The need to detect and differentiate between them
The formation of intestinal gas is a natural process for everyone, but many people often find it embarrassing and difficult to discuss it.
Excessive gas can contribute to feelings of bloating (fullness), belching, abdominal cramps, and flatulence. These symptoms are usually short and disappear once gas is released through belching or flatulence. Some people may be more sensitive to even normal amounts of gases and develop these symptoms.
Burping is also a natural process and results from swallowing air accumulated in the stomach. The air can be expelled backwards or it can pass from the stomach into the small intestine and later be passed as rectal gas (flatus).
Bloating refers to a feeling of fullness in the upper abdomen. This can be affected by the accumulation of gas and/or food in the stomach. Some patients experience symptoms even from normal amounts of stomach gas.
Gas generally consists of a combination of swallowed air and gas resulting from the action of colon bacteria on undigested carbohydrates, and flatulence indicates the passage of gas into the rectum.
According to the American College of Gastroenterology, gases that accumulate in the upper right part of the colon can lead to pain that may feel like gallbladder pain. As for the gases that accumulate in the upper left part of the colon, they can spread to the chest and appear as pain in the heart.
Dr. Raouf Haji
Medical meeting
“Your Health” met with Dr. Raouf Hajji, MD, Assistant Professor at the Faculty of Medicine – Sousse, Tunisia, Internal Medicine Consultant, Mouwasat Hospital, Jubail, Saudi Arabia. He explained that bloating is defined as a feeling of gas or a feeling of bloating, and that Belching (Belching- Burping- Eructation) reflects the expulsion of excess gases from the esophagus or stomach.
A distinction must be made between gas bloating and pathological flatulence. Abdominal bloating is a local increase in abdominal circumference, and only 50 percent of patients suffer from bloating.
Flatulence and occasional burping are not abnormal, but gas-related symptoms impair your health-related quality of life. There are a large number of promising drug treatments and nutritional interventions available that may help alleviate these symptoms.
Gas-related symptoms are common and occur as a result of the interaction between gastrointestinal movement and gas. The causes are diverse, and in some cases the evaluation of the condition may be complex and its treatment very difficult, according to a study by Ringel Y, et al. Clin Gastroenterol Hepatol.
Causes of flatulence
Dr. Raouf Hajji explained that the causes of the condition are complex, multi-factorial, and not fully understood by many. Therefore, the differential diagnosis of the condition includes both organic disorders and functional disorders.
Most patients believe that their symptoms are caused by an increased amount of gas within the digestive system. Yes, but for this reason it occurs in only a minority of patients.
Gas formation within the lumen of the gastrointestinal tract increases in only 25 percent of patients with functional gastrointestinal disorders during an episode of flatulence or after eating a diet high in gas and flatulence.
The reasons, according to the American College of Gastroenterology, are that we all swallow air during the eating process. Individuals may experience increased air swallowing due to sucking on hard candy or chewing gum. Drinking soft drinks or beer can also generate excess air in the stomach.
In addition, individuals with anxiety may swallow air excessively. Ill-fitting dentures and chronic nasal discharge or drip can also cause excess air to be swallowed. As a result, large amounts of gas can enter the stomach and small intestine within 24 hours, which may lead to belching or flatulence.
Also, some carbohydrates cannot be digested by enzymes in the small intestine and reach the colon, where bacteria metabolize them into hydrogen gas and carbon dioxide. Examples of these foods include bran, cabbage, cauliflower, broccoli, and beans. This can lead to excessive abdominal bloating in some patients.
Many patients suffer from abdominal cramps and bloating when eating milk, some types of cheese, or ice cream because they lack the lactase enzyme needed to digest milk sugars (lactose). This condition, called lactose intolerance, is less common in people of Northern European descent.
Another cause of bloating and flatulence is called bacterial overgrowth. This is not an infection, but occurs when there is an excess amount of normal bacteria in the small intestine. This leads to increased production of intestinal gases, which contributes to the symptoms mentioned above. Finally, underlying constipation may also contribute to bloating and a feeling of flatulence.
Diagnosis
* First- Clinical history:
Here Dr. Raouf Haji lists 5 simplified steps to arrive at a detailed history:
– Clarifying the prevailing symptoms and their timing from the beginning.
– Conduct a comprehensive nutritional assessment to explore the patient’s eating pattern and its relationship with symptoms.
