Bloating and Distention in Irritable Bowel Syndrome: The Role of Visceral Sensation
Open accessAbstract
Background & aims Abdominal bloating is an extremely intrusive symptom of irritable bowel syndrome (IBS) that is not always accompanied by an increase in abdominal girth (distention), raising the possibility that these 2 features of the condition may not share a common pathophysiology. A number of mechanisms have been postulated for bloating and distention, but the role of visceral sensation, which is often abnormal in IBS, has not been previously investigated, and this study aimed to address this question.Methods Abdominal girth measured by ambulatory abdominal inductance plethysmography and bloating severity was recorded over 24 hours in 39 IBS-constipation (ages, 18-73 years) and 29 IBS-diarrhea patients (ages, 20-59 years) meeting Rome II criteria. Within 1 week, rectal sensory thresholds were assessed with a barostat using the ascending method of limits and tracking.Results IBS patients who suffered with bloating alone had lower thresholds for pain (P = .005), desire to defecate (P = .044), and first sensation (P = .07) compared with those who had concomitant distention irrespective of bowel habit. When patients were grouped according to sensory threshold, hyposensitive individuals had distention significantly more than those with hypersensitivity (P = .001), and this was observed more in the constipation subgroup. Static and dynamic compliance did not differ among any of the groups.Conclusions The symptom of bloating alone is associated with visceral hypersensitivity, suggesting that the pathogenesis of bloating and distention may not be the same. Consequently, treatment approaches may have to be different, and measuring visceral sensation could have utility in choosing the right therapeutic modality.
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Approximately 20% of patients with IBS are viscerally hyposensitive or insensitive to mechanical distension, more commonly those with IBS-C than IBS-D.
“Approximately 20% of patients with IBS are viscerally hyposensitive or insensitive to mechanical distension, more commonly those with IBS-C than IBS-D, with one study suggesting that the degree of insensitivity correlated with abdominal distension (ie, a true physical increase in abdominal girth).43”
From British Society of Gastroenterology guidelines on the management of irritable bowel syndrome (2021) · cites this paper as [43]
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Cites
Pain Affect Encoded in Human Anterior Cingulate But Not Somatosensory Cortex
Rainville, P., Duncan, G. H., Price, D. D., Carrier, B., & Bushnell, M. C. (1997) · Science · doi:10.1126/science.277.5328.968 · Cited by 2,629 · see citing works
Functional bowel disorders and functional abdominal pain
Thompson, W. G., Longstreth, G. F., Drossman, D. A., Heaton, K. W., Irvine, E. J., & Müller-Lissner, S. A. (1999) · Gut · doi:10.1136/gut.45.2008.ii43 · Cited by 2,440 · see citing works
Altered rectal perception is a biological marker of patients with irritable bowel syndrome
Mertz, H., Naliboff, B. D., Munakata, J., Niazi, N., & Mayer, E. A. (1995) · Gastroenterology · doi:10.1016/0016-5085(95)90267-8 · Cited by 976 · see citing works
CONTROLLED TRIAL OF HYPNOTHERAPY IN THE TREATMENT OF SEVERE REFRACTORY IRRITABLE-BOWEL SYNDROME
Whorwell, P. J., Prior, A., & Faragher, E. B. (1984) · The Lancet · doi:10.1016/s0140-6736(84)92793-4 · Cited by 537 · see citing works
Self-citationBouin, M., Plourde, V., Boivin, M., Riberdy, M., Lupien, F., Laganière, M., Verrier, P., & Poitras, P. (2002) · Gastroenterology · doi:10.1053/gast.2002.33601 · Cited by 470 · see citing works
Müller-Lissner, S. A., Fumagalli, I. A. L., Bardhan, K. D., Pace, F., Pecher, E., Nault, B., & Rüegg, P. C. (2001) · Alimentary Pharmacology & Therapeutics · doi:10.1046/j.1365-2036.2001.01094.x · Cited by 462 · see citing works
Whitehead, W. E., & Delvaux, M. (1997) · Digestive Diseases and Sciences · doi:10.1023/a:1018885028501 · Cited by 387 · see citing works
Impaired transit and tolerance of intestinal gas in the irritable bowel syndrome
Serra, J. (2001) · Gut · doi:10.1136/gut.48.1.14 · Cited by 340 · see citing works
The Role of Intestinal Gas in Functional Abdominal Pain
Lasser, R. B., Bond, J. H., & Levitt, M. D. (1975) · New England Journal of Medicine · doi:10.1056/nejm197509112931103 · Cited by 323 · see citing works
Evidence for the hypersensitivity of lumbar splanchnic afferents in irritable bowel syndrome
Lembo, T., Munakata, J., Mertz, H., Niazi, N., Kodner, A., Nikas, V., & Mayer, E. A. (1994) · Gastroenterology · doi:10.1016/0016-5085(94)90809-5 · Cited by 290 · see citing works
