Belches, Bloating, Borborygmus and Bugs

Over the holidays, I had multiple opportunities to discuss digestive function with both patients and family. Gas was a frequent complaint, whether it was coming up (burping or eructation), distending the abdomen (bloating), or churning through the intestines making rumbling noises (borborygmus).

There are several common causes for these symptoms, and at a certain level it is considered a normal occurrence. But what’s normal and what’s a sign of something not quite right?

A certain amount of air within our digestive tract is inevitable. We frequently swallow air when drinking and eating with increased amounts seen with carbonated beverages, wolfing down our food, taking frequent sips through straws (as opposed to continuous drinking), and chewing gum.  We can also cause ourselves to suck air into our stomachs when we are nervous or anxious (aerophagia).

Gas can also be produced within the stomach and intestines through the fermentation of food by yeast or bacteria. Carbohydrates in the form of simple sugars, complex carbohydrates, or fiber can be broken down and utilized by various yeast and bacteria, causing bloating.  We shouldn’t have a predominance of yeast in the intestines, although that is a common finding with patients who have been on antibiotics. Most antibiotics target bacteria, leaving yeast to flourish. Yeast overgrowth can cause fatigue, limit absorption of vitamins and other nutrients, cause bloating, loose or constipated stools and predispose to vaginal yeast infections and “jock itch’. Some individuals also have a hampered ability to digest certain carbohydrates, like lactose or other specific carbohydrates in foods, including disaccharides and polysaccharides, resulting in gas, loose stools, and cramping.

We can also have a condition called SIBO, or small intestinal bowel overgrowth, which is characterized by too much bacteria (even good bacteria) higher up in the small intestine. This can be the result of too little acid in the stomach, or prolonged use of acid blockers, allowing bacteria to thrive higher up in the intestinal tract. It can also be caused by alterations in the movement of food and stool through the intestines and conditions such as diabetes and diverticulosis. Symptoms of SIBO include bloating, gas, abdominal pain, diarrhea, constipation, and in some cases fatigue and joint pain. A relatively recently characterized condition, SIBO can be associated with numerous other chronic conditions.

Another cause of belching and bloating is a bacteria called H. Pylori that can inhabit the stomach and is implicated in stomach ulcers. H. Pylori is quite prevalent and research suggests it may be present in as much as 30% of the world population. H. Pylori can also be the cause of stomach pain and nausea and may increase the risk of stomach cancer.

Lastly, subtle inflammation such as that caused by food sensitivities can give rise to further digestive dysfunction.

Although many of these symptoms are often perceived as “minor” and individuals often self-treat with antacids, digestive aids, and other remedies, we now know that intestinal disruption can impact neurotransmitter (brain chemical messenger) levels, absorption of nutrients our bodies need to survive, immune function and the two-way communication between our intestinal tract and our brain. The latter is an exciting new field of study that we’ve only just scratched the surface of.

So, if the holidays have come and gone and you’re still experiencing any of the above symptoms to the extent that you suspect it’s beyond the “normal” amount, come in and have an evaluation.

Prior to your visit, it is helpful to make a note of what foods might be bothersome, or when your symptoms tend to occur. Also helpful is knowing what seems to improve your symptoms as well as when you first started noticing them.  Often we can have a good idea what the culprit might be just through a thorough discussion. Other times we may need to confirm our diagnosis through a stool, urine, or blood test. Even if you’ve had testing before, there are newer and more sensitive tests that have been made available in the last several years and our bacterial flora is changeable depending on our diet as well as our exposure to other bacteria, yeasts, and molds as well as antimicrobial agents and medications.