Best Antacid for Bloating
Traditional antacids (aluminum hydroxide, calcium carbonate, magnesium salts) are not the appropriate treatment for bloating, as they primarily neutralize gastric acid rather than address the underlying mechanisms of bloating. 1, 2
Why Traditional Antacids Don't Work for Bloating
- Antacids work by neutralizing gastric hydrochloric acid and inhibiting pepsin, which makes them effective for acid-related conditions like heartburn and peptic ulcers, but not for bloating 2
- The pathophysiology of bloating involves gut hypersensitivity, impaired gas handling, altered gut microbiota, and abnormal abdominal-phrenic reflexes—none of which are addressed by acid neutralization 3
- While one recent study showed sodium alginate antacid suspension reduced bloating scores in GERD patients, this was a secondary outcome in patients with reflux disease, not isolated bloating 4
What Actually Works for Bloating
For Bloating with Constipation (IBS-C)
Secretagogues are the most effective medications for bloating when constipation is present:
- Linaclotide 290 μg once daily is superior to placebo for improving abdominal bloating in 4 trials with 3,061 patients, and is likely the most efficacious secretagogue available 5, 6
- Lubiprostone 8 μg twice daily also improves bloating and causes less diarrhea than other secretagogues, though nausea is more common 5, 6
- Tenapanor 50 mg twice daily improved bloating in 3 trials with 1,428 patients 5
- A meta-analysis using 13 trials found all secretagogues superior to placebo for treating abdominal bloating in IBS-C patients, with no significant differences between them 5
For Bloating with Diarrhea (IBS-D)
- 5-HT3 receptor antagonists (ondansetron 4-8 mg) are likely the most efficacious for IBS with diarrhea and associated bloating 5
- Rifaximin is an efficacious second-line option, though its effect on abdominal pain is limited 5
For Bloating Without Clear Bowel Pattern
The 2023 AGA guidelines provide a diagnostic algorithm: 5
- First, rule out constipation (if present, treat as IBS-C above)
- Evaluate for food intolerances (lactose, fructose, FODMAPs)—dietary restriction for 2 weeks is the simplest diagnostic approach 5
- Consider SIBO if risk factors present; treat with rifaximin or other antibiotics 5
- Central neuromodulators (tricyclic antidepressants like amitriptyline, or SNRIs like duloxetine) show benefit for bloating by reducing visceral sensations 5
- Brain-gut behavioral therapies (CBT, gut-directed hypnotherapy) improve bloating as part of global symptom improvement 5
Common Pitfalls to Avoid
- Don't prescribe traditional antacids expecting bloating relief—they lack mechanism of action for this symptom 1, 2
- Don't ignore the bowel pattern—treatment differs dramatically between constipation-predominant and diarrhea-predominant presentations 5
- Don't overlook dietary triggers—carbohydrate malabsorption (lactose, fructose) is present in 51-60% of patients with functional GI disorders 5
- Magnesium oxide, while effective for constipation, commonly causes dose-dependent bloating and flatulence as a side effect 5