Unfortunately, for as common as gas and bloating is, we don’t have much to pick from as far as medications go. One of the big difficulties in developing medications for gas and bloating is that there are so many different causes. However, we do have things to offer, and typically we can improve on the symptoms.
As we mentioned in previous sections of this article, we as humans don’t produce gas. Most of the gas in our bowels is a result of fermentation of foods by bacteria. We have literally trillions of microscopic bacteria that live in our bowels that play into this process. Although sometimes they are infectious bacterial that we don’t want (like when we get a gastroenteritis or food poisoning), the vast majority of the bacteria are essential to our survival. They help us break down certain foods and even produce certain nutrients for our bowels. However, they can also make a lot of gas if we give them the right things to eat.
Given the fact that bacteria are usually to blame for our gas production, it would make sense that if we cut down on the number of bacteria in our bowels we would make less gas. Also, if the overriding problem is small intestinal bacterial overgrowth, reducing bacteria in the small bowel will decrease gas production.
There are a few different antibiotics that we utilize most often for gas production. Metronidazole and neomycin are two very common ones. They are typically given for seven to 10 days. The main problem I find with these antibiotics is that they have quite a few side effects of their own. There are two newer antibiotics for gas and bloating that I use much more frequently because they don’t get absorbed into the body as much, so they have fewer side effects. One is called nitazoxanide (Alinia) and the other is rifaximin (Xifaxan). They are both given twice a day for seven days and are typically better tolerated.
There are many reasons why people may have slow motility in their bowels. Things like thyroid disorders, chronic constipation, gastroparesis (slow-moving stomach due to diabetes) and certain medications can all cause your bowels to move slower that they should. When this happens, several problems can occur.
First, if your bowels move too slowly, the normal amounts of gas we develop throughout the day will not be expelled often enough and will build up and make us feel bloated. Second, slow-moving bowels lead to food staying in our bowels longer than normal, which can lead to constipation and the feeling of fullness. Third, if our bowels move slowly, the food is in contact with our normal bacteria longer, which allows for more fermentation. The normal squeezing movement (peristalsis) of our bowels also helps move bacteria down to our colon and out with our stool. When we have less peristalsis and less movement of the bacteria out of our system we develop more bacterial overgrowth. All of these issues lead to more gas production.
Given this information, one of the treatments we use for gas and bloating is medications that help the bowels move. A common one is metoclopramide (Reglan). This medication does a fairly good job of increasing stomach and bowel motility, and we have been using it for a long time in medicine. Recently, there have been some concerns of the development of Parkinson’s-like symptoms when used long term, so we don’t use it as often as we used to.
Erythromycin, which is an antibiotic, is used for this as well. We use it not because it’s an antibiotic, but because it causes increased motility in the stomach and can help move the bowels. Other commonly used medications are stool softeners and laxatives in people with gas, bloating and constipation. If you can improve on the constipation in the large intestine the stomach and small intestine typically move better as well.