W. Steven Pray, PhD, DPhBernhardt Professor, Nonprescription Products and also DevicesCollege of Pharmacy, SouthwesternOklahoma State UniversityWeatherford, Oklahoma 


US Pharm. 2009;34(12):16-22.

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Patients often think about pharmacists as professionals to whom they can confide ashamed medical problems in the hope that the pharmacist will carry out some assistance. One such difficulty is ab bloating, regularly thought to be because of excess minister gas. However, patients may additionally experience abdominal muscle discomfort castle attribute to gas, yet can be caused by numerous serious medical conditions.

Prevalence that Bloating and also Gas

The ubiquity of intestinal gas and also bloating is unknown, together reliable large studies execute not exist. However, bloating and flatulence (defined as excessive air or various other gas in the stomach and/or intestines) room two of the most typical complaints because that which patient seek medical care.1

Manifestations the Bloating and also Gas

Bloating and gas can cause several complaints or coexist with them. Patients complain of too much belching (eructation).2Belching is a normal response during or after a meal, particularly one the was eaten so quickly that the patient likewise swallowed air. However, part patients gulp down air purposely to facilitate belching, a practice that can construct into an unconscious habit. Thus, if world burp excessively, they might be chronic wait swallowers. Patients may deny that they sloop down air as a worried habit, forcing doctors to provide them a winter to watch the episodes themselves.

Flatulence is a common and logical repercussion of intestinal gas. Mean patients through no pathology or underlying medical problem produce 1 come 4 pints of minister gas per day and also flatulate 14 come 23 time daily.2,3

Abdominal distention is an increase in ab girth that is frequently ascribed to excessive intestinal gas.2,4This perception is regularly incorrect, as many such patients have actually normal amounts of gas. Rather, investigators think that this patients have actually a heightened awareness of intestinal gas. Thus, also normal volumes of gas reason troublesome symptoms.

Abdominal ache is another complaint frequently thought come be as result of gas.2,3It may arise native either side of the colon, mimicking such problems as love disease, gallstones, and also appendicitis.

Possible causes of Bloating and also Gas

Various resources of overabundance gas have actually been identified, consisting of air swallowing, diet, lactose intolerance, and also irritable bowel syndrome (IBS).

Aerophagia:Aerophagia, or waiting swallowing, has long been believed to it is in responsible for bloating and gas, as previously described.5,6But there had been tiny evidence to assistance the hypothesis, as logical as it sounds. However, in 2009, investigators confirmed the theory by assessing swallowing frequency in general and also air swallowing frequency in specific in patients with suspected aerophagia.5They figured out a group of patients with common complaints the bloating, abdominal distention, flatulence, and/or excessive belching. Ab x-rays shown the visibility of excessive abdominal muscle gas, the presumed resource of the complaints. The researchers carried out 24-hour pH-impedance surveillance on subjects, finding out that swallowing frequency for the 24-hour duration was typical (741 +/- 71 episodes), yet the number of air swallows and also gastric belches was excessive (521 +/- 63 and also 126 +/-37, respectively). Thus, the advice gift in this month’sPatient Informationsection about air swallowing might be valuable for these patients.

Diet:Diet is a major cause of bloating and also gas. One of the most usual dietary worries is eating foods items that cannot be spend in the cradle (GI) tract due to a absence of the necessary enzymes.1,2

If particular food residues (mostly carbohydrates) reach the large intestine, typical bacterial inhabitants utilize them as food sources, developing carbon dioxide, hydrogen, and also sometimes methane together by-products.1,2Exactly i beg your pardon foods cause gas different from human being to person. Part patients’ bowel microorganisms destroy hydrogen, lessening their intestinal gas burden.2Nevertheless, some foods are universally figured out as gas producers.

