26 سنوات
Hello drs. plz can anyone tell me what does cause the stomach blowing ? (balonnement) . thank u
19 سبتمبر 2014
Three main gas-related complaints are most commonly reported by patients:
- excessive belching,
- distention (bloating), and
- excessive flatus
Each of these complaints is related to a number of causes.
Excessive belching:
Belching, or eructation, results from swallowed air or from gas generated by carbonated beverages. Aerophagia is a normal event that happens during eating and drinking in insignificant amounts; in some people, however, repeated unconscious swallowing of air while eating or smoking occurs, also at other times, especially when the individual is under stress or is trying to induce belching. Excessive salivation increases aerophagia and may be associated with various GI disorders (e.g., gastroesophageal reflux disease), certain drugs, gum chewing, or nausea of any cause.
Most swallowed air is eructated, and only a small amount of it gets to the small bowel; this amount is determined by body position: in an upright person, air is readily belched; when lying down, air trapped above the stomach fluid tends to be propelled down into the intestines. Excessive eructation may also be a voluntary process; patients who belch after taking antacids may attribute the relief of symptoms to belching rather than to antacids, and so may intentionally induce belching to relieve stomach disconfort.
Distention (bloating):
Abdominal bloating may occur as a sole symptom, or concomitantly with other gastrointestinal symptoms in patients with functional disorders of the GI tract, which are essentially disorders of contraction and motility, examples include:
• aerophagia
• gastroparesis: Nausea, abdominal pain, sometimes vomiting, and early satiety (feeling full soon after starting to eat)
• irritable bowel syndrome: Chronic, recurrent bloating or distention associated with a change in frequency of bowel movements or consistency of stool; typically ensues during the teens and 20s.
• chronic constipation: A long history of hard, infrequent bowel movements
However, excessive intestinal gas is not clearly linked to these complaints. In most healthy people, 1 L/h of gas can be infused into the gut with minimal symptoms. It is likely that many symptoms are incorrectly attributed to “too much gas.”
On the other hand, some patients with recurrent GI symptoms often cannot tolerate small quantities of gas. Additionally, patients with eating disorders (eg, anorexia nervosa, bulimia) often misperceive and are particularly stressed by symptoms such as bloating. Thus, the basic abnormality in patients with gas-related symptoms may be a hypersensitive intestine. Altered motility may contribute further to symptoms.
Rectal gas passage varies greatly between individuals in term of quantity and frequency. As with stool frequency, people who complain of flatulence often have a misconception of what is normal. The average number of gas passages is about 13 to 21/day. Objectively recording flatus frequency (using a diary kept by the patient) is a first step in evaluation.
Flatus is a normal metabolic byproduct of intestinal bacteria; almost none originates from swallowed air or back-diffusion of gases (primarily N2) from the bloodstream. Bacterial metabolism yields significant volumes of H2, CH4, and CO2.
Factors that lead to excessive H2 production include:
- malabsorption syndromes
- ingestion of certain fruits and vegetables containing indigestible carbohydrates, i.e., that the body cannot break down and abosrb (eg, baked beans), sugars (eg, fructose), or sugar alcohols (eg, sorbitol)
- disaccharidase deficiencies, most commonly lactase deficiency: large amounts of lactose, the sugar found in milk and dairy products, go into the colon and are fermented to H2. Celiac disease, tropical sprue, pancreatic insufficiency (poor pancreatic production of digestive enzymes), and other causes of carbohydrate malabsorption should also be considered in cases of excess colonic gas.
CH4 is also produced by colonic bacterial metabolism of the same foods (eg, dietary fiber). However, about 10% of people have bacteria that produce CH4 but not H2.
CO2 is also produced by bacterial metabolism. The acid products released by bacterial fermentation of unabsorbed carbohydrates in the colon may also react with HCO3– (naturally found in the body), leading to the production of CO2. Although bloating may occasionally occur, the rapid diffusion of CO2 into the blood generally prevents distention.
Diet accounts for much of the variation in flatus production among individuals, but poorly understood factors (eg, differences in colonic flora and motility) may also play a role. Dietary substances, including beans, dairy products, vegetables, onions, celery, carrots, Brussels sprouts, fruits (eg, raisins, bananas, apricots, prune juice), and complex carbohydrates (eg, pretzels, bagels, wheat germ) have been implicated in causing/exacerbating bloating.
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