Gas in the Digestive Tract - IBD Clinic

Gas in the Digestive Tract

U.S. Department of Health and Human Services

NATIONAL INSTITUTES OF HEALTH

National Digestive Diseases Information Clearinghouse

What is gas?

Gasisairinthedigestivetract--thelarge, musculartubethatextendsfromthemouth totheanus,wherethemovementofmuscles, alongwiththereleaseofhormonesand enzymes,allowsforthedigestionoffood.Gas leavesthebodywhenpeopleburpthroughthe mouthorpassgasthroughtheanus.

Gasisprimarilycomposedofcarbondioxide, oxygen,nitrogen,hydrogen,andsometimes methane.Flatus,gaspassedthroughthe anus,mayalsocontainsmallamountsof gassesthatcontainsulfur.Flatusthat containsmoresulfurgasseshasmoreodor.

Everyonehasgas.However,manypeople thinktheyburporpassgastoooftenandthat theyhavetoomuchgas.Havingtoomuch gasisrare.

What causes gas?

Gasinthedigestivetractisusuallycaused byswallowingairandbythebreakdown ofcertainfoodsinthelargeintestineby bacteria.

Everyoneswallowsasmallamountofair wheneatinganddrinking.Theamountofair swallowedincreaseswhenpeople

? eatordrinktoofast

? smoke

? chewgum

? suckonhardcandy

? drinkcarbonatedor"fizzy"drinks

? wearloose-fittingdentures

Mouth

Esophagus

Stomach

Large intestine

Small intestine

Anus

Thedigestivetract

Colon (shaded)

Rectum

Burpingallowssomegastoleavethe stomach.Theremaininggasmovesintothe smallintestine,whereitispartiallyabsorbed. Asmallamounttravelsintothelarge intestineforreleasethroughtheanus.

Thestomachandsmallintestinedonot fullydigestsomecarbohydrates--sugars, starches,andfiberfoundinmanyfoods. Thisundigestedfoodpassesthroughthe smallintestinetothelargeintestine.Once there,undigestedcarbohydratesarebroken downbybacteriainthelargeintestine,which releasehydrogenandcarbondioxideinthe

process.Othertypesofbacteriainthelarge intestinetakeinhydrogengasandcreate methanegasorhydrogensulfide,themost commonsulfurgasinflatus.

Studieshavedetectedmethaneinthebreath of30to62percentofhealthyadults.1A largerpercentageofadultsmayproduce methaneintheintestines,butthelevelsmay betoolowtobedetected.Researchsuggests thatpeoplewithconditionsthatcause constipationaremorelikelytoproduce detectableamountsofmethane.1More researchisneededtofindoutthereasons fordifferencesinmethaneproductionand toexploretherelationshipbetweenmethane andotherhealthproblems.

Someofthegasproducedintheintestinesis absorbedbythebloodstreamandcarriedto thelungs,whereitisreleasedinthebreath.

Normally,fewbacterialiveinthesmall intestine.Smallintestinalbacterial overgrowthisanincreaseinthenumberof bacteriaorachangeinthetypeofbacteria inthesmallintestine.Thesebacteriacan produceexcessgasandmayalsocause diarrheaandweightloss.Smallintestinal bacterialovergrowthisusuallyrelated todiseasesordisordersthatdamagethe digestivesystemoraffecthowitworks, suchasCrohn'sdisease--aninflammatory boweldiseasethatcausesinflammation,or swelling,andirritationofanypartofthe gastrointestinal(GI)tract--ordiabetes.

Which foods cause gas?

Mostfoodsthatcontaincarbohydratescan causegas.Incontrast,fatsandproteins causelittlegas.Foodsthatproducegasin onepersonmaynotcausegasinsomeone else,dependingonhowwellindividuals

1SahakianAB,JeeSR,PimentelM.Methaneandthe gastrointestinaltract.Digestive Diseases and Sciences. 2010;55(8):2135?43.Epub2009Oct15.

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digestcarbohydratesandthetypeofbacteria presentintheintestines.

Somefoodsthatmaycausegasinclude

? beans

? vegetablessuchasbroccoli,cauliflower, cabbage,brusselssprouts,onions, mushrooms,artichokes,andasparagus

? fruitssuchaspears,apples,andpeaches

? wholegrainssuchaswholewheatand bran

? sodas;fruitdrinks,especiallyapple juiceandpearjuice;andotherdrinks thatcontainhigh-fructosecornsyrup,a sweetenermadefromcorn

? milkandmilkproductssuchascheese, icecream,andyogurt

? packagedfoods--suchasbread,cereal, andsaladdressing--thatcontainsmall amountsoflactose,asugarfoundin milkandfoodsmadewithmilk

? sugar-freecandiesandgumsthat containsugaralcoholssuchassorbitol, mannitol,andxylitol

What are the symptoms of gas?

Themostcommonsymptomsofgas areburping,passinggas,bloating,and abdominalpainordiscomfort.However,not everyoneexperiencesthesesymptoms.

