Ch. 14 - Intestinal Gas Flashcards
1
Q
Intestinal Gas
A
- Uncomfortable and impairing lifestyle
- Frequent symptoms: eructation (belching), bloating, and flatulence)
- Must differentiate between healthy and not
- Treatment types: antiflatulence medications, digestive enzymes, and probiotics
- Can be caused by lactose malabsorbence, IBS, and rare conditions
- Many say that it decreases their ability to do daily activities
2
Q
Gas Pathophysiology
A
- Poorly understood, but minor disruptions of normal GI process appears to play a part
- Air mixed with stomach contents through the GI tract and expelled via anus with feces
- Diet, medical conditions, alterations in flora, and drugs may increase or decrease intestinal gas
- Dietary sugars may be incompletely absorbed and main contributor to H2 gas production in colon
- Also fatty acids, complex carbs, and oligosaccharides
- Can increase H2 production and fermentation (CO2)
- High fiber diets, IBS, slow transit, or diverticulitis patients can cause bloating and gas
- Foods containing sulfate have worse smelling gas from action of sulfate-reducing bacteria
- Smoking, chewing gum, poor fitting dentures, hyperventilating, poor eating habits, bacteria fermentation from overgrowth (probiotics), celiac disease when gluten is consumed, drugs that affect the GI/flora/metabolism, and anxiety can increase air intake or gas
3
Q
Gas Clinical Presentation
A
- Excessive belching, discomfort, cramping, bloating, gas (most common is belching and discomfort)
- Less common: nausea, bowel sounds, dyspepsia, indigestion
- Belching: easiest way for air to leave GI
- Gas pain: generalized, crampy discomfort (fear, anxiety, and large meals can increase pain)
- Gas pains with diarrhea/constipation may be IBS (medical referral due to possible underlying condition)
- Bloating: tension sensation in abdomen after eating (tight fitting clothes, uncomfortable fits)
- Eating high fiber diets, too quickly, or too much can increase bloating
- Chronic bloating or early satiation + diabetes should see PCP
- Normal flatulence: 20-40x per day
- Fiber, fructose, lactose, oligosaccharides, sorbitol, and mannitol sweeteners increase gas
4
Q
Gas Treatment Goals
A
- Decrease frequency, intensity, duration of has symptoms
- Decrease impact of symptoms on lifestyle
- DON’T expect complete gas cessation
5
Q
Gas General Treatment
A
- 1st assess symptoms, diet, eating habits, medication use, and medical conditions
- Most can decrease symptoms if they know what causes them especially when considering diets
- If gas is connected to lactose/oligosaccharides and they aren’t excluded populations, use digestive enzymes
- Non-Rx antiflatulence have limited efficacy data
- Probiotics may help some by keeping GI flora healthy, especially those with IBS
- Review exclusions and those who symptoms persist after treatment need medical referral
6
Q
Gas Nonpharmacologic
A
- Changing eating habits and diet
- Avoiding has producing foods, sometimes completely
- Lactose and oligosaccharide intolerant should avoid those compounds and use substitutes
- May be good to mention why some gas-producing foods aren’t good for everyone to the family especially if children are involved
7
Q
Gas Pharmacologic
A
- Simethicone and activated charcoal volume symptoms after they form
- Alpha-galactosidase and lactase enzymes can be taken with foods to prevent gas formation if the patient is intolerant
- Individualize based on patient symptoms
8
Q
Simethicone
A
- Mixture of inert silicon polymers
- Defoaming agent to relieve has
- Decreases surface tension as bubbles in GI which allows the gas to be expelled more easily
- FDA considers it safer and effective antiflatulence
- Quicker relief with loperamide if diarrhea is present too
- Questionable if helpful for all gas sufferers, can be used on a trial
- Many antacids also have simethicone, UAD, often not a necessary combination though
- No systemic SE
- CI: allergic, intestinal perforation or obstructions
9
Q
Activated Charcoal
A
- Used for gas but not proven safer or effective for this indication
- Proposed MOA: adsorbent effects and potential to facilitate the elimination of intestinal gas
- Also helps eliminate malodor from sulfur gases
- Poor palatability
10
Q
Gas Combination Products
A
- Antiflatulence, enzyme
- Hydrolyzes oligosaccharides into component parts before metabolized by colonic bacteria
- Recommended prophylaxis for high fiber diets, shown to reduce has from oligo. diets
- Safety is still being determined
- Don’t use in those with glactosemia, diabetes (caution) or allergic to molds
11
Q
Lactase Replacement
A
- Used for lactose intolerant to break them down into absorbable monosaccharides
- Helps aid in dairy digestion
- No ASE
12
Q
Gas Special Populations
A
- Liquid formulations of simethicone for infants, especially with colic (not found significantly better for this indication though)
- Simethicone considered safe for infants, children, nursing mothers, preggo category C
- Alpha-galactosidase shouldn’t be used in kids/infants, need medical referral for preggo/BF
- No restrictions on lactase enzymes, but contact doctor if symptoms persist after use or don’t seem to be related to dairy products
13
Q
Gas Patient Factors
A
- Use Alpha-galactosidase and lactase replacements when unable to process those substrates o own
- Use simethicone for immediate relief of symptoms not connected to specific foods
- Activated charcoal is a possible alternative, especially if malodor is a concern
- If diabetic or galactosemic, use simethicone and avoid alpha-g
- Take lactase replacement at time of dairy product exposure
14
Q
Gas Patient Preferences
A
- Different dosage forms available depending on different needs of the patient
- Liquid usually more expensive than solid forms, but more palatable
15
Q
Gas Complementary Therpies
A
- Variety of probiotics used
- Most common are capsules with one or many bacteria
- Functional fermented foods with live cultures of probiotic species are also available (kombucha)
- IBS and lactose intolerant may get temporary relief
- Need daily administration to maintain benefit, recommended for a 14 day trial
- Need more studies to determine which bacteria strains are more effective
- Carminctures and other natural products also used
- Insufficient evidence, may decrease lawer esophagela tone so don’t use in GERD
- Fennel, also usedfor has,, can cause photodermatitis, CI with preggo, enters breast milk
- Avoid in excessive sunlight, separate out use of cipro appropriately so decreased levels don’t occur
