Postgraduate Course at DDW: Complete Clinical Updates for Today's Practice

Sun 9_Chang Bloating

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Dr. Lin Chang from UCLA's Division of Digestive Diseases presented at the 2025 AGA-ASGE Postgraduate Course to address the issue of abdominal bloating, a common symptom characterized by the sensation of abdominal inflation or increase in gas, and abdominal distention, the measurable increase in abdominal girth. The course objectives included exploring pathophysiologic mechanisms involved in bloating and distention, as well as discussing diagnostic and management strategies for these conditions.<br /><br />Bloating and distention are conditions reported by about 19.6% of the population, with a formal diagnosis in 3.5% globally. Differential diagnoses for these symptoms include aerophagia, irritable bowel syndrome, functional dyspepsia, celiac disease, SIBO (small intestinal bacterial overgrowth), and other gastrointestinal conditions. <br /><br />The pathophysiology of bloating involves impaired gas transit, hypersensitivity to luminal distension, and increased gas production. Diagnostic algorithms suggest evaluating for constipation, food intolerances, and potential alarm features suggesting structural diseases. Treatment approaches include dietary modifications like a low FODMAP diet, shown to improve symptoms, and addressing underlying motility disorders with prokinetics and central neuromodulators.<br /><br />Small Intestinal Bacterial Overgrowth (SIBO), a potential cause of bloating, can be diagnosed through hydrogen breath testing, and treated with antibiotics such as Rifaximin, particularly effective in IBS-D (Irritable Bowel Syndrome with diarrhea). Central neuromodulators and gut-directed psychotherapies like cognitive behavioral therapy can alleviate symptoms. In cases of abdominophrenic dyssynergia and visceral hypersensitivity, therapies such as diaphragmatic breathing and biofeedback are recommended.<br /><br />Overall, the course underscored the complexity of bloating and highlighted the importance of individualized treatment plans leveraging dietary, therapeutic, and behavioral strategies to improve patient outcomes.

Keywords

abdominal bloating

abdominal distention

digestive diseases

pathophysiology

diagnostic strategies

treatment approaches

small intestinal bacterial overgrowth

irritable bowel syndrome

low FODMAP diet

central neuromodulators