Brian Lacy, MD, PhD: Assessing, Treating Chronic Abdominal Bloating and Distension

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Lacy reviews key considerations for the diagnostic evaluation and treatment of abdominal bloating and distension based on his session at DDW.

As 2 of the most common gastrointestinal symptoms, proper evaluation and subsequent treatment of abdominal bloating and distension are important but not fully understood due to limited research.

In a session at Digestive Disease Week (DDW) 2024, Brian Lacy, MD, PhD, of the Mayo Clinic in Jacksonville, reviewed key considerations for the diagnostic evaluation and treatment of these patients as part of a larger discussion about the multidisciplinary management of common gastrointestinal symptoms.

Following his session at DDW, the editorial team of HCPLive Hepatology sat down with Lacy to discuss the current understanding of the evaluation and treatment of abdominal bloating and distension.

HCPLive: Broadly, can you explain what abdominal bloating and distension are and our current understanding of their etiology?

Lacy: Bloating is a sensation of gassiness, trapped gas, or a feeling of being distended although there is no obvious distension or swelling of the abdomen. Patients frequently also describe a sense of fullness or pressure in the upper abdomen above the umbilicus. Abdominal distension describes a measurable change in the size of the abdomen. Patients commonly describe how their abdomen enlarges so that they look “like a balloon” or look “like I’m pregnant.” Patients frequently report that bloating and distension worsen after eating and continue to worsen during the course of the day. Specialized testing has shown that the size of the abdomen increases during the course of the day in healthy volunteers, and then returns to baseline levels overnight. Abdominal bloating and distension can occur as 2 completely separate processes although they frequently occur together.

Abdominal gas and bloating can occur for a large number of reasons. However, there are 5 major causes, which include: diet; disorders of intestinal transit; too many bacteria in the small intestine; disorders of gut sensation; and an abnormal reflex that involves the abdominal wall and the gastrointestinal tract.

HCPLive: What are some important considerations for the diagnostic evaluation of these symptoms?

Lacy: The diagnosis of gas and bloating begins with describing symptoms to your health care provider. Important questions to consider include: how long have I had these symptoms? How frequent are my symptoms? How severe are my symptoms? What makes my symptoms better? What makes my symptoms worse? Are my symptoms of gas and bloating associated with other symptoms (such as nausea or vomiting or fevers)? What is the relationship of gas and bloating to eating or drinking? Do I have symptoms of constipation? How have I tried to treat these symptoms on my own? And, what tests have I had to help identify the cause of my gas and bloating?

After a careful history and physical examination, then the health care provider may want to perform some simple tests. It is important to recognize, however, that there is no validated diagnostic algorithm for patients with symptoms of gas, bloating, and distention. Testing may include some simple laboratory tests and/or an x-ray of your abdomen to determine how much gas is present in the gastrointestinal tract and to determine whether there is more stool in your colon than normal. Some providers may want to arrange a test to determine whether SIBO is the underlying cause. More extensive testing is usually not required

HCPLive: What does treatment look like? Are there any shortcomings in our current approach to treatment?

Lacy: No validated treatment algorithm exists for patients with gas, bloating, and distention. Thus an individualized approach is required. Fortunately, a number of different treatment options are currently available, including diet; treating constipation; antibiotics; probiotics; medications to improve gut sensation; diaphragmatic breathing; and cognitive behavioral therapy.