Skip to main content

Advertisement

SpringerLink
Log in

Abdominal Bloating and Distension: What Is the Role of the Microbiota

  • Review
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Most patients with irritable bowel syndrome complain of a sensation of an increase in pressure within their abdomen during the course of the day which is called bloating and, in approximately half of these individuals, this symptom is accompanied by an actual increase in abdominal girth, which is referred to as distension. The pathophysiology of these two phenomena is somewhat different and it is now recognised that a whole variety of overlapping mechanisms are involved. Some of these are potentially amenable to treatment by modification of the bacterial flora of the gut and this article reviews the evidence for this.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Houghton LA, Lea R, Agrawal A, Reilly B, Whorwell PJ. Relationship of abdominal bloating to distention in irritable bowel syndrome and effect of bowel habit. Gastroenterology. 2006;131:1003–1010.

    Article  PubMed  Google Scholar 

  2. Agrawal A, Whorwell PJ. Review article: abdominal bloating and distension in functional gastrointestinal disorders—epidemiology and exploration of possible mechanisms. Aliment Pharmacol Ther. 2008;27:2–10.

    Article  PubMed  CAS  Google Scholar 

  3. Houghton LA, Whorwell PJ. Towards a better understanding of abdominal bloating and distension in functional gastrointestinal disorders. Neurogastroenterol Motil. 2005;17:500–511.

    Article  PubMed  CAS  Google Scholar 

  4. Serra J, Azpiroz F, Malagelada JR. Impaired transit and tolerance of intestinal gas in the irritable bowel syndrome. Gut. 2001;48:14–19.

    Article  PubMed  CAS  Google Scholar 

  5. Galati JS, McKee DP, Quigley EM. Response to intraluminal gas in irritable bowel syndrome. Motility versus perception. Dig Dis Sci. 1995;40:1381–1387.

    Article  PubMed  CAS  Google Scholar 

  6. Lewis MJ, Reilly B, Houghton LA, Whorwell PJ. Ambulatory abdominal inductance plethysmography: towards objective assessment of abdominal distension in irritable bowel syndrome. Gut. 2001;48:216–220.

    Article  PubMed  CAS  Google Scholar 

  7. Reilly BP, Bolton MP, Lewis MJ, Houghton LA, Whorwell PJ. A device for 24 h ambulatory monitoring of abdominal girth using inductive plethysmography. Physiol Meas. 2002;23:661–670.

    Article  PubMed  CAS  Google Scholar 

  8. Tremolaterra F, Villoria A, Azpiroz F, Serra J, Aguade S, Malagelada JR. Impaired viscerosomatic reflexes and abdominal-wall dystony associated with bloating. Gastroenterology. 2006;130:1062–1068.

    Article  PubMed  Google Scholar 

  9. Villoria A, Azpiroz F, Soldevilla A, Perez F, Malagelada JR. Abdominal accommodation: a coordinated adaptation of the abdominal wall to its content. Am J Gastroenterol. 2008;103:2807–2815.

    Article  PubMed  Google Scholar 

  10. Accarino A, Perez F, Azpiroz F, Quiroga S, Malagelada JR. Abdominal distention results from caudo-ventral redistribution of contents. Gastroenterology. 2009;136:1544–1551.

    Article  PubMed  Google Scholar 

  11. Agrawal A, Houghton LA, Lea R, Morris J, Reilly B, Whorwell PJ. Bloating and distention in irritable bowel syndrome: the role of visceral sensation. Gastroenterology. 2008;134:1882–1889.

    Article  PubMed  Google Scholar 

  12. Agrawal A, Houghton LA, Reilly B, Morris J, Whorwell PJ. Bloating and distension in irritable bowel syndrome: the role of gastrointestinal transit. Am J Gastroenterol. 2009;104:1998–2004.

