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Current Treatment Options in Gastroenterology

Erschienen in:

15.05.2020 | Neurogastroenterology and GI Motiliy (H Parkman and R Schey, Section Editors)

Bloating and Abdominal Distension: Exploring Hidden Depths and Insights

verfasst von: Nipaporn Pichetshote, MD, Ali Rezaie, MD, MSc

Erschienen in: Current Treatment Options in Gastroenterology | Ausgabe 2/2020

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Abstract

Purpose of review

The goal of this paper is to review categorically treatment options for the diverse mechanisms to which studies have shown underlie bloating and abdominal distension.

Recent findings

While previous studies typically associate bloating and distension with a functional gastrointestinal disorder, in appropriate clinical settings, workup to look at diseases such as postural orthostatic hypotension, chronic intestinal pseudoobstruction, Ehlers-Danlos syndrome, and mast cell activation syndrome can further provide insight into to these patients.

Summary

Bloating and distension are commonly presented to the gastroenterologist. The underlying mechanism can be ambiguous, and therefore, the treatment can be challenging. However, current treatment options that are available can be effective if used in the appropriate patient. Further research is desperately needed for the more elusive disease processes mentioned in this review that presents with bloating and distension.

Houghton LA, Lea R, Agrawal A, Reilly B, Whorwell PJ. Relationship of abdominal bloating to distention in irritable bowel syndrome and effect of bowel habit. Gastroenterology. 2006;131:1003–10.PubMed

Heaton KW, O’Donnell LJ, Braddon FE, Mountford RA, Hughes AO, Cripps PJ. Symptoms of irritable bowel syndrome in a British urban community: consulters and nonconsulters. Gastroenterology. 1992;102:1962–7.PubMed

Sandler RS, Stewart WF, Liberman JN, Ricci JA, Zorich NL. Abdominal pain, bloating, and diarrhea in the United States: prevalence and impact. Dig Dis Sci. 2000;45:1166–71.PubMed

Talley NJ, Boyce P, Jones M. Identification of distinct upper and lower gastrointestinal symptom groupings in an urban population. Gut. 1998;42:690–5.PubMedPubMedCentral

Jiang X, Locke GR 3rd, Choung RS, Zinsmeister AR, Schleck CD, Talley NJ. Prevalence and risk factors for abdominal bloating and visible distention: a population-based study. Gut. 2008;57:756–63.PubMed

Malagelada JR, Accarino A, Azpiroz F. Bloating and abdominal distension: old misconceptions and current knowledge. Am J Gastroenterol. 2017;112:1221–31.PubMed

Choi YK, Kraft N, Zimmerman B, Jackson M, Rao SSC. Fructose intolerance in IBS and utility of fructose-restricted diet. J Clin Gastroenterol. 2008;42:233–8.PubMed

Barrett JS, Gearry RB, Muir JG, Irving PM, Rose R, Rosella O, et al. Dietary poorly absorbed, short-chain carbohydrates increase delivery of water and fermentable substrates to the proximal colon. Aliment Pharmacol Ther. 2010;31:874–82.PubMed

Shepherd SJ, Parker FC, Muir JG, Gibson PR. Dietary triggers of abdominal symptoms in patients with irritable bowel syndrome: randomized placebo-controlled evidence. Clin Gastroenterol Hepatol. 2008;6:765–71.PubMed

10.

Halmos EP, Power VA, Shepherd SJ, Gibson PR, Muir JG. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology. 2014;146:67–75.e5.PubMed

11.

Serra J. Intestinal gas: has diet anything to do in the absence of a demonstrable malabsorption state? Curr Opin Clin Nutr Metab Care. 2012;15:489–93.PubMed

12.

• Harer KN, Jagielski CH, Riehl ME, Chey WD. 272 – Avoidant/restrictive food intake disorder among adult gastroenterology behavioral health patients: demographic and clinical characteristics. Gastroenterology. 2019;156:S-53. Interesting abstract that showed that FODMAPS was the most common diet in patients diagnosed with ARFID.

13.

Agrawal A, Houghton LA, Reilly B, Morris J, Whorwell PJ. Bloating and distension in irritable bowel syndrome: the role of gastrointestinal transit. Am J Gastroenterol. 2009;104:1998–2004.PubMed

14.

