Gastroinestinal disorders occur when the digestive tract
(gastrointestinal) does not function properly. As a result, patients may have
difficulty digesting food, absorbing nutrients, or having normal bowel
Several body parts, including the mouth, esophagus,
stomach, small intestine, large intestine, and anus, make up the digestive
(gastrointestinal) tract. The digestive process begins when food enters the
When a person begins chewing food, digestive enzymes in
the saliva break down the food before it is swallowed.
The esophagus is a muscular tube that carries food and
liquids from the mouth to the stomach. The stomach contains harsh enzymes that
break down food so it can be absorbed by the body.
Food then enters the small intestine, which contains
three parts: the duodenum, jejunum, and ileum. Most of digestion occurs in the
small intestine because it is responsible for absorbing nutrients from food.
The remaining food then enters the colon, which also has
three parts: the cecum, colon, and rectum. The large intestine absorbs any
remaining water from indigestible food matter and eliminates the unusable food
matter, or waste, from the body. The anus is the external opening of the rectum.
It allows waste (feces) to be excreted from the body.
There are many different types of gastrointestinal
disorders. Some gastrointestinal disorders affect multiple parts of the
digestive tract, while others only affect the esophagus, abdomen/stomach, intestines,
or anus/rectum. The severity of gastrointestinal disorders varies
significantly, depending on the specific type of the disease. Some disorders,
such as indigestion, are mild while others, such as Crohn's disease, are
THAT AFFECT MULTIPLE PARTS OF THE GASTROINTESTINAL TRACT
Diarrhea: Diarrhea occurs when an individual has loose
stools or watery stools. Diarrhea is a symptom of an underlying health problem,
such as an infection, that prevents the intestines from properly absorbing
nutrients from food. Acute diarrhea lasts a few days and affects nearly
everyone at some point in their lives. Chronic diarrhea generally lasts longer
than four weeks and may be a sign of a serious condition such as inflammatory
bowel disease (IBD) or gastroenteritis.
Diarrhea is usually caused by a viral, bacterial, or
parasitic infection. Diarrhea that is caused by an infection (often called
infectious diarrhea) may be passed from person to person. Viruses, such as the
Norwalk virus, cytomegalovirus, viral hepatitis herpes simplex virus, and
rotavirus are the most likely to cause diarrhea. Infants and young children are
most likely to develop diarrhea as a result of a rotavirus infection. If an
individual consumes food or water that is contaminated with certain bacteria or
parasites, he/she may develop diarrhea. This type of diarrhea is often called
traveler's diarrhea because it frequently occurs in people who are traveling to
developing countries. Common bacterial causes of diarrhea include
campylobacter, salmonella, Escherichia coli (E. coli), Shigella dysenteriae,
and Clostridium difficile. Common parasites that are known to cause diarrhea
include Giardia lamblia and cryptosporidium.
Diarrhea may be caused by a number of other factors,
including lactose intolerance, certain medications (especially antibiotics and
anti-HIV medications called antiretrovirals), artificial sweeteners called
sorbitol and mannitol (commonly found in sugar-free products and many types of
chewing gum), surgery, or other gastrointestinal disorders (such as irritable
bowel syndrome or IBS).
Symptoms of diarrhea often include frequent and loose
stools, abdominal pain or cramping, bloating, fever, excessive thirst, and
dehydration. Diarrhea causes dehydration because the body loses water and salts.
Infants and young children are at risk of developing severe dehydration as a
result of diarrhea. Patient with severe diarrhea may be unable to control the
passage of stool, a condition known as fecal incontinence. When a patient
experiences frequent, severe, and bloody diarrhea, the condition is often
Diarrhea usually requires little to no medical treatment.
Individuals with diarrhea should drink plenty of water. Patients may also
benefit from drinks that contain electrolytes, including Pediatric
Electrolyte©, Pedialyte©, or Enfalyte©. Individuals should avoid diuretics,
such as caffeine, because they worsen symptoms of dehydration. Certain foods,
including rice, dry toast, and bananas may help reduce symptoms of diarrhea. In
addition, anti-diarrheal medications, such as bismuth subsalicylate
(Pepto-bismol©, Bismatrol©, or Kaopectate©), diphenoxylate atropine (Lomotil©,
Lofene©, or Lonox©), or loperamide hydrochloride (Imodium©), may also be taken
to reduce diarrhea in patients older than three years of age.
If diarrhea continues for longer than four days or blood
is present in the stool, patients should visit their healthcare providers to
determine the underlying cause. If an infection is causing symptoms, an
antimicrobial medication may be prescribed. The specific type, dose, and
duration of treatment depend on the severity and type of infection.
Irritable bowel syndrome (IBS): Irritable bowel syndrome
(IBS), also called spastic colon, mucous colitis, spastic colitis, nervous
stomach, or irritable colon, is a long-term condition that is characterized by
abdominal pain, cramping, diarrhea, and constipation. IBS is a functional bowel
disorder because the bowel appears normal but does not function properly.
Although the exact cause of irritable bowel syndrome
(IBS) is unknown, researchers believe that poor diet, neurotransmitter
imbalances, and infections may contribute to the development of the disorder.
The colon contracts (colon motility) to move the contents
inside the colon toward the rectum. During this passage, water and nutrients
are absorbed into the body and waste is excreted as stool. A few times each
day, contractions push the stool down the colon resulting in a bowel movement.
In IBS patients, the muscles of the colon, sphincters,
and pelvis do not contract properly. As a result, patients experience
constipation or diarrhea. This causes symptoms of abdominal pain, cramping,
bloating, and a sense of incomplete stool movement. Symptoms may improve after
the patient has a bowel movement.
Health complications arising from IBS include hemorrhoids
(aggravated by diarrhea and/or constipation), depression, weight loss, vitamin
and mineral deficiencies, and psychosocial problems.
