Abstract
Ten to 25% of healthy persons experience bloating. It is particularly common in persons with the irritable bowel syndrome and constipation. While the cause of bloating remains unknown old explanations such as a excessive intestinal gas, exaggerated lumbar lordosis and psychiatric problems have been disproved. New suggestions include recent weight gain, weak or inappropriately relaxed abdominal muscles, an inappropriately contracted diaphragm and retained fluid in loops of distal small bowel. No treatment is of unequivocal benefit but a low FODMAPs diet, probiotics and the non-absorbable antibiotic rifaximin offer some hope. Treatment by weight loss, abdominal exercise, prokinetics and girdles need more study.
Highlights
Bloating is the symptom and distention is the sign
Let me begin at the end and say that I believe that most cases of functional abdominal bloating with visible abdominal distention can be explained by some combination of weak or inappropriately relaxed abdominal muscles, a diaphragm that contracts when it should relax; excessive intraabdominal fat; fluid in loops of small intestine and gravity
Visceral “hypersensitivity” has been invoked and may be a factor in patients who complain about bloating without abdominal distention as they are more sensitive to rectal distention than the bloaters with distention [7]
Summary
Bloating is the symptom and distention is the sign. There have been several recent exhaustive reviews of the topic and important new research [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15]. This is a brief summary of the relevant science and some of the art. I will review the evidence for my conclusions and for completeness include some other thoughts
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