Disorders of the Digestive System

Reflux
Symptoms of reflux , such as heartburn, are among the most common
digestive ills. In a Swedish study, 6 percent of people reported experiencing reflux
symptoms daily and 14 percent had them at least weekly. Such frequent symptoms
may indicate a person has GERD, or gastroesophageal reflux disease. Aside from
being painful, GERD can harm the esophagus over time or even lead to esophageal
cancer. Heartburn typically involves a "hot or burning feeling rising up from the
center of the abdomen area and into the chest under the breastbone or sternum," says
Michael Gold, a gastroenterologist at MedStar Washington Hospital Center in
Washington, D.C. "It may be accompanied by a sour taste in the mouth, or
hypersalivation, or even finding food or fluid in your mouth," particularly at night.
Pregnancy, some medications, and consuming alcohol or certain foods can cause
heartburn. Kids under age 12 and some adults may have GERD without heartburn,
instead experiencing asthma-like symptoms, trouble swallowing, or a dry cough.
Treatment options include drugs that reduce acid levels, such as the proton pump
inhibitors Aciphex, Nexium, Prevacid, Prilosec, and Protonix and the H2 blockers
Axid, Pepcid, Tagamet, and Zantac. But taking medication is not without risk. In
2008, a study found that a proton pump inhibitor may weaken the heart-protective
effect of the blood thinner Plavix in patients taking both medications. In severe cases
of GERD, surgeons can tighten a loose muscle between the stomach and esophagus to
inhibit the upward flow of acid. Laparoscopic surgery, which involves small incisions,
has been found to lessen scarring and shorten recovery time compared with open
procedures.
Peptic Ulcers
If you have unexplained stomach pain, consider this before reaching for a
painkiller: "The worst thing to do if ulcers are suspected is to take aspirin or other
NSAID [nonsteroidal anti- inflammatory drug] pain reducers," Gold says. "They
worsen it and don't help." Instead, if you think you have a peptic ulcerand 25
million living Americans will get one at some pointconsider getting tested for
Helicobacter pylori , experts advise. By disrupting a protective layer of mucus, that
bacterium causes ulcers, which are sores in the lining of the stomach or first stretch of
the small intestine. Other causes include smoking, which can elevate stomach acidity,
and excessive NSAID use. Alcohol use may also be a factor, but it's unclear whether
that alone can cause ulcers. (The old theory blaming factors like stress isn't totally
wrong: Stress can aggravate symptoms of peptic ulcers and delay healing.) Left
untreated, ulcers can cause internal bleeding and may eat a hole in the small intestine
or stomach wall, which can lead to serious infection. Ulcer scar tissue can also block
the digestive tract. And long-term H. pylori infection has been linked to an increased
risk of gastric cancer. Ten to 14 days of antibiotic treatment, often combined with acid
reduction therapy, can rid someone of H. pylori. Surgery is an option for more severe

cases. A 2008 study published in the World Journal of Surgery concluded that
laparoscopic repair should be considered for all patients with so-called perforated
ulcers.
Gallstones
Only a quarter of people with gallstones typically require treatment. That's
fortunate, because every year nearly 1 million Americans are diagnosed with these
little pebbles, which are primarily made of cholesterol and bile salts. Getting rid of
them typically requires removal of the gallbladder, one of the most common U.S.
surgeries. Gallstones can get blamed for symptoms caused by other, more elusive
culprits, such as irritable bowel syndrome, says Robert Sandler, chief of the division
of gastroenterology and hepatology with the University of North Carolina School of
Medicine. An ultrasound test might pick them up while missing the real problem. If
you're told you need to have gallstones out but they're not bothering you, get a second
opinion, he advises. Removal may be necessary if the stones instigate inflammation or
infection of the gallbladder, pancreas, or liver. This can happen if a stone moving out
of the gallbladder gets stuck blocking the flow of bilein the ducts between the
liver and the small intestine. The pain of a gallstone lodged in a duct usually comes on
quicklyin the right upper abdomen, between the shoulder blades, or under the right
shoulderand means a trip to the ER is needed, as may fever, vomiting, nausea, or
pain lasting more than five hours. Gallbladder removal can be performed
laparoscopically and more recently has been done without an external incision by
going through the mouth or vagina. Obesity is a risk factor for gallstones, and it's
theorized that they develop because of a shortage of fiber and an excess of fat in the
western diet. Losing weightthen regaining italso seems to set the stage for
gallstones. In a 2006 study of men, the more frequent the weight cycling and the
larger the number of pounds shed and regained, the greater the odds of gallstones.
Women, especially those who are pregnant or taking birth control pills, face increases
in gallstone likelihood as well.
Lactose Intolerance
Between 30 million and 50 million Americans are lactose intolerant, meaning
they lack an enzyme needed to digest the main sugar in milk, and African-Americans,
Asians, and American Indians are most likely to have the condition. Ranging in
severity from person to person, symptoms include cramping, bloating, gas, nausea,
and diarrhea. These usually occur 30 minutes to two hours after one drinks or eats a
dairy product. Doctors can test for lactose intolerance using a breath test, which
detects heightened levels of hydrogen; a blood test, before which the patient drinks a
lactose-containing beverage; or a test of stool acidity (which undigested lactose helps
generate). here's also a cheaper, do-it-yourself approach to diagnosis, Bickston says.
"Buy a tall container of milk, drink it, and call me the next day and tell me how the
afternoon was," he says. If you experience bloating, abdominal pain, or diarrhea, he
says, you're probably lactose intolerant. If so, don't despair. Over-the-counter pills can
replace the missing enzyme, called lactase, and some milk and milk substitutes are

