Intestinal Gas Related Complaints

The gut contains <200 ml of gas, whereas the daily gas excretion in the average is 600-700 ml after eating a standard diet plus 200 g baked beans. Over 75% of flatulence is due to the bacterial fermentation of recorded nutrients and endogenous glycoproteins in the gut. The intestinal gases containing hydrogen (H2), methane (CH4) and carbon dioxide (CO2). The smell of flatulence correlated with the hydrogen sulfide concentration. Choked air (aerophagia) and the diffusion from blood into the lumen can also lead to flatulence. Gas diffuses between the gut lumen and the blood, the direction depends on the difference of the partial pressures. Therefore, nitrogen is derived (N2) in the intestinal lumen predominantly from the blood stream, while hydrogen comes from the intestinal lumen in the bloodstream. Etiology There are essentially three by intestinal gas related complaint Complex: excessive belching, very strong inflation of the intestine and excessive flatulence, each having a number of causes (see Table: Some causes gas-related complaints). Recurrent wine or crying behavior in children aged 2-4 months had brought with pain attacks in combination, have been attributed to abdominal cramps or gas, and termed "colic". Investigations have, however, can prove no increase in H2 production or mouth-cecum transit time in children with colic. Therefore, the cause of this child's colic is unclear. Pronounced regurgitation regurgitation caused by swallowing air or by eating carbonated beverages. A Aerophagia normally accompanies the eating and drinking process to a small extent, some people unconsciously swallow increased air during the eating process, while smoking or on other occasions, especially when they are anxious or attempting to cause regurgitation. A pronounced salivation increases the Aerophagia and can diseases in various gastrointestinal (z. B. gastroesophageal reflux disease) occur in poorly fitting dental prosthetics, for certain drugs, gum chewing or nausea from any cause. The vast amount of swallowed air is eliminated by belching, only a small amount passes into the small intestine, where the amount is dependent on position. In the standing position, the air is easily herausgerülpst, in a lying position, the air above the gastric fluid is moved into the duodenum. Excessive burping can also be brought about deliberately. Patients who burp after taking antacids, slide the relief of their symptoms to belching and therefore encounter deliberately not to antacids and to their excruciating pain to erleichtern.Aufgeblähtsein bloating may occur in patients on its own or together with other gastrointestinal symptoms with functional disorders (eg. B. aerophagia, Non-Ulcer dyspepsia, gastroparesis, irritable bowel syndrome) or organic disease (for. example, ovarian cancer, colon cancer) can occur. Gastroparesis (and gas) also has many non-functional reasons, the most important is the autonomous visceral neuropathy due to diabetes; other causes include post viral infections, drugs with anticholinergic properties and the long-term use of opiates. However, excessive intestinal gas accumulations do not correlate clearly with these complaints. In the majority of healthy individuals l / h 1 can be infused into the intestine without significant symptoms. Probably many symptoms are mistakenly attributed to "too much gas in the gut." On the other hand, some patients can tolerate with recurrent gastrointestinal symptoms only small amounts of intestinal gas. Retrograde Kolonerweiterung by inflating a balloon or air instillation during a colonoscopy caused in some patients (eg. As with irritable bowel syndrome) severe discomfort, others none at all. In similar form to give patients with eating disorders (anorexia nervosa, bulimia) often discomfort and are particularly affected by the symptom of inflation of being. Therefore, the basic fault could be the existence of a sensitive intestine with intestinal gas-related symptoms in patients. An altered motility, the symptoms verstärken.Exzessive flatulence amount and frequency of bowel gas delivery are highly variable. Just as in the assessment of stool frequency, people who complain of flatulence, often a misconception of what is normal. The average discharge of intestinal gas is limited to about 13 to 21 events / day. An objective determination of the frequency of bowel gas discharge (using a diary) is a first step in elucidating. The "slider" (crowded elevator type), which is released slowly and noiselessly: essay about flatulence (first published in the 14th edition of the MSD Manual) bloating, which can cause major psychosocial stressors, their outstanding properties are described unofficially accordingly is, sometimes with devastating effects the open sphincter or "pooh" type, which supposedly has a higher temperature and aromatic the staccato or drumbeat type, has pleasantly exceeded the privacy of the "barking" type (in a personal message described) characterized by a sharp energetic eruption, which effectively interrupt the conversation t (and often ends) aromaticity is not a prominent