Intestinal gas raymond

Intestinal Gas:
Charting the course through a
perilous miasma

Patricia L Raymond MD FACP FACG
Rx for Sanity, Chesapeake VA
24 January 2009 1125-1215
Debbie Waiz 15th Annual RxForSanity.com
Endoscopy Symposium ColonoscopyJoke.com

“If you jog in a jogging suit,
lounge in lounging pajamas,
and smoke in a smoking jacket,

WHY would anyone want to
wear a windbreaker??"


Farts are fun!


Other terms for
Gas
 Poof/poot
 Fluff My favorites:
 Cut the cheese
 Air biscuit
 Launch a loaf
 Rhino stopper  Trouser cough
 Shot a bunny  Bottom burp


The manly art of fart-burning.
Compression, ignition, combustion
and exhaust. ~Frank Zappa

 Methane burns in oxygen forming water
and carbon dioxide often producing a blue
hue
CH4 + 2O2 → CO2 + 2H2O
 Hydrogen sulfide also combusts
2H2S + 3O2 → 2SO2 + 2H2O

How long would you need to
continuously pass flatus in
order to generate methane
gas with the energy of an
atomic bomb?

6 years and 9 months
12 years and 3 months
25 years

Flatulence in
America’s War on Terrorism


Measurement of Gas


Measurement of Gas
 Techniques include plethmography, argon
washout technique, digitized KUB
 Average amount only 200 ml,
range 115 ml to 1000 ml
 14-23 average passage per day
(flatus + eructation)


Composition of gas
 99% nitrogen, oxygen,
carbon dioxide,
hydrogen, methane
 Location, location,
location
– Stomach: high nitrogen,
oxygen (similar to
atmosphere)
– Colon: less oxygen,
more methane

Odor of gas

 Minor constituents (1%)
 Sulfur containing compounds, SCFA,
volatile amines, ammonia
 Generally attributed to bacterial metabolism


Sources of gas
Aerophagia
 Rapid eating/drinking
 Chewing gum
 Carbonated beverages
 Smoking or drinking
through straw
 Poor fitting dentures
 Nervous habit


Intraluminal production
 CO2: from digestion fat,
protein in upper SB,
bacterial fermentation of
malabsorbed foods, or
acid + bicarb
 H2: mainly from colon,
may result from small
bowel bacterial overgrowth
(bacterial fermentation)
 CH4: only from bacterial
metabolism

Instilled or iatrogenic gas


Sounds of intestinal gas
 Joseph Pujol, 19th
century France
 Vibration of anal orifice
 Variations
– Tightness of sphincter
muscle
– Velocity of gas
– Other (TMI) moisture,
body fat


Petomaine persists today
 Italian movie 'Il Petomane',
contrasting his deep
longing for normalcy with
the condition of 'freak' to
which his act relegated
him.
 Blazing Saddles (1974)
Mel Brooks plays the part
of "Governor William J. Le
Petomane".
 Johnny Depp has
mentioned frequently in
interviews that he wishes
to portray Pujol in a film.

Fart In A Jar Sells for $71 on eBay

 In 2007 a fart in a jar
from a "hot girl" sold
for $71 on eBay.
 It had 24 bids


Diamonds are forever?
 Janine Roberts' new book
"Glitter &
Greed: The Secret World
of the Diamond Cartel"
exposes the unromantic
side of diamonds.
– Roberts has seen scientists
"grow diamonds" using
methane and oxygen which
she says means diamonds
are nothing more than
"crystallized farts."

Intestinal Gas: Sounds
 Borborigmi
 Term for noises
generated as gas &
fluid travel through the
gut
 A normal sound when
rumbling/low, although
high pitched suggests
PSBO


Herring Break Wind to
Communicate, Study Suggests
 Ben Wilson, a marine biologist at the
Bamfield Marine Science Centre, British
Columbia, Canada U.K. science journal
Biology Letters, 2003
 Atlantic and Pacific herring
 Fast Repetitive Tick (FRT): high-frequency
nocturnal sound bursts up to 22 kilohertz,
accompanied by a fine stream of bubbles
from the anus.

Foods that cause gas: Sugars
 Raffinose
– Beans
– Smaller amounts in
cruciferous vegs and grains
 Lactose
– Milk products & processed
foods
– Asian, AA, Native American
– Lactase drops with aging
 Fructose
– Also soft drinks, onions,
artichokes, wheat
 Sorbitol
– Fruits, dietetic foods, sugar
free foods, gum

Gassy foods round-up
provided as a pre-lunch service by PLR
 Beyond the beans…
 Peas, lentils, soybeans
 Broccoli, cabbage, cauliflower, cucumber,
green pepper, kolrabi, brussels sprouts,
onions, leeks, artichokes, and asparagus
 Pears, apples, avocados, bananas, melon
and peaches , prunes and raisins
 Whole grains, such as whole wheat and
bran.

Starches, fiber & gas
 Most starches produce gas
with breakdown in colon
(except rice)
– Potatoes, corn, pasta
 Fiber
– Soluble fiber (dissolves in
H2O to gel) in oat bran,
fruits, beans, not broken
down until reaches colon.
 digestion by bacteria
causes gas
– Insoluble fiber (wheat bran,
some vegs) passes
unchanged through bowel &
causes no gas

Halloween Fun?


What to do about intestinal gas?


If predominantly eructation
Think about:
 GERD
 Gastroparesis
– Gastric emptying study
 Dietary Aerophagia
 Habit/learned behavior
– Responds well to
biofeedback and
antidepressant therapy


Abdominal distension & bloat
Think about:
 Nissan fundoplication
– 10% ‘gas-bloat’ syndrome
 Irritable bowel syndrome
– Positive ‘panty sign’
 Consider PSBO
– Small bowel enteroclysis
 Dietary, bacterial overgrowth
– LTT to determine role of
intolerance (not Y or N)
– > 30 mg/dl within 2 hours normal. 20-30
mg/dl inconclusive. < 20 mg/dl abnormal.

Predominant flatulence
 Food diary
 Celiac testing (TTG-
IgA & total IgA)
 Trial digestive
enzymes (beano,
lactaid, prelief)
 Hydrogen breath
testing (SBO?)
 Education (NIDDK)

ColicInfant.com


Empiric therapy
 Simethicone not very effective
(Phazyme, Mylicon, Gas-X, Mylanta
Gas)
– Changes the surface tension of gas
bubbles, enabling smaller bubbles to
join together into bigger bubbles.
 Charcoal
– Tablets, briefs or pads
– May absorb other medications
– Theoretically adsorbs gas volume
 Bismuth
– Said to reduce odor of HS gas
 Probiotic therapy/antibiotic therapy
– Replace/reduce gas producing bacteria


Never pass gas in a wetsuit.

Thanks for letting me get this
presentation out of my system…

“Better out than in,
I always say.”
~Shrek (Mike Myers)


Questions?


Have a 239 bean day!
Anything more would be ‘too farty’
(240)!

~From a SGNA colleague who shall remain nameless


Intestinal gas raymond

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