Guideline-recommended OTC strategies to manage bloating and gas, including first-line treatments like simethicone (80–160 mg after meals) and dietary modifications such as avoiding triggers and following a low-FODMAP diet. Track symptom patterns with a food journal and consider probiotics to improve gut health. For IBS-related bloating, prescription options like rifaximin may provide additional relief.
January 9, 2025

Bloating and Gas

Evidence-Based Over-The-Counter Guide

William Shen

William Shen

Co-founder & CPO

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Bloating and gas result from excess air or gas in the digestive tract. They may be caused by diet, swallowing air, or medical conditions like irritable bowel syndrome (IBS). Persistent symptoms, diarrhea, blood in stool, weight loss, or abdominal pain are reasons to be evaluated by a doctor.

First-line recommendations:

  • Simethicone: Oral anti-foaming agent that reduces gas bubbles. Dose: 80-160 mg orally after meals and at bedtime. Simethicone 125 mg softgels (FDA M002).

  • Dietary modifications: Avoid common triggers like carbonated drinks, legumes, and artificial sweeteners. The American Gastroenterological Association recommends the low-FODMAP diet. Low-FODMAP recipes guide.

  • Document triggers in a journal such as the one provided by MDandMe.

Supplement recommendations:

  • Probiotics: Supplements containing Lactobacillus or Bifidobacterium strains to improve gut flora. Dose: 1-2 capsules daily or as directed. Lactobacilli-predominant probiotic.

Prescription medications:

  • Rifaximin: A non-absorbable antibiotic for bacterial overgrowth in IBS-related bloating.

Citation

Moshiree, B., Drossman, D., & Shaukat, A. (2023). AGA clinical practice update on evaluation and management of belching, abdominal bloating, and distention: expert review. Gastroenterology.

What OTC evidence is reviewed?

  • For each condition, we performed a literature review to find a recent widely cited expert group guideline published in the leading specialty-specific peer-reviewed journal or top general medical journal.

  • Based on the recommendations in the publication, we identify recommended active ingredients and devices that are available over-the-counter per FDA regulations.

What evidence is prioritized?

Levels of evidence considered:

  • Tier 1 (Safe and Definitely Effective): Professional field consensus or multiple randomized controlled clinical trials showing the same conclusion. Wherever possible, we use Tier 1 evidence for "first-line" recommendations.

  • Tier 2 (Safe and Probably Effective): Individual clinical trials which may be discordant or large-scale observational experience. Tier 2 evidence may inform "first-line", "second-line", or "supplement" recommendations.

  • Tier 3 (Safe and Maybe Effective): Mechanistic plausibility without high-quality clinical evidence of efficacy but high-quality evidence of safety. Tier 3 evidence may inform "second-line" or "supplement" recommendations.

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  • Based on the top clinical recommendation, we evaluate products containing the recommended active agent with FDA-approved dosage based on price, average customer reviews, how often it is purchased, and how quickly it will ship to home. 

  • We provide public documentation of the active ingredients in our recommendations, using all 32 FDA monographs, Prescription-to-Nonprescription (Rx-to-OTC) Switches, as well as New Drug Application (NDA) approvals.

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  • Based on the top clinical recommendation, we evaluate devices that are FDA-cleared or comply with other medical guidelines (if not a FDA-regulated category) by reputability, price, and average customer reviews.

  • We provide public documentation of supporting evidence for each device.  

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