The Treatment of Functional Abdominal Bloating and Distension

M. Schmulson; L. Chang


Aliment Pharmacol Ther. 2011;33(10):1071-1086. 

In This Article


A literature search was performed on PubMed in the Medline database using the following terms: 'bloating syndrome', 'functional abdominal bloating', 'abdominal bloating', 'bloating', 'abdominal distension', 'flatulence' and 'gases'. These were combined using the AND operator, with studies identified with the following terms: 'therapeutics', 'combined modality therapy', 'complementary therapies', 'drug therapy', 'therapies, investigational', 'psychotherapy', 'behavior therapy', 'cognitive therapy', 'surfactants', 'antifoaming agents', 'anti-bacterial agents', 'antibiotics', 'probiotics', 'prebiotics', 'dietary supplements', 'pancreatic enzymes', 'antispasmodics' and 'parasympatholytics'. Searching limits included humans, men and women, randomised controlled trials, all adults aged 18 or older and English language. The search included all articles published in the past (no starting date restrictions) to a publication cut-off date of February 2010. A total of 167 articles were retrieved. The titles and abstracts were reviewed by the authors to select only those articles that analysed the effect of treatment on bloating and/or distension in FGIDs, excluding those that did not meet eligibility. We also performed manual searches of reference lists from relevant articles to identify other manuscripts which may have been missed by the search strategy.

Eighty-five articles were reviewed in detail. Of these, five were not included: one was a duplicate publication,[24] two did not report the treatment response on bloating[25,26] and two could not be retrieved in full text.[27,28] There were two recently published articles that were not identified by the search, but that analysed the efficacy of renzapride and linaclotide on bloating and were therefore added.[29,30] Three additional articles were identified by manual search of references from other articles.[31–33] Moreover, two multicentre, placebo-controlled trials that were recently published in abstract form were also reviewed.[34–36] Thus, a total of 87 articles were included in the review. Two of the studies were published in full text while preparing this article, therefore their references were updated.[30,36] Of the identified articles, 63% included patients with IBS, 16% with dyspepsia, 10% with chronic constipation and 10% with symptoms of other FGIDs. There were no studies conducted in patients specifically diagnosed with Functional Abdominal Bloating or Functional Bloating. We also did not identify any psychological or behavioural treatment studies that measured their efficacy on bloating or distension.

The quality of reporting of each clinical trial was graded according to Jadad's scale from 0 to 5.[37] A score of ≥4 was considered to be of high quality. Accordingly, each article was assessed based on three methodological items: randomisation, concealment of treatment and intention-to-treat analysis and withdrawals. In the case of articles published in abstract form, we did not include the Jadad's scale, as these formats do not provide all the necessary information.