Clinical investigations from the RACP

Investigation of the patient with bloating

Lara Kane, Tim Florin



A common reason for presentation to GPs and gastroenterologists, abdominal bloating is a feature of many diseases affecting the gastrointestinal system. History and examination will direct investigations.

Key Points

  • Gastrointestinal hyperaesthesia is the most common cause of abdominal bloating.
  • Detailed history taking and physical examination of a patient with bloating will direct further investigations.
  • Irritable bowel syndrome is likely to underlie bloating if a functional psychosocial context is present and symptoms have been present over a long period of time.
  • A diagnosis other than irritable bowel syndrome or hyperaesthesia is suggested by particular symptoms, abnormal physical findings, the presence of medical conditions predisposing to gastroparesis or bacterial overgrowth, and family history of colon cancer, coeliac disease or inflammatory bowel disease. The symptoms include bloating onset after the age of 50 years, bloating that wakes the patient from sleep, weight loss, gastrointestinal bleeding, increasing pain and gut obstruction.