European Consensus on Functional Bloating and Abdominal Distension—An ESNM/UEG Recommendations for Clinical Management
Year: 2025
Type: article
Abstract: INTRODUCTION: Abdominal distension is an objective visible sign of increased abdominal girth. Bloating is a feeling of abdominal fullness and discomfort. Bloating may be associated or not with abdominal distension. Bloating and abdominal distension are among the most commonly reported gastrointestinal symptoms and may be associated with both organic and functional disorders. Nevertheless, specific consensus and recommendations on diagnosis, underlying mechanisms, assessment and management of functional bloating and abdominal distension are still lacking. The aim of this European consensus, then, is to provide expert opinions and recommendations on the epidemiology, diagnosis, pathophysiology and treatment of functional bloating and abdominal distension. METHODS: A multidisciplinary team of experts in the field, including European specialists and national societies, participated in the development of this consensus. Relevant questions were formulated and addressed through a literature review and statements were developed and voted using a Delphi process. RESULTS: Functional bloating and abdominal distension are common and frequently overlap with other disorders of gut-brain interaction. Diagnosis is made according to the Rome IV criteria after the exclusion of organic disease, based on the physical examination and assessment of the patient's medical history and alarming signs. In the absence of alarming signs or any relevant finding, clinical laboratory, imaging or endoscopic tests are unnecessary. The pathophysiology of functional bloating and abdominal distension is multifactorial and involves visceral hypersensitivity, abdomino-phrenic dyssynergia, intestinal dysmotility and dysbiosis. Treatment may include dietary modifications (e.g. lactose-limiting diet and low FODMAP diet), probiotics, antispasmodics (e.g., otilonium bromide, peppermint oil), rifaximin, secretagogues (e.g., linaclotide), neuromodulators (e.g., serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, buspirone), and plethysmography-based biofeedback. Moreover, cognitive behaviour therapy and hypnotherapy can be used in case of functional bloating associated with irritable bowel syndrome. CONCLUSION: This consensus provides an evidence-based framework for the evaluation and treatment of patients with functional bloating and abdominal distension.
DOI: 10.1002/ueg2.70098
Authors: Chloé Melchior, Heinz Hammer, Serhat Bor, Elizabeth Barba, Indira Benjak Horvat, Altay Celebi, Vasile Drug, Dan Dumitrascu, Ismail Hakki Kalkan, Goran Hauser, Christos Lionis, Dan Livovsky, Amir Mari, Agata Mulak, Teodora Surdea‐Blaga, Jan Tack, Tim Vanuytsel, Edoardo Vincenzo Savarino, Natalia Zarate‐Lopez, Johann Hammer, Ram Dickman
Institutions: Inserm, Nutrition, Inflammation et axe Microbiote-Intestin-Cerveau, Université de Rouen Normandie, University of Graz, Medical University of Graz, Ege University, Hospital Clínic de Barcelona, Universitat de Barcelona, Opća Bolnica Varaždin, Kocaeli Üniversitesi, Grigore T. Popa University of Medicine and Pharmacy, Spitalul Clinic Judeţean de Urgenţe "Sf. Spiridon" Iaşi, Iuliu Hațieganu University of Medicine and Pharmacy, Spitalul Clinic Județean de Urgență Cluj-Napoca, TOBB University of Economics and Technology, University of Rijeka, Klinički Bolnički Centar Rijeka, University of Crete, Hebrew University of Jerusalem, Shaare Zedek Medical Center, Bikur Cholim Hospital, Bar-Ilan University, Nazareth Hospital EMMS, University of Wrocław, Wroclaw Medical University, KU Leuven, University of Padua, Azienda Ospedale - Università Padova, University College London, Medical University of Vienna, Tel Aviv University, Rabin Medical Center
Language: English
Subfield: Gastroenterology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $2,930
Funder: United European Gastroenterology
OpenAlex ID: W4413426663