Origin of gas retention and symptoms in patients with bloating

Salvioli, Beatrice; Serra, Jordi; Azpiroz, Fernando; Lorenzo, C Di; Aguadé, S; Castell, Joan Martí i; Malagelada, Juan R.

doi:10.1053/j.gastro.2004.12.047

Cited by 110 publications

(86 citation statements)

References 26 publications

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“…Previous studies have shown that patients with FGD exhibit impaired handling and tolerance of intestinal gas loads. [6][7][8][9][10] However, the mechanism of impaired gas transit is not clear. Impaired transit could be due either to weak propulsion or to increased resistance opposing progression.…”

Section: Discussionmentioning

confidence: 99%

Effect of selective CCK₁ receptor antagonism on accommodation and tolerance of intestinal gas in functional gut disorders

Lobo

Serra²,

D’Amato

et al. 2016

J of Gastro and Hepatol

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Section: Discussionmentioning

confidence: 99%

Effect of selective CCK₁ receptor antagonism on accommodation and tolerance of intestinal gas in functional gut disorders

Lobo

Serra²,

D’Amato

et al. 2016

J of Gastro and Hepatol

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“…It has been previously shown that patients with IBS and predominant bloating exhibit impaired transit of exogenous gas loads [8, 16]. Indeed, in response to the gas challenge, these patients develop gas retention and reproduce their customary symptoms and it has been established that the small intestine is unable to propel gas in a normal fashion [17, 18]. …”

Section: Discussionmentioning

confidence: 99%

Impaired Intestinal Gas Clearance during Marked Hyperglycemia in Patients with Functional Abdominal Bloating

et al. 2006

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Background: Especially in patients with functional intestinal disorders, impaired intestinal gas transit can be involved in abdominal symptom generation. We have previously demonstrated an acceleration of intestinal gas clearance in health during acute fasting hyperglycemia and hypothesize that in patients with functional abdominal bloating this mechanism may fail. Methods: In 14 healthy subjects and 14 patients with functional abdominal bloating we compared effects of acute fasting hyperglycemia (∼12 mmol/l) and during euglycemia (control studies) on intestinal gas dynamics. Gas was infused into the jejunum (12 ml/min) for 120 min while rectal gas evacuation was continuously measured; perception and abdominal girth changes were separately evaluated. Results: Marked hyperglycemia accelerated gas evacuation (–98 (53) ml 1 h intestinal gas retention) in health. In patients with functional abdominal bloating, marked hyperglycemia failed to accelerate gas transit and intestinal gas retention developed (421 (116) ml 1 h intestinal gas retention, p < 0.05 vs. health) which results in increased abdominal symptoms (perception score >3) and abdominal distension (>3 mm girth increment) as compared with control subjects (p < 0.05 for both). Conclusion: Intestinal gas clearance is delayed in patients with functional abdominal bloating and the increase in gas clearance during acute hyperglycemia in healthy volunteers does not occur in these patients.

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“…Moreover, studies performed with a scintigraphic technique, using Xenon 133, have shown that in patients with bloating there is a impaired small-intestinal propulsion of gases [88] , (interestingly the proximal small bowel is the site where are normally produced large amounts of carbon dioxide). 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.…”

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%

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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Origin of gas retention and symptoms in patients with bloating

Cited by 110 publications

References 26 publications

Effect of selective CCK₁ receptor antagonism on accommodation and tolerance of intestinal gas in functional gut disorders

Effect of selective CCK₁ receptor antagonism on accommodation and tolerance of intestinal gas in functional gut disorders

Impaired Intestinal Gas Clearance during Marked Hyperglycemia in Patients with Functional Abdominal Bloating

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

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Origin of gas retention and symptoms in patients with bloating

Cited by 110 publications

References 26 publications

Effect of selective CCK1 receptor antagonism on accommodation and tolerance of intestinal gas in functional gut disorders

Effect of selective CCK1 receptor antagonism on accommodation and tolerance of intestinal gas in functional gut disorders

Impaired Intestinal Gas Clearance during Marked Hyperglycemia in Patients with Functional Abdominal Bloating

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

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Product

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Effect of selective CCK₁ receptor antagonism on accommodation and tolerance of intestinal gas in functional gut disorders

Effect of selective CCK₁ receptor antagonism on accommodation and tolerance of intestinal gas in functional gut disorders