Cann PA, Read NW, Brown C, Hobson N, Holdsworth CD. Irritable bowel syndrome: relationship of disorders in the transit of a single solid meal to symptom patterns. Gut. 1983;24:405–11.PubMedPubMedCentral

15.

Cuppoletti J, Malinowska DH, Tewari KP, Li QJ, Sherry AM, Patchen ML, et al. SPI-0211 activates T84 cell chloride transport and recombinant human ClC-2 chloride currents. Am J Phys Cell Phys. 2004;287:C1173–83.

16.

Black CJ, Burr NE, Quigley EMM, Moayyedi P, Houghton LA, Ford AC. Efficacy of secretagogues in patients with irritable bowel syndrome with constipation: systematic review and network meta-analysis. Gastroenterology. 2018;155:1753–63.PubMed

17.

Accarino A, Perez F, Azpiroz F, Quiroga S, Malagelada J-R. Intestinal gas and bloating: effect of prokinetic stimulation. Am J Gastroenterol. 2008;103:2036–42.PubMed

18.

Serra J, Azpiroz F, Malagelada JR. Impaired transit and tolerance of intestinal gas in the irritable bowel syndrome. Gut. 2001;48:14–9.PubMedPubMedCentral

19.

Salvioli B, Serra J, Azpiroz F, Lorenzo C, Aguade S, Castell J, et al. Origin of gas retention and symptoms in patients with bloating. Gastroenterology. 2005;128:574–9.PubMed

20.

Serra J, Salvioli B, Azpiroz F, Malagelada J-R. Lipid-induced intestinal gas retention in irritable bowel syndrome. Gastroenterology. 2002;123:700–6.PubMed

21.

Passos MC, Serra J, Azpiroz F, Tremolaterra F, Malagelada J-R. Impaired reflex control of intestinal gas transit in patients with abdominal bloating. Gut. 2005;54:344–8.PubMedPubMedCentral

22.

Azpiroz F, Malagelada J-R. Abdominal bloating. Gastroenterology. 2005;129:1060–78.PubMed

23.

Sanger GJ. Translating 5-HT receptor pharmacology. Neurogastroenterol Motil. 2009;21:1235–8.PubMed

24.

Rao AS, Camilleri M. Review article: metoclopramide and tardive dyskinesia. Aliment Pharmacol Ther. 2010;31:11–9.PubMed

25.

Milo R. Use of the peripheral dopamine antagonist, domperidone, in the management of gastro-intestinal symptoms in patients with irritable bowel syndrome. Curr Med Res Opin. 1980;6:577–84.PubMed

26.

Cann PA, Read NW, Holdsworth CD. Oral domperidone: double blind comparison with placebo in irritable bowel syndrome. Gut. 1983;24:1135–40.PubMedPubMedCentral

27.

Prather CM, Camilleri M, Zinsmeister AR, McKinzie S, Thomforde G. Tegaserod accelerates orocecal transit in patients with constipation-predominant irritable bowel syndrome. Gastroenterology. 2000;118:463–8.PubMed

28.

Müller-Lissner SA, Fumagalli I, Bardhan KD, Pace F, Pecher E, Nault B, et al. Tegaserod, a 5-HT(4) receptor partial agonist, relieves symptoms in irritable bowel syndrome patients with abdominal pain, bloating and constipation. Aliment Pharmacol Ther. 2001;15:1655–66.PubMed

29.

Vakil N, Laine L, Talley NJ, Zakko SF, Tack J, Chey WD, et al. Tegaserod treatment for dysmotility-like functional dyspepsia: results of two randomized, controlled trials. Am J Gastroenterol. 2008;103:1906–19.PubMed

30.

Busti AJ, Murillo JR, Cryer B. Tegaserod-induced myocardial infarction: case report and hypothesis. Pharmacotherapy. 2004;24:526–31.PubMed

31.

Pfannkuche H-J, Dennis E. Tegaserod-induced myocardial infarction: case report and hypothesis--an alternative viewpoint. Pharmacotherapy. 2004;24:1649–50;discussion 1650–1651.PubMed

32.

