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BLOATING AND VISIBLE ABDOMINAL DISTENSION IN IRRITABLE BOWEL SYNDROME AND FUNCTIONAL DYSPEPSIA: OVERLAPPING OR DISTINCT SYMPTOMS?

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Introduction

Irritable bowel syndrome (IBS) and functional dyspepsia (FD) are common disorders of gut-brain interaction (DGBI), and bloating and visible abdominal distension are common symptoms among individuals with IBS and/or FD. Bloating refers to a subjective sensation of tension or pressure in the abdomen, which may or may not be reported together with visible abdominal distension. The underlying pathophysiological mechanisms may differ, with bloating suggested to be more related to hypersensitivity and visible abdominal distension to altered motility. The prevalence of these two symptoms in IBS and FD, especially as distinct symptoms, is not well known.

Aims & Methods

The aim was to investigate the link between bloating and distension with IBS and FD. Therefore, we performed a population-based internet survey of adults in the US, UK, and Mexico, including Rome IV IBS and FD diagnostic questions, somatization (PHQ-12), and psychological distress (PHQ-4). Four groups were created: those meeting the Rome IV criteria for IBS only, FD only, both IBS+FD, and a reference group including individuals without IBS, FD and organic diagnoses that could result in IBS- or FD-like symptoms. Within each group, we identified individuals who reported ≥weekly bloating alone (B), ≥weekly visible abdominal distension alone (D), ≥weekly combined B+D, or neither of both. The relationship between B, D and B+D in those with IBS and/or FD vs. the reference group was investigated using logistic regression models.

Results

The analysis included 5,448 participants (49.7% female; mean age 46.5 years, range 18-99), with 131 meeting criteria for IBS only, 360 for FD only, 217 for IBS+FD and 4,740 for the reference group. A larger proportion of individuals with IBS only (64.9%), FD only (50.6%), and especially those with IBS+FD (88.5%) reported bloating and/or visible abdominal distension compared to the reference group (13.7%). In the IBS only group, 16.0% reported bloating alone, 8.4% visible abdominal distension alone, and 40.5% combined bloating and visible abdominal distension. In the FD only group this was 12.8% (B), 8.9% (D), and 28.9% (B+D), and in the IBS+FD group 18.9% (B), 8.3% (D), and 61.3% (B+D), respectively. Reporting bloating alone or combined bloating and visible abdominal distension was strongly linked to fulfilling criteria for IBS only, FD only, and concomitant IBS+FD vs. the reference group, with weaker links for visible abdominal distension in the absence of bloating (Table). After adjusting for age, sex, BMI, psychological distress and somatization, the links persisted. The strongest association was observed between combined bloating and visible abdominal distension (vs. neither) and concomitant IBS+FD (vs. the reference group); adjusted odds ratio 28.6 [95%CI 17.6-46.6].

	IBS without FD vs. reference group Crude OR [95%]	FD without IBS vs. reference group Crude OR [95%CI]	IBS+FD vs. reference group Crude OR [95%CI]
Bloating alone^a	13.7 [8.0-23.6]	7.8 [5.4-11.2]	49.3 [29.1-83.4]
Visible abdominal distension alone^a	5.0 [2.5-9.7]	3.7 [2.5-5.6]	14.9 [8.0-27.9]
Combined bloating and visible abdominal distension^a	14.8 [9.8-22.3]	7.5 [5.8-9.8]	68.4 [44.0-106.5]
	IBS without FD vs. reference group Adjusted OR [95%]^b	FD without IBS vs. reference group Adjusted OR [95%]^b	IBS+FD vs. reference group Adjusted OR [95%]^b
Bloating alone^a	8.5 [4.6-15.5]	4.8 [3.1-7.2]	25.6 [14.5-45.1]
Visible abdominal distension alone^a	3.9 [1.9-7.9]	2.9 [1.9-4.5]	9.3 [4.9-17.9]
Combined bloating and visible abdominal distension^a	8.4 [5.1-13.6]	4.4 [3.2-6.0]	28.6 [17.6-46.6]
Table. Link between bloating and/or visible abdominal distension and IBS and FD ^a ≥weekly bloating and/or visible distension vs. <weekly bloating and distension or neither of both. ^b odds ratio based on logistic regression models, adjusted for age, sex, BMI, psychological distress (PHQ-4), and somatization (PHQ-12).