Novick, J. S., Miner, P. B., Krause, R. A., Glebas, K., Bliesath, H., Ligozio, G., Rüegg, P. C., & Lefkowitz, M. P. (2002) · Alimentary Pharmacology & Therapeutics · doi:10.1046/j.1365-2036.2002.01372.x · Cited by 288 · see citing works
Long term benefits of hypnotherapy for irritable bowel syndrome
Gonsalkorale, W. M., Miller, V, Afzal, A., & Whorwell, P. J. (2003) · Gut · doi:10.1136/gut.52.11.1623 · Cited by 283 · see citing works
Self-citationHoughton, L. A., Lea, R., Jackson, N., & Whorwell, P. J. (2002) · Gut · doi:10.1136/gut.50.4.471 · Cited by 235 · see citing works
Self-citationGonsalkorale, W. M., Houghton, L. A., & Whorwell, P. J. (2002) · The American Journal of Gastroenterology · doi:10.1111/j.1572-0241.2002.05615.x · Cited by 214 · see citing works
Self-citationHoughton, L. A., Fell, C., Whorwell, P. J., Jones, I., Sudworth, D. P., & Gale, J. D. (2007) · Gut · doi:10.1136/gut.2006.110858 · Cited by 204 · see citing works
Self-citationSymptoms and Visceral Perception in Patients With Pain-Predominant Irritable Bowel Syndrome
Lembo, T., Naliboff, B., Munakata, J., Fullerton, S., Saba, L., Tung, S., Schmulson, M., & Mayer, E. A. (1999) · American Journal of Gastroenterology · doi:10.1111/j.1572-0241.1999.01009.x · Cited by 202 · see citing works
Sensation of bloating and visible abdominal distension in patients with irritable bowel syndrome
Chang, L., Lee, O. Y., Naliboff, B. D., Schmulson, M. J., & Mayer, E. A. (2001) · The American Journal of Gastroenterology · doi:10.1111/j.1572-0241.2001.05336.x · Cited by 191 · see citing works
Modulation of gastric sensory and motor functions by nitrergic and α2-adrenergic agents in humans
Thumshirn, M., Camilleri, M., Choi, M., & Zinsmeister, A. R. (1999) · Gastroenterology · doi:10.1016/s0016-5085(99)70179-4 · Cited by 186 · see citing works
Lea, R., Houghton, L. A., Calvert, E. L., Larder, S., Gonsalkorale, W. M., Whelan, V., Randles, J., Cooper, P., Cruickshanks, P., Miller, V., et al. (2003) · Alimentary Pharmacology & Therapeutics · doi:10.1046/j.1365-2036.2003.01486.x · Cited by 172 · see citing works
Self-citationHoughton, L. A., Lea, R., Agrawal, A., Reilly, B., & Whorwell, P. J. (2006) · Gastroenterology · doi:10.1053/j.gastro.2006.07.015 · Cited by 138 · see citing works
Self-citationAzpiroz, F., & Malagelada, J. (2005) · Gastroenterology · doi:10.1053/j.gastro.2005.06.062 · Cited by 127 · see citing works
Origin of gas retention and symptoms in patients with bloating
Salvioli, B., Serra, J., Azpiroz, F., Lorenzo‐Bosquet, C., Aguadé‐Bruix, S., Castell‐Conesa, J., & Malagelada, J. (2005) · Gastroenterology · doi:10.1053/j.gastro.2004.12.047 · Cited by 122 · see citing works
Maxton, D. G., Martin, D. F., Whorwell, P. J., & Godfrey, M. (1991) · Gut · doi:10.1136/gut.32.6.662 · Cited by 112 · see citing works
Self-citationImpaired Viscerosomatic Reflexes and Abdominal-Wall Dystony Associated With Bloating
Tremolaterra, F., Villòria, A., Azpiroz, F., Serra, J., Aguadé‐Bruix, S., & Malagelada, J. (2006) · Gastroenterology · doi:10.1053/j.gastro.2005.12.036 · Cited by 110 · see citing works
Mechanisms of intestinal gas retention in humans: impaired propulsion versus obstructed evacuation
Serra, J., Azpiroz, F., & Malagelada, J.-R. (2001) · American Journal of Physiology-Gastrointestinal and Liver Physiology · doi:10.1152/ajpgi.2001.281.1.g138 · Cited by 104 · see citing works
Knowles, C. H., Scott, S. M., & Lunniss, P. J. (2001) · Digestive Diseases and Sciences · doi:10.1023/a:1005665218647 · Cited by 103 · see citing works
Evolution of Visceral Sensitivity in Patients with Irritable Bowel Syndrome
Poitras, P., Riberdy, M., Plourde, V., Boivin, M., & Verrier, P. (2002) · Digestive Diseases and Sciences · doi:10.1023/a:1014729125428 · Cited by 85 · see citing works
Heaton, K. W., Parker, D., & Cripps, H. (1993) · Gut · doi:10.1136/gut.34.8.1108 · Cited by 76 · see citing works
Houghton, L. A., & Whorwell, P. J. (2005) · Neurogastroenterology & Motility · doi:10.1111/j.1365-2982.2005.00666.x · Cited by 73 · see citing works
Self-citationLewis, M. J. V., Reilly, B., Houghton, L. A., & Whorwell, P. J. (2001) · Gut · doi:10.1136/gut.48.2.216 · Cited by 71 · see citing works
Self-citationSubtypes of constipation predominant irritable bowel syndrome based on rectal perception
Harraf, F., Schmulson, M. J., Saba, L., Niazi, N., Fass, R., Munakata, J., Diehl, D. L., Mertz, H., Naliboff, B. D., & Mayer, E. A. (1998) · Gut · doi:10.1136/gut.43.3.388 · Cited by 71 · see citing works
Roe, A. M., Bartolo, D. C. C., & Mortensen, N. J. M. C. (1988) · Digestive Diseases and Sciences · doi:10.1007/bf01535794 · Cited by 64 · see citing works
Effect of hysterectomy on anorectal and urethrovesical physiology.
