Abdominothoracic Mechanisms of Functional Abdominal Distension and Correction by Biofeedback

Barba, Elizabeth; Burri, Emanuel; Accarino, Anna; Cisternas, Daniel; Quiroga, Sergi; Monclús, Eva; Navazo, Isabel; Malagelada, Juan–R.; Azpiroz, Fernando

doi:10.1053/j.gastro.2014.12.006

Cited by 55 publications

(82 citation statements)

References 24 publications

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“…Therefore, it is possible that some patients had other mechanisms than excess gas such as visceral hypersensitivity or abnormal gas handling that caused their bloating symptoms. In addition, IBS patients have shown abdominophrenic dyscoordination involving activity of the abdominothoracic wall, resulting in abdominal distension [21]. They would be less likely to benefit solely from decreasing gas formation.…”

Section: Discussionmentioning

confidence: 99%

Does oral α-galactosidase relieve irritable bowel symptoms?

Hillilä

Färkkilä

Sipponen

et al. 2015

Scandinavian Journal of Gastroenterology

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Section: Discussionmentioning

confidence: 99%

Does oral α-galactosidase relieve irritable bowel symptoms?

Hillilä

Färkkilä

Sipponen

et al. 2015

Scandinavian Journal of Gastroenterology

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“…Patients received EMG‐guided training during the three treatment sessions on separate days within a 2‐week period, as described before . In brief, patients were trained to control the activity of the abdomino‐thoracic muscles under visual control of EMG recordings displayed on a monitor.…”

Section: Methodsmentioning

confidence: 99%

“…The abdominal wall actively adapts to its content by a tight regulation of its muscular activity . Considering these two elements, ie wall and content, abdominal distension in patients may be related to either an increase in abdominal content, eg intestinal gas accumulation, or to a dyssynergia of the abdominal walls and redistribution of normal content; the latter is a conditioned response that can be corrected by behavioral treatment …”

Section: Introductionmentioning

confidence: 99%

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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“…21 Similar disturbances (ie, diaphragmatic contraction and relaxation of the lower rectus and internal oblique) have been observed during intestinal gas infusion in IBS and functional bloating. 22 …”

Section: Relevant Anatomy Physiology and Pathophysiologymentioning

confidence: 99%

Common Functional Gastroenterological Disorders Associated With Abdominal Pain

Bharucha

Chakraborty

Sletten

2016

Mayo Clinic Proceedings

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Although abdominal pain is a symptom of several structural gastrointestinal disorders (eg, peptic ulcer disease), this comprehensive review will focus on the 4 most common nonstructural, or functional, disorders associated with abdominal pain: functional dyspepsia, constipation-predominant and diarrhea-predominant irritable bowel syndrome, and functional abdominal pain syndrome. Together, these conditions affect approximately 1 in 4 people in the United States. They are associated with comorbid conditions (eg, fibromyalgia, depression), impaired quality of life, and increased health care utilization. Symptoms are explained by disordered gastrointestinal motility and sensation, which are implicated in a variety of peripheral (eg, postinfectious inflammation, luminal irritants) and/or central (eg, stress and anxiety) factors. These disorders are defined and can generally be diagnosed by symptoms alone. Often prompted by alarm features, selected testing is useful to exclude structural disease. Identifying the specific diagnosis (eg, differentiating between functional abdominal pain and irritable bowel syndrome) and establishing an effective patient-physician relationship are the cornerstones of therapy. Many patients with mild symptoms can be effectively managed with limited tests, sensible dietary modifications, and over-the-counter medications tailored to symptoms. If these measures are not sufficient, pharmacotherapy should be considered for bowel symptoms (constipation or diarrhea) and/or abdominal pain; opioids should not be used. Behavioral and psychological approaches (eg, cognitive behavioral therapy) can be very helpful, particularly in patients with chronic abdominal pain who require a multidisciplinary pain management program without opioids.

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Abdominothoracic Mechanisms of Functional Abdominal Distension and Correction by Biofeedback

Abstract: In patients with functional gut disorders, abdominal distension is a behavioral response that involves activity of the abdominothoracic wall. This distension can be reduced with EMG-guided, respiratory-targeted biofeedback therapy.

Cited by 55 publications

References 24 publications

Does oral α-galactosidase relieve irritable bowel symptoms?

Does oral α-galactosidase relieve irritable bowel symptoms?

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

Common Functional Gastroenterological Disorders Associated With Abdominal Pain

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