Aerophagy in small amounts occurs normally during
food and drink. With each act of swallowing air into the stomach, the number of
air varies in different people, but the average is about 2-3 ml. Some
ingest an excessive amount of air is due to the peculiarities of food
behavior. Fast food with insufficient chewing, swallowing large chunks of food
lead to an increase in the volume of gastric gas bubble. More
swallowing air, patients have the habit of smoking and talking while
meal. Frequent swallowing movements peculiar to patients with chronic pathology
nasopharynx, with excessive salivation that occurs at different
lesions of the gastrointestinal tract (such as peptic ulcer), bad
dentures, nausea of various etiologies. Most of the swallowed air
subsequently removed by a spit-up, part falls into the intestine.

Gassing in the lumen of the intestine is different
ways. As a result of bacterial metabolism
allocated significant amounts of hydrogen (H2), methane (CH4), carbon dioxide (CO2), hydrogen sulfide (H2S), ammonia
(NH3). Normally, the upper section of the small intestine is practically sterile, in the distal intestine
number of bacteria increases. Particularly sharply (104 - 105
times) increases the population of bacteria outside the ileocecal valve, where it is
1011-1012 against 106/ml chyme in the ileum.
Consequently, the most significant amounts of gas as a result of
bacterial hydrolysis of food ingredients produced in the colon.

Almost all the hydrogen produced during processing by anaerobic bacteria
fermentable substances (carbohydrates, amino acids). Producers of hydrogen
are bacteria such as Bacteroides clostridiformis, Fusobacterium
necrophoasm, Escherichia coli, Citrobacter spp., Enterobacter spp., And others.
Many of hydrogen released after eating certain fasits and vegetables
(such as beans, cabbage), containing poorly digestible carbohydrates, as well as
malabsorption syndrome of various etiologies (disaccharidase deficiency,
celiac disease, exocrine pancreatic insufficiency syndrome
increased bacterial contamination of the small intestine).

Methane is formed during fermentation, obligately anaerobic bacteria
(Methanobrevibacter smithii, Methanospaere stadmamiae) endogenous substances in the
colon; food intake only slightly affects the rate of its formation.
Approximately 1 / 3 of the adult population formed a fairly large number of
CH4, so the density of faeces was less than 1.0, and they float to the surface of the water
. In people with diverticulosis of the colon, the methane content in
gas emissions increased.

Carbon dioxide can be produced during the bacterial metabolism
, butmoreimportantly it is a source of interaction
bicarbonate and hydrogen ions. Thus, in the upper small intestine is
formation of CO2 from the reaction between the ions HCO3-secreted
pancreas, intestine and liver, and ions of H + excreted in
gastric juice, and cleaved from the fatty acid foods. Theoretically, after
meal in the duodenum may be freed up to 4 liters of carbon dioxide
, but much of it is reabsorbed in the small intestine. CO2 in the
gas that accumulates in the colon, is formed to a greater extent in
the enzymatic action of intestinal bacteria on organic matter,
not suck in the small intestine. These substances are mainly
plant fiber and other plant parts containing carbohydrates,
are not hydrolyzed by amylase (cellulose, hemicellulose, pectin, lignin).

Ammonia is formed in the colon due to microbial degradation
urea or amino acids. Under the influence of intestinal microorganisms from
hydrolytic processes in ammonia is converted to 30% of urea produced in the liver
. Active producer of ammonia is Bacteroides fragilis.

Hydrogen sulfide released mainly by microbial transformation of sulfur-containing amino acids
anaerobic bacteria.

Another source of gas in the lumen of the intestine is their diffusion from
plasma. The direction of diffusion is determined by the relative partial pressure
gas in the plasma and the lumen of the intestine. In plasma, the nitrogen pressure - 600 mm Hg. Art.,
oxygen - 50 mm Hg. Art. and carbon dioxide (fasting, when low maintenance
HCO3-and H 2 +) higher than in the lumen of the gut, so gases diffuse into the gut.
Diffusion of N2 is 1-2 ml / min., and the volume diffusion of O2 and CO2 are small because
low partial pressure of these gases in the plasma.

In physiological conditions is well absorbed carbon dioxide,
less oxygen is absorbed acidophilic intestinal bacteria. Methane and hydrogen
partially absorbed and isolated lungs. Nitrogen and hydrogen sulfide is not absorbed and
allocated through the rectum.

