If tests don't suggest a cure, simple changes to diet, or perhaps reviewing medication may be the answer, says Dr Mel Wynne-Jones
Digestive symptoms are very common, and most settle naturally.
But it’s important to run persistent or severe symptoms past your GP, even if they’re embarrassing, in case you need tests, prescription-only medication and/or hospital treatment.
And you’ll still want some relief, even if there’s no serious underlying cause.
What can go wrong?
Our digestive system contains several major organs (gullet, stomach, liver, pancreas, large and small bowel) but as they work as a team, symptoms don’t always point to a specific diagnosis.
So you may notice any combination of indigestion symptoms, such as heartburn, acid reflux, poor appetite, trouble swallowing your food, excess burping or trapped wind, nausea, vomiting or tummy pain before or after meals, jaundice and/or unintended weight loss.
Or you may have loose or urgent stools, constipation, bloating, a lump or pain in your tummy or bottom, mucus (jelly) or fresh/black blood in your stools.
Some of these can sometimes be a sign of cancer or other serious disorders, so don’t delay. Or they may be caused by non-digestive disorders, such as thyroid problems, but only tests can tell.
Many of these symptoms, including irritable bowel syndrome (IBS) which disturbs the bowel’s normal regular contractions, can be made worse by intolerance to foods such as wheat, fibre, dairy, caffeine, onions, some fruit and veg, or true gluten sensitivity (coeliac disease).
Try eliminating suspects for up to three weeks, but ask to see a dietitian before doing this in the long-term to ensure you don’t miss out on essential nutrients.
Stress-busting may help too – try exercise, relaxation techniques or talking treatments such as CBT (cognitive behavioural therapy).
Acidity and heartburn can also improve if you reduce stress, alcohol, smoking and your weight. An antacid, such as Gaviscon, will quickly relieve symptoms.
Help bloating by drinking lots of fluids (not fizzy drinks or too much caffeine, which can make bloating worse), eat regularly without rushing and avoid chewing gum.
Many drugs upset digestion, including non-steroidal anti-inflammatory drugs such as ibuprofen (always read leaflets), but medication can help, too, once you’ve been diagnosed.
A proton pump inhibitor (PPI), such as lansoprazole, will suppress acid production. IBS symptoms can be treated with pharmacy medicines for diarrhoea, constipation or spasm, and your GP can prescribe newer drugs, such as linclotide.
Good bugs, bad bugs
Our guts contain ‘good bacteria’, such as lactobacilli, which help our digestion. Researchers are investigating their genomes (genetic material) to see whether this could lead to new treatments.
If the bacterial balance gets disturbed (for example, by food poisoning or antibiotics) we may get IBS-type symptoms, and foods containing probiotics may help.
Many of us carry Helicobacter pylori bacteria, which increase stomach acidity. They’re linked to peptic ulcers, heartburn and, rarely, cancer. If detected (see box, left), they can be eradicated, with a short course of strong antibiotics and a PPI.
However, Clostridium difficile, which often lives harmlessly in our bowels, can multiply if we take certain antibiotics, causing mild or severe, sometimes life-threatening, diarrhoea, tummy pain and fever, especially if we’re also taking a PPI.
But very powerful antibiotics may be needed to treat C. diff, and good hygiene is essential tominimise spread.
5 Tests you may need to have
1 Blood tests for anaemia, coeliac disease (gluten sensitivity), an unhealthy liver, gall bladder or pancreas, and/or signs of inflammation (for example, colitis or Crohn’s disease).
2 Breath and/or stool samples to check for infections.
3 Gastroscopy – a telescope test with light sedation that checks and takes samples from the lining of your gullet, stomach and duodenum.
4 Colonoscopy – a similar telescope test with stronger sedatives, which checks the large bowel.
5 Ultrasound, CT or MR scans to look at internal organ