Skip to main content
SpringerLink
Log in

Intestinal Gas

  • Chapter
  • First Online:
Geriatric Gastroenterology

  • 2357 Accesses

Abstract

Belching, bloating, and flatulence are ubiquitous. The underlying physiology involves a complex interplay of diet, bacterial gut flora, and basic metabolic pathways. Patterns of behavior and emotional factors play a role as well. The clinical gas syndromes intersect with the aging process to create issues that are unique to the elderly. Therapeutic intervention should be focused first on dietary modifications. Pharmacologic modalities are imperfect, and caution must be taken to avoid the untoward side effects to which the older population, by virtue of age and of polypharmacy, are particularly prone. When treating quality of life issues and not life-threatening illness, caution and patience must be the cornerstone of care.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 249.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Berk JE, Haubrich WS, editors. Gastrointestinal symptoms clinical interpretation. Philadelphia: B.C. Decker; 1991. p. 209–29.

    Google Scholar 

  2. Sachdeva S, Rawat AK, Reddy RS, et al. Small intestinal bacterial overgrowth (SIBO) in irritable bowel syndrome: frequency and predictors. J Gastroenterol Hepatol. 2011;26 Suppl 3:135–8.

    Article  PubMed  Google Scholar 

  3. Shah ED, Basseri RJ, Chong K, et al. Abnormal breath testing in IBS: a meta-analysis. Dig Dis Sci. 2010;55:2441–9.

    Article  PubMed  Google Scholar 

  4. Ford AC, Spiegel BM, Talley NJ, et al. Small intestinal bacterial overgrowth in irritable bowel syndrome: systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2009;7:1279–86.

    Article  PubMed  Google Scholar 

  5. Bredenoord AJ, Weusten BLA, Sifrim D, et al. Aerophagia, gastric, and supragastric belching: a study using intraluminal electrical impedence monitoring. Gut. 2004;53:1561–5.

    Article  PubMed  CAS  Google Scholar 

  6. Levitt MD. Volume and composition of human intestinal gas determined by means of an intestinal washout technique. N Engl J Med. 1971;284:1394–8.

    Article  PubMed  CAS  Google Scholar 

  7. Azpiroz F, Levitt MD. Intestinal gas. In: Feldman M, Friedman L, Brandt L, editors. Schlesinger and Fortran’s gastrointestinal and liver disease. 9th ed. Philadelphia: Saunders Elsevier; 2010. p. 233–40.

    Chapter  Google Scholar 

  8. Tomlin J, Lowis C, Read NW. Investigation of normal flatus production in healthy volunteers. Gut. 1991;32:665–9.

    Article  PubMed  CAS  Google Scholar 

  9. Rune SJ. Acid-base parameters of duodenal contents in man. Gastroenterology. 1972;62:533–9.

    PubMed  CAS  Google Scholar 

  10. Stephen AM, Cummings JH. Mechanism of action of dietary fibre in the human colon. Nature. 1980;284:283–4.

    Article  PubMed  CAS  Google Scholar 

  11. Scheppach W, Bach M, Bartam P, et al. Colonic fermentation of potato starch after a freeze-thaw cycle. Dig Dis Sci. 1991;36:1601–5.

    Article  PubMed  CAS  Google Scholar 

  12. Hamburg O, Rumessen JJ, Gudmand-Hoyer E. Inhibition of starch absorption by dietary fibre. A comparative study of wheat bran, sugar-beet fibre, and pea fibre. Scand J Gastroenterol. 1989;24:103–9.

    Article  Google Scholar 

  13. Perman JA, Modler S. Glycoproteins as substrates for production of hydrogen and methane by colonic bacterial flora. Gastroenterology. 1982;82:911–6.

    PubMed  Google Scholar 

  14. Steggerda FR. Gastrointestinal gas following food consumption. Ann N Y Acad Sci. 1968;150:57–66.

    Article  PubMed  CAS  Google Scholar 

  15. Levitt MD, Bond JH. Volume, composition and source of intestinal gas. Gastroenterology. 1970;59:921–9.

    PubMed  CAS  Google Scholar 

  16. Fortran JS, Walsh JH. Gastric acid secretion rate and buffer content of the stomach after eating: results in normal subjects and in patients with duodenal ulcer. J Clin Invest. 1973;52:645–57.

