W. Steven Pray, PhD, DPhBernhardt Professor, Nonprescription Products and also DevicesCollege that Pharmacy, SouthwesternOklahoma State UniversityWeatherford, Oklahoma 


US Pharm. 2009;34(12):16-22.

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Patients often consider pharmacists as experts to who they can confide ashamed medical problems in the hope the the pharmacist will provide some assistance. One such problem is abdominal muscle bloating, regularly thought come be due to excess intestinal gas. However, patients may likewise experience abdominal discomfort they attribute to gas, but can be led to by number of serious clinical conditions.

Prevalence the Bloating and Gas

The pervasiveness of intestinal gas and bloating is unknown, as reliable massive studies do not exist. However, bloating and flatulence (defined as excessive air or other gas in the stomach and/or intestines) are two that the most typical complaints because that which patient seek clinical care.1

Manifestations of Bloating and also Gas

Bloating and gas can cause several complaints or coexist with them. Patient complain of excessive belching (eructation).2Belching is a normal solution during or after ~ a meal, particularly one the was consumed so rapidly that the patient additionally swallowed air. However, part patients swallow air intentionally to facilitate belching, a practice that can build into an unconscious habit. Thus, if people burp excessively, they may be chronic air swallowers. Patients may deny that they gulp down air as a worried habit, forcing doctors to offer them a mirror to observe the episodes themselves.

Flatulence is a common and also logical an effect of intestinal gas. Average patients v no pathology or underlying medical problem produce 1 come 4 pints of minister gas per day and also flatulate 14 to 23 times daily.2,3

Abdominal distention is rise in ab girth the is commonly ascribed to excessive intestinal gas.2,4This perception is frequently incorrect, as numerous such patients have normal amounts of gas. Rather, investigators believe that these patients have a heightened awareness of minister gas. Thus, even normal quantities of gas cause troublesome symptoms.

Abdominal pains is an additional complaint regularly thought come be due to gas.2,3It may arise indigenous either side of the colon, mimicking such conditions as love disease, gallstones, and also appendicitis.

Possible reasons of Bloating and Gas

Various sources of overabundance gas have been identified, including air swallowing, diet, lactose intolerance, and also irritable bowel syndrome (IBS).

Aerophagia:Aerophagia, or wait swallowing, has long been thought to it is in responsible for bloating and gas, as previously described.5,6But there had actually been tiny evidence to support the hypothesis, as logical together it sounds. However, in 2009, investigators confirmed the hypothesis by assessing swallowing frequency in general and also air swallowing frequency in specific in patients through suspected aerophagia.5They figured out a team of patients with typical complaints the bloating, abdominal distention, flatulence, and/or too much belching. Ab x-rays evidenced the existence of excessive abdominal muscle gas, the presumed resource of the complaints. The researchers brought out 24-hour pH-impedance security on subjects, discovering that swallowing frequency for the 24-hour period was regular (741 +/- 71 episodes), but the variety of air swallows and also gastric belches was too much (521 +/- 63 and also 126 +/-37, respectively). Thus, the advice presented in this month’sPatient Informationsection concerning air swallowing may be advantageous for these patients.

Diet:Diet is a significant cause that bloating and also gas. Among the most typical dietary problems is eating foodstuffs that cannot be spend in the gastrointestinal (GI) tract as result of a absence of the crucial enzymes.1,2

If certain food residues (mostly carbohydrates) with the huge intestine, regular bacterial residents utilize them together food sources, producing carbon dioxide, hydrogen, and sometimes methane as by-products.1,2Exactly i m sorry foods reason gas varies from human being to person. Part patients’ bowel microorganisms ruin hydrogen, lessening your intestinal gas burden.2Nevertheless, some foods are universally determined as gas producers.

