by Dr. Jennifer Thompson and Erin Platt - PA-C
Bloating- Could it be Celiac Disease?
You may have had to loosen your belt buckle a few notches over the holidays or wondered when exactly after sitting down at the table that your regular jeans became skinny jeans. We’ve all probably experienced the sensation of bloating or seen our stomachs inflate like a Macy’s Thanksgiving Day balloon before our very eyes after a large meal. However, some individuals experience this discomfort on a daily basis, even after eating only a small meal. If you are one of these people, you are not alone.
What is bloating, and why do we experience it?
People who complain of feeling “bloated” usually mean that they feel a sense of increased pressure within the abdomen, usually from gas. Other times, this term is used to describe when the abdomen actually increases in diameter and becomes distended. There are many different causes of bloating, some of which are explained below:
Pressure due to the normal build-up of gases produced by the digestion of different foods we eat is a common cause of bloating. Gas is a normal by-product of the digestion process.
Excess gas can be produced in some people who have trouble breaking down commonly eaten carbohydrates (complex sugars) such as lactose (found in milk and other dairy products). When lactose is not broken down early in digestion, it reaches the colon whole, where the colonic bacteria can break the sugars down instead and release excess gas. Lactose intolerance becomes more common with age.
In a similar way, other carbohydrates (known as Fermentable Oligo-Di-Monosaccharides and Polyols, aka FOD-MAPS) can cause excess gas, bloating, abdominal discomfort and distention in certain people. Some examples of foods that contain these carbohydrates include fruits that are high in fructose (apples, pears, mangoes, cherries and watermelon). Vegetables such as artichokes, asparagus, broccoli, brussel sprouts, cabbage and cauliflower also contain these carbohydrates.
Gastroparesis is when your stomach does not empty well and it may take many hours for the contents of the stomach to empty into the small intestine. The slow emptying causes feelings of being 'full' with bloating and sometimes vomiting. Gastroparesis is more common in patients with longstanding diabetes, or can sometimes happen after a viral GI infection.
Gastroparesis is diagnosed through a gastric emptying study where food containing a small amount of radioactive material is eaten. A scanner is then used to measure time it takes for the radioactive material to move from the stomach to the intestines.
If gastroparesis is diagnosed, it is usually treated by making changes in your diet (small, frequent meals with less fiber and fat), and medications can also be used to speed up the stomach movement.
Small Intestinal Bacterial Overgrowth
Bloating and excess gas can also be caused by too much bacteria in your small intestine. While it is normal for the colon (large intestine) to contain many bacteria to help our digestion, the amount of bacteria in the small intestine is much lower. Various factors can change the environment of our small intestine and lead to excessive colonization of bacteria, which is known as small intestinal bacterial overgrowth (SIBO). The extra bacteria in the small bowel produce excess gas and small particles when they digest food that result in abdominal bloating/discomfort, flatulence, diarrhea, and sometimes even weight loss. The diagnosis of SIBO is usually made through a special breath test and the treatment consists of a short course of antibiotics that will clear out the extra bacteria.
Another reason that people complain of abdominal distension after meals can be due to abdomino-phrenic dyssynergia. Usually, after a meal or with increased intestinal gas, the diaphragm (muscle separating the chest cavity and the abdomen) reflexively relaxes upwards towards the chest, and the recently eaten meal and full stomach or gas-filled bowel takes up the space made by this relaxation. In people whose diaphragms do not relax appropriately, the abdominal wall has to push out to make room for the recently eaten meal or excess gas. When the normal diaphragmatic reflex does not work, this is referred to as Abdomino-Phrenic Dyssynergia and the treatment involves retraining the muscles of the diaphragm through a variety of exercises.
Celiac disease is an autoimmune disease in which body has an immune reaction to gluten (a protein found in wheat, barley, and rye), which damages the lining of the small intestine and makes it difficult to absorb nutrients. Symptoms of celiac disease are non-specific but most commonly include bloating and gas, diarrhea, and fatigue. Celiac disease is detected through blood tests and confirmed with a biopsy of the small intestine taken during an endoscopy. The treatment for celiac disease is to follow a gluten-free diet, as this will stop the immune reaction and allow the small intestine to heal. While it has recently become popular to try a gluten free diet to see whether this alleviates bloating, we recommend formal testing for celiac disease before going gluten free.
If any of these symptoms or conditions sound familiar and you would like more information, we would be happy to meet with you.