Gastrointestinal Disorders

Overview

Your digestive system is made up of hollow organs linked together in a long, twisting tube. It contains your esophagus, stomach, and small and large intestines and goes from your mouth to your anus. Involved organs include your liver, gallbladder, and pancreas. They produce juices that aid digestion. There are several sorts of intestinal problems. The symptoms differ greatly depending on the condition.

 

What is Gastrointestinal tract?

The gastrointestinal tract (also known as the GI tract) is a collection of hollow organs that create a long continuous path from our mouth to our stomach. A large network of blood veins both supplies blood to these organs and transports nutrients away from the body to other organs. Nerves and hormones work together to control digestive system function, and bacteria that live in our GI tract (called gut flora or microbiome) have a role in digestion, immunity, and general health. The digestive system organs are held in place by a membrane pouch called the peritoneum.

A variety of disorders or diseases can affect the GI system, affecting digestion and/or our general health. Some illnesses have identical symptoms, and more medical tests may be necessary before a doctor can make a diagnosis.

 

What are Gastrointestinal Disorders?

Gastrointestinal diseases are abnormalities of the digestive system, which is a large and complicated system that breaks down food to absorb water and extract nutrients, minerals, and vitamins for the body's needs, while also eliminating unabsorbed waste.

 

What causes Gastrointestinal conditions?

Common causes of gastrointestinal problems include:

A low fiber diet‍

Fiber, a kind of carbohydrate found in plants that cannot be digested, is essential for digestive health. It promotes fullness and assists in the digestion of certain meals. Everyone is talking about gut health - your microbiome health - and fiber plays a role in this. Fibers are a much-appreciated food source for the billions of good bacteria (your microbiota) that live happily in our large intestine and give several health advantages.

The total daily fiber recommendation for women is 25 grams, and for males under the age of 50, it is 38 grams. If you are above the age of 50, you should consume somewhat less (around 21 grams for women and 30 grams for men). The good news is that fiber is abundant in foods such as fruits (mostly in the skin), whole grains, legumes, beans, and vegetables.

A low-fiber diet can help reduce bloating and improve digestive issues ranging from constipation to stomach discomfort and even the beginning of colon cancer.

 

Being stressed

‍Stress and anxiety not only have an impact on your mental health; they can also have an impact on your digestive health, particularly the gut microbiota. Recent medical research has revealed that there is a well-established relationship between the GI system and the brain. Because the two are always in bi-directional connection, delivering messages to each other, the stomach possesses more neurons than the entire spinal cord.

Stress has been linked to a variety of digestive disorders, including appetite loss, inflammation, bloating, cramps, and changes in microbiota.

 

Not drinking enough water

Water is essential for digestive health since it aids in the cleansing of the whole gastrointestinal system. Water, in particular, softens the stool, which aids in constipation prevention. More importantly, water is believed to support your digestive system by aiding in the breakdown of food, allowing the GI tract to absorb nutrients more quickly and efficiently. You invite all kinds of stomach issues if you don't drink enough water.

You may acquire that 8 glasses of fluids a day by consuming unsweetened coffee, tea, or even sparkling water! Simply avoid sugary drinks such as soda! 

 

Eating a lot of dairy foods

Dairy is a relatively modern addition to the human diet; it was not consumed throughout the first 200,000 years of humanity's history. Milk and cheeses are often high in difficult-to-digest lipids and proteins that, according to some medical research, have a pro-inflammatory impact. As a result, eating a lot of dairy products might induce bloating, gas, constipation, and stomach cramps.

 

Inactive lifestyle

Inadequate physical activity is bad for your general health and digestive health. That is why doctors prescribe a mix of exercise, diet adjustments that avoid foods that increase inflammation while boosting intake of nutrients that combat inflammation, and medication when necessary to treat specific GI disorders.

 

Aging

Unfortunately, aging is inescapable, and it adds another risk factor for gastrointestinal diseases. Digestive gland activity declines as we age, impacting gut motility, reflux, and the development of some digestive diseases. The chance of getting malignancies of the digestive tract rises with age.

 

Genetic factors

Your genes are another inescapable factor! Many immunological and autoimmune gastrointestinal illnesses have a genetic component, which means they are passed down from generation to generation. In certain circumstances, these altered genes are all that is required to create a Gi disease (think cystic fibrosis, or hereditary pancreatitis). Fortunately, in most cases, they just predispose you to the condition, implying that environmental elements must be present. This implies that, while your genes play a role, they are not the complete picture. Lifestyle adjustments can aid in intervention. Ulcerative colitis, Crohn's disease, celiac disease, and various liver disorders are examples of predisposed genetic illnesses.

