Among the most common gastrointestinal symptoms and include bloating, belching, and flatulence.

Result from bacteria that normally inhabit the intestines, primarily the colon.

The normal range of volumes of flatus in normal individuals is wide, 476–1,491 ml/24 h).

All intestinal gas is either swallowed environmental air, present intrinsically in foods and beverages, or the result of gut fermentation.

Has-related symptoms are consequences of incompletely understood interactions between gastrointestinal motility and gas production.

While symptoms have been attributed to excess gas in the gut lumen, gas transit studies do not confirm this.

Bloating is the sensation of a swollen or distended abdomen that affects 10-30% of the population.

The gastrointestinal lumen normally contains less than 200 mL of gas which combines swallowed air with N2 and O and gases that are produced during acid neutralization and bacterial fermentation.

Bloating common in functional bowel disorders such as irritable bowel syndrome and functional dyspepsia.

Bacteria present in the intestinal tract cause gas to be expelled from the anus.

They produce the gas as food is digested and moved from the small intestine.

This gas builds up and causes swelling or bloating in the abdominal area before it is released.

Bloating is defined as a sense of gassiness or being distended.

Bloating within 30 minutes of eating suggest the likelihood of a gastric etiology, whereas a longer time suggest the small bowel or dietary origin.

Belching refers to the expulsion of excess gas from the esophagus or stomach and may or may not occur in association with bloating.

Bloating is distinguished from abdominal distention, where the latter is an objective increase in abdominal girth.

Abdominal distension peaks 4-6 hours before bedtime and is correlated with bloating in patients with constipation predominant irritable bowel syndrome.

Abdominal distention occurs in only half the patients who experience bloating.

Occasional flatulence and belching after meals is not abnormal, the symptoms could be bothersome, particularly when they occur in excess.

Belching or burping works by removing gas from the stomach through the mouth.

The above symptoms occur in both functional gastrointestinal disorders such as irritable bowel syndrome, and in the general population.

The onset of gastrointestinal symptoms soon after eating suggest a gastric etiology, whereas delayed symptomatology may suggest a small bowel origin.

Eating large meals less often may contribute to post prandial discomfort.

Eating meals quickly without thorough chewing and gulping of food may contribute to gastrointestinal symptoms.

Foods associated with increased intestinal gas production and includes: onions, beans, and legumes.

Intolerance of foods containing lactose, gluten, and fructose may also be related to gas.

Consumption of large quantities of caffeine or carbonated drinks can contribute to gas related symptoms.

Artificial sweeteners, specifically sugar alcohols such as sorbitol, mannitol, and glycerol can promote gas production.

Caffeine consumption can cause transient lower esophageal sphincter relaxation and belching.

Constipation can lead to gas related symptoms and may cause abdominal pain.

The presence of diarrhea should give consideration for the diagnosis of small intestine bacterial overgrowth and celiac disease as the cause of increased gas.

Evaluation requires inquiry about meal volume, frequency, speed of eating, intake of carbonated and caffeinated beverages.

The intake of lactose, gluten, fructose as well as other commonly gassy foods such as legumes and cruciferous vegetables, as well as artificial sweeteners should be questioned.

Evaluation of associated GI symptoms such as abdominal pain, change in stool for more frequency, constipation, diarrhea, or weight loss should be ascertained.

Medications should be reviewed along with supplements and include: opioids, psyllium, iron, metformin, magnesium, high intake of apples or oats which are sources of fiber, sorbitol, multivitamins, over-the-counter anti-diarrheal medications, and lactulose / osmotics.

Consideration should be given to comorbidities such as intestinal bacterial overgrowth risk factors, gastric bypass surgery, radiation, prior abdominal surgery, use of continuous positive airway pressure ventilator for sleep apnea, or Nissen fundoplication.

Weight loss raises concerns for underlying neoplasm or malabsorption conditions, such is celiac disease.

Psyllium containing products may contribute to excess gas production.

Metformin and opiates are associated with gas related symptoms.

The use of continuous positive airway pressure for obstructive sleep apnea is associated with gas related symptoms, typically with morning symptoms following overnight use.

Patients on oxygen therapy can experience gaseous symptoms.

Approximately 25% of patients experience gas-bloat syndrome after Nissen fundoplication surgery.

Treatment of Gas

Treatment of gas are changing diet, taking medicines, and reducing the amount of air swallowed.

Avoiding fermentable vegetables/carbohydrates like beans, broccoli, cabbage, and some artificial sweeteners like sorbitol, commonly found in gum, candies, and some soft drinks, can lessen the amount of gas produced.

Truly lactose intolerant individuals may improve if they avoid milk products.

Alcohol may impair intestinal digestion so that more food is available for gas production.

Certain proteins may enhance the odor of gas. If gas is a problem for you, try

Monitoring diet for time of day and description of foods eaten and drinks ingested, and times of each episode of gas may identify what may cause increased gas production or what may effect odor.

Limiting high-fat foods to reduce bloating and discomfort, helps the stomach empty faster, allowing gases to move into the small intestine.

The amount of gas caused by certain foods varies from person to person.

Dietary changes depend on trial and 2241or to evaluate how much of the offending foods one can handle.

Products containing chlorophyllin copper such as Nullo or Derifil) can help minimize offending odor.

Digestive enzymes, such as lactase supplements, actually help digest carbohydrates and may allow people to eat foods that normally cause gas.

Simethicone is a foaming agent that joins gas bubbles in the stomach so that gas is more easily belched away, however, these medicines have no effect on intestinal gas.

Beano, a digestive aid, contains the sugar-digesting enzyme that the body lacks to digest the sugar in beans and many vegetables.

Beano has no effect on gas caused by lactose or fiber.

Heat degrades the enzyme in Beano

Beano is made from an enzyme, alpha-galactosidase, extracted from a food-grade mold.

For patients who have chronic belching, ways to reduce the amount of air swallowed are to avoiding chewing gum and to avoid eating hard candy, and eating at a slow pace.

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