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Dr. Parag Lodhavia, of Central Delaware Gastroenterology Associates, says it’s important to see your doctor for a correct diagnosis. Photograph by Jared CastaldiLower abdominal discomfort, gas, diarrhea—the array of symptoms is a common complaint.

“I’ll bet it’s celiac disease. Try cutting out wheat,” a well-intended friend may say. Or, “It’s probably just lactose intolerance. I have that. Here, take one of my pills.”

Your friends might mean well, but unless they have a medical degree, it is risky to entrust your health to them. “People will often self-diagnose, but it’s important to see a doctor to get a correct diagnosis,” says Dr. Parag Lodhavia, of Central Delaware Gastroenterology Associates. Once you have a correct diagnosis, it’s important to work with your doctor and other health practitioners to manage your illness and potential complications. Here are some common gastrointestinal illnesses and treatments:
 

Irritable Bowel Syndrome

IBS is among the more prevalent illnesses, affecting about 20 percent of all people at some point in their lives, says gastroenterologist Joel Chodos of Newark. Though common, IBS is not easy to diagnose because there are no tests entirely specific for it. In most cases IBS might be the primary suspect, but other illnesses must be excluded before it can be diagnosed. “IBS can be very disabling, but it is not dangerous,” Chodos says.

Symptoms Intermittent abdominal pain, bloating, discomfort, and diarrhea or constipation are the most common symptoms of IBS. (Constipation can mean hard, difficult to pass stools or infrequent bowel movements.) These symptoms might be accompanied by gas, mucus in the stools and food intolerances. Most people are under age 35 at the onset of symptoms.

Diagnosis After a thorough medical history and physical exam, your physician will try to rule out infection, lactose intolerance and other illnesses via blood tests, stool tests, lactose intolerance test and, possibly, X-rays, sonograms or colonoscopy.

Treatment The cause of IBS is unknown, but there is new evidence from research at UCLA that bacterial overgrowth in the small intestine could contribute, Chodos says, so some doctors will prescribe an antibiotic. If antibiotics don’t help, treatment is to prevent the symptoms by avoiding foods that trigger the problem and by managing stress, which is thought to contribute to IBS. Over-the-counter diarrheal medicines can help. Constipation can be treated with added fiber and stool softeners or, under a doctor’s advice, with laxatives.

Watch out for Do not self-diagnose IBS, Lodhavia warns. IBS has many of the same symptoms as more serious gastrointestinal disorders such as celiac disease and inflammatory bowel disorder. “The threshold for doing a colonoscopy is a lot lower than it used to be because we want to diagnose IBD early on so appropriate pharmacological therapy can be initiated,” Lodhavia says.

Page 2: Celiac Disease

 

Celiac Disease

Though not among the most common GI ailments, celiac disease occurs in a significant minority of people, Lodhavia says. It has received so much media and popular attention that some people are mistakenly self-diagnosing themselves with celiac disease.

Celiac disease, also known as celiac sprue, damages the small intestine and interferes with the absorption of nutrients from food. It is caused by intolerance to gluten, a protein found in wheat, rye and barley. Once thought to be a rare disease found only in children, celiac disease is now recognized as one of the most common genetic diseases in the world, especially among people of Irish, English and Scottish ancestry.

Symptoms Symptoms vary from person to person. They can occur in the digestive system or other parts of the body. Digestive symptoms may include abdominal bloating and pain, chronic diarrhea, vomiting, constipation, weight loss, and pale, foul-smelling or fatty stools, according to the National Institute of Diabetes, Digestive and Kidney Diseases. Adults with celiac disease are much less likely than young children to have digestive symptoms, so celiac disease often goes undiagnosed for years. Other symptoms include anemia, fatigue, bone or joint pain, arthritis, depression or anxiety, tingling numbness in the hands or feet, seizures, missed menstrual periods, infertility or recurrent miscarriage, canker sores in the mouth, and an itchy skin rash. Some people with celiac disease have no symptoms.

Diagnosis Blood is tested for abnormally high levels of antibodies to celiac proteins. If symptoms and blood tests suggest celiac, a biopsy of the small intestine is performed to confirm the diagnosis.

Treatment The only treatment for celiac disease is a gluten-free diet. Ingesting even the smallest amount of gluten can cause problems, so people with celiac disease should work with a professional dietician to be sure they are truly following a gluten-free diet.

What to watch for It’s not enough to put yourself on a gluten-free diet, Lodhavia says. If you have celiac disease, you are at risk for complications and seek the care of a physician.

Page 3: GERD

 

GERD

Gastroesophageal reflux disease is also known as acid reflux disease. The stomach produces acid to digest food, which is fine, as long as the acid remains confined to the stomach. Sometimes, though, the ring of muscle that connects the esophagus to the stomach, the lower esophageal sphincter, does not close properly, which allows acid from the stomach to move up into the esophagus. When this happens occasionally, it is known as heartburn. When it happens regularly (more than twice a week), it’s acid reflux, or GERD. The incidence of acid reflux has been increasing over the past two decades, Chodos says, perhaps because the population is getting heavier. It is now a very common disorder.

Symptoms The hallmark symptom of GERD is a burning sensation in the upper abdomen and lower mid-chest behind the breastbone, sometimes going up toward the throat. Regurgitation, with a sour or bitter taste backing up into the throat or mouth, is also common. Less common symptoms, according to Chodos, include hoarseness, coughing, wheezing and chest pain. Web MD also lists as symptoms hiccups, nausea, bloating, burping, bloody or black stools or bloody vomiting, and dysphagia, or difficult swallowing. Spicy, fatty or caffeinated foods tend to trigger symptoms.

Diagnosis Diagnoses are based mainly on the patient’s medical history, but an upper endoscopy is sometimes used to diagnose uncertain or severe symptoms, such as bloody vomiting, that might suggest another diagnosis, Chodos says.

Treatment Lifestyle changes—eating smaller meals, avoiding spicy and caffeinated foods, losing excess weight, and avoiding lying down soon after meals—help. There also are effective over-the-counter and prescription drugs for treatment.

What to watch for If lifestyle changes do not eliminate a recurring problem, it’s time to go to the doctor. “When acid reflux persists, it is important to rule out complicated reflux disease, which includes erosive reflux disease and Barrett’s esophagus,” Lodhavia says. “With complicated reflux disease, you need to be on a regular treatment regimen to prevent the development of complications such as esophageal cancer.” 
 

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