Intestinal gas… what you need to know about flatulence

The entire digestive system, from the stomach to the rectum, contains intestinal gas as a natural consequence of swallowing and digestion. Everyone encounters this phenomenon regardless of lifestyle. Gases in the digestive tract are usually unnoticed until they cause bloating or distension and are expelled by belching or through the anus (flatulence). However, there are many conditions in which the amount of intestinal gas increases and causes discomfort.

The symptoms can be traced back to many causes, so it would be difficult to say which age group or sex is most affected. It largely depends on what you drank and ate. Your diet and lifestyle play an important role in the proper functioning of your digestive organs. Consuming dairy products, gas-producing fruits and vegetables, and carbonated drinks can all cause intestinal gas, belching, abdominal bloating and sometimes diarrhea.

Some foods, such as beans, are only partially broken down in the upper small intestine. When they reach the large intestine (colon), harmless gut bacteria begin to ferment them. It is estimated that 30–150 grams of undigested food reach the colon each day in the form of carbohydrates (fiber). This amount varies individually depending on diet and digestive function.

It is important to know that everyone passes gas several times a day and that occasional belching is perfectly normal. However, excessive intestinal gas causing distension, pain, etc., may indicate a digestive disorder that requires attention.

Causes of increased intestinal gas production

Excess gas can form in the upper digestive tract as a result of rapid, hurried eating, overeating, smoking or chewing gum. More commonly, excessive consumption of certain foods, inability to digest them, or dysfunction of the bacteria normally present in the colon leads to gas buildup.

Foods that cause excessive gas

Gas production varies between individuals. Foods that cause gas in one person may not cause symptoms in another. Common gas-producing foods and substances include:

1. Beans and lentils
2. Cruciferous vegetables (e.g., cabbage, broccoli, cauliflower, kale, and Brussels sprouts)
3. Bran
4. Dairy products containing lactose
5. Fructose, a sugar found in some fruits and used as a sweetener in soft drinks and other products
6. Sorbitol: a sugar substitute found in some sugar-free candies, chewing gums and artificial sweeteners
7. Carbonated drinks, such as soda or beer

Digestive disorders that cause excessive gas

We speak of excessive intestinal gas production when belching or bloating occurs more than 20 times a day. A number of disorders may underlie this, including:

Lactose intolerance

People with lactose intolerance are unable to fully digest the sugar (lactose) in milk. As a result, eating or drinking dairy products can lead to diarrhea, gas and bloating. This condition, also called lactose malabsorption, is usually harmless but its symptoms can be unpleasant. It is generally caused by low levels of the enzyme lactase in the small intestine, which prevents proper digestion of dairy. Most people with lactose intolerance can manage their condition without having to give up all dairy products.

Celiac disease (gluten sensitivity)

This is an immune reaction to gluten (the protein found in wheat, barley and rye). If you have celiac disease, consuming gluten triggers an immune response in the small intestine. Over time this reaction damages the lining of the small intestine and prevents certain nutrients from being absorbed (malabsorption). Intestinal damage often causes diarrhea, fatigue, weight loss, bloating and anemia, and can lead to serious complications. In children malabsorption may affect growth and development, while adults may have the visible symptoms described above.

There is no cure for celiac disease, but most people benefit from strict adherence to a gluten-free diet, which helps manage symptoms and promotes intestinal healing.

Eating disorders

These are persistent disorders related to unhealthy eating habits that negatively affect health, emotions and functioning in important areas of life. The most common eating disorders are anorexia nervosa, bulimia nervosa and binge-eating disorder.

These unhealthy patterns are often accompanied by an excessive focus on weight, body shape and food, which leads to dangerous eating behaviors. They can significantly impair the body's ability to obtain proper nutrition. Eating disorders can damage the heart, digestive system, bones, teeth and mouth, and can cause other health problems.

They often develop during adolescence and young adulthood, although they can occur later as well. With treatment, people can return to healthier eating habits and reverse many of the serious complications caused by eating disorders.

Gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) occurs when stomach acid flows back into the esophagus unintentionally. This reflux (acid reflux) irritates (burns) the lining of the esophagus. Most people can manage the discomfort caused by reflux with lifestyle changes and over-the-counter medications. Others may need stronger medications or even surgery to relieve symptoms.

Peptic ulcer

Open sores that develop on the inner lining of the stomach or the upper part of the small intestine (the duodenum). The most common symptom is stomach pain.

