OTC Treatment for Gas and Bloating
For gas and bloating, simethicone is the most appropriate over-the-counter medication, though its efficacy is modest and dietary modifications should be the primary first-line approach. 1
First-Line Approach: Dietary Modifications
Before reaching for OTC medications, implement these evidence-based dietary strategies:
- Start with regular exercise and basic dietary advice for all patients with bloating symptoms 2
- Trial a 2-week elimination diet to identify food intolerances, particularly lactose, fructose, and sucrose—the simplest and most economically sound diagnostic approach 3
- Consider soluble fiber (ispaghula) starting at low doses (3-4 g/day) and gradually increase to avoid paradoxically worsening bloating 2
- Reserve low FODMAP diet as second-line therapy under supervision of a trained dietitian, as fructose intolerance affects 60% of patients with functional GI disorders 3, 2
OTC Medication Options
Simethicone (Gas-X, Mylicon)
- Simethicone is FDA-approved as an antigas agent and works as an antifoaming compound to reduce gas bubbles 1
- Simethicone combined with probiotics (Bacillus coagulans) significantly reduced bloating and discomfort in IBS patients compared to placebo in controlled trials 4
- When combined with loperamide for diarrhea-associated bloating, simethicone provides faster relief of gas-related abdominal discomfort (gas pain, cramps, pressure, bloating) than either component alone 5
- However, simethicone alone was inferior to other agents (like APT036) in reducing abdominal distension and flatulence in functional bloating 6
What NOT to Use
- Avoid probiotics as primary treatment for bloating—the AGA specifically states "treatment with probiotics and medical foods is not recommended for bloating or distention" 2
- Probiotics may actually cause brain fogginess, worsening bloating, and lactic acidosis in some patients 2
- Do not rely on manufacturer probiotic claims without supporting evidence 2
When to Consider Prescription Options
If OTC approaches fail after 2-4 weeks, consider these prescription alternatives:
- Rifaximin (non-absorbable antibiotic) significantly reduces hydrogen production and flatus episodes in patients with excessive gas 7
- Linaclotide (290 μg daily) is the most efficacious secretagogue for bloating associated with constipation, improving both abdominal pain and bloating 3, 8
- Lubiprostone is less likely to cause diarrhea but more commonly causes nausea compared to other secretagogues 8
Behavioral Interventions
- Diaphragmatic breathing increases vagal tone and reduces stress response, effective for gas-related symptoms regardless of underlying cause 3, 2
- Brain-gut behavioral therapies may be beneficial for refractory symptoms 2
Common Pitfalls to Avoid
- Don't skip the diagnostic evaluation—assess for carbohydrate intolerances, SIBO, constipation, pelvic floor dyssynergia, and celiac disease before assuming functional bloating 2
- Avoid prolonged dietary restrictions without evidence of benefit, as they may lead to nutritional deficiencies 2
- Don't use probiotics in immunocompromised patients due to potential adverse effects 2