Carbohydrate-containing foods are among the most common culprits in bring about intestinal gas, whereas fatty foods and proteins are rarely responsible.1,2,7Raffinose is one such facility sugar, being found in the indigestible seed coatings the beans, cabbage, brussels sprouts, broccoli, asparagus, other vegetables, and also whole grains.2Fructose is one more offender, uncovered in onions, artichokes, pears, and also wheat; it is also used as an synthetic sweetener. Sorbitol is also an artificial sweetener, but it is a naturally emerging component that apples, pears, peaches, and prunes. Sorbitol is a cause of “Halloween diarrhea,” a phenomenon experienced by many kids who consume huge amounts of candy on Halloween night. Countless patients additionally report that psyllium ingested to ensure regularity reasons gas (e.g., Metamucil, Konsyl). This patients may benefit by switching to methylcellulose, an FDA-approved fiber supplement the is no fermented by colonic bacteria (e.g., Citrucel).

Lactose Intolerance:Lactose intolerance (LI) is another form of carbohydrate malabsorption, discussed separately since of its various etiologies.1Lactase uncovered in the brush border cell of the tiny intestine is essential for break lactose down right into its ingredient sugars because that absorption. Lactase deficiency is the underlying defect behind LI.

There space two major types the LI. Lock share the exact same consequences, in that undigested lactose get the intestinal tract, whereby the colonic microbiota digest it, creating gas, diarrhea, bloating, borborygmus, and a organize of various other complaints, start as early as 30 minute after ingestion.8,9The an ext common type of LI is the primary form, proficient by most of the world’s peoples, including those the African, native American, and Asian heritage. In major LI, lactase task drops sharply after weaning from breast milk, till it is essentially absent. Drinking milk or ingesting dairy product products reasons the symptoms to begin.

Some people additionally suffer from second LI. Lock normally produce lactase together adults, yet an eco-friendly insult or surgical procedure compromises their capacity to execute so. Possible causes of secondary LI encompass chemotherapy, diarrheal diseases, little intestine resection, or celiac disease.1Pharmacists can straight patients with suspected LI come lactase-containing additionally (e.g., Lactaid) or lactose-free dairy product products.

Irritable Bowel Syndrome:IBS causes abdominal muscle pain, cramping, bloating, constipation, and diarrhea.10-12About 20% of Americans endure from IBS, perhaps as result of colonic hypersensitivity to particular foods or in an answer to stressful situations.11Pharmacists should refer patients through suspected IBS to a doctor for a complete evaluation, but they can likewise advise patient to save a food diary to help identify dietary reasons of IBS. Elimination of specific foods and drinks (e.g., chocolate, alcohol, caffeine, cola, tea, peppers, onions) may be all the is essential to carry out relief.

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Nonprescription Products

Pharmacists can recommend two varieties of nonprescription products other than lactose-intolerance products. One group of assets contains simethicone, a nontoxic and hypoallergenic ingredient that is FDA approved together safe and effective in breaking under bubbles or froth in the GI tract, back the total amount of gas stays the same.1Simethicone’s usefulness might be because of several factors. Some patients may experience abdominal muscle discomfort as normal amounts of intestinal gas move through them. Reducing froth may permit the gas to pass through more readily. Further, patients using simethicone may have the ability to eliminate gas in several larger episodes, reducing the perception of excessive gas. Commodities with simethicone incorporate Mylanta Gas, Phazyme, and also Gas-X. The dosage is commonly 1 or 2 units as essential after meals and also at bedtime.