 

Achalasia

Achalasia is a motility problem characterized by a delayed emptying of the esophagus (food tube). The delay is caused by a failure of the lower esophageal sphincter (valve) to open properly, as well as a lack of the normal, ordered muscular action (peristalsis) that drives meals and liquids up the esophagus into the stomach.

This is caused by nerve injury or destruction in the esophagus and lower esophageal valve. The majority of instances are idiopathic, which means the etiology is unknown. It is possible that the cause is viral, autoimmune, or, in rare cases, malignancy.

Symptoms of are more common during and after a meal. Everyone has the sense of food, and generally drinks, hanging up and slowly moving into the stomach. This might happen multiple times per week or at every meal. Effortless regurgitation of bland, undigested food or white foam (saliva) is frequent and may be coupled with nighttime coughing and choking. Chest discomfort is frequent in certain persons, as is heartburn. This heartburn is not caused by acid reflux into the esophagus, but by retained acidic food or food fermentation in the esophagus.

 

Diagnosis of achalasia

Achalasia is suspected using barium x-rays and verified using esophageal manometry.

Esophageal barium tests (esophagrams) reveal a pronounced constriction of the lower esophageal valve, esophageal dilatation with retained barium in the upright position, inadequate esophageal emptying, and to-and-fro movement due to a lack of ordered peristalsis (coordinated wave-like muscle contractions).

Esophageal manometry entails inserting a tiny tube containing pressure sensors into the stomach and gradually removing it while recording lower esophageal valve pressure and peristalsis. Achalasia is characterized by aberrant relaxation (opening) of the lower esophageal valve and a lack of peristalsis (orderly wave progression) in the esophageal body. Sometimes the pressure in the lower esophageal valve is unusually high.

All achalasia patients should have an upper GI endoscopy to rule out the rare possibility of a malignancy (typically adenocarcinoma of the stomach) generating a pseudo-achalasia image.

 

Achalasia Treatment

The purpose of achalasia treatment is to disrupt and open the lower esophageal valve in order to facilitate esophageal emptying and alleviate symptoms. Unfortunately, there is no therapy available to encourage the restoration of peristalsis.

Pneumatic dilatation or laparoscopic Heller myotomy are the best therapies for healthy people. Botulinum toxin (Botox) injections may benefit frail or elderly individuals.

Treatment significantly alleviates symptoms but is seldom curative. Overall, the success rate of both the pneumatic dilation and heller myotomy treatments is 80%-90%, and it is depending on the operator's competence. A retreatment and different therapies may be required.

• Pneumatic dilatation – This treatment entails upper GI endoscopy and the introduction of various size balloons via the esophagus to rupture it from inside, therefore opening the valve. The surgery is performed under conscious anesthesia and takes around 30 minutes, with a one-day loss of activity. The most serious consequence, esophageal perforation (hole in the esophagus), is uncommon (less than 5%), but requires extensive surgery.
• Heller myotomy – Achalasia surgery entails severing the muscle (myotomy) from the outside using tiny laparoscopic incisions on the belly. The surgery necessitates general anesthesia, up to two days in the hospital, and reduced activity for two weeks. The most serious adverse effect is excessive muscular cutting, which causes acid reflux.
• Botulinum toxin – Botox can be administered into the esophagus and lower esophageal valve with an upper endoscope needle. The toxin relaxes the sphincter, relieving discomfort. Young patients often have symptom alleviation for 3-6 months, however elderly patients may experience remission for a year or longer. Adverse occurrences are uncommon.

 

Gastroesophageal reflux disease

Gastroesophageal reflux disease occurs when stomach contents backflow (reflux) produces bothersome symptoms and/or problems. If it is not treated appropriately, it can lead to serious health concerns. Heartburn and acid regurgitation are the most prevalent symptoms of and may not be related with a disease.

Self-diagnosis might lead to incorrect therapy. A doctor's consultation is required for accurate diagnosis and treatment of gastroesophageal reflux illness. Treatment options for this condition range from lifestyle modifications to medication or surgical treatments.

Individuals suffering from severe heartburn or other chronic and recurring symptoms of gastroesophageal reflux disease must obtain an accurate diagnosis, collaborate with their doctor, and receive the most effective therapy possible.

