AGA Clinical Practice Update on Evaluation and Management of Belching, Abdominal Bloating, and Distention: Expert Review.
Level 5 - mechanism / opinion, no new human data
Narrative expert review and clinical practice update without systematic review or formal evidence grading
PubMed 37452811 · doi:10.1053/j.gastro.2023.04.039
What was done
The American Gastroenterological Association (AGA) commissioned an expert review to synthesize clinical trials, observational studies, and expert consensus into 15 best practice advice statements on the diagnostic evaluation and management of belching, bloating, and abdominal distention. The panel addressed clinical features, diagnostic modalities, dietary interventions, brain-gut behavioral therapies, and pharmacologic options.
What was found
The abstract reports qualitative recommendations rather than numerical data. Key advice includes: differentiating gastric from supragastric belching using history, examination, and impedance pH testing; treating supragastric belching with brain-gut behavioral therapies (cognitive behavioral therapy, diaphragmatic breathing, speech therapy) and neuromodulators; applying Rome IV criteria for diagnosing functional bloating and distention; selective testing for celiac disease, carbohydrate malabsorption, and small intestinal bacterial overgrowth; avoiding routine endoscopy, abdominal imaging, or motility testing absent alarm features; advising against the use of probiotics for bloating and distention; involving specialized dietitians for dietary therapy; and employing biofeedback for pelvic floor dysfunction, neuromodulators for visceral hypersensitivity, and diaphragmatic breathing for abdominophrenic dyssynergia.
Why it matters
These statements provide practicing clinicians with a standardized, multidisciplinary algorithm to evaluate and treat common, debilitating upper gastrointestinal symptoms that often lack high-level therapeutic evidence.
Limits
The recommendations are based on expert review rather than a formal systematic review or meta-analysis, and no formal ratings of evidence certainty or recommendation strength were performed. The abstract provides no quantitative effect estimates, sample sizes, or study counts.
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- context Probiotics can worsen symptoms in people with ulcers who also have small intestinal bacterial overgrowth (SIBO).