Prior, A., Stanley, K., Smith, A. R. B., & Read, N. W. (1992) · Gut · doi:10.1136/gut.33.2.264 · Cited by 63 · see citing works
Does the menstrual cycle affect anorectal physiology?
Jackson, N. A., Houghton, L. A., Whorwell, P. J., & Currer, B. (1994) · Digestive Diseases and Sciences · doi:10.1007/bf02087697 · Cited by 60 · see citing works
Self-citationIrritable bowel-type symptoms in spontaneous and induced constipation.
Marcus, S. N., & Heaton, K. W. (1987) · Gut · doi:10.1136/gut.28.2.156 · Cited by 43 · see citing works
Intestinal tone and gas motion
Tremolaterra, F., Villòria, A., Serra, J., Azpiroz, F., & Malagelada, J. R. (2006) · Neurogastroenterology & Motility · doi:10.1111/j.1365-2982.2006.00809.x · Cited by 37 · see citing works
A device for 24 hour ambulatory monitoring of abdominal girth using inductive plethysmography
Reilly, B., Bolton, M. P., Lewis, M. J., Houghton, L. A., & Whorwell, P. J. (2002) · Physiological Measurement · doi:10.1088/0967-3334/23/4/306 · Cited by 29 · see citing works
Self-citationAbdominal Wall Muscle Activity in Irritable Bowel Syndrome With Bloating
McManis, P. G., Newall, D., & Talley, N. J. (2001) · The American Journal of Gastroenterology · doi:10.1111/j.1572-0241.2001.03761.x · Cited by 24 · see citing works
Hammonds, R., Houghton, L. A., Whorwell, P. J., Morris, J., Francis, C. Y., & Mills, J. (1998) · Gastroenterology · doi:10.1016/s0016-5085(98)83113-2 · Cited by 18 · see citing works
Self-citationEnhanced sensitivity of the whole gut in patients with irritable bowel syndrome (IBS)
(1995) · Gastroenterology · doi:10.1016/0016-5085(95)26715-8 · Cited by 10 · see citing works
Hammonds, R. M., Houghton, L. A., & Whorwell, P. J. (2000) · Gastroenterology · doi:10.1016/s0016-5085(00)82634-7 · Cited by 6 · see citing works
Self-citationBimodal rehabilitation has a long lasting efficacy in pelvic floor dyssynergia
Bellini, M., Pucciani, F., Alduini, P., Costa, F., Mammini, C., Berni, I., Rappelli, L., Giusti, P., Tomar, A., Maltinti, G., et al. (2000) · Gastroenterology · doi:10.1016/s0016-5085(00)85462-1 · Cited by 3 · see citing works
Flagged first, then by citations
Research works printed but not linked: 4
- Lasser RB, Bond JH, Levitt MD. Role of intestinal gas in func- tional abdominal pain. N Engl J Med 1975;293:524 -526.
- Varma JS, Smith AN. Abnormalities of colo-rectal function in intractable constipation following hysterectomy. Gut 1985;26: 581-582.
- Roe AM, Bartolo DCC, McMortensen NJ. Slow transit constipa- tion. Comparison between patients with or without previous hys- terectomy. Dig Dis Sci 1988;33:1159 -1163.
- Whorwell PJ, Ruegg P, Earnest D, et al. Tegaserod significantly improves bloating in female irritable bowel syndrome patients with constipation. Gastroenterology 2004;126:A643.
