Intestinal gas content and distribution in health and in patients with functional gut symptoms

Bendezú, R. A.; Barba, Elizabeth; Burri, Emanuel; Cisternas, Daniel; Malagelada, Carolina; Seguí, Santi; Accarino, Anna; Quiroga, S.; Monclús, Eva; Navazo, Isabel; Malagelada, J.-R.; Azpiroz, Fernando

doi:10.1111/nmo.12618

Cited by 33 publications

(42 citation statements)

References 26 publications

(88 reference statements)

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“…The increase in gas content observed was probably related to the arrival into the colon of complex carbohydrates resistant to small bowel digestion. The amount of colonic gas and the intraluminal distribution of the gaseous mass, both during basal conditions as well as after eating lettuce, was within the normal range observed in healthy subjects during fasting and after a regular meal …”

Section: Discussionsupporting

confidence: 65%

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: 65%

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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“…An experimental gas challenge test (high-rate exogenous gas infusion directly into the jejunum) has shown that patients with functional dyspepsia who complain of bloating have impaired handling of intestinal gas, that is, gas retention, abdominal symptoms or both 165 . However, studies using abdominal CT and MRI scanning in clinical conditions could not corre late abdominal symptoms with excessive intestinal gas in these patients, as in the majority of the patients the volume and distribution of intestinal gas were within the normal ranges 166,167 . Hence, the perception of abdominal bloating could be related to a poor tolerance of normal gut content.…”

Section: Gas-related Symptomsmentioning

confidence: 82%

“…Visible distension is frequently associated with a bloating sensation, but the reverse is not the rule. Patients who complain of postprandial distension indeed develop an increment in girth during the distension episodes compared with basal conditions, but the volume of gastrointestinal gas is by and large within the normal range 167 . Furthermore, this abnormal distension is produced by a paradoxical diaphragmatic contraction, which is associated with a relaxation of the anterior abdominal wall 169 .…”

Section: Abdominal Distensionmentioning

confidence: 94%

Functional dyspepsia

Enck¹,

Azpiroz

Boeckxstaens

et al. 2017

Nat Rev Dis Primers

242

247

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| Functional dyspepsia is one of the most prevalent functional gastrointestinal disorders. Functional dyspepsia comprises three subtypes with presumed different pathophysiology and aetiology: postprandial distress syndrome (PDS), epigastric pain syndrome (EPS) and a subtype with overlapping PDS and EPS features. Functional dyspepsia symptoms can be caused by disturbed gastric motility (for example, inadequate fundic accommodation or delayed gastric emptying), gastric sensation (for example, sensations associated with hypersensitivity to gas and bloating) or gastric and duodenal inflammation. A genetic predisposition is probable but less evident than in other functional gastrointestinal disorders, such as irritable bowel syndrome (IBS). Psychiatric comorbidity and psychopathological state and trait characteristics could also play a part, although they are not specific to functional dyspepsia and are less pronounced than in IBS. Possible differential diagnoses include Helicobacter pylori infection and peptic ulceration. Pharmacological therapy is mostly based on the subtype of functional dyspepsia, such as prokinetic and fundus-relaxing drugs for PDS and acid-suppressive drugs for EPS, whereas centrally active neuromodulators and herbal drugs play a minor part. Psychotherapy is effective only in a small subset of patients, whereas quality of life can be severely affected in nearly all patients. Future therapies might include novel compounds that attempt to treat the underlying gastric and duodenal inflammation. NATURE REVIEWS | DISEASE PRIMERS VOLUME 3 | ARTICLE NUMBER 17081 | 1 PRIMER © 2 0 1 7 M a c m i l l a n P u b l i s h e r s L i m i t e d , p a r t o f S p r i n g e r N a t u r e . A l l r i g h t s r e s e r v e d .standard therapy for gastro -oesophageal reflux disease. Paediatric dyspeptic symptoms are being addressed in a separate classification effort 10 . This Primer covers functional dyspepsia in adults only, although we sporadically refer to paediatric functional dyspepsia when similarities exist. EpidemiologyThe population prevalence of functional dyspepsia is quite variable across the globe, with overall high numbers (10-40%) in Western countries and low numbers (5-30%) in Asia, independent of the respective functional dyspepsia definitions 11 . A large-scale health and nutrition survey from France 12 (which involved >35,000 people) identified that 15% of individuals had suspected functional dyspepsia, 28% had irritable bowel syndrome (IBS) and 6% had both. The population of patients who are affected by both IBS and functional dyspepsia has been reported to range between 10% and 27% in previous studies 13 and to approach 30% in popu lation samples; it could be even higher in specific populations 14,15 . This observation has given rise to the term 'overlap syndrome' (REF. 13), which calls into question the sensitivity and specificity of the Rome criteria, at least for IBS and functional dyspepsia. This argument is also supported by the observation that patients with functional dyspepsia m...

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“…Unfortunately, the mechanistic insight on the generation of small bowel‐related visceral hypersensitivity and its contribution to abdominal pain and other main symptoms in IBS is much more limited than for the colon. In this sense, mechanical distension induced by increased and/or abnormal distribution of intestinal gas has been related to spontaneous bloating and ingestion of flatulogenic diet in some IBS patients . Similarly, increased activation and release of mast cell products have been shown to increase and potentiate alterations in permeability and intrinsic and afferent neurons, thereby leading to enhanced visceral pain perception in both the small bowel and the colon .…”

Section: Introductionmentioning

confidence: 99%

Mucosal pathobiology and molecular signature of epithelial barrier dysfunction in the small intestine in irritable bowel syndrome

González‐Castro

Martínez

Salvo-Romero

et al. 2017

J of Gastro and Hepatol

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Irritable bowel syndrome (IBS) is one of the most prevalent gastrointestinal disorders in developed countries. Its etiology remains unknown; however, a common finding, regardless of IBS subtype, is the presence of altered intestinal barrier. In fact, signaling and location of cell-to-cell adhesion proteins, in connection with increased immune activity, seem abnormal in the intestinal epithelium of IBS patients. Despite that most research is performed on distal segments of the intestine, altered permeability has been reported in both, the small and the large bowel of all IBS subtypes. The small intestine carries out digestion and nutrient absorption and is also the site where the majority of immune responses to luminal antigens takes place. In fact, the upper intestine is more exposed to environmental antigens than the colon and is also a site of symptom generation. Recent studies have revealed small intestinal structural alterations of the epithelial barrier and mucosal immune activation in association with intestinal dysfunction, suggesting the commitment of the intestine as a whole in the pathogenesis of IBS. This review summarizes the most recent findings on mucosal barrier alterations and its relationship to symptoms arising from the small intestine in IBS, including epithelial structural abnormalities, mucosal immune activation, and microbial dysbiosis, further supporting the hypothesis of an organic origin of IBS.

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Intestinal gas content and distribution in health and in patients with functional gut symptoms

Abstract: Azpiroz ABSTRACTBackground. The precise relation of intestinal gas to symptoms, particularly

Cited by 33 publications

References 26 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

Functional dyspepsia

Mucosal pathobiology and molecular signature of epithelial barrier dysfunction in the small intestine in irritable bowel syndrome

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