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Logo of jneuromotThis ArticleAims and ScopeInstructions to AuthorsE-SubmissionJournal of Neurogastroenterology and Motility
J Neurogastroenterol Motil. 2010 July; 16(3): 333–334.
Published online 2010 July 26. doi:  10.5056/jnm.2010.16.3.333
PMCID: PMC2912130

A 59-Year-Old Female Presenting With Bloating and Flatulence: Is the Intestinal Gas Volume in Plain Abdominal Radiographs Correlated With Symptoms?

A 59-year-old woman with bloating and flatulence for 6 months visited to our hospital. Her symptoms did not improve after treatment with antiflatulents, prokinetics and probiotics. A plain abdominal radiograph showed a moderate amount of intestinal gas (Fig. 1A). The intestinal gas volume was measured in the plain radiograph using the imaging software Image-pro Plus® (Media Cybernetics Inc, Bethesda, MD, USA).1 To standardize the quantity of intestinal gas, the ratio of the quantity of intestinal gas to the pixel value in the region surrounded by a horizontal line tangential to the suprasymphyseal margin, a horizontal line tangential to the uppermost point of the diaphragm, and the lateralmost lines tangential to the right and left costal arches was defined as the gas volume score.2,3 The gas volume score was calculated at 0.131 (Fig. 1B). Since the other medications had not been effective for the bloating, an antibiotics (metronidazole) was started to treat possible intestinal bacterial overgrowth (however, generally rifaximin is used for intestinal bacterial overgrowth). After 2 weeks, her symptoms had disappeared. When the gas volume score was measured in a follow-up plain abdominal radiograph, the amount of intestinal gas in the plain abdominal radiograph had decreased (Fig. 1C) and the gas volume score was lower at 0.049 (Fig. 1D).

Figure 1
The plain abdominal radiograph shows a moderate amount of intestinal gas (A), which has decreased after treatment with an antibiotic (C). The gas volume score (GVS) is measured in the plain abdominal radiograph using imaging software (B, D). The black ...

The amount of intestinal gas in plain abdominal radiographs may be correlated with bloating symptoms. Moreover measuring the intestinal gas volume might be more useful when combined with a breath test for intestinal bacterial overgrowth.


Financial support: None.

Conflicts of interest: None.


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2. Morken MH, Berstad AE, Nysaeter G, Berstad A. Intestinal gas in plain abdominal radiographs does not correlate with symptoms after lactulose challenge. Eur J Gastroenterol Hepatol. 2007;19:589–593. [PubMed]
3. Koide A, Yamaguchi T, Odaka T, et al. Quantitative analysis of bowel gas using plain abdominal radiograph in patients with irritable bowel syndrome. Am J Gastroenterol. 2000;95:1735–1741. [PubMed]

Articles from Journal of Neurogastroenterology and Motility are provided here courtesy of The Korean Society of Neurogastroenterology and Motility