Medical and Health Care

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Bloating (Abdominal Distension)

Possible Causes

Category

Differentials

Category

Functional / GI motility

Differentials

IBS, functional bloating, aerophagia

Category

Malabsorption / fermentation

Differentials

Coeliac disease, lactose intolerance, fructose intolerance

Category

Microbiome imbalance

Differentials

SIBO (Small Intestinal Bacterial Overgrowth)

Category

Inflammatory GI disease

Differentials

Crohn’s, Ulcerative Colitis

Category

Mechanical/structural

Differentials

Partial obstruction, volvulus, adhesions

Category

Gynaecological

Differentials

Ovarian mass/cysts, endometriosis

Category

Ascites

Differentials

Portal hypertension, cirrhosis

Investigations

First-line

FBC

CRP/ESR

Coeliac Screen (tTG IgA + total IgA)

Stool calprotectin

H. pylori stool antigen or breath test

CMP (LFT, U&E, glucose, Calcium)

Second-line

SIBO Breath Test (lactulose/glucose)

Faecal elastase (pancreatic insufficiency)

Lactose breath test

Immunoglobulins / IgG subclass

Red Flags

Unintentional weight loss, vomiting persistently, rectal bleeding and iron deficiency anaemia → urgent referral