Year 2024 / Volume 116 / Number 9
Editorial
Management of abdominal bloating and distension, from subjective to objective

461-464

DOI: 10.17235/reed.2024.10482/2024

Alberto Ezquerra-Durán, Elizabeth Barba,

Abstract
Abdominal distension is a clinical occurrence that involves a measurable, objective increase in abdominal circumference, which patients report as feeling like pregnant or like having a balloon inside the abdomen. This sign is often preceded by a subjective feeling of abdominal heaviness or bloating, reported as the sensation of having a huge amount of gas trapped inside. These manifestations are highly prevalent and may reflect on their own a gut-brain axis condition, such as functional abdominal distension, or be part of other disorders such as functional dyspepsia or irritable bowel syndrome (IBS). The prevalence of abdominal distension and bloating is 3.5 %. However, when associated with other gut-brain axis disorders such as dyspepsia or IBS, prevalence grows above 50 %. The etiology and pathophysiology of abdominal bloating and distension are highly complex and represent a challenge for both the practitioner and the patient. The patient often associates these sensations with trapped gas, and attributes them to some food intolerance, hence he/she adopts a highly restrictive diet that fails to resolve distension while incurring the risk of nutritional deficiencies or secondary dysbiosis, making a directed treatment guideline necessary.
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References
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18. Neri L, Iovino P, Laxative Inadequate Relief Survey (LIRS) Group. Bloating is associated with worse quality of life, treatment satisfaction, and treatment responsiveness among patients with constipation-predominant irritable bowel syndrome and functional constipation. Neurogastroenterology and motility. 2016;28(4):581-591. doi:10.1111/nmo.12758
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23. Barba E, Accarino A, Azpiroz F. Correction of Abdominal Distention by Biofeedback-Guided Control of Abdominothoracic Muscular Activity in a Randomized, Placebo-Controlled Trial. Clinical Gastroenterology and Hepatology. 2017;15(12):1922-1929. doi:10.1016/j.cgh.2017.06.052
24. Damianos JA, Tomar SK, Azpiroz F, Barba E. Abdominophrenic Dyssynergia: A Narrative Review. American Journal of Gastroenterology. 2023;118(1):41-45. doi:10.14309/ajg.0000000000002044
25. Barba E, Burri E, Accarino A, et al. Abdominothoracic mechanisms of functional abdominal distension and correction by biofeedback. Gastroenterology. 2015;148(4):732-739. doi:10.1053/j.gastro.2014.12.006
1. Drossman DA, Morris CB, Schneck S, et al. International survey of patients with IBS: symptom features and their severity, health status, treatments, and risk taking to achieve clinical benefit. J Clin Gastroenterol. 2009;43(6):541-550. doi:10.1097/MCG.0b013e318189a7f9
2. Sperber AD, Bangdiwala SI, Drossman DA, et al. Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study. Gastroenterology. 2021;160(1):99-114.e3. doi:10.1053/j.gastro.2020.04.014
3. Jiang X, Locke GR, Choung RS, Zinsmeister AR, Schleck CD, Talley NJ. Prevalence and risk factors for abdominal bloating and visible distention: a population-based study. Gut. 2008;57(6):756-763. doi:10.1136/gut.2007.142810
4. Palsson OS, Simren M, Tack JF, et al. Tu1387: Bloating and distention: inherent characteristics of irritable bowel syndrome (IBS) and functional dyspepsia (FD)? Gastroenterology. 2022;162(7):S-946. doi:10.1016/S0016-5085(22)62240-6
5. Lacy BE, Cangemi D, Vazquez-Roque M. Management of Chronic Abdominal Distension and Bloating. Clinical Gastroenterology and Hepatology. 2021;19(2):219-231.e1. doi:10.1016/j.cgh.2020.03.056
6. Böhn L, Störsrud S, Törnblom H, Bengtsson U, Simrén M. Self-Reported Food-Related Gastrointestinal Symptoms in IBS Are Common and Associated with More Severe Symptoms and Reduced Quality of Life. American Journal of Gastroenterology. 2013;108(5):634-641. doi:10.1038/ajg.2013.105
7. Melchior C, Algera J, Colomier E, Törnblom H, Simrén M, Störsrud S. Food Avoidance and Restriction in Irritable Bowel Syndrome: Relevance for Symptoms, Quality of Life and Nutrient Intake. Clin Gastroenterol Hepatol. 2022;20(6):1290-1298.e4. doi:10.1016/j.cgh.2021.07.004