Conclusion

Bloating and visible abdominal distension as distinct and overlapping symptoms are strongly linked to IBS, FD, and concomitant IBS+FD in the general population. Assessing bloating and visible abdominal distension as separate symptoms may be important to enable individualized treatment for individuals with IBS and FD.

BLOATING AND VISIBLE ABDOMINAL DISTENSION IN IRRITABLE BOWEL SYNDROME AND FUNCTIONAL DYSPEPSIA: OVERLAPPING OR DISTINCT SYMPTOMS?

Tom van Gils 1, Ryo Katsumata 1, Jóhann Hreinsson 1, Douglas Drossman 2, Jan Tack 3, Hans Törnblom 1, Boris Le Nevé 4, Laurent Quinquis 4, Rim Hassouna 4, Max Julio Schmulson Wasserman 5, Shrikant I. Bangdiwala 6, Olafur S. Palsson 7, Magnus Simrén 8

1 University of Gothenburg, Gothenburg, Sweden

2 University of North Carolina/Chapel Hill, Chapel Hill, United States|||The Rome Foundation, Raleigh, United States

3 University of Gothenburg, Gothenburg, Sweden|||University of Leuven, University Hospital Gasthuisberg, Leuven, Belgium

4 Danone Global Research & Innovation, Gif-sur-Yvette, France

5 Universidad Nacional Autónoma de México, Mexico City, Mexico

6 McMaster University, Hamilton, Canada

7 University of North Carolina/Chapel Hill, Chapel Hill, United States

8 University of Gothenburg, Gothenburg, Sweden|||University of North Carolina/Chapel Hill, Chapel Hill, United States

Event

UEG Week Berlin 2025

Topics

Neurogastroenterology & Motility Colorectal

Submission format

Abstract

Session

Lower GI motility I

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Therapeutic approach to DGBI: Drugs or diet?

Magnus Simrén 1

1 Sahlgrenska University Hospital - Dept of Internal Medicine, Sahlgrenska University Hospital ; Gothe, Gothenburg, Sweden

Event

UEG Week Berlin 2025

Topics

Neurogastroenterology & Motility Small Intestine & Nutrition Primary Care

Session

Disorders of gut‐brain interaction: Dietary restrictions

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Gut-brain chaos: Here’s how primary care can restore order

Christos D Lionis 1

1 University of Crete, Heraklion, Greece

Event

UEG Week Berlin 2025

Topics

Neurogastroenterology & Motility Paediatrics Standards & Guidelines Stomach & H. Pylori

Session

From guidelines to clinical practice: The gut-brain connection - PPIs and guideline application in clinical practice

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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What treatment can we offer?

Jordi Serra 1

1 University Hospital Vall d'Hebron, Barcelona, Spain

Event

UEG Week Berlin 2025

Topics

Primary Care

Session

Bloating

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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What the gastroenterologist can offer

Giovanni Sarnelli 1

1 University of Naples 'Federico II', Pozzuoli NA, Italy

Event

UEG Week Berlin 2025

Topics

Neurogastroenterology & Motility Primary Care

Session

Therapy update: Dyspepsia

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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A MULTICENTER RETROSPECTIVE STUDY OF INFLUENTIAL FACTORS ON STENOSIS AFTER MODERATE RESECTION OF CIRCUMFERENCE IN ESOPHAGEAL ENDOSCOPIC SUBMUCOSAL DISSECTION

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Introduction

Endoscopic submucosal dissection (ESD) is an effective treatment for superficial esophageal cancer, but postoperative stenosis remains a significant concern. Particularly, probability of the stenosis is less investigated in cases with a 50%-75% circumferential mucosal defect.

