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Gut microbiota and metabolic alterations in participants with flatulence identify Faecalibacterium prausnitzii as a key microbial target for clinical intervention.

Flatulence is closely associated with gut dysbiosis, yet the characteristic microbial signatures, metabolic alterations, and actionable intervention targets remain unclear. This limited mechanistic understanding has hindered the development of precise microbiota-based strategies for managing flatulence. Here, we found that participants with flatulence exhibited marked shifts in gut microbial functions and fecal metabolic profiles compared with healthy controls, characterized by enhanced abnormal fermentation, enrichment of oxidative stress-related functions, elevated low-grade inflammatory signatures, and reduced anti-inflammatory and mucosal-protective metabolic features. Faecalibacterium prausnitzii was significantly negatively associated with the high-gas-producing phenotype. In vitro replenishment experiments further validated the role of F. prausnitzii in reducing gas production, promoting butyrate generation, and remodeling butyrate-associated microbial communities. Based on microbial interaction analysis, we identified Bifidobacterium longum CCFM1319 as a candidate strain for targeting F. prausnitzii. In a double-blind, randomized, placebo-controlled clinical trial, supplementation with B. longum CCFM1319 significantly increased intestinal F. prausnitzii abundance and improved flatulence-related symptoms. Collectively, these findings reveal the microbiota and metabolic dysbiosis underlying flatulence, highlight the key regulatory role of F. prausnitzii, and lays the foundation for targeted microbiota-based intervention strategies for flatulence.

Humans

Flatulent dyspepsia in patients with gallstones undergoing cholecystectomy.

The incidence of flatulent dyspepsia and its relationship to gallbladder function has been studied in 100 consecutive patients with gallstones undergoing cholecystectomy. Thirty-three per cent of patients suffered significant flatulent dyspepsia of whom 80 per cent were cured or improved by operation. In 15 patients gastric function was studied pre- and postoperatively and it was noted that there was no difference in gastric emptying times between patients with flatulent dyspepsia who were cured by operation and those who remained symptomatic. Bacteriological studies on gallbladder bile from 39 patients suggested that infection within the gallbladder may be a factor in the causation of flatulent dyspepsia.

Adolescent

Follow-up of a flatulent patient.

This paper describes a low-flatulence diet developed by an extremely flatulent patient. Based on meticulous recording of each passage of flatus, the patient employed an elimination diet to determine what foods were responsible for his gas production. The diet reduced the frequency of his gas passage from 34 +/- 7 to 17 +/- 5 times per day (normal: 14 +/- 6) and similar reductions were observed by two other flatulent patients during adherence to the diet. The rectal gas of each of these subjects largely consisted of two gases (CO2 and H2) which result from bacterial fermentation of carbohydrates. The diet, which is low in lactose and wheat products, presumably minimizes the quantity of carbohydrates delivered to the colonic bacteria.

Adult

Comparative flatulence activity of beans and bean fractions for man and the rat.

To evaluate H2 production in the rat after ingestion of legume products as a predictive bioassay of their flatulence activity for man, responses of man and the rat to (1) a bland formula diet, (2) cooked California Small White bean (CSW) solids, (3) 70% ethanol extract of (2), (4) oligosaccharide fraction of (3), (5) non-protein nitrogen fraction of (3), and (6) combination of (4) and (5) were compared. Six human subjects were fed an 800 kcal breakfast of (1) or containing the amount of a test item equivalent to 100 g CSW. Each subject received all items once plus a single replicate of three items at the rate of one per week in random order. Total flatus volume, H2, CO2, and CH4 volumes and breath H2 concentration were measured for the interval 2.5 to 8.5 hours after breakfast. Young rats in metabolic chambers received known amounts of items 2 to 6 mixed with a bland basal diet. H2 trapped in the chambers was measured after 20 hours. Correlation of rat H2 and to human breath H2 measurements and flatus gas volumes were significant and positive except for negative correlation with flatus methane volume. Measurement of hydrogen production in the rat has potential for a predictive bioassay for flatulence in man.

Adult

Flatulent dyspepsia: a tiered symptom complex?

The symptom complex of flatulent dyspepsia is ill-defined but is made up of at least nine individual symptoms. The relationship between these symptoms is not known and thier change after cholecystectomy in gall-stone patients is unpredictable; they disappear completely in less than half the patients. We studied the symptoms in one hundred and thirty nine patients, using various computer programmes to see if the changes after operation could be predicted and if some of the symptoms were linked or formed "clusters". The results did not show any standard relationship between the symptoms. We have therefore, proposed the hypothesis of a tiered symptom complex to explain these observations. They could be produced by a motility disorder affecting different parts of the gastro-intestinal tract to a varying degree.

Cholecystectomy

Intestinal gas.

Patients with functional bowel disease commonly complain of abdominal pain, bloating, and excessive flatulence and eructation. Pain and bloating may be primarily caused by abnormal intestinal motility rather than by excessive intestinal gas. As yet there are no data available that prove excessive flatulence is actually caused by the presence of excessive intestinal gas. A study of the composition of intestinal gas provides insight into whether it is derived from swallowed air or from intraluminal metabolism. Therapy aims primarily at excluding the presence of organic disease as a cause and reassuring the patient that the disorder is functional in nature. Dietary manipulation, changing the habit of aerophagia, exercise, and pressure and heat applied to be abdominal area are all possibilities to be tried.

