Ask a doctor on the topic of Internal medicine

Causes of gas in the stomach?

November 29, 2015 | 42,00 EUR | answered by Dr. med. Frauke Gehring

Dear Sir or Madam,

for unknown reasons, gases are forming in my stomach, leading to a number of unpleasant symptoms. I would like to have a clear diagnosis and examination options for diagnostic confirmation.

+++ Medical History +++
I am male, 32 years old, 180 cm tall and weigh around 87 kg. I do not have any relevant pre-existing conditions or ongoing medication. I exercise regularly: jogging 3-4 times a week (5 to 10 km) and cycling to work 5 times a week (15 km).

In early October, I had a middle ear infection and was prescribed antibiotics (Cefurax 500mg twice daily). A few days after finishing the antibiotic treatment, typical symptoms of a heart attack occurred: shortness of breath, heart palpitations, pain in the left arm. A cardiological examination showed no abnormalities (heart and lungs are normal). The cardiologist suspected chest muscle strain and advised rest. The pain in the left arm disappeared, but frequent belching started. This made me suspect that gases are forming in the stomach for some reason. The belching is not sour and I do not have any stomach pain. My bowel movements are normal. When lying flat in bed, I experienced more symptoms, so now I fall asleep sitting up.

+++ Provisional Diagnosis +++
A gastroenterologist I visited shortly afterwards suspects a reflux disease or inflammation of the stomach lining, but a gastroscopy has not been done yet. I was prescribed Omep 40 mg around 17 days ago (once daily), which has significantly improved my symptoms. However, they have not completely disappeared yet, and the medication will be finished in around 9 days. The gastroenterologist attributes the disease to a stressful lifestyle and late, high-fat meals. While this may be true, it does not apply to my current situation.

+++ Questions +++
Therefore, my questions are:
1.) What could be the cause of my symptoms?
2.) Could the antibiotic treatment be related to this?
3.) What further tests would be recommended for a definite diagnosis?

+++ Questions for Understanding +++
4.) How can inflammation cause belching?
5.) Why do chamomile tea and oatmeal worsen the symptoms? How can this be explained?
6.) Why do the symptoms largely disappear in cold air? Can you explain this?

Thank you and best regards!

Dr. med. Frauke Gehring

Hello,

I would be happy to address your questions:

1.) The most likely cause is indeed gastritis, which causes the stomach to empty slowly. This leads to fermentation and gas formation. The fact that Omep helped (it suppresses acid production and allows gastritis to heal) supports this theory.
2.) Cefurax irritates the stomach and intestines and can worsen a pre-existing gastritis to the point where it becomes symptomatic.
3.) A gastroscopy is the gold standard for diagnosis, but does not need to be performed if you are asymptomatic. However, it should be done if symptoms reoccur. Whether a pH-metry is needed will be determined. It is useful if reflux symptoms persist despite normal mucosa.

For understanding:

4.) An inflamed stomach restricts its motility, as mentioned above. The gases push upwards.
5.) I cannot explain this unless the tea is hot. The inflamed mucosa does not like that. If you have the oatmeal with milk, that may be the cause because it is fatty.
6.) In cold air, movement occurs, and the entire body is activated. Then the stomach may also work more reliably.

Warm regards,
Dr. Höllering