Hyperactive borborygmi

Specialty: Gastrointestinal.

• Audible abdominal gurgling
• increased intestinal noises
• intestinal fighting noises

Why it occurs

• Fight phase in incipient mechanical intestinal obstruction (peristalsis increases to overcome a physical obstacle)
• Acute infectious or alimentary gastroenteritis with reflex hypermotility due to bacterial or viral enterotoxins
• Malabsorption or feeding intolerance with hypermotility induced by intraluminal osmotic gradient
• Irritable bowel syndrome with a diarrheal pattern due to colonic hyperreactive autonomic stimulation.

Initial workup

Systematic abdominal auscultation to characterize the frequency and tone of noises | Plain x-ray of the abdomen in standing position (to assess air-fluid levels and struggle handles) | Abdominal CT with intravenous contrast if there is suspicion of high or low mechanical obstruction | Emergency analysis: blood count, electrolytes, lactate blood gases and CRP.

Standard management

• Antispasmodics in gastroenteritis or IBS without suspicion of mechanical obstruction — butylscopolamine bromide 10-20 mg orally or intravenously, or otilonium bromide 40 mg orally to slow coordinated smooth muscle contractions
• Loperamide — 2 mg after each liquid stool in acute non-infectious diarrhea to delay transit, formally contraindicated if there is suspicion of infection by invasive pathogens with fever or dysentery
• Oral rehydration solutions to compensate for water losses caused by hypermotility.