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

Published:October 16, 2008DOI:https://doi.org/10.1016/j.cgh.2008.10.010
      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.
      • Agarwal A.
      • Whorwell P.J.
      Review article: abdominal bloating and distension in functional gastrointestinal disorders: epidemiology and exploration of possible mechanisms.
      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.
      • Manning A.P.
      • Thompson W.
      • Heaton K.W.
      • et al.
      Toward positive diagnosis of irritable bowel.
      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.
      • Schmulson M.
      • Lee O.Y.
      • Chang L.
      • et al.
      Symptom differences in moderate to sever IBS patients based on predominant bowel habit.
      • Lembo T.
      • Naliboff B.
      • Munakata J.
      • et al.
      Symptoms and visceral perception in patients with pain-predominant irritable bowel syndrome.
      In this month's issue of Clinical Gastroenterology and Hepatology, Ringel et al
      • Ringel Y.
      • Williams R.E.
      • Kalilani L.
      • et al.
      The prevalence, characteristics and impact of bloating symptoms in irritable bowel syndrome.
      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 al
      • Hungin A.P.
      • Whorwell P.J.
      • Tack J.
      • et al.
      The prevalence, patterns and impact of irritable bowel syndrome: an international survey of 40 000 subjects.
      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.
      • Drossman D.A.
      • Richter J.E.
      • Talley N.J.
      The functional gastrointestinal disorders: diagnosis, pathophysiology and treatment.
      • Thompson W.G.
      • Longstreth F.G.
      • Drossman D.A.
      • et al.
      Functional bowel disorders and functional abdominal pain.
      • Longstreth G.F.
      • Thompson W.G.
      • Chey W.D.
      • et al.
      Functional bowel disorders.
      If bloating and distention are so common and important to the IBS patient, why are they so ignored by the cognoscenti?
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      References

        • Agarwal A.
        • Whorwell P.J.
        Review article: abdominal bloating and distension in functional gastrointestinal disorders: epidemiology and exploration of possible mechanisms.
        Aliment Pharmacol Ther. 2008; 27: 2-10
        • Manning A.P.
        • Thompson W.
        • Heaton K.W.
        • et al.
        Toward positive diagnosis of irritable bowel.
        Br Med J. 1978; 2: 653-654
        • Schmulson M.
        • Lee O.Y.
        • Chang L.
        • et al.
        Symptom differences in moderate to sever IBS patients based on predominant bowel habit.
        Am J Gastroenterol. 1999; 94: 2929-2935
        • Lembo T.
        • Naliboff B.
        • Munakata J.
        • et al.
        Symptoms and visceral perception in patients with pain-predominant irritable bowel syndrome.
        Am J Gastroenterol. 1999; 94: 1320-1326
        • Ringel Y.
        • Williams R.E.
        • Kalilani L.
        • et al.
        The prevalence, characteristics and impact of bloating symptoms in irritable bowel syndrome.
        Clin Gastroenterol Hepatol. 2009; 7: 368-372
        • Hungin A.P.
        • Whorwell P.J.
        • Tack J.
        • et al.
        The prevalence, patterns and impact of irritable bowel syndrome: an international survey of 40 000 subjects.
        Aliment Pharmacol Ther. 2003; 17: 643-650
        • Drossman D.A.
        • Richter J.E.
        • Talley N.J.
        The functional gastrointestinal disorders: diagnosis, pathophysiology and treatment.
        1st ed. Degnon Associates, McLean, VA1994
        • Thompson W.G.
        • Longstreth F.G.
        • Drossman D.A.
        • et al.
        Functional bowel disorders and functional abdominal pain.
        Gut. 1999; 45: II43-II47
        • Longstreth G.F.
        • Thompson W.G.
        • Chey W.D.
        • et al.
        Functional bowel disorders.
        Gastroenterology. 2006; 130: 1480-1491
        • Sandler R.S.
        • Stewart W.F.
        • Liberman J.N.
        • et al.
        Abdominal pain, bloating and diarrhea in the United States: prevalence and impact.
        Dig Dis Sci. 2000; 45: 1166-1171
        • Quigley E.M.M.
        NERD, GERD, and beyond: a consideration of the expanding spectrum of gastroesophageal reflux disease.
        J Clin Gastroenterol. 2007; 41: S175-S180
        • Maxton D.G.
        • Martin D.F.
        • Whorwell P.J.
        • et al.
        Abdominal distension in female patients with irritable bowel syndrome: exploration of possible mechanisms.
        Gut. 1991; 32: 662-664
        • Sullivan S.N.
        A prospective study of unexplained visible abdominal bloating.
        N Z Med J. 1994; 107: 428-430
        • Agarwal A.
        • Houghton L.A.
        • Lea R.
        • et al.
        Bloating and distension in irritable bowel syndrome: the role of visceral sensation.
        Gastroenterology. 2008; 134: 1882-1889
        • Houghton L.A.
        • Lea R.
        • Agarwal A.
        • et al.
        Relationship of abdominal bloating to distension in irritable bowel syndrome and effect of bowel habit.
        Gastroenterology. 2006; 131: 1003-1010
        • Serra J.
        • Azpiroz F.
        • Malagelada J.R.
        Impaired transit and tolerance of intestinal gas in the irritable bowel syndrome.
        Gut. 2001; 48: 14-19
        • Azpiroz F.
        • Malagelada J.-R.
        Abdominal bloating.
        Gastroenterology. 2005; 129: 1060-1078
        • Galati J.S.
        • McKee D.P.
        • Quigley E.M.M.
        The response to intraluminal gas in the irritable bowel syndrome: motility versus perception.
        Dig Dis Sci. 1995; 40: 1381-1387
        • Tremolaterra F.
        • Villoria A.
        • Azpiroz F.
        • et al.
        Impaired viscerosomatic reflexes and abdominal wall dystony associated with bloating.
        Gastroenterology. 2006; 130: 1062-1068
        • Chang L.
        • Lee O.Y.
        • Naliboff B.
        • et al.
        Sensation of bloating and visible distension in patients with irritable bowel syndrome.
        Am J Gastroenterol. 2001; 96: 3241-3247
        • Quigley E.M.M.
        From comic relief to real understanding: how intestinal gas causes symptoms.
        Gut. 2003; 52: 1659-1661