Q. Kindly suggest the best option to cure severe burping and bloating.

Answered by
Dr. Ajeet Kumar Lohana
and medically reviewed by Dr. K Shobana
This is a premium question & answer published on Jan 20, 2021 and last reviewed on: Feb 19, 2021

Hi doctor,

Currently, I have problems with constipation, bloating, burping, and stomach cramps. Before six weeks, I had trouble with acid reflux with coughing and had a sore voice in the morning with heartburn. I tried to cure the reflux by taking a low carb diet and consumed apple cider vinegar before each meal. I added little fiber to my diet. The acid reflux got better after a week and I had severe burping and bloating. I also had constipation. So I stopped taking a low-carb diet and apple cider vinegar. I went to the doctor and he took a blood sample and did an ultrasound of the stomach and intestine. The doctor told me that I have gastritis after examining the results. After two weeks, I started to have cramps, tightness, soreness on the side of my belly. I also started to have flatulence. So I took Natriumpicosulfat and felt better the next day. After a few days, flatulence, burping, tightness, and cramps got worse. I took Natriumpicosulfat every evening and the acid reflux got better. I went to the doctor again and he told me that I have IBS. I still have burping, bloating. flatulence, tightness, and soreness in the belly with constipation. I am taking Natriumpicosulfat daily. Is it dangerous? I have lactose intolerance.

#

Hi,

Welcome to icliniq.com.

I do not think that these problems will fit under a single diagnosis. You seem to have gastroesophageal reflux disease which causes acid reflux, sore throat, and altered voice. But it improves a lot after dietary modification. The symptoms of burping and flatulence occur due to gaseous symptoms. It can occur in individuals with lactose intolerance. It can also occur due to slowing of the bowel called IBS (irritable bowel syndrome). It can occur due to abnormal bacteria present within the small bowel called small intestinal bacterial overgrowth (SIBO). I am afraid that you have IBS as there are few things to be aware of it.

Because IBS causes predominant abdominal pain and the pain changes after passing stools, gas, and burping. IBS tends to remain for many years and needs to be treated with proper medicines. You need to do some testing before confirming the diagnosis of IBS. You need to avoid taking lactose and other sugar-based foods. Taking Natriumpicosulfat is harmful when taken for months and it can numb the bowels. You can take Polyethylene glycol sachet 17 gm one sachet twice daily for constipation. Please do the blood tests and revert me.


Investigations to be done:

You need to do a complete blood count, fasting blood sugar, fasting lipid profile, liver function tests, HBA1c (hemoglobin A1c), TSH (thyroid-stimulating hormone). You need to do a Stool examination for ova and parasites, fecal calprotectin, and H pylori (helicobacter) antigen.

Treatment plan:

You can take a polyethylene glycol sachet. 17 gm twice daily in one glass of water. Take plenty of water approximately two to three liters in a day
Take Capsule Nexium 20 mg half an hour before meals if you have acidity and otherwise do not take it.

Regarding follow up:

Follow up as advised and let me know if you have any other concerns.

Thank you doctor,

thank you.

#

Hi,

Welcome back to icliniq.com.

Please say whether you understood the information given by me.

Thank you doctor,

Can I have SIBO? For some days, I have pain and sometimes I do not have pain. The pain is mild during the morning when I empty my bowel and it becomes worse throughout the day. Is there any mild medication that helps to fight against the pain? After getting diagnosed with lactose intolerance, I started to take lactose-free products. I was diagnosed with lactose intolerance before two years. The onset was sudden and after that, I started to have constipation and cramps suddenly. It went away after I stopped taking dairy products. The symptoms are similar to those I have now and so you are right with the diagnosis of some carbohydrate malabsorption. I read that only people with methane-producing bacteria develop constipation instead of diarrhea from lactose intolerance. Is it possible to have an overgrowth of bacteria in my gut? I tried to cut fructose. maltose and sucrose in my diet. Will it adopt for a low FODMAP diet? Can I consume glucose and galactose? I will try to get the results of my blood tests and ultrasound. I have a small hiatal hernia and I do not have symptoms when I follow a good diet.

#

Hi,

Welcome back to icliniq.com.

Well, SIBO (small intestinal bacterial overgrowth) is an integral part of the mechanism causing IBS (irritable bowel syndrome). Yes, methane can cause constipation and this gas is produced after carbohydrates fermentation among individuals either with SIBO or a person who is intolerant to carbohydrates. So you should appreciate SIBO and carbohydrate as both have the same endpoint resulting in producing excessive gases. So I am against the diagnosis of IBS for now. The best course of action is to get the tests that I have recommended you now and start taking some antibiotics. A Low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet is the best thing to help you. You can take Rifaximin 200 mg thrice daily for three weeks. This is used for suspected SIBO. This is relatively a safe antibiotic and it shows milder gut upsets like bloating and diarrhea. They are frequently tolerable and goes away once the course of treatment is stopped.

