bloat
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Introduction
Feelings of diffuse abdominal pain.
Etiology
- irritable bowel syndrome
- bacterial overgrowth syndrome
- giardiasis (Giardia lamblia)
- carbohydrate enzyme deficiency
- celiac disease[4]
- pelvic floor dysfunction[4]
- dyspepsia (MKSAP19)
- cholinesterase inhibitors
Pathology
- intestinal gas may be normal in quantity
- intestinal motility disturbance
- visceral hypersensitivity
- gas produced in the colon by bacterial fermentation (also see flatulence)
Diagnostic criteria
- Rome IV criteria should be used to diagnose primary abdominal bloating & abdominal distension & irritable bowel syndrome[4]
Laboratory
- hydrogen breath test for carbohydrate enzyme deficiency[4]
- tissue transglutaminase IgA in serum to evaluated for celiac disease[4]
Diagnostic procedures
- upper GI endoscopy with small bowel biopsy
- confirm celiac disease[4]
- worsening symptoms
- gastric emptying study only if nausea/vomiting[4]
- anorectal physiology testing if constipation, difficulty with defectation[4]
Radiology
Differential diagnosis
- dyspepsia*
- postprandial bloating, early satiety & minimal epigastric tenderness
Management
- pharmacologic agents*
- simethicone is indicated for treatment of gas retention in the GI tract
- may alter elasticity of gas bubbles
- anticholinergics
- dicyclomine (Bentyl) 10-30 mg 30 min before meals
- hyoscyamine
- antidepressants: begin at lower dose
- amitriptyline (Elavil) 25-150 mg QHS
- doxepin (Sinequan) 25-150 mg QHS
- fluoxetine (Prozac) 20 mg QD
- nortriptyline (prokinetic agent according to NEJM)
- prokinetic agent:
- metoclopramide
- cisapride (Propulsid) 10-20 mg BID (removed from US market)
- simethicone is indicated for treatment of gas retention in the GI tract
- behavioral modification/biofeedback especially with pelvic floor dysfunction[4]
- low FODMAP diet with GI dietician oversight if carbohydrate enzyme deficiency[4]
- do not use probiotics[4]
- Iberogast ?
* treat dyspepsia with proton pump inhibitor prior to treating bloat (MKSAP19)
More general terms
Additional terms
References
- ↑ Stedman's Medical Dictionary 26th ed, Williams & Wilkins, Baltimore, 1995
- ↑ Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 234
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 18, American College of Physicians, Philadelphia 2018
- ↑ 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 4.10 4.11 American Gastroenterological Association Clinical practice update focuses on belching, bloating, distension. https://gastroenterology.acponline.org/archives/2023/07/28/1.htm
Moshiree B, Drossman D, Shaukat A. AGA Clinical Practice Update on Evaluation and Management of Belching, Abdominal Bloating, and Distension: Expert Review. Gastroenterology. 2023. July 13 PMID: https://www.ncbi.nlm.nih.gov/pubmed/37452811 Free article Review. https://www.gastrojournal.org/article/S0016-5085(23)00823-5/fulltext - ↑ NEJM Knowledge+