Bloating resident survival guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Usman Ali Akbar, M.B.B.S.[2]

Synonyms and keywords:Approach to abdominal bloating, Approach to abdominal belching, Approach to flatulence, Use of FODMAPs.

Bloating is one of the most common gastrointestinal complaints that is attributed by the patient as the subjective sensation of incorrectly perceived excess gas. There are multiple non-functional etiologies of abdominal bloating and distension. Primary functional abdominal distension (FABD) should be diagnosed as a single entity and doesn’t overlap with other functional gastrointestinal disorders. Rome IV diagnostic criteria mentions the co-existence of mild abdominal pain and/or minor bowel movements. FABD can be treated with antispasmodic along with peppermint oil in randomized controlled trials. A stepwise approach is usually needed that includes the dietary interventions, microbiome modulation, and medical therapy in the management of FABD.

• The causes of abdominal bloating are numerous and are managed according to the underlying etiology:^[1][2]

• Shown below is an algorithm summarizing the diagnosis of abdominal bloating according to the American College of Gastroenterology Guidelines:^[3][4]

• Shown below is an algorithm summarizing the treatment of abdominal bloating according the the American College of Gastroenterology Guidelines:^[5]

• Use of probiotics can help reduce bloating.
• Antidepressants can help to reduce the symptoms of IBS but the data is unclear over the reduction of bloating.^[7]
• Hypnotherapy has been reported to be useful in reducing the symptoms of bloating.
• Bowel training and diaphragmatic breathing have been useful in the management of bloating, however the data is unclear.

• Artificial sweeteners containing sorbitol, mannitol, and xylitol should be avoided.^[8]
• Medications such as anticholinergics, opiates, calcium channel blockers, and antidepressants should also be avoided as they have an effect on bloating.^[9]
• 20% of carbohydrates in baked beans, 7–10% in wheat, oats, potatoes, and corn, and 1% in white rice are not absorbed well in the intestine and they can predispose to bloating, hence it is advisable to avoid them in the patients with increased complaints of bloating.