Año 2024 / Volumen 116 / Número 9
Editorial
Manejo de la hinchazón y de la distensión abdominal, de lo subjetivo a lo objetivo

461-464

DOI: 10.17235/reed.2024.10482/2024

Alberto Ezquerra-Durán, Elizabeth Barba,

Resumen
La distensión abdominal en un fenómeno clínico que implica un aumento mesurable y objetivo del perímetro abdominal, manifestado por los pacientes como la sensación de estar embarazada o tener un balón en el abdomen. Este signo con frecuencia está precedido por la sensación subjetiva de pesadez o hinchazón abdominal, descrita como la percepción de tener una gran cantidad de gas atrapado. Estas manifestaciones son altamente prevalentes y pueden constituir, por sí mismas una patología del eje cerebro intestino, como la distensión abdominal funcional o ser parte de otros trastornos como la dispepsia funcional o el síndrome de intestino irritable (SII). La prevalencia de la distensión y de la hinchazón abdominal es del 3,5%. Sin embargo, cuando se asocian con otros trastornos del eje cerebro-intestino como la dispepsia o el SII, la prevalencia aumenta, siendo superior al 50%. La etiología y fisiopatología de la hinchazón y de la distensión abdominal son muy complejas, presentado un dilema para el médico y para el paciente. A menudo, el paciente asocia estas sensaciones a la presencia de gas y lo atribuye a la existencia de una intolerancia alimentaria e implementa dietas sumamente restrictivas sin resolución de la distensión y con riesgo de carencias nutricionales o disbiosis secundaria, por lo que una guía de tratamiento dirigido es necesaria.
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Comentarios

23/04/2025 20:12:06
This is such a common complaint, and it is INCREDIBLY vexing to sufferers. And yet, being female-dominant and pain-associated, it is minimalized, denied, dismissed as inconsequential and over-reactive. Patients are denigrated, "gaslit" and disparaged as chronic complainers.
With this medical mindset, it is little wonder that women are turning to alternative practitioners, who profit handsomely from the hubris of our profession (might I add: cash pay up front---$200 for an initial phone consultation). Hopefully they can provide some relief to women patients suffering from this condition and our dismissal. Louise B. Andrew MD JD FIFEM