Most people can control symptoms of IBS with diet, stress
management, lifestyle modification, and prescribed medications. A medication
called loperamide (Imodium©) is commonly used to treat IBS patients with
diarrhea. Laxatives, such as polyethylene glycol (Miralax©), sorbitol, and
lactulose (Cephulac©), may be used. Phosphate enemas (Fleet Phospho-soda©) and
emollient enemas (Colace Microenema©) have also been used. Suppositories, such
as bisacodyl (Dulcolax©), may also be taken. The most widely studied drugs for
the treatment of abdominal pain are a group of drugs called antispasmodics,
which cause muscle relaxation. Commonly used antispasmodics include hyoscyamine
(Levsin© or Levsinex©), dicyclomine (Bentyl©), and methscopolamine (Pamine©).
For some patients, however, IBS may be disabling. They
may be unable to work, attend social events, or even travel short distances due
to urgency to defecate (pass stool) and/or pain in the colon.
Inflammatory bowel disease (IBD): Inflammatory bowel
disease (IBD) refers to two chronic diseases that cause inflammation of the
intestines: ulcerative colitis and Crohn's disease.
The cause of IBD remains unknown. However, current
research indicates that IBD most likely involves a complex interaction of
factors, including heredity, the immune system, and antigens in the environment.
The symptoms of these two illnesses are very similar,
which often makes it difficult to distinguish between the two. In fact, about
10% of colitis (inflamed colon) cases cannot be diagnosed as either ulcerative
colitis or Crohn's disease. When physicians cannot diagnose the specific IBD,
the condition is called indeterminate colitis.
IBD causes chronic inflammation in the gastrointestinal
tract and may lead to complications, such as colon cancer. The most common
symptoms of both ulcerative colitis and Crohn's disease are diarrhea (ranging
from mild to severe), abdominal pain, decreased appetite, and weight loss. If
the diarrhea is extreme, it may lead to dehydration, increased heartbeat, and
decreased blood pressure. As food moves through inflamed areas of the
gastrointestinal tract, it may cause bleeding. Continued loss of blood in the
stool may result in low levels of iron in the blood, a condition called anemia.
In addition, Crohn's disease may also cause intestinal
ulcers, fever, fatigue, arthritis, eye inflammation, skin disorders, and
inflammation of the liver or bile ducts.
Ulcers may extend through the intestinal wall creating a
fistula (an abnormal opening). If an internal fistula develops, food may not
reach the area of the intestine involved in absorption. External fistulas in
the anus may result in continuous bowel drainage onto the skin. Fistulas may
also become infected, a condition that can be life threatening if left
untreated. Symptoms of a fistula may include pain, fever, tenderness, itching,
and general feeling of discomfort.
Toxic megacolon is a rare, but potentially
life-threatening complication of severe IBD. Toxic megacolon is characterized
by a dilated colon (megacolon), abdominal distension (bloating), and
occasionally fever, abdominal pain, or shock. In severe cases, the condition
may cause the colon to become paralyzed. Toxic megacolon prevents the
individual from having bowel movements. If the condition is not treated, the
colon may rupture, resulting in peritonitis, a life-threatening condition that
requires emergency surgery.
Other complications may include dehydration,
malnutrition, obstruction, ulcers, and anal fissures.
Many medications are used to treat IBD.
Anti-inflammatories, such as sulfasalazine (Azulfidine©), mesalamine (e.g.
Asacol© or Rowasa©), olsalazine (Dipentum©), and balsalazide (Colazal©), help
reduce inflammation. Corticosteroids, such as prednisone (Deltasone©), have
been shown to effectively reduce inflammation of the gastrointestinal tract in
IBD patients. Medications, called immunosuppressants, have been used to treat
IBD. Examples include azathioprine (Imuran©), mercaptopurine (Purinethol©),
cyclosporine (e.g. Neoral© or Sandimmune©), and infliximab (Remicade©). A fiber
supplement, such as psyllium powder (Metamucil©) or methylcellulose
(Citrucel©), may help relieve symptoms of mild to moderate diarrhea.
Inflammation may cause the intestines to narrow, resulting in constipation.
Laxatives may be taken to relieve symptoms of constipation. Oral laxatives such
as Correctol© have been used. A qualified healthcare provider may recommend acetaminophen
(Tylenol©) to relieve mild pain. Avoid nonsteroidal anti-inflammatory drugs
(NSAIDs), such as ibuprofen (Advil© or Motrin©) or naproxen (Aleve©), as
researchers have found a strong relationship between NSAIDs and IBD flare-ups.
Therefore, NSAIDs should not be taken.
If all other treatments fail to relieve symptoms, a
qualified healthcare provider may recommend surgery. Surgery is more commonly
performed in ulcerative colitis patients because inflammation is limited to the
colon. During the procedure, the entire colon and rectum is removed
A new procedure, known as ileoanal anastomosis,
eliminates the need for recovered patients to wear a bag to collect stool. This
new procedure involves attaching a pouch directly to the anus, allowing the
patient to expel waste normally. However, the patient may have as many as five
to seven watery bowel movements a day because there is no longer a colon to
absorb water. Between 25 and 40% of patients with ulcerative colitis eventually
Indigestion (non-ulcer dyspepsia): Indigestion, also
called non-ulcer dyspepsia (upset stomach), is a general term that describes
discomfort in the upper abdomen. Patients who have indigestion typically suffer
from several symptoms, including heartburn, bloating, belching, and nausea.
Indigestion affects nearly everyone from time to time,
and it is not considered a serious health condition.
Indigestion may occur if a patient eats too much of a
particular food (especially fatty or spicy foods) or eats too quickly. Alcohol,
stress, and anxiety may also contribute to indigestion.
Because indigestion is such a common condition, it
generally does not require a diagnosis. However, patients who frequently
experience indigestion should visit their healthcare providers because it may
be a symptom of an underlying medical condition, such as acid reflux disease.
Antacids, such as calcium carbonate (e.g. Tums©,
Alka-Mints©, and Rolaids Calcium Rich©), may be taken by mouth to treat
symptoms of heartburn and upset stomach. Anti-flatulant medications, such as
alpha-galactosidase enzyme (Beano©), simethicone (Gas-X©, Genasyme©, or
Mylanta© Gas Relief), may be taken by mouth to prevent and/or treat symptoms of
bloating and flatulence (gas).