The most common causes of peptic ulcers are infection with the bacterium Helicobacter pylori and long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs). Stress and spicy foods do not cause peptic ulcers but can worsen symptoms.

Diabetes

A disease that affects how your body uses blood sugar. Glucose is essential for health because it is an important energy source for the cells that make up muscles and tissues. It is also the brain's main fuel.

Chronic diabetes can be type 1 or type 2. The triggers for diabetes vary by type. In any case, the important point is that blood sugar levels become elevated, which can lead to serious health problems.

Potentially reversible conditions include prediabetes and gestational diabetes. Prediabetes occurs when your blood sugar is higher than normal but not high enough to be classified as diabetes. It is often a precursor to diabetes unless you take appropriate measures to prevent progression. Gestational diabetes develops during pregnancy but may resolve after the baby is born.

Dumping syndrome

Also called rapid gastric emptying, it occurs when food—especially sugar—moves too quickly from the stomach into the small intestine. It can develop after surgery that removes part or all of the stomach or bypasses it, and may also occur after esophageal surgery. Most people experience symptoms such as abdominal cramps and diarrhea 10–30 minutes after eating. Others develop symptoms 1–3 hours after eating, and some experience both early and late symptoms.

In general, dumping syndrome can be prevented or lessened by changing the post-surgery diet, typically by introducing smaller meals and limiting high-sugar foods. More severe cases may require medication or surgery.

Crohn's disease

An inflammatory disease of the digestive tract that can cause abdominal pain, severe diarrhea, fatigue, weight loss and malnutrition. It can affect different areas of the digestive tract and often penetrates deeper layers of the bowel.

Crohn's disease can be painful and debilitating and sometimes leads to life-threatening complications. Although there is no known cure, treatments can greatly reduce the signs and symptoms of the disease, and may even induce long-term remission and healing of inflammation.

Irritable bowel syndrome

A common condition that affects the large intestine. Signs and symptoms include cramping, abdominal pain, bloating, gas, diarrhea or constipation, or both. It is a chronic condition that requires long-term management. Only a small portion of patients experience severe symptoms. Some people can control their symptoms with diet, lifestyle and stress management. More severe symptoms can be relieved with medications and counseling. It does not cause changes in bowel tissue and does not increase the risk of colon cancer.

Ulcerative colitis

An inflammatory bowel disease that causes inflammation and ulcers in the innermost lining of the colon and rectum. Symptoms generally develop over time rather than suddenly. It can cause weakness and sometimes life-threatening complications. Although there is no known cure, symptomatic treatment can greatly reduce signs and symptoms and result in long-term remission.

Gastroparesis

A condition in which the stomach muscles do not function properly, impairing digestion. Normally strong muscular contractions in the stomach move food through the digestive tract. If you have gastroparesis, stomach motility is slowed or does not work at all, preventing proper gastric emptying.

The cause is often unknown. It is sometimes a complication of diabetes and may develop after abdominal surgery. Certain medications—such as opioid pain relievers, some antidepressants, and drugs for high blood pressure and allergies—can cause slow gastric emptying and similar symptoms. These drugs impair stomach and intestinal motility.

It can disrupt normal digestion and cause nausea, vomiting and abdominal pain. It can also lead to problems with blood sugar control and nutrition. Although there is no cure for gastroparesis, dietary changes combined with medications can provide some relief.

Bowel obstruction

An intestinal blockage prevents food or liquid from passing through a portion of the intestine. It can occur in either the small or large intestine. Causes include adhesions that form after abdominal inflammation or surgery; hernias; tumors; certain medications; or diseases such as Crohn's disease or diverticulitis (in which trapped stool in bowel pouches can lead to inflammation), and strictures resulting from bowel inflammation. Without treatment, the obstructed portions of the bowel can die, causing serious problems. With prompt medical care, bowel obstruction is often successfully treated.

When should you see a doctor?

On their own, increased intestinal gases rarely indicate a serious condition. They can cause discomfort and embarrassment but usually reflect a normally functioning digestive system.

If gas bothers you, try changing your diet. If increased gas production causes regular problems, see a gastroenterologist and a nutrition specialist to identify possible causes. Dietary changes and avoiding certain foods generally provide a solution.

Seek medical attention promptly if abdominal symptoms are severe or are accompanied by vomiting, diarrhea, constipation, unintentional weight loss, bloody or tarry stools, or heartburn.