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

Sun_9 Chang Bloating

Pdf Summary

Dr. Lin Chang from the David Geffen School of Medicine at UCLA presented at the 2025 AGA-ASGE Postgraduate Course on addressing abdominal bloating and distension. These conditions can be experienced both subjectively and objectively, wherein bloating refers to a sensation of inflation and flatulence, while distention involves measurable increases in abdominal girth. They are common symptoms with a worldwide prevalence of 3.5%, affecting women more than men. <br /><br />Pathophysiological mechanisms behind these symptoms include impaired gas transit, heightened sensitivity to gut distension, overproduction of intestinal gas, and conditions like small intestine bacterial overgrowth (SIBO). <br /><br />A comprehensive diagnostic approach entails addressing possible underlying causes such as aerophagia, dietary factors, or conditions like irritable bowel syndrome (IBS) and gastroparesis. The diagnostic protocol includes examining factors like constipation, food intolerances, alarm features suggesting structural diseases, and SIBO. <br /><br />For treatments, modifying the diet—particularly using a low FODMAP diet—can significantly improve symptoms. Medical interventions may include using medications like secretagogues and 5HT4 agonists to target bloating and gas, especially in the context of IBS-C and chronic idiopathic constipation. Rifaximin has shown effectiveness in reducing bloating in IBS-D.<br /><br />Central neuromodulators, such as tricyclic antidepressants, and gut-directed psychotherapies—like cognitive behavioral therapy—offer additional treatment avenues by targeting brain-gut interactions, focusing on reducing symptom severity through psychological support.<br /><br />The presentation highlighted that abdominal distension can also result from factors such as diaphragmatic descent and abdominal wall relaxation, which can be managed with targeted therapies such as thoracoabdominal exercises and anorectal biofeedback.<br /><br />Overall, the talk emphasized a careful examination and tailored treatment protocols for bloating and distension, considering various contributing factors and utilizing dietary, pharmacological, and psychological interventions to alleviate symptoms efficiently.

Keywords

abdominal bloating

abdominal distension

Dr. Lin Chang

AGA-ASGE Postgraduate Course

small intestine bacterial overgrowth

low FODMAP diet

irritable bowel syndrome

central neuromodulators

thoracoabdominal exercises

anorectal biofeedback