GI Issues
Acid Reflux, also known as Gastoesophageal Reflux Disease is when patients typically complain of symptoms of heartburn and regurgitation of stomach contents to the chest and neck area.
In addition patients can also complain of other symptoms such as chest pain, night time cough, asthma, bad breath(halitosis), weakening tooth enamel, difficulty swallowing, painful swallowing.
The first line of treatment for most physicians is medication to reduce the stomach acid such as H2 blockers (Pepcid) Proton pump inhibitors (Tecta) or over the counter measures such as Tums, Rolaids, Pepto Bismol.
For many patients these measures help alleviate the symptoms somewhat but breakthrough symptoms commonly occur and many times patients have to use these medications long term albeit in an as needed capacity rather than everyday.
For others with persistent symptoms there are surgical operations designed to strengthen the lower esophageal sphincter (muscle that encircles the bottom of the esophagus) to prevent the movement of stomach contents backward but it can also lead to worsening gas bloat, and difficulty swallowing food.
Long term uncontrolled reflux can lead to permanent changes and damage to the lining cells of the esophagus. Physicians should be monitoring patients that have persistent or worsening symptoms.
Over time this damage can progress from inflammation (esophagitis) to ulcers cell changes (Barrett’s) and finally to esophageal cancer.
For Gut Check there is a better way to fix this issue. Patients don’t realize that their daily eating habits affect gastric reflux and by making simple changes they don’t have to perpetually take medication, have surgery or live with the symptoms.
Unfortunately most physicians do not understand the role of diet in GERD. This step gets forgotten and in most cases patients are left to the use of long term medication when in most cases it isn’t necessary once you understand why people develop GERD.
Remember:
Most patients with reflux do not make more ACID that people without reflux.
The vast majority of patient have a normal lower esophageal sphincter muscle further tightening it will lead to other long term concerns.
Jason knows it’s going to be a long night.
He knew he should have stopped earlier but the all you can eat wings were very tempting plus he didn’t eat much earlier.
Jason has been diagnosed with acid reflux for years.
He has to take medication on a regular basis but even then sometimes it doesn’t work.
He’s also tried over the counter medications like TUMS (antacids) and Gaviscon. They only work periodically.
He’s heard about surgeries that reinforce the muscle above the stomach but he doesn’t think he needs surgery yet.
His symptoms include heartburn, chest pain, and nighttime cough. Sometimes the acid goes all the way to his mouth and he has to spit it out.
His dentist has even mentioned that his enamel is thinning and it’s probably due to reflux.
He’s also noticed his voice becoming more hoarse at times especially when he’s having a bad night.
He read an article that said long-term reflux can lead to changes in the lining of the esophagus and sometimes even to esophageal cancer.
He doesn’t understand why it keeps happening.
He doesn’t know what else to do.
If this is you, maybe it’s time for a GUT CHECK.
All of the above diagnoses have very similar symptoms
Patients complain of bloating and abdominal cramps
Depending on the location, physicians can help figure out where this is occurring and hopefully suggest treatments that are effective
For celiac disease the problem is related to a protein found in all wheat, specifically gluten
The immune system develops an allergy to this protein and will attack the bowel when the protein is being absorbed. Biopsies of the bowel will demonstrate the damage done to the lining of the small bowel and this represents the best way to diagnose this condition
General food allergies work in a similar pattern
The main difference is that the target isn’t gluten
Patients can complain of certain foods that precipitate symptoms
The problem is which food is the culprit
Many patients are also concerned that they’re not digesting their food properly
Again they complain of bloating and cramping
They’re not sure if it’s an allergy or something else that’s wrong with the system
Typical treatments include Acid reduction agents such as H2 blocker, Proton Pump inhibitors but they rarely make a difference in symptoms. Others have tried agents that increase bowel motility to push the gas further along to alleviate the symptoms. Finally patients resort to altering their diet which include stopping spicy foods, coffee tea caffeine but there is no understanding of how this happens and also what can be done to deal with this long term
GUT CHECK’s approach involves explaining why patients have increased amounts of gas inside their bowel. We will analyse your routine dietary habits and explain what the causes of gas bloat are and suggest strategies to limit the amount of gas production in the gut.
At times the clinical use Photo food logs to get a better understanding of exactly of where your symptoms may be coming from
Also note that food you consume stays in your gut for up to 72 hours
So having a wider view of what you’ve been eating will give you a better idea or your problem food or ingredient
Amy is a 36 year old female
Amy complains of abdominal distension and discomfort typically after meals
She also complains of her abdomen being distended and feeling like she can’t eat anymore
She thinks she may be eating less food but she hasn’t lost anyway
She’s upset because she can’t enjoy the food like she used to
She also notices that her abdomen is distended and her clothes don’t fit right
She’s also a little embarrassed because she’s farting more than she used to
She also complains of having a little diarrhea off and on and has some lower abdominal cramps
Other times patients have discomfort in the abdomen directly under the breastbone like they may have overeaten that can last for 1-2 hours
It may or may not happen with every meal but typically worse with the evening meal
Patients also may feel “9 months pregnant” because their stomach is full of gas
They also note increased burping and farting which can be a bit embarrassing for the patient in their day to day activities.
She’s tried altering her diet
First she stopped all spicy foods; no difference
Then she cut out all caffeinated drinks such as Coffee and Tea
She’s also tried cutting out all carbs but despite this her symptoms persist
She’s gone to her family doctor with these complaints and was started on proton pump inhibitors
The symptoms are still there but they’re all they’re not
She sees another specialist and is started on a motility agent
This is supposed to help empty her stomach faster
Again her symptoms persist
She’s thinking about starting a gluten-free diet but it seems very difficult to stick with the program Since many of her favorite foods contain gluten
If this is you, maybe it’s time for a GUT CHECK.
