Abstract
Many patients believe their excessive rectal gas to constitute a major handicap for their social life and/or to result from a medical disorder. As a result, physicians tend to prescribe multiple laboratory, radiological and endoscopic investigations which may not explain the symptoms despite their usefulness to rule out an organic aetiology. Moreover, such diagnostic approach commonly results in an inadequate therapeutic management. This review proposes a rational approach of such complaints. Particular emphasis is placed upon a sequential strategy consisting of 1) a daily count of flatulent manifestations (normal < 20 /day); 2) an analysis, when possible, of the flatus in terms of gas composition in order to determine whether the increased flatulence results from swallowed air (predominantly nitrogen N 2) or from intraluminal production (carbon dioxide CO 2, hydrogen H 2 and methane CH 4); and 3) an adaptation of the treatment to the rectal gas origin. Currently, only dietetic measures have proven some efficacy, but probiotics seem likely to have role in the management of the diseases associated with digestive gas.
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