    Article  Google Scholar 

  17. Levitt MD, Ingelfinger FJ. Hydrogen and methane production in man. Ann N Y Acad Sci. 1968;150:75–81.

    Article  PubMed  CAS  Google Scholar 

  18. Calloway DH, Murphy EL. The use of expired air to measure intestinal gas formation. Ann N Y Acad Sci. 1968;150:82–95.

    Article  PubMed  CAS  Google Scholar 

  19. Kunkel D, Basseri RJ, Makhani MD, et al. Methane on breath testing is associated with constipation: a systematic review and meta-analysis. Dig Dis Sci. 2011;56:1612–8.

    Article  PubMed  CAS  Google Scholar 

  20. Pimental M, Mayer A, Park S, et al. Methane production during lactulose breath test is associated with gastrointestinal disease presentation. Dig Dis Sci. 2003;48:86–92.

    Article  Google Scholar 

  21. Avgerinos A, Kalantzis N, Rekoumis G, et al. Bowel preparation and the risk of explosion during colonoscopic polypectomy. Gut. 1984;25:361–4.

    Article  PubMed  CAS  Google Scholar 

  22. Hibbard JS. Gaseous distension associated with mechanical obstruction of the intestine. Arch Surg. 1936;33:146–67.

    Article  Google Scholar 

  23. Tangerman A, Winkel EG. Extra-oral halitosis: an overview. J Breath Res. 2010;4:017003.

    Article  PubMed  CAS  Google Scholar 

  24. Ritchie J. Pain from distension of the pelvic colon by inflating a balloon in the irritable colon syndrome. Gut. 1973;14:125–32.

    Article  PubMed  CAS  Google Scholar 

  25. Mertz H, Naliboff B, Munakata J, et al. Altered rectal perception is a biologic marker of patients with irritable bowel syndrome. Gastroenterology. 1995;109:40–52.

    Article  PubMed  CAS  Google Scholar 

  26. Drossman DA. The functional gastrointestinal disorders and the Rome III process. Gastroenterology. 2006;130:1377–90.

    Article  PubMed  Google Scholar 

  27. Lin H. Small intestinal bacterial overgrowth. A framework for understanding irritable bowel syndrome. JAMA. 2004;292:852–8.

    Article  PubMed  CAS  Google Scholar 

  28. Simren M. Bloating and abdominal distension: not so poorly understood anymore! Gastroenterology. 2009;136:1487–505.

    Article  PubMed  Google Scholar 

  29. Pimental M, Park S, Mirocha J, et al. The effect of a non-absorbed antibiotic (rifaximin) on the symptoms of the irritable bowel syndrome. A randomized trial. Ann Intern Med. 2006;145:557–63.

    Google Scholar 

  30. Koide A, Yamaguchi T, Odaka T, et al. Quantitative analysis of bowel gas using plain abdominal radiograph in patients with irritable bowel syndrome. Am J Gastroenterol. 2000;95:1735–41.

    Article  PubMed  CAS  Google Scholar 

  31. Yamini D, Pimentel M. Irritable bowel syndrome and small intestinal bacterial overgrowth. J Clin Gastroenterol. 2010;44:672–5.

    Article  PubMed  Google Scholar 

  32. Lasser RB, Bond JH, Levitt MD. The role of intestinal gas in functional abdominal pain. N Engl J Med. 1975;293:524–6.

    Article  PubMed  CAS  Google Scholar 

  33. Bharucha AE, Camilleri M. Functional abdominal pain in the elderly. Gastroenterol Clin North Am. 2001;30:517–29.

    Article  PubMed  CAS  Google Scholar 

  34. Lieb JG, Draganov PV. The lacunose breathe test (LBT): modified but still a lot of hot air? J Clin Gastroenterol. 2008;42:1067–9.

