Gut Reaction #34: Bloating
One of the most common reasons for referral to a gastroenterologist is the feeling of bloating (abdominal distension). It occurs when gas or fluid accumulate in the abdomen, causing expansion of the small or large intestine. In younger people it is usually a benign and harmless, albeit distressing, symptom but rarely it may be due to an underlying disease.
Bloating is most commonly a feature of irritable bowel syndrome (IBS) but the following conditions may cause bloating and need to be considered:
- Small intestinal bacterial overgrowth
- Coeliac disease
- Chronic infection with G lamblia
- Weight gain (especially if the fat accumulates in the abdominal cavity)
- Maldigestion or abnormal fermentation of carbohydrates (e.g. lactose or fructose intolerance)
And more rarely:
- Abnormal fluid accumulation (ascites)
- Large ovarian cyst or uterine fibroid (noncancerous growths of the uterus)
Investigation of Bloating
The cause of bloating may be clear following a careful history and examination by a doctor. The following tests may be undertaken to help with the diagnosis:
- Blood test to look for coeliac disease
- Stool sample to look for Giardia lambliaantigen
- Hydrogen breath tests for carbohydrate intolerances or small intestinal bacterial overgrowth
- Faecal calprotectin to exclude inflammation or infection
- Ultrasound scanning of the abdomen and pelvis (in a female) to exclude abnormal fluid accumulation or enlarged organs
Treatment of Bloating
This will depend upon the underlying cause. Thus, infection with G lambliais cured by tinidazole. Lactose or fructose intolerance may respond to dietary restriction. Small intestinal bacterial overgrowth may be helped by an antibiotic (e.g. rifamixin) or probiotics. IBS with bloating is often relieved by a low FODMAP diet (avoiding foods rich in short chain carbohydrates that are poorly absorbed in the small intestine and so are rapidly fermented by bacteria in the colon). In patients with a new diagnosis of coeliac disease, a gluten-free diet will need to be followed.
For more information about bloating and potential treatment options, please do not hesitate to contact Dr. Adam Harris.