Gas in the intestinal track is a very common problem and likely one of the hardest symptoms we, as gastroenterologists, have to deal with. The reason this is such a difficult problem to treat is that there are so many different causes of gas and bloating.
Gas in the intestinal track can present with increased belching, abdominal distention or bloating, pain or flatulence. These symptoms are caused by the production of various gases in the intestine including Carbon Dioxide (CO2), Nitrogen, Oxygen, Methane or Hydrogen. When the gas is produced, it stretches the intestines, which leads to the symptoms of bloating, pain and discomfort.
The etiologies of gas and bloating can very widely and treatment is based on resolving the underlying cause.Some of the common causes of increased intestinal gas include swallowed air, small bowel bacterial overgrowth, Helicobacter Pylori, Celiac Disease, reflux disease, disorders of the colon, Irritable Bowel Syndrome, carbohydrate malabsorption, or dietary issues.
Swallowed air or aerophagia is commonly associated with anxiety disorders, talking while eating, chewing gum or smoking. The excessive swallowed air leads to increased belching. Small intestinal bacterial overgrowth (SIBO) is a disorder where the normal bacteria from the colon, migrates back into the small intestine. It is not completely understood what causes this to occur, although it is more common in people who have slower intestinal transit. When this occurs these bacteria settle in the small intestine and break down the digested food producing methane or hydrogen gas. Irritable Bowel is commonly associated with small bowel bacterial overgrowth. Helicobacter Pylori (H. Pylori) is a bacteria that is transmitted fecal orally. When you ingest these bacteria, they inhabit the stomach and cause increased inflammation. This inflammatory change in the stomach can indirectly
lead to excess gas production. Some disorders of the colon that can cause increased methane production include inflammatory conditions such as cancer, ulcerative colitis as well as colon polyps or other inflammatory disorders of the colon. Foods such as broccoli, onions, cauliflower and other high fiber foods can cause increases in hydrogen gas or carbon dioxide. Also lactose ingestion in patients who are lactose intolerant or ingestion of sorbitol, which is found in many sugar-free products can also cause increased gas production.
Most treatments such as simethicone or activated charcoal have not been shown to be significantly beneficial. One of the reasons for this may be that these treatments are aimed at improving the gas itself, rather than the underlying problem. One product that has been shown to have some benefit in helping to improve intestinal gas is probiotics. Probiotics are natural bacteria that are similar to what your body has normally in your colon. These bacteria can come as pills or can be found naturally in things like yogurt. These bacteria may help by aiding in digestive process and restoring your body’s normal bacterial flora. Other treatments may be antibiotics if you have SIBO or H. Pylori.
One diet that has been increasingly discussed in the news lately is the FODMAP diet. This diet helps to reduce gas by decreasing the ingestion of specific carbohydrates that are poorly absorbed in the small intestine. When these sugars reach the colon bacteria ferment them, which leads to gas production.A low FODMAP diet may help with gas.
While sometimes you can improve your gas and bloating symptoms by changing your diet or taking medications, there are other times that you need to seek medical advice for your symptoms. If patients have any alarm symptoms such as weight loss, severe abdominal pain, blood in the stool, fevers or other persistent symptoms, they should discuss their condition with a physician.
Dr. Alan Gingold is a partner at Digestive Healthcare Center in Hillsborough, NJ. He also has offices in Somerville and Warren, NJ. If you would like to make an appointment you can call his office at (908) 218-9222 or you can visit the website www.DHCcenter.com