Carbohydrate-containing foodstuffs are among the most usual culprits in leading to intestinal gas, whereas fatty foods and proteins are seldom responsible.1,2,7Raffinose is one such complex sugar, being found in the indigestible seed coatings of beans, cabbage, brussels sprouts, broccoli, asparagus, other vegetables, and whole grains.2Fructose is another offender, uncovered in onions, artichokes, pears, and wheat; that is also used as an artificial sweetener. Sorbitol is additionally an synthetic sweetener, but it is a naturally arising component the apples, pears, peaches, and prunes. Sorbitol is a cause of “Halloween diarrhea,” a phenomenon skilled by many youngsters who consume huge amounts of candy on Halloween night. Many patients also report the psyllium ingested to ensure regularity causes gas (e.g., Metamucil, Konsyl). This patients may benefit by convert to methylcellulose, one FDA-approved fiber supplement that is not fermented by colonic bacteria (e.g., Citrucel).

Lactose Intolerance:Lactose intolerance (LI) is another type of carbohydrate malabsorption, disputed separately because of its various etiologies.1Lactase uncovered in the brush border cells of the little intestine is essential for breaking lactose down into its component sugars for absorption. Lactase deficiency is the basic defect behind LI.

There space two major types the LI. They share the exact same consequences, in the undigested lactose get the minister tract, whereby the colonic microbiota digest it, developing gas, diarrhea, bloating, borborygmus, and a hold of various other complaints, start as at an early stage as 30 minutes after ingestion.8,9The much more common kind of LI is the primary form, proficient by many of the world’s peoples, consisting of those the African, aboriginal American, and Asian heritage. In main LI, lactase activity drops sharply after weaning from breast milk, until it is basically absent. Drink milk or ingesting dairy product products reasons the symptoms to begin.

Some people likewise suffer from second LI. They normally create lactase as adults, however an ecological insult or operation procedure compromises their capacity to perform so. Possible causes of second LI incorporate chemotherapy, diarrheal diseases, small intestine resection, or celiac disease.1Pharmacists can direct patients v suspected LI to lactase-containing supplements (e.g., Lactaid) or lactose-free dairy products products.

Irritable Bowel Syndrome:IBS causes ab pain, cramping, bloating, constipation, and diarrhea.10-12About 20% that Americans suffer from IBS, perhaps as result of colonic hypersensitivity to details foods or in solution to stressful situations.11Pharmacists have to refer patients v suspected IBS come a physician for a full evaluation, however they can likewise advise patient to store a food diary to aid identify dietary causes of IBS. Remove of certain foods and drinks (e.g., chocolate, alcohol, caffeine, cola, tea, peppers, onions) may be all that is needed to provide relief.

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Nonprescription Products

Pharmacists deserve to recommend two types of nonprescription assets other than lactose-intolerance products. One group of commodities contains simethicone, a nontoxic and also hypoallergenic ingredient the is FDA approved together safe and effective in breaking down bubbles or froth in the GI tract, back the complete amount of gas continues to be the same.1Simethicone’s usefulness may be because of several factors. Some patients might experience abdominal discomfort together normal quantities of minister gas relocate through them. Reduce froth may enable the gas to pass through more readily. Further, patients utilizing simethicone may have the ability to eliminate gas in several larger episodes, reducing the tardy of too much gas. Assets with simethicone encompass Mylanta Gas, Phazyme, and Gas-X. The dosage is generally 1 or 2 units as essential after meals and also at bedtime.

