Gases


Es un problema muy común en el que el abdomen se siente lleno, apretado y distendido, generalmente debido a un exceso de gases intestinales.
Debemos explicar que el aire que hay en el tubo digestivo proviene del aire que se traga y también de la fermentación de los alimentos por la flora intestinal. En condiciones normales el tubo digestivo maneja bastante bien este aire y lo hace avanzar rápidamente para expulsarlo en forma de ventosidades sin que se acumule ni produzca molestias.

¿Qué es el meteorismo o gases?
Se habla de meteorismo cuando una persona tiene problema de gases en el tubo digestivo, especialmente cuando aprecia una acumulación de los mismos con hinchazón y dolor. También suelen incluir otros problemas como los eructos o el aumento de ventosidades junto con distensión abdominal.
 ¿A quién afecta?
Esta dolencia puede afectar desde la infancia, los típicos cólicos del lactante, hasta adultos mayores.
¿Por qué se produce?
El gas que contiene el tubo digestivo proviene de dos fuentes: la primera es el aire que se traga al comer. Aunque no lo notemos tragamos aire al comer y solo basta pensar en los eructos del lactante después de darle el biberón. La segunda fuente de aire son los gases producidos en el colon por las bacterias de la flora intestinal al fermentar los residuos de la comida, principalmente los derivados de los vegetales. La mayoría de los casos se deben a tragar aire de manera inconsciente o a una sensibilidad exagerada a cantidades normales de gas en el abdomen.
Pero también puede ser síntoma secundario de enfermedades concretas como por ejemplo la intolerancia a la lactosa entre otras o efecto secundario de algunos medicamentos entre los que hay que destacar algunos antidiabéticos como la metformina.
¿Qué síntomas se producen?
Las molestias producidas por los gases en el tubo digestivo pueden ser de muy distinta índole. La primera son los eructos frecuentes o abundantes que en general se relacionan con un aumento del aire que tragamos al comer lo que en su máxima expresión se denomina aerofagia. El segundo problema es el aumento de las ventosidades. El origen más frecuente para ello es la dieta rica en verduras y frutas que dejan abundante sustrato a las bacterias para fermentar y generan mucho gas que debe ser expulsado. El tercer problema es la hinchazón abdominal que en la mayoría de los casos no se relaciona con ninguno de los dos problemas anteriores si no con el defecto en cómo hace avanzar el intestino a los gases de forma no adecuada.
¿Cómo se diagnostica?
No hacen falta pruebas diagnosticas en los pacientes con problemas de gases. Basta normalmente con que el médico conozca los síntomas con detalle para saber si hay que pensar en otras enfermedades y descartar la existencia de estas.
 ¿Qué complicaciones puede tener el meteorismo?
Aunque sin duda los problemas de gases en cualquiera de sus formas pueden generar problemas sociales y plantear situaciones embarazosas, lo cierto es que salvo este deterioro en la calidad de vida que producen, no son responsables de problemas graves ni hay riesgo de que se produzcan complicaciones serias.
¿Cuál es el tratamiento del meteorismo?
Lo primero que hay que hacer para mejorar esta dolencia es modificar nuestros hábitos alimenticios y estilo de vida.
¿Y cómo podemos hacerlo? Primero disminuyendo el consumo de alimentos flatulentos, bebidas con gas. Cuando el problema son los eructos frecuentes lo más importante es tratar de disminuir el aire que se traga con la comida. Para ello se recomienda comer despacio y masticando bien los alimentos, evitando el uso de chicles así como dejar de fumar. Cuando el problema es un aumento de las ventosidades lo más recomendable es disminuir el consumo de vegetales y fruta, es decir, hacer una dieta pobre en fibra con lo cual se disminuye la cantidad de sustrato que las bacterias del colon tienen para fermentar, disminuyendo así la cantidad de gas producido. Cuando el problema es la hinchazón abdominal disponemos de muchas menos posibilidades. Otras soluciones que debemos tener en cuenta es evitar el estreñimiento e intentar realizar algo de ejercicio físico diario como caminar, ya que permite al intestino estar en movimiento y expulsar los gases de una manera más fácil.
Cuando el meteorismo es síntoma secundario de enfermedades, el tratamiento deberá ser el de la enfermedad responsable (como por ejemplo restringir la lactosa en la dieta) o retirar los fármacos que lo produzcan o cambiarlos por otros.
El uso de fármacos antiflatulentos, como los derivados de la simeticona (aero-red) o dimeticona (aero-flat) pueden ser útiles ya que tratan de disminuir el gas dentro del intestino fragmentando las burbujas de aire para que sean más manejables por el intestino o bien de aumentar la contracción del intestino para que haga avanzar el gas.  A veces y en función de los síntomas asociados, los espasmolíticos, procinéticos y fármacos ansiolíticos o antidepresivos a bajas dosis pueden ayudar a resolver el problema.
Pero como siempre decimos, antes de tomar tratamientos es mejor consultarlo con el médico, ya que podemos encontrar soluciones sin necesidad de medicación.
¿Qué puedo hacer si tengo un “cólico de gases”?
Cuando note mayor distensión de vientre, con dolor más intenso, puede conseguir mejoría con calor local (manta eléctrica, etc.) sobre el vientre, y también colocarse reclinado hacia delante (incluso de rodillas, apoyado en los codos).
Entonces ¿Cómo debo alimentarme?

