What is #Digestive #Diseases
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DIGESTIVE DISEASES

The digestive system is a group of organs working together to convert food into basic nutrients and energy to feed the entire body. The food we eat passes through a long tube inside the body known as the alimentary canal or otherwise called the gastrointestinal (GI) tract. The alimentary canal is made up of the oral cavity, pharynx, esophagus, stomach, small intestines, and large intestines. Besides the alimentary canal, several other important accessory organs help the body to digest food but do not have food pass through them. Accessory organs of the digestive system include the teeth, tongue, salivary glands, liver, gallbladder, and pancreas.

To achieve the goal of providing energy and nutrients to the body, six major functions take place in the digestive system:

Ingestion - The process of taking in food through the mouth. In vertebrates, the teeth, saliva, and tongue play important roles in mastication (which prepares the food into bolus). While the food is being mechanically broken down, the enzymes in saliva begin to chemically process the food as well.

Secretion - Secretion is the movement of material from one point to another (e.g. secreted chemical substance from a cell or gland).

Mixing and movement – This occurs in the stomach as a result of smooth muscle contraction. These repetitive contractions usually occur in small segments of the digestive tract and mix the food particles with enzymes and other fluids.

Digestion - Digestion is the breakdown of large insoluble food molecules into small water-soluble food molecules so that they can be absorbed into the watery blood plasma. In certain organisms, these smaller substances are absorbed through the small intestine into the blood stream.

Absorption - Digested food molecules are absorbed in the small intestine. This means that they pass through the wall of the small intestine and into our bloodstream. Once there, the digested food molecules are carried around the body to where they are needed.

Excretion - Excretion, the process by which animals rid themselves of waste products and of the nitrogenous by-products of metabolism.

Digestive Disorders

Many diseases and health conditions - such as ulcers, GERD, IBD and celiac disease, just to name a few - lead to dysfunction in our digestive system.   In everyone's life a little digestive distress will occur. It could be a meal that does not agree with us or a lingering gastrointestinal ailment that requires lifestyle changes and treatment, digestive problems are extremely common, afflicting many people. Here are some of the most common gastrointestinal problems and what can be done about them.

  • Chronic Diarrhea - Diarrhea is never the topic of polite conversation, but when it happens, it is almost impossible to ignore. Occasional urgency to go is normal, but loose stool often three or more times a day that lasts for at least four weeks could be a serious cause for concern. Treating diarrhea can be tricky because it can have so many possible causes. It could be a result of the body's inability to absorb foods (e.g. celiac disease and foods containing gluten), or a disease or disorder, like irritable bowel syndrome (IBS), Crohn's disease or ulcerative colitis. Viral Infections and even parasites can also be blamed sometimes. Chronic diarrhea can be an indication of a more serious problem that may need medical intervention and should be evaluated by a medical professional.
  • Irritable Bowel Syndrome (IBS) - People sometimes confuse IBS with IBD. IBS is abdominal pain that occurs at least three times a month for three months in a row. One also might have constipation or diarrhea. Unlike IBD, IBS doesn't harm the digestive tract. Treatment may include eating smaller meals and avoiding foods that cause symptoms. Some people use laxatives, fiber supplements, or probiotics to treat IBS.
  • Gastro esophageal Reflux Disease (GERD) - Heartburn occurs occasionally, but if it happens regularly to an individual, he/she may need to be evaluated for GERD. A doctor can often diagnose GERD based on a description of symptoms, but if the problem has been ongoing over a period, additional diagnostic testing may be necessary to evaluate if the disease has caused damage to the esophagus. GERD most often presents as ordinary heartburn, but uncontrolled GERD can erode the lining of the esophagus and lead to bleeding. The condition can also cause pain in the chest so extreme that it is sometimes mistaken for a heart attack. Controlling GERD usually begins with simple lifestyle changes, including avoiding food for at least two hours before bedtime.
  • Chronic Constipation - Typically defined as having fewer than three bowel movements a week for three weeks or longer. It could also be that stools are hard and difficult to pass. Like diarrhea, the cause of chronic constipation can also be difficult to diagnose. Treating the condition can begin with over-the-counter stool softeners and fiber supplements for example. Adding more fluids (e.g. water) to one's diet may help.
  • Gastroenteritis - With symptoms like a fever, vomiting, diarrhea and headaches, most people call this the stomach flu. Gastroenteritis is caused by an infection in the gut. These bacterial infections can be caused by E. coli or salmonella, while viral infections can include rotavirus or norovirus. Parasites, too, can cause gastroenteritis. If the symptoms last for a few days, the best advice is to drink plenty of fluid to avoid dehydration and try to make the best of it. Use good hand hygiene to prevent spreading the infection and, if at all possible, ask others not to use the same bathroom facilities until all symptoms stop.
  • Gluten Sensitivity and Celiac Disease – The symptoms of gluten sensitivity and celiac disease are similar. They both include diarrhea, bloating, and abdominal pain. Gluten sensitivity is relatively common. Because of similarity in symptoms it is important to see a doctor for a proper diagnosis. Unlike gluten sensitivity, celiac is an autoimmune disease that can damage the small intestine.
  • Ulcers - Research in recent years indicates that peptic ulcers are most likely caused by either bacteria in the stomach or heavy use of over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs). The bacteria or NSAIDs can damage the mucus that lines the inside of the stomach, exposing the interior of the stomach to acid which irritates the tissue and causes the peptic ulcer. Essentially a sore on the inside of the stomach, these can be very difficult to resolve because of the constant exposure to stomach acid. Untreated, ulcers can not only cause pain, but may bleed, leading to anemia.
  • Hemorrhoids - There are several causes for these small, swollen rectal veins, beginning from straining during bowel movements through family history to just plain spending too much time sitting on the toilet seat. Hemorrhoids tend to cause pain or itching around the anus. One may notice a hard knot near the anus or even bright red blood in the toilet bowl.
  • Inflammatory Bowel Disease (IBD) – This refers to long-lasting inflammation in the digestive tract. Crohn's disease and ulcerative colitis are the two most common types of inflammatory bowel disease. They are autoimmune diseases, which means there is an abnormal immune system reaction. IBD causes irritation and swelling, resulting in diarrhea, abdominal pain, loss of appetite, fever, and weight loss. Crohn's disease mainly affects the end of the small bowel and the beginning of the colon. Ulcerative colitis affects just the colon and rectum. Sometimes surgery is necessary.
  • Diverticular Disease - Diverticular disease includes diverticulosis (small pouches that form in the wall of the colon and become inflamed). Many people ages 60 to 80 have this condition. One may feel bloated, constipated, or pain in the lower abdomen.

