Bloating Common but Often Ignored

Nearly 1 in 7 US adults reported bloating symptoms in the past week, yet most didn’t seek help from a gastroenterologist or other healthcare professional, some of whom said they weren’t comfortable discussing it with their doctor, according to a large national survey.

The findings suggest doctors should “proactively” ask about bloating, especially in adults at increased risk, including women and those with irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD), the researchers say.

“Bloating is common because it usually has multifactorial causes and can also be a secondary symptom to another gastrointestinal (GI) symptom or condition. Its mechanisms are complex and individualized, making it difficult for providers to identify and treat each patient,” Janice E. Oh, MD, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, told Medscape Medical News.

“Thus, many adults may be persistently suffering without proper diagnosis or management,” Oh added.

Results of the survey are published online in Clinical Gastroenterology and Hepatology.

Common Problem, Incompletely Understood

To get a better handle on the nationwide prevalence and health-related impact of bloating in the United States, Oh and her colleagues conducted an online survey of a nationally representative group of 88,795 adults aged 18 years or older.

Altogether, 12,324 (14%) respondents reported bloating in the past week.

The likelihood of bloating was significantly higher in women (odds ratio, 2.56) and in those with certain comorbid conditions, especially IBS, chronic constipation, and ulcerative colitis, the authors write.

The odds of bloating were also higher in adults with other concomitant GI symptoms, especially abdominal pain and excess gas.

Factors associated with more severe bloating included the presence of IBS, IBD, celiac disease, bowel incontinence, abdominal pain, constipation (functional and opioid-induced), and excess gas.

Bloating severity increased with age up to 59 years and then decreased in people aged 60 years or older.

Suffering in Silence?

Notably, more than half (59%) of people who reported recent bloating never sought care for the problem. About one third of them reported that bloating resolved on its own, and 30% said the symptoms were not bothersome.

About 1 in 5 adults who did not seek care said that they were managing symptoms on their own with over-the-counter medications or lifestyle modifications. And 9% of those who did not seek care said that they were uncomfortable discussing the problem with their doctor.

“The hesitancy in seeking healthcare or discussing bloating in patients may be attributed to lack of routine screening for bloating, lack of focus on bloating complaints by providers, or patients’ dissatisfaction with management of bloating symptoms,” the researchers say.

Adults most apt to seek care for bloating were those older than 29 years; non-Hispanic Black persons; those with comorbid conditions, such as celiac disease, IBD, and IBS; and those with more severe bloating symptoms.

A limitation is that individuals with GI symptoms or conditions may be more likely to participate in a GI-focused survey, leading to a possible overestimation of the prevalence of bloating.

Also, the survey was conducted during the COVID-19 pandemic, which has the potential to overestimate the prevalence or severity of bloating because COVID-19 is known to affect the GI system.

Despite these limitations, the researchers encourage healthcare professionals to routinely ask their patients about bloating as a first step in appropriate management.

“Bloating can be associated with nutrition/diet, the gut microbiome, anatomical issues, or underlying conditions that range from neurologic to gynecologic disorders. And, the majority of the time, it is usually more than one distinct issue that is attributing to the bloating,” Oh said.

“Understanding the patterns of bloating occurrence, psychosocial factors, past medical history, and nutrition can help providers determine the causes. We hope to identify a more standardized method to identify causes of bloating,” Oh added.

Support for the survey was provided by Ironwood Pharmaceuticals in the form of an institutional research grant to Cedars-Sinai. The authors have no relevant disclosures.

Clin Gastroenterol Hepatol. Published online November 14, 2022. Abstract

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