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While nearly one in seven individuals said they experienced abdominal bloating within the past week, more than half reported that they did not seek care for this symptom, a national survey showed.

Among nearly 89,000 respondents to the National GI Survey II, 13.9% reported bloating within the past week, according to Brennan Spiegel, MD, MSHS, of Cedars-Sinai Medical Center in Los Angeles, and colleagues.

Of those who reported bloating, 58.5% never sought care, with 32.5% stating that their bloating resolved on its own, and 29.9% saying it was not bothersome, they wrote in .

Other common reasons for not seeking care included self-managing symptoms with over-the-counter medications/lifestyle changes (20.8%), not having insurance (10.2%) or time (9%), and feeling uncomfortable discussing it with their doctors (8.5%).

"The hesitancy in seeking healthcare or discussing bloating in patients may be attributed to lack of routine screening for bloating, lack of focus on bloating complaints by providers, or patients' dissatisfaction with management of bloating symptoms," Spiegel and team noted. "As such, providers should proactively ask about bloating and adequately achieve symptom control based on risk factors, etiologies, and severity."

Abdominal bloating is a relatively common symptom affecting approximately 16% to 30% of the U.S. population. It is considered a nonspecific symptom that may be linked to a wide range of gastrointestinal conditions, including chronic constipation, irritable bowel syndrome (IBS), or carbohydrate enzyme deficiency.

Bloating can especially affect those with disorders of gut-brain interaction (DGBIs), but may also affect healthy individuals, Spiegel's group said. Prior studies have found a spike in physician visits only among who sought care for bloating symptoms.

Co-author Janice Oh, MD, MSc, also of Cedars-Sinai Medical Center, told MedPage Today that "participants with disorders of brain-gut interaction, organic diseases, and other GI symptoms were likely to have more severe, persistent, or bothersome bloating."

Certain factors were tied to higher odds of bloating, such as female sex (OR 2.56, 95% CI 2.43-2.69) and comorbidities including (P<0.001 for all):

• IBS: OR 2.09 (95% CI 1.95-2.25)
• Ulcerative colitis: OR 1.39 (95% CI 1.18-1.64)
• Functional constipation: OR 1.38 (95% CI 1.27-1.50)
• Abdominal pain: OR 4.13 (95% CI 3.92-4.35)
• Excess gas: OR 3.04 (95% CI 2.90-3.20)
• Concomitant constipation: OR 2.20 (95% CI 2.08-2.33)

"We hope to see a development of standardized approaches to diagnose or treat bloating that can be generally used on many patients, prior to targeted therapies," said Oh. "Given the complexity of bloating, more efforts should be made to better understand its mechanisms and treatments, especially among higher prevalence groups determined by our study."

For this population-based study, Spiegel and colleagues examined data on 88,795 participants who completed the online National GI Survey II from May to June 2020, using symptoms based on the NIH Patient-Reported Outcomes Measurement Information System (), including bloating, abdominal pain, dysphagia, nausea or vomiting, fecal incontinence, heartburn, regurgitation, diarrhea, and constipation.

The participants were divided into age groups (18-29, 30-39, 40-49, 50-59, and ≥60), with similar proportions reporting bloating in the past 7 days. They were mostly evenly split between men and women, and over half were white.

Black participants and those over age 60 had lower odds of experiencing bloating, while higher odds of seeking out care for bloating were seen among Black participants and those over 29.

In addition, those with comorbid celiac disease, IBS, or inflammatory bowel disease (IBD) were over twice as likely to discuss bloating with their providers.

Although other GI conditions such as gastroparesis and diverticulitis were tied to more severe bloating, those with celiac disease, IBD, and IBS had the highest odds of experiencing severe bloating.

In a post-hoc analysis of 8,260 participants who reported bothersome or persistent symptoms within the past week, higher odds of bloating were noted for those with celiac disease, IBD, and DGBIs, as well as those with concomitant GI symptoms within the past week. Higher bloating PROMIS scores were seen among those who sought healthcare compared with those who did not, which suggested "that healthcare seeking is associated with more severe bloating symptoms," Spiegel and team noted.

The authors acknowledged that although a quota sampling technique was used to minimize sampling bias and to ensure national representation, the analysis lacked weighted population estimates. Furthermore, bloating may have been underestimated in older participants who have difficulty navigating the web to complete surveys, as well as overestimated in participants with GI symptoms/conditions.

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