 

Liver Disease

The liver is the second biggest organ and serves a variety of roles in digestion, including food breakdown, energy storage, and removal of waste and toxins from the circulation. All digestive problems that damage the liver are referred to as liver disease.

 

While the causes vary, they can all harm your liver and impair its function. According to the CDC, 1.8 percent of US adults have chronic liver disease, which amounts to around 4.5 million Americans. A gastroenterologist or primary care physician can detect liver disease using blood testing, or through imaging studies such as CT or MRIs. ‍

 

Liver disease Symptoms

Depending on the etiology, the symptoms of liver disease might differ from person to person. Itchy skin, chronic exhaustion, vomiting, nausea, bloated belly, legs or ankles, dark urine, jaundice, loss of appetite, and black or bloody feces are some of the common symptoms. ‍

 

Liver disease Treatment

For liver illness, lifestyle adjustments are frequently advised. These may include limiting or eliminating alcohol consumption, which is a common cause of serious liver disease, maintaining a healthy weight (obesity is often associated with a chronic inflammation of the liver known as Non-Alcoholic Fatty Liver Disease), drinking plenty of water, and adopting a low-fat, "liver-friendly" diet.

 

Depending on the underlying reason, the doctor may give antibiotics, blood pressure meds, steroids, antiviral treatments, and multivitamins. On rare circumstances, surgery to remove diseased sections of the liver may be required. If no other treatment options are available, a liver transplant may be required.

 

Crohn’s Disease

Crohn's disease is an inflammatory digestive illness that can affect any portion of the gastrointestinal system, from the mouth to the anus. It is most usually associated with the ileum (the lower side of the small bowel) being ulcerated and inflamed. This ailment, like ulcerative colitis, is part of a category of gastrointestinal disorders known as inflammatory bowel disease (IBD)

Although the ileum is the most commonly affected by inflammation, ulceration can develop in any part of the small intestine, colon, esophagus, or stomach. Crohn's disease is most commonly diagnosed in people between the ages of 15 and 30, while it can occur at any age. According to the Crohn's & Colitis Foundation, about 780,000 people in the United States have Crohn's disease.‍

 

Symptoms of Crohn’s disease

Crohn's disease, like any other IBD, generally shows itself gradually, with certain symptoms worsening as the condition advances. Fever, weight loss, decreased appetite, exhaustion, bloody stools, stomach cramps, and diarrhea may occur in the early stages of the illness. Serious symptoms do not develop till much later. These can include ulcers, skin irritation, perianal fistulas, and anemia-related shortness of breath.

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Crohn’s disease Treatment

Early screening and diagnosis can make a significant difference in your ability to begin treatment. Endoscopies (anesthesia-induced intubation of the upper and lower guts) and imaging examinations are used in the diagnosis procedure, which is overseen by gastroenterologists (X-rays, but also CT scans or Magnetic Resonance Enterography - MRE). Treatment options include:

• Medication - To reduce inflammation, you may need to take antidiarrheal medications, anti-inflammatory medications, immunomodulators, antibiotics, and biologics.
• Change in diet - Although no special dietary restrictions are normally required, a diet with a modest influence on sections of the gut that can be constricted by inflammation is usually advised. Your doctor and dietitian may also recommend additional, more complicated modifications.
• Surgery is a last-resort therapy option if lifestyle modifications and drugs are ineffective. However, three-quarters of Crohn's disease patients have elective surgery at some time.

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Ulcerative Colitis

Along with Crohn's disease, ulcerative colitis is one of the two most prevalent inflammatory bowel illnesses (IBD). This diagnosis refers to a set of digestive illnesses that result in GI tract inflammation. Ulcerative colitis is caused by inflammation of the colon's (large intestine's) inner lining, the rectum, or both. ‍

 

Ulcerative Colitis Symptoms

Ulcers or tiny sores begin to form, usually in the rectum and extending to the large intestine. It is believed that over 750,000 people in the United States have ulcerative colitis, which is most commonly diagnosed in those aged 15 to 35. The presence of other immunological illnesses, as well as environmental factors such as antigens, viruses, and bacteria, may all enhance your chances of getting ulcerative colitis.