Alpha-galactosidase is another method to stop bloating and gas.1,13This is an enzyme obtained fromAspergillus niger, and also it has actually the capacity to break down the oligosaccharide linkages that humans cannot digest. The patience is then able come absorb the single-component sugar residues. In research experimenting the enzyme’s efficacy, subjects ingested 2 meals that meatless chili written of several types of beans, cabbage, cauliflower, and onions.14They were provided either a placebo or the commercially available alpha-galactosidase product, recognized asBeano. Beano lessened the variety of flatulence events at all times other than for 2 hrs postingestion. The impact was many pronounced 5 hours after the meal.14

To use Beano solution, the patience places roughly 5 autumn on the first bite of troublesome food, such as beans, cabbage, cauliflower, broccoli, grains, cereals, nuts, seeds, and whole-grain breads.13That amount generally covers a half-cup serving of food. If the meal is composed of 2 or three servings that the food, the patient should location 10 come 15 fall on the meal. However, if the patience still experiences flatulence, the amount deserve to be changed upward until an effective dose is reached. The patient may likewise swallow or chew a Beano tablet computer with the first bite of food or crumble it onto the an initial bite. One tablet usually digests a half-cup serving; an ext tablets can be supplied for bigger portions. Patients cannot chef with Beano due to the fact that of heat-induced enzyme degradation. Patients with galactosemia should consult a physician prior come use because enzymatic destruction of oligosaccharides produce galactose. Beano is labeled only for patients age 12 years and above. If it shows up to be safe during pregnancy and breastfeeding, there space no studies to check that observation. At one time, the manufacturer recommended the patients allergic to molds not use Beano, yet the present view is that the caution is not sustained by medical literature.13

Addition Diets

Pharmacists can likewise advise patients to undergo an enhancement diet.15With this method, the patience eliminates all foods and also drinks that space thought to create symptoms. If symptom improve, the patient proceeds the diet for numerous days until reaching a regarded normal level, a state known asnormoflatulence.15Then one brand-new food or drink is added, and also the patient documents the outcomes in a diary, paying particular attention come the intensity of the symptoms. Patients need to discontinue any troublesome food because that the duration of the enhancement diet and add another doubt food or drink after 48 hours. After numerous weeks of following this simple procedure, the patient begins to build a profile of daunting foods. At some point all suspected foods will be identified, and the patient will have a much much better idea of how to choose foods and drinks, even when visiting a restaurant.

PATIENT INFORMATION

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Swallowing Air

When friend swallow air, it must either be burped up or expelled as gas. Several problems can reason one come swallow air. Dentures that do not right well reason you to swallow more saliva, i m sorry is combined with air bubbles. If this is a possible cause, you should see the dental experienced who fitted your dentures to have them adjusted. If you have actually postnasal discharge, you have tendency to swallow much more than normal, allowing an ext air to enter your stomach. Judicious use the a sleep decongestant (e.g., Sudafed, Afrin) might help. Cigarette smoking cigarettes, cigars, or pipes and also using chewing tobacco have the right to increase salivation and contribute to too much bloating, as have the right to talking too much.

Some human being belch excessively, either as a nervous habit or possibly as a resource of humor. To attain intentional belching, the human often an initial swallows air, adhered to by the belching. However, he or she hardly ever releases every one of the swallowed air, and it becomes flatulence.

Dietary Issues

Eating as well rapidly reasons you come swallow extra air. You must slow her eating and chew the food thoroughly before swallowing it. Chewing gum and also sucking on hard candy also increase the quantity of swallowed air, so this practices must be reduced.

An easy means to help minimize bloating and gas is to emphasis on carbonated beverages (e.g., Coke, Pepsi). Manufacturers intentionally add carbonation to every one of these sodas to give the assets their “fizz.” once the bottle or can is agitated before being opened, anyone knows what the an outcome will be—a good deal of bubbly drink ~ above the floor. Together a human being drinks the beverage, the carbonation bubbles go into the stomach. If they are not belched out, they come to be excess flatulence. Many world could minimize gas troubles dramatically by merely eliminating all carbonated beverages. If a human being refuses to take this simple step, probably he or she have the right to be convinced to allow the drinks to sit the end on the counter at room temperature for several hours, which permits them to walk flat and thus reduce the lot of swallowed gas.

The same advice can be given to beer drinkers. Beer contains gas, as shown by the frothy head that develops when that is poured. Girlfriend should fully eliminate it from your diet to see if your symptoms improve.

