We will help you to understand the most common problems related to stomach and abdominal pain
Celiac Sprue is an inherited disorder that is characterized by alabsorbtion of nutrients by the intestines. In the United States, it is estimated that one person in 250 has celiac sprue, according to the American College of Gastroenterology. The actual number may be greater. Celiac sprue has many names- gluten sensitive enteropathy, non-tropical sprue, idiopathic steatorrhea, celiac disease and sprue. The small intestine lining of persons with this disorder is damaged by a protein fraction of gluten, called gliadin.
Gliadin is present in wheat, rye, barley, and oats. Since the function of the small intestine is digestion and absorption of nutrients, water, and bile salts, damage can have many effects. Healing of the small intestine will only occur when gliadin is removed from the diet. Celiac sprue has no age restriction. Symptoms can occur at any time after gliadin containing food are eaten. Diagnosis can be made any time between infancy and old age.
Many questions remain about the way celiac sprue is inherited. People who develop celiac sprue must have the genetic potential to develop this disorder, a source of gliadin in the diet, and a trigger factor to develop the disorder. There must be a source of gliadin in the diet and there must be a trigger factor. When a person explores their genetic background, celiac sprue may not be found, but disorders include:
- Dermatitis Herpetiformis
- Insulin dependent diabetes mellitus (Type I)
- Systemic Lupus Erythematousus
- Sjogren's Syndrome
- Grave's Disease
- Addison's Disease
- Myasthenia Gravis
- Autoimmune Chronic Active Hepatitis
- Wegener's Granuomatosis
Many trigger factors have been reported. Some seem to have their celiac sprue triggered by surgery or stresses to the body. Women often develop symptoms of celiac sprue after delivering a baby. Some report having a virus infection, then never recovering. Others report having their celiac sprue triggered by severe psychological stress.
What are the signs and symptoms of celiac sprue?Symptoms vary, but people with celiac sprue often have abdominal bloating, cramping, distention, steatorrhea, and diarrhea accompanied by weight loss in adults and failure to thrive in babies. Irritability is also a typical symptom. Damage caused to intestinal cells results in secondary lactose intolerance and loss of potassium and other electrolytes. Vitamin deficiencies can cause osteomalaci, rickets, muscle spasms, night blindness, and anemia. Symptoms for adults can be variable. A person with celiac sprue may have isolated symptoms or multiple deficiencies. Diarrhea may or may not be present. Appetite is often increased. Weight loss, weakness, and fatigue are also common complaints. When the absorptive lining of the small intestine is damaged, fat cannot be absorbed normally. The results include fatty diarrhea, weight loss and absorption of fat soluable Vitamins A, D, E, and K.
How is Celiac Sprue diagnosed? Other than signs and symptoms, the best way to diagnose celiac sprue is by a small intestinal biopsy. In this test, a small flexible tube is passed down the throat into the stomach and out into the specific area of the small intestine where a biopsy is taken. The difference between normal bowel tissue and that found in celiac sprue is great. In celiac sprue, the normal finger-like projections (villi) which increase the absorptive surface area of the small intestine are partially or totally absent. The brush border, which normally appears on the surface of the villi, is substantially reduced. Enzymes located on the brush border are greatly reduced. Lactase, the enzyme responsible for splitting milk sugar (lactose) so it can be absorbed, is one of the border brush enzymes. This decrease in lactose explains why persons with untreated celiac sprue may not be able to tolerate milk products.
The second essential part to the diagnosis is improvement on a gluten-free diet. Elimination of wheat, rye, barley, and oat products and their derivatives from the diet is essential. About 95% of persons with abnormal biopsies related to celiac sprue improve dramatically on the gluten-free diet. When gluten is removed from the diet, the cells in the intestinal lining are already returning to normal.
Constipation can be defined as infrequent or hard pellet stools, or difficulty in evacuating stools. Passing one or more soft, bulky stools everyday is a desirable goal. While troublesome, constipation is not usually a serious disorder. However, there may be other underlying problems causing constipation and, therefore, testing is often recommended.
