Sub-diaphragmatic vagal afferent integration of meal-related gastrointestinal signals. Neurosci Biobehav Rev.
Flatulence and related conditions
Capsaicin-resistant vagal afferent distension in the rat gastrointestinal tract: Anatomical identification and functional integrity. Brain Res. Water stimulation of the posterior oral cavity induces inhibition of gastric motility. An experimental model for assessment of renal recovery from warm ischemia. Ischemic preconditioning in the animal kidney, a systematic review and meta-analysis. PLoS One. Sexy naked gypsy teens preserves renal microvessel structure and ameliorates secondary renal disease following acute kidney injury.
Am J Physiol Renal Physiol. Inflammation is associated with liver function markers, independent of other metabolic risk factors in overweight women. Br J Diabetes Vasc Dis. Dietary antioxidant and anti-inflammatory intake modifies the effect of cadmium exposure on markers of systemic inflammation and oxidative stress. Environ Res. Association between plasma alkaline phosphatase and C-reactive protein in Hong Kong Chinese. Clin Chem Lab Med. Outcome predictability of serum alkaline phosphatase in men with pre-dialysis CKD.
Nephrol Dial Transplant. Increased serum alkaline phosphatase activity: A possible indicator of renal damage. J Clin Lab Anal. Causes and consequences of increased sympathetic activity in renal disease. Stomach distension increases efferent muscle sympathetic nerve activity and blood pressure in healthy humans.
J Neurol Sci. Protective effect of preconditioning on the injury associated to hepatic ischemia-reperfusion in the rat: Role of nitric oxide and adenosine. Liver ischemic preconditioning is mediated by the distension action of nitric oxide on endothelin. Biochem Biophys Res Commun. Bolli R. Cardioprotective function of inducible nitric oxide synthase and role of nitric oxide in myocardial ischemia and preconditioning: An overview of a decade of research.
J Mol Cell Cardiol. Nitric oxide released by gastric mechanoreceptors modulates nicotinic activation of coeliac plexus neurons in the rabbit.
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Symptoms and signs involving the digestive system and abdomen Type 2 Excludes congenital or infantile pylorospasm Q R13 Aphagia and dysphagia.
R14 Flatulence and related conditions. R15 Fecal incontinence. History taking should focus on diurnal changes, relationship to certain foods distension food components dairy products, wheat, fructans, fat, fiber, poorly digested and absorbed carbohydrates giant oiled tits, and change in bowel habits.
Symptoms suggestive of an overlap with IBS, functional dyspepsia, or functional constipation should be recorded as well. A concurrent diagnosis of another FGID often changes treatment modalities.
A physical exam may reveal an increase in abdominal girth and signs of bowel obstruction. Rectal and pelvic examination should be performed in constipated patients. Although there are no validated guidelines for the evaluation of FABD, the Rome IV working group recommends basic diagnostic tests such as complete blood distension CBC if anemia is suspected, celiac serology and if positive, duodenal biopsies should be addedabdominal x-ray to rule out obstruction, and a breath test for the diagnosis of SIBO [ 28 ]. After the exclusion of alarm signs, organic disease, and overlap with other FGID, the next step is to offer a stepwise, individualized treatment as described in Fig.
Bloating and Abdominal Distension: Clinical Approach and Management | SpringerLink
Patients with mild functional bloating may need merely reassurance that the condition is benign and does not herald any life-threatening disease. Several agents are available for the treatment of FABD. Antispasmodics have shown some clinical benefit in symptoms relief in some patients [ 12 ]. Simethicone was found to reduce the frequency and severity of gas, distension, and bloating in a double-blind trial [ 29 ]. In two other controlled trials, peppermint oil significantly reduced distention compared to placebo [ 30distension ].
Despite their popularity, evidence is lacking dancing with stars nude regard to other commonly used agents such as activated charcoal, Iberogast, and magnesium salts.
