Impact of Bloating and Distention in Irritable Bowel Syndrome: Have We Wandered too far From the Manning Creed?

Bloating, distention, and various other symptoms rightly or wrongly attributed to excessive accumulation or emission of gas are undoubtedly common among irritable bowel syndrome (IBS) patients. Indeed, many clinicians would regard complaints such as “I get so bloated when I eat,” “I feel six months pregnant by evening time,” or “I suffer terribly from trapped wind” as virtually pathognomonic of IBS.¹ Furthermore, of the many symptoms that assail the IBS sufferer, bloating and distention are among those most recalcitrant to therapy, some accolade in a syndrome scarcely renowned for its susceptibility to cure! Thus distention is included in one of the first diagnostic schemes in IBS, the Manning criteria.² Later studies of the prevalence of bloating and related symptoms among IBS patients attending a physician attested not only to the high prevalence of these symptoms but also to their frequent contribution to patient distress and impairment of quality of life. In this month's issue of Clinical Gastroenterology and Hepatology, Ringel et al⁵ provided further evidence of the impact of these symptoms in their study of bloating among a large community sample by illustrating in a U.S. population, as Hungin et al⁶ had in Europe, just how common and distressful bloating is in IBS. Yet, these very symptoms are notable by their absence among the criteria most commonly used nowadays for the definition and classification of IBS for clinical trials, Rome I through III. If bloating and distention are so common and important to the IBS patient, why are they so ignored by the cognoscenti?