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All Things Windy

All Things Windy. Mounzer Al-Samman, MD, AGAF Gastroenterologist. Intestinal Gas: The Facts. It’s normal and common – 6-30% of population Average person passes gas 13 times a day Volume of gas ranges from 200-2000cc Primarily composed of methane, hydrogen, and nitrogen.

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All Things Windy

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  1. All Things Windy Mounzer Al-Samman, MD, AGAF Gastroenterologist

  2. Intestinal Gas: The Facts • It’s normal and common – 6-30% of population • Average person passes gas 13 times a day • Volume of gas ranges from 200-2000cc • Primarily composed of methane, hydrogen, and nitrogen

  3. The Long History of Bloating & Gas • Hippocrates: “Gas makes one feel whole” • Claudius: permitted gas to be passed in Rome • Emperor Constantine (in the year 315):made passing of gas illegal

  4. Think Diet, Diet, and Diet • What is your normal diet? • Do certain foods exacerbate your gas? • Could you be lactose-intolerant?

  5. Carbonated beverages Air swallowing (anxiety, stress) Eating rapidly Ill-fitting dentures Using a straw Chewing gum Hard candies Common Causes of Intestinal Gas

  6. Dietary Sources of Intestinal Gas • Noncaloric sweeteners (e.g., Equal, Splenda): nonabsorbed glucose isomers • Mannitol, sorbitol (chewing gum, candy) • Beans and legumes: raffinose, stachyose

  7. Dietary Sources –Cont’d • Beans and legumes: raffinose, stachyose • Vegetables (broccoli, cauliflower, onions) • Potatoes, sweet potatoes • Soluble fiber supplements

  8. IBS GERD Gall Bladder Disease Lactose intolerance Chronic pancreatitis Celia Disease Bacterial overgrowth Medical Causes

  9. Evaluation of Intestinal Gas • History: how long has it been going on? • Food diary • Additional testing and imaging; computed tomography, endoscopy, labs, celiac profile, breath test

  10. Treatment Option for Intestinal Gas • Anti-gas agents: simethicone (upper GI gas only), BEANO, activated charcoal • Probiotics (eg, yogurt, Align, VSL#3): • “good” bacteria to balance “bad” bacteria

  11. Treatment – Cont’d • Rifaximin: reduces bacterial overgrowth; 400mg, 3 times a day for 2 weeks • Treating IBS/constipation (Amitiza) • Treating GERD

  12. Lactase Deficiency • Inability to metabolize lactose in the small intestine (fermentable carbohydrate) • More common in African Americans, Asians, Puerto Ricans

  13. Lactase Deficiency • More common with advancing age • Gas after milk, cheese, ice cream • Often associated with diarrhea and bloating

  14. Celiac Disease • Celiac disease can be defined as a condition in which there is an abnormal small intestinal mucosa that improves morphologically when treated with a gluten free diet and relapses when gluten is introduced.

  15. Diagnosis • Serologic testing • Small bowel biopsy by endoscopy • Gluten rechallenge

  16. Components of Gluten-Free Diet • Avoid foods containing wheat, rye, and barely • Safe are soybean or tapioca flours, rice, corn, buckwheat, and potatoes

  17. Gluten-Free Diet Cont’d • Read labels on prepared foods and condiments carefully, paying particular attention to additives such as stabilizers or emulsifiers that may contain gluten. • Dairy products

  18. What is IBS? • Recurrent abdominal pain or discomfort for ≥ 3 days per month in the last 3 months, associated with ≥ 2 of the following: • Improvement with defecation • Onset associated with a change in stool frequency • Onset associated with a change in stool appearance

  19. 3 Types of IBS IBS – Diarrhea IBS – Constipation IBS - Mixed

  20. Causes (old) • Disturbed GI Motility • Stress • Visceral Hypersensitivity

  21. Causes (new) Alterations in intestinal microflora Inflammation

  22. Onset of symptoms after age 50 GI bleeding or iron-deficiency anemia Nocturnal diarrhea Weight loss Family history of organic GI disease (colorectal cancer, IBD, celiac disease) Red Flags in Suspected IBS

  23. What works for IBS –Diarrhea? Fiber Imodium Loperamide is the only antidiarrheal evaluated in randomized controlled trials; is effective for treatment for diarrhea, reducing stool frequency, and improving stool consistency No impact shown on bloating, abdominal discomfort, or global IBS symptoms Lotronex

  24. What works for IBS-Constipation? Miralax - Polyethylene Glycol (PEG) Amitiza – Lubiprostone

  25. What works for Pain/Bloating? Antispasmodics??? Antidepressants

  26. March is Colon Cancer Awareness Month

  27. American Gastroenterological Association www.Gastro.org The American College of Gastroenterology www.ACG.GI.org Resources

  28. Thank You – Questions? NorthBay.org (707) 646-3555 Mounzer Al-Samman, MD, AGAF

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