CAUSES

Many different factors can cause digestive diseases. Causes could be bacterial or viral infection, inflammation, lactase deficiency, digestive problems, poor circulation to the intestines and or other organs, ruptured or perforated organs, muscle dysfunction, gallstones, stress, etc.

  • Food allergies and food intolerance - Certain foods can cause allergic reactions, (e.g. swelling of the lips, mouth, and the back of the throat). They can also lead to nausea and vomiting, but this will take longer to develop.
  • Dietary factors - May include overeating, eating too much fatty food, not consuming enough fiber, and consuming too much alcohol.
  • Smoking - Can also contribute to some digestive diseases, including ulcers and gastric acid reflux. Some digestive disorders are long-lasting and serious, whereas others resolve themselves in a few days and have no permanent effects.
  • Poor diet - A diet low in fiber, fried and sugary foods and fatty foods and can cause stool to pass slowly through the colon. Inadequate water intake can also lead to constipation, and this can contribute to many other digestive disorders.
  • Genetic causes - Some digestive diseases like colon cancer, Crohn's disease, type 1 diabetes, pancreatic cancer, hypothyroidism, cystic fibrosis, coeliac disease and some liver diseases are thought to be hereditary.
  • Structural causes - A structural abnormality in the digestive system (such as the pouches that develop in the intestines of someone with diverticulosis) can hamper the working of the digestive system. An ulcer in the stomach lining or the intestines would be another example.
  • Viral or bacterial infection and parasites - Bacteria, viruses and parasites can get into the digestive system by means of contact with contaminated surfaces, or contact with infected stools and then ingesting the germs or from eating infected food or drinking infected water.   
  • Inflammation and auto-immune diseases - These disorders, in which the immune system attacks and harms the body's own tissues, can involve any part of the digestive system. Auto-immune diseases that affect the digestive tract include systemic lupus erymathosus, rheumatoid arthritis to name but a few.
  • Cancer - Gastro-intestinal cancer is term for the group of cancers that affect the digestive system. Examples are cancers of the throat, gallbladder, liver, pancreas, stomach, small intestine, large intestine and anus. Cancer is a malignant growth or tumor caused by an uncontrolled division of cells.
  • Ageing - Unfortunately the gastrointestinal system ages with the rest of the human body. Our saliva decreases, taste is affected, reflux gets worse, motility if affected, diverticular disease develops, etc.  
  • Post-surgical effects - Surgery most of the time changes the anatomy of the digestive tract. Problems include chronic diarrhea after gall bladder surgery or resection of part of the bowel, pain or even obstruction of the bowel etc.
  • Lifestyle choices - High stress levels, lack of exercise, smoking, and drinking can all affect the digestive system. A healthy lifestyle and diet choices can relieve the severity and the frequency of episodes of this disorder.
  • Side effects of medication - Many medicines, (e.g. certain antibiotics and NSAIDs and certain diabetes medications), can have side effects that involve the digestive system. Nausea, diarrhea, ulceration and constipation count among these.
  • Functional problems – Commonly, patients experience symptoms related to the gastro-intestinal system, but the tests return normal results. This can be frustrating to both patient and doctor.
  • Systemic diseases - Many systemic diseases affect our gastrointestinal system, such as autoimmune diseases (i.e. scleroderma that affects the motility of the gut).

