From the Guidelines
Central neuromodulators, such as tricyclic antidepressants (e.g., amitriptyline) and serotonin-norepinephrine reuptake inhibitors (e.g., duloxetine and venlafaxine), are the most effective treatment options for bloating, as they reduce visceral hypersensitivity and improve psychological comorbidities 1.
Treatment Options for Bloating
Several medications and therapies can be used to treat bloating, including:
- Over-the-counter options like simethicone and activated charcoal
- Prescription medications such as prokinetics, antispasmodics, and antibiotics for bacterial overgrowth
- Central neuromodulators like tricyclic antidepressants and serotonin-norepinephrine reuptake inhibitors
- Brain-gut behavioral therapies like cognitive behavioral therapy and hypnotherapy
- Biofeedback therapy for pelvic floor disorders
Identifying the Root Cause of Bloating
It's essential to identify and address the underlying cause of bloating for effective treatment. This can include:
- Dietary restrictions, such as a low-FODMAP diet
- Treatment of constipation or difficult evacuation
- Evaluation for small intestinal bacterial overgrowth (SIBO) or carbohydrate enzyme deficiencies
- Psychological therapies for comorbidities like anxiety or depression
Recent Guidelines and Recommendations
Recent guidelines and recommendations suggest that:
- Probiotics should not be used to treat abdominal bloating and distention 1
- Biofeedback therapy may be effective for bloating and distention when a pelvic floor disorder is identified 1
- Central neuromodulators are used to treat bloating and abdominal distention by reducing visceral hypersensitivity and improving psychological comorbidities 1
- Medications used to treat constipation should be considered for treating bloating if constipation symptoms are present 1
From the FDA Drug Label
Dicyclomine hydrochloride tablets, USP are indicated for the treatment of patients with functional bowel/irritable bowel syndrome. In controlled clinical trials involving over 100 patients who received drug, 82% of patients treated for functional bowel/irritable bowel syndrome with dicyclomine hydrochloride at initial doses of 160 mg daily (40 mg four times daily) demonstrated a favorable clinical response compared with 55% treated with placebo (p<0.05).
Medications for bloating include:
- Dicyclomine (PO) 2, 2, which is used to treat functional bowel/irritable bowel syndrome, a condition that may cause bloating. Dicyclomine has shown a favorable clinical response in patients with this condition.
From the Research
Medications for Bloating
- APT036 (xyloglucan plus tyndallized Lactobacillus reuteri and Bifidobacterium brevis) has been shown to be effective in reducing symptoms of functional bloating, including abdominal distension and flatulence, compared to simethicone 3.
- Simethicone is often used to treat bloating, and when combined with pinaverium bromide, it has been found to be effective in improving abdominal pain and bloating in patients with irritable bowel syndrome (IBS) 4.
- Loperamide-simethicone combination has been shown to provide faster and more complete relief of acute nonspecific diarrhea and associated gas-related abdominal discomfort, including bloating, compared to loperamide or simethicone alone 5.
- Amitriptyline, an antidepressant, has been found to be effective in treating IBS, including reducing symptoms of bloating, and is well-tolerated 6.
- Antispasmodic agents, such as pinaverium bromide, mebeverine, and otilonium, have been shown to be effective in treating IBS symptoms, including bloating, and may be more effective when combined with simethicone 7.
Specific Medications
- APT036: effective in reducing symptoms of functional bloating 3
- Simethicone: often used to treat bloating, and effective when combined with pinaverium bromide in IBS patients 4
- Loperamide-simethicone: effective in treating acute nonspecific diarrhea and associated bloating 5
- Amitriptyline: effective in treating IBS, including reducing symptoms of bloating 6
- Pinaverium bromide, mebeverine, and otilonium: effective in treating IBS symptoms, including bloating 7