8. Colomier E, Van Oudenhove L, Tack J, et al. Predictors of Symptom-Specific Treatment Response to Dietary Interventions in Irritable Bowel Syndrome. Nutrients. 2022;14(2):397. doi:10.3390/nu14020397
9. Yao CK, Tuck CJ. The clinical value of breath hydrogen testing. J Gastroenterol Hepatol. 2017;32 Suppl 1:20-22. doi:10.1111/jgh.13689
10. Varjú P, Gede N, Szakács Z, et al. Lactose intolerance but not lactose maldigestion is more frequent in patients with irritable bowel syndrome than in healthy controls: A meta-analysis. Neurogastroenterology and motility. 2019;31(5):e13527. doi:10.1111/nmo.13527
11. Böhn L, Störsrud S, Liljebo T, et al. Diet low in FODMAPs reduces symptoms of irritable bowel syndrome as well as traditional dietary advice: a randomized controlled trial. Gastroenterology. 2015;149(6):1399-1407.e2. doi:10.1053/j.gastro.2015.07.054
12. Ford AC, Harris LA, Lacy BE, Quigley EMM, Moayyedi P. Systematic review with meta-analysis: the efficacy of prebiotics, probiotics, synbiotics and antibiotics in irritable bowel syndrome. Aliment Pharmacol Ther. 2018;48(10):1044-1060. doi:10.1111/apt.15001
13. Amieva-Balmori M, Coss-Adame E, Rao NS, Dávalos-Pantoja BM, Rao SSC. Diagnostic Utility of Carbohydrate Breath Tests for SIBO, Fructose, and Lactose Intolerance. Dig Dis Sci. 2020;65(5):1405-1413. doi:10.1007/s10620-019-05889-9
14. Losurdo G, Leandro G, Ierardi E, et al. Breath Tests for the Non-invasive Diagnosis of Small Intestinal Bacterial Overgrowth: A Systematic Review with Meta-analysis. J Neurogastroenterol Motil. 2020;26(1):16-28. doi:10.5056/jnm19113
15. Rezaie A, Heimanson Z, McCallum R, Pimentel M. Lactulose Breath Testing as a Predictor of Response to Rifaximin in Patients with Irritable Bowel Syndrome With Diarrhea. American Journal of Gastroenterology. 2019;114(12):1886-1893. doi:10.14309/ajg.0000000000000444
16. Martín Domínguez V, Malagelada C, Santander C. Small intestinal bacterial overgrowth. A position paper of ASENEM-SEPD. Revista Española de Enfermedades Digestivas. 2023;116. doi:10.17235/reed.2023.10027/2023
17. Neri L, Iovino P, Laxative Inadequate Relief Survey (LIRS) Group. Bloating is associated with worse quality of life, treatment satisfaction, and treatment responsiveness among patients with constipation-predominant irritable bowel syndrome and functional constipation. Neurogastroenterology and motility. 2016;28(4):581-591. doi:10.1111/nmo.12758
18. Bharucha AE, Wald A. Chronic Constipation. Mayo Clin Proc. 2019;94(11):2340-2357. doi:10.1016/j.mayocp.2019.01.031
19. Videlock EJ, Lembo A, Cremonini F. Diagnostic testing for dyssynergic defecation in chronic constipation: meta‐analysis. Neurogastroenterology & Motility. 2013;25(6):509. doi:10.1111/nmo.12096
20. Grossi U, Carrington E V, Bharucha AE, Horrocks EJ, Scott SM, Knowles CH. Diagnostic accuracy study of anorectal manometry for diagnosis of dyssynergic defecation. Gut. 2016;65(3):447-455. doi:10.1136/gutjnl-2014-308835
21. Drossman DA, Tack J, Ford AC, Szigethy E, Törnblom H, Van Oudenhove L. Neuromodulators for Functional Gastrointestinal Disorders (Disorders of Gut-Brain Interaction): A Rome Foundation Working Team Report. Gastroenterology. 2018;154(4):1140-1171.e1. doi:10.1053/j.gastro.2017.11.279
22. Barba E, Accarino A, Azpiroz F. Correction of Abdominal Distention by Biofeedback-Guided Control of Abdominothoracic Muscular Activity in a Randomized, Placebo-Controlled Trial. Clinical Gastroenterology and Hepatology. 2017;15(12):1922-1929. doi:10.1016/j.cgh.2017.06.052
23. Damianos JA, Tomar SK, Azpiroz F, Barba E. Abdominophrenic Dyssynergia: A Narrative Review. American Journal of Gastroenterology. 2023;118(1):41-45. doi:10.14309/ajg.0000000000002044
24. Barba E, Burri E, Accarino A, et al. Abdominothoracic mechanisms of functional abdominal distension and correction by biofeedback. Gastroenterology. 2015;148(4):732-739. doi:10.1053/j.gastro.2014.12.006
25. Moshiree B, Drossman D, Shaukat A. AGA Clinical Practice Update on Evaluation and Management of Belching, Abdominal Bloating, and Distention: Expert Review. Gastroenterology. 2023;165(3):791-800.e3. doi:10.1053/j.gastro.2023.04.039
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Publication history

Received: 15/04/2024

Accepted: 22/04/2024

Online First: 11/07/2024

Published: 09/09/2024

Article revision time: 6 days

Article Online First time: 87 days

Article editing time: 147 days


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