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Gases expand with falling ambient pressure (Boyle’s law). As cabin altitude increases, intraluminal gastric air volume rises, worsening distention, increasing aspiration risk, and impairing ventilation due to diaphragmatic elevation. Lowering the cabin altitude (i.e., increasing pressurization) directly reduces gas expansion. Temperature control does not meaningfully influence intraluminal volume at constant pressure. Increasing tidal volume risks barotrauma and air trapping, and does not address gastric distention. Diuretics have no role in managing gas expansion. Complementary measures include nasogastric decompression when appropriate, avoiding excessive bagging that insufflates the stomach, and monitoring for emesis. In fixed-wing operations, pre-planned cabin altitude profiles for at-risk patients can prevent complications, improve ventilation mechanics, and enhance transport safety.