    Article  PubMed  Google Scholar 

  13. Sullivan SN. A prospective study of unexplained visible abdominal bloating. N Z Med J. 1994;107:428–430.

    PubMed  CAS  Google Scholar 

  14. Spiller RC. Postinfectious irritable bowel syndrome. Gastroenterology. 2003;124:1662–1671.

    Article  PubMed  Google Scholar 

  15. Madden JA, Hunter JO. A review of the role of the gut microflora in irritable bowel syndrome and the effects of probiotics. Br J Nutr. 2002;88:S67–S72.

    Article  PubMed  CAS  Google Scholar 

  16. Kassinen A, Krogius-Kurikka L, Makivuokko H, Rinttila T, et al. The fecal microbiota of irritable bowel syndrome patients differs significantly from that of healthy subjects. Gastroenterology. 2007;133:24–33.

    Article  PubMed  CAS  Google Scholar 

  17. King TS, Elia M, Hunter JO. Abnormal colonic fermentation in irritable bowel syndrome. Lancet. 1998;352:1187–1189.

    Article  PubMed  CAS  Google Scholar 

  18. Whorwell PJ. Do probiotics improve symptoms in patients with irritable bowel syndrome? Therap Adv Gastroenterol. 2009;2:37–44.

    Article  PubMed  Google Scholar 

  19. Marchesi J, Shanahan F. The normal intestinal microbiota. Curr Opin Infect Dis. 2007;20:508–513.

    Article  PubMed  Google Scholar 

  20. Pimentel M, Chatterjee S, Chow EJ, Park S, Kong Y. Neomycin improves constipation-predominant irritable bowel syndrome in a fashion that is dependent on the presence of methane gas: subanalysis of a double-blind randomized controlled study. Dig Dis Sci. 2006;51:1297–1301.

    Article  PubMed  CAS  Google Scholar 

  21. Pimentel M, Park S, Mirocha J, Kane SV, Kong Y. The effect of a nonabsorbed oral antibiotic [rifaximin] on the symptoms of the irritable bowel syndrome: a randomized trial. Ann Intern Med. 2006;145:557–563.

    PubMed  Google Scholar 

  22. Sharara AI, Aoun E, Abdul-Baki H, Mounzer R, Sidani S, Elhajj I. A randomized double-blind placebo-controlled trial of rifaximin in patients with abdominal bloating and flatulence. Am J Gastroenterol. 2006;101:326–333.

    Article  PubMed  CAS  Google Scholar 

  23. Pimentel M, Lembo A, Chey WD, Zakko S, et al. Rifaximin therapy for patients with irritable bowel syndrome without constipation. N Engl J Med. 2011;364:22–32.

    Article  PubMed  CAS  Google Scholar 

  24. Shanahan F. Irritable bowel syndrome: shifting the focus toward the gut microbiota. Gastroenterology. 2007;133:340–342.

    Article  PubMed  CAS  Google Scholar 

  25. Eckburg PB, Bik EM, Bernstein CN, Purdom E, et al. Diversity of the human intestinal microbial flora. Science. 2005;308:1635–1638.

    Article  PubMed  Google Scholar 

  26. Collins S, Verdu E, Denou E, Bercik P. The role of pathogenic microbes and commensal bacteria in irritable bowel syndrome. Dig Dis. 2009;27:85–89.

    Article  PubMed  Google Scholar 

  27. Malinen E, Krogius-Kurikka L, Lyra A, Nikkila J et al. Association of symptoms with gastrointestinal microbiota in irritable bowel syndrome. World J Gastroenterol. 2010;16:4532–4540.

    Google Scholar 

  28. Malinen E, Rinttila T, Kajander K, Matto J, et al. Analysis of the fecal microbiota of irritable bowel syndrome patients and healthy controls with real-time PCR. Am J Gastroenterol. 2005;100:373–382.

