Common Symptoms of Gastrointestinal Diseases and Disorders
These common gastrointestinal symptoms may indicate an underlying health problem. If you frequently experience any of these symptoms or if they are per- sistent, talk to your doctor as soon as possible.
• Vomiting. Vomiting usually is preceded by nausea, sweating, and pallor (abnormally pale skin) and is accompanied by involuntary contractions of the abdominal muscles. Vomiting is a medical concern when the vomit contains blood (it may have reddish streaks or may resemble coffee grounds), when it is accompanied by sudden, severe abdominal pain, or when it lasts so long or occurs so frequently that it results in dehydration. Symptoms of dehydration include excessive thirst, infrequent urination, dry skin, fatigue, and light- headedness. Talk to your doctor if vomiting is persistent or if you experience any of these symptoms. Treatment will depend on the underlying cause of the vomiting.
• Constipation. Frequency of bowel movements varies widely; each person has his or her own usual pattern of bowel movements. Constipation refers to difﬁ- cult, infrequent passing of hard, dry stool. It can be caused by a poor diet (especially a diet high in fat and sugar and low in ﬁber), long-distance travel, a sedentary lifestyle, poor bowel habits (such as frequently ignoring the urge to have a bowel movement), pregnancy, laxative abuse, certain medications, or speciﬁc diseases. You can prevent constipation by drinking plenty of ﬂuids, eating a well-balanced diet that includes plenty of ﬁber, exercising regularly (such as taking a brisk walk every day), taking a psyllium-based ﬁber supple-ment, responding promptly to the urge to have a bowel movement, and main- taining a regular routine for using the toilet. Talk to your doctor if the consti- pation is severe, occurs suddenly without an identiﬁable cause, lasts more than 10 days, or is accompanied by blood in the stool.
• Diarrhea. Diarrhea is frequent passage of loose, watery stool. Usually it results from consuming food or ﬂuid contaminated by certain bacteria, para- sites, or viruses. Certain medications also can cause diarrhea, as can anxiety, food allergy, and food intolerance. Diarrhea usually clears up on its own within 2 to 3 days. You can help manage the problem by drinking clear ﬂuids and eating bland, low-ﬁber foods as your symptoms improve. Over-the- counter antidiarrheal drugs also are available. Contact your doctor if the diar- rhea is accompanied by severe abdominal pain or a high fever (102 degrees Fahrenheit or higher), is bloody (it may be red-streaked or appear black and tarry), or lasts more than 3 days. You should also watch for symptoms of dehydration—excessive thirst, infrequent urination, dry skin, fatigue, or light- headedness—and contact your doctor if you are unable to consume enough ﬂuids to prevent these symptoms.
• Gas. Gas is a normal by-product of digestion. It is caused by the action of bac- teria in the large intestine on carbohydrates and proteins in digested food. Air that is swallowed while eating may be belched back out through the mouth or passed along through the digestive tract until it is released through the rec- tum. The same is true for gases contained in carbonated beverages. Eating fatty meals can cause bloating and discomfort because the delayed emptying of the stomach that is caused by fatty foods allows gas to build up in the stom- ach. Persistent belching without an obvious cause may also indicate the pres- ence of Helicobacter pylori (H pylori), a bacterium that is the most common cause of peptic ulcers (see page 264). Bloating and excess gas also may be symptoms of lactose intolerance (the inability to digest the milk sugar lactose due to a deﬁciency of an enzyme called lactase; see page 266). This condition can be controlled by taking over-the-counter lactase supplements, by eating only those dairy products that contain added lactase to aid digestion, or by fol- lowing a dairy-free diet. Regular exercise, such as brisk walking, can help move gas along and prevent its buildup in the digestive tract, thereby elimi- nating cramping and bloating.
Disorders of the Esophagus
The esophagus is a narrow tube that permits the transfer of food from the mouth to the stomach. The upper third of the esophagus is composed of skeletal muscle, and the remaining two thirds is composed of smooth muscle. The upper portion works to propel food downward; the lower portion relaxes when food is pro- pelled downward and then constricts (narrows) to ensure that nothing ﬂows
backward from the stomach. The esophagus is not meant to store or hold swal- lowed food or digestive juices, both of which can damage its delicate lining.
Difﬁculty swallowing is called dysphagia. It is a symptom of either an obstruc- tive problem (such as cancer or scarring of the esophagus) or a muscular prob- lem (such as megaesophagus, when the lower esophageal sphincter does not relax and allow food into the stomach).
Heartburn is another symptom of esophageal disorders. This burning pain rises in the chest and can be felt in the neck, throat, or face. Heartburn usually occurs after meals, after taking certain medications, or while lying down. Some people also may feel a burning pain or tightness when swallowing solids or liq- uids. Heartburn can indicate a problem with a medication or with the lower esophageal sphincter, the muscular valve that prevents stomach acid from rising up into the esophagus. (Heartburn also may be a symptom of coronary artery disease; see page 204.)
