Treatment of Bloating and Stomach Sounds
For bloating and stomach sounds (borborygmi), implement a low-FODMAP diet as first-line therapy, combined with diaphragmatic breathing exercises, as these interventions have the strongest evidence for symptom reduction. 1, 2
Immediate Dietary Intervention
Start with a 2-4 week low-FODMAP elimination diet, which reduces fermentable carbohydrates that produce gas and bloating. 1, 2, 3
- This diet restricts fermentable oligosaccharides, disaccharides, monosaccharides, and polyols that cause excessive gas production and intestinal distention. 4, 5
- Studies show 50-52% of patients achieve adequate symptom relief with this approach. 6, 7
- The low-FODMAP diet significantly reduces bloating, abdominal pain, and gas compared to standard dietary advice. 5, 6
- Work with a gastroenterology dietitian to implement this diet properly, as unsupervised restriction can lead to nutritional deficiencies. 1, 2
Common dietary triggers to eliminate initially:
- Fructose (affects 60% of patients with digestive disorders). 2, 3
- Lactose (affects 51% of patients). 3
- Artificial sweeteners (sorbitol, sugar alcohols). 3
- High-FODMAP foods (beans, cabbage, onions, certain fruits). 8
Non-Pharmacological Therapies
Diaphragmatic breathing exercises provide immediate symptom relief by reducing vagal tone and correcting abnormal abdominal wall muscle coordination. 1, 2, 3
- These exercises are particularly effective for abdominophrenic dyssynergia (APD), where paradoxical diaphragm contraction causes visible distention. 2, 9
- Practice these exercises multiple times daily for sustained benefit. 1, 2
Brain-gut behavioral therapies (cognitive behavioral therapy, gut-directed hypnotherapy) show robust evidence for symptom improvement when dietary measures alone are insufficient. 1, 3
- These therapies address the psychological amplification of bloating sensations. 3
- FDA-approved prescription-based apps are now available for convenient access. 3
Pharmacological Options for Persistent Symptoms
If dietary modification and breathing exercises fail after 4 weeks, consider:
Central neuromodulators (tricyclic antidepressants like amitriptyline, or SNRIs like duloxetine) reduce visceral hypersensitivity and raise the sensation threshold for bloating. 1, 2, 3
Secretagogues (lubiprostone, linaclotide, plecanatide) are superior to placebo for bloating, especially when constipation coexists. 1, 3
Rifaximin (non-absorbable antibiotic) treats small intestinal bacterial overgrowth (SIBO), which may underlie persistent bloating. 2, 3
Diagnostic Testing When First-Line Therapy Fails
Breath testing for hydrogen, methane, and CO2 identifies specific carbohydrate intolerances or SIBO. 2, 3, 9
Anorectal physiology testing evaluates for pelvic floor disorders if constipation or difficult evacuation accompanies bloating. 1, 9
Critical Pitfalls to Avoid
Do NOT use probiotics for bloating treatment—evidence does not support their efficacy. 1, 9
Avoid prolonged dietary restrictions without dietitian supervision, as this risks malnutrition. 2
Do not attribute all bloating to excess gas—even small gas increases (10%) can trigger significant distention in susceptible patients with abnormal viscerosomatic reflexes. 2, 9
Loperamide (antidiarrheal) commonly causes constipation, bloating, flatulence, and abdominal distention as adverse effects, so avoid this medication if bloating is already problematic. 10