SYMPTOMS

The signs of digestive disease often includes one or more of the following symptoms:

  • Asthma – When a person's airways narrow and swell and may produce extra mucus.
  • Bloating - When the belly feels swollen after eating
  • Constipation - When bowel movements become less frequent
  • Diarrhea - Loose and watery stool during a bowel movement
  • Heartburn - When some of the stomach contents are forced back up into the esophagus.
  • Regurgitations - The action of bringing swallowed food up again to the mouth.
  • Incontinence - Urinary incontinence means a person leaks urine by accident.
  • Nausea and vomiting - Nausea is the urge to vomit, Vomiting is the forcible voluntary or involuntary emptying of stomach contents
  • Pain in the belly - Pain that one feels anywhere between the chest and groin.
  • Swallowing problems – When a person has trouble getting food or liquid down his throat.
  • Weight gain or loss – An increase or loss in body weight
  • Chronic cough, frequent hiccups - A cough is a voluntary or involuntary act that clears the throat. Hiccups are involuntary contractions of the diaphragm
  • Bad breath – Unpleasant odor of the mouth

WHEN TO SEE A DOCTOR

It may be time to schedule an appointment with a gastroenterologist when digestion problems fail to resolve with changes to one's lifestyle. Ongoing problems could indicate health issues that may need medical attention. These may include:

  • Gallstones
  • Acid reflux
  • Severe viral or parasitic infections
  • Crohn's disease
  • Celiac disease
  • Colitis
  • Ulcerative colitis
  • Irritable bowel syndrome (IBS)

These are issues that cannot be resolved without medical attention.

Individuals should see their doctor immediately they experience severe abdominal pain, bloody stools, or unintentional weight loss.

Risk factors

Anyone can suffer from occasional digestive disorders, but some people are more at risk:

  • Pregnant women
  • People who are into endurance sports
  • People with anxiety or depression
  • People with other chronic diseases

DIAGNOSING DIGESTIVE DISEASES

In order to reach a diagnosis, a thorough and accurate medical history will be taken by the physician, noting the symptoms being experienced and any other pertinent information. A physical examination will also done to help assess the problem more completely. Some patients may need to undergo a more extensive diagnostic evaluation, which may include laboratory tests, imaging tests, endoscopic procedures, and other procedures.

These tests may include any, or a combination of, the following:

LABORATORY TESTS

  • Fecal occult blood test - Checks for hidden blood in the stool. A very small amount of stool is placed on a special card, which is then tested in the physician's office or sent to a laboratory.
  • Stool culture - A stool culture checks for the presence of abnormal bacteria in the digestive tract that may cause diarrhea and other problems. A small sample of stool is collected and sent to a laboratory by the physician's office.

IMAGING TESTS

  • Ultrasound - A diagnostic imaging technique that uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. An ultrasound is used to view internal organs as they function, and to assess blood flow through various vessels. A picture or video tape of the test is usually made so it can be reviewed in the future.
  • Computed tomography scan (CT or CAT scan) - This diagnostic imaging procedure uses a combination of x-rays and computer technology to produce cross-sectional images, both horizontally and vertically, of the body. CT scans are more detailed than x-rays.
  • Magnetic resonance imaging (MRI) - MRI is a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. The patient lies on a bed that moves into the cylindrical MRI machine. The machine takes a series of pictures of the inside of the body using a magnetic field and radio waves. The computer enhances the pictures produced.
  • Oropharyngeal motility (also called modified barium swallow) study - During this test, the patient is given small amounts of a liquid containing barium. This is a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an x-ray.
  • Upper GI (gastrointestinal) series and small bowel follow-through series - A diagnostic test that examines the organs of the upper part of the digestive system: the esophagus, stomach, duodenum (i.e. the first section of the small intestine), and small bowel. A fluid called barium is used to coat the inside of organs so that they will show up on an x-ray) is swallowed.
  • Lower GI (gastrointestinal) series (also called barium enema) - A lower GI series is a procedure that examines the rectum, the large intestine, and the lower part of the small intestine. Again barium is used to coat the inside of organs so that they will show up on an x-ray) is placed into the rectum as an enema. An x-ray of the abdomen shows strictures (narrowed areas), obstructions (blockages), and other problems.
  • Radioisotope gastric-emptying scan - The patient eats food containing a radioisotope, which is a slightly radioactive substance that will show up on a scan. The dosage of radiation from the radioisotope is not harmful, but it allows the radiologist to see the food in the stomach and observe how quickly it leaves the stomach.
  • Colorectal transit study - This shows how well food moves through the colon. Capsules containing small markers which are visible on x-ray is swallowed. The patient subsequently follows a high-fiber diet during the course of the test, and the movement of the markers through the colon is monitored with abdominal x-rays.

