Digestive Disorders Treatment Center

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Abdominal Pain - an unpleasant subjective experience that may be based on organic, objective anatomic disease causing tissue damage, or functional, based on motility or peristalsis of the gut, usually without an organic component. Important aspects in the evaluation of pain include acuteness of onset, location, duration, and intensity. Recent onset of severe abdominal pain is an emergency that requires prompt medical attention.

Swallowing Disorders - include difficulty in swallowing, pain on swallowing, "heartburn," gastroesophageal reflux disease (GERD) or "reflux," regurgitation, rumination, and vomiting. Difficulty in swallowing may range from mild and intermittent sensations of solid food "sticking," "hanging up, " or "not going down right," to complete obstruction with inability to swallow liquids or saliva. Complete obstruction is usually preceded by milder symptoms, may be due to benign or malignant disease, and is always an emergency. Acute obstruction of the esophagus by a solid piece of meat can almost always be relieved by an endoscopic procedure, but then requires evaluation for underlying causes.

Indigestion - means different things to different people, and to doctors as well. This should be differentiated from "heartburn" or "reflux," and may include bloating, fullness, early satiety at meals, and nausea (a feeling of impending urge to vomit). In medical jargon, "dyspepsia" may be used, but is equally vague as "indigestion." Symptoms related to hunger and relieved by meals or antacids may be ulcer-related, while those brought on by eating may be due to disorders of motility or peristalsis, or even to gallbladder stones.

Nausea & Vomiting - need no definition but may be caused by a wide variety of conditions and diseases, some transient or innocuous, and some not. Causes may include pregnancy, motion sickness, radiation therapy, drug toxicity or side effects, infection, obstruction, heart attack, kidney failure, diabetes, brain diseases, etc. Prolonged severe vomiting may lead to dehydration or hemorrhage, which require emergency treatment.

Gas - everyone has gas, more or less, and those with more gas go to doctors more frequently. The volume, rate of expulsion, and odor are subjective and not readily quantifiable. One pioneer in the academic study of this subject was described as having given "class to gas, and status to flatus." Most excessive gas is due to air-swallowing, or to the fermentation of carbohydrates by the bacteria normally living in the colon. Malabsorption of carbohydrates in the small intestine, due to enzyme deficiencies, inflammatory bowel diseases - usually Crohn's Disease or ileitis - or partial surgical removal of the small bowel may be treatable causes of excessive gas, and treatable by dietary modification or supplementation. In some cases, antibiotics may be warranted to suppress small bowel bacterial overgrowth.

Diarrhea - increased liquidity or decreased solid consistence of stools, usually medically significant if more than 3 times a day, or if awakens the patient from sleep. Acuteness of onset, frequency of occurrence, and duration of illness are also important in evaluation, as is the presence or absence of blood. Diarrhea may be caused by infection, inflammation, medications, various benign and malignant tumors, endocrine disorders such as diabetes or hyperthyroidism, or reactions to psychosocial stress (functional diarrhea or irritable bowel syndrome).

Constipation - again subjective, but recent changes in bowel habits are most significant. "Normal" bowel frequency varies greatly, from several times a day to twice a week. If the act of defecation is accompanied by symptoms, including straining, pain (rectal, pelvic, or abdominal), or bleeding, medical evaluation is warranted. An objective definition of constipation includes straining more than 25% of the time, hard stools more than 25% of the time, a feeling of incomplete evacuation more than 25% of the time, and 2 or less BM's per week. Most cases of constipation are due to disorders of bowel function rather than to organic anatomical obstruction, but in appropriate patients, colorectal cancer must be excluded.

Gastrointestinal Bleeding - may be from upper GI sources, such as peptic ulcer, or esophageal varices associated with cirrhosis, and causing vomiting of bright red blood or "coffee-ground" material, or the passage of black or maroon stools; or from lower GI sources, including colitis, diverticulitis, colorectal cancer and other tumors, vascular disorders of the intestine, and hemorrhoids. Acuteness of onset, duration of bleeding, and volume of blood lost may determine other associated symptoms and the urgency for evaluation. Large amounts of blood loss may cause weakness, dizziness, faintness, shortness of breath, angina, or total collapse. Severe bleeding requires prompt evaluation in an ER, including gastroscopy and/or colonoscopy, and possible blood transfusions. Most episodes of GI bleeding resolve spontaneously, or are amenable to endoscopic and medical therapy. Significantly, some causes of bleeding may require surgery in order to be controlled.

Jaundice - yellowness of the skin and/or the whites of the eyes from an elevation in blood bilirubin level, most often due to liver or biliary tract diseases, including hepatitis, drug toxicity, gallstones that pass into the bile duct, and strictures or tumors of the bile ducts and pancreas. Jaundice may be associated with itching (pruritus). Classically, jaundice has been divided into obstructive, or "surgical" jaundice - due to partial or complete mechanical obstruction of the bile ducts from stones or tumors - and nonobstructive or "medical" jaundice. Occasionally, blood or bone marrow diseases may cause jaundice by an overproduction of bilirubin, as in hemolytic anemias. Advances in endoscopic techniques may allow relief from obstructive jaundice by non-surgical decompression of the bile duct.

Further information about specific conditions may be found on Medical Links, including:

Esophagus - dysphagia, gastroesophageal reflux, GERD, esophagitis, hiatus hernia, Barrett's esophagus, achalasia, esophageal cancer;

Stomach - gastritis, peptic ulcer disease, gastric ulcer, Helicobacter pylori infection, NSAID ulcers, gastric cancer;

Small Intestine - duodenal ulcer, malabsorption, celiac disease (nontropical sprue or gluten-sensitive enteropathy), ileitis, Crohn's Disease, ischemic/vascular disorders of the intestine;

Inflammatory Bowel Diseases (IBD) - Crohn's Disease, ulcerative colitis, granulomatous enterocolitis, proctitis, immunosuppressive and immunomodulatory therapy, including corticosteroids, 6-MP, azathioprine, cyclosporine, and Remicade;

Large Intestine/Colon - irritable bowel syndrome (IBS), diverticulosis, diverticulitis, polyps, colorectal cancer.