Bloating
Bloating is a sensation of abdominal fullness or gas, evaluated per the 2023 AGA Clinical Practice Update on Bloating and Distention.
Symptoms
A subjective sensation of abdominal fullness or pressure, sometimes accompanied by visible distention, often worsening over the course of the day.
Causes and risk
Common causes include IBS, functional bloating, carbohydrate malabsorption, constipation, and small intestinal bacterial overgrowth (SIBO); in most cases bloating is a benign, functional symptom.
How it is evaluated
Per the AGA, bloating without alarm features rarely requires imaging or endoscopy. In women, a specific symptom cluster -- bloating, increased abdominal size, early satiety, and urinary urgency, occurring more than 12 times a month for less than a year -- is the recognized ovarian cancer warning pattern per ACOG guidance, especially in women 50 and older; CA-125 is not a screening test and is used only for symptomatic evaluation.
Treatment
Treatment is cause-directed and stepwise -- addressing constipation, trialing a low-FODMAP diet, or testing for and treating SIBO where appropriate, rather than one universal fix.
When to seek care
In women, persistent bloating alongside increased abdominal size, early satiety, or urinary urgency occurring frequently for a sustained period should prompt prompt evaluation for ovarian cancer, particularly at age 50 or older. Bloating with alarm features (bleeding, weight loss, anemia) also warrants evaluation.