Cited by
Sorted by citations
Lacy, B. E., Mearin, F., Chang, L., Chey, W. D., Lembo, A. J., Simren, M., & Spiller, R. (2016) · Gastroenterology · doi:10.1053/j.gastro.2016.02.031 · Cited by 2,866 · see citing works
Enck, P., Aziz, Q., Barbara, G., Farmer, A. D., Fukudo, S., Mayer, E. A., Niesler, B., Quigley, E. M. M., Rajilić-Stojanović, M. D., Schemann, M., et al. (2016) · Nature Reviews Disease Primers · doi:10.1038/nrdp.2016.14 · Cited by 1,057 · see citing works
British Society of Gastroenterology guidelines on the management of irritable bowel syndrome
Vasant, D. H., Paine, P. A., Black, C. J., Houghton, L. A., Everitt, H. A., Corsetti, M., Agrawal, A., Aziz, I., Farmer, A. D., Eugenicos, M. P., et al. (2021) · Gut · doi:10.1136/gutjnl-2021-324598 · Cited by 547 · see citing works
Self-citationAGRAWAL, A., HOUGHTON, L. A., MORRIS, J., REILLY, B., GUYONNET, D., GOUPIL FEUILLERAT, N., SCHLUMBERGER, A., JAKOB, S., & WHORWELL, P. J. (2009) · Alimentary Pharmacology & Therapeutics · doi:10.1111/j.1365-2036.2008.03853.x · Cited by 322 · see citing works
Self-citationMarciani, L., Cox, E. F., Hoad, C. L., Pritchard, S. E., Totman, J. J., Foley, S., Mistry, A., Evans, S., Gowland, P. A., & Spiller, R. E. (2009) · Gastroenterology · doi:10.1053/j.gastro.2009.10.055 · Cited by 217 · see citing works
Yao, C. K., Tan, H. ‐., van Langenberg, D. R., Barrett, J. S., Rose, R., Liels, K., Gibson, P. R., & Muir, J. G. (2013) · Journal of Human Nutrition and Dietetics · doi:10.1111/jhn.12144 · Cited by 127 · see citing works
Zhu, Y., Zheng, X., Cong, Y., Chu, H., Fried, M., Dai, N., & Fox, M. R. (2013) · The American Journal of Gastroenterology · doi:10.1038/ajg.2013.198 · Cited by 122 · see citing works
Abdominal Distention Results From Caudo-ventral Redistribution of Contents
Accarino, A. M., Pérez, F., Azpiroz, F., Quiroga, S., & Malagelada, J. (2009) · Gastroenterology · doi:10.1053/j.gastro.2009.01.067 · Cited by 122 · see citing works
Management of Chronic Abdominal Distension and Bloating
Lacy, B. E., Cangemi, D. J., & Vázquez‐Roque, M. I. (2020) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2020.03.056 · Cited by 124 · see citing works
Bloating and Distension in Irritable Bowel Syndrome: The Role of Gastrointestinal Transit
Agrawal, A., Houghton, L. A., Reilly, B., Morris, J., & Whorwell, P. J. (2009) · The American Journal of Gastroenterology · doi:10.1038/ajg.2009.251 · Cited by 104 · see citing works
Self-citationVisceral hypersensitivity in endometriosis: a new target for treatment?
Issa, B., Onon, T. S., Agrawal, A., Shekhar, C., Morris, J., Hamdy, S., & Whorwell, P. J. (2012) · Gut · doi:10.1136/gutjnl-2011-300306 · Cited by 90 · see citing works
Self-citationScott, S. M., Simrén, M., Farmer, A. D., Dinning, P. G., Carrington, E. V., Benninga, M. A., Burgell, R., Dimidi, E., Fikree, A., Ford, A. C., et al. (2020) · Neurogastroenterology & Motility · doi:10.1111/nmo.14050 · Cited by 93 · see citing works
Bloating and Abdominal Distension: Old Misconceptions and Current Knowledge
Malagelada, J. R., Accarino, A. M., & Azpiroz, F. (2017) · The American Journal of Gastroenterology · doi:10.1038/ajg.2017.129 · Cited by 87 · see citing works
Abdominal Bloating: Pathophysiology and Treatment
Seo, A. Y., Kim, N., & Oh, D. H. (2013) · Journal of Neurogastroenterology and Motility · doi:10.5056/jnm.2013.19.4.433 · Cited by 86 · see citing works
Zhao, Y., Ma, X., Wang, R., Yan, X., Li, Z.-S., Zou, D., & He, J. (2011) · Alimentary Pharmacology & Therapeutics · doi:10.1111/j.1365-2036.2011.04809.x · Cited by 85 · see citing works
Rectal hypersensitivity as hallmark for irritable bowel syndrome: defining the optimal cutoff
Ludidi, S., Conchillo, J. M., Keszthelyi, D., van Avesaat, M. H. P., Kruimel, J. W., Jonkers, D. M. A. E., & Masclee, A. (2012) · Neurogastroenterology & Motility · doi:10.1111/j.1365-2982.2012.01926.x · Cited by 83 · see citing works
Lacy, B. E., Schey, R., Shiff, S. J., Lavins, B. J., Fox, S. M., Jia, X. D., Blakesley, R. E., Hao, X., Cronin, J. A., Currie, M. G., et al. (2015) · PLoS ONE · doi:10.1371/journal.pone.0134349 · Cited by 81 · see citing works
Burgell, R., & Scott, S. (2012) · Journal of Neurogastroenterology and Motility · doi:10.5056/jnm.2012.18.4.373 · Cited by 172 · see citing works
Emmanuel, A., Cools, M., Vandeplassche, L., & Kerstens, R. (2014) · American Journal of Gastroenterology · doi:10.1038/ajg.2014.74 · Cited by 75 · see citing works
Rectal sensorimotor dysfunction in constipation
Scott, S. M., van den Berg, M. M., & Benninga, M. A. (2011) · Best Practice & Research Clinical Gastroenterology · doi:10.1016/j.bpg.2011.01.001 · Cited by 70 · see citing works
Dietary Triggers in Irritable Bowel Syndrome: Is There a Role for Gluten?
