Abdominal distention and bloating are thought to be due to too much gas and are some of the most common gastrointestinal complaints. These symptoms can be eliminated with the help of your gastroenterologist. There are some causes of bloating that that can be easily identified and treated.
Small Intestinal Bacterial Overgrowth
There are bacteria in the gastrointestinal tract that convert foods much as salad, broccoli, and beans into gas. Small intestinal bacterial overgrowth occurs when too many bacteria form in the small intestine and can cause gas, bloating, abdominal discomfort, diarrhea and anemia. It can be caused by slow motility of the intestine that can occur in normal aging, diabetes and scleroderma. Other causes include decreased stomach acid from medications such as omeprazole or gastric surgery, NSAID use, Crohn’s disease, pancreatitis, cirrhosis, Celiac disease, diverticulosis of the small bowel and prior surgeries. Bacterial overgrowth can be diagnosed in our office with a simple breath test and is treated with antibiotics.
Lactose is present in most diary products such as milk, cheese and ice cream and is digested by an enzyme in the lining of the intestine. The enzyme can be missing since birth. The enzyme can also be lost later in life due to injury of the intestine due to infection, Celiac disease, alcoholism, and Crohn’s disease. More commonly, the enzyme simply disappears with aging. This late onset lactose malabsorption effects people more depending on their race and ethnicity and can effect close 100% of Asians in the U.S., 80% of African Americans and 70% of Italians. Symptoms of lactose intolerance include abdominal cramps, distention, flatulence, diarrhea or vomiting. Lactose intolerance is also diagnosed with a simple breath test offered in the office.
Fructose is a sugar found in candy, soda, barbecue sauce, ketchup, jellies, fruit on the bottom yogurts, apples, mangos, watermelon, canned fruit, honey, corn syrup and many other food products. Fructose can be malabsorbed by the intestine and produce symptoms of gas and bloating. Fructose intolerance can also be diagnosed by at simple breath test in our office.
High FODMAP Diet Intolerance
FODMAP stands for Fermentable Oligo-Di-Monosaccarides and Polyols. These include fructose, lactose, sweeteners, beans, wheat, onion, garlic, lentils, and some fruits. When trying to eliminate bloating and gas, one strategy is to follow the low FODMAP diet . This diet tries to eliminate foods that can commonly cause bloating. This elimination diet is usually followed 6 weeks. After this, high FODMAP foods are added one at a time to see if foods trigger symptoms An alternative dietary approach that I commonly start with is to have patients write down a diet/symptom diary of what they eat and how they feel. This can be used to try to pinpoint what foods are causing bloating and eliminate those foods from the diet rather then making drastic dietary changes. These results can also help guide which breath tests to start with.
Hydrogen Breath Testing
Bacterial overgrowth and lactose and fructose malabsorption can be detected using a hydrogen breath detector. Patients either drink a can of soda for fructose intolerance or a glass of whole milk for lactose intolerance at home. Three hours later patients come to the office and blow into the machine once which takes a few seconds. For the bacterial overgrowth test patient drink something one hour before coming to the office and have to blow into the machine every 20 minutes until the test is positive. This can take from one hour up to three hours. Our practice has an entire office dedicated to breath testing at least one morning a week.
If you suffer from symptoms of bloating and gas, contact your gastroenterologist to initiate proper testing.