March 23, 2018 at 2:20 pm #850Natalie R Gillan, PhDParticipant
Bloating after stomach acid soda test
A 67 yo female patient with postprandial bloating after evening meals experience a significant bloating and no belching after a ‘soda’ stomach acid test first thing in the morning. In your opinion, is this simple test safe, has any clinical value and what can be the reasons for the created gas not escaping via mouth?
Many thanks for your thoughts.
Posted By Natalie Gillan 23/3/2018
March 5, 2019 at 2:23 pm #853Christine BaileyModerator
Many thanks for your question regarding your client who experiences postprandial bloating. There are many reasons for postprandial bloating and yes it may be the case that she is not able to produce sufficient stomach acid or digestive enzymes to break down food effectively or quickly. However, do consider other causes as well.
Bloating generally could indicate imbalances in gut flora and therefore it may be appropriate for you to conduct a comprehensive stool test. Other factors to consider – the macro nutrients of the meal. Is it high in fat, for example, which may be digested more slowly? Does this client eat very quickly or consume a large quantity of meal in one sitting. Does the client drink lots of water during the meal? Does the client consume fizzy water or drinks at meals?
There are a range of papers on this topic:
Seo AY et al. Abdominal Bloating: Pathophysiology and Treatment Journal of Neurogastroenterology and Motility 2013; 19(4): 433-453. https://tinyurl.com/y9klftk5
The pathophysiology of bloating remains ambiguous, although some evidences support the potential mechanisms, including gut hypersensitivity, impaired gas handling, altered gut microbiota, and abnormal abdominal-phrenic reflexes. However, if there are imbalances in gut flora then shifting to a low FODMAPs diet temporarily may be helpful. If you suspect it is more linked to digestive efficiency, then consider separating different macro nutrients (i.e. carbs eaten away from proteins), which is along the basis of a HAY diet approach; protein with low starch vegetables and without excess fatty cuts either. Avoid eating fruit with meals as well may help.
In a 67 yo individual, it is more likely that digestion has been compromised in time.
Imbalances in gut flora can affect transit and therefore lead to bloating.
The abdominal cavity is determined by the placement of the walls of abdominal cavity including diaphragm, vertebral column and abdominal wall musculature. Even if there is no increase in intra-abdominal volume, a change of the position of abdominal cavity components may produce abdominal distension Thus, there have been some efforts to evaluate the relationship between bloating and lumbar lordosis or weakened abdominal muscles. It has been suggested that the patients with bloating have weak abdominal muscles and frequently had recently gained weight than controls.
Sullivan SN. A prospective study of unexplained visible abdominal bloating. N Z Med J. 107, 428-430, 1994. https://tinyurl.com/yb9h8llx
In some clients, stress may be playing a role in affecting the nervous system. The autonomic nervous system may also contribute to modulation of the visceral sensitivity. Sympathetic activation is known to increase the perception of intestinal distention in FD patients; likewise, autonomic dysfunction could affect the visceral sensitivity in IBS patients.
Park DI, Rhee PL, & Kim YH. Role of autonomic dysfunction in patients with functional dyspepsia. Dig Liver Dis. 33, 464-471, 2001. https://tinyurl.com/yblyf8uy
It is well recognised that dietary habits may be responsible for abdominal symptoms, and there have been efforts to prove the relationship between diet and IBS symptoms. Fibre
overload has long been regarded as worsening factor of IBS symptoms through decreased small bowel motility or intraluminal bulking.
Francis CY & Whorwell PJ. Bran and irritable bowel syndrome: time for reappraisal. Lancet. 344, 39-40, 1994. https://tinyurl.com/y8cyayqt
In addition, lactose intolerance may contribute to symptom development in IBS patients. In the small intestine, disaccharides are split by intestinal enzymes into monosaccharides which are then absorbed. If this process is not carried out, the disaccharide reaches the colon, in turn is split by bacterial enzymes into short chain carbonic acids and gases. Hence, malabsorption of lactose may produce the symptom of bloating in patients with IBS. Many constipated patients complain of bloating so making sure client regularly opens her bowels can be helpful.
If you suspect food sensitivities then either a low FODMAPs approach, challenge – elimination diet and / or IgG food tests may be helpful.
Hormonal effect has also been speculated, that is, the variation of reproductive hormones throughout the menstrual cycle and after the menopause may influence the gut motility and visceral perception. Has the condition worsened for example post menopause?
Heitkemper MM, Cain KC, Jarrett ME, Burr RL, Hertig V & Bond, EF. Symptoms across the menstrual cycle in women with irritable bowel syndrome. Am J Gastroenterol. 98, 420-430, 2003. https://tinyurl.com/yd8zkm42
The right strains of probiotics may actually help relieve symptoms One placebo-controlled study conducted in IBS patients revealed a beneficial effect of Bifidobacterium infantis and they suggested immune-modulating role of that organism.
Whorwell PJ, Altringer L & Morel J. Efficacy of an encapsulated probiotic Bifidobacterium infantis 35624 in women with irritable bowel syndrome. Am J Gastroenterol. 101, 1581-1590, 2006. https://tinyurl.com/y7wg22m6
In some cases, antibiotics and prokinetics can alleviate symptoms most likely to be due to addressing a bacterial imbalance and ensuring efficient movement through the digestive tract. So, do consider a stool test – this can also look at pancreatic function and fat digestion. Zinc is important for digestive function, so a supplement may be helpful in the short term.
I would also consider whether there are other underlying conditions as well such as gastroparesis.
The following supplements are suggested for you to consider in light of your relevant expertise and intimate understanding of the needs of your client or patient. It is not intended for them all to be taken, but rather just those that you select. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the individual you are responsible for.
Please consider these suggestions in light of the other clinical information pertaining to this individual. If you have any more information about the specific problems this individual is experiencing, further refinement of these suggestions may be considered. I hope this information is helpful, and if you have any further questions or information specific to the problems this individual is experiencing, please do provide feedback.
Stomach acid support with enzyme
Hydrozyme (BRC) – take 1-2 with each meal – https://tinyurl.com/l3fb9x4
Beta-TCP (BRC) – take 1-2 with each meal (for bile support) – https://tinyurl.com/hskrbum
Zn-Zyme (BRC) – take 1 daily – https://tinyurl.com/lnlffjd
ADP Oregano (BRC) – take 2-3 with each meal – https://tinyurl.com/y9a5xbhr
To support bowel movements if needed
Mg-Zyme (BRC) – take 1-2 after evening meal – https://tinyurl.com/y9zxt7uq
BioBifido BacT Powder (BRC) – take 1 tsp twice daily
I hope this helps with your client
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