Intestinal Gas
(Belching, Bloating, Flatulence)

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Medical Author: Jay Marks, MD
Medical Editor: William C. Shiel Jr., MD, FACP, FACR

• What causes belching?
• What causes bloating?
• What causes flatulence?
• What are the causes of intermittent abdominal bloating/distention?
• How is belching, bloating/distention, and flatulence evaluated?
• How is excessive intestinal gas treated?
• Intestinal Gas At A Glance
• Patient Discussions: Intestinal Gas - Effective Treatments

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. Read the rest of Dr. Mark's story » Top Searched Intestinal Gas Terms: fart, farting, causes of gas, intestinal gas symptoms

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.

Intestinal Gas - Effective Treatments

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