Management of bloating

Abstract

Abdominal bloating is a subjective sensation of trapped abdominal gas, producing abdominal pressure, fullness sensation, and, in some patients, associated objective abdominal distension. In this month's edition of the journal, a new validated questionnaire to assess the prevalence and impact of gas-related symptoms is presented by Duracinsky et al., showing that gas-related abdominal symptoms are prevalent in patients with irritable bowel syndrome and have a measurable impact on patients daily life. A parallel study by Gardiner et al. assessing the severity of bloating in functional gastrointestinal disorders shows that severe bloating is associated with the severity of abdominal pain, constipation, and somatization, advancing our understanding of the clinical characteristics and relevance of gas-related symptoms in the broad spectrum of functional gastrointestinal disorders. Management of bloating includes non-pharmacological and pharmacological strategies. Dietary interventions to reduce intestinal fermentation and ingestion of food supplements like prebiotics or probiotics can reduce bloating by reducing gas production. The main targets of pharmacological treatments are to improve transit and evacuation with prokinetics, to improve intestinal gas tolerance with antispasmodics and/or neuromodulators, and to modify intestinal microbiota with antibiotics. Secretagogues act by increasing intestinal secretion and decreasing visceral sensitivity and have been reported to be an effective treatment alternative for patients with bloating associated with constipation. Biofeedback therapy addressed to correct abdomino-phrenic dysynergia may be useful for patients with objective abdominal distension, and patients with bloating associated with outlet obstructed defecation may benefit from anorectal biofeedback.

Keywords: abdominal distension; bloating; intestinal fermentation; intestinal gas; visceral sensitivity.