What causes constipation? The stomach churns and mixes food so it can be digested. The near-liquid food then enters the small intestine which extracts calories, minerals, and vitamins. The small intestine ends in the right-lower abdomen where it enters the colon. The colon, or large bowel, is 5 to 6 feet long. Its function is to withdraw water from the liquid stool, so that by the time it reaches the rectum there is a soft formed stool. If an excessive amount of water is extracted, the stool cane become hard and difficult to expel. Constipation is often caused by a lazy colon that does not contract properly and fails to move the stool to the rectum. The colon also can become spastic and remain contracted for a prolonged time. In this case, stool cannot move along and, again, too much water is absorbed. Constipation also can result from a mechanical obstruction, such as tumors or advanced diverticulosis. Other conditions that can produce a sluggish, poorly contracting bowel include: pregnancy, anal fissures and hemorrhoids, certain drugs, certain hormone deficiencies, the abuse of laxatives, travel, and stress.
Diagnosis The patient's medical history is the most important factor in diagnosing constipation. The physician also will perform a physical exam and obtain certain blood tests. A barium x-ray exam of the lower bowel or colon is often warranted. In addition, a "procto" or sigmoidoscopic exam is necessary to rule out a mechanical blockage of the lower bowel, such as a tumor. This exam allows the physician to view the bowel wall and obtain biopsies (tissue samples) of any suspicious areas. Colonoscopy is the visual examination of the inside of the entire colon using a lighted fiberoptic colonoscope. The exam is usually performed under mild sedation. At times colonoscopy is necessary when the cause of constipation is not clear. In certain cases, pressure measurements of the rectum and lower colon can provide valuable information.
Crohn's Disease Crohn's disease is a chronic, recurrent inflammatory disease of the intestinal tract. The intestinal tract has four major parts: the esophagus, or food pipe; the stomach, where food is churned and digested; the long, small bowel, where nutrients, calories, and vitamins are absorbed; and the rectum and colon, where water is absorbed and stool is stored. The two primary sites for Crohn's disease are the ileum, which is the last portion of the small bowel, and the colon. The condition begins as small, microscopic nests of inflammation which persist and smolder. The lining of the bowel then becomes ulcerated and the bowel wall thickened. Eventually, the bowel may become narrowed.
What causes Crohn's Disease? After many years of intense research, the cause of Crohn's disease still remains unknown. One theory is that the condition is caused by an unidentified, slow-growing microorganism. The body's immune system, which protects it against many different infections, is also thought to be a factor. In spite of the unknown cause, enormous understanding and knowledge currently exist about the disease and its treatment.
Symptoms can include recurrent pain in the right lower abdomen, diarrhea (sometimes bloody),fever, and weight loss.
Diagnosis There is no conclusive diagnostic test for Crohn's disease. The physician uses a series of tests to assess the patient's overall condition and then makes a diagnosis. The patient's medical history and physical exam are always helpful. Certain blood and stool tests are performed in arriving at a diagnosis. X-rays of the small intestine and colon are required. In addition, a visual examination (sigmoidoscopy) of the lining of the rectum and lower bowel is usually necessary. A more extensive exam of the entire colon (colonoscopy) allows photography and small, painless biopsies to be performed.
Who gets Diverticulosis? Since it takes so long to develop, diverticulosis usually appears later in life. However, it is not uncommon to see this occur in people who are in their 30s.
Diagnosis The medical history is the physician's most important tool in diagnosing diverticulitis. The physical exam may find tenderness present in the left lower abdomen. A barium enema x-ray usually is required to determine the extent of the disorder. Flexible sigmoidoscopy and colonoscopy are exams performed through the rectum with a lighted, flexible endoscope. These exams view the colon from the inside and provide additional information about the problem.
Signs and Symptoms Heartburn occurs when acid refluxes into the esophagus. It is experienced as a burning sensation in the lower chest and may be felt up the esophagus. At times, bitter-tasting liquid may regurgitate up into the mouth. When esophagitis is severe and ulcers are present, swallowing may cause pain when food reaches this part of the esophagus. Furthermore, if the lower esophagus narrows due to scarring, food may stick in this area. The symptom is called dysphagia and is uncomfortable. Esophagitis also may cause bleeding. Black stools, anemia, and vomiting of blood are signs of bleeding.
