Flatulence (gas) is the condition of having excess gas in the stomach or intestine. It is an uncomfortable condition that causes abdominal distention (bloating). It is usually accompanied by gas coming from the rectum or burping (belching, burping).
Gas has 5 types of primary components. These; nitrogen, hydrogen, carbon dioxide, oxygen and methane are odorless. Most nitrogen gas is taken up through aerophagy. Hydrogen, carbon dioxide and methane make up about 74% of intestinal gases. What gives its characteristic smell is volatile sulfur compounds from trace gases. At the beginning of these sulfur compounds are substances such as hydrogen sulfide (H2S), methyl mercaptan (MM), dimethylsulfide (DMS). They occur mainly by colonic bacterial fermentation of sulfur-containing amino acids. There are studies that show that bismuth and activated charcoal especially reduce intestinal H2S.
Gases with flammable character in flatulans are hydrogen and methane. Methanobrevibacter smithii, one of the methan-producing archaea, is located in the gut microbiota.
Most of the intestinal gas is produced during sleep. Most of these gases are provided by bacteria in the colon. When the indigestible oligosaccharides and oligosaccharide fibers come to the colon, they are subjected to bacterial digestion by the bacteria in the colon, and intestinal gas is produced as a result. However, the gas that occurs in people who follow the same diet differs between people.
Gas production; Apart from diet and fermentation of residual food, it is also altered by the metabolic activity and composition of the colonic microbiota. Colonic bacteria generally lead to the production of Hydrogen and CO2 by playing their way in fermentation. While most of the intestinal bacteria are involved in intestinal gas formation, some of the colonic bacteria reduce intestinal gas formation. Sulfate-reducing bacteria, Acetogenic bacteria and Methanogenic Archea consume the gases produced by fermentation. The frequency of gas evacuation is positively correlated with the increase of 3 bacteria (Bacteriodes uniformis, Bacteriodes Ovatus, Parabacteriodes distasonis). It has been shown that B.ovatus is found at higher levels in flatulence. It has been observed that these 3 members of the Bacteriodes fragilis group produce enterotoxin.
In particular, B. ovatus has been found to be associated with changes in epithelial integrity and systemic antibody response in animal models of chronic intestinal inflammation. Although B.ovatus is a commensal bacterium, it was found to be more antigenic to intestinal tissue in IBD than pathogenic B.vulgatus.
Bilophila wadsworthia is an opportumistic pathogenic bacterium found in various anaerobic infections. It is a saccharolytic bacterium. It is directly related to gas production. It converts nitrate to nitrite. It produces nitrogen and produces hydrogen sulfide from sulfur-containing amino acids. Hydrogen sulfide is a carcinogenic substance. It has strong catalase activity.
Healthy gut microbiota; It has a protective effect against pathogenic bacteria, intestinal parasites and other flatulagenic bacteria such as Candida. Healthy commensal bacteria (probiotics) make up 85% of the intestinal microbiota, and pathogenic microorganisms make up 15%. If this ratio deteriorates in favor of pathobionts, dysbiosis occurs. Intestinal gas is associated with the instability of the intestinal microbiota ecosystem.
Antibiotics are the leading causes of dysbiosis. It takes 1-2 months for the intestinal microbiota to become normal and for commensal bacteria to colonize after antibiotics are taken. Therefore, problems such as intestinal gas (flatulence) and abdominal distention and abdominal cramps occur during this period. Candida overgrowth occurs, especially in the intestine, with taking antibiotics. Candida colonization causes dysbiosis through its toxins. These toxins are especially uric acid, ammonia and acetaldehyde. In cases of chronic candidiasis and Candida overgrowth, symptoms similar to hangover syndrome are observed. Acetaldehyde is a toxic product. In ethanol intake, it is broken down by alcohol dehydrogenase and converted to acetaldehyde. It also occurs as a result of alcohol production by Candida albicans in the case of chronic candidiasis and candida overgrowth.
This causes headache, fatigue, weakness, nausea, anxiety, dyspeptic symptoms and intestinal gas, which we call alcohol hangover syndrome. Alcohol is tried to be detoxified by the liver. Therefore, Candida dysbiosis also increases alcohol production, and as a result of the formation of acetaldehyde, the metabolic product of alcohol, symptoms similar to hangover syndrome occur. This situation has taken its place in the terminology as “gut fermentation syndrome”, not intestinal Candida infection.
Intestinal parasites such as Dientamoeba fragilis, Blastocystis hominis, Giardia also cause intestinal flatulence with cramping. These, like bacteria, produce gas using carbohydrates.
Probiotics increase intestinal gas formation by fermenting prebiotics, which are indigestible oligosaccharides, in the large intestine. At the same time, short-chain fatty acids Propionic acid, Acetic acid, Butyric acid have a protective effect against pathobionts in the colon. The acidity of the colon increases the formation of mucin. Thus, colonization and translocation of pathogenic bacteria is prevented. The harmful effects of intestinal pathobionts are prevented.