Diarrhea, frequently with bloodstains in the stool, fever, malnutrition, weight loss, stomach discomfort, and recurrent abdominal noises are the most prevalent signs of the illness. Other symptoms associated with UC include inflamed eyes, mouth sores, skin problems, loss of appetite, joint swelling, and joint discomfort. ‍

 

Ulcerative Colitis Treatment:

Of course, proper diagnostic measures are required, which will most likely entail a colonoscopy and will be supervised by a gastroenterologist. The optimal course of therapy will be determined depending on the severity of the problem and other circumstances, and will commonly involve prescription medications such mesalamine, sulfasalazine, balsalazide, or olsalazine, as well as steroids to assist reduce swelling and inflammation.

Antibiotics, probiotics, and other treatments that may help decrease immune activity, as well as biologic therapies that help block inflammation, may be prescribed by the doctor. The therapy is usually lengthy, and it may last a lifetime. Because the problem does not reach up to the small intestine, surgery to remove all or sections of the colon and rectum may be considered in tough instances.

 

Irritable Bowel Syndrome

Irritable bowel syndrome (IBS), also known as spastic or nervous colon and spastic bowel, is a functional gastrointestinal illness characterized by a cluster of symptoms that include stomach discomfort and changes in stool composition. These symptoms manifest over a lengthy period of time, frequently years.

In the absence of concerning signs and after all other probable illnesses have been ruled out, the diagnosis is based on symptoms. Worrying symptoms include beginning beyond the age of 50, weight loss, blood in the stool, or a family history of inflammatory bowel disease. Celiac disease, microscopic colitis, inflammatory bowel disease, bile acid malabsorption, and colon cancer are among illnesses that might appear similarly.

IBS has no recognized treatment. Treatment aims to alleviate symptoms and may involve dietary modifications, medication, human milk oligosaccharides, probiotics, and counseling. Increased soluble fiber intake, a gluten-free diet, or a short-term diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols are some dietary strategies. Loperamide may be used to treat diarrhea, whereas laxatives may be used to treat constipation. Antidepressants may alleviate pain and improve overall symptoms. Patient education and a positive doctor-patient interaction are critical components of treatment.

 

Malabsorption

Malabsorption refers to issues with the body's capacity to absorb nutrients from diet. Malabsorption can be caused by a variety of illnesses. Malabsorption is most commonly associated with difficulties absorbing certain carbohydrates, lipids, proteins, or vitamins. It might also be a general difficulty with food absorption.

Small intestine difficulties or injury that might cause problems absorbing vital nutrients. These are some examples:

• Celiac disease
• Tropical sprue
• Crohn disease
• Whipple disease
• Damage from radiation treatments
• Overgrowth of bacteria in the small bowel
• Parasite or tapeworm infection
• Surgery that removes all or part of the small intestine

Pancreatic enzymes aid in the absorption of lipids and other nutrients. When these enzymes are depleted, it becomes more difficult to absorb lipids and certain nutrients. Pancreatic problems can be caused by:

• Cystic fibrosis
• Infections or swelling of the pancreas
• Trauma to the pancreas
• Surgery to remove part of the pancreas

Some of the other causes of malabsorption include:

• AIDS and HIV
• Certain medicines (tetracycline, some antacids, some medicines used to treat obesity, colchicine, acarbose, phenytoin, cholestyramine)
• Gastrectomy and surgical treatments for obesity
• Cholestasis
• Chronic liver disease
• Cow's milk protein intolerance
• Soy milk protein intolerance

 

Malabsorption Symptoms

Current weight or rate of weight increase in children is frequently substantially lower than that of other children of comparable age and gender. This is referred to as failure to flourish. The child's growth and development may be disrupted. Adults may also experience failure to thrive, which manifests as weight loss, muscular atrophy, frailty, and even cognitive difficulties.

Changes in the stools are often present, but not always. Changes in the stools may include:

• Bloating, cramping, and gas
• Bulky stools
• Chronic diarrhea
• Fatty stools (steatorrhea)

 

Malabsorption Treatment

Treatment is based on the reason and aims to relieve symptoms while also ensuring the body obtains enough nutrition. A high-calorie diet might be attempted. It should include:

• Key vitamins and minerals, such as iron, folic acid, and vitamin B12
• Enough carbohydrates, proteins, and fats

If necessary, injections of vitamins and minerals, as well as specific growth agents, will be administered. Those who have pancreatic impairment may require pancreatic enzymes. If required, your doctor will prescribe them.

It is possible to try medications that slow down the usual flow of the gut. This may allow meals to stay in the gut for a longer period of time. Total parenteral nutrition (TPN) is used when the body is unable to absorb adequate nutrients. It will assist you or your child in receiving nutrients from a particular formula via a vein in the body. Your provider will determine the appropriate calorie and TPN solution for you. You can sometimes eat and drink while receiving TPN nutrition.

