Gas-related Symptoms and Behaviors are Associated with Rome IV Functional Abdominal Bloating: An Internet Survey

Introduction: Functional abdominal bloating (FAB) is a bowel disorder of gut-brain interaction (DGBI) characterized by predominant bloating symptom. Given gas dynamics in the digestive tract, gas-related symptoms (belching and flatulence) and behaviors may contribute to the development of FAB. This study aimed to examine their relationships. Methods: We conducted an internet survey for individuals aged from 18 to 79 years using a questionnaire including items on demographic and clinical characteristics, lifestyle, and gas-related symptoms and behaviors. DGBI including FAB were diagnosed based on the Rome IV criteria. The severity of bloating was assessed using visual analogue scale. Health-related quality of life (HRQOL) was evaluated using the SF-8. Logistic and multiple regression analyses identified factors associated with FAB and their bloating severity. Results: A total of 9,995 individuals were included in the analysis, in which 123 (1.2%) were classified as having FAB. HRQOL was significantly impaired in the FAB group compared to the non-FAB group. Multivariable analysis demonstrated that gas-related symptoms and behaviors such as frequent flatulence (OR 2.55, 95%CI 1.74–3.72, p<0.001), frequent suppression of flatulence (OR 2.09, 95%CI 1.32–3.32, p=0.002) and resisting the urge to defecate (OR 2.77, 95%CI 1.57–4.90), p<0.001) were significantly and independently associated with an increased odds of FAB, in addition to lower BMI and gastroesophageal reflux disease. Younger age and resisting the urge to defecate were related to increased severity of bloating in patients with FAB. Conclusion: Gas-related symptoms and behaviors may contribute to the pathophysiology of FAB.