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기능성 팽만감(Functional Bloating)의 진단과 치료

Diagnosis and Treatment of Functional Bloating

  • 박무인 (고신대학교 의과대학 내과학교실)
  • Park, Moo In (Department of Internal Medicine, Kosin University College of Medicine)
  • 발행 : 2012.11.01

초록

Functional abdominal bloating is a common and significant problem in men and women of all ages. Bloating is very common in patients with irritable bowel syndrome and constipation, and also occurs in patients with organic disorders and psychiatric conditions. If an organic or psychiatric cause are not found, then bloating can be considered to be functional. The possible causes of functional bloating are combination of several factors such as gut microflora, gas production, intestinal transit, intestinal propulsion of gas, and sensory function within the gastrointestinal tract. Evaluation of a patient with bloating should begin with a careful history and physical examination to rule out an organic disorders. Reassurance and education are the first essential step as a treatment for functional bloating. The therapeutic approach involving diet, probiotics, and medications usually improve bloating.

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참고문헌

  1. Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders. Gastroenterology 2006;130:1480-1491. https://doi.org/10.1053/j.gastro.2005.11.061
  2. Alvarez WC. Hysterical type of nongaseous abdominal bloating. Arch Intern Med (Chic) 1949;84:217-245. https://doi.org/10.1001/archinte.1949.00230020020002
  3. Drossman DA, Li Z, Andruzzi E, et al. U.S. householder survey of functional gastrointestinal disorders: prevalence, sociodemography, and health impact. Dig Dis Sci 1993;38:1569-1580. https://doi.org/10.1007/BF01303162
  4. Sandler RS, Stewart WF, Liberman JN, Ricci JA, Zorich NL. Abdominal pain, bloating, and diarrhea in the United States: prevalence and impact. Dig Dis Sci 2000;45:1166-1171. https://doi.org/10.1023/A:1005554103531
  5. Ringel Y, Williams RE, Kalilani L, Cook SF. Prevalence, characteristics, and impact of bloating symptoms in patients with irritable bowel syndrome. Clin Gastroenterol Hepatol 2009;7:68-72. https://doi.org/10.1016/j.cgh.2008.07.008
  6. Jiang X, Locke GR 3rd, Choung RS, Zinsmeister AR, Schleck CD, Talley NJ. Prevalence and risk factors for abdominal bloating and visible distention: a populationbased study. Gut 2008;57:756-763. https://doi.org/10.1136/gut.2007.142810
  7. Ho KY, Kang JY, Seow A. Prevalence of gastrointestinal symptoms in a multiracial Asian population, with particular reference to reflux-type symptoms. Am J Gastroenterol 1998;93:1816-1822. https://doi.org/10.1111/j.1572-0241.1998.00526.x
  8. Park JM, Choi MG, Cho YK, et al. Functional gastrointestinal disorders diagnosed by Rome III questionnaire in Korea. J Neurogastroenterol Motil 2011;17:279-286. https://doi.org/10.5056/jnm.2011.17.3.279
  9. Lembo T, Naliboff B, Munakata J, et al. Symptoms and visceral perception in patients with pain-predominant irritable bowel syndrome. Am J Gastroententerol 1999;94: 1320-1326. https://doi.org/10.1111/j.1572-0241.1999.01009.x
  10. Spiegel B, Strickland A, Naliboff BD, Mayer EA, Chang L. Predictors of patient-assessed illness severity in irritable bowel syndrome. Am J Gastroenterol 2008;103:2536-2543. https://doi.org/10.1111/j.1572-0241.2008.01997.x
  11. Houghton LA, Lea R, Agrawal A, Reilly B, Whorwell PJ. Relationship of abdominal bloating to distention in irritable bowel syndrome and effect of bowel habit. Gastroenterology 2006;131:1003-1010. Erratum in: Gastroenterology 2006;131:2029. https://doi.org/10.1053/j.gastro.2006.07.015
  12. Sullivan SN. A prospective study of unexplained visible abdominal bloating. N Z Med J 1994;107:428-430.
  13. Sullivan SN. Functional abdominal bloating with distention. ISRN Gastroenterol 2012;2012:721820.
  14. Hart AI, Stagg AJ, Groffner H, et al. Gut Ecology. London: Martin Duntiz Ltd, 2002.
  15. Levitt MD. Volume and composition of human intestinal gas determined by means of an intestinal washout technic. N Engl J Med 1971;284:1394-1398. https://doi.org/10.1056/NEJM197106242842502