Odors emissions from the intestine gases associated with the presence of trace amounts of
such aromatic compounds as indole, skatole,
hydrogen sulfide and mercaptan produced in the colon as a result of exposure
intestinal microflora in the small intestine undigested organic compounds
.

Normally in gastrointestinal tract contains on average about
200 ml of gas. In healthy people daily through the rectum is allocated about 600
ml of gas (from 200 to 2000 ml), and they come in the form of approximately 15 servings of
40 ml each, although there are significant individual differences.

Usually a gas mixture intestine consists of 99% nitrogen,
oxygen, carbon dioxide, hydrogen and methane. The relative proportions of these gases
strongly fluctuate depending on the individual rights and
origin of the gas mixture. According to different authors, the composition of intestinal gas
follows: nitrogen - 70-86%, -0-12% of oxygen, carbon dioxide - 12.6%, hydrogen - 1-10%,
methane - 0,1 -2%, hydrogen sulfide - 0-10%.

If any relationship between the formation of gas in the intestines,
removals and removal of conditions arise for the excessive accumulation of gases in the
gastrointestinal tract. But in the liquid contents of the intestine
solutions of various organic substances with properties of blowing agents: proteins, fats, bile
acid mucopolysaccharides, slime, soap. The free energy of these substances and forces
surface tension acting on the boundary of two media (gas - liquid),
contribute to the formation of stasctures with minimal surface, providing
stability. Such a minimum condition of the surface and meets the spherical
form of droplets in the system "liquid into a gas (water droplets in the intestinal gas mixture)
or gas bubbles in a liquid medium.

Whatmoredisturbed the normal processes of digestion and absorption of food ingredients
, the greater the formation of intestinal gas and
facilitate the conditions for the formation of stable gas-foam. This slimy foam
covers a thin layer of surface mucosa, which in turn
turn, complicates the cavitary and membrane digestion, absorption violates
nutrient resorption and removal of gases through the anus.

Depending on the etiology and pathogenesis
conditionally possible to allocate the following types of flatulence: nutritional, digestive, dysbiotic,
mechanical, dynamic, circulatory, psychogenic, high altitude (Fig. 1).
most important in the development of excessive gassing are violations
cavitary processes or membrane digestion (digestive flatulence) that
observed in patients with gastritis, duodenitis, pancreatitis, cholecystitis,
disaccharidase deficiency, celiac disease. Usually act simultaneously
several mechanisms responsible for the development of flatulence. In connection with this
for selection of adequate therapy is important to the selection of the driving member.

Excessive gas can cause pain and bloating,
belching, increased volume and bad emitted gases.
Involuntary emission of gases often leads to psychological discomfort, the appearance
neuroses.

treatment builds on the underlying disease and includes:

1) correction of the diet;

2) the treatment of diseases caused by flatulence;

3) restoration of gut microbiota;

4) remove accumulated gases from the lumen of the intestine with the use of prokinetic
, adsorbents, defoamers.

begin treatment of the patient suffering from flatulence, you need to
organization of nutrition, which builds on the basic
disease. Apart from the aforementioned legumes and foods containing casde fiber
(cabbage, spinach, sorrel, grapes, apples, gooseberries, raspberries, figs
, etc.) from the diet should exclude the use of highly carbonated beverages,
products causing fermentation reaction (brew young beer, black bread,
raisins). The patient should be warned that chewing gum craze,
smoking, taking copious protein foods, especially indigestible (pork,
lamb, goose) can lead to increased flatulence. Fasits and Vegetables
appointed in raw and cooked, are particularly indicated mashed carrots and beets.
recommended intake of dairy products, casmbly porridge made of buckwheat and millet
cereals. Meat should be boiled or baked, preferably a piece. Bread
preferred wheat wholemeal or with the addition of wheat bran
. It is important to observe the correct diet. Food should be taken 5 times
a day, breakfast should be quite voluminous, contain food from cereal crops
.

