Abdominal accommodation induced by meal ingestion: differential responses to gastric and colonic volume loads

Burri, Emanuel; Cisternas, Daniel; Villòria, Albert; Accarino, Anna; Soldevilla, Alfredo; Malagelada, J.-R.; Azpiroz, Fernando

doi:10.1111/nmo.12068

Cited by 18 publications

(31 citation statements)

References 31 publications

(93 reference statements)

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“…Previous studies in healthy subjects using abdominal CT imaging combined with EMG of the abdominal walls showed that the anterior wall and the diaphragm, adapt their muscular tone to the intraabdominal content. Increases of intraabdominal content, induce an abdominal accommodation response, featuring a relaxation and upward displacement of the diaphragm with cephalad expansion of the abdominal cavity and limited impact on the anterior abdominal wall . The present study shows that abdominal distension after eating lettuce in our patients is produced by a paradoxical contraction of the diaphragm with caudo‐ventral redistribution of abdominal content.…”

Section: Discussionsupporting

confidence: 53%

Abdominal distension after eating lettuce: The role of intestinal gas evaluated in vitro and by abdominal CT imaging

Barba

Sánchez

Burri

et al. 2019

Neurogastroenterology Motil

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BackgroundSome patients complain that eating lettuce, gives them gas and abdominal distention. Our aim was to determine to what extent the patients' assertion is sustained by evidence.MethodsAn in vitro study measured the amount of gas produced during the process of fermentation by a preparation of human colonic microbiota (n = 3) of predigested lettuce, as compared to beans, a high gas‐releasing substrate, to meat, a low gas‐releasing substrate, and to a nutrient‐free negative control. A clinical study in patients complaining of abdominal distention after eating lettuce (n = 12) measured the amount of intestinal gas and the morphometric configuration of the abdominal cavity in abdominal CT scans during an episode of lettuce‐induced distension as compared to basal conditions.Key ResultsGas production by microbiota fermentation of lettuce in vitro was similar to that of meat (P = .44), lower than that of beans (by 78 ± 15%; P < .001) and higher than with the nutrient‐free control (by 25 ± 19%; P = .05). Patients complaining of abdominal distension after eating lettuce exhibited an increase in girth (35 ± 3 mm larger than basal; P < .001) without significant increase in colonic gas content (39 ± 4 mL increase; P = .071); abdominal distension was related to a descent of the diaphragm (by 7 ± 3 mm; P = .027) with redistribution of normal abdominal contents.Conclusion and InferencesLettuce is a low gas‐releasing substrate for microbiota fermentation and lettuce‐induced abdominal distension is produced by an uncoordinated activity of the abdominal walls. Correction of the somatic response might be more effective than the current dietary restriction strategy.

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Section: Discussionsupporting

confidence: 53%

Abdominal distension after eating lettuce: The role of intestinal gas evaluated in vitro and by abdominal CT imaging

Barba

Sánchez

Burri

et al. 2019

Neurogastroenterology Motil

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“…The study was designed to maximize both the cognitive and metabolic responses to a meal. For this purpose we used a well‐characterized standard meal with controlled and varied nutrient composition . Participants were instructed to consume the meal to their own level of maximal satiation in order to induce a standard cognitive response.…”

Section: Discussionmentioning

confidence: 99%

“…The probe meal has been previously described . In brief, it was an aqueous mixture of nutrients (0.8 kcal/mL) containing per liter meal 833 mL of a nutrient preparation (Edanec; Abbott, Madrid, Spain) and 27 g non‐absorbable polyethylenglycol 4000.…”

Section: Methodsmentioning

confidence: 99%

Cognitive and hedonic responses to meal ingestion correlate with changes in circulating metabolites

Malagelada

Barba

Accarino

et al. 2016

Neurogastroenterology Motil

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“…These changes were observed also during more physiological conditions such as meal ingestion [92] . In supine position, these responses to volume load express a similar posture-dependent coordination: the diaphragm in this case contracts to exert anti-gravitational activity while the anterior abdominal wall remains inactive.…”

Section: Impaired Abdominal Emptingmentioning

confidence: 72%

Bloating and functional gastro-intestinal disorders: Where are we and where are we going?

Iovino

Bucci

Tremolaterra

et al. 2014

WJG

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Bloating is one of the most common and bothersome symptoms complained by a large proportion of patients. This symptom has been described with various definitions, such as sensation of a distended abdomen or an abdominal tension or even excessive gas in the abdomen, although bloating should probably be defined as the feeling (e.g. a subjective sensation) of increased pressure within the abdomen. It is usually associated with functional gastrointestinal disorders, like irritable bowel syndrome, but when bloating is not part of another functional bowel or gastrointestinal disorder it is included as an independent entity in Rome Ⅲ criteria named functional bloating. In terms of diagnosis, major difficulties are due to the lack of measurable parameters to assess and grade this symptom. In addition, it is still unclear to what extent the individual patient complaint of subjective bloating correlates with the objective evidence of abdominal distension. In fact, despite its clinical, social and economic relevance, bloating lacks a clear pathophysiology explanation, and an effective management endorsement, turning this common symptom into a true challenge for both patients and clinicians. Different theories on bloating etiology call into questions an increased luminal contents (gas, stools, liquid or fat) and/or an impaired abdominal empting and/or an altered intra-abdominal volume displacement (abdomino-phrenic theory) and/ or an increased perception of intestinal stimuli with a subsequent use of empirical treatments (diet modifications, antibiotics and/or probiotics, prokinetic drugs, antispasmodics, gas reducing agents and tricyclic antidepressants). In this review, our aim was to review the latest knowledge on bloating physiopathology and therapeutic options trying to shed lights on those processes where a clinician could intervene to modify disease course. Key words: Bloating; Functional gastro-intestinal disorders; Irritable bowel syndrome; Constipation; Diarrhea Core tip: Bloating is one of the most common and bothersome symptoms complained by a large proportion of patients, mostly with functional gastrointestinal disorders, but when bloating is not part of another functional bowel or gastrointestinal disorder it is included as an independent entity in Rome Ⅲ criteria named functional bloating. Despite its clinical, social and economic Iovino P et al . Bloating and functional gastro-intestinal disorders relevance, bloating lacks a clear pathophysiology explanation and an effective management endorsement. Moreover, it is unclear to what extent subjective complaint of bloating correlates with the objective evidence of abdominal distension. The aim of this paper is to review the latest knowledge on bloating and to explore future research directions to improve its management.

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Abdominal accommodation induced by meal ingestion: differential responses to gastric and colonic volume loads

Abstract: Meal ingestion induces a metered and region-specific response of the abdominal walls to accommodate the volume load. Abnormal abdominal accommodation could be involved in postprandial bloating.

Cited by 18 publications

References 31 publications

Abdominal distension after eating lettuce: The role of intestinal gas evaluated in vitro and by abdominal CT imaging

Abdominal distension after eating lettuce: The role of intestinal gas evaluated in vitro and by abdominal CT imaging

Cognitive and hedonic responses to meal ingestion correlate with changes in circulating metabolites

Bloating and functional gastro-intestinal disorders: Where are we and where are we going?

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