PHP 315 - Intestinal Gas

What is intestinal gas?

Belching of air

Bloating

Gas pains

Flatulence

What do we have to differentiate between for treatment of intestinal gas?

healthy adults vs those with IBS, lactose intolerance, or celiac disease

What percentage of the US population has lactose malabsorption?

29%

What percentage of the US population has IBS?

5-15%

What percentage of the US population has celiac disease?

1-3%

What are the treatment goals for intestinal gas?

Reduce frequency, intensity, and duration of intestinal gas symptoms

Reduce the impact of gas symptoms on a patient's lifestyle

Is it realistic to eliminate all intestinal gas?

No, because a certain amount is normal

What is the general treatment approach for intestinal gas?

Identifying the underlying cause will guide treatment options

Inquire about the patient's diet

-types of foods and rate of ingestion

-dietary modification may be key

Consider exclusion criteria

What are the exclusions for self-care of intestinal gas?

Symptoms for several days or occur more than occasionally

Severe debilitating symptoms

Sudden change in location of abdominal pain, significant increase in frequency or severity of symptoms, or an onset of symptoms in individuals > 40

Symptoms accompanied by significant abdominal discomfort or a sudden change in bowel function

Presence or accompanying symptoms such as severe or persistent diarrhea or constipation, GI bleeding, fatigue, unintentional weight loss, or frequent nocturnal symptoms

What does self-management for intestinal gas include?

Dietary reduction

Eating & other habits

Medication

What does the self-management treatment "dietary reduction" include?

Reduction of legumes, carbs, carbonated beverages, caffeinated beverages, and air-whipped foods

Lactose intolerance should avoid milk and dairy products or use lactase supplements

Keep a food jounral

What does the self-management treatment "eating & other habits" include?

Eat & drink slowly

Control aerophagia

Do not induce belching or passing gas

Do not overload the stomach at one meal

Check if dentures fit well

Do not lie down or sit ina slumped position immediately after eating

Avoid tight-fitting garments, girdles, and bels

Develop a regular routine of exercise and rest

How can aerophagia be controlled?

decrease gum and candy chewing, decrease smoking, and avoid deep sighing

What does the self-management treatment "medication" include?

Avoid long term or frequent intermittent use of medications or cold & allergy symptoms

Avoid or minimize the use of drugs affecting GI motility

Avoid or minimize the use of drugs affecting glucose metabolism

Avoid or minimize the use of drugs that affect intestinal flora

Avoid or gradually increase the intake of food or medications that are high in fiber

Avoid nonabsorbable polymers

Avoid medications that contain or release gas

What are the nonprescription pharmacologic categories for intestinal gas?

Antiflatulents

Digestive enzymes

Probiotic products

Mixture of inert silicon polymers that reduces surface tension of gas bubbles

Gas-X, Mylicon Infant's Drops, Phazyme

Simethicone

Simethicone and _____ combination for nonspecific diarrhea produced quicker relief than either alone

loperamide

Simethicone and _____ product often contain less simethicone and are not as well studied

antacid

What is the adult dosage for simethicone?

40-125 mg four times daily as needed after means and at bedtime

What is the infant dosage for simethicone?

40 mg per 0.6 mL

Why are there no side effects of simethicone?

The drug is not absorbed, so there are no reported side effects

When is the use of simethicone contraindicated?

known hypersinsitivity or suspected intestinal perforation and obstruction

Promoted to relieve intestinal gas

-neither approved not shown to be effective

Activated charcoal

What is the proposed mechanism for activated charcoal?

absorbent properties

What is the dosage for activated charcoal?

500-520 mg orally after meals as needed

NO PEDIATRIC DOSES

FDA approved antiflatulent

Beano

Alpha-galactosidase

Where is Alpha-galactosidase derived?

a mold called Aspergillus niger

How does Alpha-galactosidase work?

Hydrolyzes oligosaccarides before metabolized by colonic bacteria

You should avoid Alpha-galactosidase with ______ or allergy to _____

galactosemia; mold

an inherited metabolic disorder that causes galactose to accumulate in the blood due to a deficiency of the enzyme that catalyzes the conversion of galactose into glucose

Galactosemia

Why should patients with diabetes consult with their PCP before self-treatment with Alpha-galactosidase?

it produces carbohydrates

What is the dosage for Alpha-galactosidase?

300-450 units per serving of food (with the first bite)

Not recommended in children

At what temperature may Alpha-galactosidase be inactivated?

>130 F

Lactaid, Lactrase, Dairy Ease, or SureLac

lactase enzyme

What is the dosing of lactase enzymes?

3000-9000 U at the first bite of food or drink with lactose NTE 18,000 units per day

may provide temporary relief for patients with IBS or lactose intolerance

Probiotic products

Bifobacterium, Lactobacillus, Sacchromyces, and Streptococcus

Bacteria in probiotic products

Bifobacterium animalis or Lactobacillus

Probiotic functional foods

T or F: Daily administration requires to maintain bacteria rates. 14 day trial recommended (discontinue if no benefit)

True

What are the key points?

Limit to minor symptoms and those without exclusions

Differentiate intestinal gas vs. IBS

Counsel on dietary measures

Agents may be useful despite contradictory evidence

Digestive enzymes may help with specific foods

Refer those with exclusions