Gastric and Intestinal Ulcers: Is Bloating Really Caused by Constipation?

Unpacking the Truth Behind Belching, Gas, and "Wind" in Ulcer Sufferers

Is constipation the main cause of gas and bloating in ulcer patients? Discover the real reasons behind “wind” in gastric and intestinal ulcers, including inflammation, spasms, and low food intake.

By Brian S., MH, MD (Alt. Med.) | Zent Nutri

Have you ever heard someone say that the belching or “wind” experienced by people with gastric or intestinal ulcers is simply due to constipation? It’s not uncommon to hear this in holistic circles. In fact, I recently came across a response from a holistic practitioner who insisted that flatulence and bloating in ulcer sufferers are mainly a result of constipation.

But here's where things got interesting—when asked about a case where the patient vomits every time they try to eat, consuming very little food, the practitioner had no reply. No constipation, yet still gas and discomfort? Let's dig deeper into the science and physiology behind this.

The Physiology Behind Ulcers and Gas

1. Inflammation Comes First

Ulcers—whether in the stomach (gastric ulcers) or intestines (intestinal ulcers)—are open sores caused by erosion of the mucosal lining. These sores often result from H. pylori infection, excessive NSAID use, or stress, and are typically accompanied by inflammation (Sung et al., 2009).

Inflammation activates local immune cells and releases substances like histamine, prostaglandins, and cytokines. These mediators trigger local pain receptors, increase gastric acid secretion, and may disrupt smooth muscle function (Wallace, 2008).

2. Spasms and Nerve Irritation

The gastrointestinal tract has its own nervous system, the enteric nervous system, which coordinates muscle movement. Inflammation irritates these nerves, leading to smooth muscle spasms. These spasms can cause cramping, pain, and erratic movement of gas and digestive contents (Furness, 2012).

3. Gas Accumulation: Belching and Flatulence

In the stomach, ulcers and inflammation can make the digestive tract hypersensitive. This can cause the person to swallow more air (aerophagia) due to anxiety, nausea, or irregular eating patterns. The trapped air is expelled as belching, sometimes with an acidic or sour aftertaste due to reflux (Katz et al., 2013).

In the intestines, spasms and slowed motility can lead to fermentation of undigested food by gut bacteria, even in the absence of a large food intake. This fermentation releases gases like hydrogen, methane, and carbon dioxide, leading to bloating and flatulence (Camilleri, 2020).

What If There's No Food Intake or Constipation?

Here lies the crux: even when a person barely eats due to vomiting—common in severe gastric ulcers or gastroparesis—gas and "wind" can still occur. This is not due to constipation but to spasms, fermentation, and altered gut motility. The bloating may even worsen due to empty stomach acidity and delayed gastric emptying.

Constipation’s Role: Not the Sole Cause

Constipation certainly can contribute to bloating, but it is not the main reason for gas in ulcer sufferers. It becomes problematic when we overemphasize it and ignore the more relevant issues like:

• Chronic inflammation

• Gastric hypersensitivity

• Acid imbalance

• Nerve irritation

• Dysbiosis or small intestinal bacterial overgrowth (SIBO)

A Balanced Holistic Approach

As holistic health professionals, it's vital we stay grounded in physiology and pathophysiology. Instead of reducing all symptoms to constipation, we must consider:

• Mucosal healing: using slippery elm, marshmallow root, or deglycyrrhizinated licorice (DGL)

• Spasm relief: using peppermint (in reflux-free cases), chamomile and fennel

• Inflammation control: with turmeric or aloe vera

• Microbiome support: probiotics or fermented foods (when tolerated)

• Stress management: as psychological stress worsens gastric output and motility disorders

Conclusion

So, is gas in ulcer patients just a result of constipation? Not quite. Inflammation, nerve irritation, and disordered motility are far more relevant in most cases—especially when food intake is low or vomiting occurs. Let’s not oversimplify the complex workings of the gut. A nuanced understanding makes us better healers.

References

Camilleri, M. (2020) ‘Bloating and abdominal distension: pathophysiology and management’, Nature Reviews Gastroenterology & Hepatology, 17(11), pp. 731–740.

Furness, J.B. (2012) ‘The enteric nervous system and neurogastroenterology’, Nature Reviews Gastroenterology & Hepatology, 9(5), pp. 286–294.

Katz, P.O., Gerson, L.B. and Vela, M.F. (2013) ‘Guidelines for the diagnosis and management of gastroesophageal reflux disease’, The American Journal of Gastroenterology, 108(3), pp. 308–328.

Sung, J.J.Y. et al. (2009) ‘Systematic review: the global incidence and prevalence of peptic ulcer disease’, Alimentary Pharmacology & Therapeutics, 29(9), pp. 938–946.

Wallace, J.L. (2008) ‘Prostaglandins, NSAIDs, and gastric mucosal protection: why doesn't the stomach digest itself?’, Physiological Reviews, 88(4), pp. 1547–1565.

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