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Clinical investigations from the RACP

Abdominal bloating: is it all in the gas?

James Pang, Ian Turner

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Abstract

Bloating is a common problem that is usually functional, but investigations to exclude organic disease may be needed depending on patient age and symptoms and signs. Treatment should be individualised and usually begins with dietary changes, followed by a short-term trial of medications if needed.

Key Points

  • Bloating is a common presenting symptom of functional gastrointestinal (GI) disorders, occurring either in isolation (functional bloating) or as part of a disorder such as irritable bowel syndrome (IBS); more rarely, it is a manifestation of an organic disease.
  • The underlying pathophysiological mechanisms for bloating have been difficult to define but likely involve retained intraluminal gas, altered GI motility and visceral hypersensitivity.
  • Functional bloating and bloating as a manifestation of IBS can usually be diagnosed clinically, but judicious use of investigations to exclude organic disease should be considered.
  • Treatment of functional bloating is challenging; a trial of lifestyle and dietary changes is appropriate, including a diet low in FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols), with dietitian overview.
  • A trial of simple measures such as proton-pump inhibitors, the herbal mixture Iberogast, peppermint oil capsules or probiotics might be beneficial in some patients.

    Picture credit: © 9nong/Dollar Photo Club.

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