Հայերեն
Русский
Abdominal Bloating (abdominal bloating, distension)
Abdominal bloating is a subjective sensation of increased abdominal volume, pressure, or fullness, which is not always associated with an increased amount of intestinal gas.
It is important to distinguish between:
Bloating — a subjective sensation;
Abdominal distension — an objective increase in abdominal girth;
Meteorism (flatulence) — excessive accumulation of gas within the intestines.
In clinical practice, these conditions may coexist but are not synonymous.
Causes and risk factors
Main causes
Functional gastrointestinal disorders, particularly irritable bowel syndrome (IBS)
Visceral hypersensitivity — increased perception of normal intestinal processes
Impaired intestinal motility
Disorders of carbohydrate digestion and absorption (lactase deficiency, FODMAP intolerance)
Discoordination between the abdominal wall and diaphragm (abdominophrenic reflex)
Celiac disease, exocrine pancreatic insufficiency
Gynecological, endocrine, and metabolic conditions (when indicated)
Risk factors
Psychoemotional stress
Anxiety disorders
Irregular eating habits
Low physical activity
Diets high in fermentable carbohydrates
Main pathophysiological mechanisms
Current research shows that in many patients with bloating:
the total volume of intestinal gas remains within normal limits,
but its distribution and perception are altered.
Key mechanisms include:
Visceral hypersensitivity
Impaired intestinal motility
Alterations in the gut microbiota
Functional abdominal distension without excess gas
Dysregulation of the gut–brain axis
Symptoms
Sensation of abdominal pressure and bloating
Feeling of heaviness after meals
Visible increase in abdominal circumference (not always present)
With or without associated abdominal pain
Possible worsening of symptoms in the evening
Diagnosis (criteria)
Diagnostic evaluation is aimed not at “detecting gas,” but at excluding organic pathology and identifying the functional nature of symptoms.
Core principles
Clinical assessment of symptoms
Identification of alarm features
Minimal necessary diagnostic testing
Additional investigations (when indicated)
Laboratory tests
Endoscopy or imaging — only in the presence of alarm symptoms
Treatment
Treatment depends on the underlying mechanism, not merely on the presence of bloating.
Possible approaches include:
Dietary modification (including low FODMAP diet, when indicated)
Normalization of intestinal motility
Treatment of SIBO when confirmed
Interventions targeting the gut–brain axis
Limited and evidence-based use of anti-gas medications
Empirical treatment without understanding the underlying mechanism is ineffective.
Complications and prevention
Bloating itself is not a dangerous symptom, but it may:
significantly reduce quality of life;
require differential diagnosis when symptoms are persistent or progressive.
Preventive strategies include:
an individualized dietary approach;
stress management;
timely medical consultation when symptoms change.
When to see a doctor
Persistent or progressive bloating
Nocturnal symptoms
Unintentional weight loss
Anemia
Blood in the stool
Symptom onset after the age of 50
yeranik hambardzumyan
CEO, gastroenterologist, endoscopist
meri soghoyan
gastroenterologist, hepatologist
lucy hovakimyan
gastroenterologist, nutritionist
