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Gastroenterol Hepatol (N Y). 2014 Sep;10(9):561-71.

Management Strategies for Abdominal Bloating and Distension.

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Dr Foley and Dr Burgell are gastroenterologists, Dr Barrett is a dietitian, and Dr Gibson is a professor and the director of the Department of Gastroenterology at Monash University and Alfred Hospital in Melbourne, Victoria, Australia.


Bloating and distension are among the most common gastrointestinal complaints reported by patients with functional gut disorders and by the general population. These 2 complaints are also among the most prevalent of the severe symptoms reported by patients with irritable bowel syndrome. Nonetheless, only a limited number of published studies have specifically addressed bloating; it is infrequently studied as a primary endpoint, and what little systematic information exists has often been garnered from the assessment of secondary endpoints or the dissection of composite endpoints. This lack of data, and our consequent limited understanding of the pathophysiology of bloating, had hampered the quest for effective and targeted therapies until recently. Advances in the knowledge of underlying mechanisms, particularly with regard to the roles of diet, poorly absorbed fermentable carbohydrates, dysbiosis of the gut bacteria, alterations in visceral hypersensitivity, and abnormal viscerosomatic reflexes, have enabled the development of improved treatment options. The most significant recent advance has been a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, which significantly reduces patients' symptoms and improves quality of life. Given the prevalence of bloating and its perceived severity, it is clear that further studies regarding the pathogenesis and treatment of this problem are needed.


Bloating; FODMAP; biofeedback; constipation; dietary therapy; distension; fermentable carbohydrates; irritable bowel syndrome


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