Gas in the Digestive Tract

What is gas in the digestive tract?

Gas in the digestive tract is created from:

Everyone has gas. It may be uncomfortable and embarrassing, but it is not life-threatening. Gas is eliminated by burping or passing it through the rectum. Most people produce about 1 to 4 pints of gas a day and pass gas about 14 times a day.

Most gas is made up of odorless vapors–carbon dioxide, oxygen, nitrogen, hydrogen, and sometimes methane. Bacteria in the large intestine release gases that contain sulfur and produce an unpleasant odor of flatulence.

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What causes gas in the digestive tract?

Gas in the digestive tract comes from two sources:

• Aerophagia (air swallowing). This is usually caused by eating or drinking rapidly, chewing gum, smoking, or wearing loose dentures.

  Belching is the way most swallowed air leaves the stomach. The remaining gas is partially absorbed into the small intestine and a small amount goes into the large intestine and is released through the rectum.

• Breakdown of certain undigested foods by harmless bacteria naturally present in the large intestine (colon)

  Some carbohydrates (sugar, starches, and fiber) are not digested or absorbed in the small intestine because of a shortage or absence of certain enzymes. The undigested or unabsorbed food then passes into the large intestine, where harmless and normal bacteria break down the food. This process produces hydrogen, carbon dioxide, and, in about one-third of all people, methane gases, which are released through the rectum.

Foods that commonly cause gas

According to the National Institute of Diabetes and Digestive and Kidney Diseases, most foods that contain carbohydrates can cause gas, however, fats and proteins cause little gas. Foods that cause gas include the following: Raffinose. A complex sugar found in beans, cabbage, Brussels sprouts, broccoli, asparagus, other vegetables, and whole grains. Lactose. A natural sugar found in milk and milk products, such as cheese, ice cream, and processed foods, such as bread, cereal, and salad dressing. Gas after eating these foods may mean you have lactose intolerance. Fructose. A sugar found in onions, artichokes, pears, and wheat. Fructose is also used as a sweetener in some soft drinks and fruit drinks. Sorbitol. A sugar found naturally in fruits, including apples, pears, peaches, and prunes. Sorbitol is also used as an artificial sweetener in many dietetic foods and sugar-free candies and gums. Starches. Most starches, including potatoes, corn, noodles, and wheat produce gas as they are broken down in the large intestine. (Rice is the only starch that does not cause gas.) Soluble fiber. Fiber that dissolves easily in water and takes on a soft, gel-like texture in the intestines; is found in oat bran, beans, peas, and most fruits. Insoluble fiber. Fiber, such as that found in wheat bran and some vegetables, which passes essentially unchanged through the intestines and produces little gas.

What are the symptoms of gas?

Chronic symptoms caused by too much gas or by a serious disease are rare. The following are the most common symptoms of gas. However, each individual may experience symptoms differently. Symptoms may include:

• Belching. Belching during or after meals is normal, but people who belch frequently may be swallowing too much air and releasing it before the air enters the stomach.

  Chronic belching may also indicate an upper GI disorder, such as peptic ulcer disease, gastroesophageal reflux disease (GERD), or gastritis.

  According to the NIDDK, rare, chronic gas syndromes associated with belching include the following:

  • Meganblase syndrome. Meganblase syndrome causes chronic belching. It is characterized by severe air swallowing and an enlarged bubble of gas in the stomach following heavy meals. Fullness and shortness of breath caused by this disorder may mimic a heart attack.

  • Gas-bloat syndrome. Gas-bloat syndrome may occur after surgery to correct GERD. The surgery creates a one-way valve between the esophagus and stomach that allows food and gas to enter the stomach.

• Flatulence. Passing gas through the rectum is called flatulence. Passing gas 14 to 23 times a day is considered normal.

• Abdominal bloating. Bloating is usually the result of an intestinal motility disorder, such as irritable bowel syndrome (IBS). Motility disorders are characterized by abnormal movements and contractions of intestinal muscles. These disorders may give a false sensation of bloating because of an increased sensitivity to gas.

  • Splenic-flexure syndrome is a chronic disorder that may be caused by gas trapped at bends (flexures) in the colon.

  • Crohn’s disease, colon cancer, or any disease that causes intestinal obstruction, may also cause abdominal bloating.

  • Internal hernias or adhesions (scar tissue) from surgery may cause bloating or pain.

  • Fatty foods can delay stomach emptying and cause bloating and discomfort, but not necessarily too much gas.

