Chronic bloating is more than just a discomfort—it is a physiological sign that your digestive system is out of balance. As a UK-trained Consultant Gastroenterologist (MBBS London, FRCP UK) with a special interest in GI Physiology, I provide advanced, personalized care for patients across the UAE suffering from persistent abdominal swelling and gas.
The London-Dubai Clinical Advantage
"In my practice, I find that bloating in Dubai often results from a unique combination of high-stress environments, dietary shifts, and specific gut motility issues. Having practiced in London and now Dubai, I use GI Physiology to identify the 'why' before we treat the symptoms." — Dr. Pranab Gyawali
Top 7 Things I Look Out For When Someone Comes to Clinic With Bloating
In clinic, the important question is: what pattern is driving the symptom of bloating?
| What I look out for | Why it matters | What may help |
|---|---|---|
| 1. Constipation or incomplete emptying | You can open your bowels every day but still not empty properly. Stool sitting in the colon can trap gas and worsen bloating. | Bowel habit assessment, constipation treatment, fibre strategy where appropriate, and review for incomplete evacuation. |
| 2. FODMAP food triggers | Foods such as onion, garlic, wheat, beans, sweeteners and some fruits can ferment and produce gas in sensitive patients. | A structured low FODMAP trial, followed by reintroduction to identify personal triggers rather than permanent restriction. |
| 3. Lactose or fructose intolerance | Milk, fruit juice, honey, sweeteners and certain fruits can trigger bloating when poorly absorbed. | Lactose or fructose breath testing when the symptom pattern fits, or a structured dietary trial. |
| 4. SIBO | Small intestinal bacterial overgrowth can cause bloating, gas, diarrhoea, discomfort and food sensitivity. | Hydrogen and methane breath testing, especially after bowel surgery, strictures, altered gut movement or recurrent symptoms. |
| 5. Gut sensitivity | Some patients do not produce excessive gas, but their gut feels normal gas much more intensely. This is common in IBS and after gut inflammation. | Gut-directed treatment, bowel regulation, dietary strategy, and selected medication or gut-brain approaches when appropriate. |
| 6. Abdominal muscle coordination | If the abdomen is flat in the morning but visibly expands by evening, this may be due to abdominophrenic dyssynergia, not just excess gas. | Diaphragmatic breathing, physiotherapy or biofeedback in selected patients with visible abdominal distension. |
| 7. Probiotics and supplements | Many patients try probiotics first, but for bloating they are often disappointing if the underlying cause has not been identified. | Use selectively, not as the default solution. The first step is to understand why the bloating is happening. |
Short video: Bloated Stomach? 7 Things I Check First
Personalized Treatment & Management
Treatment depends on the likely mechanism behind the bloating. My approach may include:
Food and fermentation strategy
This may include a structured low FODMAP approach, review of trigger foods, and careful reintroduction rather than long-term unnecessary restriction.
Constipation and motility strategy
If stool retention, slow transit, gastroparesis or incomplete evacuation is contributing, treatment needs to focus on improving movement and emptying rather than simply reducing gas.
Targeted testing and treatment
When appropriate, hydrogen and methane breath testing, lactose or fructose breath testing, microbiome assessment, gastroscopy, colonoscopy or other investigations may be considered. Rifaximin or other treatments may be used selectively when SIBO is suspected or confirmed.
Gut sensitivity and distension strategy
For some patients, the issue is gut hypersensitivity or abnormal abdominal muscle coordination. In these cases, gut-directed treatment, breathing retraining, physiotherapy or biofeedback may be more logical than another supplement.
Microbiome and supplement strategy
Probiotics, enzymes or microbiome-directed approaches may help selected patients, but they are not the default answer for every patient with bloating. The first step is to understand why the bloating is happening.
Diagnostic Checklist: Red Flags
Seek a formal medical evaluation if your bloating is accompanied by these 'Red Flag' symptoms:
- Unintentional weight loss
- Persistent pain that wakes you up at night
- Sudden changes in bowel habits
- Iron deficiency (Anaemia) or chronic fatigue
- Visible abdominal distension that does not resolve
Featured Gut Health Vlog
Educational insights from Dr. Gyawali’s clinical library for UAE patients:
- Why Bland Diets Don't Heal Your Gut
- Foods to Avoid Before Flying
- How Poor Sleep Affects Your Gut
- Stress & the Gut-Brain Axis
- Vaping & Gut Inflammation
- Coke Zero vs Regular Coke
- Impact of Ultra-Processed Foods
- Morning Coffee & Reflux
- Hair Loss & Iron Deficiency
- Late-Night Eating in Dubai
- The Truth About Mold & Candida
Clinical Procedures & Diagnostics
Advanced investigations commonly used for a professional bloating work-up:
- Gastroscopy | Colonoscopy
- Hydrogen & Methane Breath Test (SIBO)
- Gut Microbiome Analysis
- Lactose & Fructose Breath Testing
- Anorectal Manometry
- Capsule Endoscopy
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Request an Appointment
If you wish to discuss your symptoms further or would like to make an appointment, please use the booking form on this page. Expect a response within 12 business hours.