Intestinal gas raymond

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We all have gas, and we let loose about a liter a day.<p> Get the inside story: Everything you’ve been dying to know about ‘air biscuits’- their cause, composition, and cure.<p>
A belch is but a gentle wind <p>That cometh from the heart, <p>But when it takes a downward turn<p> It then becomes a fart.

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Intestinal gas raymond

  1. 1. Intestinal Gas: Charting the course through a perilous miasma Patricia L Raymond MD FACP FACG Rx for Sanity, Chesapeake VA 24 January 2009 1125-1215Debbie Waiz 15th Annual RxForSanity.com Endoscopy Symposium ColonoscopyJoke.com
  2. 2. “If you jog in a jogging suit, lounge in lounging pajamas, and smoke in a smoking jacket, WHY would anyone want to wear a windbreaker??"Debbie Waiz 15th Annual RxForSanity.com Endoscopy Symposium ColonoscopyJoke.com
  3. 3. Farts are fun!Debbie Waiz 15th Annual RxForSanity.com Endoscopy Symposium ColonoscopyJoke.com
  4. 4. Other terms for Gas Poof/poot Fluff My favorites: Cut the cheese  Air biscuit Launch a loaf Rhino stopper  Trouser cough Shot a bunny  Bottom burpDebbie Waiz 15th Annual RxForSanity.com Endoscopy Symposium ColonoscopyJoke.com
  5. 5. Debbie Waiz 15th Annual RxForSanity.com Endoscopy Symposium ColonoscopyJoke.com
  6. 6. The manly art of fart-burning. Compression, ignition, combustion and exhaust. ~Frank Zappa Methane burns in oxygen forming water and carbon dioxide often producing a blue hue CH4 + 2O2 → CO2 + 2H2O Hydrogen sulfide also combusts 2H2S + 3O2 → 2SO2 + 2H2ODebbie Waiz 15th Annual RxForSanity.com Endoscopy Symposium ColonoscopyJoke.com
  7. 7. How long would you need to continuously pass flatus in order to generate methane gas with the energy of an atomic bomb? 6 years and 9 months 12 years and 3 months 25 yearsDebbie Waiz 15th Annual RxForSanity.com Endoscopy Symposium ColonoscopyJoke.com
  8. 8. Flatulence in America’s War on TerrorismDebbie Waiz 15th Annual RxForSanity.com Endoscopy Symposium ColonoscopyJoke.com
  9. 9. Measurement of GasDebbie Waiz 15th Annual RxForSanity.com Endoscopy Symposium ColonoscopyJoke.com
  10. 10. Measurement of Gas Techniques include plethmography, argon washout technique, digitized KUB Average amount only 200 ml, range 115 ml to 1000 ml 14-23 average passage per day (flatus + eructation)Debbie Waiz 15th Annual RxForSanity.com Endoscopy Symposium ColonoscopyJoke.com
  11. 11. Composition of gas  99% nitrogen, oxygen, carbon dioxide, hydrogen, methane  Location, location, location – Stomach: high nitrogen, oxygen (similar to atmosphere) – Colon: less oxygen, more methaneDebbie Waiz 15th Annual RxForSanity.com Endoscopy Symposium ColonoscopyJoke.com
  12. 12. Debbie Waiz 15th Annual RxForSanity.com Endoscopy Symposium ColonoscopyJoke.com
  13. 13. Odor of gas Minor constituents (1%) Sulfur containing compounds, SCFA, volatile amines, ammonia Generally attributed to bacterial metabolismDebbie Waiz 15th Annual RxForSanity.com Endoscopy Symposium ColonoscopyJoke.com
  14. 14. Debbie Waiz 15th Annual RxForSanity.com Endoscopy Symposium ColonoscopyJoke.com
  15. 15. Sources of gas Aerophagia  Rapid eating/drinking  Chewing gum  Carbonated beverages  Smoking or drinking through straw  Poor fitting dentures  Nervous habitDebbie Waiz 15th Annual RxForSanity.com Endoscopy Symposium ColonoscopyJoke.com