Monosodium glutamate symptom complex (Chinese restaurant
syndrome): Monosodium glutamate symptom complex, also called Chinese restaurant
syndrome, is a group of symptoms that some patients develop after eating
Chinese foods. Symptoms typically include flushing, headache, sweating, facial
pain or swelling, numbness or burning around the mouth, and chest pain.
Although it has been suggested that a food additive in
Chinese food, called monosodium glutamate (MSG), may cause the reaction, it has
not been proven. Since there is limited scientific data about the condition, it
remains unknown if the frequency and amount of MSG exposure increases or
decreases an individual's risk of experiencing symptoms.
Patients generally do not require treatment for
monosodium glutamate symptom complex because symptoms are mild and resolve on
their own. However, if patients experience chest pain or difficulty breathing,
they should seek immediate medical treatment because this may be a sign of a
serious allergic reaction called anaphylaxis.
Diverticulosis and diverticulitis: Diverticulosis refers
to small, bulging pouches (diverticula) in any part of the digestive tract.
Diverticula are most often found in the large intestine (colon). However, they
may also develop in the esophagus, stomach, or small intestine.
Diverticulosis is a common condition that affects more
than half of Americans who are older than 60 years of age. Most patients do not
know they have diverticulosis because they do not experience any signs or
symptoms of the condition.
However, if the diverticula become infected or inflamed,
the condition is called diverticulitis. Patients with diverticulitis typically
experience intense abdominal pain, nausea, bloating, bleeding from the rectum,
tenderness in the abdomen, difficulty or pain during urination, fever, and
changes in bowel movements.
Diverticulitis is usually diagnosed after a computerized
tomography (CT) scan is performed. A machine produces images of the internal
organs in the abdomen. Inflamed diverticula will be apparent if the patient has
Mild cases of diverticulitis can be treated with rest,
changes in the diet, and antibiotics. Patients should not eat any fiber,
including whole grains, fruits and vegetables, for several days. This
restricted diet gives the colon time to heal. Antibiotics, such as
metronidazole (Flagyl©), moxifloxacin (Avelox©), ciprofloxacin (Cipro©),
amoxicillin/clavulanate (Augmentin©), and Imipenem (Primaxin©) are commonly
prescribed to kill the bacteria that are infecting the diverticula.
Serious cases of diverticulitis may eventually require
surgery to remove the infected part of the colon.
Peptic ulcers: An ulcer is an open sore or break in a
body tissue. Peptic ulcers develop on the inside lining of the stomach (gastric
peptic ulcer), upper small intestine (duodenal peptic ulcer), or esophagus
(esophageal peptic ulcer).
Researchers have found that a bacterial infection with
Helicobacter pylori is the most common cause of gastric and duodenal ulcers.
Some medications, including aspirin and nonsteroidal anti-inflammatory drugs
(NSAIDS), such as ibuprofen (Motrin© or Advil©), may also cause gastric and
duodenal ulcers. In addition, smoking tobacco increases a patient's risk of
developing ulcers. It remains unclear whether or not excessive alcohol
consumption leads to an increased risk of ulcers.
Esophageal peptic ulcers are usually associated with acid
Contrary to popular beliefs, diet and stress do not cause
peptic ulcers. However, high levels of stress and acid foods and beverages,
such as coffee, may aggravate symptoms of peptic ulcers.
Peptic ulcers generally cause pain that may be felt
anywhere from the chest to the stomach. Pain may last a few minutes to several
hours. Symptoms are often the worst when the stomach is empty or at night. They
may also come and go for a few days to weeks. Less common symptoms include
vomiting blood, dark blood in the stools, nausea, vomiting, and unexplained
Most ulcers are diagnosed after an X-ray is taken of the
upper gastrointestinal tract. An endoscopy may also be performed. During the
procedure, a thin tube with a camera (endoscope) is inserted into the mouth and
into the digestive tract. This allows the healthcare provider to see if ulcers
Patients take antibiotics, such as amoxicillin (Amoxil©),
clarithromycin (Biaxin©), or metronidazole (Flagyl©), if an H. pylori infection
is causing peptic ulcers. Patients also take medications called acid-blockers,
which reduce the amount of acid in the stomach. As a result, the patient
experiences less pain, and the gastrointestinal tract is able to heal. Examples
of acid blockers include ranitidine (Zantac©), famotidine (Pepcid©), cimetidine
(Tagamet©), and nizatidine (Axid©).
Patients should take their medications exactly as
prescribed. If medication is not taken regularly or stopped too early, the
ulcer may not heal properly. Also, during treatment, patients should not smoke,
consume alcohol, or take nonsteroidal anti-inflammatory drugs (NSAIDs) because
they may worsen symptoms.
Pyloric stenosis: Pyloric stenosis is a rare condition
that occurs when babies are born with abnormally large muscles at the opening
at the bottom of the stomach (pylorus). The pylorus connects the stomach to the
Babies with pyloric stenosis are unable to transport food
into the small intestine. This may lead to: extremely forceful vomiting (also
called projectile vomiting) that may contain blood, weight loss, dehydration,
and electrolyte imbalances. Babies are usually hungry after vomiting. They may
cry without tears because they are dehydrated.
The exact cause of pyloric stenosis remains unknown.
However, researchers believe that genetics plays a role.
Most patients are diagnosed and treated when they are
three to 12 weeks old. Babies with pyloric stenosis need to have surgery as
soon as possible to correct the pylorus. The surgical procedure, called
pyloromyotomy, involves reducing the size of the pylorus muscles. Patients
typically experience an improvement in symptoms about 24 hours after surgery.
Colic (infancy): Colic is usually defined as crying for
more than three hours a day, three days per week, for longer than three weeks
in an otherwise healthy baby.
It remains unknown what causes colic. However,
researchers have suggested that it may be caused by gastrointestinal problems,
such as lactose intolerance or an immature digestive system. This is because
sometimes a colic episode stops after a baby passes gas or has a bowel movement.
Other possible causes include maternal anxiety, differences in the way a baby
is fed or comforted, and/or allergies.
