Bloating

bloatingI’m excited to write about bloating, because it happens to be one of the most common complaints in my clinic. Bloating is extremely uncomfortable and causes a poor quality of life, therefore I always spend a lot of time in my clinic with patients who experience bloating, to help them discover the cause. At times it becomes a multi-step process, and the diagnosis is made by a process of elimination.

I have patients who describe their belly goes from flat to looking 9 months pregnant in a matter of few minutes after eating a meal. Some describe such extreme bloating where they have to unbutton their paints after a meal.

The intestine of a normal person contains about 200 mL of gas, and flatus evacuation averages about 600 mL per day. The flatus contains multiple gases including nitrogen, oxygen, carbon dioxide, hydrogen, and methane. Nitrogen and oxygen come from swallowed air, whereas the other gases result from bacterial fermentation process in the colon.

A few conditions that can cause gas and bloating include:

  1. Carbohydrate Maldigestion
  2. Small Intestinal Bacterial Overgrowth
  3. Irritable Bowel Syndrome
  4. Other causes: celiac disease, medications, hypothyroidism, ulcers, GERD, constipation, gallbladder problems, pancreas problems.

Below, I will describe each one of the above conditions in a little bit more detail.

Carbohydrate Maldigestion:

Lactose intolerance is the most common form of carbohydrate intolerance, affecting approximately 20% of the population in the USA. Lactose is a sugar found in dairy products such as milk, cheese, butter, yogurt, and cream. There is dairy hidden in so many different products such as salad dressing, bread, sauces, and other products, which makes it very difficult to avoid. A lot of times my patients really underestimate how much dairy they consume in their diet. Once they start reading labels and avoid all dairy, they notice a tremendous amount of relief.

Fructose is another sugar which is found in fruit and honey that can cause bloating. Sorbitol found in candy and chewing gum can also cause bloating. Complex carbohydrates such as whole wheat, oat, potato, and corn flour, can also cause bloating. There are also non-digestible sugars in beans and legumes are also a common cause of bloating.

Small Intestine Bacterial Overgrowth:

There are a few disorders that can lead to overgrowth of bacterial in the small intestine. The bacteria can proliferate in the lumen and cause malabsorption. In extreme cases, patient report fatty or oily stools that float.

The treatment of small bowel bacterial overgrowth is antibiotics. To date, the only antibiotic that works well in treating this condition is Rifaxamine, and it happens to be very expensive.

Irritable Bowel Syndrome (IBS):

There was a study done several years ago, where colon of healthy individuals was compared with individuals with IBS. Both groups had there bowel insufflated with gas equally. The group with IBS experienced much more discomfort compared to the other group, concluding that hypersensitivity may contribute to the problem. Also, retarded gas explosion could cause discomfort, in particular in patients with constipation predominant IBS.

 

Treatment:

The treatment usually revolves around avoiding the cause of bloating, which is most likely diet related. Unfortunately, the over the counter medications such as gas-x and simethicone are completely ineffective.