Meteorism and abdominal distension

Abstract

Meteorism or bloating in the abdomen and abdominal distension are among the most common digestive issues that patients experience at both primary and secondary care levels. Up to 10-30% of the general population experiences bloating problems. Symptoms are even more prevalent in patients with functional gastrointestinal disorders. Bloating is often associated with a feeling of increased pressure in the abdomen and the release of gas from the intestines. A healthy individual can tolerate up to 500 ml of air in the gastrointestinal tract without major symptoms, but in patients with irritable bowel syndrome, symptoms can be triggered by even minimal increases in gas volume in the gastrointestinal tract. The composition of intestinal gases partly explains their origin: nitrogen (N2) is usually from swallowed air; hydrogen (H2) is produced by bacterial fermentation of carbohydrates; carbon dioxide (CO2) is produced by bacterial fermentation of carbohydrates, fats, and proteins; methane (CH4) is produced during anaerobic bacterial metabolism. When there is an imbalance between gas production and expulsion in the digestive system, it manifests as a feeling of bloating with or without visible abdominal distension. When defining functional disorders related to bloating, it is crucial to exclude possible organic causes of symptoms. Bloating and abdominal distension occasionally occur even in healthy individuals as a result of normal digestion (especially after meals rich in fats and fermentable sugars). The characteristic of "physiological" bloating and distension is that they occur shortly after meals, are short-lived, and disappear after urination or passing gas. Initially, bloating and abdominal distension were only understood as consequences of excessive air in the intestines. Today, we know that the pathophysiology of both conditions is much more complex and the result of different mechanisms. In addition to increased gas production, which accumulates in the intestines along with fluid, altered intestinal microbiota and functionally altered enteric nervous system, which cause visceral hyperalgesia and motility disorders, also have a significant impact. The epidemiological dimension and numerous causes, including malignancies, indicate the need for this type of diagnostic approach in patients with bloating. Diagnosis can involve many tests, including invasive ones, which may pose a certain risk to the patient and a financial burden on the healthcare system. Therefore, a step-by-step approach and a targeted approach are necessary when managing each individual case. The purpose of this study is to present the treatment approach for patients with bloating and to draw attention to the most common medical conditions that may cause increased gas in the gastrointestinal tract.