Abstract
The article presents a comprehensive overview of current concepts regarding abdominal bloating and distension, including their etiology, pathogenesis, diagnostic approaches, and therapeutic strategies. The traditional term meteorism is considered outdated, as it encompasses two distinct conditions — the subjective sensation of bloating (bloating) and the objective increase in abdominal volume (distension). Epidemiological data indicate that up to 30% of adults experience bloating episodes, while among patients with irritable bowel syndrome, the prevalence reaches 85–90%.
The physiological and pathological mechanisms of gas accumulation in the gastrointestinal tract are analyzed, including aerophagia, excessive fermentation of carbohydrates, maldigestion, dysbiosis, and motility disorders. Particular attention is given to pseudometeorism and Alvarez syndrome — conditions in which abdominal enlargement is not related to gas retention but results from altered neuromuscular regulation or psychosomatic factors.
The role of exocrine pancreatic insufficiency in the development of intestinal dysbiosis and small intestinal bacterial overgrowth is emphasized, highlighting its contribution to maldigestion and impaired nutrient absorption. Recent data on gut microbiota alterations in chronic pancreatitis and their clinical relevance are discussed.
Differential diagnostic criteria distinguishing functional from organic gastrointestinal disorders are summarized, along with the pathogenetic role of disturbed viscero-somatic and anorectal reflexes underlying functional bloating. A diagnostic algorithm consistent with the latest American Gastroenterological Association (AGA) (2023) recommendations is proposed, emphasizing stepwise exclusion of organic disease, assessment of gastrointestinal motility, pancreatic exocrine function, and microbiota status. A multidisciplinary approach combining enzyme replacement therapy, microbiota modulation, and behavioral interventions is advocated for optimal management.
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