What is gas and boating?
Gas is embarrassing and can be uncomfortable for the patient and the people around him or her! The term gas refers to air in your gut or digestive tract. It is either swallowed or produced by the foods we eat or drink. There are only two ways to eliminate it; through the mouth or through the anus. When gas accumulates in the digestive tract, patients feel distended or bloated.
What causes gas and bloating?
Gas is caused by swallowed air and the food we eat. A large part of the gas in the upper GI tract comes from swallowed air. Smokers, gum chewers, and rapid eaters often swallow excessive amounts of air. Pulmonary conditions such as asthma and bronchitis can result in air swallowing. Anxiety is a contributor to air swallowing. Carbonated beverages release gas as they warm in the stomach and this can result in gas. The excess air in the upper GI tract is either belched up or passed along into the small intestine where it may cause bloating if not completely absorbed.
Gas in the lower GI tract is most commonly caused from bacterial fermentation of undigested foods. This happens when we eat foods that our bodies cannot digest completely. The undigested foods are passed along into the large intestine where bacteria try to digest them. This process called fermentation results in gas production. Milk products and certain carbohydrates can be poorly absorbed in individuals and the bacterial fermentation can cause gas. The gas is usually expelled out the anus, but sometimes accumulates and causes bloating.
A malabsorptive condition called Celiac Disease resulting from an allergy to wheat can also cause bloating and gas. More on this condition can be found under the Celiac Disease section.
Another digestive condition that can cause gas and bloating, is Small Intestinal Bacterial Overgrowth (SIBO). This happens when the small bowel develops excessive amounts of different types of bacteria that are typically found in the colon. These different types of bacteria slow down the motility of the small intestine and can cause bothersome GI symptoms such as gas, bloating, diarrhea and constipation. More on this condition can be found under the SIBO section.
What are the symptoms of gas and bloating?
Gas and bloating can cause pain, distension, belching and flatulence. Some patients with gas also have acid reflux while others have diarrhea and constipation. Most gas and bloating patients are just uncomfortable.
How is gas and bloating diagnosed?
The main tool for diagnosis is an accurate medical history and a careful physical exam to exclude danger signs or symptoms. A food diary can be helpful. Patients can be tested for lactase deficiency, celiac disease and other malabsorptive conditions as well.
How is gas and bloating treated?
The main treatments for upper GI tract gas include reducing air swallowing by stopping smoking, avoiding gum chewing and eating more slowly. Dietary measures like cutting out carbonated beverages are also important.
Gas in the lower GI tract can be avoided by diet changes. If you are deficient in lactase (the enzyme that breaks down the milk sugar lactose), you should either avoid milk products or take supplemental lactase when you consume milk products. Certain poorly digested carbohydrates should be avoided. These include:
- Brussel sprouts
Other foods to avoid include fructose which is a sugar found in fruits and is also used as a sweetener in processed foods and sodas. Our bodies have a limited ability to absorb this sugar. When it is not completely absorbed it enters the lower GI tract, where bacteria in the colon ferment it and release gas.
Artificial sweeteners should also be avoided because they are metabolized by bacteria in the colon resulting in gas and in many cases diarrhea too!
Many patients benefit from a low FODMAP diet. This diet which is low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols is quite difficult to follow, but has been shown to help with bothersome bloating and gas symptoms.
A dietary supplement called Atrantil® has proven to help many patients with gas and bloating.
Is gas and bloating serious?
Gas and bloating are more bothersome than serious. While conditions such as inflammatory bowel disease, ulcer disease, gastroesophageal reflux disease, diverticulosis, partial bowel obstruction, intestinal infections, and cancer can sometimes cause gas and bloating, they will be carefully considered and systematically excluded through consultation and diagnostic testing under the care of a board certified gastroenterologist.