Flatulence; Causes, Symptoms, Diagnosis, Treatment

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Flatulence or intestinal gas is the state of having the excessive stomach and/or intestinal gas (waste gas produced during digestion) that is usually released from the anus with sound and/or odor. Flatulence is a medical term for releasing gas from the digestive system through the anus. It occurs when gas collects inside the digestive system and is a normal process.

Gas collects in two main ways. Swallowing air while you eat or drink can cause oxygen and nitrogen to collect in the digestive tract. Second, as you digest food, digestive gases such as hydrogen, methane, and carbon dioxide collect. Either method can cause flatulence.

Causes of Flatulence

Common Causes

  • Swallowed air – the mouth isn’t vacuum-sealed, so small quantities of air are swallowed along with food and liquid. The oxygen and nitrogen from the swallowed air are absorbed into the bloodstream from the small intestine, and any excess is allowed to continue its journey through the bowel for expulsion. ‘Air-swallowing’ often occurs in people who are anxious.
  • Normal digestion – stomach acid is neutralized by pancreatic secretions, and the resulting interaction creates gas (carbon dioxide) as a by-product.
  • Intestinal bacteria – the bowel contains a host of bacteria that help digestion by fermenting some of the food components. The process of fermentation produces gas as a by-product. Some of the gas is absorbed into the bloodstream and breathed out by the lungs. The remainder is pushed along the bowel.
  • Bloating – is the subjective sensation (feeling) that the abdomen is full or larger than normal. Thus, bloating is a symptom akin to the symptom of discomfort.
  • In contrast – distention is the objective determination (physical finding) that the abdomen is larger than normal. Distention can be determined by such observations as the inability to fit into clothes, the need to loosen the belt or looking down at the stomach and noting that it is clearly larger than normal.
  • High fiber foods – fiber is essential to the health of the digestive system, but it can create excessive gas. The small intestine can’t break down certain compounds, which means extra work for the gas-producing intestinal bacteria, and accompanying flatus. High-fiber diets should be introduced slowly to allow the bowel sufficient time to adjust.
  • Lactose intolerance – the body’s inability to digest the particular sugars found in cows milk will produce excessive amounts of intestinal gas. This is because the bacteria of the gut digest the sugars by fermentation, a gas-creating process.
  • Intolerance of short-chain carbohydrates – other than lactose – certain people may be susceptible to gas production from fermentation of other carbohydrates such as fructose, present in many foods including honey, corn syrup, and some fruits. These short-chain carbohydrates together are now known
  • Raffinose – Beans contain large amounts of the complex sugar known as raffinose. Smaller amounts are found in cabbage, Brussels sprouts, broccoli, asparagus, and in other vegetables and whole grains.
  • Starches – Most starches (potatoes, corn, noodles, and wheat) produce gas as they are broken down in the large intestine. Rice is the only starch that does not cause gas.
  • Fructose – The sugar known as fructose occurs naturally in onions, artichokes, pears, and wheat. It is also used as a sweetener in some soft drinks and fruit drinks.
  • Sorbitol – This sugar is found naturally in fruits including apples, pears, peaches, and prunes. It’s also used as an artificial sweetener in sugar-free gum, candy, and other diet products.
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Fiber & vegetable 

  • Fiber – Many foods contain soluble and insoluble fiber. Soluble fiber dissolves easily in water and takes on a soft, gel-like texture in the intestines. Found in oat bran, beans, peas, and most fruits, soluble fiber is not broken down until it reaches the large intestine, where digestion causes gas. Insoluble fiber, on the other hand, passes essentially unchanged through the intestines and produces little gas. Wheat bran and some vegetables contain this kind of fiber.
  • Fruits & Vegetable – Flatulence-producing foods are typically high in certain polysaccharides, especially oligosaccharides such as inulin. Those foods include beans, lentils, dairy products, onions, garlic, spring onions, leeks, turnips, swedes, radishes, sweet potatoes, potatoes, cashews, Jerusalem artichokes, oats, wheat, and yeast in bread. Cauliflower, broccoli, cabbage, Brussels sprouts and other cruciferous vegetables that belong to the genus Brassica are commonly reputed to not only increase flatulence but to increase the pungency of the flats

