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Bloating and Abdominal Distension: Old Misconceptions and Current Knowledge

Malagelada, Juan R, MD1; Accarino, Anna, MD1; Azpiroz, Fernando, MD1

American Journal of Gastroenterology: August 2017 - Volume 112 - Issue 8 - p 1221–1231
doi: 10.1038/ajg.2017.129

Bloating, as a symptom and abdominal distension, as a sign, are both common functional-type complaints and challenging to manage effectively. Individual patients may weight differently the impact of bloating and distension on their well-being. Complaints may range from chronic highly distressing pain to simply annoying and unfashionable protrusion of the abdomen. To avoid mishaps, organic bloating, and distension should always be considered first and appropriated assessed. Functional bloating and distension often present in association with other manifestations of irritable bowel syndrome or functional dyspepsia and in that context patients tend to regard them as most troublesome. A mechanism-based management bloating and distension should be ideal but elucidating key operational mechanisms in individual patients is not always feasible. Some clues may be gathered through a detailed dietary history, by assessing bowel movement frequency and stool consistency and special imaging technique to measure abdominal shape during episodes of distension. In severe, protracted cases it may be appropriate to refer the patient to a specialized center where motility, visceral sensitivity, and abdominal muscle activity in response to intraluminal stimuli may be measured. Therapeutic resources focussed upon presumed or demonstrated pathogenetic mechanism include dietary modification, microbiome modulation, promoting gas evacuation, attenuating visceral perception, and controlling abdominal wall muscle activity via biofeedback.

1Digestive System Research Unit, University Hospital Vall d'Hebron; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Universitat Autònoma de Barcelona, 08193 Cerdanyola del Vallès, Spain

Correspondence: Juan R Malagelada, MD, Digestive System Research Unit, Hospital General Vall d'Hebron, 08035 Barcelona, Spain. E-mail:

Received 01 November 2016; accepted 07 March 2017

Guarantor of the article: Juan R Malagelada, MD.

Specific author contributions: J.R.M. wrote the review and A.A. and F.A. made suggestions, corrected and added on pertinent material.

Financial support: No financial support for this review article.

Potential competing interests: None.

© The American College of Gastroenterology 2017. All Rights Reserved.
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