Excessive flatulence

Specialty: Gastrointestinal.

• Meteorism
• increased gas expulsion
• excess intestinal gas
• recurring winds

Why it occurs

• Malabsorption of short-chain carbohydrates (lactose, fructose or sorbitol intolerance) that undergo rapid bacterial fermentation in the colon
• Small intestinal bacterial overgrowth (SIBO) with proximal colonization by gas-producing bacteria
• Irritable bowel syndrome with alteration of colonic motility and visceral tolerance to gas volume
• Dietary habits with high FODMAP content
• Aerophagia secondary to rapid chewing, constant chewing of gum or active smoking.

Initial workup

Hydrogen and expired methane breath test using glucose or lactulose substrates (for the diagnosis of SIBO) | Oral lactose or fructose tolerance test with hydrogen measurement | Functional coprology and fecal elastase to exclude digestive insufficiency | General analysis with anti-transglutaminase IgA antibodies (celiac disease).

Standard management

• Simethicone — 80-120 mg three or four times a day after meals, acts by reducing the surface tension of gas bubbles in the intestinal lumen, facilitating their coalescence and elimination
• Specific digestive enzymes — lactase administered before dairy ingestion; or alpha-galactosidase before consuming legumes or flatulent vegetables
• Nonabsorbable luminal-acting antibiotics for SIBO — rifaximin 550 mg three times a day or 400 mg three times a day for 10-14 days to reduce the fermentative bacterial load
• Probiotics with selected strains of Bifidobacterium infantis or Lactobacillus plantarum to regulate the fermentative flora.