 

Celiac Disease

Celiac disease is a dangerous autoimmune illness that develops in genetically susceptible persons when gluten is consumed, causing damage to the small intestine. It is believed that one in every 100 individuals globally is affected, although only around 30% are adequately diagnosed.

 

What Are the Signs & Symptoms of Celiac Disease?

Celiac disease, also known as celiac sprue, gluten-sensitive enteropathy, and non-tropical sprue, is characterized by a wide range of symptoms. Failure to thrive occurs when infants do not achieve the expected weight and length. Older children can have:

• Diarrhea
• Constipation
• Pale, foul-smelling stools (poop)
• belly pain and bloating
• Weight loss
• Tiredness
• Headaches
• Painful skin rashes (usually in older teens and adults), especially around the elbows and knees

Some folks have no symptoms. Symptoms might appear at any age in a child. Some children experience issues the first time they consume gluten, while others develop symptoms years later after ingesting gluten products safely.

A newborn may exhibit the first symptoms of celiac disease soon after starting solid meals like cereal. Diarrhea, stomach discomfort, and a slow rate of weight gain are all symptoms. A youngster may not achieve the desired height, have anemia and mouth sores, and exhibit behavioral difficulties over time.

 

How is Celiac Disease Diagnosed?

A blood test to screen for antibodies to gluten and other proteins in the gut lining is commonly used to diagnose celiac disease. Antibodies are proteins produced by the immune system that identify and eliminate infections and other dangers. They typically remain in our bodies in case we need to tackle the same virus or disease again. If the blood test reveals high levels of gluten antibodies, the doctor would most likely perform a sample of the small intestine to submit for testing.

To get a tiny tissue sample, physicians insert a long, thin tube (called an endoscope) through the mouth and stomach into the small intestine. To sleep through the treatment, a youngster is frequently sedated or given general anesthesia.

If a kid has celiac disease, their siblings, parents, and grandparents should be checked as well. They may have the illness yet show no symptoms. Celiac disease that has not been detected in adults for a long time might cause major health complications.

 

How is Celiac Disease Treated?

Celiac disease has no known treatment. Researchers are developing novel medicines, and several of them show promise. However, for the time being, the problem is being controlled with a gluten-free diet. This allows the gut lining to repair and alleviates discomfort.

 

Dietary Changes

If your kid has celiac disease, the doctor will advise you on which foods he or she should avoid. These modifications will have a significant influence on your family's daily life as well as your child's food. As a result, the doctor may advise you to consult with a dietician.

Wheat, barley, rye, and other similar grains should not be included in your child's diet. Because no regulation mandates food producers to put gluten on food labels, it can be difficult to ensure that your child avoids it. In the United States, any items containing any of the top eight food allergies, including wheat, must be properly labeled. However, wheat-free does not imply gluten-free; certain wheat-free goods may contain gluten-containing cereals such as barley and rye.

Lactose Intolerance

Lactose intolerance is a condition in which a person is unable to adequately digest lactose, a simple carbohydrate found in the milk of all animals and its derivatives. This is related to insufficient levels of lactase, an enzyme responsible for lactose digestion. Lactose intolerance affects roughly 79% of Native Americans, 75% of African Americans, 51% of Hispanics, and 21% of Caucasians.‍

 

Lactose Intolerance Symptoms:

Symptoms from consuming dairy might range from minor to severe. Lactose intolerance symptoms include diarrhea, gas, stomach cramps, and bloating. Symptoms vary across individuals due to varying levels of intestinal lactase deficiency, and generally depend on the quantity of lactose consumed.‍

 

Lactose Intolerance Treatment:

Lactose intolerance can be treated with enzyme supplements that help break down lactose and by switching from conventional milk to lactose-free or dairy-free milk. As part of your diagnosis and therapy, it's critical to distinguish between lactose intolerance, milk allergy, and dairy sensitivity.

 

Conclusion 

The gastrointestinal tract is a huge organ system that performs multiple functions such as food digestion, vitamin and fluid absorption, protection from invading microorganisms or noxious chemicals, and waste elimination. Any ailment that affects the digestive system is classified as a gastrointestinal disorder. While symptoms vary according to the ailment and underlying cause, most gastrointestinal disorders have similar symptoms such as abdominal discomfort, diarrhea, constipation, bloating, weight loss, and excess gas.