gastrointestinal disorders
Gas Related Complaints
Evaluation of Gas Related Complaints
History of present illnessin patients with belching should be directed at finding the cause of aerophagia, especially dietary causes. In patients complaining of gas, bloating, or flatus, the relationship between symptoms and meals (both timing and type and amount of food), bowel movements, and exertion should be explored. Certain patients, particularly in the acute setting, may use the term "gas" to describe their symptoms of coronary ischemia. Changes in frequency and color and consistency of stool are sought. History of weight loss is noted. Review of systemsshould seek symptoms of possible causes, including diarrhea and steatorrhea (malabsorption syndromes such as celiac sprue. tropical sprue, disaccharidase deficiency, and pancreatic insufficiency) and weight loss (cancer, chronic malabsorption). Past medical historyshould review all components of the diet for possible causes (see table). The examination is generally normal, but in patients with bloating or flatus, signs of an underlying organic disorder should be sought on abdominal, rectal, and (for women) pelvic examination. The following findings are of concern: Weight loss Blood in stool (occult or gross) "Gas" sensation in chest Chronic, recurrent bloating or distention in a patient with abdominal pain that is related to defecation and associated with change in frequency or consistency of stool but without red flag findings suggests Irritable Bowel Syndrome (IBS) . Long-standing symptoms in an otherwise well young person who has not lost weight are unlikely to be caused by serious physiologic disease, although an Introduction to Eating Disorders should be considered, particularly in young women. Bloating accompanied by diarrhea, weight loss, or both (or only after ingestion of certain foods) suggests a Testing is not indicated for belching unless other symptoms suggest a particular disorder. Testing for carbohydrate intolerance (eg, lactose, fructose) with breath tests should be considered particularly when the history suggests significant consumption of these sugars. Testing for small intestinal bacterial overgrowth should also be considered, particularly in patients who also have diarrhea, weight loss, or both, preferably by aerobic and anaerobic culture of small-bowel aspirates obtained during upper GI endoscopy. Testing for bacterial overgrowth with hydrogen breath tests, generally glucose-hydrogen breath tests, is prone to false-positive (ie, with rapid transit) and false-negative (ie, when there are no hydrogen-producing bacteria) results. Testing for rare conditions such as sucrase-isomaltase deficiency can be considered in patients with refractory or severe symptoms ( Evaluation reference ). New, persistent bloating in middle-aged or older women (or those with an abnormal pelvic examination) should prompt pelvic ultrasonography to rule out ovarian cancer. 1.Husein DM, Rizk S, Naim HY: Differential effects of sucrase-isomaltase mutants on its trafficking and function in irritable bowel syndrome: Similarities to congenital sucrase-isomaltase deficiency.Nutrients13(1):9, 2021. doi: 10.3390/nu13010009 