Meteorism

METEORISM (from Greek meteorizo - I raise upward) (synonym: tympany, distension), abdominal bloating, an extremely frequent symptom of various diseases; in the strict sense of the word, M. is not a nosological entity, however it often predominates over other pathological symptoms to such an extent that it becomes the main complaint of the patient. Under physiological conditions, the digestive tract always contains a small amount of air and gases, possibly playing a protective role against trauma and a cushion for maintaining the organs of the abdominal cavity: in the stomach (air bubble), in the small intestines, in the flexures of the transverse colon, and in the rectal ampulla. It is not always possible to draw a precise boundary between physiological and pathological M. Pathological M. should be spoken of only when it causes subjective symptoms and functional disorders. Post-mortem M. is the usual result of the development of products of putrefaction and relaxation of the tone of the intestinal wall. Etiology and pathogenesis. M. occurs on the basis of increased accumulation of gases in the digestive tract ("gastrointestinal M.") or in the abdominal cavity ("peritoneal M.") on the basis of: 1) increased swallowing of air with food (see Aerophagia), 2) increased formation of gases from food (mainly H₂, CO₂, CH₄, H₂S and CH₃SH), 3) prolonged retention in the intestines, and 4) insufficient absorption through the intestinal wall. Under physiological conditions, CO₂ is always well absorbed from intestinal gases, to a lesser extent O₂, partly absorbed by acidophilic intestinal bacteria. Of the gases formed from food fermentation, methane is partly absorbed and excreted by the lungs. H₂, N₂ and H₂S are hardly absorbed and are excreted with feces (Kato, cited by Noorden). Absorption of gases may decrease with venous hyperemia of the intestine on the basis of disorders of portal or general circulation. - Hence it is clear that intestinal gases under corresponding pathological conditions can be the cause of a number of clinical symptoms.--Along with some German authors (Glaessner), one can accept the following tentative classification of individual forms of M., keeping in mind mixed forms: 1) Alimentary M. on the basis of formation of gases from food that gives a large amount of fermentation products (mainly grains, vegetables, greens, fruits, bran, sugary substances). Gas formation depends not only on the nature of the food but also on various biochemical processes as a result of the interaction of flora and the chemical environment of the intestine. 2) Mechanical M. on the basis of violation of intestinal evacuation (sharp spasm, stenosis, adhesions, tumors, hemorrhoidal nodes, anomalies of the uterus and other conditions that can cause temporary or persistent intestinal obstruction). 3) Dynamic M. (neurogenic) on the basis of violation of peristalsis, paresis or paralysis of the stomach and intestines in tabes, myelitis, peritonitis, necrosis of pancreas, after childbirth, acute infections (enterocolitis, typhoid, dysentery) and intoxications (tuberculosis of mesenteric glands), in childhood or senile muscle atrophy or in asthenia, then M. of constitutional and psychogenic nature. This also includes reflex M. in incarceration of the omentum, minor injuries to the abdomen, aseptic laparotomies, as well as psychogenic M. in hysteria, which can simulate abdominal tumors or pregnancy ("Phantom tumor" - prolonged spasm of the diaphragm with simultaneous relaxation of the abdominal muscles; Trousseau).-By localization M. can be general, uniformly covering the entire abdomen, or local, uneven, affecting certain parts of the digestive tract: stomach (in pylorospasm and aerophagia), duodenum (torsion of the mesentery root, periduodenitis, duodenitis), cecum (in typhlitis and appendicitis), incarcerated hernia, stenosed intestinal loop (Valle's symptom). In the so-called lateral M., gas accumulation refers to the ascending and descending colon, and partly to the last loops of ileum (Notlmagel). Clinical symptoms in mild forms: belching, hiccup, a feeling of heaviness and distension in the abdomen, frequent, sometimes noisy passage of gas ("wind") without odor or with a foul odor, especially tormenting for patients. The motor function of the intestine may be disturbed (more often diarrhea on the basis of fermentative dyspepsia, less often spasmodic constipation) or normal. In more serious forms - violent peristalsis, attacks of colicky pains in the abdomen, disappearing after the passage of gas (gas colic, colica flatulenta), shortness of breath, palpitations, spasmodic urination, symptoms of general intoxication (headaches, anemia, etc.). It is clear that M. always complicates the picture of any disease, especially of abdominal organs (cholecystitis, appendicitis, stomach ulcer, etc.), causing intensification of pains and other painful symptoms. M. can be a very important early symptom of decompensation in disorders of portal and general circulation. The most severe forms of M. are associated with peritonitis, intestinal obstruction and acute paralysis of the stomach. In early childhood, colica flatulenta may manifest without symptoms of general M., being caused by spastic contraction of part of the intestines and distension of the overlying loop; these phenomena are accompanied by colicky pains causing children to cry, which disappears after the passage of gas or cessation of spasm. According to clinical course, M. can be constant or periodic, appearing during periods of digestion, especially after taking food that is easily fermented. Periodic forms can become constant depending on a number of exogenous factors. Persistent M. is characteristic of certain population groups and depends on dietary features (consumption of large amounts of black bread, cabbage and potatoes, excessive consumption of beer, e.g. in Bavaria). Diagnosis of individual forms of M. is important for carrying out etiological treatment. In acute severe cases, it is most important to differentiate between peritonitis and intestinal obstruction, as well as between individual forms of the latter. Sudden passage of gas distinguishes spastic ileus from mechanical and gives decisive indications in the question of surgical intervention. Alimentary forms are less persistent than mechanical forms, where the main role is played by retention of gases. Topical diagnosis is possible with the help of fluoroscopy (without contrast mixture or after its administration), revealing a spastic two-chambered stomach, "aerocolia" (distended loops of the large intestine with smoothed haustral folds) or high standing of the diaphragm with limitation of its mobility. A particularly typical picture is given by megasigma (see Hirschsprung's disease). Treatment of M. Dietotherapy of M. is difficult to systematize due to the variety of diseases that cause M. and individual peculiarities in tolerance to different foods. Symptomatically, it is important in all cases to limit the total caloric content and reduce the amount of carbohydrates with an increase in the amount of proteins and fats, especially to limit food rich in slag and fermentative substances, as well as abundant drinking of acidic beverages. Any fresh bread with high water content is prohibited, especially rye bread (crackers from any flour are better tolerated); fresh flour dishes, sweet fruits, sugary substances (honey, confectionery), beer, kvass. Peas, beans, cabbage, potatoes, products from low-quality flour and cereals with high bran content are sharply restricted (especially in children). Broth, soups from pureed vegetables, lean meat, fish, eggs, fresh cottage cheese and sour cream, buttermilk, a little milk (better with tea) are allowed. Individual types of carbohydrates are tolerated individually differently, e.g. greens and fruits often cause less M. than potatoes, and black bread is sometimes better tolerated than white (according to Noorden, in cases of true or hidden constipation). Black bread, although it contains more fermentative substances than white, moves faster through the large intestine and does not have time to ferment strongly. Best tolerated is bread from finely ground whole grain with bran ("Schrotbrot", "Grahambrot", in our country - "doctor's" bread from rye flour or unsoured unleavened bread). Of general dietary measures, regulation of meal times, restriction of individual portions are recommended. For prolonged retention of gases - complete fasting until the passage of gas. - Drug treatment. Adsorbents (prescribed for a short time with a sharp general restriction of food): charcoal (preferably animal) 0.5-1.0 in tablets, 2-3 times a day after meals [or 15% solution of colloidal charcoal (Carbolid) 4 times a tablespoonful according to Walther], white clay (Bolus alba) 0.5-2.0 several times a day. Less reliable are resorcin (0.15-0.2), bismuth salicylate, salol, benzonaphthol (0.3), calcium carbonate 0.5. Essential oils ("carminatives", carminativa) in the form of an infusion of chamomile, valerian, caraway, mint, etc. (5.0-10.0: 200.0, tablespoons several times a day) limit the intestinal flora and fermentative processes in the intestines, increase peristalsis and accelerate the passage of gas. Antispasmodics (atropine, belladonna, papaverine).