There is currently no treatment that has been proven to
be effective for the treatment of colic in babies. Colic typically goes away
once the baby reaches three months of age.
Biliary colic: Biliary colic, also called a gallbladder
attack, describes pain and nausea that accompanies many disorders that affect
the gallbladder. The gallbladder is an organ that stores digestive fluids that
are needed to break down fats in foods.
Biliary colic may occur when a gallstone moves through
the biliary tract towards the small intestine. An attack may also be the result
of cholestasis, which occurs when the flow of bile is blocked. Gallbladder attacks
may also occur if the gallbladder becomes inflamed.
Gallbladder attacks generally last one to four hours.
Common symptoms include pain on the right side of the abdomen, nausea,
vomiting, and bloating. The gallbladder, which is located in the lower right
side of the abdomen, is usually tender to the touch. The pain may be dull,
sharp, or excruciating. It is common for the pain to radiate to the right
A healthcare provider will be able to tell if a patient
is having gallbladder attacks after a detailed medical history and physical
examination is performed. The next step is to determine the underlying cause of
Blood tests and liver function tests may be performed to
determine if the patient has cholestasis. If the patient's alkaline phosphatase
levels are three times higher than normal, cholestasis is indicated.
A computerized tomography (CT) scan, magnetic resonance
imaging (MRI) scan, or ultrasound may also be performed. These tests produce
images of the internal organs and may help the healthcare provider detect
abnormalities, such as gallstones, that may be causing the condition.
An endoscopic retrograde cholangiopancreatography (ERCP)
may be performed at the hospital to check for problems in the liver,
gallbladder, bile ducts, and pancreas. During the procedure, a thin, flexible
tube with a camera is inserted through the mouth into the small intestine. The
tube then hooks into the bile duct, allowing the healthcare provider to see the
Treatment of gallbladder attacks depends on the
underlying cause. For instance, a gallstone may need to be surgically removed
if it is causing symptoms. Antibiotics may be prescribed if an infection is the
cause. If a medication is the suspected cause, a healthcare provider may
recommend an alternative medication.
Gastroenteritis: Gastroenteritis describes inflammation
of the stomach and intestine that causes diarrhea, vomiting, and cramps.
Gastroenteritis is often mistaken for the stomach flu or
food poisoning because it causes similar symptoms. Although some doctors may
call gastroenteritis the flu, gastroenteritis is not caused by any of the
An infection in the digestive tract may cause
gastroenteritis. This may happen if patients consume foods or beverages that
contain disease-causing bacteria, viruses, or parasites. In some cases, the
food itself may irritate the patient's digestive tract. For instance, if a
lactose intolerant patient consumes a dairy product, the stomach and intestines
become irritated, which may lead to gastroenteritis. In addition, some
mediations, including aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs),
some antibiotics, caffeine, laxatives, and steroids, may cause gastroenteritis.
Most patients recover quickly from gastroenteritis.
However, babies and the elderly have a greatest risk of developing
life-threatening complications, such as dehydration and poor nutrition.
If an infection is causing gastroenteritis, patients take
medications called antimicrobials to kill the disease-causing organisms.
Commonly prescribed antimicrobials include ciprofloxacin (Cipro©),
trimethoprim/sulfamethoxazole (Bactrim©), and rifaximin (Xifaxan©, RedActiv©,
or Flonorm©). Adults may also take medications, called antiemetics, which
reduce vomiting. Commonly prescribed antiemetics include promethazine
(Phenergan© or Anergan©), prochlorperazine (Compazine©), or ondansetron
(Zofran©). Anti-diarrheals, such as diphenoxylate atropine (Lomotil©, Lofene©,
or Lonox©) or loperamide hydrochloride (Imodium©), may also be taken to reduce
diarrhea in patients older than three years old.
Gaucher's disease: Gaucher's disease is a rare, inherited
disorder that occurs when a fatty substance called glucocerebroside accumulates
in the spleen, liver, lungs, and bone marrow. In some cases, it also affects
the functioning of the brain.
Patients with Gaucher's disease are born with low levels
of a digestive enzyme called glucocerebrosidase, which breaks down
glucocerebroside. This deficiency causes glucocerebroside to build up in the
There are three types of Gaucher's disease: Type I, Type
II, and Type III. Type I is the most common form. It causes enlargement of the
liver (hepatomegaly) and spleen (splenomegaly) and it may also affect the lungs
and kidneys. When fat develops in the liver, it is often called hepatic
steatosis. Type I may develop at any age. Type II is a fatal condition that
develops during infancy and causes severe brain damage. Most children with Type
II Gaucher's disease die by the age of two years old. Type III causes the liver
and spleen to enlarge and brain damage gradually occurs over time. Type III usually
occurs in children and adolescents.
Gaucher's disease is diagnosed after a blood test.
Patients with the disorder will have low levels of glucocerebrosidase in their
There is currently no cure for Gaucher's disease.
Patients with Type I and Type III Gaucher's disease take enzyme replacement
therapy, which has been proven to effectively manage symptoms. However, there
is no effective treatment to manage the symptoms of Type II.
Gastroesophageal reflux disease (GERD): Gastroesophageal
reflux disease (GERD), also called acid reflux disease, occurs when liquid from
the stomach backs up (regurgitates) into the esophagus. This liquid may contain
stomach acids and bile. In some cases, the regurgitated stomach liquid can cause
inflammation (esophagitis), irritation, and damage to the esophagus.
It remains unknown exactly what causes GERD. Several
factors, including hiatal hernias (when the stomach pushes up through a hole in
the diaphragm muscle), abnormally weak contractions of the lower esophageal
sphincter, and abnormal emptying of the stomach after a meal, have been
associated with GERD.
Common symptoms of GERD include a burning sensation in
the chest that may spread to the throat (heartburn), chest pain (especially
when lying down), difficulty swallowing (dysphagia), regurgitating food or sour
liquid, coughing, hoarseness, sore throat, and wheezing.
