Flatulence

The term flatulence describes a condition characterized by an "excessive synthesis of gases in the gastrointestinal tract, accompanied by an" abnormal emission of the same gases from the rectum.

The causes at the origin of the phenomenon can be many. Often flatulence is caused by an increase in fermentative or putrefactive processes, consequent to qualitative and quantitative food errors. Other times it is the fault of drugs, stress and excessive tension.

Although intestinal fermentation is an absolutely physiological phenomenon, the excessive production of gas that characterizes flatulence is often accompanied by an annoying or painful abdominal distension (meteorism), especially when, for physiological or social reasons, such gases cannot find vent.

FUN FACT: the noise commonly associated with flatulence is caused by the vibration of the anal opening.

Some people are able to control the sphincter that normally closes this orifice and, by reducing abdominal pressure, draw air into the rectum through the "anus. This is the case of the famous Joseph Pujol who, more than a century ago, animated the nightlife of the Belle. Parisian Epoque with a musical show based on pernacchie. This peculiar ability earned him the nickname of "the Petomane".

: excessive swallowing of air, usually followed by noisy belching. It can have a pathological basis (gastroesophageal reflux, hiatal hernia, angina pectoris, dyspepsia, peptic ulcer) or behavioral (smoking and bad dietary habits, such as hasty ingestion of food or drinks, especially carbonated).

Excessive bacterial fermentation: in these cases flatulence is linked to the ingestion of foods rich in oligosaccharides which, not being completely digested, arrive in the colon, where they constitute the energetic substrate of the local microflora. These microorganisms synthesize gaseous waste products, mainly composed of : hydrogen, oxygen, carbon dioxide, methane, nitrogen and foul-smelling skatole, sulfur, indole and butyric acid. Excess bran can also cause flatulence and abdominal tension.
If flatulence is not associated with pathologies or frequent belching, it is most likely due to excessive bacterial fermentation. In these cases we speak of pure hyperflatulence.

Pathologies: gastritis, peptic ulcer (gastric or duodenal), hiatal hernia, colitis, irritable bowel syndrome, bacterial contamination syndrome of the small intestine and food allergies, but also emotional and mental disorders (anxiety, depression and stress excessive).

To learn more, read: Flatulence - Causes and Symptoms .

When flatulence creates significant discomfort in the social context or severe pain caused by excessive gas accumulation, an accurate diagnostic investigation can still be useful.

1. First of all, a thorough medical history of the patient is required, for example by investigating whether flatulence:
• it is associated with the consumption of particular foods or with certain psychological conditions
• if it is accompanied by other symptoms such as changes in the bowel (constipation, diarrhea), abdominal pain or faecal discharge of mucus and blood
• if it is associated with the intake of particular drugs, with diseases in progress or if there is a familiarity with certain pathologies
2. Thanks to an accurate patient history, the doctor can now hypothesize the origin of flatulence, for example:
   • if it is associated with the consumption of particular foods → possible food intolerance
   • if it is associated with particular eating habits (abuse of sugary drinks, sweets, starchy foods, diet low in fruit and vegetables, overeating, sedentary lifestyle) → possible loss of the optimal absorption capacity of the intestinal mucosa (dripping bowel syndrome or hyper- intestinal permeability)
   • if it is associated with alterations of the alvo and states of nervousness, anxiety, stress, depression, hypochondria → possible irritable bowel syndrome
   • if it is associated with fever, diarrheal discharges, severe abdominal pain → possible intestinal infection in progress
   • if it is associated with diseases with an important autoimmune component (e.g. psoriasis, arthritis), blood in the stool, abundant presence of mucus in the excrement, periods of constipation and others of diarrhea, with alternating remissions and relapses → possible presence of an inflammatory bowel disease
   • if associated with ribbon-like stools, age> 50 years, abdominal pain, anemia and blood in stool → possible colon cancer (malignant or benign)
3. To confirm or deny these hypotheses, the doctor can subject the patient to one or more diagnostic tests
   • The traditional examination consists in collecting the gas expelled through a rectal tube inserted in the anus and connected to a syringe. The chemical analysis of these gases will therefore be able to establish the origin of flatulence: if the majority constituent is nitrogen at the base of the disorder, there is most likely aerophagia; if, on the other hand, the fart is rich in hydrogen and carbon dioxide it is a malabsorption of carbohydrates, with consequent bacterial hyperfermentation, as happens in lactose intolerant subjects. In any case, to be able to speak of flatulence, the number of daily expulsions must be greater than 25; the gas emitted must also exceed 100 ml / h. Instead, 10-20 passages per day are completely normal, for a total volume of about a liter of air (Bibliography: Outpatient colon proctology - treatise for surgeons, gastroenterologists and practitioners, p. 97).
   • When the doctor supposes that the origin of flatulence is linked to a food intolerance, to a bacterial contamination syndrome of the small intestine or to intestinal malabsorption problems, he can perform the so-called breath test, certainly more practical and used than the previous test. To deepen the subject, we suggest reading the articles on the Breath test for the diagnosis of lactose intolerance and on the sorbitol Breath test.
   • Alternatively or together with breath tests, the doctor may prescribe stool tests (e.g. measurement of fecal pH) and blood tests (e.g. search for specific antibodies, for celiac disease)
   • When symptoms indicate a possible severe pathology, X-ray examinations of the gastrointestinal tract and possibly endoscopic examination (gastroscopy and / or colonoscopy) with biopsy are indicated.

It often happens that the patient attributes the origin of abdominal pain to flatulence, when in reality there is only an increased sensitivity of the colic wall (irritable bowel syndrome) at the base of the disorder. Thus one gets the impression that some foods cause bloating but, in fact, they stimulate not so much flatulence, but a series of involuntary intestinal contractions, which are perceived as an annoying sense of gaseous distension.

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