OVERVIEW
Functional bloating is a recurrent subjective sensation of abdominal distension, different from the discomfort of fullness after eating, with or without a measurable increase in abdominal circumference, which is not part of other functional bowel disorders, such as irritable bowel syndrome, or functional gastroduodenal disorders, such as functional dyspepsia. 10% to 30% of the general population can be affected by abdominal bloating, which is common in women regardless of age. It is common in women and is not related to age. It is generally recognized that functional bloating is associated with obesity, aerophagia, gluttony, decreased diaphragm, anterior spinal protrusion, weakened abdominal muscles, and especially mental status, and that it is an intermittent, chronic process.
Etiology
At present, the pathophysiologic mechanism of functional abdominal distension has not been fully elucidated, and it is mainly related to physiologic factors and psychosomatic factors. ① Physiological factors include intestinal gas accumulation, abnormal sensory-dynamic function, food intolerance, fluid retention, weak abdominal wall muscle strength, etc.; ② Psychological factors include depression, insomnia, coping disorders, panic disorders, phobias and so on.
Symptoms
The typical symptom is abdominal distension, which gradually worsens during the day, especially after eating, and decreases at night. It is accompanied by epigastric pain, and the gathering phenomenon of early saturated food retention in the stomach.
Examination
The main test for functional bloating is the physical examination. Physical examination reveals a visible swelling of the abdomen.
Blood tests: routine blood tests, blood electrolytes, liver and kidney functions to rule out other diseases.
Ultrasound of the abdomen, CT if necessary, endoscopy, etc.
Diagnosis
The Rome III diagnostic criteria for functional abdominal distension are as follows: ① recurrent feeling of bloating or abdominal distension visible to the naked eye on at least 3 days per month for 3 months; ② insufficient evidence to diagnose functional dyspepsia, irritable bowel syndrome or other functional gastrointestinal diseases. Symptoms have been present for at least 6 months prior to diagnosis and the above criteria have been met for the last 3 months.
Differential Diagnosis
1. Aerophagia
Patients often have nervousness, emotional instability or depression, the main symptom of digestive tract is belching or hiccups, patients feel comfortable after belching, but actually swallow a large amount of air while belching, so that the epigastric abdomen has a feeling of bloating or fullness. there is no obvious organic lesion in X-ray barium meal or gastroscopy.
2. Chronic atrophic gastritis
Mostly seen in middle-aged patients or above, the main symptoms are vague pain in the epigastrium, abdominal distension, loss of appetite, emaciation, anemia and other symptoms. Gastroscopy and histopathologic examination of mucosal biopsy can establish the diagnosis.
3. Gastroptosis
It occurs in long, thin, powerless body type, elderly people with flaccid abdominal wall, menstruating women or people with chronic wasting disease. Abdominal distension is usually mild in the early morning when waking up, and the symptoms are aggravated in the afternoon and evening after standing for a long time, and may be accompanied by loss of appetite, nausea, belching, weakness of limbs, etc. Barium X-ray examination reveals that the position of the stomach is obviously shifted downward, and the stomach contour is shifted downward below the line of iliac spine on both sides, and the stomach is in the shape of powerlessness, which is conducive to the diagnosis of gastric ptosis.
Treatment
There is no effective preventive and curative measure for this disease.
1. General treatment
Provide health promotion and education to patients, reminding them to pay attention to regular exercise and weight reduction.
2. Dietary adjustment
Avoid consuming gas-producing foods, such as high-sugar foods, beans or milk. If symptoms worsen after consuming daily food, fresh fruits or fruit juices, it suggests lactose or fructose intolerance and further examination or dietary exclusion test is needed.
3. Medication
(1) Probiotics: ① adjust microecological imbalance, prevention and treatment of diarrhea; ② relieve lactose intolerance symptoms, promote nutrient absorption; ③ metabolites can produce biological antagonism, resistance to bacterial and viral infections, enhance the body’s immunity, improve the barrier function of the intestinal tract, alleviate the role of allergies; ④ prevention and treatment of certain diseases, such as intestinal syndrome, respiratory infections, allergies, bad breath, gastric ulcers and so on.
(2) Gastrointestinal prokinetic agents: Gastrointestinal prokinetic agents may have some effect on some patients.
(3) Other drugs: such as pancreatic enzyme preparations, activated charcoal (medicinal charcoal), and surface-active substances may be effective.