lactose-free. Avoiding all dairy products, in any case, may not be necessary. Many
lactase-deficient people "can tolerate small amounts of lactose," Bickston says.
Diverticulitis
By one estimate, 3 in 5 Americans older than 70 have the abnormal bulges
called diverticula somewhere in the wall of their intestinal tract. Yet only 20 percent
will ever experience a complication like diverticulitis (inflammation of a pouch), a
tear, or an abscess. Doctors have long advised people with diverticula to avoid nuts,
corn, and popcorn for fear those foods would get lodged in a pouch during digestion
and wreak havoc. But in 2008, research published in the Journal of the American
Medical Association found that regular consumption of these foods did not boost the
risk of diverticular complications. In fact, eating plenty of nuts and popcorn seemed to
lower risk. When diverticulitis does arise, it's very likely to make its presence known
through abdominal paintypically in the lower left quadrant in westerners, but often
on the right side in Asiansand possibly fever; antibiotics can treat the condition. In
extreme cases, a tear can lead to an abscess, which can cause nausea, vomiting, fever,
and intense abdominal tenderness that requires a surgical fix. Some experts believe a
diet too low in fiber may trigger the condition, which grows increasingly common
with age and is most prevalent in western societies.
Inflammatory Bowel Disease
People with Crohn's disease or ulcerative colitis, the two most common
inflammatory bowel diseases , complain of abdominal pain and diarrhea and
sometimes experience anemia, rectal bleeding, weight loss, or other symptoms. No
definitive test exists for either disease, and patients endure two initial misdiagnoses on
average, says R. Balfour Sartor, chief medical adviser to the Crohn's & Colitis
Foundation of America. With Crohn's, he says, appendicitis, irritable bowel
syndrome, an ulcer, or an infection is often wrongly suspected. Both disorders may
arise from a wayward immune system that leads the body to attack the gastrointestinal
tract. Crohn's involves ulcers that may burrow deep into the tissue lining at any
portion of the GI tract, leading to infection and thickening of the intestinal wall and
blockages that need surgery. Ulcerative colitis, by contrast, afflicts only the colon and
rectum, where it also causes ulcers; colitis is characterized by bleeding and pus.
Treating either disease requires beating back and then continuously holding in
checkthe inappropriate inflammatory response. Both steps are achieved through
some combination of prescription anti-inflammatories, steroids, and
immunosuppressants. Crohn's patients may also be given antibiotics or other
specialized drugs. Of current hot debate is whether Crohn's sufferers benefit if given
highly potent drugs early in the course of treatment as opposed to escalating potency
over time from milder initial treatments, as is traditionally done, explains Themos
Dassopoulos, director of inflammatory bowel diseases at Washington University in St.
Louis. Surgery "cures" ulcerative colitis by removing the colon but means patients
must wear a pouch internally or externallyfor waste. IBD patients should take
special care when popping NSAIDs like aspirin, as these painkillers can trigger

further gut inflammation in 10 to 20 percent of patients, says Dassopoulos.

Celiac Disease
About 1 percent of the U.S. population has celiac disease, an autoimmune and
digestive disorder. Sufferers are unable to eat glutena protein found in rye, barley,
wheat, and morewithout triggering an attack on their small intestine. Symptoms
vary from person to person, but include: abdominal pain and bloating; chronic
diarrhea; vomiting; constipation; and pale, foul- smelling, or fatty stool. Doctors
typically diagnose it with blood tests and stool samples. While there's no cure, people
can manage celiac disease by adopting a gluten-free diet. Within several weeks,
inflammation in the small intestine will subsidethough accidently eating a product
with gluten could cause a flare-up at any time.
Constipation
The fact that Americans spend $725 million a year on laxatives suggests that
trying to unclog the nation's plumbing, so to speak, is almost a national pastime. But
overuse of stimulant laxatives, which cause the intestines to contract rhythmically, can
make the gut dependent, requiring more of the drug and eventually rendering the aid
ineffective. First, a bit of clarification on the, um, frequency of your flushing: There's
no need to obsess about having a daily bowel movement; anywhere between three
times a day and three times a week is normal, says Sandler. But if you're experiencing
discomfort and can't make your bowels move, try an over-the-counter remedy like
good old milk of magnesia, he says. And whether you've tried laxatives or not, going
a week without a bowel movement is good reason to visit the doc, says Sandler.
Constipation, hard stools, and straining could lead to hemorrhoids or an anal fissure.
Constipation is best avoided through regular exercise and a diet high in fiber from
whole grains, fruits, and vegetables. To older folks, who tend to get constipated more
frequently: Be sure you're hydrating properly and aware of any medications that
might be causing the holdup.
Gastroparesis
This is a condition that slows or inhibits the stomach's ability to empty its
contents, also known as delayed gastric emptying. It typically affects more women
than men, though the reason being is unknown. Most people with this condition have
not been diagnosed with a known cause, despite medical tests; this is called idiopathic
gastroparesis. For those with an identifiable cause, diabetes is the most common
culprit. High levels of blood glucose in diabetics over time can damage the vagus
nerve, which controls the stomach muscles and movement of food through the
digestive tract. Gastroparesis can affect those with both type 1 and type 2 diabetes.
Among the other identifiable causes are intestinal surgery and diseases of the nervous
system, like Parkinson's disease and multiple sclerosis. The most common symptoms
of gastroparesis include:
- Nausea

Feeling full after consuming a small amount of food

Heartburn
Abdominal bloating
In most cases, gastroparesis is a chronic, incurable condition. However, a
combination of nutritional changes and medication can help manage the severity of
symptoms. The best way to minimize how these disorders threaten your digestive
health is to learn their major symptoms and promptly report any that appear to your
doctor.