From the Guidelines
Intestinal gas accumulation is primarily caused by swallowing air and the malabsorption of carbohydrates, such as lactose, fructose, and sorbitol.
Causes of Intestinal Gas Accumulation
- Aerophagia: swallowing air, which can lead to intestinal gas accumulation, as seen in patients with supragastric belching 1
- Malabsorption of carbohydrates: undigested sugars, such as lactose, fructose, and sorbitol, can lead to bloating and gas accumulation due to their osmotic effects in the colon 1
- Food intolerance and hypersensitivity: can also contribute to bloating and gas accumulation 1
- Carbohydrate enzyme deficiencies: deficiencies in enzymes such as lactase and sucrase can lead to malabsorption of carbohydrates and subsequent gas accumulation 1
Diagnosis and Management
Diagnosis of intestinal gas accumulation can be made through a combination of clinical history, physical examination, and impedance pH monitoring 1. Treatment options may include dietary restrictions, breath testing, and medications such as proton pump inhibitors (PPIs) and antibiotics, although careful patient selection is necessary when using antibiotics 1. Brain-gut behavioral therapies, such as cognitive behavioral therapy and diaphragmatic breathing, may also be effective in managing symptoms 1.
From the Research
Causes of Intestinal Gas Accumulation
- Intestinal gas accumulation can be caused by various factors, including:
- Aerophagia, which is the swallowing of air, leading to abdominal distention and increased flatus 2, 3
- Altered gas transit or impaired gas transport through the gut, which can lead to the retention of gas within segments of the gut 2, 4
- Abnormal perception of normal amounts of gas within the gastrointestinal tract, which can be exacerbated by visceral hypersensitivity 2, 4
- Carbohydrate intolerance syndromes, small intestinal bacterial overgrowth, and diseases of gut motor activity 4
- Functional bowel disorders, including irritable bowel syndrome (IBS) 2, 4, 3
- Intestinal gases can also come from three sources: swallowed air, CO2 from gastric acid neutralization, and intestinal bacterial colonies that produce hydrogen and methane 5
- The formation of bubbles destined to become flatulence might depend on altered rheological conditions of the large bowel content, with local abundant production of bacterial gases near bacterial colonies 5
Pathophysiology of Intestinal Gas Accumulation
- The pathophysiology of intestinal gas accumulation is poorly understood, but it is thought to involve the interaction of gas production, gas transport, and gas perception 2, 4, 3
- Visceral hypersensitivity can exacerbate the sensation of distention and contribute to other "gas-related" symptoms 2, 4
- The composition of intestinal gases can be altered in various gastrointestinal and extra-gastrointestinal diseases, and assessing gas composition in breath can be a useful tool for diagnosis 6