Some medications (especially aspirin, antibiotics, and quinidine) and vitamins and minerals (especially potassium chloride, vitamin C, and iron) may damage the esophagus if not taken properly. If you take a pill or a capsule without drink- ing enough water, it can release chemicals that irritate the lining of the esopha- gus and possibly cause ulcers, inﬂammation, or bleeding. If you are taking medications that can cause irritation on swallowing, be sure to drink plenty of ﬂuid (at least 8 ounces) before and after taking them. Sit upright while taking the medication, and remain upright until you have drunk enough ﬂuid to ensure that it has passed into the stomach. Be sure to tell your doctor if a certain pill or cap- sule continues to irritate your esophagus.
Gastroesophageal Reflux Disease
The most common disorder of the esophagus is gastroesophageal reﬂux disease (GERD). In GERD, the muscle at the bottom of the esophagus, the lower esophageal sphincter, does not close completely, allowing stomach acids and other irritants to ﬂow backward (reﬂux) into the esophagus.
Certain medications can interfere with the action of this muscle, including nitrates, calcium channel blockers, theophylline, and anticholinergics. Smoking and diet also contribute to GERD. Excessive consumption of chocolate, pepper- mint, coffee, alcohol, and fried or fatty foods can weaken the lower esophageal sphincter.
Some people with GERD also have a hiatal hernia, in which a portion of the stomach protrudes through the diaphragm (the large muscle that separates the abdomen from the chest cavity) and allows stomach acid to remain trapped just beneath the sphincter muscle. Coughing, vomiting, straining, and sudden physi-cal exertion can increase pressure in the abdomen, resulting in a hiatal hernia. This condition is common among pregnant women, obese adults, and many oth- erwise healthy people over age 50.
If you regularly experience heartburn, you should avoid the foods listed above as well as acidic foods that can cause additional irritation to the esophagus, such as citrus fruits and juices, tomatoes and tomato products, peppers, and onions. Eating smaller, more frequent meals may help. Also avoid lying down within 2 to 3 hours of eating. If you smoke, quit now (see page 107). If you are overweight, losing weight (see page 73) will help relieve gastroesophageal reﬂux disease symptoms. You can also try elevating the head of your bed on 6-inch blocks or sleeping on a specially designed foam wedge. Over-the-counter antacids may help, but if you ﬁnd yourself taking them for longer than 3 weeks, talk to your doctor.
If changes to your diet and lifestyle do not improve GERD symptoms, your doctor may want to perform additional tests, such as an upper gastrointestinal (GI) series or an endoscopy (see “Diagnostic Procedures,” page 282).
In cases of chronic heartburn and GERD, doctors usually prescribe medica- tions to reduce the acid in the stomach and to hasten gastric emptying (moving food and acids out of the stomach and into the duodenum). In rare situations, surgery may be required to increase pressure on the lower esophagus. If the esophagus is badly scarred and narrowed, surgery also may be needed to widen the passageway.
Heartburn and GERD are more than painful and inconvenient. If left untreated, they can cause bleeding or ulcers in the esophagus and also may lead to frequent infections. The esophagus may become permanently narrowed due to scarring from the exposure to stomach acid. People who have had heartburn for
5 or more years are at increased risk for developing Barrett esophagus, a condi- tion in which the cells that line the esophagus change from one type of cell to another. This condition cannot be cured and may lead to esophageal cancer.
Disorders of the Stomach and the Duodenum
Most digestion of food occurs in the stomach and duodenum. This portion of the digestive tract produces and receives from other organs a wide range of chemi- cals to break down food for nutrient absorption. The stomach uses both mechan- ical means and chemicals (such as hydrochloric acid and pepsin) to break down food. The duodenum releases hormones that stimulate the pancreas to ensure the proper release of enzymes to digest carbohydrates, proteins, and fats. The duo- denum releases another hormone to stimulate the gallbladder to contract and release bile (which is made in the liver and stored in the gallbladder) into the duodenum to digest fats. This tremendous concentration of powerful chemicals accounts for many of the problems that can occur in the stomach and duodenum.
Almost everyone has experienced indigestion (also known as an upset stomach or dyspepsia). This painful, burning sensation in the upper abdomen is often accompanied by nausea, bloating, belching, and sometimes vomiting. Indiges- tion is usually a symptom of a digestive disorder, such as an ulcer. However, some people have persistent indigestion that has no identiﬁable cause; this is called functional indigestion or nonulcer indigestion. Smoking, drinking too much alcohol, taking certain medications, or being exhausted or stressed can cause or worsen indigestion.
If you frequently experience indigestion, see your doctor so that he or she can examine you, determine the cause of your symptoms, and provide treatment. Contact your doctor promptly if your indigestion is accompanied by vomiting, weight loss, lack of appetite, blood in vomit or stool, pain when you eat, or severe pain in the upper abdomen. Symptoms of indigestion accompanied by shortness of breath, sweating, or pain radiating to the jaw, neck, or left arm can be warning signs of heart disease or a heart attack (see page 207).
As with heartburn, you should not rely on antacids to treat indigestion. You may ﬁnd that certain foods or situations (such as exercising too soon after eating) are related to your indigestion. Smoking, especially just before meals, often causes or aggravates indigestion.