Gastroenterology

Gastroenterology

Volume 115, Issue 3, September 1998, Pages 542-550
Gastroenterology

Alimentary Tract
Intestinal gas dynamics and tolerance in humans,☆☆

Presented in part at the annual meeting of the American Gastroenterological Association, San Francisco, California, May 1996.
https://doi.org/10.1016/S0016-5085(98)70133-7Get rights and content

Abstract

Background & Aims: Abdominal symptoms are often attributed to intestinal gas. In humans, gas production and composition have been previously investigated, but intestinal gas dynamics and tolerance remain virtually unknown. The aim of this study was to establish the relationship between intestinal gas loads, evacuation, perception of symptoms, and objective abdominal distention in healthy humans. Methods: A dose-response study was performed in 46 healthy subjects; intestinal gas was infused for 3 hours (0, 1, 4, 12, and 30 mL/min), and anal gas evacuation, symptom perception, and abdominal distention were measured. A mixture of gases was infused in venous proportions to minimize diffusion. Anal gas recovery and calculations of gas retention were validated using sulfur hexafluoride as a nonabsorbable gaseous marker. Results: At all of the infusion rates, gas evacuation rapidly equilibrated and paralleled gas infusion without significant differences in perception. Only 6 subjects retained >400 mL gas, and 5 of them developed abdominal distention and symptoms. By contrast, all but 4 of the 41 subjects without retention tolerated the gas loads without discomfort. Conclusions: Intestinal gas tolerance is normally high, because expeditious gas transit and evacuation prevent gas pooling and symptoms. When this protective mechanism is insufficient, gas retention occurs, and it causes abdominal symptoms and distention.

GASTROENTEROLOGY 1998;115:542-550

Section snippets

Participants

Forty-six healthy individuals (21 women and 25 men; age range, 21–29 years) participated in the study after giving written informed consent. Before entering the study, each subject completed a questionnaire to determine the absence of medication intake and gastrointestinal symptoms, particularly constipation, excessive straining at defecation, difficult anal gas evacuation, feeling of excessive abdominal gas, or excessive gas evacuation. The protocol for the study had been approved by the

General conditions

In all studies, the infusion of gas was uneventful, without any sign of leakage or inflow problems. All subjects but 5 tolerated the whole procedure. In these 5 subjects, who underwent infusion at 4 mL/min (n = 1), 12 mL/min (n = 1), and 30 mL/min (n = 3), the study had to be discontinued between 90 and 150 minutes, after the start of infusion. Nevertheless, data from these 5 subjects were included for analysis. The anal cannula proved to have been kept reliably in the appropriate position by

Discussion

We have shown that within the physiological range, intestinal gas tolerance is normally high, because gut transit and evacuation prevent gas pooling and symptoms. However, when this protective mechanism fails or is overcome, subjective symptoms, predominantly bloating, and objective abdominal distention may develop.

Little is known about the mechanical aspects of gas handling by the normal gut. Basically, the only quantitative data on intestinal gas physiology were acquired by Levitt et al. more

Acknowledgements

The authors thank Nuria Ferrer and Isidre Casals, Serveis Cientifico-tecnics of the Central University of Barcelona, for help in gas infrared absorbance analysis; Anna Aparici and Maite Casaus for technical support; and Gloria Santaliestra for secretarial assistance.

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    ☆☆

    Supported in part by the Spanish Ministry of Education (Dirección General de Enseñanza Superior del Ministerio de Educacion y Cultura, PM 97-0096). Dr. Serra was supported by a scholarship from the Spanish Ministry of Education (CICYT).

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