Bloating: from diagnosis to treatment

Bloating is a feeling of abdominal fullness and discomfort while abdominal distension presents as an objective increase in abdominal girth. Bloating is one of the most common gastrointestinal symptoms and one of the most annoying experienced by patients. These symptoms are common and can be associated with multiple conditions in irritable bowel syndrome. According to the Rome IV criteria, the prevalence of functional bloating is 3.5% (after exclusion of other disorders of the gut–brain interaction). Its prevalence is much higher in irritable bowel syndrome (up to 80%). The pathophysiology of functional bloating is multifactorial and includes, among other factors, constipation, pelvic floor dysfunction, visceral hypersensitivity, abdomino-phrenic dyssynergia, and carbohydrate intolerance. Treatments are based on targeting the main symptoms and include diet, medication, and biofeedback. Transit disorders such as constipation and diarrhea can be treated, respectively, by secretagogues and rifaximin, but these treatments are not available in France. Biofeedback is useful in case of pelvic floor dysfunction and abdomino-phrenic dyssynergia. Low FODMAP diet is useful in patients with food-related bloating and distension, but should only be proposed to selected patients. Neuromodulators help to decrease the sensation of bloating and the viscero-somatic reflex associated with abdominal distension. Both of these treatments are available in France. Probiotics and antibiotics targeting small intestinal bacterial overgrowth cannot be recommended for this indication.