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Comparative Study
. 2019 Dec;31(12):e13703.
doi: 10.1111/nmo.13703. Epub 2019 Aug 11.

Abdominal distension after eating lettuce: The role of intestinal gas evaluated in vitro and by abdominal CT imaging

Elizabeth Barba  1   2 , Borja Sánchez  3   4 , Emanuel Burri  5 , Anna Accarino  1   2 , Eva Monclus  6 , Isabel Navazo  6 , Francisco Guarner  1   2 , Abelardo Margolles  3   4 , Fernando Azpiroz  1   2
Affiliations
Comparative Study

Abdominal distension after eating lettuce: The role of intestinal gas evaluated in vitro and by abdominal CT imaging

Elizabeth Barba et al. Neurogastroenterol Motil. 2019 Dec.

Abstract

Background: Some patients complain that eating lettuce, gives them gas and abdominal distention. Our aim was to determine to what extent the patients' assertion is sustained by evidence.

Methods: An in vitro study measured the amount of gas produced during the process of fermentation by a preparation of human colonic microbiota (n = 3) of predigested lettuce, as compared to beans, a high gas-releasing substrate, to meat, a low gas-releasing substrate, and to a nutrient-free negative control. A clinical study in patients complaining of abdominal distention after eating lettuce (n = 12) measured the amount of intestinal gas and the morphometric configuration of the abdominal cavity in abdominal CT scans during an episode of lettuce-induced distension as compared to basal conditions.

Key results: Gas production by microbiota fermentation of lettuce in vitro was similar to that of meat (P = .44), lower than that of beans (by 78 ± 15%; P < .001) and higher than with the nutrient-free control (by 25 ± 19%; P = .05). Patients complaining of abdominal distension after eating lettuce exhibited an increase in girth (35 ± 3 mm larger than basal; P < .001) without significant increase in colonic gas content (39 ± 4 mL increase; P = .071); abdominal distension was related to a descent of the diaphragm (by 7 ± 3 mm; P = .027) with redistribution of normal abdominal contents.

Conclusion and inferences: Lettuce is a low gas-releasing substrate for microbiota fermentation and lettuce-induced abdominal distension is produced by an uncoordinated activity of the abdominal walls. Correction of the somatic response might be more effective than the current dietary restriction strategy.

Keywords: abdominal distension; diaphragmatic activity; functional gut disorders; intestinal gas; lettuce.

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Conflict of interest statement

No competing interests declared.

Figures

Figure 1
Figure 1
Gas production by microbiota fermentation in vitro. The three predigested foodstuff and the nutrient‐free control were incubated with preparations of human colonic microbiota (n = 3). Gas production by microbiota fermentation of lettuce was similar to that of meat (a low gas‐releasing substrate), 78 ± 15% lower than that of beans (a high gas‐releasing substrate; P < .001) and 25 ± 19% higher than with the nutrient‐free control (P = .05)
Figure 2
Figure 2
Distribution of gas in the colon. During a lettuce‐induced episode of abdominal distension, colonic gas content tended to be higher, but not significantly, than during basal conditions. To note, the absolute differences were small and would hardly account for the abdominal distension
Figure 3
Figure 3
Abdominal CT image in a patient during basal conditions and during an episode of lettuce‐induced distension. Note that abdominal distension is associated to a diaphragmatic descent (blue arrow) and anterior wall protrusion (orange arrow) without substantial increase of intestinal gas
See this image and copyright information in PMC

References

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