Bloating in English is defined as the subjective sensation of an increase in abdominal girth, while abdominal distension is the visible or true increase in abdominal girth. 1 The first one is a symptom, while the second one is both a symptom and a clinical sign. In addition, bloating and distension can coexist and they are very commonly reported by patients and subjects in the general population. 2 Their underlying mechanism is not completely elucidated; however, bloating may be related to gut hypersensitivity, while abdominal distension can be related to an increment in intraluminal gas, as well as a behavioral response, featuring a diaphragmatic contraction and descent with anterior wall protrusion known as abdomino-phrenic dyssynergia. 2 Earlier epidemiological studies in North America