• Abdominal pain and discomfort. Gas in the intestine causes pain for some people. When it collects on the left side of the colon, the pain can be confused with heart disease. When it collects on the right side of the colon, the pain may feel like the pain associated with gallstones or appendicitis.

The symptoms of gas may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

How is gas in the digestive tract diagnosed?

Symptoms of gas may be caused by a serious disorder, which should be determined. In addition to a complete medical history and physical examination, your doctor may suggest the following activities to assist in the diagnosis:

• Abdominal X-ray

• Food diary. You may be asked to keep a diary of foods and beverages consumed for a specific time period, and/or to count the number of times you pass gas during the day.

• Colonoscopy. For people 50 years of age and older, and for those with a family history, the possibility of colorectal cancer is considered. Colonoscopy is a procedure that allows the doctor to view the entire length of the large intestine, and can often help identify abnormal growths, inflamed tissue, ulcers, and bleeding. It involves inserting a colonoscope, a long, flexible, lighted tube, in through the rectum up into the colon. The colonoscope allows the doctor to see the lining of the colon, remove tissue for further examination, and possibly treat some problems that are discovered.

• Sigmoidoscopy. A sigmoidoscopy is a diagnostic procedure that allows the doctor to examine the inside of a portion of the large intestine, and is helpful in identifying the causes of diarrhea, abdominal pain, constipation, abnormal growths, and bleeding. A short, flexible, lighted tube, called a sigmoidoscope, is inserted into the intestine through the rectum. The scope blows air into the intestine to inflate it and make viewing the inside easier.

• Upper GI (gastrointestinal) series (also called barium swallow). For chronic belching, your doctor will look for signs or causes of excessive air swallowing and may request an upper GI series. An upper GI series is a diagnostic test that examines the organs of the upper part of the digestive system: the esophagus, stomach, and duodenum (the first section of the small intestine). A fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an X-ray) is swallowed. X-rays are then taken to evaluate the digestive organs.

Treatment for gas in the digestive tract

Specific treatment for gas in the digestive tract will be determined by your doctor based on:

• Your age, overall health, and medical history

• Extent of the condition

• Your tolerance for specific medications, procedures, or therapies

• Expectations for the course of the condition

• Your opinion or preference

Preventing gas in the digestive tract

The most common ways to reduce the discomfort of gas include the following:

Gas – flatulence Information | Mount Sinai

Flatulence; Flatus

Gas is air in the intestine that is passed through the rectum. Air that moves from the digestive tract through the mouth is called belching.

Gas is also called flatus or flatulence.

Gas is formed in the intestines by the action of bacteria as food is being digested. Gas is also called flatus or flatulence, and is passed through the intestine and out the body through the rectum.

Considerations

Gas is normally formed in the intestines as your body digests food.

Gas can make you feel bloated. It can cause crampy or colicky pains in your belly.

Causes

Gas can be caused by certain foods you eat. You may have gas if you:

• Eat foods that are hard to digest, such as fiber. Sometimes, adding more fiber into your diet can cause temporary gas. Your body may adjust and stop producing gas over time.
• Eat or drink something your body cannot tolerate. For example, some people have lactose intolerance and cannot eat or drink dairy products.

Other common causes of gas are:

• Antibiotics
• Irritable bowel syndrome
• Inability to absorb nutrients properly (malabsorption)
• Inability to digest nutrients properly (maldigestion)
• Swallowing air while eating
• Chewing gum
• Smoking cigarettes
• Drinking carbonated beverages
• Talking while eating and eating too rapidly

Home Care

The following tips may help you prevent gas:

• Chew your food more thoroughly.
• Do not eat beans or cabbage.
• Avoid foods high in poorly digestible carbohydrates. These are called FODMAPs and include fructose (fruit sugar).
• Avoid lactose.
• Do not drink carbonated drinks.
• Do not chew gum.
• Eat more slowly.
• Relax while you eat.
• Walk for 10 to 15 minutes after eating.

When to Contact a Medical Professional

Contact your health care provider if you have:

• Gas and other symptoms such as stomach pain, rectal pain, heartburn, nausea, vomiting, diarrhea, constipation, fever, or weight loss
• Oily, foul-smelling, or bloody stools

What to Expect at Your Office Visit

Your provider will perform a physical exam and ask questions about your medical history and symptoms, such as:

• What foods do you commonly eat?
• Has your diet changed recently?
• Have you increased the fiber in your diet?
• How fast do you eat, chew, and swallow?
• Would you say that your gas is mild or severe?
• Does your gas seem to be related to eating milk products or other specific foods?
• What seems to make your gas better?
• What medicines do you take?
• Do you have other symptoms, like abdominal pain, diarrhea, early satiety (premature fullness after meals), bloating, or weight loss?
• Do you chew artificially sweetened gum or eat artificially sweetened candy? (These frequently contain indigestible sugars that can lead to production of gas. )

Tests that may be done include:

• Abdominal CT scan
• Abdominal ultrasound
• Barium enema x-ray
• Barium swallow x-ray
• Blood work such as CBC or blood differential
• Sigmoidoscopy
• Upper endoscopy (EGD)
• Breath test

Azpiroz F. Intestinal gas. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 17.

