Your digestive system is a marvel of engineering – it extracts all the nutrients and energy you need from the food you eat and you rely on it to fuel your body. But what happens when everything isn’t running as smoothly as it should? This week, Mediscene speaks with Dr. Sanjeewa Aryasingha, Consultant Gastroenterologist and Hepatologist about some of the most common problems patients bring into his examination room.
The symptoms listed have been linked to many different conditions and so it’s a good idea to have a physician examine you before rushing to any conclusions. While there’s more specific advice to come, we’ll start with a few general rules for maintaining good digestive health: eat a balanced diet rich in fibre and drink plenty of water. Avoid alcohol, stop smoking and go easy on the coffee…and you’ll find yourself the healthier for it.
Abdominal pain
Abdominal pain can have many different causes, both gastrointestinal and otherwise, says Dr. Aryasingha. Gastrointestinal causes could be traced to a condition such as appendicitis or be caused by the presence of gallstones. One of the most common causes, however, is gastritis. Gastritis occurs when there is inflammation of the inner lining of the stomach. Many patients complain of a burning sensation in their upper abdomen.
A diet too rich in spices or overconsumption of alcohol have all been known to trigger attacks of gastritis. Finding it difficult to cope with work or your personal life? That could contribute too. “When one has a lot of stress, it releases various hormones in the body which in turn cause increased secretions of hormones that affect the stomach,” says Dr. Aryasingha. Drugs, in particular, ones like aspirin, and pain killers have been associated with gastritis.
The most troublesome cause of gastritis however might just be the bacteria known as Helicobacter pylori. “It can persist for a long time and is thereby implicated in causing gastric cancer,” says Dr. Aryasingha, explaining that your doctor might have to test specifically for H. Pylori. While it’s worth giving over the counter antacids a shot, if your symptoms last more than 4 weeks or are particularly bad, you should consult a medical professional.
In addition, the appearance of serious symptoms such as vomiting blood or passing it as black stools, a gradual reduction in weight or trouble swallowing also necessitate a visit to the doctor sooner rather than later. Changes to your diet, severely restricted alcohol intake and a course of drugs might be prescribed. Untreated gastritis can lead eventually to ulceration and may even require surgery, cautions Dr. Aryasingha. These patients will require an endoscopy to look inside the stomach for a proper assessment of the condition.
Rectal bleeding
Seeing that spot of bright red blood in the toilet bowl can be a cause for immediate concern. The colour of the blood provides vital cues to your physician – bright-red blood means the bleeding has come from somewhere near your anus, but a dark stool could mean the bleeding is occurring higher up in your digestive system. Your doctor will have to examine you and consider other symptoms to fully understand the cause of the bleeding.
“If it happens once in a blue moon, you don’t have to worry about it, but if it persists for about a week or there are recurrent episodes you should consult a doctor,” advises Dr. Aryasingha. For many patients who come to him with this complaint, the cause turns out to be haemorrhoids or an anal fissure in the sensitive skin of the anus. Preventing constipation and ensuring that you don’t hurt yourself by straining can help relieve the symptoms.
Rectal bleeding must always be treated seriously however because it can be a sign of early colon cancer, says Dr. Aryasingha explaining that since colon cancer is so common, patients over the age of 45 should be screened for it. Changes in bowel habits, abdominal pain, rectal bleeding, unexplained weight loss and anaemia are also indicators of colon cancer. This type of cancer progresses slowly, typically beginning in the form of a benign polyp. If caught early, it is totally preventable and treatment offers a very good prognosis. If neglected, it can travel to the liver and elsewhere, becoming ever more dangerous. “We see many patients coming to us in advanced stages of the cancer,” says Dr. Aryasingha.
For others, the real problem might be an Inflammatory Bowel Disease or IBD such as ulcerative colitis or Crohn's disease. The former is predominantly a disease of the large intestine or colon while the latter commonly affects the last part of the small intestine and parts of the large intestine. Diarrhoea and abdominal pain are among the most common symptoms of both conditions. “They are chronic diseases which unfortunately have no cure. They can only be controlled,” says Dr. Aryasingha.
To identify the problem, your consultant might recommend a flexible sigmoidoscopy or a colonoscopy. Here a tiny flexible tube with a camera at the end is inserted up the back passage to allow the doctor to examine the interior carefully.
Peptic ulcers
Stomach ulcers and duodenal ulcers together are known as peptic ulcers. The most common type is called duodenal and it is found in the upper small intestine. Ulcers that form in the stomach itself are called gastric ulcers. While the former are almost always benign, stomach ulcers have the potential to become malignant, cautions Dr. Aryasingha. As in gastritis, injury of the gastric mucosal lining and weakening of the mucosal defences can lead to ulceration.
Sometimes, a simple asprin is the culprit for all the havoc; however, it can also be another attack of H. Pylori bacteria. Patients with ulcers complain of deep burning pain, says Dr. Aryasingha, adding that it is much more severe than that caused by gastritis. This intense discomfort can stretch from minutes into hours and many patients find themselves waking from a deep sleep because of it. This pain is often misinterpreted as indigestion or hunger but ulcers also cause bleeding, with blood showing up in vomit or in stools.
A doctor will have to take a look at the stomach from inside to be able to make a correct diagnosis. It’s worth noting that cigarette smoking has been linked to ulcer formation as well as to the failure of ulcer treatments.
Many powerful drugs exist for the treatment of ulcers, says Dr. Aryasingha, explaining that these are used to stop the production of acid. Their first order of business is typically to stop bleeding and promote healing. Severe bleeding from ulcers may even require surgery if it cannot be controlled by doing an endoscopy.
Constipation
Constipation is one of the most common complaints and everyone is likely to have multiple episodes throughout their lives. Stools might be hard and dry or difficult to pass, but in most cases constipation lasts only a short while. However some patients complain of chronic constipation, says Dr. Aryasingha explaining that it can be linked to the worsening of conditions like haemorrhoids and anal fissures.
Relieving constipation can be as simple as increasing your consumption of fibre rich fruits and vegetables and drinking plenty of water every day. Regular exercise will also help. Your doctor will need to check if you are on certain medications that could aggravate the condition. It is not advisable to take laxatives often without proper medical advice, as this can worsen your condition in the long run. It’s worth noting that not everyone has a bowel movement every day, and this is alright. However, if there is a dramatic change in your bowel movements it would be a good idea to ask for a doctor’s advice.
Bloating
Does your belly feel full and tight? “Bloating, in simple terms, is mainly due to the build up of gas in the stomach and the intestines,” explains Dr. Aryasingha. Whenever we eat, we swallow air along with the solid parts of our food. “There are some people who inadvertently swallow a whole lot,” he says, adding, babies in particular do this often. This air is then moved through the digestive tract, and if you delay in emptying your stomach, it can collect there and cause significant discomfort. Chewing slowly, avoiding slurping and drinking from the glass instead of using a straw can help reduce the amount of air you swallow.
Another, sometimes more obvious cause of bloating is directly related to the kind of food we eat. Bacteria living in our guts break down our food and produce gas as a by-product. This happens especially with wheat flour based food, and while it isn’t a serious problem, it can cause a patient a great deal of discomfort. Dr. Aryasingha recommends that one avoid certain types of food – such as bread, buns, cakes and short eats. Another group, those heavy in starch such as potatoes and chickpeas can also cause gassiness.
Lactose intolerance has also been known to cause bloating but this is a rare condition in our country. Depending on the cause of the bloating, a doctor will recommend either a course of drugs or appropriate lifestyle changes. |
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