    Article  PubMed  CAS  Google Scholar 

  29. Matto J, Maunuksela L, Kajander K, Palva A, et al. Composition and temporal stability of gastrointestinal microbiota in irritable bowel syndrome—a longitudinal study in IBS and control subjects. FEMS Immunol Med Microbiol. 2005;43:213–222.

    Article  PubMed  Google Scholar 

  30. Noor SO, Ridgway K, Scovell L, Kemsley EK et al. Ulcerative colitis and irritable bowel patients exhibit distinct abnormalities of the gut microbiota. BMC Gastroenterol. 2010;10:134.

    Google Scholar 

  31. Krogius-Kurikka L, Lyra A, Malinen E, Aarnikunnas J, et al. Microbial community analysis reveals high level phylogenetic alterations in the overall gastrointestinal microbiota of diarrhoea-predominant irritable bowel syndrome sufferers. BMC Gastroenterol. 2009;9:95.

    Article  PubMed  Google Scholar 

  32. Tana C, Umesaki Y, Imaoka A, Handa T, Kanazawa M, Fukudo S. Altered profiles of intestinal microbiota and organic acids may be the origin of symptoms in irritable bowel syndrome. Neurogastroenterol Motil. 2010;22:512–519, e114–115.

    Google Scholar 

  33. Yang J, Lee HR, Low K, Chatterjee S, Pimentel M. Rifaximin versus other antibiotics in the primary treatment and retreatment of bacterial overgrowth in IBS. Dig Dis Sci. 2008;53:169–174.

    Article  PubMed  CAS  Google Scholar 

  34. Kim HJ, Camilleri M, McKinzie S, Lempke MB, et al. A randomized controlled trial of a probiotic, VSL#3, on gut transit and symptoms in diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther. 2003;17:895–904.

    Article  PubMed  CAS  Google Scholar 

  35. Kim HJ, Vazquez Roque MI, Camilleri M, Stephens D, et al. A randomized controlled trial of a probiotic combination VSL# 3 and placebo in irritable bowel syndrome with bloating. Neurogastroenterol Motil. 2005;17:687–696.

    Article  PubMed  CAS  Google Scholar 

  36. Whorwell PJ, Altringer L, Morel J, Bond Y, et al. Efficacy of an encapsulated probiotic Bifidobacterium infantis 35624 in women with irritable bowel syndrome. Am J Gastroenterol. 2006;101:1581–1590.

    Article  PubMed  Google Scholar 

  37. Ritchie J. Pain from distension of the pelvic colon by inflating a balloon in the irritable colon syndrome. Gut. 1973;14:125–132.

    Article  PubMed  CAS  Google Scholar 

  38. Azpiroz F, Bouin M, Camilleri M, Mayer EA, et al. Mechanisms of hypersensitivity in IBS and functional disorders. Neurogastroenterol Motil. 2007;19:62–88.

    Article  PubMed  CAS  Google Scholar 

  39. Mertz H, Naliboff B, Munakata J, Niazi N, Mayer EA. Altered rectal perception is a biological marker of patients with irritable bowel syndrome. Gastroenterology. 1995;109:40–52.

    Article  PubMed  CAS  Google Scholar 

  40. Bercik P, Verdu EF, Collins SM. Is irritable bowel syndrome a low-grade inflammatory bowel disease? Gastroenterol Clin North Am. 2005;34:235–245, vi–vii.

    Google Scholar 

  41. Spiller R, Garsed K. Postinfectious irritable bowel syndrome. Gastroenterology. 2009;136:1979–1988.

    Article  PubMed  Google Scholar 

  42. McKernan DP, Fitzgerald P, Dinan TG, Cryan JF. The probiotic Bifidobacterium infantis 35624 displays visceral antinociceptive effects in the rat. Neurogastroenterol Motil. 2010;22:1029–1035, e268.

    Google Scholar 

  43. Ait-Belgnaoui A, Han W, Lamine F, Eutamene H, et al. Lactobacillus farciminis treatment suppresses stress induced visceral hypersensitivity: a possible action through interaction with epithelial cell cytoskeleton contraction. Gut. 2006;55:1090–1094.

