# Bowel Gas Volume Useful in Diagnosing Irritable Bowel Syndrome



## eric (Jul 8, 1999)

FYI:Bowel Gas Volume Useful inDiagnosing Irritable Bowel Syndrome WESTPORT, Aug 09 (Reuters Health) - Patients with irritablebowel syndrome (IBS) have significantly more bowel gas thannormal individuals, according to a report published in the Julyissue of the American Journal of Gastroenterology. The lack of objective methods of diagnosing bowel disordershas hampered the elucidation of the relationship of IBS tobowel function, the authors explain. Dr. Taketo Yamaguchi, of Chiba University School ofMedicine, in Chiba, Japan, and colleagues used computerinterpretation of digitized abdominal X-rays to compute gasvolume scores (GVS) and relate them to symptoms of IBS. The mean GVS of 30 patients with IBS (0.069) was more thantwice that of 30 healthy controls (0.033), the authors report, butthe mean GVS scores did not differ significantly according toIBS type. Sixty percent of IBS patients had GVS scores at leasttwo standard deviations above the mean of the control group,the investigators note, whereas 40% of the patients had scoreswithin that range. Among the 18 IBS patients with high GVS scores, 14 hadabdominal distention and 14 complained of abdominal pain, theresults indicate, but both were less common among patientswith normal GVS scores. "The significantly higher level of bowel gas in IBS patients inthe present study is thought to reflect one of the pathologies ofIBS, suggesting that the quantity of bowel gas can be a usefulindex during the diagnosis of IBS," the authors conclude. "Moreover," they add, "not only improvement in symptoms butalso changes in the quantity of bowel gas may become valuablecriteria in assessing the effectiveness of agents in improvinggastrointestinal function." Being able to identify excessive bowel gas does notnecessarily mean one can do much about it, says Dr. P. J.Whorwell, of University Hospital of South Manchester, inManchester, UK, in a related editorial. "The treatment of IBSpatients who complain of passing excessive gas is notoriouslyunrewarding and largely empirical," he writes, "with agentssuch as peppermint preparations worth trying." "No other pharmacological approaches are currentlyavailable," notes Dr. Whorwell, "although it has recently beensuggested that in patients with a motility component to their gasretention, drug treatment may have a role." ------------------ http://www.ibshealth.com/


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## eric (Jul 8, 1999)

FYI: The Problem of Gas in Irritable Bowel Syndrome P. J. Whorwell, M.D.a Patients with irritable bowel syndrome (IBS) complain of a constellation of symptoms (1), of which abdominal pain is not necessarily the most intrusive (2, 3). Recognition of this fact is important from a therapeutic point of view, as successful management is dependent on targeting the features that the patient finds most troublesome. It is becoming increasingly recognized that abdominal distension is very distressing for many patients (3), but the pathophysiology of this symptom is poorly understood, although the obvious explanation of excessive gas is unlikely to be the whole answer (4, 5). Thus, although patients often attribute bloating to gas, this is not always the case. It has been shown that some normal subjects consistently pass more gas than others (6), but the passage of excessive gas seems to be a particular problem for many patients with IBS. However, they are often reluctant to admit to it and it is seldom referred to in the literature. In our tertiary referral clinic, it is not uncommon to see IBS patients who avoid relationships because of this problem and many other sufferers find it incapacitating both socially and in the workplace. Not surprisingly, the problem is further compounded if the gas consistently smells offensive. With the notable exception of the work of Dr. Michael Levitt there has, until recently, been remarkably little interest in intestinal gas, especially in relation to IBS. On balance, what evidence there is points to a considerable proportion of patients with IBS having excessive intestinal gas. The study by Koide et al. (7) in this issue of the Journal, using a radiological technique, confirms this view. An interesting additional observation highlighted in their paper was that individual gas volume scores were remarkably consistent from day to day. The accumulation of gas within the gut of IBS patients can only result from a limited number of mechanisms such as excessive swallowing, over production, changes in tone/motility, or impaired release. There is evidence to support all of these possibilities in IBS patients (8, 9, 10, 11), but it remains to be determined how much these abnormalities overlap in a particular individual and whether they are additive. It is important to realize that if air swallowing is suspected, that this can be subconscious and is not necessarily indicative of psychopathology. If intestinal gas analysis is available, this problem should be suspected if nitrogen is the predominant constituent (12). Another extremely important consideration in all of this is the problem of perception. It is now generally accepted that a significant proportion of patients with IBS seem to have disordered perception (13), which could appreciably affect how they report the sensation of gaseousness or even the passage of flatus. The treatment of IBS patients who complain of passing excessive gas is notoriously unrewarding and largely empirical, with agents such as peppermint preparations worth trying. The traditional remedy of activated charcoal has not stood up to scrutiny either for reducing volume of gas or odor (14). The best we can do at present is to consider the different possible mechanisms and, for instance, use dietary manipulation with the aim of minimizing the intake of flatogenic foods and additives or reducing fermentation. Alternatively, if excessive swallowing is suspected, then a behavioral technique may be worth considering. Antibiotics are not practicable as they cannot be used long term, sometimes exacerbate other symptoms of IBS, and, on cessation, the bacterial flora frequently revert to pretreatment patterns. No other pharmacological approaches are currently available, although it has recently been suggested that in patients with a motility component to their gas retention, drug treatment may have a role (15). Lastly, the whole concept of perception has to be borne in mind, because if this happens to play a part in a patient's symptomatology, then a completely different therapeutic approach may be required. aDepartment of Medicine, University Hospital of South Manchester, Manchester, United Kingdom ------------------ http://www.ibshealth.com/


