APPROACH TO BLOATING Epidemiology Very common symptom in primary - - PowerPoint PPT Presentation

APPROACH TO BLOATING

Dr Juanda Leo Hartono Associate Consultant Div Gastroenterology and Hepatology National University Hospital, Singapore

Epidemiology

• Very common symptom in primary care (10-

30% in population based studies)

• Most are benign
• Majority present as part of other Functional

GI Disorder, esp Functional Dyspepsia and IBS

• Bloating as the only symptom (Functional

Bloating) is uncommon

Patient’s Possible Range of Symptoms

• Bloatedness
• Abdominal fullness
• Abdominal Tightness
• Distension
• Increased burping / belching
• Increase flatulence

Bloating NOT THE SAME AS Distension

Before you label ‘Functional…’ make sure it is not physiological

Consider Possible Organic Etiology

Foley et al. Gastroenterol & Hepatol 2014;10(9):561-71

Red Flag Features

• Age >50 years old
• Family history of GI malignancy in a first

degree relative

• Unintended weight loss
• GI bleeding or iron deficiency anemia
• Dysphagia
• Worsening or change in character of

symptoms despite usual measures

Basic Investigation

• FBC, LFT, Renal Panel
• ESR (especially in diarrhea)
• Ultrasound (HBS or pelvic depending on

suspicion)

Dyspepsia Algorithm

ASGE guideline 2015

Rome III Criteria : FD

Rome III Criteria : IBS

Rome III Criteria : Functional Bloating

Only small proportion of patients will fall into this group

Putative Mechanism

Abdominal Wall displacement theory

Visceral Hypersensitivity

‘ What do you mean I am not being sensitive inw(n)ardly ? ‘

Non-medical therapy for Bloating

• Low FODMAP diet (50-75% response in RCT)
• Physical activity promote gas transit
• Biofeedback for

 Constipation with pelvic floor dysfunction  Abdominal wall displacement correction

(preliminary)

What is FODMAP?

• Fermentable
• Oligosaccharides

 Inulin & fructo-oligosaccharides (eg: wheat, onion)  Galacto-oligosacharrides (eg: legumes: beans, peas)

• Disaccharides (eg lactose in dairy products)
• Monosaccharides

 Free fructose (excess fructose relative to glucose)

• And Polyols ( sorbitols, mannitols) : artificial

sweeteners

Management : low FODMAP diet

RCTs of Medications used to relieve bloating

Ionivo P et al. World J Gastroenterol 2014;20(39):14407-19

Algorithm

Foley et al. Gastroenterol & Hepatol 2014;10(9):561-71

Algorithm

Foley et al. Gastroenterol & Hepatol 2014;10(9):561-71

THANK YOU