  1. Elimine o disminuya de su dieta los siguientes alimentos flatulentos:
  • Legumbres: Habas, alubias, garbanzos, lentejas, guisantes… (puede tomarlas en purés o bien pasadas por el “chino”).
  • Verduras y hortalizas: Col, coliflor, coles de Bruselas, repollo, alcachofas, nabos, espinacas, acelgas, lechuga, espárragos, pepino, pimiento, cebolla cruda, patatas, rábanos. Puede tomarlos pero debe hacerlos muy cocidos y evitarlos de manera cruda, mejor en forma de puré.
  • Cereales: cereales integrales, arroz, pan y harinas integrales.
  • Frutas: pasas, albaricoque, piña, ciruela.
  • No tome leche durante un par de semanas; si con esto observa que sus molestias se han reducido, restrinja entonces la leche y los helados; pero puede tomar yogurt y mantequilla.
  • Modere las grasas de la dieta.
  • Los alimentos que no llevan azúcar pero sí sorbitol (empleado como edulcorante), pueden producir gases.
  • Otros: chocolate, bebidas gaseosas, refrescos de cola, cerveza, vino tinto.
  1. Disminuya el consumo de lo siguiente:
  • Tome preferentemente frutas maduras y peladas: melocotón, albaricoque, piña, manzana, pera, melón, sandía, kiwi… Evite pasas, albaricoque, plátanos y ciruelas.
  • Limite el uso de tomate, apio y zanahoria en las ensaladas. El tomate tómelo preferentemente pelado.
  1. Puede tomar:
  • Son de amplio uso popular las infusiones “carminativas”, es decir, las especificas para disminuir los gases a base de anís, manzanilla o melisa que pueden tomarse a diario y varias veces.
  • Carnes (vaca, ternera, pollo, pavo, cordero lechal) y pescados (blancos y azules). Cocine de forma sencilla, mejor cocido o asado, peor fritos o rebozados.
  • Huevos escalfados, pasados por agua, duros o en tortilla francesa.
  • Puede tomar todo tipo de zumos de frutas naturales y sin gas.

Y de nuevo recordamos las recomendaciones generales:

  1. Beba poca cantidad de líquido durante las comidas (agua, vino, zumos), sin gas y sin utilizar porrón, bota, botijo o paja para chupar.
  2. Coma lentamente, mastique y ensalive bien los alimentos.
  3. Evite chupar caramelos y mascar chicle.
  4. Haga comidas pequeñas y regulares, más bien solidas que liquidas.
  5. No hable acaloradamente mientras coma y evite hacer ruidos deglutorios al beber.
  6. Consulte a su médico respecto a sus problemas con los gases y explique bien sus hábitos alimentarios
  7. El ejercicio físico moderado mejora el meteorismo.
  8. Evite fumar
  9. El meteorismo es un problema molesto pero no tiene repercusiones serias sobre la salud.
  10. Tome la medicación como se lo indique su médico.

María Hernández Carrasco
Médico residente, MFyC, C.S. Arturo Eyries, Valladolid

REFERENCIAS:

  • León Barúa R. Flatulencia. Rev Gastroenterol Peru, 2002; 22:234 – 42
  • Yamada T. Manual de Gastroenterología. Mr Graw– Hill Interamericana. Editores S.A. Mexico. 1999
  • Yrriberry S. Dispepsia, conceptos, tipos de dispepsia, fisiopatología, diagnóstico y tratamiento Diagnóstico 2003; 5 y 6. Set-Dic.
  • León Barúa, R. Zapata – Solari, C. Fermentación fecal en el meteorismo. Acta Gastroenterol Lat Amer, 1977, 7: 251-59

REVISADO: enero 2018

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  39. My problem is that the filename column is not displayed in the colummn list on the creation of the tblIngredient.

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    A:

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  41. This has made it a lot easier for you to remember them all. You can also use this Password Manager to save all your money that you spend on internet. With this program you can never loose your money.
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  42. The reason for this is that CryptoTools is a standalone entity and uses two timers; the System Timer and a custom timer for time precision. When the System Timer is
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  43. Manages connections and files
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  46. Server side component implements these functions.
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  47. Some of its functionality includes opening files in embedded preview pane, splitting/merging existing tabs, browsing through list of recent PDF files and explore them. You can also add extra annotations and draw different shapes.

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  48. The speed with which conventional wireless access points are deployed and upgraded has to double for the project to be successful.

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