Intestinal Gas (Belching, Bloating, Flatulence)
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
- Intestinal gas facts
- What causes belching or burping?
- What causes bloating?
- What causes flatulence (gas)?
- What are the causes of intermittent abdominal bloating/distention?
- Which specialties of doctors treat excessive gas, belching, bloating, and flatulence?
- How are the causes of belching, bloating/distention, and flatulence evaluated?
- What is the treatment for excessive intestinal gas caused by medical conditions?
- What natural or home remedies help soothe and get rid of intestinal gas?
- What over-the-counter (OTC) products are available to soothe and cure excessive gas?
- What foods cause intestinal gas?
- What's new in intestinal gas?
Intestinal gas facts
- The intestine normally contains gas that is rapidly transmitted through the small intestine to the colon. The amount of gas that is normally present is dependent on the effects of colonic bacteria on the undigested food that reaches the colon and the speed with which the gas passes through the intestines and is passed. In normal individuals, most of the lower intestinal gas that is passed (flatus) is gas produced in the colon and is not transmitted from the upper intestines.
- The definition of excessive gas varies by individual, usually based on what they have considered normal in the past. Some individuals consider excessive gas to be excessive belching or excessive burping (burping a lot), others excessive passing of gas (flatulence), and still others as the sensation of fullness in the abdomen. Although everyone goes through periods of excessive gas, particularly flatulence, it is only when the symptoms become chronic that people become concerned.
- The most common normal cause of belching is excessive gas in the stomach that comes from swallowed air. However, discomfort in the abdomen for any reason also may lead to excessive belching. Therefore, belching does not always indicate the presence of excessive gas in the stomach. It is not difficult usually to differentiate between excessive gas in the stomach and other causes of excessive gas. If the problem is gas in the stomach, belching brings relief. If it is not gas in the stomach belching does not bring relief. Although excessive belching may be a sign of excessive gas, it usually is not and is rather a sign of abdominal discomfort of many causes or a learned habit of swallowing and immediately regurgitating the air as a belch. Rarely excessive belching (burping a lot) is due to swallowed air during acute psychiatric issues associated with anxiety.
- Bloating is the subjective feeling that the abdomen is full than it should be, but does not necessarily mean that the abdomen is enlarged. Distention is the objective enlargement of the abdomen. Bloating is not the same (synonymous) as excessive gas.
- Continuous distention of the abdomen usually is caused by fluid, tumors, enlarged organs, or fat within the abdomen.
- Intermittent distention of the abdomen may be caused by excessive formation of intestinal gas, but also physical or functional obstruction of the intestines.
- Belching and flatulence (farting or passing gas) are virtually universal. The maximum number of farts for a normal person is 20 per day. The number that defines a "lot" of burping has not been determined.
- Flatulence results from the production of gas by bacteria within the intestines (usually the colon) when they digest dietary sugars and polysaccharides that reach the colon undigested.
- Increased gas is not caused by the irritable bowel syndrome (IBS) or most parasitic or bacterial intestinal infections. It also is not caused by gastritis, gastric cancer, gallstones, cholecystitis, and pancreatitis or cystic fibrosis (unless there is maldigestion of food). It also should not be confused with indigestion which has causes other than gas.
- Excessive production of gas and increased flatulence may occur because of:
- the greater ability of some bacteria to produce gas;
- maldigestion or malabsorption of sugars and polysaccharides such as that seen in chronic pancreatitis with pancreatic insufficiency, celiac disease; and
- bacterial overgrowth of the small intestine.
- Abdominal pain is not a common symptom of people with excessive gas although the discomfort of bloating may be described as pain. Cramps and severe pain suggest causes other than gas, for example, intestinal obstruction that also can lead to abdominal distention and discomfort.
- Remedies for truly excessive gas include changes in diet and suppression of intestinal bacteria that produce the gas. There is no evidence that digestive enzymes, activated charcoal, and simethicone (Gas-X, Mylanta, and others).
- The remedy for excessive belching not due to excessive gas is by learning new physical habits such as breathing with the mouth open.
- Foul smelling gas (flatus) is not synonymous (the same) with excessive gas. The foul smell of flatus results from the types of food that are eaten and the types of gasses produced by the bacteria in the colon, particularly gasses that contain sulfur.
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