Intestinal Gas Belching Bloating

Medical Author - Jay Marks M.D.
Medical Editor - Leslie J. Schoenfield M.D. PhD.

What causes belching?
The ability to belch is almost universal. Belching, also known as burping, is the act of expelling gas from the stomach out through the mouth. The usual cause of belching is a distended (inflated) stomach caused by swallowed air. The distention of the stomach causes abdominal discomfort, and the belching expels the air and relieves the discomfort. The common reasons for swallowing large amounts of air (aerophagia) are gulping food or drink too rapidly, anxiety, and carbonated beverages. People are often unaware that they are s wallowing air. "Burping" infants during bottle or breast feeding is important in order to expel air in the stomach that has been swallowed with the formula or milk.

What causes bloating?
It is important to distinguish between bloating and distention. Bloating is the subjective sensation (feeling) that the abdomen is larger than normal. Thus, bloating is a symptom akin to the symptom of discomfort. In contrast, distention is the objective determination (physical finding) that the abdomen is actually larger than normal. Distention can be determined by such observations as the inability to fit into clothes or looking down at the stomach and noting that it is clearly larger than normal. In some instances, bloating may represent a mild form of distention since the abdomen does not become physically (visibly or measurably) enlarged until its volume increases by one quart. Nevertheless, bloating should never be assumed to be the same as distention.

There are three ways in which abdominal distention can arise. The causes are an increase in air, fluid, or tissue within the abdomen. The diseases or conditions that cause an increase of any of these three factors are very different from one anther. Therefore, it is important to determine which of them is distending the abdomen.

What causes flatulence?
Flatulence, also known as farting, is the act of passing intestinal gas from the anus. Gas in the gastrointestinal tract has only two sources. It is either swallowed air or it is produced by bacteria that normally inhabit the intestines, primarily the colon. Swallowed air is rarely the cause of excessive flatulence. The usual source is the production of excessive gas by intestinal bacteria. The bacteria produce the gas (hydrogen and/or methane) when they digest foods, primarily sugars and polysaccharides (e.g., starch, cellulose), that have not been digested during passage through the small intestine. Sugars that are commonly poorly digested (maldigested) and malabsorbed are lactose, sorbitol, and fructose. Lactose is the sugar in milk. The absence of the enzyme lactase in the lining of the intestines, which is a genetic trait, causes the maldigestion. Lactase is important because it breaks apart the lactose so that it can be absorbed. Sorbitol is a commonly used sweetener in low calorie foods. Fructose is a commonly used sweetener in all types of candies and drinks.

Starches are another common source of intestinal gas. Starches are polysaccharides that are produced by plants and are composed of long chains of sugars. Common sources of different types of starch include wheat, oats, potatoes, corn, and rice. Rice is the most easily digested starch and little undigested rice starch reaches the colon and the colonic bacteria. Accordingly, the consumption of rice produces little gas. In contrast, the starches in wheat, oats, potatoes, and, to a lesser extent, corn, all reach the colon and the bacteria in substantial amounts. These starches, therefore, result in the production of appreciable amounts of gas.

The starch in whole grains produces more gas than the starch in refined (purified) grains. Thus, more gas is formed after eating foods made with whole wheat flour than with refined wheat flour. This difference in gas production probably occurs because the fiber present in the whole grain flour slows the digestion of starch as it travels through the small intestine. Much of this fiber is removed during the processing of whole grains into refined flour. Finally, certain fruits and vegetables, for example, cabbage, also contain poorly digested starches that reach the colon and result in the formation of gas.

Most vegetables and fruits contain cellulose, another type of polysaccharide that is not digested at all as it passes through the small intestine. However, unlike sugars and other starches, cellulose is used only very slowly by colonic bacteria. Therefore, the production of gas after the consumption of fruits and vegetables usually is not great unless the fruits and vegetables also contain sugars or polysaccharides other than cellulose.

Excessive production of gas
Excessive production of gas by bacteria is a common cause of intermittent abdominal bloating/distention. Bacteria can produce too much gas in three ways:

First, the amount of gas that bacteria produce varies from individual to individual. In other words, some individuals may have bacteria that produce more gas, either because there are more of the bacteria or because their particular bacteria are better at producing gas.
Second, there may be poor digestion and absorption of foods in the small intestine, allowing more undigested food to reach the bacteria in the colon. The more undigested food the bacteria have, the more gas they produce. Examples of diseases of that involve poor digestion and absorption include lactose intolerance, pancreatic insufficiency, and celiac disease.
Third, bacterial overgrowth can occur in the small intestine. Under normal conditions, the bacteria that produce gas are limited to the colon. In some medical conditions, these bacteria spread into the small intestine. When this bacterial spread occurs, food reaches the bacteria before it can be fully digested and absorbed by the small intestine. Therefore, the bacteria in the small intestine have a lot of undigested food from which to form gas. This condition in which the gas-producing bacteria move into the small intestine is called bacterial overgrowth of the small intestine (bowel)

Excessive production of gas by bacteria is usually accompanied by more flatulence. Increased flatulence may not always occur, however, since gas potentially can be eliminated in other ways-absorption into the body, utilization by other bacteria, or possibly, by elimination at night without the knowledge of the gas-passer.

Next - How are belching, bloating/distension and flatulence evaluated?

The above information is provided for general educational purposes only. It is not intended to replace competent health care advice received from a knowledgeable healthcare professional. You are urged to seek healthcare advice for the treatment of any illness or disease.
Health Canada and the FDA (USA) have not evaluated these statements. This product is not intended to diagnose, treat, cure, or prevent any disease.

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