Increased gas formation in the intestines - be careful with gases!

Formation of gases in the intestines

The predominant microflora in the intestines “feeds” mainly on dietary fiber and incompletely digested carbohydrate residues - oligo- and disaccharides. Some carbohydrates and hard-to-digest fibers are not fully digested in the small intestine; from there they enter the large intestine and are used by microflora2,4.

Microbial fermentation processes are accompanied by the release of large amounts of gases. As a result of lactic acid fermentation, lactic acid, carbon dioxide, hydrogen, water and other substances are formed. Alcoholic fermentation leads to the appearance of carbon dioxide and ethanol, formic acid, propionic acid, butyric acid and other types lead to the release of volatile fatty acids, carbon dioxide, hydrogen and water. In addition, carbon dioxide is produced as a result of chemical alkalization of the acidic contents of the stomach in the duodenum4.

Methane is released during the vital activity of colon microflora and depends little on the composition of food, and hydrogen sulfide is released during the breakdown of sulfur-containing amino acids by microflora4.

If some processes accompanied by the release of gases are too active, and the removal of gases through the lower gastrointestinal tract is difficult, flatulence develops.

Types of flatulence depending on the cause of its development1,4

• Nutritional.
• Digestive.
• Dysbiotic.
• Dynamic.
• Mechanical.
• Circulatory.
• High-rise
• Psychogenic.

The syndrome of increased gas formation is closely associated with alimentary, digestive, dysbiotic and dynamic types of flatulence.

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What should I do to prevent bloating from appearing?

Simple rules to reduce the risk of flatulence:

• Eating should be slow, with thorough chewing of food, without distraction by extraneous actions.
• Avoid quick snacks on the go, smoking, and drinking alcohol.
• Limit the consumption of foods that increase gas formation.
• Avoid sugary carbonated drinks (there is nothing healthy in them).
• Drink enough clean water per day.
• Follow a proper diet (fried, fatty foods should not predominate)3.

Before a big feast or when overeating, it is better to take care of preventing bloating* in advance. To do this, you can take Creon® 10000 capsule with food or immediately after it. The active substances contained in the drug help natural digestion, reducing the risk of discomfort and heaviness after eating.

Symptoms of flatulence

Gaseous substances in the intestines are contained in a free and bound state. Free gases, thanks to intestinal peristalsis, constantly move towards the lower gastrointestinal tract and are excreted in portions: approximately 40 ml 15-20 times a day1,2.

Bound gases are enclosed in small bubbles lined with mucus4. With flatulence, their number increases sharply and foam forms. The increasing volume of foam leads to stretching of the intestinal wall. This causes discomfort in the abdomen, sensations of bloating, fullness and rumbling, as well as the development of pain. Additionally, abdominal enlargement and flatulence may be observed - frequent and profuse passage of gases, often with a foul odor and sound of varying timbre and volume1.

Symptoms of flatulence

• Regurgitation.
• Belching air.
• Feelings of bloating and fullness in the abdomen.
• Increase in abdominal circumference.
• Rumbling in the intestines.
• Stomach ache.
• The release of large amounts of gases from the intestines (flatulence)1.

The appearance of abdominal pain during flatulence is associated with overstretching of the intestinal walls and its mesentery. The degree of discomfort depends on the height of the pain sensitivity threshold: the lower this threshold, the more severe the pain. It appears in one part of the abdomen, gradually intensifies, then, as the gas bubble moves through the intestines, it weakens and even disappears, but then appears again, albeit in a different place in the abdominal cavity1.

Foamed stool covers the intestinal walls and makes it difficult to digest food and absorb nutrients1. This further complicates the situation: undigested food remains accumulate in the intestines and fermentation processes intensify. Gas formation increases, the symptoms of flatulence become even more pronounced.

If it persists for a long time, flatulence can disrupt a person’s usual way of life, force him to give up active pastime and limit communication. This can lead to psychological problems, increased anxiety and depression2.

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What examinations need to be performed?

Due to the numerous causes of flatulence, it is difficult to immediately determine a diagnostic method to identify the source of the problem. The patient’s initial visit takes place at an appointment with a local therapist, who will give a referral for further examination by a gastroenterologist. Most of the patients who complained of gas accumulation had gastrointestinal disorders.

The list of necessary examinations includes:

• After a visual examination and palpation of the swellings, the patient is referred for colonoscopy and endoscopy. Having received the main indicators, a biopsy is taken from the stomach to study the problem in more detail.
• An ultrasound of the abdominal cavity allows you to see a full picture of what is happening, possible deviations, the condition of the organs, the presence of a cyst. If necessary, the doctor conducts an additional ultrasound examination of the liver, stomach, and pancreas.
• Examination of the abdominal cavity using an X-ray machine. The walls of the large and small intestines are visible.
• Passing pH measurements to identify disorders of gastric secretions.
• Blood and stool tests, which are given and examined in the laboratory.

Foods that cause flatulence

Scientists have proven and repeatedly confirmed the role of nutrition in the occurrence of flatulence2,3.

Products that increase gas formation2,3:

• legumes,
• cabbage,
• spinach,
• sorrel,
• onion and garlic,
• radishes and turnips,
• carrot,
• celery,
• dates,
• bananas,
• apples,
• gooseberry,
• raspberries,
• kvass and beer,
• black bread,
• raisin,
• prunes,
• whole milk,
• carbonated drinks,
• caffeinated drinks,
• alcohol1,3.

