Some Causes of Gas-Related Symptoms

Belching

Aerophagia (swallowing air)

With or without awareness of swallowing air

Sometimes in patients who smoke or chew gum excessively

Sometimes in patients who have esophageal reflux or ill-fitting dentures

Clinical evaluation

Gas from carbonated beverages

Beverage consumption usually obvious based on history

Clinical evaluation

Voluntary

Patient usually admits when questioned

Clinical evaluation

Distention or bloating

Aerophagia

See Belching

Clinical evaluation

Irritable bowel syndrome

Chronic, recurrent bloating or distention associated with a change in frequency of bowel movements or consistency of stool

No red flag findings

Typically beginning during adolescence and the 20s

Clinical evaluation

Examination of stool

Blood tests

Gastroparesis

Nausea, abdominal pain, sometimes vomiting

Early satiety

Sometimes in patients known to have a causative disorder

Upper endoscopy and/or nuclear scanning that evaluates stomach emptying

Eating disorders

Long-standing symptoms

In patients who are thin but still very concerned about excess body weight, particularly young women

Clinical evaluation

Constipation if chronic

A long history of hard, infrequent bowel movements

Clinical evaluation

Anorectal manometry

Nongastrointestinal disorders (eg, ovarian cancer or colon cancer)

New, persistent bloating in middle-aged or older adults

For colon cancer, sometimes blood in stool (blood may be visible or detected during an examination)

For ovarian cancer, pelvic ultrasonography

For colon cancer, colonoscopy

Flatus

Dietary substances, including beans, dairy products, vegetables, onions, celery, carrots, Brussels sprouts, fruits (eg, raisins, bananas, apricots, prune juice), and complex carbohydrates (eg, pretzels, bagels, wheat germ)

Symptoms that develop mainly after consuming food that can cause gas

Clinical evaluation

Trial of elimination

Disaccharidase deficiency

Bloating, cramps, and diarrhea after consuming milk products

Breath tests

Celiac disease, tropical sprue

Symptoms of anemia, steatorrhea, loss of appetite, diarrhea

For celiac disease, weakness, symptoms that often begin during childhood

For tropical sprue, nausea, abdominal cramps, weight loss

Blood tests

Biopsy of the small intestine

Pancreatic insufficiency

Diarrhea, steatorrhea

Usually a known history of pancreatic disease

Abdominal CT

Sometimes MRI/MRCP, endoscopic ultrasonography, or ERCP

Stool for fecal elastase