The Treatment of Functional Abdominal Bloating and Distension

M. Schmulson; L. Chang

Disclosures

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

In This Article

Conclusions

To the best of our knowledge, this is the first comprehensive review on the treatment of bloating and distension. We have found that at least two-thirds of the studies were conducted in IBS patients in whom these symptoms were evaluated as secondary variables. Less than 5% of the treatment trials were performed in patients specifically complaining of bloating and/or distension. Therefore, the studies may not have been sufficiently powered to detect significant differences in bloating and distension. In addition, many of the earlier trials performed within group analyses of efficacy and not between group analyses and therefore no definitive conclusions can be drawn from their results. More importantly, the optimal patient reported outcome measures to detect a treatment response for bloating and visible abdominal distension have yet to be determined. Moreover, it seems highly likely that there is publication bias and negative trials are less likely to be published, particularly with respect to symptoms that are subjective and secondary outcome measures such as bloating and distension.

The large majority of trials investigated the efficacy of prokinetics and probiotics and the studies are heterogeneous in terms of the patient population, diagnostic criteria for the FGIDs and outcome measures. The available evidence suggests that currently there is no treatment that has unequivocally proven to be effective for abdominal bloating or distension. Overall, some efficacy has been demonstrated with 5HT4 agonists (cisapride in FD and tegaserod in chronic constipation and IBS-C), lubiprostone in both chronic constipation and IBS-C, rifaximin in patients with predominantly bloating, as well as in IBS and certain probiotics such as Bifantis 35624 and B. animalis. While there are inconsistent results with the other therapies, most have not been evaluated in well-designed, appropriately sized trials that have employed rigorous statistical analyses or in well-characterised patient populations. Future studies need to develop valid patient reported endpoints for bloating and distension, evaluate these symptoms as primary outcome measures and determine predictors of treatment response.

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