Volta, U., Pinto-Sánchez, M. I., Boschetti, E., Caio, G., GIORGIO, R. D., & Verdu, E. F. (2016) · Journal of Neurogastroenterology and Motility · doi:10.5056/jnm16069 · Cited by 69 · see citing works
Abdomino-Phrenic Dyssynergia in Patients With Abdominal Bloating and Distension
Villòria, A., Azpiroz, F., Burri, E., Daniel Cisternas, C., Soldevilla, A., & Malagelada, J. (2011) · The American Journal of Gastroenterology · doi:10.1038/ajg.2010.408 · Cited by 67 · see citing works
Mechanisms of postprandial abdominal bloating and distension in functional dyspepsia
Burri, E., Barba, E., Huamán, J. W., Daniel Cisternas, C., Accarino, A. M., Soldevilla, A., Malagelada, J., & Azpiroz, F. (2013) · Gut · doi:10.1136/gutjnl-2013-304574 · Cited by 66 · see citing works
Nellesen, D., Chawla, A., Oh, D. L., Weissman, T., Lavins, B. J., & Murray, C. W. (2013) · Postgraduate Medicine · doi:10.3810/pgm.2013.03.2640 · Cited by 66 · see citing works
Systematic review: instruments to assess abdominal pain in irritable bowel syndrome
Mujagic, Z., Keszthelyi, D., Aziz, Q., Reinisch, W., Quetglas, E. G., Leonardis, F. D., Segerdahl, M., & Masclee, A. (2015) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.13378 · Cited by 64 · see citing works
Bloating in Gastroparesis: Severity, Impact, and Associated Factors
Hasler, W. L., Wilson, L., Parkman, H. P., Nguyen, L. A. B., Abell, T. L., Koch, K. L., Pasricha, P. J., Snape, W. J., Farrugia, G., Lee, L., et al. (2011) · The American Journal of Gastroenterology · doi:10.1038/ajg.2011.81 · Cited by 62 · see citing works
Gastroparesis and Gastroparesis-like Syndrome: Response to Therapy and Its Predictors
Anaparthy, R., Pehlivanov, N., Grady, J. J., Han, Y., & Pasricha, P. J. (2009) · Digestive Diseases and Sciences · doi:10.1007/s10620-009-0717-4 · Cited by 60 · see citing works
Gale, J. D., & Houghton, L. A. (2011) · Frontiers in Pharmacology · doi:10.3389/fphar.2011.00028 · Cited by 58 · see citing works
Self-citationPeripheral factors in the pathophysiology of irritable bowel syndrome
Gunnarsson, J., & Simrén, M. (2009) · Digestive and Liver Disease · doi:10.1016/j.dld.2009.07.006 · Cited by 57 · see citing works
Kanazawa, M., Miwa, H., Nakagawa, A., Kosako, M., Akiho, H., & Fukudo, S. (2016) · BioPsychoSocial Medicine · doi:10.1186/s13030-016-0070-8 · Cited by 57 · see citing works
Colonic Responses to Gas Loads in Subgroups of Patients With Abdominal Bloating
Hernando-Harder, A. C., Serra, J., Azpiroz, F., Milà, M., Aguadé‐Bruix, S., Malagelada, C., Tremolaterra, F., Villòria, A., & Malagelada, J. (2010) · The American Journal of Gastroenterology · doi:10.1038/ajg.2010.75 · Cited by 56 · see citing works
Clinical Presentation and Pathophysiology of Gastroparesis
Nguyen, L. A. B., & Snape, W. J. (2015) · Gastroenterology Clinics of North America · doi:10.1016/j.gtc.2014.11.003 · Cited by 55 · see citing works
Halac, U., Noble, A. J., & Faure, C. C. (2009) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2009.06.062 · Cited by 54 · see citing works
Phenotyping of subjects for large scale studies on patients with IBS
Boeckxstaens, G. E., Drug, V. L., Dumitrascu, D. L., Farmer, A. D., Hammer, J., Hausken, T., Niesler, B., Pohl, D., Pojskić, L., Polster, A. V., et al. (2016) · Neurogastroenterology & Motility · doi:10.1111/nmo.12886 · Cited by 56 · see citing works
Self-citationSpiller, R. E., & Thompson, G. W. (2010) · The American Journal of Gastroenterology · doi:10.1038/ajg.2010.69 · Cited by 49 · see citing works
Nevé, B. L., Brazeilles, R., Derrien, M., Tap, J., Guyonnet, D., Öhman, L., Törnblom, H., & Simrén, M. (2015) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2015.09.039 · Cited by 47 · see citing works
Traditional Thoughts on the Pathophysiology of Irritable Bowel Syndrome
Hasler, W. L. (2011) · Gastroenterology Clinics of North America · doi:10.1016/j.gtc.2010.12.004 · Cited by 46 · see citing works
Caecal pH is a biomarker of excessive colonic fermentation
Farmer, A. D. (2014) · World Journal of Gastroenterology · doi:10.3748/wjg.v20.i17.5000 · Cited by 47 · see citing works
Vollebregt, P. F., Burgell, R., Hooper, R., Knowles, C. H., & Scott, S. M. (2020) · The American Journal of Gastroenterology · doi:10.14309/ajg.0000000000001039 · Cited by 45 · see citing works
Pathophysiology, evaluation, and treatment of bloating: hope, hype, or hot air?
