Patient's question:
It has been a week, and I've been feeling gas in my stomach pushing upwards. I can't eat much and always feel like I can't eat. I've taken digestive pills, but they haven't been effective. I don't know what's wrong. I want to ask the doctor what medicine to take for stomach gas.Doctor's answer:
Vomiting, belching, hiccups, nausea) Normally, people swallow small amounts of gas while eating and drinking (aerophagia), but some people, especially when anxious, unconsciously swallow gas repeatedly during eating and other activities. Most of the swallowed gas is subsequently belched out (belching), while only a small portion enters the small intestine. The amount of gas entering the intestine is greatly influenced by posture: when the esophagus empties its contents into the back of the stomach, in an upright position, the gas rises to the top of the liquid in the stomach and comes into contact with the gastroesophageal junction, making it easier to belch. When lying down, gas trapped below the stomach fluid is more easily pushed into the duodenum. Excessive salivation can also lead to increased air intake and may be associated with many gastrointestinal diseases (gastroesophageal reflux disease), inappropriate dentures, other therapies, or any cause of nausea. Belching may be related to the use of antacids; as patients attribute the relief of ulcer symptoms to belching rather than antacids, they may continue to belch to alleviate discomfort. Gas production in the intestinal lumen can occur through several mechanisms. Bacterial metabolism can produce large amounts of hydrogen (H2), methane (CH4), and CO2. Almost all H2 is produced in the colon by bacteria metabolizing fermentable substances (carbohydrates and amino acids) ingested, so the amount of hydrogen can be negligible after prolonged fasting or when food has been completely absorbed by the small intestine. Other less understood factors (such as differences in gut microbiota and motility) may also be related to the production of different gases. Normal individuals cannot completely absorb certain carbohydrates found in common foods. Normally, undigested polysaccharides in fruits and vegetables can also produce excessive gas. After consuming certain fruits and vegetables containing indigestible carbohydrates (e.g., cooked beans) or in patients with malabsorption, large amounts of H2 are produced. Patients with disaccharidase deficiency (mostly lactose intolerance) can excrete large amounts of disaccharides into the colon, where they ferment to produce H2 (see Section 30). In cases of excessive colon gas, celiac disease, tropical sprue, insufficient pancreatic secretion, and other causes of carbohydrate malabsorption should be considered. CH4 is produced by bacteria in the colon metabolizing endogenous substances. The rate of CH4 production is only slightly affected by food intake. Some people continuously expel large amounts of CH4, while others produce little or no gas, which is often familial, appearing in infancy and persisting lifelong. CO2 may also be produced by bacterial metabolism, but its more important source is the reaction between HCO-3 and H+, where 1 milliequivalent of HCO-3 releases 22.4 ml of CO2. Hydrogen ions can be endogenously derived from gastric hydrochloric acid or exogenously from fatty acids released during fat digestion, which sometimes corresponds to hundreds of milliequivalents of hydrogen ions. Theoretically, up to 4 liters of CO2 can be released into the duodenum after a meal. Acidic products released by bacterial fermentation of unabsorbed carbohydrates in the colon may also react with HCO-3 to produce CO2. Although bloating occasionally occurs, CO2 is rapidly absorbed into the blood, preventing unbearable intestinal gas. The direction of gas diffusion between the intestinal lumen and the blood depends on the partial pressure difference between the two. The production of H2, CH4, and CO2 reduces the partial pressure of nitrogen in the intestinal lumen, making it much lower than in the blood, which explains the presence of more nitrogen in the lumen. Gas can enter the blood from the intestinal lumen through belching and ultimately be expelled from the lungs through bacterial metabolism at the anus (flatulence). Belching (associated with conditions such as gastritis, gastric and duodenal ulcers, gastric ptosis, gastric neurosis, neurotic belching, and duodenitis) refers to the upward reversal of turbid gas from the stomach, passing through the esophagus and escaping from the mouth with a deep, prolonged sound, unlike the short, sharp sound of hiccups. It is often caused by weakness of the spleen and stomach or food stagnation leading to poor digestion and the upward reversal of turbid gas. It is also known as "ai" or "ai qi," and Zhang Jingyue called it "satisfied breath." Internal treatment for belching with spleen and stomach deficiency type [Etiology] It is often caused by constitutional weakness or imbalance after illness, leading to spleen and stomach qi deficiency and abnormal transportation, resulting in disharmony of stomach qi. [Symptoms] The characteristic features are intermittent belching with low-pitched sounds and poor appetite. Accompanied by pale or yellow complexion, vomiting of clear water, fatigue, pale tongue with thin white coating, and weak pulse. [Treatment] Tonify the spleen and stomach. [Main prescription] Jianpi Wan (modifications available) (Request this prescription) Liver and stomach disharmony type belching [Etiology] It is caused by worry, anger, liver qi stagnation, transverse invasion of the stomach, and upward reversal of stomach qi. [Symptoms] The characteristic features are frequent belching with loud sounds, discomfort in the chest and flanks, and mild pain in the costal margins. Accompanied by abdominal distension, nausea, depression, often triggered or worsened by emotional stress, thin white coating on the tongue, and wiry pulse. [Treatment] Soothe the liver, regulate qi, and harmonize the stomach. [Main prescription] Chaihu Shugan San (modifications available) (Request this prescription) Food stagnation type belching [Etiology] It is often caused by irregular diet, food stagnation in the stomach, obstruction of middle-jiao qi, and upward reversal of stomach qi. [Symptoms] The characteristic features are frequent belching with muffled, sour, and foul-smelling sounds. Accompanied by fullness in the chest and abdomen, poor appetite, foul-smelling stools, thick greasy coating on the tongue, and slippery and substantial pulse. [Treatment] Tonify the spleen and stomach, and resolve food stagnation. [Main prescription] Baohe Wan (modifications available) (Request this prescription) Phlegm-heat internal accumulation type belching [Etiology] It is caused by spleen deficiency and inability to transport water-dampness, leading to phlegm accumulation and internal heat accumulation. [Symptoms] The characteristic features are frequent loud belching with coughing up thick phlegm. Accompanied by thirst, nausea, bitter and dry mouth, or constipation, or short and dark urine, red tongue with yellow greasy coating, and rapid slippery pulse. [Treatment] Clear heat, resolve phlegm, harmonize the stomach, and regulate qi. [Main prescription] Wen Dan Tang (additions available) (Request this prescription) Experience of famous practitioners The theory of Qin Bohui Belching is common in patients with stomach diseases and weak spleen and stomach. Middle-jiao qi stagnation, chest and diaphragm fullness, and relief after belching are generally not treated as primary symptoms, but can be included in the prescription.