Disease Condition & Drug

  • Gallbladder problems – Gallstones and cholecystitis can cause additional gas.
  • Constipation –  Feces can make it harder to expel excess gas, resulting in further accumulation and discomfort.
  • Gastroenteritis and other intestinal infections – A viral, bacterial, or parasitic infection of the digestive system, or food poisoning, can cause a buildup of gas. Examples include Escherichia coli (E. coli) infection, amebiasis, and giardiasis.
  • Antibiotics – These can upset the normal intestinal flora, or bacterial flora, in the gut, leading to flatulence.
  • Laxatives – Regular and excessive use of laxatives can increase the risk of developing flatulence.

Symptoms of Flatulence

Symptoms of excessive (or embarrassing) flatulence include:

Diagnosis of Flatulence

  • Abdominal X-rays Simple X-rays of the abdomen, particularly if they are taken during an episode of bloating or distention, often can confirm air as the cause of the distention since large amounts of air can be seen easily within the stomach and intestine. Moreover, the cause of the problem may be suggested by noting where the gas has accumulated. For example, if the air is in the stomach, the emptying of the stomach is likely to be the problem.
  • Small intestinal X-rays – X-rays of the small intestine, in which barium is used to fill and outline the small intestine, are particularly useful for determining if there is an obstruction of the small intestine.
  • Gastric emptying studies – These studies measure the ability of the stomach to empty its contents. For gastric emptying studies, a test meal that is labeled with a radioactive substance is eaten and a Geiger counter-like device is placed over the abdomen to measure how rapidly the test meal empties from the stomach. A delay in emptying of the radioactivity from the stomach can be caused by any condition that reduces emptying of the stomach (for example, pyloric stenosis, gastroparesis).
  • Ultrasound, CT scan, and MRI – Imaging studies, including ultrasound examination, computerized tomography (CT), and magnetic resonance imaging (MRI), are particularly useful in defining the cause of distention that is due to enlargement of the abdominal organs, abdominal fluid, and tumor.
  • Maldigestion and malabsorption tests – Two types of tests are used to diagnose maldigestion and malabsorption; general tests and specific tests.
  • The best general test –  is a 72 hour collection of stool in which the fat is measured; if maldigestion and/or malabsorption exist because of pancreatic insufficiency or diseases of the lining of the small intestine (for example, celiac disease), the amount of fat in the stool will increase before proteins and starches.
  • Specific tests –  can be done for maldigestion of individual sugars that are commonly maldigested, including lactose (the sugar in milk) and sorbitol (a sweetener in low-calorie foods). The specific tests require ingestion of the sugars followed by hydrogen/methane breath testing. (See below.) The sugar fructose, a commonly used sweetener, like lactose and sorbitol, also may cause abdominal bloating/distention and flatulence. However, the problem that can occur with fructose is different from that with lactose or sorbitol. Thus, as already described, lactose and sorbitol may be poorly digested by the pancreatic enzymes and small intestine. Fructose, on the other hand, maybe digested normally but may pass so rapidly through the small intestine that there is not enough time for digestion and absorption to take place.
  • Hydrogen/methane breath tests – The most convenient way to test for bacterial overgrowth of the small intestine is hydrogen/methane breath testing. Normally, the gas produced by the bacteria of the colon is composed of hydrogen and/or methane. For hydrogen/methane breath testing, a non-digestible sugar, lactulose, is consumed. At regular intervals following ingestion, samples of breath are taken for analysis. When the lactulose reaches the colon, the bacteria form hydrogen and/or methane
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Treatment of Flatulence

  • Nonprescription antigas medications containing simethicone  or bismuth
  • Antiulcerant drug- such as omeprazole, pantoprazole, Esomeprazole
  • Antacid –  to prevent heartburn & bloating or indigestion
  • Domperidone – to assist the digestion easily
  • Pancreative enzyme stimulator to erase the digestion
  • Corticosteroid –  oral tablet to increase metabolism
  • Albendazole – if last 3 month is not taken this medication
  • Take over-the-counter tablets or liquids containing the enzyme lactase before you eat or drink products containing milk.
  • Lactose-reduced dairy products are available in grocery stores.

