Intestinal gas and bloating: effect of prokinetic stimulation.
BACKGROUND
It is unknown if abdominal bloating is attributable to excess abdominal gas or improved by a prokinetic agent.


OBJECTIVE
To assess abdominal gas content in functional abdominal bloating and to ascertain the effect of a prokinetic agent on intestinal gas symptoms in these patients.


METHODS
In 20 patients, intra-abdominal gas content and symptoms were quantified before and during treatment with pyridostigmine (30 mg/8 hp. o) in this randomized, placebo-controlled, double-blind study. Daily symptoms were quantified for 5 days before and 10 days during treatment, and abdominal gas volume was quantified by CT imaging before and at the fourth day of treatment. A CT scan was also obtained in 10 healthy subjects.


RESULTS
Before treatment, the total volume of intestinal gas was similar in patients (112 +/- 18 mL) and in healthy controls (116 +/- 20 mL). The treatment-induced change in total and regional intestinal gas volume was not significantly different between pyridostigmine (-4 +/- 18 mL; mean +/- SEM) and placebo (0 +/- 15 mL). However, pyridostigmine reduced the severity of bloating from 3.3 +/- 0.3 to 2.6 +/- 0.4 (P < 0.05), whereas placebo did not (3.2 +/- 0.3 vs 3.0 +/- 0.4), although the change did not reach statistical difference across groups.


CONCLUSIONS
In patients complaining of functional bloating, the volume and distribution of intestinal gas, measured on nonselected days, is comparable to asymptomatic subjects. Prokinetic stimulation improves bloating sensation without detectable changes in gas content.
Accarino
Anna
A
Digestive System Research Unit , University Hospital Vall d'Hebron, Barcelona, Spain.
Perez
Frederic
F
Azpiroz
Fernando
F
Quiroga
Sergi
S
Malagelada
Juan-R
JR
D015746:Abdominal Pain / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D000328:Adult; D000368:Aged; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005414:Flatulence / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D005769:Gastrointestinal Motility; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011729:Pyridostigmine Bromide / Q000627:therapeutic use*; D011859:Radiography
D002800:Cholinesterase Inhibitors; D011729:Pyridostigmine Bromide