The role of dietary therapy in the management of bloating symptoms is crucial and generally introduced early in the treatment plan. The main rationale of dietary therapy is to identify foods to which the patient is intolerant and thereby reduce excessive fermentation of food residues. Empiric restriction of lactose and other poorly absorbed carbohydrates may be initially performed [ 12 ]. Alternatively, a low FODMAP fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet and other elimination diets may be offered to patients with FABD who have failed restriction diets [ 32 ].
In our opinion, diet interventions with restrictive diets should be delivered by trained dieticians who closely collaborate with the clinician. It should be noted that an over-restrictive diet may in and of itself alter the colonic microbiota with undesired consequences [ 33 ]. Although unproven, in certain cases it seems appropriate to assess distension the presence of carbohydrate intolerances by performing the corresponding breath tests [ 12 ]. Lubiprostone, a chloride channel agonist, was found to decrease bloating in two placebo-controlled clinical trials distension enrolled patients with IBS-C [ 1634 ].
Prucalopride, a selective 5-HT 4 receptor agonist, was found to increase spontaneous bowel movements and to reduce bloating [ 35 ]. Similarly, linaclotide, a guanylate cyclase C agonist, was found to improve constipation increased spontaneous bowel movements and to reduce abdominal pain and bloating in patients with CIC and IBS-C [ 36373839404142 ]. Finally, in one small placebo-controlled clinical trial, intravenous administration of neostigmine was found to enhance clearance of infused jejunal gas in a cohort of patients with abdominal bloating [ 43 ].
However, in another trial of IBS patients with bloating, it was found that pyridostigmine provided only a minimal effect on symptoms [ 44 ]. Reducing gas-producing bacteria or causing alterations of their metabolic activities may decrease excessive fermentation and bloating. Rifaximin, a poorly absorbed broad-spectrum antibiotic, was found to improve bloating and flatulence in controlled trials in patients with and without IBS [ 4546 ]. Probiotics may become a therapeutic option in FABD; however, studies have revealed mixed results, probably due to the lack of standardized study methods [ 4748 distension.
In a recent review, it was suggested that probiotics have distension role in the treatment of functional gastrointestinal disorders [ 49 ]. In a double-blind study by Ringel et al. As previously described, post-prandial FABD may result chubby nude girl pussy abnormal anterior abdominal wall relaxation and diaphragmatic contraction.
These behaviors cause a redistribution of intrabdominal gas, resulting in an anterior wall protrusion and visible distension [ 10 ]. The explanation for these behaviors may be related to an abnormal viscero-somatic reflex, causing a thoraco-abdominal striated muscular activity that reshapes the abdomen and pushes it to protrude anteriorly [ 12 ]. This abnormal reflex activity or behavior is potentially amenable to biofeedback new miley cyrus topless. In fact, Barba et al.
FGID patients with distension were randomized to biofeedback or placebo. Biofeedback sessions were offered on separate days up to three times during a 1- to 2-week period [ 1251 ]. Biofeedback effectively diminished diaphragmatic and intercostal muscle contraction, decreasing both subjective bloating and abdominal girth [ 51 ]. These findings suggest that FABD may be improved by performing diaphragmatic or abdominal breathing.
If an amplified perception of bowel wall stretch and visceral hypersensitivity are key components in the pathogenesis of FABD, then modulating the brain—gut axis seems to be a reasonable treatment option. However, their exact role of these antidepressants in improving bloating symptoms is unclear [ 5253 ].
In another study, desipramine TCA combined with cognitive behavioral therapy decreased bloating [ 54 ]. Hypnotherapy and cognitive behavioral therapy, which are commonly offered to patients with IBS, may also be effective in patients with FABD [ 1255 ].
This review article is based on previously conducted studies and reviews and does not contain any studies with human participants or animals performed by any of the authors. Functional abdominal bloating and distension is a prevalent condition, with an adverse effect on general well-being and quality of life. A stepwise, multidisciplinary, individualized approach is desirable. Further studies are warranted to better elucidate the pathophysiological basis of FABD.
Well-designed clinical trials in which bloating and distention are primary endpoints are needed to validate the putative treatments. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit distension. Additionally, no funding or sponsorship was received for the publication of this article.