Thank you doctor,

I will do the tests but it can take several weeks. Is there any mild medication that helps with bloating and gas? Is there any mild medication to help with the cramps and muscle pains? Glucose and Galactose are relatively safe for SIBO. Is it right?

#

Hi,

Welcome back to icliniq.com.

Galactose does not help you as it is a part of lactose. Glucose can help you as it does not cause any trouble by producing excessive gas. Take complex sugars in fruits and vegetables. Do not take refined sugars present in cold drinks and avoid adding sugar in tea or coffee, shakes, energy drinks, and sweets and sweeteners. For gas and bloating, you can take Metoclopramide 10 mg thrice daily half-hour before food for two weeks. I do not suggest any medications for pain as they are anti-spasmodic medications. They could worse constipation. If you want to take a pill for pain, then you can take Mebeverine 200 mg once a day.

Thank you doctor,

I have scheduled to do the tests next week. I will share the results when I receive them. In the meantime, many of my symptoms have greatly improved. After our last conversation, I did some more research and found a supplement called Atrantil which was developed by a gastroenterologist to treat IBS-C or methane SIBO. It has helped me a lot.

My constipation is completely gone. The belly muscles are relaxed and the pain is also gone. I am not taking laxatives for two weeks now. But it has not helped with the gas or pressure in my stomach. Throughout the day I have increased pressure in my stomach or chest area and I feel uncomfortable. Whenever I eat or drink a large amount of water or soda, I get massive burping and I have relief after several burps. Then the cycle starts again after the next meal.

I also found that deep breathing through the nose can also lead to burping in the belly and cause pressure. Sitting for long periods seems to worsen the pressure and gas buildup. There is no flatulence and there is only burping. I forgot to say last time that I was diagnosed with an axial hiatal hernia (4 cm) before seven years. This was diagnosed with a gastroscopy. But this hernia was there without symptoms for the past few years. Can this be the cause of the pressure and gas buildup? I have no feelings of reflux or pain or burning. Does it make sense to do another gastroscopy?

#

Hi,

Welcome back to icliniq.com.

It is good to know that your symptoms have improved. As you do not have symptoms of gastroesophageal reflux, then the axial hernia is not a problem. You can simply ignore it. The drug Atranil is herbal medicine, and it has shown efficacy in controlling pain, constipation, and gas bloating in IBS -constipated predominant patients. It was seen in a case series of 30 patients or so, but not seen in a randomized study which is the best way to explore any medicines therapeutic effect.

Anyway, there were no side effects reported in their study, and so you can use it for two weeks and see if does help you. But you must understand that I am not an expert in herbal medicines, I can only support you, but can not suggest or recommend you. But these alternative and complementary medicines are now becoming a part of the allopathic health system. But requires significant research in that field. A hernia can trap gas sometimes, but I do not feel that it is the cause for your symptoms. I suggest you use Polyethylene glycol for constipation and Metoclopramide for bloating and gas. Please mention whether they helped you or not. For gas and bloating, you can do diaphragmatic breathing.

Thank you doctor,

I have taken Atranil for three weeks now and it has cured constipation and belly pain. Polyethylene glycol has helped me with bowel movement, but it is no longer needed. The Metoclopramide did not help with the gas. Is there any other medication that works against the gas?

#

Hi,

Welcome back to icliniq.com.

For the gas, you should do diaphragmatic breathing which means breathing through the belly. You said in your previous query that taking deep breaths from the nose and into the belly helps to relieve the pressure. Actually, this is diaphragmatic breathing or belly breathing. You take deep breaths from your nose, and move just your belly, keeping your chest still. You keep one hand on the chest and another on the abdomen, and see only your abdominal hand moves, which hand over the chest remains still. You can learn how to do it by simply seeing a video. Actually this breathing exercise relaxes your diaphragm and accommodates the abdominal gas sufficiently, thereby you would feel less sense of gas. This is proven medical therapy for gas and bloating. Second, you can use a Semethicone capsule. It is proven to relieve gas and bloating. Take Semthicone extra strength capsules 125 to 250 mg orally after meals and at bedtime as needed. Lastly, since SIBO is an underlying mechanism of excessive gas production, you can simply test for it, and if it is positive, then use Rifaximin 200 mg thrice daily for three weeks. The test for SIBO is the hydrogen breath test (HBT).


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