2021 Expert Interpretation: 3-minute reading of abdominal bloating and abdominal distension

Author: Dr David Johnson This article was compiled finishing NMT Medical, please do not reprint without authorization
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Introduction Dr David Johnson, professor of medicine and director of gastroenterology at the Eastern Virginia School of Medicine in Norfolk, Virginia, recently discussed a very common problem: the management of abdominal bloating and abdominal distension
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Let's interpret it in detail below: the main characteristics of abdominal bloating: Abdominal bloating can be divided into two types: abdominal bloating and abdominal distention
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The main characteristics of abdominal bloating are gas accumulation, increased abdominal pressure, and a feeling of fullness, which is a conscious symptom of the patient
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In contrast, abdominal bulging reflects objective changes in abdominal circumference
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Abdominal bloating and abdominal bulging are common, and the prevalence in the general population ranges from 16% to 31%
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The prevalence of abdominal distension in patients with irritable bowel syndrome (IBS) may reach 66%-90%, and abdominal distension is more common in constipation patients and women
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 The impact of abdominal bloating on life Dr David Johnson said that whether it is abdominal bloating or distended abdomen, the impact on life is very significant
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Nearly 75% of patients with abdominal bloating think that their symptoms are moderate to severe, and 50% of patients say that these symptoms of bloating have led to a decline in their ability to perform daily living
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Some patients even told Dr David Johnson that they felt as if they were pregnant, or that there was a balloon in their belly, and it was simply unbearable for them
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What is even more surprising is that the development of abdominal bloating and abdominal bulging are often not synchronized, and only about 50%-60% of patients with abdominal bloating have abdominal bulging
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What caused this kind of situation to happen? When Dr David Johnson talked to his patients with bloating symptoms about the underlying pathophysiological theory, most patients believed that their symptoms might be caused by the body producing too much gas, but in fact, only a small number of patients with bloating felt this way.

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This symptom is not so much caused by a large increase in abdominal gas, as it is caused by the patient's own sensory errors
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Dr David Johnson said: Excessive growth of small intestinal bacteria and carbohydrate intolerance, especially lactose and fructose intolerance, are the main pathophysiological factors of this disease
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Lactase deficiency does not necessarily cause corresponding malabsorption, and not all individuals with low lactose intake will have corresponding symptoms
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On the contrary, some symptoms that occur in some patients may be caused by some additional factors, such as genetic susceptibility factors and visceral allergies
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Its pathogenesis is also very likely to be affected by the microbiome.
This situation can be seen in almost all disease states.
The role of the intestinal microbiome in causing changes in gastrointestinal motility, sensation or permeability , Has a profound effect on the production of abdominal bloating and abdominal swelling
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Abdominal distension is very common in patients with abnormal gastrointestinal motility, and it is especially common in patients with mild gastroparesis.
Their prevalence may be 50% or more, which is actually very similar to patients with pelvic floor dysfunction
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Such patients with established anal and rectal motor dysfunction may have problems with the function of emptying the gastrointestinal tract
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Similarly, pelvic drainage disorders may also increase the possibility of delayed colonic transit
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Another syndrome associated with bloating is called abdominal diaphragmatic dyssynchrony
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This is a paradoxical reaction, that is, when your bowel movement is forced downward, the abdominal diaphragm shrinks and the abdominal wall relaxes
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Under normal circumstances, the abdominal muscles contract while the diaphragm muscles are correspondingly relaxed, which can maintain the integrity of the head and tail axial function and avoid expansion.
If you forcibly reverse this movement method, it may cause abdominal bloating and abdominal distension
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Visceral allergies and abdominal distension also have an obvious causal relationship: that is, complex brain-gut-nervous interactions and some related factors, such as anxiety, depression, somatization disorders, and hyperglycemia, all of which may aggravate abdominal distension.