feature. Rarely this has onerous symptom is wrong in general into an advantage, so called "Le Petomane" as a Frenchman, who became wealthy as flatulist who brought on stage at the Moulin Rouge with the gas from his gut melodies hearing , Flatus is a metabolic byproduct of the intestinal bacterial flora, it has its origin in of swallowed air or in the back diffusion of gases (v. A., Nitrogen) from the blood stream. The bacterial metabolism leads to significant amounts of hydrogen, Metha and carbon dioxide. Hydrogen is contained in large amounts in patients with malabsorption syndrome after ingestion of certain fruits and vegetables, the non-digestible carbohydrates (beans) and sugars (for. Example, fructose) or sugar alcohols (eg., Sorbitol), is formed. In patients with Disaccharidasemangel (mostly lactase deficiency) get large amounts of disaccharides into the colon where they are fermented to hydrogen. Celiac disease, tropical sprue, and pancreatic insufficiency as well as other causes of carbohydrate malabsorption must also be considered in cases of excessive gas formation in the colon. Methane is also produced by bacterial decomposition of the same foods (eg. As dietary fiber) in the colon. However, have about 10% of people bacteria which produce methane, but not hydrogen. Carbondioxid is also formed in the reaction of bicarbonate and hydrogen ions. Hydrogen ions derived from the hydrochloric acid of the stomach or of fatty acids that are formed during fat digestion - the latter sometimes form several hundred mEq of hydrogen ions. The acidic products formed by bacterial decomposition of unabsorbed carbohydrates in the colon to produce carbon dioxide by reaction with bicarbonate. Although flatulence may occur occasionally, the rapid diffusion of carbon dioxide prevented a stronger intestine expansion into the blood normally. The composition of the diet is mainly responsible for the different expression of flatus in different individuals. However (as such. Differences in colonic flora and motility) may also still unknown factors play a role. Although hydrogen and methane are flammable, it is not dangerous to work near open flames. Gas explosions, including fatalities, have been described, however, for operations on small and large intestine and at colonoscopy if diathermy was used during the tests and the patients have experienced only an inadequate bowel cleansing. Some causes gas-related symptoms cause suspicious findings diagnostic approach belching aerophagia (swallowing air) Deliberate or unconscious swallowing of air Sometimes in patients who smoke or excessive gum chewing Sometimes in patients esophageal reflux or ill-fitting dentures have clinical evaluation gas of carbonated drinks beverage consumption mostly off Obviously, based on history Clinical evaluation Voluntary Returns patient to a rule when you aim asked Clinical evaluation bloating or flatulence Aerophagia See belching Clinical evaluation irritable bowel syndrome Chronic, recurrent bloating or fullness, associated with a change in stool frequency or consistency No alarming findings beginning Type Clinical ischerweise with teens and 20-somethings clarification stool examination blood tests gastroparesis nausea, abdominal pain, possibly vomiting Early satiety Sometimes in patients who have a known causative disease endoscopy of the upper digestive tract and / or nuclear medical diagnostics for assessing gastric emptying eating disorders Long-standing symptoms in patients which are thin, but still have great fear of obesity, especially young women Clinical evaluation Constipation when chronically A long history of hard, infrequent stools Clinical evaluation Nichtgastrointestinale disorders (eg. B. ovarian or colon cancer) New aufgetrene, persistent bloating middle-aged or older patients for colon cancer, possibly blood (in the stool blood can be visible or detected during a medical examination) for ovarian cancer, pelvic sonography for colon cancer, colonoscopy flatus food ingredients, including beans, dairy products, vegetables, onions, celery, carrots, Brussels sprouts, fruits (z. B. raisins, bananas, apricots, prune juice) and complex carbohydrates (eg. as pretzels, bagels, wheat germ oil) symptoms that are develop especially after the consumption of foods that can cause gas Clinical Abklä tion elimination attempt Disaccharidasemangel bloating, cramping and diarrhea after eating dairy products breath tests celiac disease (tropical sprue) anemia signs, steatorrhea, loss of appetite, diarrhea for celiac disease, weakness, symptoms often begin in childhood for sprue, nausea, abdominal cramps, weight loss blood tests small intestine biopsy pancreatic insufficiency diarrhea, steatorrhea Normally history of pancreatic diseases abdominal CT if necessary MRCP, endoscopic ultrasound or ERCP MRCP = magnetic resonance cholangiopancreatography. Clarification history in patients with regurgitation the history of existing disease should be directed at elucidating the cause of Aerophagia, especially on nutrition-related causes. In patients who complain of gas, bloating or flatus, the relationship between