28/10/2024 6:12:10
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09/09/2024 18:24:48
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Bibliografía
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23. Barba E, Accarino A, Azpiroz F. Correction of Abdominal Distention by Biofeedback-Guided Control of Abdominothoracic Muscular Activity in a Randomized, Placebo-Controlled Trial. Clinical Gastroenterology and Hepatology. 2017;15(12):1922-1929. doi:10.1016/j.cgh.2017.06.052
24. Damianos JA, Tomar SK, Azpiroz F, Barba E. Abdominophrenic Dyssynergia: A Narrative Review. American Journal of Gastroenterology. 2023;118(1):41-45. doi:10.14309/ajg.0000000000002044
25. Barba E, Burri E, Accarino A, et al. Abdominothoracic mechanisms of functional abdominal distension and correction by biofeedback. Gastroenterology. 2015;148(4):732-739. doi:10.1053/j.gastro.2014.12.006
1. Drossman DA, Morris CB, Schneck S, et al. International survey of patients with IBS: symptom features and their severity, health status, treatments, and risk taking to achieve clinical benefit. J Clin Gastroenterol. 2009;43(6):541-550. doi:10.1097/MCG.0b013e318189a7f9
2. Sperber AD, Bangdiwala SI, Drossman DA, et al. Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study. Gastroenterology. 2021;160(1):99-114.e3. doi:10.1053/j.gastro.2020.04.014
3. Jiang X, Locke GR, Choung RS, Zinsmeister AR, Schleck CD, Talley NJ. Prevalence and risk factors for abdominal bloating and visible distention: a population-based study. Gut. 2008;57(6):756-763. doi:10.1136/gut.2007.142810
4. Palsson OS, Simren M, Tack JF, et al. Tu1387: Bloating and distention: inherent characteristics of irritable bowel syndrome (IBS) and functional dyspepsia (FD)? Gastroenterology. 2022;162(7):S-946. doi:10.1016/S0016-5085(22)62240-6
5. Lacy BE, Cangemi D, Vazquez-Roque M. Management of Chronic Abdominal Distension and Bloating. Clinical Gastroenterology and Hepatology. 2021;19(2):219-231.e1. doi:10.1016/j.cgh.2020.03.056
6. Böhn L, Störsrud S, Törnblom H, Bengtsson U, Simrén M. Self-Reported Food-Related Gastrointestinal Symptoms in IBS Are Common and Associated with More Severe Symptoms and Reduced Quality of Life. American Journal of Gastroenterology. 2013;108(5):634-641. doi:10.1038/ajg.2013.105
7. Melchior C, Algera J, Colomier E, Törnblom H, Simrén M, Störsrud S. Food Avoidance and Restriction in Irritable Bowel Syndrome: Relevance for Symptoms, Quality of Life and Nutrient Intake. Clin Gastroenterol Hepatol. 2022;20(6):1290-1298.e4. doi:10.1016/j.cgh.2021.07.004
8. Colomier E, Van Oudenhove L, Tack J, et al. Predictors of Symptom-Specific Treatment Response to Dietary Interventions in Irritable Bowel Syndrome. Nutrients. 2022;14(2):397. doi:10.3390/nu14020397
9. Yao CK, Tuck CJ. The clinical value of breath hydrogen testing. J Gastroenterol Hepatol. 2017;32 Suppl 1:20-22. doi:10.1111/jgh.13689
10. Varjú P, Gede N, Szakács Z, et al. Lactose intolerance but not lactose maldigestion is more frequent in patients with irritable bowel syndrome than in healthy controls: A meta-analysis. Neurogastroenterology and motility. 2019;31(5):e13527. doi:10.1111/nmo.13527
11. Böhn L, Störsrud S, Liljebo T, et al. Diet low in FODMAPs reduces symptoms of irritable bowel syndrome as well as traditional dietary advice: a randomized controlled trial. Gastroenterology. 2015;149(6):1399-1407.e2. doi:10.1053/j.gastro.2015.07.054
12. Ford AC, Harris LA, Lacy BE, Quigley EMM, Moayyedi P. Systematic review with meta-analysis: the efficacy of prebiotics, probiotics, synbiotics and antibiotics in irritable bowel syndrome. Aliment Pharmacol Ther. 2018;48(10):1044-1060. doi:10.1111/apt.15001
13. Amieva-Balmori M, Coss-Adame E, Rao NS, Dávalos-Pantoja BM, Rao SSC. Diagnostic Utility of Carbohydrate Breath Tests for SIBO, Fructose, and Lactose Intolerance. Dig Dis Sci. 2020;65(5):1405-1413. doi:10.1007/s10620-019-05889-9
14. Losurdo G, Leandro G, Ierardi E, et al. Breath Tests for the Non-invasive Diagnosis of Small Intestinal Bacterial Overgrowth: A Systematic Review with Meta-analysis. J Neurogastroenterol Motil. 2020;26(1):16-28. doi:10.5056/jnm19113
15. Rezaie A, Heimanson Z, McCallum R, Pimentel M. Lactulose Breath Testing as a Predictor of Response to Rifaximin in Patients with Irritable Bowel Syndrome With Diarrhea. American Journal of Gastroenterology. 2019;114(12):1886-1893. doi:10.14309/ajg.0000000000000444
16. Martín Domínguez V, Malagelada C, Santander C. Small intestinal bacterial overgrowth. A position paper of ASENEM-SEPD. Revista Española de Enfermedades Digestivas. 2023;116. doi:10.17235/reed.2023.10027/2023
17. Neri L, Iovino P, Laxative Inadequate Relief Survey (LIRS) Group. Bloating is associated with worse quality of life, treatment satisfaction, and treatment responsiveness among patients with constipation-predominant irritable bowel syndrome and functional constipation. Neurogastroenterology and motility. 2016;28(4):581-591. doi:10.1111/nmo.12758
18. Bharucha AE, Wald A. Chronic Constipation. Mayo Clin Proc. 2019;94(11):2340-2357. doi:10.1016/j.mayocp.2019.01.031
19. Videlock EJ, Lembo A, Cremonini F. Diagnostic testing for dyssynergic defecation in chronic constipation: meta‐analysis. Neurogastroenterology & Motility. 2013;25(6):509. doi:10.1111/nmo.12096
20. Grossi U, Carrington E V, Bharucha AE, Horrocks EJ, Scott SM, Knowles CH. Diagnostic accuracy study of anorectal manometry for diagnosis of dyssynergic defecation. Gut. 2016;65(3):447-455. doi:10.1136/gutjnl-2014-308835
21. Drossman DA, Tack J, Ford AC, Szigethy E, Törnblom H, Van Oudenhove L. Neuromodulators for Functional Gastrointestinal Disorders (Disorders of Gut-Brain Interaction): A Rome Foundation Working Team Report. Gastroenterology. 2018;154(4):1140-1171.e1. doi:10.1053/j.gastro.2017.11.279
22. Barba E, Accarino A, Azpiroz F. Correction of Abdominal Distention by Biofeedback-Guided Control of Abdominothoracic Muscular Activity in a Randomized, Placebo-Controlled Trial. Clinical Gastroenterology and Hepatology. 2017;15(12):1922-1929. doi:10.1016/j.cgh.2017.06.052
23. Damianos JA, Tomar SK, Azpiroz F, Barba E. Abdominophrenic Dyssynergia: A Narrative Review. American Journal of Gastroenterology. 2023;118(1):41-45. doi:10.14309/ajg.0000000000002044
24. Barba E, Burri E, Accarino A, et al. Abdominothoracic mechanisms of functional abdominal distension and correction by biofeedback. Gastroenterology. 2015;148(4):732-739. doi:10.1053/j.gastro.2014.12.006
25. Moshiree B, Drossman D, Shaukat A. AGA Clinical Practice Update on Evaluation and Management of Belching, Abdominal Bloating, and Distention: Expert Review. Gastroenterology. 2023;165(3):791-800.e3. doi:10.1053/j.gastro.2023.04.039
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Ezquerra-Durán A, Barba E. Manejo de la hinchazón y de la distensión abdominal, de lo subjetivo a lo objetivo. 10482/2024


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Recibido: 15/04/2024

Aceptado: 22/04/2024

Prepublicado: 11/07/2024

Publicado: 09/09/2024

Tiempo de revisión del artículo: 6 días

Tiempo de prepublicación: 87 días

Tiempo de edición del artículo: 147 días


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