Is a rapidly bloated stomach a symptom of any illness?

Q. My wife is 33 years old. Starting early this year, her stomach suddenly became bloated over a period of three months and she looks like someone who is pregnant.

We are trying for our second child but when we went to the doctor to check if she was pregnant, the result came back negative.

Besides burping more due to gas and the occasional stomach ache, she feels fine.

Is a rapidly bloated stomach a symptom of any illness? What could possibly be wrong with my wife?

A. Abdominal bloating is a common complaint and may be due to numerous medical conditions involving both the gastrointestinal tract as well as other organs.

However, in most instances, the cause is benign, which means it does not result in death or serious physical harm.

Nonetheless, these conditions can be bothersome with adverse effects on the patients' quality of life.

One example of these benign conditions is irritable bowel syndrome (IBS), which is characterised by the presence of abdominal bloating or discomfort associated with a change in bowel habit, in the absence of any structural abnormality in the body.

It is a common condition which affects 9 per cent of the population in Singapore.

The general approach is that your doctor will obtain a history and perform a physical examination to establish the diagnosis and exclude "red flag" symptoms which allude to other more serious conditions.

In the absence of any "red flag" symptoms, it is reasonable to administer a trial of symptomatic treatment while monitoring the patient's progress.

The presence of "red flag" symptoms or failure of the treatment trial would warrant further investigations which include blood tests, abdominal scans and endoscopies (a flexible camera which looks inside the gastrointestinal tract) to exclude more serious diseases.

The exact cause of irritable bowel syndrome is multifactorial and not completely understood.

They include abnormal movement of the gastrointestinal tract, impaired food digestion and absorption, excessive intestinal bacteria and psychological factors such as anxiety or depression.

Depending on the suspected cause, further evaluation may be performed, such as tests of gastrointestinal movements, food malabsorption, excessive intestinal bacteria or psychological assessment.

However, in most instances, these investigations are not necessary except for severe cases which have failed to respond to regular treatment.

IBS is a long-term condition with periodic worsening of symptoms.

There is no specific cure.

As it is a benign condition, treatment is targeted towards controlling the bothersome symptoms.

Management may involve multiple modalities such as reassurance and education, lifestyle and diet modifications, medications, as well as psychological intervention with the aim to target the predominant underlying cause.

For example, excessive gas production through a chemical reaction (fermentation) of poorly absorbed foods by the intestinal bacteria may result in abdominal bloating and even visible abdominal distension as in your wife's case.

To that end, a new dietary intervention called the low Fodmap diet, which involves the elimination of highly fermentable types of food, has recently been introduced and may be a useful treatment option.

The low Fodmap diet was initiated by Australian researchers who have shown that this diet can help reduce IBS symptoms in three out of four patients.

Fodmap refers to a group of short chain carbohydrates. It stands for fermentable oligosaccharides, disaccharides and monosaccharides, and polyols.

These are poorly absorbed in the small bowel and when they travel to the large intestine, the microflora (bacteria) ferments them with gas production, which may give rise to wind, bloating and cramps.

In addition, these poorly absorbed foods increase the delivery of water through the bowel, contributing to diarrhoea.

Therefore, restricting Fodmap-rich food may reduce IBS symptoms. These include honey, wheat, apples, pears, stone fruits (such as plums and peaches), onions and artichokes.

Generally, individuals are recommended to follow a low Fodmap diet for about six to eight weeks. Firstly, the dietitian will assess the individual's nutritional status and diet intake. The dietitian will educate on the types of food to avoid/restrict and recommend alternatives to make sure the diet remains nutritionally balanced.

If symptoms respond to the low Fodmap diet, the dietitian will guide the individual to reintroduce Fodmap-containing food and determine the level of tolerance.

As each individual's tolerance is different, the dietitian will establish a modified, individualised Fodmap approach for each individual.

In addition, avoiding common trigger foods and drinks such as oily food, spicy food, alcohol, caffeine and carbonated beverages may be helpful.

Other general recommendations include avoiding large meals, chewing food well and eating slowly to improve digestion.

DR WANG YU TIEN,

consultant at the department of gastroenterology and hepatology at the Singapore General Hospital

MS CHERRY LI,

senior dietitian at the department of dietetics at SGH

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