  16. Lasser RB, Bond JH, Levitt MD. The role of intestinal gas in functional abdominal pain. N Engl J Med 1975;293:524-526. https://doi.org/10.1056/NEJM197509112931103
  17. Perez F, Accarino A, Azpiroz F, Quiroga S, Malagelada JR. Gas distribution within the human gut: effect of meals. Am J Gastroenterol 2007;102:842-849. https://doi.org/10.1111/j.1572-0241.2007.01071.x
  18. Tomlin J, Lowis C, Read NW. Investigation of normal flatus production in healthy volunteers. Gut 1991;32:665-669. https://doi.org/10.1136/gut.32.6.665
  19. King TS, Elia M, Hunter JO. Abnormal colonic fermentation in irritable bowel syndrome. Lancet 1998;352:1187-1189. https://doi.org/10.1016/S0140-6736(98)02146-1
  20. Serra J, Azpiroz F, Malagelada JR. Impaired transit and tolerance of intestinal gas in the irritable bowel syndrome. Gut 2001;48:14-19. https://doi.org/10.1136/gut.48.1.14
  21. Caldarella MP, Serra J, Azpiroz F, Malagelada JR. Prokinetic effects in patients with intestinal gas retention. Gastroenterology 2002;122:1748-1755. https://doi.org/10.1053/gast.2002.33658
  22. Accarino A, Perez F, Azpiroz F, Quiroga S, Malagelada JR. Abdominal distention results from caudo-ventral redistribution of contents. Gastroenterology 2009;136:1544-1551. https://doi.org/10.1053/j.gastro.2009.01.067
  23. Hernando-Harder AC, Serra J, Azpiroz F, et al. Colonic responses to gas loads in subgroups of patients with abdominal bloating. Am J Gastroenterol 2010;105:876-882. https://doi.org/10.1038/ajg.2010.75
  24. Salvioli B, Serra J, Azpiroz F, et al. Origin of gas retention and symptoms in patients with bloating. Gastroenterology 2005;128:574-579. https://doi.org/10.1053/j.gastro.2004.12.047
  25. Salvioli B, Serra J, Azpiroz F, Malagelada JR. Impaired small bowel gas propulsion in patients with bloating during intestinal lipid infusion. Am J Gastroenterol 2006;101:1853-1857. https://doi.org/10.1111/j.1572-0241.2006.00702.x
  26. Agrawal A, Houghton LA, Lea R, Morris J, Reilly B, Whorwell PJ. Bloating and distention in irritable bowel syndrome: the role of visceral sensation. Gastroenterology 2008;134:1882-1889. https://doi.org/10.1053/j.gastro.2008.02.096
  27. Tremolaterra F, Villoria A, Azpiroz F, Serra J, Aguadé S, Malagelada JR. Impaired viscerosomatic reflexes and abdominal- wall dystony associated with bloating. Gastroenterology 2006;130:1062-1068. https://doi.org/10.1053/j.gastro.2005.12.036
  28. Villoria A, Azpiroz F, Soldevilla A, Perez F, Malagelada JR. Abdominal accommodation: a coordinated adaptation of the abdominal wall to its content. Am J Gastroenterol 2008;103:2807-2815. https://doi.org/10.1111/j.1572-0241.2008.02141.x
  29. Schmulson M, Chang L. Review article: the treatment of functional abdominal bloating and distension. Aliment Pharmacol Ther 2011;33:1071-1086. https://doi.org/10.1111/j.1365-2036.2011.04637.x
  30. Lacy BE, Gabbard SL, Crowell MD. Pathophysiology, evaulation, and treatment of bloating: hope, hype, or hot air? Gastroenterol Hepatol (N Y) 2011;11:729-739.
  31. Choi YK, Kraft N, Zimmerman B, Jackson M, Rao SS. Fructose intolerance in IBS and utility of fructose-restricted diet. J Clin Gastroenterol 2008;42:233-238.
  32. Barrett JS, Gibson PR. Clinical ramifications of malabsorption of fructose and other short-chain carbohydrates. Practical Gastroenterol 2007;31:51-65.
  33. Shepherd SJ, Parker FC, Muir JG, Gibson PR. Dietary triggers of abdominal symptoms in patients with irritable bowel syndrome: randomized placebo-controlled evidence. Clin Gastroenterol Hepatol 2008;6:765-771. https://doi.org/10.1016/j.cgh.2008.02.058
  34. Villoria A, Serra J, Azpiroz F, Malagelada JR. Physical activity and intestinal gas clearance in patients with bloating. Am J Gastroenterol 2006;101:2552-2557. https://doi.org/10.1111/j.1572-0241.2006.00873.x
  35. Dainese R, Serra J, Azpiroz F, Malagelada JR. Influence of body posture on intestinal transit of gas. Gut 2003;52:971-974. https://doi.org/10.1136/gut.52.7.971
  36. Ringel-Kulka T, Palsson OS, Maier D, et al. Probiotic bacteria Lactobacillus acidophilus NCFM and Bifidobacterium lactisBi-07 versus placebo for the symptoms of bloating in patients with functional bowel disorders: a double-blind study. J Clin Gastroenterol 2011;45:518-525. https://doi.org/10.1097/MCG.0b013e31820ca4d6