Several factors may worsen symptoms of the condition. For
instance, spicy foods, fatty foods, chocolate, caffeine, tomato sauce,
carbonated beverages, mint, alcoholic beverages, large meals, lying down after
eating, some medications (e.g. sedatives, tranquilizers, or blood pressure
drugs), and cigarette smoking may worsen symptoms of GERD.
Most cases of GERD can be diagnosed based on the
GERD is usually a lifelong condition because there is no
cure for the disorder. Patients must take medications for the rest of their
lives to manage symptoms. In addition, patients should not smoke because it may
increase the amount of stomach acid and worsen symptoms.
Patients with mild cases of GERD may be able to manage
their symptoms with over-the-counter medications and changes in the diet.
Patients may experience improvements in symptoms if they eat smaller meals and
eliminate foods that are known to cause heartburn.
Antacids, such as Gelusil©, Rolaids©, Mylanta©, Maalox©,
or Tums©, may neutralize stomach acid and provide quick relief of GERD
symptoms. However, they will not help the esophagus heal. Patients who take
antacids frequently may experience diarrhea or constipation.
Some over-the-counter H-2 receptor blockers, such as cimetidine
(Tagamet HB©), famotidine (Pepcid AC©), nizatidine (Axid AR©), and ranitidine
(Zantac 75©), may also help provide quick relief of symptoms. These medications
reduce the amount of stomach acid that is produced. Side effects of H-2
receptor blockers, which are uncommon, may include changes in bowel movements,
dry mouth, dizziness, or drowsiness. Proton pump inhibitors, such as omeprazole
(Prilosec©), may also be taken short-term to help the esophagus heal. Patients
should not take these medications long term unless they talk with their
healthcare providers first.
Patients with persistent GERD may require
prescription-strength medications to manage symptoms and prevent esophageal
damage. H-2 blockers, such as Axid©, Pepcid©, Tagamet©, and Zantac©, are commonly
prescribed. Examples of prescription-strength proton pump inhibitors include
esomeprazole (Nexium©), lansoprazole (Prevacid©), omeprazole (Prilosec©),
pantoprazole (Protonix©), and rabeprazole (Aciphex©).
Achalasia: Achalasia is a rare disease that occurs when
the muscles of the esophagus are unable to relax. The esophageal sphincter,
which is the muscle between the lower esophagus and stomach, is unable to relax
enough to allow food to pass into the stomach. Also, the lower half of the
esophagus does not contract and relax properly. As a result, the food is not
properly pushed down into the stomach, and patients have difficulty swallowing
The exact cause of achalasia remains unknown. Researchers
believe that several factors, including infections, genetics, and abnormalities
in the immune system, may contribute to the development of the condition.
The most common symptom of achalasia is difficulty
swallowing solid foods and liquids. Some patients experience heavy sensations
in the chests after eating that feels like chest pain. If food collects in the
esophagus, it may cause irritation and lead to esophagitis (inflamed
esophagus). Some patients may regurgitate their food if it is trapped in the
esophagus. If regurgitated food enters the windpipe (trachea), it may cause
infections such as pneumonia.
Since patients have difficulty swallowing and consuming
foods and beverages, they typically experience weight loss. Other complications
may include malnutrition and dehydration.
Achalasia is usually diagnosed after a video-esophagram
is performed. During the procedure, the patient drinks a barium solution and
video X-rays are taken of the esophagus. The healthcare provider is able to see
if the barium enters the stomach properly. If the patient has achalasia, the
barium will stay in the esophagus longer than normal. In addition, the lower
end of the esophagus will be very narrow.
Some patients may experience an improvement in symptoms
if they eat slowly, take small bites, and chew their food thoroughly.
In addition, patients with achalasia usually take
nitrates, such as isosorbide dinitrate (Isordil©), and calcium-channel
blockers, such as nifedipine (Procardia©) or verapamil (Calan©), to relax the
muscles of the esophagus. These medications provide short-term relief of
A procedure called forceful dilation, or stretching of
the lower esophageal sphincter, is often needed to open the esophagus and allow
food to enter the stomach. During the procedure, a tube with a balloon at the
end is inserted into the patient's esophagus. The balloon is placed across the
sphincter and inflated. As a result, the sphincter stretches out. Forceful
dilation successfully treats 65-90% of patients with achalasia. The most
serious complication of forceful dilation is rupture of the esophagus, which
occurs in about five percent of patients. If a rupture occurs, antibiotics
and/or surgery may be required. Forceful dilation is generally quicker and less
expensive than surgery.
If forceful dilation is unsuccessful, a surgical
procedure, called esophagomyotomy, may be performed. During the procedure, the
sphincter is cut, which expands the esophagus and makes it easier for the
patient to swallow. The procedure is more effective than forceful dilation. An
estimated 80-90% of patients are treated successfully with esophagomyotomy.
However, in some cases, dysphagia may return. The most common side effect of
esophagomyotomy is GERD. In order to prevent GERD, the esophagomyotomy may be
modified so that it does not completely cut the sphincter or the esophagomyotomy
may be combined with anti-reflux surgery. Regardless of which surgery is
performed, some healthcare providers recommend lifelong treatment with GERD
medications, such as Axid©, Pepcid©, Tagamet©, or Zantac©. Other doctors only
recommend lifelong treatment if GERD is diagnosed 24 hours after surgery.
Botox injections in the lower sphincter are the newest
treatment for achalasia. The botulinum toxin is injected to weaken the
sphincter. The effects of treatment usually last for several months. Patients
may require additional injections. Patients who are elderly or unable to
undergo surgery typically receive this treatment. It may also be performed to
help patients gain weight and improve their nutritional status before surgery.
Esophageal spasms: Patients may experience spasms in the
esophagus. Esophageal spasms may cause difficulty swallowing, painful
swallowing, sensation that something is stuck in the throat, heartburn, and
The exact cause of spasms remains unknown. However,
eating hot or cold foods may contribute to the condition. Also,
gastroesophageal reflux disease (GERD) or heartburn may also play a role in the
development of esophageal spasms.
Patients typically take nitrates, such as isosorbide
dinitrate (Isordil©), or calcium-channel blockers, such as nifedipine
(Procardia©) or verapamil (Calan©), to relax the muscles.
