Flatulence and Burping

Flatulence (commonly known as farting) and burping are common phenomena associated with excessive gas in the gastrointestinal (GI) tract, and are natural bodily processes that help expel the excess gas. This gas could accumulate from swallowed air during eating or drinking, or when certain foods are broken down in the intestines.

Although flatulence and burping are completely normal, healthy functions, it may be a cause for concern when persistent or accompanied by other concerning symptoms. This could be a sign of underlying conditions, such as acid reflux (GERD), food intolerances or imbalances of the gut. 

What causes flatulence and burping?

Both flatulence and burping are caused by an excess of gas in the digestive system. The reasons for excess gas varies, such as:

Swallowed air (Aerophagia) 

Swallowed air typically enters the body when eating or drinking, although some of this air can be expelled through burping or farting. This may happen when we:

• Eat or drink too fast
• Chew gum
• Drink carbonated beverages
• Use straws 
• Smoke

High-fibre, high-fat or processed foods 

Consuming foods high in fibre, fat, or processed foods can cause more gas in the stomach and intestines. Some examples include:

• Beans, legumes, cruciferous vegetables, and whole grains – These foods are high in fibre, which are fermented in the large intestine by bacteria, producing flatulence.
  
• Fruits – Fruits are also high in fibre and in natural sugars which the body may not fully digest. These undigested sugars are then fermented by gut bacteria to produce gas.
  
• Carbonated drinks – Carbonated drinks can increase burping. Additionally, added sugars or artificial sweeteners in these beverages are also fermented by bacteria in the large intestine.
  
• Heavy cream or whole milk – Lactose intolerant people may experience gastrointestinal gas from dairy products as their body is unable to digest lactose.
  
• Fried and greasy foods – Although dietary fats do not contribute much to gastrointestinal gas, a high-fat meal can slow down digestion and gastric emptying, this can lead to bloating and discomfort. Gas from other sources may also be trapped.

What are the risk factors for flatulence and burping?

Certain factors that can contribute to excessive gas in the gastrointestinal tract include:

• Dietary fibres – Foods rich in fibre such as vegetables, grains, and legumes are known to contribute to increased flatulence.
  
• Artificial sweeteners, caffeine, or carbonated drinks – Artificial sweeteners in foods such as xylitol, sorbitol, and mannitol are commonly made from carbohydrate sources which may not be fully digested by the human body, this leads to increased intestinal gases [2]. Caffeine and carbonated drinks are known to lead to burping.
  
• Eating or drinking habits – Eating or drinking too fast can lead to the increased swallowed air, which contributes to burping.
  
• Food intolerances – Food intolerances such as lactose intolerance or gluten intolerance can lead to increase in flatulence. This is likely due to the body not absorbing these substances, leading to bacterial fermentation and gas production [1].
  
• Medical conditions – In some cases, certain underlying medical conditions may lead to increased gases such as intestinal obstruction diseases, intestinal bacterial overgrowth, irritable bowel syndrome, and dyspepsia [4].

When is flatulence and burping a concern?

Flatulence and burping are completely normal. However, frequent flatulence, burping, and GI gas accompanied by other symptoms that may indicate an underlying digestive issue. You should visit your doctor if you notice the following symptoms accompanying frequent flatulence and burping:

• Changes in bowel movement, diarrhoea or constipation
• Changes in stool consistency
• Difficulty passing motion
• Bloody stools
• Bloating 
• Abdominal pain
• Heartburn
• Chest pain
• An abdominal mass
• Dysphagia (difficulty swallowing)
• Nausea and vomiting
• Unintentional weight loss

What digestive disorders could excessive flatulence and burping mean?

Certain digestive issues may also increase the likelihood of gas production in the gastrointestinal tract.

• Gastroesophageal reflux disease (GERD) – GERD increases trapped gas in the stomach due to increased swallowing, this leads to more frequent burping.
  
• Irritable bowel syndrome (IBS) – People with IBS often experience a variety of gastrointestinal symptoms including abdominal pain, bloating, changes in bowel movement, as well as flatulence. 

• Lactose intolerance – Lactose intolerance refers to the inability of the body to digest lactose, these sugars end up in the large intestine where bacterial fermentation leads to increased flatulence.
  
• Coeliac disease – In Coeliac disease, poor absorption of carbohydrates lead to increased undigested food in the intestine, which increases flatulence [6].
  
• Small intestinal bacterial overgrowth (SIBO) – Bacterial overgrowth in the intestine can lead to an increase in gas production from fermentation.

How can I reduce flatulence and burping?

Reducing gas can be done by the following:

• Eat and drink slowly to avoid swallowing too much air
• Avoid spicy or fatty foods, as well as too much caffeine, alcohol, and carbonated drinks
• Know what foods trigger your flatulence, and regulate your diet accordingly
• Eat foods rich in probiotics to maintain a healthy gut flora
• Get proper treatment for any underlying GI issues or conditions

How are flatulence and burping diagnosed?