Symptoms
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Many of these diseases are also affected by the quality of sleep, which is a much-discussed issue recently
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Sleep fragmentation will lower the sensory threshold, and it will increase visceral hypersensitivity
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How to make a diagnosis of the disease? The breath test is a very simple diagnostic tool used to assess bacterial overgrowth
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We can try the breath test of lactose and fructose.
Of course, we can also consider the more common breath test of glucose and lactulose.
These tests are commercially feasible and relatively easy to obtain
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Of course, we must not forget that we need to consider celiac disease.
When this disease is suspected, serological examination can be performed
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When the patient has signs that indicate an early warning of physical condition, upper gastrointestinal endoscopy and abdominal imaging can be performed.
In fact, changes related to gastrointestinal motility and mild gastroplegia should also be considered
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For example: Anorectal exercise examination is the best choice for patients with suspected pelvic floor dysfunction, which may be combined with defecation X-ray photography
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A series of treatment options When it comes to treatment options, Dr David Johnson said that his first thought was to intervene through diet.
It is recommended that a good diet record should be used to assess whether there is abdominal bloating and bulging
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Dr David Johnson believes that the use of artificial sweeteners is usually a common cause of bloating symptoms.
These sweeteners usually contain unfermented carbohydrates, which will ferment in the intestinal tract and cause an increase in gas in the intestinal cavity
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Of course, we should also consider the influence of carbohydrates in fructose and FODMAPs (fermentable oligosaccharides, disaccharides and monosaccharides), which may significantly increase the osmotic load
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Many patients are worried about the role of gluten.
About 70% of non-celiac gluten sensitive patients have symptoms of bloating
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But the cause of this situation is not necessarily the gluten itself, but related products containing gluten, especially wheat, barley, fructans and FODMAPs
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Reducing the intake of these ingredients from the patient's diet may be a very effective way to solve their chronic bloating and bloating
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Dr David Johnson emphasized: We should also remember that carbohydrates may be mixed into our daily diet in the form of high fructose corn syrup
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 Although it is easy for clinicians to identify foods like FODMAPs, it is a difficult concept for patients to understand
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Research by Dr.
Bill Chey and colleagues shows that if patients with abdominal bloating and abdominal distension want to discuss the treatment of FODMAPs in the treatment of bloating disease, it is best to involve a nutritionist
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 Probiotics have little effect on alleviating the symptoms of bloating
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Antibiotics have been proven to be effective in the treatment of abdominal distension, especially rifaximin 550mg, 3 times a day, intravenous infusion, 14 days, but it is still difficult to obtain authorization to pay for medical insurance, except for those with IBS and diarrhea Patient
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Some experts believe that the combination of antispasmodics and simethicone may be a more reasonable choice
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If you are treating a patient with constipation, secretagogues are another option, because secretagogues can effectively improve the efficiency of fecal transport
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There are also a large number of alternative therapies.
For example, peppermint oil is a good way to try because it has almost no disadvantages.
For patients with dilated abdominal diaphragm, biofeedback therapy may be very useful
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Dr David Johnson stated that he personally found that diaphragmatic breathing is beneficial to some patients
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There is also some evidence that hypnotherapy can bring some improvements
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Step-by-step summary First, the first step in dealing with abdominal bloating and abdominal distension is to determine the underlying cause, which will help determine the direction of the test
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Second, pay attention to additional and further targeted detection of early warning signs and early warning symptoms, whether it is breathing detection or invasive detection
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Third, assess the diet and drug use, surgical factors and behavioral factors that may cause the disease
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Finally, according to your suspected pathophysiological point of view, initiate specific related treatments, whether it is diet intervention for carbohydrate intolerance or FODMAPs replacement, behavioral therapy, anxiety or sleep medication, or other interventions
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Written at the end, I sincerely hope that this discussion can provide you with some useful insights about the symptoms of abdominal bloating and abdominal distension.
This is not only a problem that medical institutions usually encounter, but also a problem that makes patients feel very frustrated
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Reference: David A.
Johnson, MD.
Bloating and Distention: How to Manage These Common Complaints.
Medscape Gastroenterology.
2021, Sep 16.
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