1. FLATUS FRIEND OR FOE EVERYTHING YOU WANTED TO KNOW BUT WERE AFRAID TO ASK MARSHA JOHNSON SCHULTE DNP, ANP-BC

2. NAME THAT FART Common names Fill in the blank……. Types of farts The Reluctant Fart ­, The Anticipated Fart, The Relief Fart, ­The S.B.D. Fart, The Crowd Fart ­ or Thank God I'm Alone Fart ­

3. GAS YOU CAN SEE

4. 6.81818182 MPH

5. “DOCTOR, I HAVE TOO MUCH GAS!” Belching, excess gas, abdominal pain, cramping, constipation, bloating N2, O2, CO2, H2 and CH4 makes up 99% of bowel gas (odorless) Swallowing, production within the gut or diffusion from the blood (partial pressure of intestinal gases). Normal to produce 200ml of gas daily ( expel 400-2000ml) and pass “gas” twenty times a day.

6. INTRALUMINAL PRODUCTION CO2, H2 and CH4 Digestion of fat, protein, bacterial fermentation, nondigestible carbohydrates, malabsorption Methane is a product of bacterial metabolism Interplay between food digestion, absorption and bacterial activity (metabolism, fermentation)

7. BURDEN OF FLATUS

8. ANNOYING SOURCE OF EMBARRASSMENT

9. FLATAL INCONTINENCE Sphincter dysfunction, pelvic floor injury, ostomies Reports of feelings of embarrassment and isolation Affect intimate areas of life impacting Social interactions, self image, sexuality, psychological well –being

10. APPROACH TO THE PATIENT WITH INTESTINAL GAS Common Disorders IBS Dietary Anxiety Medications

11. Less Common Disorders Infectious etiology, SBIO Malabsorption, lactose or fructose intolerance,,celiac disease, pancreatic insufficiency Motility Disorders, Diabetes, Connective Tissue Disease Intestinal Disorders, obstruction, malignancy, UC, polypoid disorders.

12. RED FLAGS Weight loss Nocturnal symptoms Fever Signs of obstruction Steatorrhea

13. TREATMENT OPTIONS Reassurance IBS Management Treat the underlying Cause

14. IBS dietary measures simethicone level of evidence is low Beano, showed reduction in gas production in patients challenged with baked beans Bismuth (pepto-bismal ) reduces the odor arising from hydrogen sulfide external devices to deodorize flatus ( charcoal –lined cushions and pads).

15. FOAMP Fermentable Oligosaccharides, fructans Disaccharides, Lactose Monosaccharides, free fructose Polyols, sorbitol, mannitol

16. EFFICACY OF RIFAXIMIN FOR IBS 400mg bid, Primary efficacy was subjective global symptom relief at the end of 3, 10 day phases LHBT performed pre and post 124 patients 63 study patients and 61 control. Comparable baseline characteristics, normal LHBT. 41% relief vs 22 % and improvement was maintained 28.6 vs 11.5 % 40.5 % reported a favorable response persisting at the end of the 3 rd phase vs 18% No adverse events.

17. FLATUS! FRIEND OR FOE You be the judge…… Thank you!