Aims & Methods

This study aimed to identify influential factors for postoperative stenosis after the moderate circumferential resection in esophageal ESD. This multi-center retrospective observational study analyzed data from 513 patients across 19 institutions who underwent esophageal ESD from April 2018 to March 2022 and showed 50% to 75% of the circumferential mucosal defect. We firstly overviewed the current status on the postoperative stenosis, the steroid use, and postoperative adverse events in these patients. Subsequently, we identified influential factors for postoperative stenosis. Patients were categorized into stenosis and no stenosis groups, and univariate and multivariate analyses were performed for each parameter. We further investigated influential factors of stenosis in two cohorts: steroid and no steroid groups. Finally, the parameters were compared between the steroid and no steroid groups to assess the tendency of the steroid use in general practice.

Results

Postoperative stenosis was observed in 28 cases (5%). Univariate analysis comparing the stenosis group (n = 28) and no stenosis group (n = 485) revealed significant differences in the prior endoscopic treatment near the lesion (p = 0.02), cervical esophageal location (p = 0.04), defect circumference (p =0.01), and procedure duration (p = 0.02). There was no significant difference in the steroid use between two groups. Multivariate analyses identified history of prior endoscopic treatment close to the lesion (p = 0.01, odds ratio [OR], 5.10), cervical esophageal lesions (p = 0.03, OR, 3.97), large circumferential defect (p <0.01, OR, 3.78), and longer procedure duration (p <0.01, OR, 3.83) as independent risk factors for stenosis formation. Among the steroid group, significant associations of the postoperative stenosis were revealed with the prior endoscopic treatment near the lesion (p = 0.02), cervical esophageal location (p = 0.04), and >5/8 of defect circumference (p = 0.02). In the no steroid group, only the procedure duration (p = 0.01) showed a significant difference between the stenosis and non-stenosis groups. Comparison between the steroid (n = 223) and no steroid groups (n = 290) revealed significant differences in the prior endoscopic treatment near the lesion (p <0.01), cervical esophageal lesions (p <0.01), and resected specimen dimensions (p <0.01). The stenosis rates were 7% in the steroid group and 4% in the no steroid group, without a significant difference. No significant difference in adverse events was observed between the two groups.

Conclusion

In esophageal ESD with a 50%-75% circumferential mucosal defect, the steroid was used in over 40% of patients, and postoperative stenosis still occurred in 5%. Because wider circumference, location of the cervical esophagus, prior endoscopic treatment close to the lesion, and prolonged operative time were identified as independent risk factors on the stenosis, steroid therapy should be preferred in these cases. Particularly, lesions with a history of endoscopic treatment, on cervical esophagus, and with >5/8 of defect circumference should require more aggressive countermeasures than currently applied.

A MULTICENTER RETROSPECTIVE STUDY OF INFLUENTIAL FACTORS ON STENOSIS AFTER MODERATE RESECTION OF CIRCUMFERENCE IN ESOPHAGEAL ENDOSCOPIC SUBMUCOSAL DISSECTION

Akira Dobashi 1, Tsugumi Habu 2, Osamu Goto 3, Toshiyuki Yoshio 4, Waku Hatta 5, Noboru Kawata 6, Atsushi Goto 7, Unknown Unknown 8, Yugo Iwaya 9, Tetsuya Tatsuta 10, Takuto Hikichi 11, Jun Nakamura 11, Shinjiro Yamaguchi 12, Takashi Ohta 12, Yohei Furumoto 13, Tsutomu Nishida 14, Masashi Yamamoto 14, Mikitaka Iguchi 15, Tatsuo Yachida 16, Hiroko Nebiki 17, Tomoaki Yamasaki 17, Toshiaki Narasaka 18, Eriko Koizumi 2, Yosuke Tsuji 19, Kazuki Sumiyama 1, Mitsuhiro Fujishiro 19

