Belching, bloating, and flatulence: pitfalls and challenges in evaluating and managing symptoms of intestinal gas and how to avoid them.

Introduction: Belching, bloating, and flatulence are common complaints that significantly affect quality of life. Although these often arise from benign functional disorders, their underlying mechanisms are multifactorial, involving disordered motility, visceral hypersensitivity, and psychological influences.

Areas covered: A selective literature search was conducted across electronic databases (PubMed, MEDLINE, Embase, and Cochrane Library) to identify relevant publications on intestinal gas related symptoms. Randomized controlled trials, meta-analyses, systematic reviews, evidence-based clinical practice guidelines and selected expert consensus statements and narrative reviews were included.This narrative review highlights common diagnostic and therapeutic pitfalls in managing gas-related symptoms, including failure to recognize alarm features, misclassifying symptoms, excessive investigations, and inappropriate treatment choices. It discusses intestinal gas's physiological basis, challenges distinguishing pathological from normal symptoms, and provides a framework for evidence-based evaluation and treatment.

Expert opinion: Effective management requires a structured, individualized approach incorporating thorough clinical assessment, dietary evaluation, psychological screening, and judicious use of noninvasive tests. Neglect of psychosocial contributors often lead to suboptimal care. Personalised strategies such as breath testing, low FODMAP diet, microbiota-targeted therapies, and cognitive-behavioral interventions can improve outcomes. Enhancing clinician education and fostering interdisciplinary collaboration is essential to bridging the gap between current evidence and clinical practice.