Lacy, B. E., Gabbard, S. L., & Crowell, M. D. (2011) · Europe PMC (PubMed Central) · Cited by 43 · see citing works
The low‐FODMAP diet in the management of functional dyspepsia in East and Southeast Asia
Tan, V. P. Y. (2017) · Journal of Gastroenterology and Hepatology · doi:10.1111/jgh.13697 · Cited by 43 · see citing works
Prolonged Balloon Expulsion Is Predictive of Abdominal Distension in Bloating
Shim, L., Prott, G. M., Hansen, R. D., Simmons, L., Kellow, J. E., & Malcolm, A. (2010) · The American Journal of Gastroenterology · doi:10.1038/ajg.2010.54 · Cited by 40 · see citing works
Nelson, A. D., Black, C. J., Houghton, L. A., Lugo‐Fagundo, N. S., Lacy, B. E., & Ford, A. C. (2021) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.16437 · Cited by 39 · see citing works
Self-citationNevé, B. L., Posserud, I., Böhn, L., Guyonnet, D., Rondeau, P., Tillisch, K., Naliboff, B. D., Mayer, E. A., & Simrén, M. (2013) · The American Journal of Gastroenterology · doi:10.1038/ajg.2013.75 · Cited by 39 · see citing works
Management Strategies for Abdominal Bloating and Distension.
Foley, A., Burgell, R., Barrett, J. S., & Gibson, P. R. (2014) · Europe PMC (PubMed Central) · Cited by 38 · see citing works
Urgesi, R., Casale, C., Pistelli, R., Rapaccini, G. L., & Vitis, I. D. (2014) · PubMed · Cited by 38 · see citing works
Bolino, C., & Berčík, P. (2010) · Infectious Disease Clinics of North America · doi:10.1016/j.idc.2010.07.005 · Cited by 34 · see citing works
Pohl, D., Oudenhove, L. V., Törnblom, H., Nevé, B. L., Tack, J. F., & Simrén, M. (2018) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2018.04.034 · Cited by 34 · see citing works
Hippocampal AMPAR s involve the central sensitization of rats with irritable bowel syndrome
Chen, A., Chen, Y., Tang, Y., Bao, C.-J., Cui, Z., Xiao, M., & Lin, C. (2017) · Brain and Behavior · doi:10.1002/brb3.650 · Cited by 31 · see citing works
The role of diet in the management of irritable bowel syndrome: a focus on FODMAPs
Dolan, R. D., Chey, W. D., & Eswaran, S. L. (2018) · Expert Review of Gastroenterology & Hepatology · doi:10.1080/17474124.2018.1476138 · Cited by 30 · see citing works
Camilleri, M. (2009) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2009.10.009 · Cited by 30 · see citing works
Aliu, A., Bosch, D. H. C. A., Keszthelyi, D., Ardabili, A. R., Colombel, J., Sawyer, R., Törnblom, H., Hart, A. L., Jonkers, D. M. A. E., Pierik, M. J., et al. (2024) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.17988 · Cited by 30 · see citing works
Functional Abdominal Bloating with Distention
Sullivan, S. N. (2012) · ISRN Gastroenterology · doi:10.5402/2012/721820 · Cited by 25 · see citing works
Barba, E., Accarino, A. M., & Azpiroz, F. (2017) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2017.06.052 · Cited by 24 · see citing works
The Predictive Value of the Hydrogen Breath Test in the Diagnosis of Fructose Malabsorption
Helwig, U., Koch, A. K., Koppka, N., Holtmann, S., & Langhorst, J. (2018) · Digestion · doi:10.1159/000489877 · Cited by 22 · see citing works
Focus on irritable bowel syndrome.
Scalera, A., & Loguercio, C. (2012) · PubMed · Cited by 19 · see citing works
Rao, S. S. C., Yan, Y., Erdoğan, A., Coss‐Adame, E., Patcharatrakul, T., Valestin, J., & Ayyala, D. N. (2021) · Neurogastroenterology & Motility · doi:10.1111/nmo.14226 · Cited by 18 · see citing works
Probiotic Lactobacillus reuteri Alleviates the Response to Gastric Distension in Rats,
Duncker, S. C., Kamiya, T., Wang, L., Yang, P., & Bienenstock, J. (2011) · Journal of Nutrition · doi:10.3945/jn.110.136689 · Cited by 18 · see citing works
Bloating and Abdominal Distention: Not So Poorly Understood Anymore!
