The first question gastroenterologists ask patients with bloating: why the answer is essential to establishing the diagnosis
Bloating and flatulence are among the most common reasons for presenting to a gastroenterologist, and specialists say that the diagnosis does not begin with complex analyses, but with a seemingly simple but decisive question: when do the symptoms appear and how do they evolve over time.
Bloating affects more and more patients Photo: archive, the truth
“I want to know the timing and pattern of bloating: Is it after meals? Is it related to certain foods? What are their bowel habits?”“, explains Dr. Sripati Ketu, a gastroenterologist. According to the doctor, this first step can quickly orient the investigation and reduce the need for unnecessary tests in the absence of alarm signs, according to Blic.
Bloating is one of the most common complaints in gastroenterology offices, being described as a “multifactorial” symptom, influenced by diet, gut microbiome, medications, but also by stress or hormonal imbalances.
“Out of 20 patients who come for an examination during the day, I even examine four precisely because of flatulence,” says Dr. Sripati Ketu.
Dr. Asma Capra, a gastroenterologist specializing in inflammatory bowel diseases, confirms the same trend and points out that the first step in the evaluation is to understand the context of the symptoms.
“It's important for me to distinguish whether it's upper stomach bloating rather than lower stomach bloating”she explains, noting that the location and timing of symptoms can suggest completely different causes.
In the case of upper abdominal bloating, symptoms often occur after meals and are accompanied by belching or gastric reflux, while lower abdominal bloating is more often associated with transit disturbances such as constipation or diarrhea.
For women, doctors say a gynecological history is essential, as the menstrual cycle or conditions such as endometriosis can significantly influence symptoms.
The possible causes of bloating are numerous and include lactose intolerance, Helicobacter pylori infection, irritable bowel syndrome (IBS), small intestinal bacterial overgrowth (SIBO), chronic constipation, celiac disease, but also sudden fiber consumption or certain hormonal imbalances.
Doctors emphasize that investigations are not always necessary from the first stage, in the absence of alarm signs such as unexplained weight loss, blood in the stool or persistent vomiting. “A specific examination of the abdomen to check for bloating, abnormal bowel sounds or a mass is usually enough to quickly rule out any serious problem”, the specialists explain.
Before the consultation, patients can try some simple measures, such as cutting down on carbonated drinks, alcohol and artificial sweeteners. Probiotics can be helpful, but doctors recommend a trial period of at least four weeks.
“Wait at least four weeks before deciding if it works; if there is no clear improvement, stop using it,” advises Dr. Ketu.
In some cases, peppermint oil or over-the-counter gas medications can provide quick relief. If symptoms persist, elimination diets or the low FODMAP diet can be reached, considered effective in identifying problematic foods, but which must be followed under medical supervision.
“A low-FODMAP diet can be very effective, but must be implemented with proper guidance, not self-imposed long-term restrictions”warns Dr. Ketu.
The connection between the gut and the brain also plays an important role, with doctors pointing out that stress and anxiety can amplify digestive symptoms.