Thompson CA. Novartis suspends tegaserod sales at FDA’s request. Am J Health-Syst Pharm. 2007;64(10):1020.

33.

Camilleri M, Kerstens R, Rykx A, Vandeplassche L. A placebo-controlled trial of prucalopride for severe chronic constipation. N Engl J Med. 2008;358:2344–54.PubMed

34.

Tack J, van Outryve M, Beyens G, Kerstens R, Vandeplassche L. Prucalopride (Resolor) in the treatment of severe chronic constipation in patients dissatisfied with laxatives. Gut. 2009;58:357–65.PubMed

35.

Quigley EMM, Vandeplassche L, Kerstens R, Ausma J. Clinical trial: the efficacy, impact on quality of life, and safety and tolerability of prucalopride in severe chronic constipation--a 12-week, randomized, double-blind, placebo-controlled study. Aliment Pharmacol Ther. 2009;29:315–28.PubMed

36.

Carbone F, van den Houte K, Clevers E, Andrews CN, Papathanasopoulos A, Holvoet L, et al. Prucalopride in gastroparesis: a randomized placebo-controlled crossover study. Am J Gastroenterol. 2019;114:1265–74.PubMed

37.

Malagelada C, Nieto A, Mendez S, Accarino A, Santos J, Malagelada JR, et al. Effect of prucalopride on intestinal gas tolerance in patients with functional bowel disorders and constipation. J Gastroenterol Hepatol. 2017;32:1457–62.PubMed

38.

Tack J, Janssens J, Vantrappen G, Peeters T, Annese V, Depoortere I, et al. Effect of erythromycin on gastric motility in controls and in diabetic gastroparesis. Gastroenterology. 1992;103:72–9.PubMed

39.

Arts J, Caenepeel P, Verbeke K, Tack J. Influence of erythromycin on gastric emptying and meal related symptoms in functional dyspepsia with delayed gastric emptying. Gut. 2005;54:455–60.PubMedPubMedCentral

40.

Caldarella MP, Serra J, Azpiroz F, Malagelada J-R. Prokinetic effects in patients with intestinal gas retention. Gastroenterology. 2002;122:1748–55.PubMed

41.

Ahuja NK, Mische L, Clarke JO, Wigley FM, McMahan ZH. Pyridostigmine for the treatment of gastrointestinal symptoms in systemic sclerosis. Semin Arthritis Rheum. 2018;48:111–6.PubMed

42.

Ringel Y. The gut microbiome in irritable bowel syndrome and other functional bowel disorders. Gastroenterol Clin N Am. 2017;46:91–101.

43.

McClure R, Massari P. TLR-dependent human mucosal epithelial cell responses to microbial pathogens. Front Immunol. 2014;5:386.PubMedPubMedCentral

44.

Halvorson HA, Schlett CD, Riddle MS. Postinfectious irritable bowel syndrome--a meta-analysis. Am J Gastroenterol. 2006;101:1894–9;quiz 1942.PubMed

45.

Rajilić-Stojanović M, et al. Intestinal microbiota and diet in IBS: causes, consequences, or epiphenomena? Am J Gastroenterol. 2015;110:278–87.PubMedPubMedCentral

46.

Simrén M, Barbara G, Flint HJ, Spiegel BM, Spiller RC, Vanner S, et al. Intestinal microbiota in functional bowel disorders: a Rome foundation report. Gut. 2013;62:159–76.PubMed

47.

Sachdev AH, Pimentel M. Antibiotics for irritable bowel syndrome: rationale and current evidence. Curr Gastroenterol Rep. 2012;14:439–45.PubMed

48.

Issa B, Wafaei NA, Whorwell PJ. Abdominal bloating and distension: what is the role of the microbiota. Dig Dis Sci. 2012;57:4–8.PubMed

49.

Tziatzios G, Giamarellos-Bourboulis EJ, Papanikolaou IS, Pimentel M, Dimitriadis GD, Triantafyllou K. Is small intestinal bacterial overgrowth involved in the pathogenesis of functional dyspepsia? Med Hypotheses. 2017;106:26–32.PubMed

50.

Attar A, Flourié B, Rambaud JC, Franchisseur C, Ruszniewski P, Bouhnik Y. Antibiotic efficacy in small intestinal bacterial overgrowth-related chronic diarrhea: a crossover, randomized trial. Gastroenterology. 1999;117:794–7.PubMed

51.