Flatulence and burping may not always be a medical concern. However, tests can be done to rule out other underlying conditions that cause excessive flatulence and burping, such as [3]:

• Physical examination – Physical examination in the doctor’s office typically involves taking your symptoms, medical, and family history. Your doctor may also palpate parts of your abdomen to look for signs of bloating or abdominal distention.

• OGD (oesophago-gastro-duodenoscopy) — An OGD involves inserting an endoscope to examine the upper digestive tract. The endoscope travels through the oesophagus, to the stomach, and the duodenum, or first part of the small intestine. OGD allows your doctor to look for upper gastrointestinal issues or lesions.
  
• Colonoscopy – A colonoscopy is similar to an OGD. In a colonoscopy, the probe is inserted from the anus and into the colon, or large intestine.
  
• Blood tests – A blood test may not be necessary for diagnosis of flatulence and burping conditions, but can be used to look for underlying diseases such as Celiac’s disease or irritable bowel syndrome.

How are flatulence and burping treated?

Treatment largely depends on what’s causing your excessive flatulence and burping. In many cases, lifestyle changes can effectively manage your symptoms. However, other medical conditions, such as lactose intolerance, may require other treatment modalities, such as medication or targeted therapies. 

• Dietary changes – Changes to your diet and dietary habits can significantly improve GI gas symptoms and bloating. Being mindful of how fast you eat can reduce the amount of air swallowed. High-fibre foods, although beneficial for your health, can cause flatulence and burping, hence regulating your intake, or finding which foods work best for you can help you manage your symptoms.
  
• Alpha-galactosidase – Enzyme preparations such as alpha-galactosidase can reduce flatulence by reducing gas production after a carbohydrate-rich meal [5]. You can take these enzyme preparations before eating a meal which normally gives you gas.
  
• Lactase – Lactase supplements can be beneficial for those with lactose intolerance in reducing gas and flatulence.
  
• Antibiotics – In cases of gut bacteria overgrowth, antibiotics can be used to reduce the number of intestinal bacteria [4]. However, it is important to follow your doctor’s instructions when taking antibiotics.

Summary

Flatulence and burping are normal, healthy processes of the body and are not typical causes for concern. However, in certain cases, excessive GI gas can be the result of underlying medical conditions which require more serious medical interventions. 

No issue is too small. Schedule a consultation with Dr Aaron Poh today for a detailed diagnosis and personalised treatment plan. 

Frequently Asked Questions

How much flatulence is normal?

Flatulence between 14 to 25 times a day is normal for healthy people. You may also notice that you pass gas more often after eating certain types of food, or during menstruation.

How to stop burping?

Burping allows you to release gas from your stomach, you may stop burping if you release this gas. Common methods to try include doing light movements or exercises, knee-to-chest position while lying on your side, medications such as antacid, or ginger tea. Additionally, you may want to eat or drink slower in the future. 

Is burping a sign of acid reflux?

Burping can be a sign of acid reflux or gastroesophageal reflux disease (GERD). GERD also commonly presents other symptoms such as heartburn, chest pains, nausea, and a sour taste at the back of your mouth. If you experience these symptoms as well, a visit to your healthcare provider is highly recommended.

Is flatulence and burping a sign of an unhealthy digestive system?

Excessive gastrointestinal gas on its own may not be a sign of digestive disorders. More likely it is caused by your diet. However, if your flatulence and burping are accompanied with other digestive symptoms such as abdominal pain, constipation, diarrhoea, or bloating, it may be a sign of an underlying digestive disorder. Visiting a healthcare provider can help you identify possible causes of your gastrointestinal discomfort and treat it accordingly.

References

1. Kurbel S, Kurbel B, Vcev A. Intestinal gases and flatulence: possible causes of occurrence. Med Hypotheses. 2006;67(2):235-9. doi: 10.1016/j.mehy.2006.01.057. Epub 2006 Mar 29. PMID: 16574342.
2. Mutuyemungu E, Singh M, Liu S, Rose DJ. Intestinal gas production by the gut microbiota: A review. J. Funct. Foods. 2023;100:105367. doi: 10.1016/j.jff.2022.105367.
3. Wilkinson JM, Cozine EW, Loftus CG. Gas, Bloating, and Belching: Approach to Evaluation and Management. Am Fam Physician. 2019 Mar 1;99(5):301-309. PMID: 30811160.
4. Hasler WL. Gas and Bloating. Gastroenterol Hepatol (N Y). 2006 Sep;2(9):654-662. PMID: 28316536; PMCID: PMC5350578.
5. Di Stefano M, Miceli E, Gotti S, Missanelli A, Mazzocchi S, Corazza GR. The effect of oral alpha-galactosidase on intestinal gas production and gas-related symptoms. Dig Dis Sci. 2007 Jan;52(1):78-83. doi: 10.1007/s10620-006-9296-9. Epub 2006 Dec 7. PMID: 17151807.
6. Masoodi M, Mokhtare M, Agah S, Sina M, Soltani-Kermanshahi M. Frequency of Celiac Disease in Patients With Increased Intestinal Gas (Flatulence). Glob J Health Sci. 2015 Oct 26;8(6):147-53. doi: 10.5539/gjhs.v8n6p147. PMID: 26755470; PMCID: PMC4954875.