Burping.Burping,orbelching,onceina while,especiallyduringandaftermeals, isnormal.However,peoplewhoburp frequentlymaybeswallowingtoomuchair andreleasingitbeforetheairentersthe stomach.

Somepeoplewhoburpfrequentlymay haveanupperGIdisorder,suchas gastroesophagealrefluxdisease--achronic conditioninwhichstomachcontentsflow

backupintotheesophagus.Peoplemay believethatswallowingairandreleasingit willrelievethediscomfort,andtheymay intentionallyorunintentionallydevelopa habitofburpingtorelievediscomfort.

Passing gas.Passinggasaround13to 21timesadayisnormal.2Flatulenceis excessivegasinthestomachorintestinethat cancausebloatingandflatus.Flatulence maybetheresultofproblemsdigesting certaincarbohydrates.

Bloating.Bloatingisafeelingoffullnessand swellingintheabdomen,theareabetween thechestandhips.Problemsdigesting carbohydratesmaycauseincreasedgasand bloating.However,bloatingisnotalways causedbytoomuchgas.Bloatingmay resultfromdiseasesthataffecthowgas movesthroughtheintestines,suchasrapid gastricemptying,orfromdiseasesthatcause intestinalobstruction,suchascoloncancer. Peoplewhohavehadmanyoperations, internalhernias,orbandsofinternalscar tissuecalledadhesionsmayexperience bloating.

Disorderssuchasirritablebowelsyndrome (IBS)canaffecthowgasmovesthrough theintestinesorincreasepainsensitivity intheintestines.IBSisafunctionalGI disorder,meaningthatthesymptomsare causedbychangesinhowthedigestivetract works.ThemostcommonsymptomsofIBS areabdominalpainordiscomfort,often reportedascramping,alongwithdiarrhea, constipation,orboth.IBSmaygivea sensationofbloatingbecauseofincreased sensitivitytonormalamountsofgas.

Eatingalotoffattyfoodcandelaystomach emptyingandcausebloatinganddiscomfort, butnotnecessarilytoomuchgas.

2Gas-relatedcomplaints.TheMerckManuals OnlineMedicalLibrary. professional/sec02/ch008/ch008d.html.Updated October2007.AccessedJune26,2012.

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Abdominal pain and discomfort.People mayfeelabdominalpainordiscomfortwhen gasdoesnotmovethroughtheintestines normally.PeoplewithIBSmaybemore sensitivetogasandfeelpainwhengasis presentintheintestines.

How is the cause of gas found?

Peoplecantrytofindthecauseofgason theirownbykeepingadiaryofwhattheyeat anddrinkandhowoftentheyburp,passgas, orhaveothersymptoms.Adiarymayhelp identifyspecificfoodsthatcausegas.

Ahealthcareprovidershouldbeconsultedif

? symptomsofgasarebothersome

? symptomschangesuddenly

? newsymptomsoccur,especiallyin

peopleolderthanage40

? gasisaccompaniedbyothersymptoms, suchasconstipation,diarrhea,orweight loss

Thehealthcareproviderwillaskabout dietaryhabitsandsymptomsandmayaska persontokeepafooddiary.Carefulreview ofdietandtheamountofburpingorgas passedmayhelprelatespecificfoodsto symptomsanddeterminetheseverityofthe problem.Recordinggassymptomscanhelp determinewhethertheproblemistoomuch gasintheintestinesorincreasedsensitivity tonormalamountsofgas.

Ifmilkormilkproductsarecausinggas,the healthcareprovidermayperformbloodor breathteststocheckforlactoseintolerance, theinabilityorinsufficientabilitytodigest lactose.Lactoseintoleranceiscausedbya deficiencyoftheenzymelactase,whichis neededtodigestlactose.Thehealthcare providermaysuggestavoidingmilkproducts forashorttimetoseeifsymptomsimprove.

Thehealthcareprovidermayperforma physicalexamandorderothertypesof diagnostictests,dependingonaperson's symptoms.Thesetestscanruleoutserious healthproblemsthatmaycausegasor symptomssimilartothoseofgas.

How is gas treated?

Gascanbetreatedbyreducingswallowed air,makingdietarychanges,ortakingoverthe-counterorprescriptionmedications. Peoplewhothinktheyhavetoomuchgascan trytotreatgasontheirownbeforeseeinga healthcareprovider.Healthcareproviders canprovideadviceaboutreducinggasand prescribemedicationsthatmayhelp.

Reducing swallowed air.Swallowinglessair mayhelpreducegas,especiallyforpeople whoburpfrequently.Ahealthcareprovider maysuggesteatingmoreslowly,avoiding gumandhardcandies,orcheckingwitha dentisttomakesuredenturesfitcorrectly.

Making dietary changes.Peoplemaybeable toreducegasbyeatinglessofthefoodsthat causegas.However,manyhealthyfoodsmay causegas,suchasfruitsandvegetables,whole grains,andmilkproducts.Theamountofgas causedbycertainfoodsvariesfrompersonto person.Effectivedietarychangesdependon learningthroughtrialanderrorwhichfoods causeapersontohavegasandhowmuchof theoffendingfoodsonecanhandle.

