Mechanisms of intestinal gas retention in humans: impaired propulsion versus obstructed evacuation

Serra, Jordi; Azpiroz, Fernando; Malagelada, Juan–R.

doi:10.1152/ajpgi.2001.281.1.g138

Cited by 82 publications

(73 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…After including all published trials in which probiotics were tested to asses bloating or distension relief as primary or secondary endpoints in IBS or non IBS patients, conclusion was that specific probiotics can lead to bloating relief in some patients with IBS [117] . Experimental data in healthy controls showed that glucagon, a potent muscle relaxant, reduced abdominal symptoms but gas retention and objective abdominal distension were unaffected [77] . Domperidone has been shown to be ineffective in IBS symptoms [118] whereas the administration of neostigmine, a prokinetic drug, produced gas clearance and improvement of both abdominal symptoms and objective distension [119] .…”

Section: Treatmentmentioning

confidence: 99%

“…They have suggested that while gas volumes may be normal in patients with bloating, they have an impaired intestinal handling of gas loads [57,67,76,77] . This may be of particular relevance since a sensory-motor gut abnormality might represent the pathophysiological basis of bloating.…”

Section: Impaired Abdominal Emptingmentioning

confidence: 99%

“…Over twenty years later, it has been shown that patients with IBS and functional bloating had impaired transit and tolerance of intestinal gas [67,76,77] . For example, they retained gas and complaining about their usual symptoms in response to infusion of gas, which was well tolerated by the majority of healthy subjects.…”

Section: Impaired Abdominal Emptingmentioning

confidence: 99%

“…In healthy volunteers two important mechanisms have been demonstrated to give a possible explanation of the mechanisms of gas retention increased resistance to gas flow and impaired intestinal propulsion [77] . In particular, subjective abdominal complaints were much higher when it were produced by increased resistance to flow than when gas retention was induced by inhibition of propulsion produced by glucagon-induced motor inhibition.…”

Section: Impaired Abdominal Emptingmentioning

confidence: 99%

“…More recently this alteration in gas handling was detected in the proximal colon [86,89] that is the first physiological site of colonic gas production. While alterations of the aforementioned intestine-intestinal reflexes could explain the small intestinal impaired gas transit [68,88] , the proximal colon gas retention could be due to a proximal-to-distal uncoupling: low colon proximal tone, increased resistance to flow through the distal colon or both [77] . However, the clinical correlation remains unclear.…”

Section: Impaired Abdominal Emptingmentioning

confidence: 99%

See 4 more Smart Citations

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

Iovino

Bucci

Tremolaterra

et al. 2014

WJG

View full text Add to dashboard Cite

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.

show abstract