Distended. How to investigate and manage bloating

Bloating is a sensation of increased abdominal pressure with or without visible abdominal distention.  Feeling distended is common. It affects 16% to 19% of people. Only half the people that complain of bloating actually have abdominal distention when examined by a doctor.

What causes bloating

  • Aerophagia. This is excessive air swallowing. Aerophagia can be caused by fast eating, carbonated drinks, poorly fitting dentures, CPAP mask, and psychological disorders.
  • Gastroparesis. This is a stomach that is slow to empty.
  • Functional dyspepsia.
  • Gastrointestinal blockage.
  • Chronic constipation.
  • Irritable bowel syndrome.
  • Celiac disease.
  • Small intestinal bacterial overgrowth.
  • Inflammatory bowel disease (ulcerative colitis, crohn’s disease).
  • Certain foods.
  • Medications.
  • Pseudo-bloat or false bloat caused by ascites (fluid in the abdomen), abdominal fat, or pregnancy.

How to investigate bloating

  • Careful history and physical examination by your doctor.
  • Complete blood count.
  • Complete metabolic panel.
  • Blood sugar and hemoglobin A1C to test for diabetes mellitus.
  • Thyroid function tests.
  • Celiac serologies to test for celiac disease.
  • Helicobacter pylori testing.
  • Abdominal imaging studies like ultrasound and CT scan.
  • Upper endoscopy. Also known as esophagogastroduodenoscopy (EGD).
  • Gastric emptying study.
  • Smart pill motility study.
  • Hydrogen breath test.
  • Colonoscopy.
  • Enterography.
  • Anorectal manometry.
  • Tests are usually selected based on your history and examination. You do not necessarily need all of these tests.


How to treat bloating 

Since bloating is caused by several conditions, treatment is usually specific to the cause of the problem.

  • Avoid foods that are high in fermentable carbohydrates like wheat, beans, apples, pears, watermelon, onions, garlic, broccoli, artichokes, cauliflower, cabbage.
  • Stay away from high fiber diets.
  • Avoid carbonated drinks.
  • Stay away from chewing gums.
  • Eat slowly.
  • Properly fit your dentures and CPAP mask.
  • Try the Belly Bio App. 
  • See a gastroenterologist.


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