  37. O'Mahony L, McCarthy J, Kelly P, et al. Lactobacillus and bifidobacterium in irritable bowel syndrome: symptom responses and relationship to cytokine profiles. Gastroenterology 2005;128:541-551. https://doi.org/10.1053/j.gastro.2004.11.050
  38. Whorwell PJ, Altringer L, Morel J, et al. Efficacy of an encapsulated probiotic Bifidobacterium infantis 35624 in women with irritable bowel syndrome. Am J Gastroenterol 2006;101:1581-1590. https://doi.org/10.1111/j.1572-0241.2006.00734.x
  39. Kim HJ, Camilleri M, McKinzie S, et al. A randomized controlled trial of a probiotic, VSL#3, on gut transit and symptoms in diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther 2003;17:895-904. https://doi.org/10.1046/j.1365-2036.2003.01543.x
  40. Kim HJ, Vazquez Roque MI, Camilleri M, et al. A randomized controlled trial of a probiotic combination VSL# 3 and placebo in irritable bowel syndrome with bloating. Neurogastroenterol Motil 2005;17:687-696. https://doi.org/10.1111/j.1365-2982.2005.00695.x
  41. Guandalini S, Chiaro A, Romano C, et al. Efficacy of the probiotic VSL#3 in children with irritable bowel syndrome: an international, randomized, placebo controlled, doubleblind, cross-over trial. Am J Gastroenterol 2008;103:A1342.
  42. Sharara AI, Aoun E, Abdul-Baki H, Mounzer R, Sidani S, Elhajj I. A randomized double-blind placebo-controlled trial of rifaximin in patients with abdominal bloating and flatulence. Am J Gastroenterol 2006;101:326-333. https://doi.org/10.1111/j.1572-0241.2006.00458.x
  43. Pimentel M, Park S, Mirocha J, Kane SV, Kong Y. The effect of a nonabsorbed oral antibiotic (rifaximin) on the symptoms of the irritable bowel syndrome: a randomized trial. Ann Intern Med 2006;145:557-563. https://doi.org/10.7326/0003-4819-145-8-200610170-00004
  44. Pimentel M, Lembo A, Chey WD, et al. Rifaximin therapy for patients with irritable bowel syndrome without constipation. N Engl J Med 2011;364:22-32. https://doi.org/10.1056/NEJMoa1004409
  45. DiPalma JA, Cleveland MB, McGowan J, Herrera JL. A comparison of polyethylene glycol laxative and placebo for relief of constipation from constipating medications. South Med J 2007;100:1085-1090. https://doi.org/10.1097/SMJ.0b013e318157ec8f
  46. Accarino A, Perez F, Azpiroz F, Quiroga S, Malagelada JR. Intestinal gas and bloating: effect of prokinetic stimulation. Am J Gastroenterol 2008;103:2036-2042. https://doi.org/10.1111/j.1572-0241.2008.01866.x
  47. Johnson AG. Controlled trial of metoclopramide in the treatment of flatulent dyspepsia. Br Med J 1971;2:25-26. https://doi.org/10.1136/bmj.2.5752.25
  48. Drossman DA, Chey WD, Panas R, et al. Lubiprostone significantly improves symptom relief rates in adults with irritable bowel syndrome and constipation (IBS-C): data from two twelve-week, randomized, placebo-controlled, double blind trials. Gastroenterology 2007;132:2586-2587.
  49. Chey WD, Drossman DA, Johanson JF, Scott C, Panas RM, Ueno R. Safety and patient outcomes with lubiprostone for up to 52 weeks in patients with irritable bowel syndrome with constipation. Aliment Pharmacol Ther 2012;35:587-599. https://doi.org/10.1111/j.1365-2036.2011.04983.x
  50. Johnston JM, Kurtz CB, Macdougall JE, et al. Linaclotide improves abdominal pain and bowel habits in a phase IIb study of patients with irritable bowel syndrome with constipation. Gastroenterology 2010;139:1877-1886. https://doi.org/10.1053/j.gastro.2010.08.041
  51. Ford AC, Talley NJ, Schoenfeld PS, Quigley EM, Moayyedi P. Efficacy of antidepressants and psychological therapies in irritable bowel syndrome: systematic review and metaanalysis. Gut 2009;58:367-378. https://doi.org/10.1136/gut.2008.163162
  52. Drossman DA, Toner BB, Whitehead WE, et al. Cognitivebehavioral therapy versus education and desipramine versus placebo for moderate to severe functional bowel disorders. Gastroenterology 2003;125:19-31. https://doi.org/10.1016/S0016-5085(03)00669-3

피인용 문헌

  1. Bloating vol.70, pp.6, 2012, https://doi.org/10.4166/kjg.2017.70.6.288
  2. Gut Microbiota in Health and Probiotics in Functional Bowel Disease vol.40, pp.1, 2012, https://doi.org/10.12771/emj.2017.40.1.22