To enhance intestinal peristalsis—hypophysin intravenously or intramuscularly 1 cm³ and physostigmine (Physostigminum salicyl. 0.0002-0.0005 subcutaneously). For severe constipation—liquid paraffin (1-2 tablespoons per day) and enema emulsions. The vaccine therapy with intestinal cultures proposed by some authors (Pevzner) for the purpose of changing local immunity (according to Bezredka) and influencing gas formation has not yet given clear results due to the diversity of intestinal flora and the difficulty of obtaining specific vaccines. In some cases, brewer's yeast (change in intestinal flora) has a good effect (Pevzner). Surgical treatment—for appropriate indications (mainly in ileus).-Physiotherapy (for alimentary and dynamic forms): manual and vibrational abdominal massage, therapeutic gymnastics; for severe spasms—galvanofaradization of the abdomen, for chronic colitis and adhesions—diathermy. Hydrotherapy in various forms (baths, showers).-Sanatorium treatment. In chronic forms of diseases of the digestive organs—drinking and mud resorts (Essentuki, Zheleznovodsk, Pyatigorsk, Borjomi, Staraya Russa, etc.). For symptoms of atony, asthenia, and spasmophilia—general strengthening treatment at mountain-climate stations (Teberda, etc.) or at seaside resorts (in summer—Sestroretsk, in spring and autumn—Gelendzhik, Gagra, etc.). In combination of M. with disorders of cardiovascular activity—Kislovodsk, with joint diseases and metabolic disorders—Matesta.

** Prevention. 1) Postpartum and postoperative hygiene—fight against splanchnoptosis, wearing a bandage, strengthening the abdominal press, etc. 2) Nutrition hygiene: fighting excesses in food and drink (general overeating, beer, kvass and tea in excessive amounts, fresh warm bread, abuse of plant food, especially when quickly switching from meat, lack of necessary intestinal training); limiting the volume of food portions, especially in parturients, the elderly, neuropaths, asthenics, and the exhausted; limiting easily fermentable carbohydrates (sugar) in the diet of young children and replacing them with less fermentable ones (flour). 3) General strengthening regimen and physical exercises (gymnastics, sports, walks), dosed according to age and physical strength reserves. 4) Early treatment of all diseases predisposing to M. or directly causing it, especially catarrhs of the digestive organs, constipation, hemorrhoids, etc. 5) Fighting the abuse of frequent large enemas (more than 3 glasses of liquid), leading to mechanical stretching of the intestines.