Pimentel M, Park S, Mirocha J, Kane SV, Kong Y. The effect of a nonabsorbed oral antibiotic (rifaximin) on the symptoms of the irritable bowel syndrome: a randomized trial. Ann Intern Med. 2006;145:557–63.PubMed

52.

• Pimentel M, et al. Rifaximin therapy for patients with irritable bowel syndrome without constipation. N Engl J Med. 2011;364:22–32 Largest scale trial looking at antibiotics in the treatment of non-constipating IBS. This study validated the use of rifaximin in patients for treatment of IBS-D with improvement in symptoms of bloating, abdominal pain, and diarrhea.PubMed

53.

Pimentel M, Chang C, Chua KS, Mirocha J, DiBaise J, Rao S, et al. Antibiotic treatment of constipation-predominant irritable bowel syndrome. Dig Dis Sci. 2014;59:1278–85.PubMed

54.

Low K, Hwang L, Hua J, Zhu A, Morales W, Pimentel M. A combination of rifaximin and neomycin is most effective in treating irritable bowel syndrome patients with methane on lactulose breath test. J Clin Gastroenterol. 2010;44:547–50.PubMed

55.

Marsh E, et al. Lovastatin lactone inhibits methane production in human stool homogenates: 1771. Am J Gastroenterol. 2015;110:S753.

56.

• Gottlieb K, et al. Su1210 SYN-010, a proprietary modified-release formulation of lovastatin lactone, lowered breath methane and improved stool frequency in patients with IBS-C: results of a multi-center randomized double-blind placebo-controlled phase 2a trial. Gastroenterology. 2016;150:S496–7 Interesting abstract that showed the lovastatin lactone, and not just antibiotics, can decrease methane production in patient with IBS-C.

57.

Erdogan A, Rao SSC. Small intestinal fungal overgrowth. Curr Gastroenterol Rep. 2015;17:16.PubMed

58.

• Jacobs C, Coss Adame E, Attaluri A, Valestin J, Rao S. Dysmotility and ppi use are independent risk factors for small intestinal bacterial and/or fungal overgrowth. Aliment Pharmacol Ther. 2013;37:1103–11 First study investigating the prevalence of SIFO in patients with persistent GI symptoms. The study showed that symptoms are poor predictors of SIBO and testing is helpful.PubMedPubMedCentral

59.

Erdogan A, Lee YY, Sifuentes H, Rao SS. Sa2026 small intestinal fungal overgrowth (SIFO): a cause of gastrointestinal symptoms. Gastroenterology. 2014;146(5):2–358.

60.

King TS, Elia M, Hunter JO. Abnormal colonic fermentation in irritable bowel syndrome. Lancet. 1998;352:1187–9.PubMed

61.

Whorwell PJ, Altringer L, Morel J, Bond Y, Charbonneau D, O’Mahony L, et al. Efficacy of an encapsulated probiotic Bifidobacterium infantis 35624 in women with irritable bowel syndrome. Am J Gastroenterol. 2006;101:1581–90.PubMed

62.

Kim HJ, et al. A randomized controlled trial of a probiotic combination VSL# 3 and placebo in irritable bowel syndrome with bloating. Neurogastroenterol Motil. 2005;17:687–96.PubMed

63.

Choi CH, Jo SY, Park HJ, Chang SK, Byeon JS, Myung SJ. A randomized, double-blind, placebo-controlled multicenter trial of saccharomyces boulardii in irritable bowel syndrome: effect on quality of life. J Clin Gastroenterol. 2011;45:679–83.PubMed

64.

Ki Cha B, et al. The effect of a multispecies probiotic mixture on the symptoms and fecal microbiota in diarrhea-dominant irritable bowel syndrome: a randomized, double-blind, placebo-controlled trial. J Clin Gastroenterol. 2012;46:220–7.PubMed

65.

• Allen SJ, et al. Lactobacilli and bifidobacteria in the prevention of antibiotic-associated diarrhoea and Clostridium difficile diarrhoea in older inpatients (PLACIDE): a randomised, double-blind, placebo-controlled, multicentre trial. Lancet. 2013;382:1249–57 Large scale study that showed the use of probiotics in antibiotic associated diarrhea and Clostridium difficile diarrhea had an increased rate of bloating.PubMed

66.

