superior in improving abdominal pain and bloating 4.
Probiotics in Bloating Management
- Probiotics, such as Bifidobacterium, may improve abdominal pain in patients with IBS, although results from randomized controlled trials are conflicting 5.
- A systematic review of the efficacy of Bifidobacteria on abdominal pain in IBS found that 50% of the included studies reported a statistically significant improvement in abdominal pain following Bifidobacteria supplementation compared to placebo 5.
- A study comparing the response of symptoms and cytokine ratios in IBS with ingestion of probiotic preparations containing a lactobacillus or bifidobacterium strain found that Bifidobacterium infantis 35624 alleviated symptoms in IBS and normalized the ratio of an anti-inflammatory to a proinflammatory cytokine 6.
Simethicone in Bloating Management
- Simethicone is an adjunct frequently used during bowel preparation before colonoscopy and has been found to improve colon cleanliness and decrease bloating 7.
- A systematic review and meta-analysis found that simethicone improves colon cleansing compared with polyethylene glycol alone and decreases abdominal bloating, but has no effect on nausea, vomiting, and abdominal pain 7.