Simrén, M. (2009) · Gastroenterology · doi:10.1053/j.gastro.2009.03.023 · Cited by 17 · see citing works
Leung, W., JONES, A. Y. M., Ng, S. S. M., Wong, C. Y. N., & Lee, J. F. Y. (2011) · Journal of Gastrointestinal Surgery · doi:10.1007/s11605-011-1446-5 · Cited by 16 · see citing works
Symptomatic Management of Gastroparesis
Navas, C. M., Patel, N. K., & Lacy, B. E. (2018) · Gastrointestinal Endoscopy Clinics of North America · doi:10.1016/j.giec.2018.08.005 · Cited by 15 · see citing works
Irritable bowel syndrome evaluation using computed tomography colonography
Ohgo, H., Imaeda, H., Yamaoka, M., Yoneno∥, K., Hosoe, N., Mizukami, T., & Nakamoto, H. (2016) · World Journal of Gastroenterology · doi:10.3748/wjg.v22.i42.9394 · Cited by 14 · see citing works
Almansa, C., Agrawal, A. K., & Houghton, L. A. (2012) · Expert Review of Gastroenterology & Hepatology · doi:10.1586/egh.12.9 · Cited by 14 · see citing works
Self-citationFunctional Abdominal Bloating and Gut Microbiota: An Update
Crucillà, S., Caldart, F., Michelon, M., Marasco, G., & Costantino, A. (2024) · Microorganisms · doi:10.3390/microorganisms12081669 · Cited by 14 · see citing works
Quigley, E. M. M. (2008) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2008.10.010 · Cited by 13 · see citing works
Abdominal Bloating and Distension: What Is the Role of the Microbiota
Issa, B., Wafaei, N. A., & Whorwell, P. J. (2011) · Digestive Diseases and Sciences · doi:10.1007/s10620-011-1834-4 · Cited by 13 · see citing works
Self-citationSadrin, S., Sennoune, S. R., Gout, B., Marque, S., Moreau, J., Grillasca, J., Pons, O., & Maixent, J. M. (2017) · Cellular and Molecular Biology · doi:10.14715/cmb/2017.63.9.21 · Cited by 15 · see citing works
Azpiroz, F., & Levitt, M. D. (2010) · Elsevier eBooks · doi:10.1016/b978-1-4160-6189-2.00016-0 · Cited by 11 · see citing works
Kovaleva, A. L., Poluektova, E. A., & Shifrin, O. S. (2020) · Russian Journal of Gastroenterology Hepatology Coloproctology · doi:10.22416/1382-4376-2020-30-4-52-59 · Cited by 13 · see citing works
Melchior, C., Bril, L., Leroi, A., Gourcerol, G., & Ducrotte, P. R. (2018) · Neurogastroenterology & Motility · doi:10.1111/nmo.13290 · Cited by 10 · see citing works
Bloating in constipation: Relevance of intraluminal gas handling
Houghton, L. A. (2011) · Best Practice & Research Clinical Gastroenterology · doi:10.1016/j.bpg.2010.12.009 · Cited by 10 · see citing works
Self-citationMelchior, C., Hammer, H. F., Bor, S., Barba, E., Horvat, I. B., Çelebi, A., Drug, V. L., Dumitrascu, D. L., Kalkan, İ. H., Hauser, G., et al. (2025) · United European Gastroenterology Journal · doi:10.1002/ueg2.70098 · Cited by 11 · see citing works
How much bloating in the irritable bowel syndrome?
Pop, L. L., Muresan, I. A. P., & Dumitrascu, D. L. (2018) · Romanian Journal of Internal Medicine · doi:10.2478/rjim-2018-0017 · Cited by 8 · see citing works
A Pragmatic Approach to the Evaluation and Treatment of Abdominal Bloating
Lacy, B. E., & Cangemi, D. J. (2022) · The American Journal of Gastroenterology · doi:10.14309/ajg.0000000000001665 · Cited by 7 · see citing works
A Practical Approach to the Diagnosis and Treatment of Abdominal Bloating and Distension.
Cangemi, D. J., & Lacy, B. E. (2022) · PubMed Central · Cited by 7 · see citing works
Hassanin, T. M., Fouad, Y., Mohamed, F. E. Z. A., Abdel-Hafeez, E. H., & Hassnine, A. (2022) · European Journal of Gastroenterology & Hepatology · doi:10.1097/meg.0000000000002363 · Cited by 6 · see citing works
Shim, L., Hansen, R. D., Prott, G. M., Morris, L. A. I., Malcolm, A., & Kellow, J. E. (2012) · American Journal of Physiology-Gastrointestinal and Liver Physiology · doi:10.1152/ajpgi.00400.2011 · Cited by 6 · see citing works
Triadafilopoulos, G. (2016) · BMJ Open Gastroenterology · doi:10.1136/bmjgast-2016-000110 · Cited by 6 · see citing works
Rangan, V., Singh, P., Ballou, S., Hassan, R., Yu, V., Katon, J. M., Nee, J. W., Iturrino, J., & Lembo, A. J. (2021) · Neurogastroenterology & Motility · doi:10.1111/nmo.14253 · Cited by 6 · see citing works
Petrisor, D. C., Etropolska, Z., Elenski, K., Dimitrova, E., & Santos, J. (2023) · Digestive Diseases and Sciences · doi:10.1007/s10620-023-08155-1 · Cited by 5 · see citing works
Lee, H. J., & Park, K. S. (2017) · Korean Journal of Gastroenterology · doi:10.4166/kjg.2017.70.6.288 · Cited by 5 · see citing works
