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Bloating and Abdominal Distension: Old Misconceptions and Current Knowledge.

Juan R Malagelada1, Anna Accarino1, Fernando Azpiroz1

  • 1Digestive System Research Unit, University Hospital Vall d'Hebron; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Universitat Autònoma de Barcelona, 08193 Cerdanyola del Vallès, Spain.

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Bloating and abdominal distension are common, challenging functional complaints. Effective management requires considering organic causes first, then exploring mechanism-based therapies for functional cases.

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Area of Science:

  • Gastroenterology
  • Functional Bowel Disorders

Background:

  • Bloating and abdominal distension are prevalent symptoms causing significant patient distress.
  • These functional complaints are often associated with Irritable Bowel Syndrome (IBS) and functional dyspepsia.
  • Patient-reported impact varies from severe pain to cosmetic concerns.

Purpose of the Study:

  • To review the assessment and management of functional bloating and abdominal distension.
  • To highlight the importance of differentiating organic from functional causes.
  • To discuss current and potential therapeutic strategies.

Main Methods:

  • Review of existing literature on functional bloating and distension.
  • Discussion of diagnostic clues including dietary history, stool consistency, and imaging.
  • Consideration of specialized center investigations like motility and sensitivity testing.

Main Results:

  • Organic causes must be ruled out before diagnosing functional bloating/distension.
  • Mechanism-based management is ideal but challenging due to complex pathophysiology.
  • Therapeutic approaches include dietary changes, microbiome modulation, gas evacuation, and biofeedback.

Conclusions:

  • Functional bloating and distension require a comprehensive diagnostic approach.
  • Management strategies should be tailored to individual patient mechanisms.
  • Multifaceted therapies targeting diet, microbiome, gas, sensation, and muscle activity offer potential relief.