Home Advice

  • Eating smaller meals – symptoms often improve if the person eats four to six smaller meals each day, rather than three large ones. Peppermint tea may help.
  • Eating slowly – digestion starts in your mouth, so food should be chewed thoroughly before swallowing.
  • Avoiding gum and carbonated drinks – chewing gum makes people swallow more air. This can increase flatulence.
  • Not smoking – smoking causes people to swallow more air, and it can also irritate the digestive system.
  • Choosing a low-lactose dairy product – eliminating foods high in lactose may improve symptoms.
  • Choosing beans that are fermented before cooking –these have less soluble fiber and higher nutritional content and may decrease flatulence.
  • Doing exercise – activity enhances the functioning of the digestive system, and this can help reduce gas and bloating.
  • Charcoal pads – Placed inside clothing, these absorb released gas and reduce the impact of foul-smelling gas. These are available to purchase online.
  • Probiotics – these may reduce symptoms in some people. Probiotic supplements are available to purchase online from different brands.
  • Be aware of foods that cause flatulence – Foods with the fewest complex carbohydrates cause the fewest flatulent consequences. These include fish, meat, grapes, berries, nuts, and eggs. Foods that are highest in complex carbohydrates and produce excess intestinal gas include certain pink beans, soybeans, cabbage, cauliflower, and Brussels sprouts. In some people, prune juice, milk, and milk products can also produce gas.
  • Gradually increase your fiber intake – Eating food rich in fiber is one of the best ways to prevent constipation and ensure soft, bulky stools. If you’re eating less than the recommended 20 to 30 grams of fiber daily, you need to increase your fiber intake. Be prudent, because introducing too much fiber at once may quickly lead to increased flatulence. Eat moderate amounts of fiber-rich foods at first, gradually increasing your intake over a period of time. If specific fiber-rich foods continue to disturb your system, reduce or eliminate them from your diet.
  • Soak beans before cooking  Soaking uncooked beans four to five hours or overnight will remove some of the water-soluble carbohydrates that cause gas. You must discard the soaking water and then cook and simmer the beans slowly, then discard the water once again.
  • Chew food thoroughly – If you gulp it, you swallow harder-to-digest lumps that remain longer in the intestine, where their residue may ferment.
  • Avoid constipation – When you’re constipated, the passage of food through the gastrointestinal tract is slowed, thereby stepping up fermentation. Eat high-fiber foods and drink plenty of fluids.
  • Avoid diet candies containing sorbitol – Read labels carefully. This artificial sweetener is often used in sugarless gums and candies and can cause or contribute to flatulence and diarrhea.
  • Beano may help – Beano is a dietary supplement containing an enzyme that is said to help break down the complex sugars found in high-fiber foods into simple sugars that can be comfortably digested. A few small controlled studies found that it reduces flatulence, but the evidence for its effectiveness is not conclusive and it won’t help everyone.
  • Don’t expect relief from other over-the-counter remedies  Antifoaming agents (such as simethicone), found in some “antacid-antigas” preparations, merely change large gas bubbles into smaller ones—hardly a remedy for flatulence. Bulk-forming laxatives can actually promote the kind of fermented residues that cause the problem in the first place. As for products containing “activated charcoal,” there’s little or no evidence that—contrary to what they claim—they can actually absorb gas in humans; they can, however, interfere with the absorption of birth-control pills and other drugs.
  • Quit smoking  – Smoking increases the amount of air swallowed.
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References

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4893422/
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5350578/

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