Flatulence

Question 1

What is flatus? What is flatulence?

Answer 1

Flatus = gas generated in GIT

Flatulence = expelling flatus through anus

Question 2

Describe the physiology of flatulence?

Answer 2

• Normal but volume, frequency vary depencing on diet (especially fermentable fiber), presence of methane producing bacteria, and concurrent disease.
• Most from GIT, some from blood stream

Question 3

Describe the role of aerophagia in flatulence?

Answer 3

• Aerophagia may contribute to flatus
• Aerophagia provokes more flatus in dogs with functional alimentary tract abnormalities – examples include defects in gastro-esophageal sphincter function, eructation, or alimentary gas transit

Question 4

Describe the pathophysiology of flatulence

Answer 4

Excessive flatulence causes =

• Aerophagia: disorded gastroesophageal sphincter function, eructation, alimentary gas transit, GDV, respiratory disease (brachycephalic)
• Dietary: edogenous gases as either a byproduct of certain foods or incomplete digestion.
• Vegetables: polysaccharides and substrate for LI microbiotica containing fermentable fiber and resistant starch, dairy products, and other components (e.g. carrageenan and guar gum).
• Hypersensitivity to proteins or changes in protein content.
• Lactose intolerance is occasional cause of flatulence
• Alimentary tract disease: enteric infections (e.g. Giardia sp.), and antimicrobials use
  
  • diseases affecting other organs
• Odour producing compounds include carboxyclic acids, phenol, ammonia, hydrogen sulphide, indole, skatole, mercaptans, volatile amines, ketones, alcohols, and short-chain fatty acids.
• Hydrogen sulphide most importand and vary probably due to presence of sulfer-reducing bacteria.
• Sources of sulfer = intestinal mucin, nuts and vegetabls, carrageenan (sulphated polysaccharide)., and high protein diet
• Propulsion of gas in GIT is active process and separate from solid and liquid contents.
• Influencing Diet factors – protein, fat, and fiber all slow transit; and simple sugars and dietary moisture have no effect.
• Physical activity increased speed of gas and decreases retention.

Question 5

What are the differential diagnoses for a patient with flatulence?

Answer 5

• Aerophagia
• Dietary factors- excessive fibre and adverse food reactions
• Motility disorders – esophageal dysmotility, GDV, dysautonomia, ileus, obstruction, irritable coln syndrome
• Malabsorption – EPI and IBD, lymphoma
• Antimicrobial causes -
• Swallowing disorders (e.g. esophageal dysmotility and megaesophagus)
• Resp tract disorders – anything causing dyspnea
• Problems with feeding – e.g. rapid food ingestion, obsessive compulsive disorders

Question 6

What are the clinical presentations of a patient with flatulence?

Answer 6

Clinical signs:

• Excessive volume
• unpleasant flatus odor
• noise
• abdominal pain or abdominal distension (‘bloating)
• eructation or borborygmi
• vomiting, diarrhea, and weight loss

Question 7

Answer 7

Question 8

How should flatulence be managed?

Answer 8

If underlying disease specific therapy should be implemented

• IBD – immunosuppressive medication
• EPI – pancreatic enzyme supplementation
• Antiparasitic medication for giardiasis
• Symptomatic – dietary management, altering feeding behaviour, and medical therapies

Question 9

What dietary management can be used for patients with flatulence

Answer 9

• Dietary management is to reduce fat, fermentable fiber, and gelling agents, r eliminate proteins cause hypersensitivity.
• Offer a highly digestible diet which is reduced fat and fermentable fiber
• Dog – 30g/1000kcal fat and 15g/1000kcal crude fiber (<25g/1000kcal total dietary fiber)
• Formulated therapeutic diet or home-prepared diet can be used but will need to be nutritionally balanced for long term feeding
• Avoid vegetarian diets, and foods containing lactose.
• Dry foods and kibble require chewing which slows food intake.
• If adverse food reaction is suspected then using hydrolyzed or single source protein diet.
• Trial should last for 2 weeks since signs associated with adverse food reactions usually improve in 7-10 days.

Question 10

How can aerophagia be managed to reduce flatulence?

Answer 10

• Change pattern, timing, andmethod of feeding
• Feed animals in separatly to avoid rapid eating.
• Interactive feeders
• Give food ration over a number of meals can help
• Increasing physical activity can be considered since it increases the rate of intestinal gas transit, and decrease gas retention; dogs that are exercised frequently are less likely to bloat than sedentary dogs

Question 11

What treatments that are medications or surgery can be used to manage flatulance

Answer 11

• Surfactants, adsorbents, antibacterials and probiotics reduce the volume and odour
• Semiethicone- surfactant reduces surface tension causing gas bubbles to coalesces, to reduce trapping and promote passage. 25-200 mg q 6h PO
• Plant saponins from yucca schidigera have effets on antimicrobial fermentation and reduce fecal odour wen fed dogs and cats
• Adsorbents used for symptomatic flatulence include activated charcoal, bismuth subsalicylate, and zinc compounds.
• Bismuth and zinc are divalent cations that bind compounds with sulhydryl group (e.g. hydrogen sulphide) while activated charcoal has internal surface area binding molecules leading to flatulence.
• Activated charcoal reduces hydrogen sulphide and odor associated with flatus in dogs.
• Yucca schidigera extract, activated charcoal, and zinc acetate significantly decreased hydrogen sulphide content of flatus

Antibacterials

• Suitable drugs should be orally administered, effective against anaerobic bacteria, not systemically absorbed and free from side effects.
• Examples include rifaximin which is more effective than activated charcoal for treating humans
• Antibacterial therapy can be used but caution against antimicrobial resistances.
• Probiotics are possible alternative

Surgery options:

Prophylactic gastropexy