Diagnosing And Treating Gas - Excessive Gas: Digestive Disorders

Content provided by the Faculty of the Harvard Medical School

Diagnosing and treating gas

The important thing for a doctor to consider in diagnosing a belching, bloating, or flatulence problem is whether it's occurring alone or in conjunction with one or more of the various functional GI disorders or a more serious GI illness. He or she should be alert to problems that may suggest organic disease, such as weight loss or anemia. Of course, a physician may be able to determine quickly that the problem is the result of eating too many beans or swallowing too much air. In most cases, evaluating complaints of gassiness will not require extensive diagnostic testing.

What the doctor will do

To assess your gassiness, your doctor will first question you about your symptoms and dietary patterns. If upper GI bloating and belching are the major problems, excessive air swallowing may be the culprit. The doctor will ask about possible lactose intolerance as well as habits such as gulping down meals, drinking carbonated beverages, sipping through a straw, chewing gum, smoking cigarettes, or chewing tobacco.

The doctor will also want to know about anxiety and psychological problems that may contribute to air swallowing and predispose people to symptoms, including gas and cramping. Likewise, he or she will want to review the medications you are taking, since some — especially drugs that are encapsulated with a sorbitol filler — can induce gas, bloating, and diarrhea.

An abdomen distended with air can be detected by listening for a hollow sound when tapped. Organic causes of intestinal distention may include obstruction of the bowel or ulcerative colitis. But other signs usually accompany these more serious problems. Some, such as gastric distention, can be identified with a simple abdominal x-ray. If they suspect lactose intolerance, some doctors may want to run a lactose absorption test or hydrogen breath test.

Treating belching

The key here is to reduce the amount of air you swallow. Quitting chewing gum and smoking — and maybe trading in loose dentures for snugger ones — should cut down on air gulping. One easy fix is to avoid carbonated drinks and whipped desserts, which trigger burping. Some people swear by including certain foods in the diet, such as brown rice or barley broth. Papaya and pineapple are also said to help. Make sure to chew foods slowly, avoid washing food down with liquids, and try to eat smaller meals. And don't eat when you are anxious, upset, or overtired.

Taking a brisk stroll after eating, rather than taking a nap, is a good idea. It promotes gastric emptying and helps relieve the bloated feeling. When it's time to go to bed, try sleeping on your stomach or right side to aid in the escape of gas and alleviate fullness.

Treating pain and bloating

Gas pain and bloating may be helped by regular bowel function. Gradually adding fiber to the diet and using laxatives as needed can reduce constipation and speed the transit of food through the system. But fiber can also increase gassiness, at least initially, so be sure to add it little by little.

There are a number of products advertised to reduce gas symptoms. Some contain simethicone (Gas-X, Phazyme, Mylicon) and are used alone or in conjunction with antacids. They are designed to break up large collections of gas bubbles, thereby relieving symptoms. Their effectiveness is debatable.

When excess intestinal gas is caused by an infection, antibiotics taken in intermittent courses can help.

Treating flatulence

This one is easy. Stop eating the foods that cause gas: beans, fruits, and other complex carbohydrates, as well as the artificial sweetener sorbitol. But don't eliminate all fruits and vegetables, because these foods are the basis of a healthy diet. A product called Beano, which contains the enzyme alpha-galactosidase, can help metabolize difficult-to-digest complex carbohydrates when taken before meals.

For some people, a drastic reduction in dietary sugars and some cutback in refined starches and wheat flour may help. When all else fails, activated charcoal, a tasteless black powder, absorbs gas and for some people cuts down on gassiness, particularly after a high-carbohydrate meal. Occasional use is not harmful. Pepto-Bismol may reduce the odor of flatus.

Some people have had success with anticholinergics, drugs that block nerves that stimulate the digestive tract. If you have aerophagia, antidepressants and tranquilizers may calm the nerves or lessen anxiety, but they must be used carefully and only under a doctor's close supervision.

Wearing a deodorizing and absorbing pad containing activated charcoal beneath the undergarments doesn't stop flatulence, but it can prevent others from noticing it. A 2005 study in the American Journal of Gastroenterology found that such devices are moderately effective.

Last updated:	August 21, 2007