symptoms and meals (time and type and amount of food), bowel movements and loading should be investigated. Certain patients, especially in acute situations, use the term "gas" to describe their symptoms of coronary ischemia. Changes in frequency, color and consistency of the chair should be consulted. A weight loss in the history is recorded. Review of systems should seek symptoms of possible causes, including diarrhea and steatorrhea (malabsorption syndromes such as sprue. Sprue, disaccharidase deficiency and pancreatic insufficiency) and weight loss (cancer, chronic malabsorption). Medical history should check all components of the diet for possible causes (see Table: Some causes gas-related complaints) .Körperliche investigation generally takes place a normal investigation limited to patients with bloating or flatus or sign of an underlying organic disorder but an abdominal, rectal and ( werden.Warnhinweise performed gynecological examination in women) the following findings are worrying: weight loss blood (in the stool occult or macroscopic) "gas" feeling in the chest interpretation of the findings bloating or chronic, recurrent bloating, which relieved by defecation and are associated with changes in the frequency or consistency of stool, but without alarming findings can suspect an irritable bowel syndrome. Long-standing symptoms in an otherwise unremarkable young patients without weight loss are probably not caused by a more serious physiological disease, although one always should think about an eating disorder, v. a. at young women. Bloating, accompanied by diarrhea, weight loss, or both (or just after the intake of certain foods), create a malabsorption syndrome nahe.Testverfahren In belching are testing procedure not indicated unless other symptoms suggest a particular disorder. A study on carbohydrate intolerance (eg., Lactose, fructose) with breath tests should be considered, especially if the history suggests a significant consumption of these sugars. A test for bacterial overgrowth in the small intestine should also be considered, particularly in patients who also exhibit diarrhea, weight loss, or both. This is preferably done by aerobic and anaerobic cultures of Dünndarmaspiraten that were obtained during endoscopy of the upper gastrointestinal tract. A study on bacterial overgrowth with hydrogen breath test, usually glucose hydrogen breath test is prone to false positives (i. E. With fast passage) and false negatives (d. E., There are no H2-producing bacteria) results. New onset, persistent bloating in women of middle or older age (or in those with an abnormal gynecological examination findings) require a pelvic ultrasound to rule out ovarian cancer. Therapy belching and distention are difficult to eliminate because they are generally governed by unconscious air swallowing or increased sensitivity to normal amounts of gas. Aerophagie can be reduced by dispensing with chewing gum and carbonated beverages, by cognitive behavioral therapy techniques for preventing the Lufschluckens and the treatment of associated diseases of the upper gastrointestinal tract (eg. B. gastric ulcer). Foods containing nonabsorbable carbohydrates should also be avoided. Patients with lactose intolerance tolerate usually up to one glass of milk, which is drunk in small increments throughout the day. The process of repeatedly Aufstoßens must be described to the patient and demonstrated. When the air swallowing is disturbing behavioral therapy to promote diaphragmatic breathing with an open mouth and avoid excessive swallowing can be effective. Drugs offer little advantage. Results with simethicone, a substance that small gas bubbles destroyed and various anticholinergic drugs are unsatisfactory. Some patients with dyspepsia and postprandial upper abdominal fullness benefit from antacids, a low dose of antidepressants (eg. As nortriptyline 10-50 mg po once daily.) Or both, to reduce visceral hypersensitivity. The symptoms of pronounced flatus be treated by avoiding the triggering substances (see table: Some causes gas-related complaints). Indigestible substances in food (eg. As bran, psyllium) are added to the diet in order to accelerate the Kolonpassage, but may appear in some patients cause a worsening of symptoms. Activated carbon sometimes reduces the amount of gas and unpleasant odor, but it makes stains on the clothes and colors the oral mucosa. With activated carbon treated underwear is available. Probiotics (z. B. VSL # 3) can also in a reduction of bloating and flatulence contribute by modulation of the intestinal flora. Antibiotics are useful in patients with documented bacterial overgrowth. Functional burping, distension and flatulence manifest chronically in patients and this can only be restricted improved by therapy. When appropriate, it should be the patient assured again and again that these problems are not harmful to his health. Key points The test methods are based on the clinical signs. Particular caution is required regarding newly occurring, persistent symptoms in the elderly.

Health Life Media Team

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