Gas, bloating and belching: an approach to assessment and control

Gas, bloating and belching associated with various conditions, but most often they are caused by functional gastrointestinal disorders. These disorders are characterized by impaired motility and visceral hypersensitivity, which are often aggravated by psychological stress.

An organized approach to the assessment of symptoms contributes to the establishment of a trusted therapeutic relationship. Patients can be reliably diagnosed without exhaustive testing and can be classified as having bloating, small bowel distention, bloating with constipation or belching.

Functional dyspepsia, irritable bowel syndrome and chronic idiopathic constipation are the most common causes of these disorders. For putative functional dyspepsia-invasive testing for Helicobacter pylori and the elimination of confirmed infection (i.e. testing and treatment) are more cost-effective than endoscopy. Patients with symptoms of irritable bowel syndrome should be screened for celiac disease.

Patients with chronic constipation should undergo a rectal examination in order to assess dissynergic defecation. Empirical therapy is a reasonable initial approach to functional gastrointestinal disorders, including acid suppression using proton pump inhibitors for functional dyspepsiopasmolytics in irritable bowel syndrome, osmotic laxatives, and elevated fiber levels in chronic idiopathic constipation.

Insensitive sensitivity to gluten and other food components is becoming increasingly accepted, but strict exclusion diets do not have sufficient evidence to support their normal use, with the exception of confirmed celiac disease.

Wilkinson JM, Cozine EW, Loftus CG.
I am a fam doctor. 2019 March 1; 99 (5): 301−309