Alpha-galactosidase is another method to avoid bloating and also gas.1,13This is one enzyme acquired fromAspergillus niger, and also it has actually the capability to malfunction the oligosaccharide linkages that people cannot digest. The patience is then able come absorb the single-component street residues. In research exploring the enzyme’s efficacy, subjects ingested 2 meals of meatless chili created of several varieties of beans, cabbage, cauliflower, and onions.14They were provided either a placebo or the commercially accessible alpha-galactosidase product, recognized asBeano. Beano lessened the variety of flatulence occasions at every times other than for 2 hrs postingestion. The result was most pronounced 5 hours after the meal.14

To use Beano solution, the patience places roughly 5 fall on the first bite of troublesome food, such together beans, cabbage, cauliflower, broccoli, grains, cereals, nuts, seeds, and also whole-grain breads.13That amount usually covers a half-cup serving of food. If the meal is composed of 2 or 3 servings that the food, the patient should ar 10 to 15 drops on the meal. However, if the patience still experience flatulence, the amount can be changed upward until an efficient dose is reached. The patience may additionally swallow or chew a Beano tablet with the first bite of food or crumble the onto the an initial bite. One tablet usually digests a half-cup serving; more tablets can be supplied for larger portions. Patients cannot cook with Beano since of heat-induced enzyme degradation. Patients through galactosemia have to consult a physician prior come use due to the fact that enzymatic destruction of oligosaccharides to produce galactose. Beano is labeled only for patients age 12 years and above. When it appears to be safe during pregnancy and breastfeeding, there room no studies to check that observation. In ~ one time, the manufacturer recommended that patients allergy to molds not usage Beano, but the present view is that the fist is not sustained by clinical literature.13

Addition Diets

Pharmacists can additionally advise patient to experience an addition diet.15With this method, the patience eliminates all foods and drinks that are thought to develop symptoms. If symptom improve, the patient proceeds the diet for numerous days until reaching a viewed normal level, a state well-known asnormoflatulence.15Then one new food or drink is added, and the patient documents the results in a diary, paying particular attention come the strongness of the symptoms. Patients must discontinue any type of troublesome food for the expression of the enhancement diet and add another suspected food or drink ~ 48 hours. After number of weeks of adhering to this basic procedure, the patient starts to build a file of difficult foods. At some point all suspected foods items will be identified, and also the patient will have a much better idea of just how to select foods and drinks, even when visiting a restaurant.

PATIENT INFORMATION

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Swallowing Air

When girlfriend swallow air, it need to either it is in burped up or expelled as gas. Several difficulties can cause one to swallow air. Dentures that perform not to the right well reason you to swallow much more saliva, i beg your pardon is combined with waiting bubbles. If this is a feasible cause, you have to see the dental professional who fitted her dentures to have them adjusted. If you have postnasal discharge, you tend to swallow an ext than normal, allowing much more air to get in your stomach. Wise use the a sleep decongestant (e.g., Sudafed, Afrin) might help. Smoking cigarettes, cigars, or pipes and using chewing tobacco have the right to increase salivation and also contribute to too much bloating, as can talking also much.

Some people belch excessively, either as a concerned habit or probably as a resource of humor. To attain intentional belching, the person often very first swallows air, adhered to by the belching. However, that or she seldom releases every one of the swallowed air, and also it i do not care flatulence.

Dietary Issues

Eating too rapidly causes you to swallow extra air. You need to slow your eating and also chew the food thoroughly prior to swallowing it. Chewing gum and also sucking on hard candy likewise increase the quantity of swallowed air, so this practices need to be reduced.

An easy way to help minimize bloating and gas is to emphasis on carbonated beverages (e.g., Coke, Pepsi). Manufacturers intentionally include carbonation to all of these sodas to provide the commodities their “fizz.” when the bottle or have the right to is agitated before being opened, everyone knows what the an outcome will be—a good deal the bubbly drink on the floor. Together a human being drinks the beverage, the carbonation bubbles go into the stomach. If they room not belched out, they end up being excess flatulence. Many world could reduce gas problems dramatically by simply eliminating every carbonated beverages. If a person refuses to take it this straightforward step, perhaps he or she can be persuaded to enable the drinks to sit out on the respond to at room temperature for several hours, which enables them to go flat and also thus reduces the lot of swallowed gas.

The exact same advice have the right to be offered to beer drinkers. Beer has gas, as indicated by the frothy head that creates when that is poured. You should fully eliminate the from her diet to check out if her symptoms improve.