  16. 16. Intraluminal production  CO2: from digestion fat, protein in upper SB, bacterial fermentation of malabsorbed foods, or acid + bicarb  H2: mainly from colon, may result from small bowel bacterial overgrowth (bacterial fermentation)  CH4: only from bacterial metabolismDebbie Waiz 15th Annual RxForSanity.com Endoscopy Symposium ColonoscopyJoke.com
  17. 17. Instilled or iatrogenic gasDebbie Waiz 15th Annual RxForSanity.com Endoscopy Symposium ColonoscopyJoke.com
  18. 18. Debbie Waiz 15th Annual RxForSanity.com Endoscopy Symposium ColonoscopyJoke.com
  19. 19. Sounds of intestinal gas  Joseph Pujol, 19th century France  Vibration of anal orifice  Variations – Tightness of sphincter muscle – Velocity of gas – Other (TMI) moisture, body fatDebbie Waiz 15th Annual RxForSanity.com Endoscopy Symposium ColonoscopyJoke.com
  20. 20. Petomaine persists today  Italian movie Il Petomane, contrasting his deep longing for normalcy with the condition of freak to which his act relegated him.  Blazing Saddles (1974) Mel Brooks plays the part of "Governor William J. Le Petomane".  Johnny Depp has mentioned frequently in interviews that he wishes to portray Pujol in a film.Debbie Waiz 15th Annual RxForSanity.com Endoscopy Symposium ColonoscopyJoke.com
  21. 21. Debbie Waiz 15th Annual RxForSanity.com Endoscopy Symposium ColonoscopyJoke.com
  22. 22. Fart In A Jar Sells for $71 on eBay  In 2007 a fart in a jar from a "hot girl" sold for $71 on eBay.  It had 24 bidsDebbie Waiz 15th Annual RxForSanity.com Endoscopy Symposium ColonoscopyJoke.com
  23. 23. Diamonds are forever? Janine Roberts new book "Glitter & Greed: The Secret World of the Diamond Cartel" exposes the unromantic side of diamonds. – Roberts has seen scientists "grow diamonds" using methane and oxygen which she says means diamonds are nothing more than "crystallized farts."Debbie Waiz 15th Annual RxForSanity.com Endoscopy Symposium ColonoscopyJoke.com
  24. 24. Intestinal Gas: Sounds Borborigmi Term for noises generated as gas & fluid travel through the gut A normal sound when rumbling/low, although high pitched suggests PSBODebbie Waiz 15th Annual RxForSanity.com Endoscopy Symposium ColonoscopyJoke.com
  25. 25. Herring Break Wind to Communicate, Study Suggests Ben Wilson, a marine biologist at the Bamfield Marine Science Centre, British Columbia, Canada U.K. science journal Biology Letters, 2003 Atlantic and Pacific herring Fast Repetitive Tick (FRT): high-frequency nocturnal sound bursts up to 22 kilohertz, accompanied by a fine stream of bubbles from the anus.Debbie Waiz 15th Annual RxForSanity.com Endoscopy Symposium ColonoscopyJoke.com
  26. 26. Debbie Waiz 15th Annual RxForSanity.com Endoscopy Symposium ColonoscopyJoke.com
  27. 27. Foods that cause gas: Sugars  Raffinose – Beans – Smaller amounts in cruciferous vegs and grains  Lactose – Milk products & processed foods – Asian, AA, Native American – Lactase drops with aging  Fructose – Also soft drinks, onions, artichokes, wheat  Sorbitol – Fruits, dietetic foods, sugar free foods, gumDebbie Waiz 15th Annual RxForSanity.com Endoscopy Symposium ColonoscopyJoke.com