ABDOMEN AND STOMACH DISORDERS
Appendicitis: Appendicitis occurs when an organ in the
lower right-side of the abdomen, called the appendix, becomes inflamed and
filled with pus.
The cause of appendicitis is not always clear. In some
cases, appendicitis may occur if food waste or a solid piece of stool becomes
trapped in an opening near the appendix. It may also occur after an infection.
The most common symptom of appendicitis is severe pain in
the lower right-hand side of the abdomen. Additional symptoms may include
nausea, vomiting, loss of appetite, low-grade fever, constipation, bloating or
inability to pass gas, diarrhea, and abdominal swelling.
Patients with appendicitis will have high levels of white
blood cells in their blood. Imaging studies are also performed to determine if
the appendix is enlarged.
Patients with appendicitis must have their appendix
surgically removed as quickly as possible. Since the appendix has no known
purpose, the patient's life is unaffected after the appendix is removed.
If the appendix is not removed quickly, it may break open
or rupture. If the appendix ruptures, it may lead to an infection in the lining
of the abdominal cavity. Infections may cause a condition called peritonitis,
which occurs when the abdominal lining becomes inflamed. If the appendix
ruptures, the patient may start to feel better. However, soon after, the
abdomen may swell because it becomes full of gas and fluid. At this point, the
abdomen usually feels hard, tight, and tender to the touch. Severe pain also
develops throughout the entire abdomen. Patients may be unable to pass gas or
have a bowel movement. Additional symptoms of peritonitis include fever,
thirst, and decreased urination.
Patients who have symptoms of peritonitis should seek
immediate medical treatment. Even if the condition is treated quickly, it may
be fatal. Patients will receive aggressive treatment with intravenous
antibiotics. Surgery is necessary to remove the burst appendix. Patients will
also receive all fluids and nutrition through injections until their condition
Stomach inflammation (gastritis): Stomach inflammation,
also called gastritis, may develop suddenly (acute) or gradually over a longer
period of time (chronic).
Most cases of gastritis are caused by an infection with
the same bacterium (Helicobacter pylori) that causes stomach ulcers. Gastritis
may also be caused by traumatic injury or surgery, excessive alcohol
consumption, and regular use of nonsteroidal anti-inflammatory drugs (NSAIDs),
such as ibuprofen (Motrin© or Advil©) or naproxen (Aleve©).
A condition called bile reflux disease may also cause, or
occur simultaneously with, gastritis. Bile reflux occurs when bile, a fluid
that helps digest fats, flows upward from the small intestine into the stomach
and esophagus. Bile reflux has also been found to be common after gallbladder
removal, or as a result of complications from gastric surgery which may damage
the pyloric valve (a ring of muscle that separates the stomach from the
duodenum) such as gastrectomy, or gastric bypass. Further inflammation and
damage to the lining of the stomach and esophagus may occur as a result.
In rare cases, gastritis may occur when the body's own
immune cells attack the stomach. It remains unknown what triggers this
autoimmune reaction. The acid in the stomach may worsen symptoms of gastritis.
Symptoms of gastritis generally include a burning pain or
aching in the upper abdomen that may worsen when food is eaten, nausea,
vomiting, loss of appetite, bloating, feeling of fullness in the upper abdomen
after eating, and weight loss. In some cases, gastritis may cause stomach
bleeding. Symptoms of stomach bleeding include blood in the vomit and black or
In some cases, gastritis may lead to ulcers and an
increased risk of stomach cancer.
In most cases, patients fully recover quickly once
treatment is started. Patients typically take antacids, such as Tums©,
Mylanta©, or Rolaids©, to help neutralize the stomach acid. This helps reduce
symptoms of gastritis quickly. Acid blockers, such as cimetidine (Tagamet©),
ranitidine (Zantac©), nizatidine (Axid©), or famotidine (Pepcid©), may be taken
to reduce the amount of stomach acid that is produced. Proton pump inhibitors,
such as omeprazole (Prilosec©), lansoprazole (Prevacid©), rabeprazole
(Aciphex©), and esomeprazole (Nexium©), may also be taken to reduce the amount
of stomach acid produced.
If an infection with H. pylori is causing gastritis,
patients generally receive a combination of antibiotics and proton pump
inhibitors. Commonly prescribed antibiotics include amoxicillin (Amoxil©),
clarithromycin (Biaxin©), and metronidazole (Flagyl©).
Hypochlorhydria (low stomach acid): Hypochlorhydria
occurs when patients have low levels of stomach acid, also called hydrochloric
acid. The body needs stomach acid in order to break down foods so that they can
be absorbed in the intestines.
Natural aging, a poor diet, chronic use of certain
medications, and past infection with the Helicobacter pylori bacteria may limit
a patient's ability to produce hydrochloric acid.
Hypochlorhydria may also be a symptom of an underlying
medical condition such as Addison's disease, depression, asthma, eczema,
gallstones, hepatitis, osteoporosis, psoriasis, thyroid disease, and autoimmune
If there is low acidity in the stomach, patients may only
be able to partially digest food. This may lead to malnutrition. Symptoms of
hypochlorhydria may include bloating, gas, belching, burning or dryness of the
mouth, heartburn, multiple food allergies, rectal itching, redness or dilated
blood vessels in the cheeks and nose, adult acne, hair loss (in women), iron
deficiency, undigested foods in the stool, yeast infection, as well as diarrhea
or constipation. Patients with hypochlorhydria also have an increased risk of
developing infections in the gastrointestinal tract because it provides an
ideal environment for disease-causing organisms, such as bacteria.
Patients with hypochlorhydria take betaine hydrochloride
or glutamic acid hydrochloride with meals and snacks. These medications
increase the amount of stomach acid, which helps the body properly break down
and digest foods.
Ileus: Ileus occurs when the small and/or large intestine
is partially or completely blocked. Ileus is a non-mechanical blockage. Unlike
mechanical blockages, which occur when the bowel is physically blocked, a
non-mechanical blockage occurs when the rhythmic contractions that move
material through the bowel, called peristalsis, stops.