Violations of quantitative and qualitative composition of the intestinal
microflora may be important in the emergence of flatulence. Art
doctor is to adequately assess the role of dysbiosis in the development of
disease. Correction of dysbiosis (appointment of intestinal antiseptics, pro-and prebiotics
) should be carried out when his relationship with clinical manifestations of disease
established objective methods of investigation or she is supposed to
circumstantial evidence.

great importance in the treatment of flatulence is attached to the normalization
motility. Some patients with dyspepsia and a sense of over-the top
abdomen, occurs immediately after a meal helps to metoclopramide (10 mg
for 30 min. To food), which increases the rate of gastric emptying and increases the tone of the lower
esophageal sphincter.

dasgs of choice, which rapidly increased cropped
flatulence and facilitate the removal of gas from the intestines are adsorbents and
defoamers.

However, the use of adsorbents are often amplified or
appear constipation, and from the intestinal lumen, together with the gases are removed microorganisms,
minerals, vitamins, lack of which subsequently have to compensate
.

fundamentally new way to combat flatulence is
medication simethicone (Espumizan ®, "Berlin-Chemie), which is a high molecular polymer
dimethylsiloxane synthesized on silicon-based
with the addition of 4-7% silicon dioxide. He has the ability to reduce
surface tension (surface energy) at the interface
liquid-gas, which leads to "pull" fluid from the shell and bladder damage
liquid membrane. In this case coalesce - merge
gas bubbles and the destasction of the foam, resulting in free gas gets
opportunity absorbed through the mucous membranes or to evacuate along with
intestinal contents. Thus, the effect of simethicone is based on the change
physicochemical properties of gassy foam rather than a physiological effect
biochemistry of digestion.

Studies conducted by different authors showed that
simethicone is resistant to oxidizing agents, has oleo-, lipo-and hydrophobic
properties is not sensitive to any micro-organisms, is not absorbed in
gastrointestinal tract, excreted unchanged in and does not interfere in
biochemical processes of digestion. However, due to the effect defoaming
and reduce the gas content in the intestine, it indirectly affects the normalization
cavitary and membrane digestion, absorption of nutrients. Espumizan
can assign the long term. Form release: capsules 40 mg (pack of 50 and 100
pieces), an emulsion of 40 mg per 5 ml (100 ml vial).

indications for simethicone can be treated any
pathology associated with excessive flatulence. Figure 2 shows
clinical efficacy Espumizan in patients with the syndrome of flatulence
in various diseases of the gastrointestinal tract. (Dynamics syndrome
bloating was assessed on a scale from 0 to 5, depending on its severity.)
The first day of dosing in patients showed a significant decrease in
discomfort and abdominal pain. Espumizan used in capsules (2 capsules 3
times daily after meals).

Appointment simethicone in patients with gastroesophageal reflux (GER)
leads to a significant improvement state at a joint application with
antacids. In a comparative study of patients with GER were divided into two
groups: group A received simethicone and antacids, Group B - alginates and antacids.
In both groups there was a significant improvement, but after
8-week course of treatment histological features were much better
patients of group A (Barbara Cabaska, Jadwiga Prokopczyk).

Antigazoobrazuyuschee action simethicone can be used to
prepare patients for abdominal ultrasound, endoscopy
upper gastrointestinal tract, colonoscopy.

In 1992, Bertoni held a double-blind, randomized study of the efficacy
destination simethicone before endoscopy for
provide better visualization of esophagus, stomach and duodenum
. The author concludes that the use of Espumizan
reduces the duration of the procedure (about 50%), which is especially
important for elderly patients with severe concomitant diseases, and
leads to a twentyfold reduction in the volume of fluid removed. Bertoni
recommends the use of simethicone prior to endoscopy in all patients with resected stomach
.

number of authors (Major Peter, Lazorini, Klark Vildgasb, Layer) was
proved that the use of simethicone before the kolonoskospii
has definitely a positive impact, because it allows to reduce the number
gas in the colon, which facilitates the interpretation of data obtained through
clearer visualization kolonoskopicheskoy paintings.

recommended dosage?? To prepare a diagnostic study
: 3 x 2 capsules (or 3 times with 10 ml of emulsion), the day before
survey, take 2 capsules (10 ml emulsion) on the morning of the study.
to improve a double contrast image of the stomach 20 ml of emulsion was added
a barium suspension. In preparation for colonoscopy 60-120 ml simethicone emulsion
injected with cleaning solution.

article was published in the journal
Pharmaceutical Bulletin