RECND559

Gas

Condition:Flatulence
Other:Meteorism

Summary

Top 5 natural treatments for gas:

1. Elimination diet
2. Carminative herbs (peppermint, chamomile, fennel)
3. Digestive enzymes

Naturopathic Treatments

Lifestyle
• eat slowly (to reduce amount of air swallowed)
• stress management
• ensure proper digestion and elimination

Diet:
• elimination diet
• avoid lactose, sorbitol, fructose, inulin, etc
• increase bitter greens - promotes digestion

Herbal Carminatives
peppermint (Mentha piperita)
fennel (Foeniculum vulgare )
ginger (Zingiber officinale)

Supplements
• probiotics
peppermint oil capsules
• digestive enzymes (e.g. alpha-galactosidase for beans and legumes)
• activated charcoal

Conventional Treatments

• dietary modifications (avoid foods that exacerbate, cut back on fried/fatty foods, decrease consumption of high-fiber foods, reduce dairy or wheat products)
• Beano
• lactase supplements
• simethicone
• activated charcoal

Signs & Symptoms

• voluntary or involuntary passage of gas
• sharp, knotting or cramping pains in abdomen
• abdominal distension

DDx

• food allergy, sensitivity
irritable bowel syndrome (IBS)
• diverticular disease
• high-fiber diet
• high legume diet
• lactose intolerance
• lactase deficiency
• giardiasis
• celiac disease
• malabsorption
• pancreatic insufficiency
gallstones
• stomach infection

Pathogenesis

• common causes include: swallowing air (when eating too fast, chewing gum, anxious), consumption of legumes or other foods that are harder to digest or are high in fiber;
• other causes include: excessive laxative use, constipation, antibiotics, food intolerances (gluten, lactose), artifical additives (e.g. sweeteners), another health condtion (e.g. IBD)

Diagnostics

• physical exam
• subjective history
• dietary review

Diagnostic Tests
• tympany over areas of the abodomen
• x-ray
• CT
• ultrasound
• contrast enema
• colonoscopy

References

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Volker Fintelmann & Rudolf Fritz Weiss "Herbal Medicine" Georg Thieme Verlag, New York, 2000. p 72-77.

Suarez FL, Furne J, Springfield J, Levitt MD. Failure of activated charcoal toreduce the release of gases produced by the colonic flora. Am J Gastroenterol.1999 Jan;94(1):208-12. PubMed PMID: 9934757.

Giffard CJ, Collins SB, Stoodley NC, Butterwick RF, Batt RM. Administration ofcharcoal, Yucca schidigera, and zinc acetate to reduce malodorous flatulence indogs. J Am Vet Med Assoc. 2001 Mar 15;218(6):892-6. PubMed PMID: 11294313.

Ohge H, Furne JK, Springfield J, Ringwala S, Levitt MD. Effectiveness ofdevices purported to reduce flatus odor. Am J Gastroenterol. 2005Feb;100(2):397-400. PubMed PMID: 15667499.

Hall RG Jr, Thompson H, Strother A. Effects of orally administered activatedcharcoal on intestinal gas. Am J Gastroenterol. 1981 Mar;75(3):192-6. PubMedPMID: 7015846.

Appel A. [Activated charcoal as deodorizing agent in colostomy]. Chirurg. 1974Jan;45(1):43. German. PubMed PMID: 4823125.

Kim HJ, Vazquez Roque MI, Camilleri M, Stephens D, Burton DD, Baxter K,Thomforde G, Zinsmeister AR. A randomized controlled trial of a probioticcombination VSL# 3 and placebo in irritable bowel syndrome with bloating.Neurogastroenterol Motil. 2005 Oct;17(5):687-96. PubMed PMID: 16185307.

Ojetti V, Gigante G, Gabrielli M, Ainora ME, Mannocci A, Lauritano EC,Gasbarrini G, Gasbarrini A. The effect of oral supplementation with Lactobacillusreuteri or tilactase in lactose intolerant patients: randomized trial. Eur RevMed Pharmacol Sci. 2010 Mar;14(3):163-70. PubMed PMID: 20391953.

Kalman DS, Schwartz HI, Alvarez P, Feldman S, Pezzullo JC, Krieger DR. Aprospective, randomized, double-blind, placebo-controlled parallel-group dualsite trial to evaluate the effects of a Bacillus coagulans-based product onfunctional intestinal gas symptoms. BMC Gastroenterol. 2009 Nov 18;9:85. PubMedPMID: 19922649; PubMed Central PMCID: PMC2784472.

Liu JH, Chen GH, Yeh HZ, Huang CK, Poon SK. Enteric-coated peppermint-oilcapsules in the treatment of irritable bowel syndrome: a prospective, randomized trial. J Gastroenterol. 1997 Dec;32(6):765-8. PubMed PMID: 9430014.

Lohsiriwat S, Rukkiat M, Chaikomin R, Leelakusolvong S. Effect of ginger onlower esophageal sphincter pressure. J Med Assoc Thai. 2010 Mar;93(3):366-72.PubMed PMID: 20420113.

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