Intestinal Gas
(Belching, Bloating, Flatulence)
Medical Author: Jay Marks, MD
Medical Editor: William C. Shiel Jr., MD, FACP, FACR
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Gum for Gas?
Medical Author: Jay W. Marks, MD
Medical Editor: Dennis Lee, MD
 We all produce gas in our intestines, especially our colons, or, at least,
our intestinal bacteria produce it, from undigested food. We are fortunate
because the overwhelming majority of the gas that is formed by the bacteria is
used up by other bacteria in the intestine.
Some people are more fortunate than others. All of the gas produced in their
intestines is used up by bacteria, and they pass gas (fart) very little, that
is, unless they eat foods that bacteria can use to form lots of gas—like
beans—that overwhelm even the most ardent, gas–devouring bacteria. A small
amount of intestinal gas is absorbed into the blood from the intestine and is
eliminated in the breath. The gas that is not used up by bacteria or eliminated
in the breath must be passed. Passing gas relies on the functioning of the
intestinal muscles. The gas distends the intestine, and the intestinal muscles
respond by contracting and pushing the gas further along the intestine until the
gas is finally expelled. Sometimes this process fails.
I recently underwent removal of a portion of my sigmoid colon for
diverticulitis. The surgery was done laparoscopically and went very well. There
were no complications, and my discomfort was easily controlled with medication.
Manipulation of the intestines during surgery "stuns" the intestinal muscles,
and they usually stop working for a time. Before patients can eat after surgery,
their intestinal muscles must start working. The signs that the muscles are
working is the presence of abdominal gurgling (borborygmi) and the passing of
gas. Laparoscopic surgery stuns the intestine less than "open" (large
incisional) surgery, and the intestinal muscles usually recover quickly.
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What causes belching?
The ability to belch is almost universal. Belching, also
known as burping (medically referred to as eructation), is the act of expelling gas from the stomach out through the
mouth. The usual cause of belching is a distended (inflated) stomach caused by
swallowed air. The distention of the stomach causes abdominal discomfort, and the
belching expels the air and relieves the discomfort. The common reasons for
swallowing large amounts of air (aerophagia) are gulping food or drink too
rapidly, anxiety, and carbonated beverages. People are often unaware that they
are swallowing air. "Burping" infants during bottle or
breastfeeding is important in order to expel air in
the stomach that has been swallowed with the formula or milk.
Excessive air in the stomach is not the only cause of belching. For some
people, belching becomes a habit and does not reflect the amount of air in their
stomachs. For others, belching is a response to any type of abdominal discomfort
and not just to discomfort due to increased gas. Everyone knows that when they
have mild abdominal discomfort, belching often relieves the problem. This is
because excessive air in the stomach often is the cause of mild abdominal
discomfort. As a result, people belch whenever mild abdominal discomfort is felt
regardless of its cause.
Belching is not the simple act that many people think it is. Belching requires the coordination of several activities.
- The larynx must be closed-off so that any liquid or food that might return with the air from the stomach won't get into the lungs.
- This is accomplished by voluntarily raising the larynx as is done when swallowing.
- Raising the larynx also relaxes the upper esophageal sphincter so that air can pass more easily from the esophagus into the throat.
- The lower esophageal sphincter must open so that air can pass from the stomach into the esophagus.
- While all this is occurring, the
diaphragm descends just as it does when a breath is taken.
- This increases abdominal pressure and decreases pressure in the chest.
- The changes in pressure promote the flow of air from the stomach in the abdomen to the esophagus in the chest.
One unusual type of belching has been described in aerophagic individuals who swallow air. It has been demonstrated that during some of their belches, room air enters the esophagus and is immediately expelled, giving rise to a belch. This in and out flow of air also is likely to be the explanation for the ability of many people to belch at will, even when there is little or no air in the stomach.
If the problem causing the discomfort is not excessive air in the stomach, then belching
does not provide relief from the discomfort. When belching does not ease the discomfort, the
belching should be taken as a sign that something may be wrong within the abdomen
and the cause of the discomfort should be sought. Belching by itself, however,
does not help the physician determine what may be wrong because belching can
occur in virtually any abdominal disease or condition that causes abdominal discomfort.
Next: What causes bloating? »
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What is lactose intolerance?
Lactose intolerance is an inability to digest and absorb
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What causes lactose intolerance?
Lactose is a larger sugar that is made up of two smaller sugars, glucose and
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