Multidisciplinary, patient-centered care key to managing belching, bloating and distention
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Key takeaways:
- Symptoms of belching, bloating and distention are common and may impair patients’ daily activities.
- Management of these conditions includes dietary, gut-directed behavioral and drug therapies.
A new clinical practice update from the AGA highlights the value of physical examination, effective communication and integrated care in the diagnosis and management of patients with belching, abdominal bloating or distention.
“Few studies address the pathophysiology or risk factors of belching and bloating, and their treatment options remain suboptimal,” Baha Moshiree, MD, MSc, AGAF, clinical professor of gastroenterology at Wake Forest University School of Medicine and Atrium Health, and colleagues wrote in Gastroenterology. “Furthermore, these disorders overlap with other common disorders of gut-brain interaction and their mechanisms involve both centrally mediated and peripheral processes.”
Researchers reviewed published data from clinical trials, observational studies and expert opinion and developed 15 best practice statements for the diagnosis and treatment of belching, bloating and distention. Highlights follow.
- Clinical history, physical examination and impedance pH monitoring may assist in the differentiation between gastric and supragastric belching.
- Rome IV criteria should be used to diagnose primary abdominal bloating and distention.
- Dietary restriction and/or breath testing may be used to rule out carbohydrate enzyme deficiencies, while serologic testing may rule out celiac disease in patients with bloating.
- Abdominal imaging and upper endoscopy should be ordered for patients presenting with “alarming features, recent worsening symptoms or an abnormal physical examination.”
- A gastrointestinal dietitian should monitor treatment when dietary modifications, such as a low-fermentable oligosaccharides, disaccharides, monosaccharides and polyols diet, are needed.
- Neuromodulators may be used to reduce visceral hypersensitivity, raise sensation thresholds and improve psychological comorbidities in patients with bloating and distention.
- Psychological, cognitive and other brain-gut behavior therapies may be used to treat patients with bloating and distention.
- Diaphragmatic breathing and central neuromodulators may be used to treat patients with abdominophrenic dyssynergia.
“We believe a multidisciplinary approach and a patient-centered model are keys to managing treatment in patients with belching, abdominal bloating and distention,” Moshiree and colleagues concluded. “Careful attention to the patients’ primary symptoms, physical examination and limited diagnostic studies can help to navigate patients toward the proper diagnostic evaluation.”
They continued: “Education and effective communication skills using a patient-centered care model will optimize treatment with improved outcomes and increased patient and provider satisfaction, and reduce unneeded diagnostic testing and health care costs.”
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