Aerophagy

[Functional disorders of the gastrointestinal tract (author's transl)].

Functional disroders are the most important cause for complaints in the gastrointestinal tract. Dysfunction may concern one or more physiologic properties like tonus, motility, secretion, sometimes also resorption and digestion, or their interaction. Functional disorders of the esophagus (esophagospasm and achalasia) become manifest as dysphagia. Halitosis, bad taste, burning tongue, and flatulent abdomen are frequent symptoms of functional disorders of the gastrointestinal tract. Irritable bowel syndrome is probably the functional disorder most freqently found in the gastrointestinal tract. Characteristic symptoms are pain in the lower and upper middle abdominal region, obstipation and/or diarrhea, flatulent abdomen, mucous discharge with the stools and urgent defecation with cramps relieved after discharge. Prognosis quoad vitam is good, the course, however, is subject to many changes. Therapie is symptomatic. Diagnostic and psychotherapeutic measures are intended to help remove carcinophobia and to overcome conflicts and fears.

Adult

The clinical significance of gallstones and their radiological investigation.

The symptoms of 122 patients with gallstones were correlated with the radiological findings. No specific indigestion was present which could be termed 'flatulent dyspepsia'. Sensitivity to fatty foods occurred in 69 per cent, heartburn in 42 per cent, regurgitation of of acidtasting or bitter fluid to the mouth in 31 per cent and increased passage of flatus from the stomach upwards in 38 per cent. If the gallbladder concentrated contrast medium or an oral cholecystogram but did not contract after a fatty meal, the patients suffered less heartburn than if the gall bladder functioned normally. However, since surgeons rarely perform a cholecystectomy for flatulent dyspepsia alone, knowlege of gallbladder function may be unnecessary.

Adult

Lactose intolerance among Mexican Americans.

Thirty-three Mexican Americans between the ages of 9 and 60 were interviewed and tested for lactose intolerance. The participants of the study included 16 children and 17 persons not related by birth, including the parents of the children. Determination of lactose intolerance was based on a rise of less than 25mg/100 ml of blood glucose as measured by an Ames Dextrostix/Reflectance Meter following consumption of a lactose load. Forty-seven percent of the 17 nonrelated Mexican Americans were lactose intolerant. There was a marked relationship between low rise in blood glucose and symptoms of diarrhea, flatulence, and distention. Sixteen children from four families had an incidence of 50 per cent intolerance. The findings of intolerance in two successive generations of three families and in both sexes of the families adds support to the contention that lactose intolerance has a genetic basis, without sex predilection.

Adolescent

Polypoid lesions of the acalculous gallbladder.

The controversy about gallbladder polyps has centered chiefly around their potential for malignancy. Among 3,525 cholecystectomies done over a 25-year period, there were 26 cases of carcinoma with only 9% not associated with stones. Thirty-nine cases of polypoid lesions of the acalculous gallbladder were investigated. The classic symptoms of pain, flatulence, food intolerance, and nausea were present in the great majority of cases. Most patients, especially those with symptoms of short duration, reported improvement following cholecystectomy.

Cholecystectomy

Ultrasonic diagnosis of the retroperitoneal space.

A precondition for ultrasonic diagnosis of the retroperitoneum is an optimal preparation of the patient to eliminate flatulence in the intestines. If the large vessels of the retroperitoneum are well demarcated, the optimal examination conditions are present. Tumorous and cystic changes of 2 cm or more, can be visualized. Difficulties, however, in the coordination and the differentiation of retroperitoneal tumors from organic tumors (pancreatic tail, splenic and gynecological tumors) can arise. Tumor changes in the lymphatic nodes, the adrenal gland and the sympathetic trunk, tumors in the retroperitoneum from other causes, and aortic aneurysms are discussed.

Adrenal Gland Neoplasms

Safety profile of acarbose, an alpha-glucosidase inhibitor.

Acarbose, an alpha-glucosidase inhibitor, delays absorption of carbohydrate in the gut, thereby lowering postprandial glucose levels. Safety data on this drug have been gathered in a series of studies on animals and in extensive clinical trials in humans. Although an initial long term feeding study in rats showed an excess of renal tumours at very high dosages of acarbose (up to 300 mg/kg bodyweight daily), further evaluation with similar studies in rats, hamsters, and dogs indicated that the problem was related to carbohydrate malabsorption. With adequate glucose intake and in gavage studies, no difference in tumour incidence between placebo- and acarbose-treated groups was seen. From 1976 to 1989, safety data on acarbose were obtained in approximately 8800 patients in 2 separate groups of clinical trials, the Bayer International Clinical Data Pool and the American phase III trials. Almost all adverse experiences, as reported by 56 to 76% of patients on acarbose vs 32 to 37% of patients on placebo, were related to the digestive system and included diarrhoea, flatulence, bloating and nausea. Most symptoms were of mild to moderate intensity and tended to improve with time. In the American trials a small but significant increase in liver transaminases was seen, 3.8% in acarbose-treated patients vs 0.9% in controls together with a 1% increase in anaemia in the acarbose group. Overall, acarbose was well tolerated and the adverse experience profile was clinically acceptable.

Acarbose