From the Guidelines
Gas and bloating can be effectively managed by identifying and addressing underlying causes, such as food intolerances, and utilizing treatments like brain-gut behavioral therapies and central neuromodulators, as recommended by the most recent guidelines 1.
Key Considerations
- The latest clinical practice update on evaluation and management of belching, abdominal bloating, and distention suggests a multidisciplinary approach, including dietary modifications, psychological therapies, and pharmacological interventions 1.
- Identifying food intolerances, such as lactose or fructose intolerance, through dietary restriction or breath testing can help alleviate symptoms 1.
- Brain-gut behavioral therapies, including cognitive behavioral therapy and hypnotherapy, have been shown to be effective in managing bloating and distention 1.
- Central neuromodulators, such as antidepressants, can reduce visceral hypersensitivity and improve symptoms of bloating and distention 1.
Management Strategies
- Dietary modifications, such as a low-FODMAP diet, may be beneficial in reducing symptoms, but should be implemented under the guidance of a trained gastroenterology dietitian or provider 1.
- Avoiding gas-producing foods and introducing probiotic supplements may not be effective in treating bloating and distention, and may even cause adverse effects 1.
- Anorectal biofeedback therapy may be beneficial in patients with bloating and distention, particularly those with evacuation disorders 1.
- Medications that treat constipation, such as secretagogues and 5-hydroxytryptamine 4 receptor agonists, may also improve bloating symptoms 1.
From the Research
Causes of Gas and Bloating
- Abdominal bloating and distension are two of the most commonly reported gastrointestinal symptoms, often caused by food intolerances, previous infections, disordered visceral sensation, delayed intestinal transit, or abnormal viscero-somatic reflux 2
- Functional gastrointestinal disorders, such as functional dyspepsia, irritable bowel syndrome, and functional constipation, are common causes of gas, bloating, and belching 3
- Small intestinal bacterial overgrowth (SIBO) is a manifestation of gut microbiome dysbiosis and is highly prevalent in irritable bowel syndrome (IBS) 4
Diagnosis and Evaluation
- Patients with symptoms of irritable bowel syndrome should be tested for celiac disease, and those with chronic constipation should have a rectal examination to evaluate for dyssynergic defecation 3
- A systematic review and meta-analysis found that SIBO prevalence in patients with IBS was significantly increased compared with controls, with an odds ratio of 3.7 5
- Breath testing, such as lactulose breath test, can be used to diagnose SIBO, with a higher prevalence in patients with IBS-diarrhea compared with IBS-constipation 5
Treatment Options
- Therapeutic options for gas and bloating include dietary changes, probiotics, antibiotics, prokinetic agents, antispasmodics, neuromodulators, and biofeedback 2
- Empiric therapy, such as acid suppression with proton pump inhibitors for functional dyspepsia, antispasmodics for irritable bowel syndrome, and osmotic laxatives and increased fiber for chronic idiopathic constipation, can be a reasonable initial approach 3
- Management of bloating includes non-pharmacological and pharmacological strategies, such as dietary interventions to reduce intestinal fermentation and ingestion of food supplements like prebiotics or probiotics 6