Notes by dr. Claudio Italiano
Did you eat foods that generate gas, onions, potatoes? Sweetened sugary drinks?
Are you suffering from constipation and you have abdominal colic, you expel
intestinal gas badly smelling and you have the abdomen always swollen? Then you
have to read this article and correct your mistakes, keep the regular hounds. It
is clear that you have to contact your doctor, because behind a colonic there is
often a bigger pitfall, for example a lesion of the intestine or other organs of
the digestive tube that can hinder intestinal function, slow down the movement
of the viscera and generate gas.
- objective: presence of gas in pathologically increased quantities in the gastrointestinal tract
- subjective: abdominal discomfort in terms of "feeling full" or "feeling
bloated". Most patients who feel swollen do not have an increased amount of gas
in the intestine; their disorders are often an expression of irritable bowel
syndrome. Normal content of gas in the intestine: up to 150 ml.
2 Eruption and aerophagia
A pathological increase in the amount of swallowed air is the consequence of an increased frequency of swallowing and / or an increased will of gas swallowed with each swallowing. Increasing the amount of air in the stomach causes belching. The lying position and fundoplication interventions make the eructation more difficult (the left lateral decubitus and the decubitus in the sitting position instead facilitate it).
3 Flatulence:
its daily frequency varies from individual to individual and is
strongly dependent on diet. An increase in intestinal gas emissions from the
anus> 24 / day is pathological. The daily emission of gas varies from 0.5 to 2 l.
1. Meteorism, along with abdominal pain and constipation, is the most frequently
complained abdominal disorder. Some patients do not speak spontaneously of this
type of disorder, but report to the doctor to suffer from colic and intestinal
pain. Let us remember that gaseous colics are often the cause of abdominal pain
and pain in the middle abdomen.
1. Air swallowed: every time a person swallows it introduces 2-3 ml of air into
the stomach. With deep inhalation, 1-2 ml can be reached. Even foods contain
air. 2-3 liters of air per day usually arrive in the stomach. The transit time
from the stomach to the anus is on average 35 min
2. CO2 derives from carbonated soft drinks and the neutralization of HCl and
fatty acids by bicarbonate produced by digestive glands. The C02 is reabsorbed
into the small intestine and eliminated through the lungs; other CO2 is produced
by colon bacteria, by enzymatic digestion of carbohydrates. The quantity of gas
produced in this way depends on the quantity of ingested carbohydrates reaching
the colon (in particular cellulose and fibrous substances) and on the quality of
the foods consumed: fiber-rich foods, wholemeal bread, muesli, fruit, vegetables,
legumes and onions increased formation of gas in the colon by bacterial
fermentation. The ability to split lactose and fructose has a wide
inter-individual variability. In case of lactase deficiency, the undigested
lactose reaches the colon and leads to the formation of C02 and lactic acid, and
evtl. at diarrhea. Sorbitol (present in fruit, diabetic diet foods, chewing gum)
is reabsorbed in small part and causes the formation of gas in the colon.
Carbohydrates in the colon are metabolized, thanks to the anaerobes, to short
chain fatty acids, H2 and C02. Substrate availability and bacterial flora
composition determine the amount of H2 and C02 in the individual.
Quantity of the 5 main odorless gases, which represent 99% of the volume of
gastrointestinal gases:
30-50% of the population has anaerobes in the colon that can form methane from
H2 and C02. The unpleasant odor of any intestinal gas is determined by the
presence of traces of H2S, NH3, indole, box, volatile fatty acids (eg butyric
acid, propionic acid) resulting from the bacterial fermentation of unabsorbed
protein products.
1. Acute magnetism: paralytic and mechanical ileus
2.a) aerophagia
- neurotic behavioral disorder (more frequent)
- emotional stress, fear
- increased salivation, e.g. from consumption of chewing gum
- dry mouth
- incorrect eating habits: too hasty intake of food and drink, excessive
consumption of carbonated drinks
- tracheostomy
- after narcosis with intubation and abdominal operations
b) increased intestinal gas formation
- increased availability of substrates for intestinal bacterial flora:
- intake of undigested or non-absorbed carbohydrates: cellulose, raffinose,
lactose, sorbitol
- intake of carbohydrates with limited absorption (lactose, fructose)
- alternative supply
- gluten enteropathy
- lactase deficiency
- exocrine pancreatic insufficiency (malodorous odor from latiti acids)
- accelerated transit in the small intestine
- bacterial hypercrescita (blind loop syndrome, stenosis of the intestines :.
- Giardia lamblia infection
- increased C02 formation in the duodenum
c) reduced absorption of gas and consumption of H2 by the intestinal flora
- portal hypertension
- insufficiency of the right heart
- intestinal atony
- antibiotic treatment
d) disorders of gastrointestinal motility - irritable bowel syndrome (more
frequent)
- gastric paresis, intestinal paresis
e) rare causes: e.g. pneumatosis cystoides intestinalis (radiological study of
the intestine / colonoscopy: cysts containing H2 along the colon's course, test
of H2 positive breath).
- feeling of suppleness and swelling; feeling of tight clothes
- presence of borborigmi
- tension or pain in the right or left hypochondrium (hepatic or splenic
flexure syndrome)
-frequent eructations
-flatulence
- Roemheld syndrome: functional cardiac disorders triggered by meteorism in the
upper abdomen and evtl. superelevation of the diaphragm.
• cardio-respiratory oppression
• evtl. heart rhythm disorders
• evtl. anginal disorders.
- belching during: pyloric stenosis, gallbladder disease, uremia
- in case of pain in the left or right hypochondrium: exclusion of diseases of
the colon, kidneys; right hypochondrium: liver, gallbladder, duodenum; left
hypochondrium, stomach, spleen.
- History: predisposing diseases, eating habits, pharmacological history,
duration of disorders, evtl. demonstration of irritable bowel syndrome, etc.
- Objective examination: documentation of meteorism for inspection, palpation,
percussion (visit of the gastroenterological patient)
- Stool examination, occult blood research, general laboratory screening
- Ultrasound
- Evtl. radiological study of the abdomen without contrast medium (to be
performed in case of acute meteorism, also allows to visualize the air taken
head)
- Specific investigations to exclude organic diseases: e.g. gastroscopy to rule
out a carcinoma of the stomach or other gastric diseases), colonoscopy (exclusion
of a colon carcinoma, a chronic inflammatory bowel disease, etc.), H2-lactose
breath test (exclusion of a lactase deficiency), evtl. diagnostic investigations
for the study of the small intestine and pancreas, evtl. microbiological
investigations of faeces.
1. Causal therapy of chronic meteorism
- elimination of an evtl. obstacle to intestinal transit
- therapy of lambliasis, blind loop syndrome
- gluten-free foods in case of gluten enteropathy
- lactose-free foods in case of lactase deficiency
- intake of enzymes in exocrine pancreatic insufficiency
- reduction of the intake of non-digestible carbohydrates (eg, raffinose in
legumes) or not reabsorbed or only partially reabsorbed (lactose, fructose,
lactulose, sorbitol)
- avoid or use cautiously medicines that can cause flatulence (eg lactulose as a
laxative, acarbose in diabetes therapy)
- reconstitution of intestinal flora destroyed after antibiotic therapy.
The therapeutic results in irritable bowel syndrome are unsatisfactory.
- diet: avoiding foods that facilitate meteorism (cf. meteoric diet) and
carbonated drinks; eat and drink slowly and calmly; small and frequent meals,
possibly speaking little while eating; digestive walk (movement) after lunch
- in case of cramps from intestinal spasms (often with pains in the colonic
flexure) administration of fennel carminatives, cumin, etc., and evtl. local
application of heat, see treatment with plants in the irritable colon).
- in the treatment of chronic meteorism, surface-acting substances (eg
dimethicone) have not proven effective
- in case of particularly intense pains, evtl. short-term administration of
spasmolytics (spasmolytics slow down intestinal transit and may therefore
trigger new disorders)
- psychosomatic support, e.g. in aerofagia with frequent belching.
see index of gastroenterology