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Gas-Bloat Syndrome

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Essential Medical Disorders of the Stomach and Small Intestine

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Abstract

Gas-bloat syndrome refers to a three-faceted clinical picture: the patient feels bloated; the abdomen distends; and the individual may verbalize the discomfort as suffering from “too much gas.” Nowadays, it is more often designated and classified as functional bloating by the Rome criteria (with or without abdominal distension). The gas-bloat syndrome is produced by several interacting mechanisms including excess accumulation of intra-luminal air and/or fluid in the gut, visceral hypersensitivity, and abnormal viscera-somatic reflexes that reshape the abdominal cavity creating the appearance of distension. The diagnosis is largely clinical, but specialized imaging, breath tests, and more sophisticated motility tests may be helpful in selected cases. Treatment is tailored to symptom severity and patient concerns, ranging from simple reassurance to dietary modification and pharmacotherapy to help clear retained stool in patients with constipation, reduce gas production, decrease visceral hypersensitivity, and correct abnormal chest-diaphragm-abdominal muscle activity by biofeedback.

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Essential Reading

  • Burri E, Barba E, Huaman JW, Cisternas D, Accarino A, Soldevilla A, et al. Mechanisms of postprandial abdominal bloating and distension in functional dyspepsia. Gut. 2014;63(3):395–400. A human mechanistic study showing the similarities between dyspepsia and IBS-associated bloating.

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  • Malagelada JR, Accarino A, Azpiroz F. Bloating and abdominal distension: old misconceptions and current knowledge. Am J Gastroenterol. 2017;112(8):1221–31. An updated review on the topic describing the various clinical presentations, appropriate diagnostic procedures, and management.

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Author information

Authors and Affiliations

  1. Digestive System Research Unit, University Hospital Vall d’Hebron, Barcelona, Spain

    Carolina Malagelada & Juan R. Malagelada

  2. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Barcelona, Spain

    Carolina Malagelada & Juan R. Malagelada

Authors
  1. Carolina Malagelada
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  2. Juan R. Malagelada
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Editor information

Editors and Affiliations

  1. Mayo Clinic, Jacksonville, FL, USA

    Brian E. Lacy

  2. Mayo Clinic, Scottsdale, AZ, USA

    John K. DiBaise

  3. Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Mark Pimentel

  4. Leeds Teaching Hospitals NHS Trust, Leeds Gastroenterology Institute, Leeds, UK

    Alexander C. Ford

Self-Test

Self-Test

  • Question 1. Abdominal biofeedback treatment of abdominal distension achieves its therapeutic goal by:

    1. A.

      Promoting belching and expelling intragastric air

    2. B.

      Promoting flatulence and expelling intra-colonic gases

    3. C.

      Relaxing the patient and hence diminishing abdominal pain perception

    4. D.

      Helping the patient inhibit intercostal and diaphragmatic muscular activity while contracting the anterior abdominal muscles to reduce distension

    5. E.

      Reducing intra-luminal pressure via colon and omentum repositioning within the abdominal cavity

  • Question 2. Clinical factors that should be assessed because of their pathogenetic relevance to bloating and abdominal distension include:

    1. A.

      Presence or absence of Helicobacter pylori infection

    2. B.

      High dietary protein intake

    3. C.

      Prior surgery such as anti-reflux Nissen-type fundoplication

    4. D.

      Presence or absence of gallstones

    5. E.

      Carcinoid syndrome due to multiple metastatic liver lesions

  • Question 3. Which of the following statements is correct?

    1. A.

      Passing flatus frequently prevents bloating.

    2. B.

      Ingestion of large amounts of psyllium fiber prevents both bloating and flatulence.

    3. C.

      Frequent ingestion of carbonated beverages increases both bloating and flatulence.

    4. D.

      Bloating may occur without flatulence and may resolve without apparent expelling of gas by mouth or anus.

    5. E.

      Activated charcoal, which absorbs intestinal gas, relieves both flatulence and bloating.

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Malagelada, C., Malagelada, J.R. (2019). Gas-Bloat Syndrome. In: Lacy, B., DiBaise, J., Pimentel, M., Ford, A. (eds) Essential Medical Disorders of the Stomach and Small Intestine. Springer, Cham. https://doi.org/10.1007/978-3-030-01117-8_10

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  • DOI: https://doi.org/10.1007/978-3-030-01117-8_10

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-01116-1

  • Online ISBN: 978-3-030-01117-8

  • eBook Packages: MedicineMedicine (R0)

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