Bloating

A lot of people complain about gas trouble but don't take it seriously because they think it is embarrassing. But there's a lot you need to know about this common digestive physiological process. Gas is produced as a by-product of the normal digestion process which occurs in the body. Excess gas escapes either through the intestine in the form of a ‘flatus’ (farting/flatulence) or through the windpipe in the form of a ‘belch’ (belching/burping). In some cases, it may also be retained in the digestive tract and lead to abnormal bloating.

Other names #

Also known as Stomach gas, Belching, Flatulence and Abdominal distension

Causes #

• Consuming higher quantities of certain foods that cannot be easily digested in the small intestine, like beans, cabbage, cauliflower, broccoli, cereal, etc.

• Eating stale food or undercooked food which leads to over-fermentation in the intestine, resulting in the release of gases with a foul-smelling odor.

• In people with lactose intolerance, consumption of milk and dairy products leads to indigestion and the formation of excess gas.

• Swallowing a lot of air while eating food. Air enters the stomach via the mouth and gets mixed with the food, and maybe released by burping.

• Consuming aerated beverages causes excessive gas to enter the stomach and can be a cause for belching or burping.

• Certain protein and multivitamin supplements and artificial sweeteners also cause excessive gas.

• Small intestinal bacterial overgrowth is a condition in which the intestinal microbes increase in number and lead to increased breakdown of food, causing gas, bloating, malabsorption of food, and nutrient malnutrition.

• Chronic constipation or intestinal obstruction may also lead to excessive gas formation, as the food stays in the bowels for a longer time causing it to degenerate and release a rotten smell.

Risk factors #

Following things can increase the chances of excessive gas in the gastrointestinal tract.

Increasing age: With age, the body’s digestive system weakens, and chances of flatulence increase, even with the consumption of simpler meals.

Heavy meals: Eating large meals at a time instead of eating smaller portions throughout the day.

Pregnancy: Pregnancy can lead to excessive gas formation as the uterus grows and presses on the intestines.

Sedentary lifestyle: Leading a sedentary lifestyle can also increase the risk of digestive issues and cause increased gas formation.

Gas is found to be a common presenting symptom in the following medical conditions:

Lactose intolerance: This condition refers to the body’s inability to digest the lactose present in milk and milk products. Consumption of milk and milk products leads to indigestion, bloating, diarrhea, and flatulence.

GERD (gastroesophageal reflux disease): This is a chronic condition where acid from the stomach regurgitates up the digestive tract and irritates the esophageal lining. Chronic belching could be a symptom of GERD.

IBS (irritable bowel syndrome): Symptoms like bloating, diarrhea, and excessive gas are seen in this condition that affects the large intestine.

Celiac Disease: In this condition, the body abnormally reacts to gluten, a protein found in grains such as wheat and barley. Bloating, diarrhea, and excess gas formation are the symptoms of this disease.

Crohn’s Disease: It is a type of inflammatory bowel disease that presents with symptoms like abdominal cramps, diarrhea, increased passing of wind, etc.

Diagnosis #

• Stool test to find out disorders like lactose intolerance, malabsorption syndrome and celiac disease

• X-Ray Abdomen helps visualize the internal organs of the abdomen and looks for the presence of gas in the stomach or intestines.

• USG Abdomen, Dual Phase CT Abdomen to visualize the internal organs of the abdomen in greater detail and diagnose any abnormalities.

• Barium Meal Follow Through, Barium Swallow test helps identify any abnormalities or obstruction of the esophagus, stomach, or intestines.

• Endoscopy and Colonoscopy are invasive tests in which a probe is inserted via the mouth (endoscopy) or the rectum (colonoscopy) to visualize the inner structures of the digestive tract in real-time.

• Laboratory studies have a very limited role in diagnosing conditions that may be associated with flatulence. Certain tests like Allergy, Individual Marker, Gluten can help identify if the patient’s symptoms are due to gluten allergy, also known as celiac disease.

Prevention #

• Eat fresh, home-cooked food, which is simple and easy to digest.

• Eat smaller portions throughout the day rather than consuming large meals all at once.

• Limit the consumption of aerated beverages.

• Quit smoking.

• Perform light exercises, such as walking after consuming heavy meals to help with the digestion process.

• Drink plenty of water and fluids throughout the day.

• Do not consume foods to which you are allergic.

• Establish a healthy bowel routine. Go to the loo at the same time every day and try to empty your bowels.

Treatment #

The treatment aims to relieve symptoms and treat the underlying causative agent.

Symptomatic relief #

Simethicone preparations are prescribed for bloating and abdominal distension. They help break down gas bubbles and allow easy passage of gas. Some studies have shown that activated charcoal when used along with simethicone is more effective in reducing bloating.

Digestive enzymes and probiotics help relieve the symptoms of indigestion and improve the body’s digestive system.

Treatment of underlying cause #

• If symptoms of gas are due to an underlying cause, it is necessary to treat the causative condition to provide complete relief.

• Lactase enzyme preparations are used to treat patients with lactose intolerance.

• Mesalazine formulations are used to treat Crohn’s Disease and ulcerative colitis.

• Antacids and prokinetic agents are used to treat gastroesophageal disease (GERD)