Rao SSC, Rehman A, Yu S, de Andino NM. Brain fogginess, gas and bloating: a link between SIBO, probiotics and metabolic acidosis. Clin Transl Gastroenterol. 2018;9(6):162.

67.

Kumar K, Saadi M, Ramsey FV, Schey R, Parkman HP. Effect of bifidobacterium infantis 35624 (align) on the lactulose breath test for small intestinal bacterial overgrowth. Dig Dis Sci. 2018;63:989–95.PubMed

68.

Tabibian N, Swehli E, Boyd A, Umbreen A, Tabibian JH. Abdominal adhesions: a practical review of an often overlooked entity. Ann Med Surg (Lond). 2017;15:9–13.PubMed

69.

Bove GM, Chapelle SL. Visceral mobilization can lyse and prevent peritoneal adhesions in a rat model. J Bodyw Mov Ther. 2012;16:76–82.PubMed

70.

Chapelle SL, Bove GM. Visceral massage reduces postoperative ileus in a rat model. J Bodyw Mov Ther. 2013;17:83–8.PubMed

71.

Rice AD, King R, Reed ED, Patterson K, Wurn BF, Wurn LJ. Manual physical therapy for non-surgical treatment of adhesion-related small bowel obstructions: two case reports. J Clin Med. 2013;2:1–12.PubMedPubMedCentral

72.

Rice AD, Reed ED, Patterson K, Wurn BF, Wurn LJ. Clearing bowel obstruction and decreasing pain in a terminally ill patient via manual physical therapy. J Palliat Med. 2013;16:222–3.PubMed

73.

Rice AD, et al. Decreasing adhesions and avoiding further surgery in a pediatric patient involved in a severe pedestrian versus motor vehicle accident. Pediatr Rep. 2014;6:5126.PubMedPubMedCentral

74.

Rice AD, et al. Treating small bowel obstruction with a manual physical therapy: a prospective efficacy study. Biomed Res Int. 2016;2016:1–8.

75.

Tremolaterra F, Pascariello A, Gallotta S, Ciacci C, Iovino P. Colonic gas transit in patients with bloating: the effect of an electromechanical stimulator of the abdominal wall. Tech Coloproctol. 2013;17:405–10.PubMed

76.

Beckers AB, et al. Gastrointestinal disorders in joint hypermobility syndrome/Ehlers-Danlos syndrome hypermobility type: a review for the gastroenterologist. Neurogastroenterol Motil. 2017;29:e13013.

77.

Di Nardo G, Karunaratne TB, Frediani S, De Giorgio R. Chronic intestinal pseudo-obstruction: progress in management? Neurogastroenterol Motil. 2017. https://doi.org/10.1155/2016/7610387.

78.

DiBaise JK, Harris LA, Goodman B. Postural tachycardia syndrome (POTS) and the GI tract: a primer for the gastroenterologist. Am J Gastroenterol. 2018;113:1458–67.PubMed

79.

Hsieh F, Gastrointestinal H. Involvement in mast cell activation disorders. Immunol Allergy Clin N Am. 2018;38:429–41.

80.

Castori M, Morlino S, Pascolini G, Blundo C, Grammatico P. Gastrointestinal and nutritional issues in joint hypermobility syndrome/ehlers–danlos syndrome, hypermobility type. Am J Med Genet C: Semin Med Genet. 2015;169:54–75.

81.

Fikree A, et al. Functional gastrointestinal disorders are associated with the joint hypermobility syndrome in secondary care: a case-control study. Neurogastroenterol Motil. 2015;27:569–79.PubMed

82.

Zeitoun J-D, et al. Functional digestive symptoms and quality of life in patients with Ehlers-Danlos syndromes: results of a national cohort study on 134 patients. PLoS One. 2013;8:e80321.PubMedPubMedCentral

83.

Grundy D, Schemann M. Enteric nervous system. Curr Opin Gastroenterol. 2007;23:121–6.PubMed

84.

