By Dr Pranab Gyawali, Consultant Gastroenterologist
Published and medically reviewed:
Bloating assessment and treatment in Dubai
If you feel bloated most days, become uncomfortable after eating, or notice that your abdomen visibly expands as the day progresses, the next step is to work out which pattern is driving it. Bloating can be related to constipation, food intolerance, IBS, altered gut movement, increased gut sensitivity or, in selected patients, SIBO. Feeling bloated and having visible abdominal distension are not always the same problem.
Dr Pranab Gyawali assesses persistent bloating in Dubai in a JCI accredited clinical facility. He has more than 25 years of gastroenterology experience from London and Dubai. The consultation reviews your symptoms, bowel habit, diet, medicines, medical and surgical history, examination findings and any results you already have.
His assessment follows the best practice advice in the American Gastroenterological Association Clinical Practice Update on the evaluation and management of belching, abdominal bloating and distension. This means separating the feeling of bloating from visible abdominal distension, looking for the most likely clinical pattern and arranging tests only when they are likely to answer a specific question.
Quick answers
Who should I see for persistent bloating?
A consultant gastroenterologist can assess bloating that is persistent, recurrent or affecting daily life, particularly when it is associated with pain, constipation, diarrhoea, vomiting, weight loss, iron deficiency or a marked change in bowel habit.
What happens at the first appointment?
Dr Pranab will look at when the bloating occurs, whether the abdomen visibly expands, your bowel emptying, meal relationship, medicines, previous surgery and any warning features. Please bring recent blood tests, scans, endoscopy reports and a list of medicines or supplements if available.
Will I need tests?
Not always. Many patients can be assessed from the clinical pattern and examination. Blood tests, breath tests, imaging, endoscopy or bowel function tests are selected when the findings provide a reason for them.
Where does the assessment take place?
The assessment takes place in Dubai in a JCI accredited clinical facility.
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Bloating explained
Seven patterns I look for
1. Constipation or incomplete emptying
You can open your bowels every day and still not empty properly. Stool retention, slow movement through the colon or difficulty evacuating can increase bloating and visible distension. Treatment needs to improve movement and emptying rather than simply remove foods.
2. The relationship to meals and fermentable foods
The timing matters. Onion, garlic, wheat, beans, some fruits and sweeteners can increase fermentation in sensitive patients. If a dietary trial is appropriate, it should be structured and followed by reintroduction so that foods are not restricted unnecessarily.
3. Lactose, fructose or coeliac disease
Milk, fruit juice, honey, sweeteners and certain fruits can produce symptoms when particular carbohydrates are poorly absorbed. A dietary trial, coeliac blood testing or lactose and fructose breath testing may be considered when the history fits.
4. SIBO risk
SIBO can cause bloating, gas, discomfort and changes in bowel habit, but these symptoms do not prove that SIBO is present. Hydrogen and methane breath testing is most useful when there are relevant risk factors or a clinical pattern that makes bacterial overgrowth more likely.
5. IBS and increased gut sensitivity
Some patients do not produce an unusual amount of gas. The bowel feels normal stretching and gas more intensely. This can occur in IBS and other disorders of gut brain interaction. Treatment may need to address bowel function and gut sensitivity as well as diet.
6. Visible abdominal distension and muscle coordination
If your abdomen is relatively flat in the morning but expands visibly later in the day, excess gas may not be the only explanation. Abdominophrenic dyssynergia is a change in how the diaphragm and abdominal wall respond. Diaphragmatic breathing, physiotherapy or biofeedback may help selected patients.
7. Medicines, surgery and other medical clues
Medicines and supplements can alter bowel movement or fermentation. Previous abdominal surgery can also change risk. Nausea, vomiting, weight loss, bleeding, iron deficiency or an abnormal examination may point away from uncomplicated functional bloating and require a different investigation pathway.
Bloated stomach: seven things I check first
Which tests might be considered?
Testing depends on the history and examination. It may include:
- Blood tests, including coeliac testing when relevant
- Hydrogen and methane breath testing for selected patients at risk of SIBO
- Lactose or fructose breath testing when symptoms suggest carbohydrate malabsorption
- Imaging or endoscopy when symptoms have recently worsened, the examination is abnormal or warning features are present
- Gastric emptying assessment when bloating occurs with significant nausea or vomiting
- Anorectal or pelvic floor testing when constipation or difficult evacuation remains a major problem
Gastroscopy, colonoscopy, capsule endoscopy and microbiome testing are not routine bloating investigations. They may be considered when there is a separate clinical reason.
How is bloating treated?
Treatment depends on the pattern found during assessment. It may involve improving constipation or evacuation, a structured dietary trial with careful food reintroduction, treatment of a confirmed intolerance or selected case of SIBO, or treatment directed at gut sensitivity.
Visible distension related to abdominal muscle coordination may require diaphragmatic breathing, physiotherapy or biofeedback. Pelvic floor treatment may help when difficult evacuation is contributing. Probiotics are not the default treatment for persistent bloating, and the AGA update advises against using them specifically to treat bloating and distension.
The aim is to choose the smallest useful treatment plan rather than add several tests, supplements or dietary restrictions at once.
When should bloating be assessed promptly?
Arrange medical review if bloating is associated with:
- Unintentional weight loss
- Vomiting or difficulty eating
- Gastrointestinal bleeding or black stools
- Iron deficiency anaemia
- Persistent or worsening abdominal pain
- A new or marked change in bowel habit
- Visible abdominal swelling that does not settle
- An abnormal abdominal examination
Severe pain, persistent vomiting, inability to pass stool or gas, fainting or heavy bleeding requires urgent medical assessment.
Related services and guidance
Clinical references
- AGA Clinical Practice Update on Evaluation and Management of Belching, Abdominal Bloating, and Distention: Expert Review, Gastroenterology, 2023.
- European Consensus on Functional Bloating and Abdominal Distension, United European Gastroenterology Journal, 2025.
Request a bloating assessment in Dubai
If persistent bloating or visible abdominal distension is affecting you, request an assessment using the form below or contact the Admin Team on WhatsApp.