Diagnosis An upper GI series x-ray is usually done to outline the esophagus. An endoscopy also is performed using a flexible, fiberoptic endoscope. Tissues can be visualized and biopsied during this procedure. This examination is important since cancer of the esophagus can mimic esophagitis.
Gallstones Bile is composed of a variety of chemicals, including cholesterol, salts, and certain pigments. The gallbladder absorbs water from the bile, causing it to thicken. In some people, tiny crystals form the cholesterol and pigments. These crystals grow gradually until one or even hundreds of gallstones develop. About 80 percent of gallstones are composed of cholesterol, while the remainder are made of pigments, salts, and other chemicals. The way stones are formed is a gradually becoming known to scientists. It is possible that in the future gallstones can be prevented.
Diagnosis The physician, and even the patient, may suspect the presence of gallstones simply from the medical history. A sound wave test (ultrasound or sonography) provides a simple, quick method of diagnosis. In this test, sound waves are beamed into the gallbladder. If hard stones are present the wave is reflected back (echo) to the machine which picks up and documents this echo. This test looks at the anatomy of the gallbladder. Another way of testing is to evaluate the function. In this test (a hapatobiliary scan) a small amount of radioactive material is injected by vein. It then concentrates in the gallbladder. An agent is then given that will cause the gallbladder to contract and empty. A diseased gallbladder does not do this very well and so this test can indicate a gallbladder problem. There are other tests available for difficult cases.
BELCHING is the result of too much air in the stomach. It gets there by being swallowed with food or liquid. The stomach releases it by forcing it up the windpipe in a belch. Occasionally, it is necessary to treat excessive belching with medicine. In most cases, however, patients can reduce belching by following simple lifestyle changes to correct the causes.
- BLOATING for most people is simply the sensation of stuffiness. However, for some it can feel painful. Usually bloating is a result of poor motility. Motility refers to the contractions that automatically move food through the digestive tract. Poor motility slows the movement of food through the stomach and intestinal tract. Bloating is often part of irritable bowel syndrome, a condition in which there is disorganized motility and spasm of the bowel. For this reason, the physician may perform tests, including x-rays and endoscopy.
- RECTAL GAS is most often produced by bacteria in the colon. There are literally hundreds of different bacteria normally present in the colon. Most are harmless. In fact, they are even beneficial to digestion. In the process of breaking down nutrients, bacteria generate gases such as hydrogen, carbon dioxide, and methane. Under normal conditions, many of these gases are reabsorbed and do not cause excessive gas.
What is GERD? Gerd is a very common disease of the digestive tract that is characterized by the reflux of gastric fluid from the stomach back up to the esophagus or swallowing tube. Approximately 15% of the adult population suffers from GERD and it occurs equally between men and women. frequent heartburn. Characteristic symptoms of GERD include:
- Frequent heartburn
- Difficult or painful swallowing
- Sour or bitter taste in the mouth from the reflux of stomach fluids
- Nighttime wheezing or coughing
- Feeling like you need to clear your throat repeatedly
Usually some or all of the symptoms worsen after eating, or when bending over or lying down. Occasionally heartburn is common in all of us, however, frequent or regular heartburn accompanied by other symptoms should alert you to the possibility of GERD.
What is the cause of GERD? To understand the cause of GERD it is important to understand the process of digestion. Normally, when we eat food, it passes from the mouth down through the esophagus (swallowing tube) and into the stomach. At the junction of the esophagus and the stomach there is a valve known as the lower esophageal sphincter or LES. The LES normally opens just long enough to allow food to pass from the esophagus to the stomach and then closes to prevent food from refluxing back into the esophagus. In patients who suffer from GERD there is generally a malfunction of the LES that allows stomach juices to flow back into the esophagus. Most commonly this malfunction is a transient relaxation of the LES but it can also be an anatomic malfunction caused by a hiatal hernia. In a very small percentage of people the LES is simply to weak to do its job. Regardless of the cause there is unwanted reflux of stomach contents into the esophagus.