    Article  PubMed  CAS  Google Scholar 

  44. Eutamene H, Lamine F, Chabo C, Theodorou V, et al. Synergy between Lactobacillus paracasei and its bacterial products to counteract stress-induced gut permeability and sensitivity increase in rats. J Nutr. 2007;137:1901–1907.

    PubMed  CAS  Google Scholar 

  45. Caldarella MP, Serra J, Azpiroz F, Malagelada JR. Prokinetic effects in patients with intestinal gas retention. Gastroenterology. 2002;122:1748–1755.

    Article  PubMed  Google Scholar 

  46. Marteau P, Cuillerier E, Meance S, Gerhardt MF, et al. Bifidobacterium animalis strain DN-173 010 shortens the colonic transit time in healthy women: a double-blind, randomized, controlled study. Aliment Pharmacol Ther. 2002;16:587–593.

    Article  PubMed  CAS  Google Scholar 

  47. Meance SCC, Raimondi A. Recent advances in the use of functional foods: effects of the commercial fermented milk with Bifidobacterium animalis strain DN-173 010 and yoghurt strains on gut transit time in the elderly. Microb Ecol Health Dis. 2003;15:15–22.

    Article  Google Scholar 

  48. Bouvier MMS, Bouley C. Effects of consumptionn of a milk fermented by the probiotic strain Bifidobacterium animalis DN-173 010 on colonic transit times in healthy humans. Bioscience Microflora. 2001;20:43–48.

    CAS  Google Scholar 

  49. Meance SCC, Turchet P. A fermented milk with a bifidobacterium probiotic strain DN-173 010 shortened oro-fecal gut transit time in elderly. Microb Ecol Health Dis. 2001;13:217–222.

    Article  Google Scholar 

  50. Agrawal A, Houghton LA, Morris J, Reilly B, et al. Clinical trial: the effects of a fermented milk product containing Bifidobacterium lactis DN-173-010 on abdominal distension and gastrointestinal transit in irritable bowel syndrome with constipation. Aliment Pharmacol Ther. 2009;29:104–114.

    Article  PubMed  CAS  Google Scholar 

  51. Pimentel M, Soffer EE, Chow EJ, Kong Y, Lin HC. Lower frequency of MMC is found in IBS subjects with abnormal lactulose breath test, suggesting bacterial overgrowth. Dig Dis Sci. 2002;47:2639–2643.

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

Professor Whorwell has served as an advisory board member or has received research funding from the following pharmaceutical companies: Novartis Pharmaceuticals, Glaxo SmithKline, Solvay Pharmaceuticals, Rotta Research, Proctor and Gamble, Danone Research, Astellas Pharma, Ironwood Pharmaceuticals, Sucampo Pharmaceuticals, Almirall Pharma, Movetis UK, Norgine and Chr Hansen. Boehringer–Ingelheim, Heel GMBH.

Author information

Authors and Affiliations

  1. Neurogastroenterology Unit, Department of Translational Medicine, University of Manchester, Manchester, UK

    B. Issa & P. J. Whorwell

  2. Department of General and Colorectal Surgery, Fairfield General Hospital, The Pennine Acute Hospitals NHS Trust, Bury, BL9 7TD, UK

    N. A. Wafaei

  3. Education and Research Centre, Wythenshawe Hospital, Manchester, M23 9LT, UK

    P. J. Whorwell

Authors
  1. B. Issa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. N. A. Wafaei
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. J. Whorwell
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P. J. Whorwell.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Issa, B., Wafaei, N.A. & Whorwell, P.J. Abdominal Bloating and Distension: What Is the Role of the Microbiota. Dig Dis Sci 57, 4–8 (2012). https://doi.org/10.1007/s10620-011-1834-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-011-1834-4

Keywords

Search

Navigation