Ileus is usually associated with an infection of the
peritoneum, which is the membrane that lines the abdomen. This is most common
in infants and children. Intestinal surgery may lead to temporary ileus that
lasts two to three days. Ileus may also be a complication of surgery on other
body parts, such as the chest or joints. Other medical conditions, including
kidney disease and heart disease, may cause ileus. Some chemotherapy drugs,
such as vincristine (Oncovin©, Vincasar PES©, or Vincrex©) or vinblastine
(velban© or Velsar©), may cause ileus.
Symptoms of ileus may include abdominal distention,
abdominal cramping, nausea, vomiting, bloating or failure to pass gas, and
difficulty having bowel movements.
Patients with ileus must receive nutrition and fluids
intravenously to give the intestines time to heal. If an infection is causing
the condition, antibiotics are prescribed. Other medications, including
cisapride and vasopressin (Pitressin©), may be prescribed to stimulate the
intestines to contract and relax.
Celiac disease (non-tropical sprue): Celiac disease, also
called non-tropical sprue, is a digestive disorder that occurs when an
individual's immune system overreacts to gluten, a protein found in wheat, rye,
barley, and oats.
When a patient with the disease eats food that contains
gluten, the immune cells flood to the stomach and intestine to destroy the
gluten. However, among these immune cells are autoantibodies that attack the
lining of the intestine by mistake. As a result, the intestinal lining becomes
It has not been determined what triggers this reaction in
celiac patients. However, celiac disease is associated with autoimmune
disorders, such as lupus. Autoimmune disorders occur when the patient's immune
system mistakenly identifies body cells as harmful invaders, such as bacteria.
As a result, the immune cells in celiac patients attack the patient's
intestinal cells when gluten is consumed.
Celiac disease causes symptoms of abdominal pain and
bloating after consuming gluten.
Additionally, complications, including poor absorption,
may occur if the patient continues to eat gluten-containing foods. When the
intestinal lining is damaged, patients have difficulty absorbing nutrients.
Symptoms of poor nutrition include weight loss, diarrhea, abdominal cramps,
gas, bloating, fatigue, foul-smelling or grayish stools that may be oily
(steatorrhea), stunted growth in children, and osteoporosis (hollow, brittle
If celiac disease is suspected, blood tests will be
performed to determine whether or not the patient has autoantibodies associated
with the disease. If autoantibodies are present, a positive diagnosis is made.
Although there is currently no cure for celiac disease,
the condition can be managed with a gluten-free diet. Patients should avoid all
foods that contain gluten. This includes any type of wheat (including farina,
graham flour, semolina, and durum), barley, rye, bulgur, Kamut, kasha, matzo
meal, spelt, and triticale. Therefore, foods such as bread, cereal, crackers,
pasta, cookies, cake, pie, gravy, and sauce should be avoided unless they are
labeled as gluten-free. In general, patients who strictly follow a gluten-free
diet can expect to live normal, healthy lives. Symptoms will subside several
weeks after the diet is started, and patients will be able to absorb food
normally once they avoid eating gluten. A dietician or certified nutritionist
may help a patient with celiac disease develop a healthy diet. Patients with
celiac disease may also find gluten-free cookbooks to be a helpful resource.
Many products, including rice flour and potato flour, can be used as
substitutes for gluten-containing flour.
Menke's kinky hair disease: Menke's kinky hair disease,
also called Menke's disease, is an inherited disorder that decreases the body's
ability to absorb copper. Cells in the body need copper to function properly.
The disease is characterized by sparse and coarse hair, short stature, and
progressive deterioration of the nervous system.
Symptoms develop during infancy. Babies with Menke's
kinky hair disease show slightly slowed development for two to three months
after birth. The baby's condition will worsen after this time and he/she will
lose previously developed skills. Other symptoms include silver or colorless
hair, seizures, and osteoporosis (hollow and brittle bones).
There is currently no cure for Menke's kinky hair
disease. Patients may receive injections of copper. However, patients typically
die by the age of ten.
Acrodermatitis enteropathica: Acrodermatitis
enteropathica is an inherited condition that occurs when the body is unable to
absorb zinc. This trace element is necessary for the functioning of over 300
different enzymes and plays a vital role in an enormous number of biological
The exact cause of acrodermatitis enteropathica remains
unknown. However, researchers believe that genetics may play a role.
Symptoms of acrodermatitis enteropathica may include red
and swollen patches of dry and scaly skin, crusted or pus-filled blisters on
the skin, swollen skin around the nails, mouth ulcers, red and glossy tongue,
impaired wound healing, as well as hair loss on the scalp, eyelashes, and
eyebrows. Additional symptoms may include pinkeye, sensitivity to light,
decreased appetite, diarrhea, irritability, failure to grow, and depressed
A zinc deficiency can be diagnosed after a blood test.
Although there is no cure for the disorder, zinc
supplements taken by mouth daily have been shown to effectively manage
symptoms. Without treatment, acrodermatitis enteropathica will lead to death.
Skin lesions usually heal one to two weeks after treatment is started. Other
symptoms begin to improve within 24 hours.
Hemorrhoids: Hemorrhoids are inflamed veins in the anus
and rectum. Hemorrhoids may develop inside or outside of the rectum, depending
on the specific veins that are affected.
Hemorrhoids are common, affecting nearly half of
individuals who are older than 50 years of age.
Hemorrhoids develop when there is increased pressure in
the veins of the anus and rectum. This is often due to straining during
constipation, sitting or standing for extended periods of time, pregnancy,
childbirth, and diarrhea. Obese patients have an increased risk of developing
Internal hemorrhoids are not painful because pain nerves
are not present inside the membranes of the rectum. However, internal hemorrhoids
may cause bleeding when stools are passed. External hemorrhoids are usually
painful. The veins outside of the rectum are swollen and may itch. Bleeding may
occur, especially when straining to move the bowels.
External hemorrhoids can be diagnosed after observing the
inflamed veins. If internal hemorrhoids are suspected, a healthcare provider
may examine the rectum with an anoscope, proctoscope, or sigmoidoscope.