1 The Jikei University School of Medicine, Tokyo, Japan

2 Nippon Medical School Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan

3 Nippon Medical School, Tokyo, Japan

4 Cancer Institute Hospital, Japanese Foundation for Cancer Reserch, Tokyo, Japan

5 Tohoku University, Graduate School of Medicine, Sendai, Japan

6 Shizuoka Cancer Center, Shizuoka, Japan

7 Yamaguchi University Graduate School of Medicine, Ube, Japan

8 Tonan Hospital, Hokkaido, Japan

9 Shinshu University School of Medicine, Matsumoto, Japan

10 Hirosaki University Hospital, Aomori, Japan

11 Fukushima Medical University Hospital, Fukushima, Japan

12 Kansai Rosai Hospital, Hyogo, Japan

13 Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan

14 Toyonaka Municipal Hospital, Toyonaka, Japan

15 Wakayama Medical University, Wakayama, Japan

16 Faculty of Medicine, Kagawa University, Kagawa, Japan

17 Osaka City General Hospital, Osaka, Japan

18 University of Tsukuba, Tsukuba, Japan

19 The University of Tokyo, Tokyo, Japan

Event

UEG Week Berlin 2025

Topics

Endoscopy Oesophagus

Submission format

Abstract

Session

Endoscopic resection in the upper GI tract

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Poster

Standard Poster

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Introduction

Functional dyspepsia (FD) is a common gastrointestinal disorder with limited treatment options. Itopride, a compound that combines dopamine D2 receptor antagonism with inhibition of acetylcholinesterase, may offer benefits over other prokinetics.

Aims & Methods

This meta-analysis evaluates the therapeutic efficacy of Itopride compared to placebo and other prokinetic agents in managing FD symptoms.
A total of 19 randomized controlled trials were included in the analysis, comprising six placebo-controlled studies (n=1981, 976 on placebo and 1005 on Itopride) and 13 trials comparing Itopride to another prokinetic (n=1077, 515 on Itopride and 562 on control prokinetics including mosapride citrate, levosulpiride, metoclopramide, domperidone, and cisapride). Meta-analyses were conducted using a random-effects (DerSimonian and Laird) model. Outcome measures included overall responder rate and symptom assessment, comparing Itopride to 1) all prokinetics and 2) placebo. In addition, Itopride was compared to placebo and domperidone for symptom scores of epigastric pain and early satiation. Results are presented as Cohen’s d (95% CI) or odds ratios(OR) (95% CI).

Results

Analysis of responder rates from seven placebo-controlled and nine active comparator studies showed a statistically significant benefit of Itopride over placebo (OR=1.25, 1.07 to 1.45, p=0.01), with no significant difference when compared to other prokinetics (OR=1.11, 0.93 to 1.34).
When assessing overall symptom scores, three placebo-controlled and four prokinetic-controlled trials were analyzed. Itopride showed a moderate effect size compared to other prokinetics (Cohen’s d=0.51, 0.13 to 0.88, p=0.01) and a large but not statistically significant effect compared to placebo (Cohen’s d=1.14, -0.43 to 2.71).
Early satiation was assessed in six domperidone-controlled trials, yielding a significant odds ratio of 1.37 (1.02 to 2.67, p=0.04). A large but not statistically significant difference was found compared to placebo (two trials, Cohen’s d=1.10, -0.47 to 2.67). For epigastric pain, a moderate but not statistically significant difference was found with placebo (two trials, Cohen’s d=0.68, -0.01 to 1.38) or domperidone (four trials, OR=0.85, 0.63 to 1.16).

Conclusion

This meta-analysis suggests that Itopride provides significant symptom relief in patients with FD compared to placebo, particularly in overall responder rates. While Itopride’s benefits over other prokinetics were modest in general symptom relief, it demonstrated a statistically significant advantage over domperidone for early satiation.