Whilefatdoesnotcausegas,limitinghighfatfoodscanhelpreducebloatingand discomfort.Lessfatinthediethelpsthe stomachemptyfaster,allowinggasestomove morequicklyintothesmallintestine.

Taking over-the-counter medications.Some over-the-countermedicationscanhelpreduce gasorthesymptomsassociatedwithgas:

? Alpha-galactosidase(Beano),anoverthe-counterdigestiveaid,containsthe sugar-digestingenzymethatthebody

lackstodigestthesugarinbeansand manyvegetables.Theenzymecomes inliquidandtabletform.Fivedrops areaddedperservingoronetabletis swallowedjustbeforeeatingtobreak downthegas-producingsugars.Beano hasnoeffectongascausedbylactoseor fiber.

? Simethicone(Gas-X,MylantaGas)can relievebloatingandabdominalpainor discomfortcausedbygas.

? Lactasetabletsordropscanhelppeople withlactoseintolerancedigestmilkand milkproductstoreducegas.Lactase tabletsaretakenjustbeforeeating foodsthatcontainlactose;lactasedrops canbeaddedtoliquidmilkproducts. Lactose-freeandlactose-reducedmilk andmilkproductsareavailableatmost grocerystores.

Taking prescription medications.Health careprovidersmayprescribemedicationsto helpreducesymptoms,especiallyforpeople withsmallintestinalbacterialovergrowthor IBS.FormoreinformationaboutIBS,see theIrritable Bowel Syndromefactsheetfrom theNationalDigestiveDiseasesInformation Clearinghouseatdigestive.niddk..

Eating, Diet, and Nutrition

People'seatinghabitsanddietaffectthe amountofgastheyhave.Forexample, eatinganddrinkingtoofastmayincrease theamountofairswallowed,andfoods thatcontaincarbohydratesmaycausesome peopletohavemoregas.

Trackingeatinghabitsandsymptomscan helpidentifythefoodsthatcausemoregas. Avoidingoreatinglessofthesefoodsmay helpreducegassymptoms.

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Points to Remember

? Gasisairinthedigestivetract.

? Everyonehasgas.However,many peoplethinktheypassgastoo oftenandthattheyhavetoomuch gas.Havingtoomuchgasisrare.

? Gasinthedigestivetractisusually causedbyswallowingairandbythe breakdownofcertainfoodsinthe largeintestinebybacteria.

? Mostfoodsthatcontain carbohydratescancausegas.In contrast,fatsandproteinscause littlegas.

? Foodsthatproducegasinone

personmaynotcausegasfor

someoneelse.

? Themostcommonsymptoms ofgasareburping,passinggas, bloating,andabdominalpainor discomfort.

? Gascanbetreatedbyreducing swallowedair,makingdietary changes,ortakingover-the-counter orprescriptionmedications.

Hope through Research

TheNationalInstituteofDiabetesand DigestiveandKidneyDiseases(NIDDK) sponsorsresearchintodigestiveconditions, includinggas.Researchersarestudying disordersthatmaycausegassymptoms,such asIBS.

TheNIDDKandothercomponentsof theNationalInstitutesofHealth(NIH) areconductingclinicaltrialsaimedat improvingthediagnosisandtreatmentof

IBS.SelfAdministeredCognitiveBehavior TherapyforIrritableBowelSyndrome, fundedunderNIHclinicaltrialnumber NCT00738920,assessestheshort-and long-termefficacyofcognitivebehavior therapyforIBSusingtwotreatmentdelivery systems:selfadministeredandtherapist administered.Long-termprojectgoals includedevelopmentofaneffectiveselfadministeredbehavioraltreatmentprogram thatcanenhancequalityofpatientcare, improveclinicaloutcomes,anddecreasethe economicandpersonalcostsofIBS.

SafetyStudyofProbioticsinAdultswith IrritableBowelSyndrome,fundedunder NIHclinicaltrialnumberNCT00971711,isa phaseIstudyofthesafetyandeffectiveness ofVSL#3inadultswithIBS.VSL#3isa high-potencyprobioticmedicalfoodthat iscommerciallyavailable.Acupuncture/ MoxibustionforIrritableBowelSyndrome (Acu/MoxalIBS),fundedunderNIH clinicaltrialnumberNCT00945074,tests theefficacyofacupunctureincombination withmoxibustionforsymptomimprovement inadultswithIBS.Moxibustionisthe applicationofheatfromaburningherbat theacupuncturepoint.Allparticipantswill receivemoxibustionandwillbeassignedto oneofthreetreatmentprotocols:standard acupuncture,individualizedacupuncture, andshamacupuncture.

Participantsinclinicaltrialscanplayamore activeroleintheirownhealthcare,gain accesstonewresearchtreatmentsbefore theyarewidelyavailable,andhelpothers bycontributingtomedicalresearch.For informationaboutcurrentstudies,visit .

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