Functional bloating can be isolated. Excessive gas production can be linked to modifications of the intestinal microbiota.
Intestinal bloating is one of the most frequent functional digestive symptoms and is often the underlying reason for consulting a doctor. In 1998, a SOFRES inquiry including 4,817 adults revealed that 47% of the participants complained of abdominal bloating1 and that 59% of the participants reported that they were regularly bothered by passing gas (flatulence). Bloating is a feeling of distension in the abdominal wall, sometimes associated with the development of abdominal obesity for overweight subjects, but more often with abdominal discomfort associated with regular flatulence2.
Several causes may be responsible for bloating: intestinal obstruction, like a tumor or abdominal adhesion, intestinal malabsorption (particularly celiac disease), a diet rich in legumes (white kidney beans, peas, lentils, etc.), sedentary lifestyle, etc. Bloating is sometimes associated with abdominal pain, making it one of the symptoms of irritable bowel syndrome (IBS), and its management is that of IBS2.
Bacteria in the small intestine
Even though the colon is most often affected, bloating can also be caused by proliferation of intestinal bacteria in the small intestine4 or by dysbiosis, that promotes gas production5. Methanogenesis is ensured by the activity of methanogenic Archaea (Methanobrevibacter smithii) or other bacteria, like Blautia hydrogenotrophica6.
Several therapeutic approaches
In addition to excluding potentially methanogenic foods (legumes, artichokes, red meat, etc.) from the patient’s diet, activated carbon can absorb the gas in the small intestine. Or, the microbiota can be rebalanced by daily intake of pre- or probiotics7 as a way to prevent gas formation. Lastly, regular physical exercise (30 minutes of walking every day, for example) can also channel this gas production and more progressively eliminate it.
1. Frexinos J et al.1. Etude descriptive des symptômes fonctionnels digestifs dans la population générale française. Gastroenterol Clin Biol 1998;22:785-91.
2. Association Française de FMC en hépato gastroentérologie, ballonnement abdominal quoi de neuf, http://www.fmcgastro.org/postu-main/archives/postu-2007-lyon/ballonnement-abdominal-quoi-de-neuf/
3. SFNGE, sfnge.org, les troubles fonctionnels intestinaux, http://www.snfge.org/content/les-troubles-fonctionnels-intestinaux
4. Ford AC, Spiegel BM, Talley NJ, et al. Small intestinal bacterial overgrowth in irritable bowel syndrome. Clin Gastroenterol Hepatol 2009;7:1279-86
5. Ph Ducrotté. Tirés à part: Philippe Ducrotté, ADEN EA 3234
6. Bernalier A, Rochet V, Leclerc M, Dore J, Pochart P. Diversity of H2/CO2-utilizing acetogenic bacteria from feces of nonmethane-producing humans. Curr Microbiol 1996;33:94-9
7. Bergonzelli GE, Blum S, Brüssow H, Corthésy-Theulaz I. Probiotics as a treatment strategy for gastrointestinal diseases? Digestion 2005;72:57-68.