Hall JE, Hall ME. Physiology of gastrointestinal disorders. In: Hall JE, Hall ME, eds. Guyton and Hall Textbook of Medical Physiology. 14th ed. Philadelphia, PA: Elsevier; 2021:chap 67.

McQuaid KR. Approach to the patient with gastrointestinal disease. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 123.

Last reviewed on: 5/4/2022

Reviewed by: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Flatulence

Hemorrhoids

Esophageal hernia

Gastroesophageal reflux

Irritable bowel syndrome

Diverticulitis

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February 26

Flatulence – the causes of occurrence, in which diseases it occurs, diagnosis and methods of treatment.

Excessive gas formation in the gastrointestinal tract leads to severe discomfort, especially if it is impossible to hold gases. Gaseous substances that fill the lumen of the stomach and intestines include hydrogen, methane, hydrogen sulfide and carbon dioxide. Together with food, air can enter the stomach, but mostly gases are a waste product of microorganisms, and also arise as a result of the interaction of hydrochloric acid of the stomach with bicarbonate coming from the pancreas. Increased gas formation is accompanied by bloating, a feeling of fullness and pain. This phenomenon is called flatulence.

In some cases, spastic conditions of the gastrointestinal tract interfere with the passage of gases, and sometimes a person cannot control this process even with a slight content of gases in the intestines.

Varieties of flatulence

Flatulence occurs with increased processes of gas formation and deterioration of intestinal motility.

Excess gas is removed from the stomach by eructations , from the intestines – through the rectum . In addition, gases can enter the bloodstream and be released with exhaled air. Gases formed in the intestines are absorbed only in the small intestine, where their bubbles are mixed with liquid contents. In the large intestine, gases are not absorbed into the blood due to the high density of feces, so the only way out for them is through the rectum, which occurs on average 15-20 times a day. Participating in the regulation of the intestines, gases have a different effect on its function: methane slows down the passage of feces and contributes to the development of constipation, hydrogen reduces the motility of the ileum, but promotes the promotion of contents in the final sections of the colon.

Possible causes of increased gas production and incontinence

The reasons for the development of flatulence may be associated with: 1) dietary habits; 2) indigestion; 3) imbalance in the composition of the intestinal microflora; 4) impaired intestinal motility. Overfilling with gases of the stomach leads to belching, which often bothers patients with incomplete closure of the cardiac sphincter in hiatal hernia, gastroesophageal reflux disease 0018 .

In addition, impaired motility of the gastrointestinal tract in gastric ulcer, biliary dyskinesia, and some intestinal diseases is also accompanied by rapid belching, sometimes even with regurgitation. With the development of putrefactive processes in the stomach with gastroparesis belching may have an unpleasant odor.

However, often belching is not a symptom of the disease, but an indicator of malnutrition.

For example, when eating food hastily, a person can swallow a large amount of air. Also, excess gas in the stomach occurs after drinking carbonated drinks.

If gases fill the intestines, there is a feeling of bloating.

It can occur due to an excessive content of gaseous substances, and be subjective due to the increased sensitivity of the intestinal mucosa.

Often this symptom occurs in functional disorders: irritable bowel syndrome, diseases of the pancreas accompanied by enzymatic deficiency, reproduction of pathological microflora. An increased formation of gases occurs when a large amount of legumes, cabbage, onions, carrots, raisins, bananas, apples, grapes, yeast dough products are consumed. Evidence of functional disorders is the appearance of swelling some time after eating. In the morning, before breakfast, this sensation is absent.

An unpleasant symptom is gas incontinence, which is possible even with their slight accumulation in the intestine. Such a problem may occur in patients with cracks and fistulas in the anus.

Gas incontinence is also a concern for patients with anal sphincter insufficiency. As a rule, this condition accompanies other types of pathology – hemorrhoids, prolapse of the rectum. Sometimes insufficiency of the internal anal sphincter can be the result of neurological disorders, surgical interventions or injuries, accompanied by the formation of scars and strictures.

The sphincter muscles weaken with age, which is why the problem of gas incontinence is more common in older people.

