INTRODUCTION – Gigglefarting is no laughing matter. Individuals with the disorder often rate their quality of life similarly to patients on dialysis and the acne-prone. Gigglefarting is believed to be an antibody-driven disease, which categorizes it as a humoral disorder. Circulating IgM-IgG complexes cause a relaxing of the rectal tone, leading to escapes of flatus. The pathogenesis, epidemiology, diagnosis and treatment of Gigglefarting will be reviewed here.

PATHOGENESIS – It is thought that the rapid paroxysmal contractions of the diaphragm, as are often observed in short bursts of juvenile laughter, kinetically activate gigglefarting-related IgG-IgM pentamers (so-called “gigglefactor1”). This factor then induces a rapid onset Lambert-Eaton-like relaxation in the smooth muscle of the rectum, allowing for the passage of flatus. Injecting rectal isolates from afflicted humans recapitulates the disease in rabbits.

EPIDEMIOLOGY – Gigglefarting is more prevalent in women, especially ages 10-15. Self identified “hipsters” are at a staggering 5-fold increased risk of acquiring this disorder. Though there have been reports of apparent familial gigglefarting, no chromosomal loci have been identified. It is unclear how gigglefarting may be acquired, although it’s probably something to do with the t-helper 17 response.

DIAGNOSIS

HISTORY – Patients suffering from gigglefarting (so-called “gigglefarters”) tend to complain that humor “smells bad.” It is important during the history to exclude synesthesia or transient ischemic attack. Patients may also report a history of microlaughter, including “tittering,” “giggling” and “sniggering.”

PHYSICAL EXAM – Key findings include the emission of a malodorous rectal discharge upon performing the feather-armpit test. The Richard-Starling maneuver may also be employed. This is done by telling a funny joke during the rectal exam and feeling for rectal tone variance. The first joke to be used in this manner runs “knock knock” (await appropriate response, then) “Do you really think you should be answering the door with a physician’s finger in your rectum?” This joke has been shown to have upwards of 80% specificity in identifying gigglefarters during rectal exam, with only a 2% increase in the likelihood of pursuant lawsuit.

LABS – A simple Brown Stain of a rectal biopsy is 96% sensitive for gigglefactor1 accumulation. Elevated circulating gigglefactor1 is 82% sensitive at three-times normal.

TREATMENT – There has been limited but encouraging success with pharmacologic depressants and gaba-agonists. Encourage the use of boring television and alcoholism. Lifestyle interventions include avoiding humorous situations and taking oneself seriously.