Intestinal Gas (Belching, Bloating, Flatulence) (cont.)
How is excessive intestinal gas treated?
The treatment of excessive intestinal gas depends on the cause. If there is
maldigestion of specific sugars-lactose, sorbitol, or fructose--the offending
sugars can be eliminated from the diet. In the case of lactose in milk, an
alternative treatment is available. Enzymes that are similar to intestinal
lactase can be added to the milk in order to break down the lactose prior to its
ingestion so that it can be absorbed normally. Some people find that yogurt, in
which the lactose has been broken down partially by bacteria, produces less gas
than milk. There also are certain types of vegetables and fruits that contain
types of starches that are poorly digested by people but well digested by
bacteria. These include beans, lentils, cabbage, brussel sprouts, onions,
carrots, bananas, apricots, and prunes. Reducing the intake of these vegetables
and fruits, as well as foods made from whole grains, should reduce gas and
flatulence. However, the list of gas-producing foods is rather long, and it may
be difficult to eliminate them all without severely restricting the diet.
When maldigestion is due to pancreatic insufficiency, then supplemental
pancreatic enzymes can be ingested with meals to replace the missing enzymes. If
maldigestion and/or malabsorption is caused by disease of the intestinal lining,
the specific disease must be identified, most commonly through a small bowel
biopsy. Then, treatment can be targeted for that condition. For example, if
celiac disease is found on the biopsy, a gluten-free diet can be started.
An interesting form of treatment for excessive gas is alpha-D-galactosidase,
an enzyme that is produced by a mold. This enzyme, commercially available as
Beano, is consumed as either a liquid or tablet with meals. This enzyme is able
to break down some of the difficult-to-digest polysaccharides in vegetables so
that they may be absorbed. This prevents them from reaching the colonic bacteria
and causing unnecessary production of gas . Beano has been shown to be effective
in decreasing the incidence of intestinal gas.
Two other types of treatment have been promoted for the treatment of gas;
simethicone and activated charcoal. It is unclear if simethicone has an effect
on gas in the stomach. However, it has no effect on the formation of gas in the
colon. Moreover, in the stomach, simethicone would be expected only to affect
swallowed air, which, as previously mentioned, is an uncommon cause of excessive
intestinal gas. Nevertheless, some individuals are convinced that simethicone
helps them. Activated charcoal has been shown to reduce the formation of gas in
the colon, though the way in which it does so is unknown.
If there is a physical obstruction to the emptying of the stomach or passage
of food, liquid, and gas through the small intestine, then surgical correction
of the obstruction is required. If the obstruction is functional, medications
that promote activity of the muscles of the stomach and small intestine are
given. Examples of these medicines are erythromycin or metoclopramide (Reglan).
Bacterial overgrowth of the small bowel is usually treated with antibiotics.
However, this treatment is frequently only temporarily effective or not
effective at all. When antibiotics provide only a temporary benefit, it may be
necessary to treat patients intermittently or even continuously with
antibiotics. If antibiotics are not effective, probiotics (e.g., lactobacillus)
can be tried although their use in bacterial overgrowth has not been studied.
This condition may be difficult to treat.
- The usual cause of belching is excessive gas in the stomach that comes from
swallowed air. However, discomfort in the abdomen for any reason may also cause
belching. Therefore, belching does not always indicate the presence of excessive
gas in the stomach.
- Bloating is the subjective feeling that the abdomen is enlarged but does not
necessarily mean that the abdomen is, in fact, enlarged. Distention is the
objective enlargement of the abdomen.
- Continuous distention of the abdomen is usually caused by fluid, tumors,
enlarged organs, or fat within the abdomen.
- Intermittent distention of the abdomen may be caused by excessive formation
of intestinal gas, as well as physical or functional obstruction of the
intestines.
- Flatulence results from the production of gas by bacteria within the
intestines when they digest sugars and polysaccharides.
- Excessive production of gas and increased flatulence may occur because of:
(1) the greater ability of some bacteria to produce gas; (2) maldigestion or
malabsorption of sugars and polysaccharides; and (3) bacterial overgrowth of the small
intestine.
- Belching, bloating/distention, and flatulence are evaluated with a medical
history, simple abdominal x-rays, small intestinal x-rays, gastric emptying
studies, ultrasound examination, computerized tomography (CT), magnetic
resonance imaging (MRI), tests for maldigestion and malabsorption, and hydrogen
breath testing.
- The treatment of excessive intestinal gas depends on the underlying cause and
may include dietary changes, medications that reduce the amount of gas,
medications that stimulate the muscles of the intestine, or antibiotics.
Last Editorial Review: 11/13/2006
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