A major dietary cause of gas is beans, and also other foods items with indigestible components, such together cabbage, cauliflower, and also broccoli. Her intestinal bacteria usage these materials as foods, creating gas as a by-product.

Lactose intolerance likewise contributes to gas and bloating. The is best to prevent dairy commodities or to take it supplements the contain lactase, such together Lactaid.

Consult your Pharmacist

There are numerous OTC commodities you deserve to take to help relieve symptoms. Your pharmacist deserve to assist girlfriend by advising on the usage of simethicone (e.g., Gas-X, Mylanta Gas, Phazyme), which eases removed of gas. Beano, a product that reduces the amount of gas, is a liquid equipment that can be used directly to food or taken as a tablet prior come eating

Remember, if you have actually questions, Consult her Pharmacist.

REFERENCES

1. Pray WS.Nonprescription Product Therapeutics.2nd ed. Baltimore, MD: Lippincott Williams & Wilkins; 2006.2. Gas in the cradle tract. NIDDK.http://digestive.niddk.nih.gov/ddiseases/pubs/gas/. Accessed October 29, 2009.3. Gas—flatulence. MedlinePlus.www.nlm.nih.gov/medlineplus/ency/article/003124.htm. Accessed October 29. 2009.4. Agrawal A, Whorwell PJ. Review article: abdominal muscle bloating and distension in practical gastrointestinal disorders—epidemiology and explorations of feasible mechanisms.Aliment Pharmacol Ther. 2008;27:2-10.5. Hemmink GJ, Weusten BL, Bredenoord AJ, et al. Aerophagia: excessive air swallowing prove by esophageal impedance monitoring.Clin Gastroenterol Hepatol. 2009;7:1127-1129.6. Azpiroz F. Minister gas dynamics: mechanisms and also clinical relevance.Gut. 2005;54:893-895.7. Hernot DC, Boileau TW, Bauer LL, et al. In vitro fermentation profiles, gas manufacturing rates, and also microbiota modulation as impacted by details fructans, galactooligosaccharides, and also polydextrose.J Agric Food Chem. 2009;57:1354-1361.8. Saulnier DM, Kolida S, Gibson GR. Microbiology of the person intestinal tract and approaches because that its diet modulation.Curr Pharm Des. 2009;15:1403-1414.9. Ozdemir O, Mete E, Catal F, et al. Food intolerances and also eosinophilic esophagitis in childhood.Dig Dis Sci. 2009;54:8-14.10. Gasbarrini A, Lauritano EC, Garcovich M, et al. Brand-new insights into the pathophysiology of IBS: minister microflora, gas production and also gut motility.Eur Rev Med Pharmacol Sci. 2008;12(suppl 1):111-117.11. Irritable bowel syndrome. NIDDK.http://digestive.niddk.nih.gov/ddiseases/pubs/ibs/. Accessed October 29, 2009.12. Rana SV, Sharma S, Sinha SK, et al. Incidence of predominant methanogenic flora in irritable bowel syndrome patients and apparently healthy controls from phibìc India.Dig Dis Sci. 2009;54:132-135.13. Beano FAQs. GlaxoSmithKline.www.beanogas.com/FAQ.aspx. Accessed October 29, 2009.14. Ganiats TG, Norcross WA, Halverson AL, et al. Does Beano stop gas? A double-blind crossover study of oral alpha-galactosidase to treat dietary oligosaccharide intolerance.J Fam Pract. 1994;39:441-445.15. Clearfield HR. Clinical minister gas syndromes.Prim Care. 1996;23:621-628.16. Adolf Hitler had bad table manners and suffered flatulence.

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Telegraph. February 17, 2009.www.telegraph.co.uk/news/newstopics/howaboutthat/4678840/Adolf-Hitler-had-poor-table-manners-and-suffered-flatulence.html. Accessed October 29, 2009.