Rezaie A, Raphael Y, Sukov R, Liu X. Ehlers-Danlos syndrome type III (EDS) and visceroptosis: getting to the bottom of this diagnosis: 469. Am J Gastroenterol. 2018;113:S270.

85.

• Di Nardo G, et al. Chronic intestinal pseudo-obstruction in children and adults: diagnosis and therapeutic options. Neurogastroenterol Motil. 2017. https://doi.org/10.1111/nmo.12945. First study to develop a quantifiable set of criteria for visceroptosis during small bowel follow-through.

86.

De Giorgio R, Cogliandro RF, Barbara G, Corinaldesi R, Stanghellini V. Chronic intestinal pseudo-obstruction: clinical features, diagnosis, and therapy. Gastroenterol Clin N Am. 2011;40:787–807.

87.

Stanghellini V, et al. Natural history of chronic idiopathic intestinal pseudo-obstruction in adults: a single center study. Clin Gastroenterol Hepatol. 2005;3:449–58.PubMed

88.

Soudah HC, Hasler WL, Owyang C. Effect of octreotide on intestinal motility and bacterial overgrowth in scleroderma. N Engl J Med. 1991;325:1461–7.PubMed

89.

Peeters TL, Janssens J, Vantrappen GR. Somatostatin and the interdigestive migrating motor complex in man. Regul Pept. 1983;5:209–17.PubMed

90.

Robertson D. The epidemic of orthostatic tachycardia and orthostatic intolerance. Am J Med Sci. 1999;317:75–7.PubMed

91.

Schondorf R, Low PA. Idiopathic postural orthostatic tachycardia syndrome: an attenuated form of acute pandysautonomia? Neurology. 1993;43:132–7.PubMed

92.

Wang LB, Culbertson CJ, Deb A, Morgenshtern K, Huang H, Hohler AD. Gastrointestinal dysfunction in postural tachycardia syndrome. J Neurol Sci. 2015;359:193–6.PubMed

93.

Bharucha AE, Camilleri M, Low PA, Zinsmeister AR. Autonomic dysfunction in gastrointestinal motility disorders. Gut. 1993;34:397–401.PubMedPubMedCentral

94.

Kanjwal K, Karabin B, Sheikh M, Elmer L, Kanjwal Y, Saeed B, et al. Pyridostigmine in the treatment of postural orthostatic tachycardia: a single-center experience. Pacing Clin Electrophysiol. 2011;34:750–5.PubMed

95.

Bharucha AE, Low P, Camilleri M, Veil E, Burton D, Kudva Y, et al. A randomised controlled study of the effect of cholinesterase inhibition on colon function in patients with diabetes mellitus and constipation. Gut. 2013;62:708–15.PubMed

96.

Afrin LB, Self S, Menk J, Lazarchick J. Characterization of mast cell activation syndrome. Am J Med Sci. 2017;353:207–15.PubMed

97.

Feoktistov I, Ryzhov S, Goldstein AE, Biaggioni I. Mast cell-mediated stimulation of angiogenesis: cooperative interaction between A2B and A3 adenosine receptors. Circ Res. 2003;92:485–92.PubMed

98.

Worobec AS. Treatment of systemic mast cell disorders. Hematol Oncol Clin North Am. 2000;14:659–87.PubMed

99.

Turner PJ, Kemp AS, Rogers M, Mehr S. Refractory symptoms successfully treated with leukotriene inhibition in a child with systemic mastocytosis. Pediatr Dermatol. 2012;29:222–3.PubMed

100.

Soter NA, Austen KF, Wasserman SI. Oral disodium cromoglycate in the treatment of systemic mastocytosis. N Engl J Med. 1979;301:465–9.PubMed

Titel: Bloating and Abdominal Distension: Exploring Hidden Depths and Insights
verfasst von: Nipaporn Pichetshote, MD
Ali Rezaie, MD, MSc
Publikationsdatum: 15.05.2020
Verlag: Springer US
Erschienen in: Current Treatment Options in Gastroenterology / Ausgabe 2/2020
Print ISSN: 1092-8472
Elektronische ISSN: 1534-309X
DOI: https://doi.org/10.1007/s11938-020-00288-w

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Bloating and Abdominal Distension: Exploring Hidden Depths and Insights

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