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## eric (Jul 8, 1999)

Bump------------------ http://www.ibshealth.com/


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## Guest (Aug 9, 2000)

Very interesting Eric, and very true !!! I always knew this as a fact, myself - from my own lab work (HA HA).When I had a colonoscopy, the only thing the surgeon remarked on (besides the internal hemhroids, was the right angles in my colon, which I believe, accompanied with the extra gas volume - created much of my distention and constipation.But.... I hate to sound like a broken record... with the control of my diet - such as switching to that Eziekeil 4:9 bread, I think I have reduced the amount of gas in my system, promoting less cramps and allowing better bowel function.Thanks for the interesting article.Stomach Troubless


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## Maro (Aug 9, 1999)

This is a very interesting article. Thanks for posting it. maro





















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## JeanG (Oct 20, 1999)

Thanks for posting these interesting articles, Eric.







It's good to know they're looking at it, even though they don't have quite the answer yet.JeanG


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## moms777 (Jan 29, 2000)

Thank you Eric for this information. I remember when I first told the GI that I had excessive bad gas, he actually LAUGHED! It was very humiliating to say the least! And to top it off, he looked liked he was about fourteen years old! I wanted to bop him on the head!!


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## JeanG (Oct 20, 1999)

LOL Moms. The older we get the younger the docs get, don't they?







When my IBS first started after taking antibiotics I had a tremendous amount of gas. I complained to 2 docs and they said there is nothing that can be done. I was sure mad. Eventually, by taking probiotics, I got rid of it, but that was because it was caused by the antibiotics. I really feel for people who have it all the time.JeanG


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## Guest (Aug 10, 2000)

Thanks for the article. I had a complete abdominal ultrasound before being diagnosed with ibs. All the organs looked fine but the tech couldn't beleive how much gas I had. She actually had to push down on spots to get the gas to move out of the way. Gas and gas pains seem to be my biggest problems.


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## cookies4marilyn (Jun 30, 2000)

Who would have thought that the "treatment of excessive gas would be notoriously unrewarding" ??????







Gee, if I were a doc, and I could actually treat this problem, I think I would be highly sought after!!!! I just found that statement rather humorous..given all the Gas-X type products out there, it does seem to be a prevelent complaint. However I recall one of my docs saying, hey, I take mints now and then myself for gas!!!Good article, Eric!!! Thanks for posting all of these...







------------------"Cookies" alias Marilyn


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## Un Fatigued (Aug 3, 2000)

Thanks, Eric. Just one more thing that might point to a misdiagnosis as well. I had no gas or distension the entire 7 months that I had the big D.It would seem: No pain, no gas = no IBS.


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## Guest (Aug 10, 2000)

Like many of us, I had a real problem with gas, until I started using Remeron. No more gas!


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## moldie (Sep 25, 1999)

Good article eric. I always knew it wasn't "just in our heads." It is a real problem. I am probably one of those who minimized it to the doctor at firts because it is something people don't really discuss much. How much is too much? They do seem to minimize it too, when you bring it up. Most likely because as it states above, they haven't come up with a whole lot that is helpful so far. My problem wasn't that I passed so much gas, but that I couldn't seem to pass what was obviously in there and causing discomfort and distention. When I finally do, it helps relieve this.Guy, I take it the Remeron is helping the motility problem?Certainly, the one problem that has lingered is the gas discomfort when I decide to blow the low sugar diet or am off the antifungal for too long. Glad to hear they ix-neyed the antibiotic treatment and recognize that it can cause more problems if used for long-term.


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## rebel (Jul 17, 2000)

bump


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## flux (Dec 13, 1998)

Certainly, this finding is disagreement to the previously established findings of virtually gas-free abdomens in IBSers.It's not completely clear why they found something different, but the study does look good.One thing to note is that they didn't test whether IBSers have excess gas going into or being created in the bowel, only the presence of excess gas. This could mean that the gas there doesn't move as it should. However, the motility studies they performed did not seem to be associated with the gas volume, implying there was an excess. One other thing to note is 40% of the IBSers they studied had normal amounts of gas.It's not clear where all the gas was located, so it's not clear where the gas comes from, internally or from the atmosphere.


> quote:but that I couldn't seem to pass what was obviously in there and causing discomfort and distention


However, they found the gas was *not* related to either distension or discomfort.[This message has been edited by flux (edited 08-13-2000).]


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## babydoc_au (Jan 26, 2000)

Interesting study. I had a chuckle at the bit about the altered perception of bloating - maybe my inability to do up my jeans after dinner is a complex hallucination! (That's how altered perception is defined in my line of work!)


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## Guest (Aug 17, 2000)

Eric thank you very much, very interesting,I am wondering is this study compared individuals with IBS as oppose to normal people only , what about comparing IBS patients with patients suffering from other digestive disease? because if the results are also different then that will make it much easier to diagnose IBS.I hope they keep researching and find a cure.


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