Products containing carbohydrates are recognized as dangerous from the point of view of increased gas formation: oligosaccharides, disaccharides, monosaccharides and polyols7. All these carbohydrates are united by the term “FODMAP”, meaning Fermentable Oligo-, Di-, Mono- and Polyol. They are poorly absorbed in the intestine; remaining in it, they become food for bacteria and provoke the development of flatulence with all its inherent symptoms3,7.

FODMAP - foods containing “dangerous” carbohydrates

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Treatment of flatulence

Treatment of flatulence primarily involves eliminating the cause that caused it. If bloating is associated with a gastrointestinal disease, you can get rid of it only by restoring the functioning of the digestive system1.

The main directions of flatulence therapy6:

1. Diet and diet correction9.
2. Drug therapy:

• normalization of intestinal microflora with the help of pre-, pro- and synbiotic drugs;
• transferring gases from a bound state to a free one and removing them from the intestines with the help of “defoamers”.

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Diet and nutrition

Treatment of flatulence begins with normalization of nutrition1,2. Doctors recommend eating small meals 5-6 times a day and be sure to have breakfast. Moreover, for breakfast it is better to eat dishes made from grain crops, that is, porridge, pasta, flour products1.

You need to eat in a calm environment, slowly and chewing every bite thoroughly. Do not talk while eating, much less smoke, to prevent air from entering the stomach - aerophagia6. Aerophagia is one of the main factors leading to flatulence1,6. For the same reason, you should not drink through a straw or drink carbonated drinks2,6.

There is no universal diet that would prevent and reduce the manifestations of flatulence. The nature of nutrition is determined by the underlying disease that caused increased gas formation in the gastrointestinal tract. So, with lactase deficiency, it is often enough not to consume foods containing oligosaccharides, in particular milk sugar - lactose. And with irritable bowel syndrome, it is better to exclude from the diet everything that provokes gas formation2. If you are intolerant to certain types of carbohydrates, the FODMAP diet will help you create a healthy diet.

FODMAP diet: allowed foods

For any nature of flatulence, it is recommended to limit the consumption of indigestible meat (pork, lamb, goose), sugar and sweet flour products. It is better to steam, stew or boil food. Use bread made from wholemeal flour and preferably yesterday's bread, that is, slightly dried out1.

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Drug therapy

Since in most cases flatulence is combined with a violation of the intestinal microflora, treatment is primarily aimed at normalizing its composition1,2,9.

For this, doctors prescribe:

• Probiotics are preparations that contain microorganisms that help restore intestinal microflora; preference is given to products based on lactobacilli and bifidobacteria1,2;
• Prebiotics are a substrate for feeding “beneficial” bacteria inhabiting the gastrointestinal tract, for example, lactulose;
• Synbiotics are preparations based on bacteria that are part of the normal intestinal microflora and nutrients for them1.

In case of severe enzyme deficiency, drugs based on pancreatic enzymes are used. They improve digestion, reduce the content of undigested food residues in the intestines and thereby eliminate the soil for the processes of microbial fermentation and excessive gas formation1,2,9.

Simethicone preparations1,2,9, such as Motilegaz® Forte, can be used as a means of quick relief from flatulence, allowing relief from bloating.

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Motilegaz® Forte – first aid for flatulence

MOTILEGAZ® FORTE is a medicinal product based on an active substance with the international nonproprietary name “simethicone”, which has an antifoaming and carminative effect10.

The drug is available in soft gelatin capsules, which are tasteless and odorless and are easy to swallow.

Mechanism of action of MOTILEGAZ® FORTE

• Once in the gastrointestinal tract, the capsule dissolves and releases the active substance - simethicone.
• Simethicone “spreads” over the surface of gas bubbles, increases the surface tension of their walls, promotes their rupture and the release of gaseous substances.
• The resulting free gases are partially absorbed in the intestine. The other part of the gases is released from the intestines naturally.

The drug MOTILEGAZ® FORTE acts directly in the intestines. Simethicone is a chemically inert polymer, is not absorbed into the gastrointestinal tract and does not enter the general bloodstream. This ensures a high safety profile of the drug.

MOTILEGAZ® FORTE is approved for use from the age of 18 years10.

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The information in this article is for reference only and does not replace professional advice from a doctor. To make a diagnosis and prescribe treatment, consult a qualified specialist.

Literature

1. Gureev A. N. Syndrome of increased gas formation // Regular issues of “RMZh”. —2010. - No. 5. — P. 306.
2. Belmer S.V., Kovalenko A.A., Gasilina T.V. Flatulence: norm and pathology // Attending physician. - 2008. - No. 2. — P. 38-42.
3. Dicheva D. T., Kazyulin A. N., Russ I. S. et al. Diet therapy with a reduced content of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) for irritable bowel syndrome // Consilium Medicum. - 2016; 18 (8): 75–78.
4. V. Makhov Flatulence: from pathogenesis to treatment // Doctor - 2010 - No. 3 - P.20-24
5. A. Nogaller. Flatulence: causes and treatment // Doctor – 2021 – No. 7 – P.6-8
6. Yu.O. Shulpekova. Flatulence: circle of knowledge or circle of ignorance // Medical Council - 2013 - No. 10 - pp. 54-58.
7. Yu.O. Shulpekova Bloating: analysis of the origin of the symptom // Attending physician. - 2021. - No. 8. — P. 16-25.
8. I.B. Khlynov Galactooligosaccharide-dependent flatulence and bloating // Attending physician. - 2021. - No. 9.
9. L. I. Butorova, N. G. Kadnikova, etc. Bloating and gas formation: modern treatment options // Attending physician. - 2018. - No. 2. — P. 61-66
10. Instructions for medical use MOTILEGAZ® FORTE.

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