– Inquire about gastrointestinal symptoms associated with gas formation, specifically abdominal pain, diarrhea, constipation, and weight loss.
– Review the patient’s medications that he is currently taking and inquire about them, especially nutritional supplements. Reviewing medications is necessary for all patients who suffer from unexplained chronic gastrointestinal symptoms.
– Asking about the diseases associated with the disease and exploring the risks and risk factors for abnormal bacterial overgrowth in the small intestine (Small Intestinal Bacterial Overgrowth (SIBO)), especially the types of bacteria that are not usually found in that part of the digestive system. This condition is sometimes called blind loop syndrome.
* Second: Clinical examination to reach diagnostic results:
– Search for clues to the etiology of invasive symptoms through careful observation during the history taking process.
– Abdominal examination to detect bloating.
– Search for non-invasive causes of flatulence, and take this into account.
– Bowel sounds should be heard carefully.
A detailed digital rectal examination must also be performed.
* Third- Laboratory tests:
Dr. Raouf Haji says that there are no specific tests to detect functional gastrointestinal disorders (FGIDs).
Tests should be performed with the aim of ruling out specific diagnoses and not just to reassure the patient. Patients’ concerns about specific diagnoses, in particular cancer or infection, should be elicited and addressed.
treatment
– Reassure the patient after ensuring that the diagnosis is generally benign, and that there are no serious diseases such as tumors.
The concept of the biopsychosocial model should be introduced.
Anxiety, depression, and psychological and social stress are factors that exacerbate symptoms.
-Self-administered medication combinations and nutritional interventions are the most effective.
– Many safe and inexpensive medications are available, often without a prescription.
– New medicines for patients with complex or intractable symptoms.
-Most patients will have gradual improvement over time with occasional flare-ups. In 50 percent of patients, symptoms will disappear, while 30 percent will experience fluctuating symptoms.
Serious symptoms and causes
There are warning symptoms that indicate potentially serious causes of gas, bloating, and burping:
– Those patients 55 years of age and older who report new symptoms should be considered for a more in-depth evaluation to rule out alternative diagnoses, as patients do not usually develop functional gastrointestinal disorders later in life.
-Women 55 years of age and older who report new-onset bloating, increased abdominal size, difficulty eating, or early satiety with abdominal, pelvic, or back pain should be considered for evaluation for ovarian cancer.
Patients who suffer from recurrent episodes of acute or chronic disabling pain, especially over many years of alcohol abuse, should be considered for evaluation for chronic pancreatitis (rarely confused with irritable bowel syndrome, gastroparesis, or small bowel obstruction). ).
Patients with a family history of gastrointestinal tumors, especially pancreatic or colorectal cancer, should be considered for evaluation of gastrointestinal cancers.
– Abdominal mass (palpable swelling).
– Dysphagia (difficulty swallowing).
– Symptoms of severe diarrhea (large volume, bloody, nocturnal, gradual pain, does not improve with fasting).
– Fever – jaundice – vomiting.
– Gastrointestinal bleeding (melena or bloody defecation).
– Lymphadenopathy.
– New symptoms appear in patients aged 55 years and over.
Odynophagia, painful swallowing.
– Symptoms of chronic pancreatitis.
– Symptoms of gastrointestinal cancer, including family history.
– Symptoms of ovarian cancer, including family history.
– Rectal pain or a feeling of incomplete evacuation (Tenesmus).
– Unintended weight loss.
Risk factors for gas accumulation
Excessive swallowing of air and some foods and soft drinks contributes significantly to belching and flatulence. Some patients with irritable bowel syndrome (IBS) appear to be uniquely sensitive to normal or slightly excessive amounts of intestinal gas and may develop abdominal cramps as a result. Patients with changes in anatomy due to surgery or those with certain rheumatic diseases may be at increased risk of bacterial overgrowth in the small intestine, which may lead to belching or flatulence.
Some patients, especially women who have been pregnant once or more, suffer from abdominal bloating when standing in an erect position. This is often assumed to be a buildup of gas. However, if the bulge is not present when the patient is lying flat, the likely explanation is weakness of the abdominal muscles (which extend from the lower rib cage to the pelvis on either side of the navel) due to stretching, weight loss, and muscle weakness that occurs during pregnancy.
* Community medicine consultant
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2024-04-13 11:38:25
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