With intestinal diverticula – sac-like protrusions of the mucous membrane and submucosa of the intestine – bloating and profuse discharge of gases are almost always noted.

In addition, there are feelings of fullness and heaviness in the abdomen, pain in the left iliac region and irregular, spastic stools (“sheep”). Often there is rumbling in the abdomen and rapid discharge of gases with an unpleasant odor.

In women, uncontrolled gas discharge develops in the last months of pregnancy, after childbirth due to pelvic floor dysfunction. The same problem occurs in one third of patients with prolapse and prolapse of the uterus and in a small percentage of cases with pathological lengthening of the cervix.

Gas incontinence occurs with lesions of the central nervous system due to injuries of the spine and head, and in this case it is accompanied by uncontrolled fecal and urination. With an epileptic seizure in the relaxation phase, urine, gases and feces can also occur. Gas control is lost at mental disorders (manic-depressive syndrome, dementia) and psycho-emotional stress.

Which doctors should I contact?

The problem of increased gas formation and uncontrolled discharge of gases can occur under different conditions of the body. In any case, you should visit
primary care physician. If the symptoms of flatulence bother a woman during pregnancy, after childbirth, or flatulence is accompanied by other symptoms, you should consult a
gynecologist. If bowel diverticula, anal sphincter insufficiency, or gastrointestinal dyskinesia are suspected, referral should be made to
gastroenterologist.

Diagnostics and examinations

If uncontrolled gas discharge occurs during pregnancy, after childbirth, as a rule, additional examination is not required. When complaining of a constant discharge of gases without symptoms of bloating, it is necessary to check the condition of the anal sphincter and intestines. For this, sigmoidoscopy and colonoscopy are performed.

If gas incontinence is accompanied by bloating, pain, a feeling of fullness, an examination of the entire gastrointestinal tract is required to exclude the pathology of the biliary tract, pancreas and intestines. To rule out diverticula, your doctor may order a barium X-ray contrast study, a colonoscopy, a helical CT scan, and a comprehensive abdominal ultrasound examination.

Biliary dyskinesia can be detected using an ultrasound of the gallbladder, and an ultrasound of the pancreas.

If the doctor suspects a violation of intestinal motility as the cause of flatulence, he may prescribe an electrogastroenterography and manometry.

Be sure to conduct laboratory tests to assess enzymatic deficiency and intestinal microflora.

In these cases, informative general;

complex biochemical blood test with determination of total protein and albumin,

bilirubin and its fractions,

as well as a coprogram.

Treatment

Bloating and increased gas can be both a sign of a disease and a consequence of an improper diet and lifestyle. You can cope with these symptoms only by establishing their cause.

In any case, it is necessary to normalize the diet and exclude gas-forming products from the diet.

Functional disorders involve correction of the motility of the gastrointestinal tract, microflora and elimination of enzymatic deficiency. It is also necessary to eliminate the causes of psycho-emotional stress. To reduce the pressure of gases in the intestine, adsorbents (activated carbon, etc.), carminatives, enzymatic preparations are used.

If the cause of uncontrolled gas passage is an insufficiency of the anal sphincter due to hemorrhoids, fissure or fistula, surgical treatment is necessary. At intestinal diverticula non-drug treatment is possible, which involves changes in lifestyle and diet. Patients are not recommended cleansing enemas and the use of laxatives. Nutrition should include fiber-rich foods. Antispasmodics, phosphodiesterase inhibitors, non-selective calcium channel antagonists, and water-soluble fiber preparations are used as drug therapy.

What should be done in case of flatulence?

With increased gas formation and bloating, it is desirable to identify those foods that cause flatulence, and refuse them or reduce their number.

After the digestion processes are normalized, these products should be introduced into the diet gradually, helping the intestines with enzyme preparations. The improvement of peristalsis is facilitated by the consumption of a sufficient amount of liquid – up to 2-2.5 liters per day.

It is advisable not to eat foods containing a large amount of fat, and sweet dishes. Fermentation in the intestines is also facilitated by fruits and foods containing yeast. Before cooking legumes (which contribute to the occurrence of flatulence), you should first soak them in water.

It is very important to eat properly to prevent swallowing air while eating.

Eating should be done slowly, avoiding lying down. An active lifestyle and moderate physical activity contribute to the reduction of flatulence.

Sources:

1. Clinical guidelines “Irritable bowel syndrome”. Developed by: Russian Gastroenterological Association, Association of Coloproctologists of Russia. – 2021.
2. Clinical guidelines “Diverticular disease”. Developed by: Russian Gastroenterological Association, Association of Coloproctologists of Russia. – 2021.

