Management of Intestinal Gas and Diarrhea - Gracen

Intestinal gas

Air in the gastrointestinal tract that can lead to symptoms such as belching, bloating, and flatulence.

Eructation

Belching of swallowed air.

Bloating

Uncomfortable fullness or abdominal distention.

Flatulence

Excessive passage of air from stomach/intestines through the anus.

Non-pharmacologic recommendations for managing gas

Strategies such as avoiding gulping liquids, eliminating smoking, avoiding chewing gum, eating smaller meals, avoiding gas-producing foods, avoiding tight-fitting clothes, not lying down after eating, and developing a regular exercise routine.

Pharmacologic recommendations for managing gas

Avoiding or minimizing drugs that treat cold/allergy symptoms, affect GI motility, affect glucose metabolism, or release gas.

OTC medications for gas

Over-the-counter options including antiflatulents, digestive enzymes, and probiotics.

Antiflatulents

Medications used for the treatment of gas, such as simethicone and activated charcoal.

Digestive enzymes

Medications used for the prevention of gas, including lactase replacements and α-galactosidase products.

Probiotics

Live microorganisms that provide health benefits, such as Lactobacillus and Saccharomyces, with evidence in IBS and lactose intolerance.

Simethicone

An antiflatulent agent that reduces surface tension of gas bubbles in the GI tract and is not absorbed, hence has no known systemic adverse effects.

Simethicone dosing for >12 years

40-125mg after meals or at bedtime as needed (max daily dose = 500mg).

Simethicone dosing for 2-12 years

40mg after meals or at bedtime as needed (max daily dose = 480mg).

Simethicone dosing for <2 years

20mg after meals or at bedtime as needed (max daily dose = 240mg).

Contraindications for Simethicone

Contraindicated in intestinal perforation or obstruction.

Combination products with Simethicone

In patients with diarrhea, simethicone + loperamide produces quicker gas relief than either agent alone.

Gas-X in the UK

Gas-X is referred to as Simethicone in the UK.

Activated Charcoal

Antiflatulent agent that traps gas in GI tract.

Activated Charcoal Mechanism of Action (MOA)

Traps gas molecules and eliminates them from GI.

α-galactosidase

Digestive enzyme that hydrolyzes oligosaccharides.

Oligosaccharides

Complex carbohydrates that can cause gas production.

Dosing for α-galactosidase

>12 years: 300-450 units per food serving.

Contraindication for α-galactosidase

Not safe for patients with galactosemia.

Lactase Replacement Products

Enzyme that breaks down lactose for intolerance.

Dosing for Lactase

>4 years: 3,000-18,000 units with lactose food.

Intestinal Gas Symptoms

Signs indicating possible underlying health issues.

Exclusions for Self-Treatment

Severe symptoms or sudden changes warrant evaluation.

Signs of Serious Conditions

Include persistent diarrhea, GI bleeding, weight loss.

Age-Based Treatment

Guidelines vary for treatment based on age groups.

Common Diarrhea Causes

Include colchicine, HAART, antibiotics, SSRIs.

Fluid and Electrolyte Imbalance

Most common complication of diarrheal illness.

OTC Medications for Diarrhea

Include antimotility, antisecretory, and digestive enzymes.

Antimotility Agents

Medications like loperamide used to reduce diarrhea.

Digestive Enzymes

Help break down food components to prevent gas.

Symptoms of Intestinal Gas

Include bloating, discomfort, and excessive flatulence.

High Fiber Foods

Foods that can increase gas production in intestines.

Dietary Supplement

Products like α-galactosidase used to aid digestion.

Intestinal Gas Decision Tree

Framework for determining treatment based on age.

Bismuth Subsalicylate

Antisecretory agent reducing fluid loss and pathogens.

Lactase Replacement

Enzyme supplement for lactose intolerance management.

First-line Treatment

Initial approach for mild to moderate diarrhea.

Diarrhea Duration

Most episodes resolve within 48 hours.

Oral Rehydration Solutions (ORSs)

Fluids designed to prevent dehydration during diarrhea.

Rehydration Phase

Initial ORS phase completed within 3-4 hours.

Maintenance Phase

Second ORS phase following rehydration.

Commercial ORS Products

Includes Ceralyte, Enfalyte, Pedialyte, Rehydralyte.

Household Remedies

Apple juice, broth, colas, Gatorade for hydration.

High Carbohydrate Content

Can worsen diarrhea if osmolality is too high.

Loperamide

Opioid agonist slowing GI motility for absorption.

Loperamide Dosing

>18 years: 4mg initially, max 8mg/day.

Salicylate Toxicity

Avoid Bismuth with aspirin or salicylates.

Bismuth Adverse Effects

Includes tinnitus, neurotoxicity, and stool discoloration.

Contraindications for Bismuth

Not for patients <12 years or recovering from chickenpox.

Lactase Dosing

>12 years: 3,000 - 18,000 units with lactose.

Pregnancy Considerations

Self-care for diarrhea not recommended during pregnancy.

Geriatric Treatment Caution

Self-treatment of diarrhea is strongly cautioned.

Clinical Pearls

Pedialyte has higher electrolytes than Gatorade.

Diarrhea from Antibiotics

Common cause requiring specific treatment considerations.

Soft Stool vs Diarrhea

Fiber recommended to bulk stool consistency.