Ropert, A., & Bouguen, G. (2009) · Gastroentérologie Clinique et Biologique · doi:10.1016/s0399-8320(09)71523-4 · Cited by 5 · see citing works
Gils, T. V., Katsumata, R., Hreinsson, J. P., Drossman, D. A., Tack, J. F., Törnblom, H., Nevé, B. L., Quinquis, L., Hassouna, R., Schmulson, M. J., et al. (2026) · United European Gastroenterology Journal · doi:10.1002/ueg2.70186 · Cited by 4 · see citing works
Efficacy of Rifaximin in Patients With Abdominal Bloating or Distension
Arora, U., Sachdeva, K., Garg, P., Baitha, U., Kedia, S., Kalaivani, M., Ahuja, V., Kumar, A., Ranjan, P., Vikram, N. K., et al. (2023) · Journal of Clinical Gastroenterology · doi:10.1097/mcg.0000000000001872 · Cited by 3 · see citing works
Whorwell, P. J. (2012) · Neurogastroenterology & Motility · doi:10.1111/j.1365-2982.2012.01896.x · Cited by 3 · see citing works
Self-citationDiagnosis and Treatment of Functional Bloating
Park, M. I. (2012) · Korean Journal of Medicine · doi:10.3904/kjm.2012.83.5.562 · Cited by 2 · see citing works
Abdominal distension in health and irritable bowel syndrome: The effect of bladder filling
Issa, B., Morris, J., & Whorwell, P. J. (2018) · Neurogastroenterology & Motility · doi:10.1111/nmo.13437 · Cited by 2 · see citing works
Self-citationSpiller, R. E., & Thompson, W. (2012) · Arquivos de Gastroenterologia · doi:10.1590/s0004-28032012000500008 · Cited by 2 · see citing works
Choi, C. H. (2013) · Journal of Neurogastroenterology and Motility · doi:10.5056/jnm.2013.19.4.544 · Cited by 2 · see citing works
Irritable bowel syndrome in the general population : epidemiology, comorbidity and societal costs
Hillilä, M. T. (2010) · Työväentutkimus Vuosikirja · Cited by 2 · see citing works
Kobayashi, Y., Sawada, A., Hisaki, Y., Hosomi, S., Tanaka, F., & Fujiwara, Y. (2025) · Digestion · doi:10.1159/000548838 · Cited by 1 · see citing works
Wyndaele, J. (2022) · Springer eBooks · doi:10.1007/978-3-031-16964-9_5 · Cited by 1 · see citing works
Almansa, C., DeVault, K. R., & Houghton, L. A. (2014) · Springer eBooks · doi:10.1007/978-1-4939-1498-2_10 · Cited by 1 · see citing works
Self-citationColonic Eosinophilia in Irritable Bowel Syndrome Patients
Hassanin, T. M., Hassanin, A. S., Hassanin, M., & Abdel-Hafeez, E. H. (2021) · Minia Journal of Medical Research · doi:10.21608/mjmr.2021.223299 · Cited by 1 · see citing works
Spiller, R. E. (2012) · doi:10.1002/9781118321386.ch62 · Cited by 1 · see citing works
Practical Approach to Clinical Assessment of Irritable Bowel Syndrome
Spiller, R. E., & Lam, C. (2013) · doi:10.1002/9781118444689.ch5
Abdominal Bloating and Visible Distension
Hwang, L. J., & Pimentel, M. (2010) · Wiley eBooks · doi:10.1002/9781444328417.ch23
Implementation of Gut-Directed Hypnotherapy for Irritable Bowel Syndrome In Clinical Practice
Lindfors, P. (2012) · Gothenburg University Publications Electronic Archive (Gothenburg University)
Urgesi, R., Casale, C., Pistelli, R., & Vitis, I. D. (2014)
Irritable bowel syndrome: etiology, pathogenesis and pathophysiology
Almansa, C., & Houghton, L. A. (2013) · doi:10.2217/ebo.13.545
Self-citation
- Authors
- Agrawal, A., Houghton, L. A., Lea, R., Morris, J., Reilly, B., & Whorwell, P. J.
- Affiliations
- University of Manchester (GB)
- Wythenshawe Hospital (GB)
- Corresponding author
- Houghton, Lesley A.
- Venue
- Gastroenterology
- Publisher
- Elsevier BV
- Published
- 2008-06
- Volume
- 134
- Issue
- 7
- Pages
- 1882-1889
- ISSN
- 0016-5085 (ISSN-L)
- OpenAlex
- W2110459138
- Cited by
- 114
- References
- 42
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 2 · 2023: 2 · 2022: 4 · 2021: 5 · 2020: 4 · 2019: 2 · 2018: 9 · 2017: 8 · 2016: 8 · 2015: 4 · 2014: 7 · 2013: 10 · 2012: 12
- FWCI
- 10.85
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Health Sciences › Health Professions › Pharmacy › Infant Health and Development
- Keywords
- irritable bowel syndrome, bloating, abdominal distension, visceral sensation, visceral hypersensitivity, rectal sensory threshold, barostat, rectal compliance
- MeSH terms
- Adult, Aged, Circadian Rhythm, Constipation, Defecation, Diarrhea, Dilatation, Pathologic, Humans, Middle Aged, Pain Measurement, Plethysmography, Surveys and Questionnaires, Rectum, Sensation, Sensory Thresholds, Severity of Illness Index, Abdominal Pain, Case-Control Studies, Pain Threshold, Somatosensory Disorders, Irritable Bowel Syndrome, Body Size
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