  28. 28. Gassy foods round-up provided as a pre-lunch service by PLR Beyond the beans… Peas, lentils, soybeans Broccoli, cabbage, cauliflower, cucumber, green pepper, kolrabi, brussels sprouts, onions, leeks, artichokes, and asparagus Pears, apples, avocados, bananas, melon and peaches , prunes and raisins Whole grains, such as whole wheat and bran.Debbie Waiz 15th Annual RxForSanity.com Endoscopy Symposium ColonoscopyJoke.com
  29. 29. Starches, fiber & gas Most starches produce gas with breakdown in colon (except rice) – Potatoes, corn, pasta Fiber – Soluble fiber (dissolves in H2O to gel) in oat bran, fruits, beans, not broken down until reaches colon.  digestion by bacteria causes gas – Insoluble fiber (wheat bran, some vegs) passes unchanged through bowel & causes no gasDebbie Waiz 15th Annual RxForSanity.com Endoscopy Symposium ColonoscopyJoke.com
  30. 30. Halloween Fun?Debbie Waiz 15th Annual RxForSanity.com Endoscopy Symposium ColonoscopyJoke.com
  31. 31. What to do about intestinal gas?Debbie Waiz 15th Annual RxForSanity.com Endoscopy Symposium ColonoscopyJoke.com
  32. 32. Debbie Waiz 15th Annual RxForSanity.com Endoscopy Symposium ColonoscopyJoke.com
  33. 33. If predominantly eructation Think about:  GERD  Gastroparesis – Gastric emptying study  Dietary Aerophagia  Habit/learned behavior – Responds well to biofeedback and antidepressant therapyDebbie Waiz 15th Annual RxForSanity.com Endoscopy Symposium ColonoscopyJoke.com
  34. 34. Abdominal distension & bloatThink about: Nissan fundoplication – 10% ‘gas-bloat’ syndrome Irritable bowel syndrome – Positive ‘panty sign’ Consider PSBO – Small bowel enteroclysis Dietary, bacterial overgrowth – LTT to determine role of intolerance (not Y or N) – > 30 mg/dl within 2 hours normal. 20-30 mg/dl inconclusive. < 20 mg/dl abnormal.Debbie Waiz 15th Annual RxForSanity.com Endoscopy Symposium ColonoscopyJoke.com
  35. 35. Predominant flatulence  Food diary  Celiac testing (TTG- IgA & total IgA)  Trial digestive enzymes (beano, lactaid, prelief)  Hydrogen breath testing (SBO?)  Education (NIDDK)Debbie Waiz 15th Annual RxForSanity.com Endoscopy Symposium ColonoscopyJoke.com
  36. 36. ColicInfant.comDebbie Waiz 15th Annual RxForSanity.com Endoscopy Symposium ColonoscopyJoke.com
  37. 37. Empiric therapy Simethicone not very effective (Phazyme, Mylicon, Gas-X, Mylanta Gas) – Changes the surface tension of gas bubbles, enabling smaller bubbles to join together into bigger bubbles. Charcoal – Tablets, briefs or pads – May absorb other medications – Theoretically adsorbs gas volume Bismuth – Said to reduce odor of HS gas Probiotic therapy/antibiotic therapy – Replace/reduce gas producing bacteriaDebbie Waiz 15th Annual RxForSanity.com Endoscopy Symposium ColonoscopyJoke.com
  38. 38. Never pass gas in a wetsuit.Debbie Waiz 15th Annual RxForSanity.com Endoscopy Symposium ColonoscopyJoke.com
  39. 39. Thanks for letting me get this presentation out of my system… “Better out than in, I always say.” ~Shrek (Mike Myers)Debbie Waiz 15th Annual RxForSanity.com Endoscopy Symposium ColonoscopyJoke.com
  40. 40. Questions?Debbie Waiz 15th Annual RxForSanity.com Endoscopy Symposium ColonoscopyJoke.com
  41. 41. Have a 239 bean day! Anything more would be ‘too farty’ (240)! ~From a SGNA colleague who shall remain namelessDebbie Waiz 15th Annual RxForSanity.com Endoscopy Symposium ColonoscopyJoke.com
  42. 42. Debbie Waiz 15th Annual RxForSanity.com Endoscopy Symposium ColonoscopyJoke.com

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