Mild cases of hemorrhoids are usually treated with
over-the-counter creams or ointments, such as Preparation H©. Warm baths may
also help improve symptoms.
If a blood clot forms in a hemorrhoid, a healthcare
provider can make a surgical incision to remove the clot.
Rubber band litigation may be used to treat severe or
persistent cases of hemorrhoids. During the procedure, small rubber bands are
inserted around the base of the hemorrhoids. This cuts off the blood supply in
the vein until the hemorrhoid falls off.
During a procedure called sclerotherapy, a chemical is
injected near the hemorrhoid to shrink the inflamed vein.
If these therapies are ineffective, the hemorrhoids may
be surgically removed in a process called hemorrhoidectomy.
Rectal prolapse: Rectal prolapse occurs when the inner
lining of the rectum, called the rectal mucosa, protrudes from the anus. Rectal
prolapse occurs when the tissues that normally support that rectal mucosa
become loose and allow the tissue to slip down through the anus.
Without treatment, the condition may worsen and a large
part of the rectum may protrude from the body through the anus. When this
happens, the condition is called a complete prolapse. Most patients do not
realize that they have rectal prolapse until it reaches this stage. Initially,
the rectum may protrude during certain activities, such as coughing or
laughing. Eventually, the prolapsed rectum may protrude more frequently or
Patients may be able to feel the tissue protruding out of
the anus. Common symptoms of rectal prolapsed include pain during bowel
movements, mucus or bleeding from the protruding tissue, and inability to
control bowel movements.
Most patients with rectal prolapsed require surgery. The
surgeon reattaches the rectum to the backside of the inner pelvis. Surgery may
be performed through the abdomen or the perineum.
Stool softeners, such as calcium docusate (Surfak©) or
sodium docusate (Colace©), may help reduce pain and straining during bowel
Rectal inflammation (proctitis): Rectal inflammation,
also called proctitis, occurs when the lining of the rectum (rectal mucosa)
becomes swollen. Patients with proctitis often experience rectal bleeding, anal
and rectal pain, frequent urge to have a bowel movement, passing mucus through
the rectum, feeling of rectal fullness, and diarrhea.
There are many potential causes of proctitis. The most
common cause is sexually transmitted diseases, which are acquired through anal
or oral-anal intercourse. Other causes may include inflammatory bowel disease
(IBD) and bacterial infections, such as streptococcus. Less common causes
include chemicals (such as hydrogen peroxide enemas), injury to the rectum,
radiation therapy that is applied near the rectum (for conditions such as
prostate or cervical cancer), and medications or objects that are inserted into
Several tests may be performed to diagnose the underlying
cause of proctitis. Blood tests may be performed to detect possible infections.
A colonoscopy may be performed to examine the inside of the colon for
abnormalities. Healthcare providers may also use a swab to collect a sample of
fluid from the rectum or urethra. The sample is then tested for STDs.
Most cases of proctitis are effectively treated and
patients experience a full recovery. Treatment depends on the underlying cause
of proctitis. If a bacterial infection is present, antibiotics, such as
ciprofloxacin (Cipro©), levofloxacin (Levaquin©), penicillin, amoxicillin
(Amoxil© or Trimox©), azithromycin (Zithromax©), clarithromycin (Biaxin©), or
clindamycin (Cleocin©), may be taken. If a viral infection (e.g. herpes) causes
proctitis, antivirals, such as such as acyclovir (Zovirax©), may be taken.
Corticosteroids may be taken if radiation therapy is causing proctitis. If IBD
is causing symptoms, anti-inflammatories, such as sulfasalazine (Azulfidine©)
or anti-diarrheals, such as psyllium powder (Metamucil©), may be taken.
Laxative-induced colon damage: Laxatives are medications
that are used to stimulate bowel movements. They are primarily used to treat
constipation. Patients who overuse laxatives may develop colon damage.
Long-term use of laxatives may cause the muscles in the colon to become weak
from lack of use. The nerves in the lining of the colon may also become damaged.
As a result, this may slow intestinal mobility and cause constipation.
Symptoms of laxative abuse include weight loss, hair
loss, vomiting, abdominal pain, low energy, dehydration, dry eyes, headaches,
mood swings, and bone pain.
Therefore, patients should not take laxatives more
frequently than the packaging label suggests. If symptoms persist, patients
should consult their healthcare providers to diagnose and properly treat the
Patients should not take laxatives more frequently than
the packaging label suggests. If symptoms persist, patients should consult
their healthcare providers to diagnose and properly treat the underlying cause.
Patients who have a history of indigestion should eat
smaller, more frequent meals to help prevent symptoms. Limiting spicy, fried,
or fatty foods may also reduce the risk of indigestion.
Patients should not consume excessive amounts of alcohol
because it irritates the stomach. Abusing alcohol may cause inflammation or
bleeding in the stomach.
Patients are encouraged not to smoke because smoking
damages the protective lining of the stomach. Smoking increases an individual's
risk of developing gastritis and ulcers. In addition, smoking increases the
amount of stomach acid and delays healing, which increases a patient's risk of
developing stomach cancer.
Patients should limit their use of nonsteroidal
anti-inflammatory drugs (NSAIDS), such as ibuprofen (Motrin© or Advil©) because
they may cause stomach inflammation and bleeding, as well as ulcers.
Patients should properly wash all produce thoroughly
before eating to reduce the risk of developing gastrointestinal infections.
Individuals who are in areas of the world that have poor
sanitation should only drink bottled water to avoid the risk of
gastrointestinal infections. If this is not possible, individuals should boil
their water before drinking it. This kills any disease-causing bacteria or
parasites that may be living in the water.
Patients should only consume dairy products that have
been pasteurized. This reduces the risk of developing a gastrointestinal
infection that may cause diarrhea.
Individuals should avoid or limit their intake of the
artificial sweeteners sorbitol and mannitol because they may cause diarrhea.
These artificial sweeteners are commonly found in sugar-free products and
Patients with gastrointestinal disorders should take
their medications exactly as prescribed in order to prevent complications from
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