Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
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
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, Brussels sprouts, onions,
carrots, 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.
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 amount of intestinal gas.
Two other types of treatment have been promoted for the treatment of gas;
simethicone (Phazyme; Flatulex; Mylicon; Gas-X; Mylanta Gas) 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
Bacterial overgrowth of the small bowel usually is 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 (for example, lactobacillus)
can be tried although their use in bacterial overgrowth has not been studied.
This condition may be difficult to treat.