OTHER PROCEDURES

  • Esophageal manometry - This test helps determine the function of the muscles in the esophagus. It is useful in evaluating swallowing abnormalities and other esophageal symptoms.
  • 24-hour catheter-based pH monitoring – This measures the levels of acid inside of the esophagus. It is helpful in evaluating gastro esophageal reflux disease (GERD).
  • 48-hour wireless pH monitoring - This test uses a tiny acidic probe that is attached to the wall of the esophagus. The probe communicates with a receiver that patients wear on their belt. This test is like the 24-hour catheter-based test because the patient is asked to participate in normal activity and to keep a diary of symptoms.
  • 24-hour catheter-based pH-impedance monitoring - An esophageal pH-impedance monitor measures not just the acidity inside of the esophagus but can also determine all reflux events even if the reflux is not acidic. The patient is encouraged to maintain normal activity levels during the study and to keep a diary of symptoms of activity that might seem like reflux, such as gagging or coughing, and any food that is eaten.
  • Anorectal manometry - This test helps determine the strength of the muscles in the rectum and anus. These muscles normally tighten to hold in a bowel movement and relax when a bowel movement is passed.

TREATMENT

Once a correct diagnosis has been made, treatment can begin. Below are possible treatments for digestive disorders:

  • Identifying problematic foods and lifestyle choices - particular foods exacerbate certain conditions (e.g. spicy food increases the level of discomfort experienced by those with stomach ulcers or GORD. Avoidance of certain foods may have to be a life-long decision, such as gluten in the case of those with Coeliac Disease. Smoking, drinking and a lack of exercise could also contribute to the severity of digestive diseases, and lifestyle changes may be necessary.
  • Medication - In the case of bacterial or parasitic infections, a short course of antibiotics may be prescribed. Antacids could be recommended for heartburn, and pain medication for abdominal pain caused by any of the digestive disorders. Certain conditions may require long-term medication and vigilance as far as diet is concerned. Anti-nausea medication and anti-diarrheal medication is available from the pharmacy without a prescription.
  • Surgery - Some digestive disorders (e.g. appendicitis) constitute a medical emergency. These are usually accompanied by acute abdominal pain, as in the case of an abdominal obstruction, or a ruptured organ. Gastrointestinal bleeding can also be life-threatening and can require immediate surgery. Surgery is also used to repair structural problems, such as hernias or blockages in the bile duct (gallstones), or certain ulcers. Surgery is used to remove tumors and many more.
  • Endoscopic treatment – This plays a major role in the diagnosis and management in cases of bleeding in the gastrointestinal systems. There are also endoscopic treatments available for reflux disease and achalasia, strictures in the gastrointestinal tract, removal of gall stones, etc.

PREVENTION

  • Eat more frequent meals - Many weight loss proponents advocate eating smaller, more frequent meals to help boost metabolism and keep one from overeating. This rule of thumb can also help prevent digestion problems. Aiming to consume five to six mini-meals a day can help promote overall good digestive health. One must make sure he/she eats a mix of carbohydrates, protein, and heart-healthy fat at each meal. People should avoid lying down after eating as it increases the risk of heartburn and nausea.
  • Eat more fiber -  Fiber is a key component when it comes to digestive health. It is the bulk in plant foods that cannot be digested. Soluble fiber creates a gel in the digestive tract to keep the tummy full, while insoluble fiber adds bulk to stools. At Diamed Diagnostic center, we recommend a total daily fiber intake of 38 grams for men under age 50, and 25 grams for women in the same age bracket. Adults over 50 will need slightly less fiber, with 30 grams a day for men and 21 grams for women. Fiber helps prevent digestion problems by regulating the system. Fiber is naturally available in:

Whole grains

Beans

Fruits

Vegetables

Legumes

  • Drink plenty of water - Water aids the digestive health by helping to cleanse the entire system. It is particularly helpful in preventing constipation because water helps soften stool. Furthermore, water may help the digestive system to absorb nutrients more effectively by assisting the body to break down food. Aim to drink eight glasses of water a day and skip the sugary drinks. Added sugars can make digestion problems worse.

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