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Bloating and functional gastro-intestinal disorders: Where are we and where are we going?

World Journal of Gastroenterology 2014年第39期20卷 14407-14419页

作者： Paola Iovino Cristina Bucci fabrizio tremolaterra Antonella Santonicola Giuseppe Chiarioni Gastrointestinal Unit Department of Medicine and SurgeryUniversity of Salerno 84081 Baronissi Salerno Italy IRCCS Centro di riferimento Oncologico di Basilicata Rionero in Vulture 85100 Potenza Italy Division of Gastroenterology of the University of Verona Azienda Ospedaliera Universitaria Integrata di Verona 37100 Verona Italy Division of Gastroenterology and Hepatology and Center for functional GI and Motility Disorders University of North Carolina at Chapel HillChapel HillNC 27599 United States

Bloating is one of the most common and bothersome symptoms complained by a large proportion of patients. This symptom has been described with various definitions, such as sensation of a distended abdomen or an abdominal tension or even excessive gas in the abdomen, although bloating should probably be defined as the feeling (e.g. a subjective sensation) of increased pressure within the abdomen. It is usually associated with functional gastrointestinal disorders, like irritable bowel syndrome, but when bloating is not part of another functional bowel or gastrointestinal disorder it is included as an independent entity in Rome III criteria named functional bloating. In terms of diagnosis, major difficulties are due to the lack of measurable parameters to assess and grade this symptom. In addition, it is still unclear to what extent the individual patient complaint of subjective bloating correlates with the objective evidence of abdominal distension. In fact, despite its clinical, social and economic relevance, bloating lacks a clear pathophysiology explanation, and an effective management endorsement, turning this common symptom into a true challenge for both patients and clinicians. Different theories on bloating etiology call into questions an increased luminal contents (gas, stools, liquid or fat) and/or an impaired abdominal empting and/or an altered intra-abdominal volume displacement (abdomino-phrenic theory) and/or an increased perception of intestinal stimuli with a subsequent use of empirical treatments (diet modifications, antibiotics and/or probiotics, prokinetic drugs, antispasmodics, gas reducing agents and tricyclic antidepressants). In this review, our aim was to review the latest knowledge on bloating physiopathology and therapeutic options trying to shed lights on those processes where a clinician could intervene to modify disease course.

关键词： Bloating Functional gastro-intestinal disorders Irritable bowel syndrome Constipation Diarrhea

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