What are the complications associated with GERD? If left untreated, GERD can cause serious complications. The chronic reflux of stomach acids into the esophagus can result in inflammation, ulcers, or stricture of the delicate esophageal tissue. Stricture of the esophagus occurs secondary to the chronic inflammation caused by the chronic reflux of stomach acids. This complication can progress to the point where it becomes difficult to swallow food. If this occurs it may become necessary to undergo esophageal dilatation to open the area of stricture. Barrett's esophagus describes a complication of GERD where there are actual precancerous changes in the tissue that lines the esophagus. Once Barrett's esophagus is diagnosed it becomes very important to undergo regular biopsies of the esophagus as there is an increased risk for the development of esophageal cancer. Because the complications associated with GERD can be so serious, it is important to recognize the problem and implement appropriate treatment in the early stages of the disease in order to prevent these more serious consequences.
What is the treatment for GERD? The focus of the treatment for GERD is to neutralize the stomach acids, reduce the volume of acid in the stomach, hasten the passage of food into the small intestine, and increase the tone of the LES. Your doctor, by prescribing different medications, a change in dietary habits, and a change in lifestyle can help reduce or eliminate reflux and the symptoms associated with GERD.
Hemorrhoids are enlarged veins which occur around the anus and rectum. They may be external or internal and can be felt or seen as lumps or knots.
Conditions which contribute to hemorrhoids are:
- Poor Bowel Habits
- Frequent straining when having a bowel movement
Some patients do not suffer from these conditions and still develop hemorrhoids.
What are the complications?
- Itching and Irritation
Treatment of Hemorrhoids
- Keep anal are clean
- Keep anus and hemorrhoids as dry as possible
- Eat a high-fiber diet
- Avoid straining when having a bowel movement
- Hot sitz baths
- Ligation - A common method of treating internal hemorrhoids by using a small rubberband to tie off the base of the swollen vein. While under treatment, the blood circulation to the hemorrhoid stops and the hemorrhoid later falls off.
- Infared Photocoagulation - An infared light source is used to coagulate the internal hemorrhoidal vein.
- Lasers - A laser directs a high-intensity light beam at tissue and produces great heat, thereby coagulating the hemorrhoid. This technique is still in the research phase, but may have applications in the future.
- Alcohol - Binge drinking can inflict an acute hepatitis injury on the liver.
- Drugs - Certain drugs can injure the liver.
- Autoimmune Disorders
- Hereditary Conditions
- Loss of taste in food
- Loss of taste in cigarettes
- Heaviness in the right-upper abdomen
- Jandice - with acute B hepatitis
- Blood tests
- Liver Biopsy
Treatment No specific treatments are available for acute viral hepatitis. Fortunately, in most cases the body develops antibodies that fight and kill the virus. For alcohol and drug-induced hepatitis, the patient has to avoid the offending agent.
Chronic Phase The liver smolders with persistent inflammation. These patients must be followed closely. Effective treatment is available for many types of chronic hepatitis.
Contagion and Spread Contaminated water and poor sanitation provide easy transmission for these viruses. In addition, during acute phases, all body secretions are infectious.
Vaccination Passive and active vaccines are now available against hepatitis A and B.
Hiatus Hernia In some people, the hiatus or hole in the diaphragm weakens and enlarges. It is not known why this occurs. It may be due to heredity, while in others it may be caused by obesity, exercises such as weightlifting, or straining at stool. Whatever the cause, a portion of the stomach herniates, or moves up, into the chest cavity through this enlarged hole. Hiatus hernias are very common, occurring in up to 60 percent of people by age 60.
Diagnosis of a hiatus hernia is typically made through an upper GI barium x-ray. A complementary test is gastroscopy, or upper GI endoscopy, in which the physician visually examines the esophagus and stomach.
What is Inflammatory Bowel Disease? IBD is a group of chronic disorders of the bowel that are characterized by inflammation or ulceration of the large and small intestines. IBD is a true inflammation of the intestine that can result in the following :
- Cramping abdominal pain
- Elevation of the white blood cell count
IBD can be confirmed by a barium x-ray or by a colonoscopy procedure.
there different types of IBD?
