A recent article (AK Kamboj, AS Oxentenko. Clin Gastroenterol Hepatol 2018; 16; 1030-33) provides some useful guidance on bloating.

They describe bloating as an acronym:

• Bowel disturbance (constipation, SIBO, celiac, IBD)
• Liquid (ascites)
• Obstruction
• Adiposity
• Thoracic (overexpansion, diaphragm contraction)
• Increased sensitivity (functional bloating, IBS, dyspepsia)
• Neuromuscular (gastroparesis, impaired accommodation, medications)
• Gas (aerophagia, dietary sources, post-Nissen)

The diagnostic approach they recommend:

• If bloating with diarrhea, evaluate diet, SIBO, celiac, IBD, IBS-D, and medications
• If bloating with constipation, evaluate for constipation, pelvic floor dysfunction, IBS-C, and medications
• If bloating and suspected mechanical disturbance, evaluate for gastric outlet obstruction/small bowel obstruction
• If bloating without bowel disturbance, consider aerophagia, gastroparesis, and functional dyspepsia

Treatment:

• Treat any underlying disorder
• For mild symptoms, reassurance may be sufficient
• Dietary modifications to avoid food triggers & reduce fermentable food products
• Treating constipation when present
• A large number of other treatments can be considered as well including antispasmotics, agents to help with visceral hyperalgesia, cognitive behavioral therapy

My take: I like BLOATING acronym, though the 5 Fs I learned a long time ago is a little easier for me to remember — which include flatus (gas), feces (constipation), fluid, fat, and fetus/masses. Flatus can be caused by swallowing air (aerophagia), malabsorption (celiac, lactose intolerance, parasites), muscular discoordination (abdominal phrenic dyssynergia), and motility problems.”

Related blog posts:

• Understanding Functional Abdominal Distention
• Abdominal distention -a medical mystery

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