A significant dietary cause of gas is beans, and other foods items with indigestible components, such as cabbage, cauliflower, and also broccoli. Your intestinal bacteria use these components as foods, producing gas together a by-product.

Lactose intolerance additionally contributes to gas and also bloating. That is ideal to protect against dairy commodities or to take supplements that contain lactase, such together Lactaid.

Consult your Pharmacist

There are number of OTC assets you deserve to take to assist relieve symptoms. Her pharmacist can assist girlfriend by advising on the usage of simethicone (e.g., Gas-X, Mylanta Gas, Phazyme), i m sorry eases removed of gas. Beano, a product that reduces the lot of gas, is a liquid systems that deserve to be applied directly come food or taken as a tablet prior to eating

Remember, if you have questions, Consult your Pharmacist.

REFERENCES

1. Pray WS.Nonprescription Product Therapeutics.2nd ed. Baltimore, MD: Lippincott Williams & Wilkins; 2006.2. Gas in the cradle tract. NIDDK.http://digestive.niddk.nih.gov/ddiseases/pubs/gas/. Accessed October 29, 2009.3. Gas—flatulence. MedlinePlus.www.nlm.nih.gov/medlineplus/ency/article/003124.htm. Accessed October 29. 2009.4. Agrawal A, Whorwell PJ. Review article: ab bloating and also distension in sensible gastrointestinal disorders—epidemiology and also explorations of possible mechanisms.Aliment Pharmacol Ther. 2008;27:2-10.5. Hemmink GJ, Weusten BL, Bredenoord AJ, et al. Aerophagia: excessive air swallowing demonstrated by esophageal impedance monitoring.Clin Gastroenterol Hepatol. 2009;7:1127-1129.6. Azpiroz F. Intestinal gas dynamics: mechanisms and also clinical relevance.Gut. 2005;54:893-895.7. Hernot DC, Boileau TW, Bauer LL, et al. In vitro fermentation profiles, gas manufacturing rates, and also microbiota modulation as affected by certain fructans, galactooligosaccharides, and polydextrose.J Agric Food Chem. 2009;57:1354-1361.8. Saulnier DM, Kolida S, Gibson GR. Microbiology that the human intestinal tract and also approaches for its diet modulation.Curr Pharm Des. 2009;15:1403-1414.9. Ozdemir O, Mete E, Catal F, et al. Food intolerances and also eosinophilic esophagitis in childhood.Dig Dis Sci. 2009;54:8-14.10. Gasbarrini A, Lauritano EC, Garcovich M, et al. Brand-new insights into the pathophysiology the IBS: minister microflora, gas production and also gut motility.Eur Rev Med Pharmacol Sci. 2008;12(suppl 1):111-117.11. Irritable bowel syndrome. NIDDK.http://digestive.niddk.nih.gov/ddiseases/pubs/ibs/. Accessed October 29, 2009.12. Rana SV, Sharma S, Sinha SK, et al. Incidence of primary methanogenic flora in irritable bowel syndrome patients and also apparently healthy controls from phibìc India.Dig Dis Sci. 2009;54:132-135.13. Beano FAQs. GlaxoSmithKline.www.beanogas.com/FAQ.aspx. Accessed October 29, 2009.14. Ganiats TG, Norcross WA, Halverson AL, et al. Walk Beano avoid gas? A double-blind crossover research of dental alpha-galactosidase to treat dietary oligosaccharide intolerance.J Fam Pract. 1994;39:441-445.15. Clearfield HR. Clinical minister gas syndromes.Prim Care. 1996;23:621-628.16. Adolf Hitler had negative table manners and also suffered flatulence.

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Telegraph. February 17, 2009.www.telegraph.co.uk/news/newstopics/howaboutthat/4678840/Adolf-Hitler-had-poor-table-manners-and-suffered-flatulence.html. Accessed October 29, 2009.