This is a common symptom described by patients and is often characterised by a sensation of abdominal discomfort, with a feeling of fullness and even some visible distension of the abdomen. Women often describe the sensation as ‘feeling pregnant’! The symptom is usually intermittent but any persistent symptoms should be reported to the family doctor.
Symptoms It is one of the commonest symptoms described in irritable bowel syndrome (IBS) It probably arises from the build-up of gases in the small and large intestine either as a result of increased fermentation of gut products by commensal (host) bacteria or as result of poor coordination of gut peristalsis or motility. Upper abdominal bloating frequently occurs in acid reflux (GORD) but may also be a symptom of gallstones (or cholelithiasis). Upper abdominal bloating is frequently associated with a sensation of feeling full quickly when eating (early satiety), nausea and burping (eructation). It can also be experienced in much rarer conditions associated with delayed gastric emptying such as diabetes, scleroderma or a blockage to the outflow tract of the stomach by ulcers or even tumours.
Investigation Mid and lower abdominal bloating is commonly associated with constipation, irritable bowel syndrome and excess flatus production but can also be associated with more uncommon conditions, such as lactose intolerance, inflammatory bowel disease and coeliac disease. Another more serious condition that may mimic the sensation of bloating, is ascites. This is the build up of fluid in the abdominal cavity. This can arise as a result of chronic liver disease, chronic pancreatitis, heart failure, severe malnutrition, or even intra-abdominal or pelvic cancer. The symptoms are always persistent and progressive and usually associated with weight gain and should be reported urgently to the GP.
Management Treating straight-forward bloating is not always easily achieved. Managing constipation with high fibre diets or laxatives may help, as do antispasmodic medications such as mebeverine (colofac) and peppermint oil. Dietary exclusion and even low dose antidepressants are also shown to be beneficial. Written by Dr M J Webberley, Consultant Gastroenterologist, August 2015