IMPORTANT!

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.
For a correct assessment of the results of your analyzes in dynamics, it is preferable to do studies in the same laboratory, since different laboratories may use different research methods and units of measurement to perform the same analyzes.

Bloating and gas formation: causes, treatment

Why flatulence and bloating can occur?

The mechanisms by which these symptoms develop are varied. Sometimes they can
occur for functional reasons, and sometimes they lead to
certain diseases ³ .

The everyday reasons for which the stomach can swell are quite obvious – first of all, this is the consumption of a large number of foods that can cause active formation of gases ³ .

Pathological conditions leading to bloating and gas formation may be different. Among them, for example, a deficiency of
digestive enzymes and disorders of the circulation of bile acids.
In addition, other diseases of the digestive tract may be the cause
systems: Crohn’s disease, irritable bowel syndrome (
will be discussed below), pancreatitis. Also, the cause of a swollen abdomen can
be a violation of the peristalsis of the intestinal walls after surgery on the gastrointestinal tract,
in chronic diseases or acute infections ^1-3 .

Belching with a swollen abdomen and against the background of excessive accumulation of gases
can also be a sign of illness. So, for example, “a feeling of
accumulation of gases” in the chest in adults can occur at
severe pathologies of the heart, such as myocardial ischemia. Bitter or sour eructation
, not associated with food, may be associated with hiatal hernia
, GERD (gastroesophageal
reflux disease), peptic ulcer, biliary tract,
pancreas. But belching with an unpleasant odor can often
occur due to stenosis of the gastric outlet. Also, belching
can be a side effect when taking certain medications
means ^{2, 3} .

Irritable bowel syndrome (IBS)

Hypersensitivity of the abdominal organs is one of the main causes of symptoms in IBS. With this pathology, there may be an increase in pain sensitivity in response to stretching of the intestinal wall, in which the disturbance of the metabolism of painkillers produced in the body plays a role ⁴ .

Characteristically, in IBS, there is often a diffuse nature of the violation of pain perception throughout the intestine, and increased sensitivity occurs selectively to mechanical stimuli ⁴ . Therefore, throughout the day, patients may complain of a swollen abdomen, which may be accompanied by rumbling and transfusion in the intestines. Such complaints are not confirmed by objective methods ⁵ .

Dysbacteriosis

As a result of changes in the composition and quantity of
normal intestinal microflora, microorganisms may
move from the large intestine to the small intestine. For this reason,
fermentation and putrefactive processes begin
earlier, at the level of the small intestine, due to
which may bloat the stomach and cause diarrhea,
disrupt the absorption of nutrients ⁶ .
Intestinal distension
without diarrhoea, which is predominant among the symptoms, can be observed with
overgrowth of bacteria that convert
carbohydrates into short-chain fatty acids
and gas ⁷ .

Flatulence and bloating

in women

In the luteal phase of the menstrual cycle and
especially before the start and in the first days
menstruation in women may occur
gas retention in the intestines and bloating.
This is due to an increase in the level of hormones
prolactin, vasopressin, which in turn
reduce the activity of prostaglandin
E. As a result, constipation,
fluid retention in the body, bloated abdomen,
depression and irritability may occur ^{8 90 166 .}

Diagnosis

To find out the cause of bloating, you should consult a doctor. The main method confirming the accumulation of gases in the intestines is a survey radiography of the abdominal cavity. The study allows you to evaluate the amount of gas, its location, the presence or absence of intestinal obstruction ⁶ .

If, according to the results of the examination, the formation of gases with bloating and belching is not associated with diseases (functional disorder), the doctor can prescribe a diet and advise simple measures to help restore the normal functioning of the digestive organs ^{1, 3} .

How can you help yourself with excessive gas formation?

As a medical treatment for bloating, the physician may
prescribe adsorbents that can absorb certain compounds and
defoamers that help break up small gas bubbles,
making them more comfortable to evacuate ³ .

Also, with symptoms of impaired digestion, which include
bloating, the processes of digestion of food can be helped by
enzyme preparations. Their components are selected in such a way that
compensate for the deficiency of enzymes necessary for digestion in
various diseases, as well as to improve food digestion in

2 errors in nutrition, sedentary lifestyle ¹¹ . One of these
preparations is Festal® ^{11, 12} .

Festal® contains several active substances at once, which can
promote the digestion of food components. Pancreatin and its
enzymes facilitate the digestion of carbohydrates, fats and proteins, which
contributes to their more complete absorption in the small intestine.