    Article  PubMed  Google Scholar 

  35. King CE, Toskes PP. Comparison of the 1-gram (14C) xylose, 10-gram lacunose-H2, and 80-gram glucose-H2 breath tests in patients with small intestinal bacterial overgrowth. Gastroenterology. 1986;91:1447–51.

    PubMed  CAS  Google Scholar 

  36. Kerckhoffs AP, Visser MR, Samsom M, et al. Critical evaluation of diagnosing bacterial overgrowth in the proximal small intestine. J Clin Gastroenterol. 2008;42:1095–102.

    Article  PubMed  Google Scholar 

  37. Shepherd SJ, Gibson PR. Fructose malabsorption and symptoms of irritable bowel syndrome: guidelines for effective dietary management. J Am Diet Assoc. 2006;106:1631–9.

    Article  PubMed  Google Scholar 

  38. Kyaw MH, Mayberry JH. Fructose malabsorption. True condition or a variance from normality. J Clin Gastroenterol. 2011;45:16–21.

    Article  PubMed  CAS  Google Scholar 

  39. Stone-Dorshow T, Levitt MD. Gaseous response to ingestion of a poorly absorbed fructose oligosaccharide sweetener. Am J Clin Nutr. 1987;46:61–5.

    PubMed  CAS  Google Scholar 

  40. Rumessen JJ, Gudmand-Hoyer E. Malabsorption of fructose-­sorbitol mixtures. Interaction causing abdominal distress. Scand J Gastroenterol. 1987;22:431–6.

    Article  PubMed  CAS  Google Scholar 

  41. Skoog SM, Bharucha AE, Zinsmeister AR. Comparison of breath testing with fructose and high fructose corn syrups in health and IBS. Neurogastroenterol Motil. 2008;20:505–11.

    Article  PubMed  CAS  Google Scholar 

  42. Jain NK, Rosenberg DB, Ulahannan MJ. Sorbitol intolerance in adults. Gastroenterology. 1985;80:678–81.

    CAS  Google Scholar 

  43. Levitt MD, Hirsh P, Felzer CA, et al. H2 excretion after ingestion of complex carbohydrates. Gastroenterology. 1987;92:383.

    PubMed  CAS  Google Scholar 

  44. Pitt P, de Bruija KN, Beeching MF, et al. Studies on breath methane: the effect of ethnic origins and lactulose. Gut. 1980;21:951–9.

    Article  PubMed  CAS  Google Scholar 

  45. Price KR, Lewis J, Wyatt GM, et al. Flatulence-causes, relation to diet and remedies. Nahrung. 1988;32:609–26.

    Article  PubMed  CAS  Google Scholar 

  46. Rao SS. Belching, bloating, and flatulence. How to help patients who have troublesome abdominal gas. Postgrad Med. 1997;101(263–9):275–8.

    Google Scholar 

  47. Sharara AI, Aoun E, Abdul-Baki H, et al. A randomized double-blind placebo-controlled trial of rifaximin in patients with abdominal bloating and flatulence. Am J Gastroenterol. 2006;101:326–33.

    Article  PubMed  CAS  Google Scholar 

  48. Rackis JJ, Honig DJ, Sessa DJ, et al. Flavor and flatulence factors in soybean protein products. Food Chem. 1970;18:977–82.

    Article  CAS  Google Scholar 

  49. Scheppach W. Effects of short chain fatty acids on gut morphology and function. Gut. 1994;35:S35–8.

    Article  PubMed  CAS  Google Scholar 

  50. Wolfe MS. Giardiasis. JAMA. 1975;253:1362–5.

    Article  Google Scholar 

  51. Salvioli B, Serra J, Azpiroz F, et al. Impaired small bowel gas propulsion in patients with bloating during intestinal lipid infusion. Am J Gastroenterol. 2006;101:1853–7.

    Article  PubMed  Google Scholar 

  52. Nwinuka NM, Abbey BW, Ayalogu EO. Effect of processing flatus-producing oligosaccharides in cowpea (Vigna unguiculata) and the tropical African yam bean (Sphenostylis sternocarpa). Plant Foods Hum Nutr. 1997;51:209.

