gastrointestinal disorders
Gas Related Complaints
Treatment of Gas Related Complaints
Belching and bloating are difficult to relieve because they are usually caused by unconscious aerophagia or increased sensitivity to normal amounts of gas. Aerophagia may be reduced by eliminating gum and carbonated beverages, cognitive behavioral techniques to prevent air swallowing, and management of associated upper GI diseases (eg, peptic ulcer). Foods containing unabsorbable carbohydrates should be avoided. Even lactose-intolerant patients generally tolerate up to 1 glass of milk drunk in small amounts throughout the day. The mechanism of repeated belching should be explained and demonstrated. When aerophagia is troublesome, behavioral therapy to encourage open-mouth, diaphragmatic breathing and minimize swallowing may be effective. Drugs provide little benefit. Results withsimethicone, an agent that breaks up small gas bubbles, and various anticholinergics are poor. Some patients with dyspepsia and postprandial upper abdominal fullness benefit from antacids, a low dose of tricyclic antidepressants (eg, oralnortriptyline10 to 50 mg once/day), or both to reduce visceral hypersensitivity. Complaints of excess flatus are treated with avoidance of triggering substances (see table). Patients can try reducing their intake of the triggering substances one at a time and noting the effect on their symptoms. Roughage (eg, bran,psylliumseed) may be added to the diet to try to increase colonic transit; however, in some patients, worsening of symptoms may result. Patients can also try a low-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet. Activatedcharcoalcan sometimes help reduce gas and unpleasant odor; however, it stains clothing and the oral mucosa.Charcoal-lined undergarments are available. Probiotics may also reduce bloating and flatulence by modulating intestinal bacterial flora, but data in this area are limited. Antibiotics are useful in patients with documented bacterial overgrowth. Certain aromatic oils (carminatives) can relax smooth muscle and relieve pain caused by cramps in some patients. Slow-release peppermint oil is the most commonly used agent in this class. Functional bloating, distention, and flatus may run an intermittent, chronic course that is only partially relieved by therapy. When appropriate, reassurance that these problems are not detrimental to health is important. 