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Intestinal gas is often incriminated as a major cause of irritable bowel syndrome (IBS), particularly when bloating is predominant, but no general relationship between intestinal gas and IBS symptoms has yet been established. Koide et al. [21] found a significantly increased intestinal gas volume score in plain abdominal radiographs in patients with IBS as compared with healthy controls, suggesting that abnormal accumulation of intestinal gas could be a problem in these patients. In contrast, Morken et al. [22] reported that intestinal gas volume is not correlated with abdominal discomfort after lactulose challenge and concluded that intestinal gas may not be the major cause of abdominal discomfort following carbohydrate ingestion in IBS.

In some diseases that favor bacterial proliferation, such as inflammatory bowel diseases, it may be difficult to determine the extent to which clinical deterioration is caused by bacterial overgrowth or the primary intestinal diseases. Actually, many individuals harbor bacterial overgrowth without symptoms. Thus, the clinical features of bacterial overgrowth, closely related to intraluminal gas production, vary greatly in individuals. However, several trials reported the results of H₂ breath testing for carbohydrate malabsorption and small intestinal bacterial overgrowth in patients with suspected IBS [23]. Intestinal fermentation products such as gas, short-chain fatty acids and intraluminal acidification could all affect colonic motility, possibly in part resulting in abdominal symptoms.