The common types of IBD include:
- Ulcerative Colitis
- Crohn's Disease
Is there a differnce between Ulcerative Colitis and Crohn's Disease? Although ulcerative colitis and Crohn's disease cause very similar symptoms they exhibit some distinct differences. Ulcerative colitis causes ulceration and inflammation of the inner lining of the colon and rectum, and very rarely extends into the small intestine. Crohn's disease effects not only the superficial lining of the intestine, but also extends into the deeper layers of the intestinal wall. Unlike ulcerative colitis, Crohn's disease can involve the small intestine and in some instance inflammation of the mouth, esophagus, stomach, and appendix.
What causes IBD? There are many theories regarding causes of IBD, however, the exact cause of IBD has yet to be proven. The current prevailing theory suggests that IBD occurs secondary to a viral, bacterial, or allergic process that results in the production of antibodies that attack the intestine, thus resulting in inflammation. IBD also exhibits a family or genetic predisposition as 10 to 20 percent of the patients with IBD have a close family member that has the disease. Stress, although it may increase the severity of IBD, is probably not a major cause of the disease.
How is IBD diagnosed? If you are exhibiting symptoms of IBD your doctor will most likely perform a complete physical exam, including blood tests and stool tests. A colonoscopy procedure that allows visualization of the intestinal lining will be performed and biopsies of the intestinal lining will be taken. The colonoscopy and biopsies (tissue samples) will help determine if you have ulcerative colitis or Crohn's disease. It will also help determine the extent and severity of the IBD.
What is the treatment for IBD? The majority of patients with IBD can be treated on an outpatient basis with drugs that have been proven helpful in treating the inflammation. Occasionally, severe cases of IBD require hospitalization for more aggressive treatment with intravenous medications and fluids. Complicated cases of IBD may also require surgical intervention with removal of the intestine or removal of the entire colon. Fortunately, the majority of patients with IBD can be treated without surgical intervention.
Irritable Bowel Syndrome (IBS) is a common disorder of the intestines that leads to crampy pain, gassiness, bloating, and changes in bowel habits. IBS effects the entire gastrointestinal tract , but especially the colon.
When does IBS occur? IBS occurs when the colon does not contract properly. Instead, it contracts in a disorganized and, at times, violent manner.
What causes IBS? The cause of IBS is not known. It is often called a functional disorder because there is no sign of disease when the colon is examined. IBS causes a great deal of discomfort and distress, but it does not cause permanent harm to the intestines and does not lead to intestinal bleeding of the bowel or to a serious disease such as cancer.
- Examination of the patients medical history
- Lab tests
- Stool Samples - to check for the presence of blood
The treatment of IBS is directed to both the bowel and the emotional/stress aspects. The diet requires review, as there may be foods that aggravate symptoms. Eating causes contractions of the colon. Normally, this response may cause an urge to have a bowel movement within 30-60 minutes after a meal. In people with IBS, the urge may come sooner with cramps and diarrhea.
Stress also stimulates colonic spasms in people with IBS. This process is not clearly understood, but scientists point out that the colon is controlled partly by the nervous system. Mental health counseling and stress reduction can help relieve the symptoms of IBS. It is important to note that this does not mean IBS is the result of a personality disorder or problem.
Proper diet is important. Increasing dietary fiber and eating smaller meals or smaller portions may help decrease symptoms.
Specific medications and exercises may be prescribed by the physician.
Lactose Intolerance Lactose intolerance is a condition in which the body is not capable of properly digesting lactose. Lactose is a complex sugar that is found in milk and in all other dairy products. Lactose can also be found in many processed foods. Lactose intolerance has also been associated with numerous prescription and non-prescription medications since lactose is used as a filler in the production of many of these medicines.
Why can't the body digest the lactose? Normally lactose, like other sugars, is broken down by an intestinal enzyme (lactase) so that it can then be used as fuel by the body. When there is a deficiency or absence of the lactase enzyme in the small intestine the body cannot properly digest and utilize this complex sugar. The reduced or absent lactase activity in the small intestine can occur secondary to other diseases affecting the intestines. Approximately 75 percent of the American adult population develops some degree of lactose intolerance. Lactose intolerance is most common in the African-American and Asian populations.