    Article  PubMed  CAS  Google Scholar 

  53. Nobaek S, Johansson ML, Molin G, et al. Alteration of intestinal micro flora is associated with reduction in abdominal bloating and pain in patients with irritable bowel syndrome. Am J Gastroenterol. 2000;95:1231–8.

    Article  PubMed  CAS  Google Scholar 

  54. Pimental M, Chow EJ, Lin HC. Eradication of small intestinal bacterial overgrowth reduces symptoms of irritable bowel syndrome. Am J Gastroenterol. 2000;95:3503.

    Article  Google Scholar 

  55. Pimental M, Chow EJ, Lin HC. Normalization of lactulose breathe testing correlates with symptom improvement in irritable bowel syndrome. A double-blind, randomized, placebo-controlled study. Am J Gastroenterol. 2003;98:412–9.

    Google Scholar 

  56. Gasbarrini A, Lauritano EC, Garcovich M, et al. New insights into the patho-physiology of IBS: intestinal micro flora, gas production and gut motility. Eur Rev Med Pharmacol Sci. 2008;12:111–7.

    PubMed  Google Scholar 

  57. Accarino A, Perez F, Azpiroz F, et al. Intestinal gas and bloating: effect of prokinetic stimulation. Am J Gastroenterol. 2008;103:2036–42.

    Article  PubMed  Google Scholar 

  58. Serra J, Azpiroz F, Malagelada JR. Mechanisms of intestinal gas retention in humans: impaired propulsion versus obstructed evacuation. Am J Physiol Gastrointest Liver Physiol. 2001;281:G138–43.

    PubMed  CAS  Google Scholar 

  59. Suarez F, Levitt MD, Adshead J, et al. Pancreatic supplements reduce symptomatic response of healthy subjects to a high fat meal. Dig Dis Sci. 1999;44:1317–21.

    Article  PubMed  CAS  Google Scholar 

  60. Ganiats TG, Norcross WA, Halverson AL, et al. Does Beano prevent gas? A double-blind crossover study of oral alpha-glycosidase to treat dietary oligo-saccharide intolerance. J Fam Pract. 1994;39:441–5.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Saint Peter’s University, New Brunswick, NJ, USA

    Debra R. Goldstein MD, FACP

  2. Robert Wood Johnson School of Medicine, Drexel University School of Medicine, Philadelphia, USA

    C. S. Pitchumoni MD, MPH, FRCP(C), MACP, MACG, AGAF (Clinical Professor of Medicine)

  3. New York Medical College, Vallhala, NY, USA

    C. S. Pitchumoni MD, MPH, FRCP(C), MACP, MACG, AGAF (Adjunct Professor of Medicine)

  4. Gastroenterology, Hepatology and Nutrition, Saint Peter’s University Hospital, New Brunswick, NJ, USA

    C. S. Pitchumoni MD, MPH, FRCP(C), MACP, MACG, AGAF (Chief)

Authors
  1. Debra R. Goldstein MD, FACP
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. S. Pitchumoni MD, MPH, FRCP(C), MACP, MACG, AGAF
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. S. Pitchumoni MD, MPH, FRCP(C), MACP, MACG, AGAF
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. S. Pitchumoni MD, MPH, FRCP(C), MACP, MACG, AGAF
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. S. Pitchumoni MD, MPH, FRCP(C), MACP, MACG, AGAF .

Editor information

Editors and Affiliations

  1. Hospital, Department of Medicine, Saint Peter’s University, 254 Easton Ave, New Brunswick, 08901, New Jersey, USA

    C. S. Pitchumoni

  2. (North Division), Department of Medicine, Montefiore Medical Center, 600 East 233rd Street, Bronx, 10466, New York, USA

    T. S. Dharmarajan

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Goldstein, D.R., Pitchumoni, C.S., Pitchumoni, C.S., Pitchumoni, C.S. (2012). Intestinal Gas. In: Pitchumoni, C., Dharmarajan, T. (eds) Geriatric Gastroenterology. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-1623-5_33

Download citation

  • DOI: https://doi.org/10.1007/978-1-4419-1623-5_33

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4419-1622-8

  • Online ISBN: 978-1-4419-1623-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation