Making Sense of Patients with Gas and Bloating of Undetermined Origin

Juan Castro-Combs, MD1 Evelyn Eichler MS, RD, LD2 Richard W. McCallum, MD, FACP, FRACP (Aust), FACG3 1Texas Tech University Health and Sciences, Internal Medicine Department, Gastroenterology 2University Medical Center, Food and Nutrition Care Services 3Texas Tech University Health and Sciences, Department of Internal Medicine, Gastroenterology, Center for Neurogastroenterology and GI Motility, El Paso, TX Unexplained bloating is one of the most common and bothersome gastroenterology complaints in gastrointestinal (GI) specialty and primary care clinics. Abdominal bloating is likely to present in association with other complaints including belching, flatulence, post-prandial distension, borborygmi, abdominal pain and diarrhea. Given the lack of a systematic approach to these complaints, symptomatic patients are often asked to keep a food diary and dietary modifications are suggested. If symptom resolution does not occur, further testing (blood and stool tests, imaging studies, endoscopic procedures) to rule out organic disorders is initiated. A “negative” or unremarkable work up often places patients into the “functional” GI disorder compartment. This article attempts to provide physicians with a simple and rational approach to unexplained abdominal bloating and to identify underdiagnosed entities that could be responsible for this symptom.