What are the symptoms associated with lactose intolerance? The symptoms of lactose intolerance may include nausea, bloating, abdominal cramps, gas, and diarrhea. The symptoms normally begin to develop approximately 30 minutes to 2 hours after ingesting lactose containing foods. When undigested lactose reaches the large intestine it is broken down by bacteria resulting in acid containing by-products. These acidic by-products are responsible for producing the symptoms of lactose intolerance. The severity of the symptoms is normally related to the degree of lactose defiance and the amount of lactose ingested.
How is lactose intolerance diagnosed? If you experience symptoms of lactose intolerance you should consult your physician for a definitive diagnoses. There are other more severe digestive diseases that may have symptoms similar to the symptoms of lactose intolerance. Your physician, after reviewing your history, physical, and necessary tests can exclude the more serious causes associated with your symptoms. There are several relatively simple tests that your doctor can utilize to determine if you have lactose intolerance.
What is the treatment for lactose intolerance? Treatment for lactose intolerance will depend on the severity and tolerance of the symptoms that develop after ingesting foods containing lactose. Some individuals may experience relief simply by reducing milk consumption. Individuals with more severe symptoms may need to completely eliminate lactose containing foods from their diet. Many groceries now carry lactose free products in the specialty sections of their stores. Your physician can help you develop a diet to help you avoid food products containing lactose. Along with diet restrictions, there are now over-the-counter lactose enzyme tablets available that can be taken with meals to aid in the digestion of foods containing lactose. Since a high percentage of daily calcium requirements come from lactose containg food (milk), individuals on lactose restricted diets may require calcium supplements. Again, your physician can help determine if a dietary calcium supplement is necessary.
Although lactose intolerance is not a life threatening condition, it can certainly be an annoying condition because of the symptoms associated with it. If you are suffering from any of the aforementioned symptoms you should consult your physician to rule out the possibility of more severe gastrointestinal diseases. If the diagnosis of lactose intolerance is made your physician can provide you with the necessary guidance for minimizing or eliminating your symptoms.
Liver Disease When we talk about liver disease, most people entertain visions of the alcoholic who has abused alcohol to the point where the liver no longer functions. Alcohol can in fact cause liver disease, however, there are many other causes of liver disease such as Hepatitis and Wilson's disease which is inherited.
What are the symptoms of Liver Disease? The signs and symptoms of early liver disease are many times very subtle and non-specific. Some people in the very early stages of liver disease may not experience any symptoms at all. Others may experience flu like symptoms that might include fatigue, fever, muscle and joint aches, loss of appetite, and nausea. Other symptoms that should alert you to seek medical attention include darkening of the urine, jaundice, easy bruising or bleeding.
What kind of Liver Disease does alcohol cause? Alcohol can cause an acute liver disease as well as permanent liver damage. "Fatty liver" can occur in the earliest stage of alcoholic liver disease but can go unrecognized because it is usually not associated with symptoms. Fatty liver caused by alcohol consumption is reversible if the consumption of alcohol is discontinued. A more serious consequence of alcohol toxicity is alcoholic hepatitis. Alcoholic hepatitis causes inflammation of the cells of the liver and in many cases will present itself after an episode of binge drinking. With alcoholic hepatitis the normal functions of the liver are impaired and in some cases alcoholic hepatitis can be fatal. If alcoholic hepatitis is detected and treated early, it is possible to prevent the more serious consequences of cirrhosis. With alcoholic cirrhosis, permanent damage of the liver occurs. Normal liver cells are damaged and replaced with scar tissue. Once cirrhosis occurs in the liver, it is no longer capable of performing its' normal functions. Unfortunately, at this point, the alcohol induced damage is irreversible.
Causes of rectal bleeding:
- Fistula- an abnormal, burrowing channel that usually runs from the rectum to the skin around the anus.
- Fissure- tears in the lining tissue of the anus caused by the passage of a hard stool or severe diarrhea.
- Proctitis and Colitis
- Polyps and Cancer
- Protrusion from the rectum
DiagnosisThe physician will inspect the anal area looking for tears and hemorrhoids. A finger exam can provide information when there is tenderness or a tumor inside. In men, the prostate is also examined. A colonoscopy or flexible sigmoidoscopy are used to visually examine the colon using a lighted, flexible endoscope.