Abstract: Abdominal bloating and distension are 2 of the most commonly reportedgastrointestinal symptoms. Abdominal bloating is characterized by symptoms of trapped gas,abdominal pressure, and fullness. Abdominal distension is defined as a measurable increase inabdominal girth. These symptoms frequently co-exist, although they can occur separately.Defined by Rome IV criteria, functional abdominal bloating and distension commonly coincidewith other functional gastrointestinal disorders, such as functional dyspepsia, irritable bowelsyndrome, and functional constipation. Abdominal bloating and distension can develop formultiple reasons, including food intolerances, a previous infection that perturbed the intestinalmicrobiota, disordered visceral sensation, delayed intestinal transit, or an abnormal viscerosomatic reflux. Treatment can be challenging to patients and providers—no regimen has beenconsistently successful. Successful treatment involves identifying the etiology, assessingseverity, educating and reassuring patients, and setting expectations. Therapeutic options includedietary changes, probiotics, antibiotics, prokinetic agents, antispasmodics, neuromodulators, andbiofeedback. We review the epidemiology and effects of chronic bloating and distension andpathophysiology, discuss appropriate diagnostic strategies, and assess available treatmentoptions.