This is defined as a myriad of symptoms that include abdominal bloating cramping pain
This is also associated with alteration in your bowel habit this can include diarrhea, constipation, or a combination of both
Patients are also started on the Myriad of diets including FODMAP, gluten free low residue Etc
patients are also started on probiotics laxatives anti-diarrheals
It’s a very confusing treatment that really is not effective in many patients
It’s very much like a shotgun approach
At GUT CHECK Clinic we will take a careful history to better understand your symptoms
In addition we can suggest alterations in your diet that are simple and generally effective
In many ways the problem with IBS stems from inconsistency of bowel habit
Some days you do the right thing and some days you don’t
A photo food log should give you a better idea of how consistent you are
Consistency is really important and for the bowel function it needs a consistent input to ensure a consistent output
Make no mistake this is a very tricky problem to deal with. We just hope to make it easier in the long run.
Joanne is a 42 year old mother of two
She’s always had issues with her bowels
She’s seen doctor after doctor after doctor
She’s undergone multiple investigations including both gastroscopy and colonoscopy
She’s been told she has something called irritable bowel syndrome
Everyone tells her she’s fine but she knows she’s not
She can have issues with diarrhea alternating with constipation
At times she can go multiple times a day
While others she has to wait three to four days between bowel movement
She also has to strain quite a bit to go
She is noticed bleeding and has been told she has hemorrhoids
She has taken psyllium husk powder but it tasted bad and didn’t work
She’s been to a dietitian
She started on the FODMAP diet again didn’t work
She’s gone on a gluten-free diet again with mixed results
To deal with her symptoms she sometimes has to take laxatives
In addition she started using probiotics as well as magnesium
In the end it’s not very effective
She doesn’t know what else to do
There’s always another diet but she’s not very optimistic
If this is you, maybe it’s time for a GUT CHECK.
This is characterized as loose watery stool
It’s typically associated with urgency (really have to go now) and frequently (at least three times a day). Patients also typically complain of abdominal cramps bloating and abdominal pain
Most common reasons include infections (either bacterial viral or parasite)
Allergies to medication (e.g. antibiotics)
Most the time this is a short-term problem
If symptoms persist however then other diagnoses are possible including celiac disease, inflammatory bowel disease malignancy
GUT CHECK’s approach is to fully understand your symptoms with careful history taking
to make suggestions on what further investigations are required and finally dietary suggestions to help alleviate your symptoms
John is a 50-year-old software engineer
John tends to have problems with diarrhea
He’s worried because he just came back from a trip to Mexico
Maybe he picked up something there
Or maybe it was the sushi he had last week
Everyone around him seems okay but his guts are just more sensitive
You can get diarrhea with the drop of a hat
This time however it’s different
This time it’s not getting better
He noticed he’s having more problems with loose bowel movements
He can go up to three to four times a day
Generally each time is a mix of both solid and liquid
At times he’s even notice some fresh blood when wiping
He’s also noticed he farts more than before and his abdomen is a bit distended
He’s worried about going out and always tries to empty his bowels before meeting with friends
He’s glad he can work from home because he would be embarrassed at work with how often he has to go to the bathroom
He’s tried taking fiber powder but it doesn’t taste very good and doesn’t work very well
In fact he finds after taking it, he has even more gas and more cramps
He takes Imodium periodically and it helps a little bit but he doesn’t want to take it for the rest of his life
He spoke to a nutritionist
He was started on many different diets
Many of them were very difficult to maintain
He’s a busy professional and he doesn’t have time to look for specific ingredients all the time
He notices after every meal he immediately has to run to the bathroom
It feels like he’s never completely empty
If this is you, maybe it’s time for a GUT CHECK.
The opposite of diarrhea is constipation
The problem with this term is that it actually can mean different types of problems
On one hand patients complain that they have to wait days between bowel movement
At first patients feel fine and have no complaints
But over time symptoms will become more apparent. There’s more abdominal bloating distension, mild abdominal cramps on the left and/or right side. It will eventually worsen, especially just before a bowel movement. These patients count the days between bowel movements and typically will give themselves laxatives to help move things along
Type 2 constipation occurs with patients who go pretty much every day
Their problem is once they sit down they will have strain in order to go
Patients can take anywhere from 10 minutes to half an hour to go
Typically they bring in books or magazines or the telephone to keep them company
Patients can also complain of lower abdominal pain
In addition they can also complain of pain around the anus
These patients typically take suppositories and enemas to help ease emptying
There’s another type of constipation where patients go pretty much every day
and they don’t actually need to strain much
They complain that they never feel that their bowels are empty
They go multiple times a day but solid stool
After going they feel there’s more and a strain but nothing more comes out
But hours later they have to go again, and again a few hours after that
GUT CHECK’s approach for this problem is to fully understand what kind of constipation you have
We ask questions like how often you go a day as well as how long it takes for you to finish
We think it’s important that consistent eating behaviors lead to consistent bowel movements
We teach patients how to eat properly to ensure that the bowels are also working properly
Constipation
Jacqueline is worried about her bowels again
She is a busy 45 year old Elementary School teacher with two children
The last time she had a poop was 4 days ago
She notices she’s starting to have some cramps. This is typically located in the left side below the belly button
She tries to go to the bathroom but there’s nothing there
She’s tried straining still nothing or very little comes out
This has been something she’s had to deal with for years
The cramps get worse and she’s feeling more distended and starting to hurt more on the right side as well now
She wants to go but she can’t
She’s talked to a dietitian and her family doctor
She’s been taking laxatives when she needs to
Typically she waits 3 to 4 days and knows that it’s time
She opens the bottle and pours out her dosage
After taking the medication the cramps get worse
But eventually it comes out
It always comes out as runny diarrhea
It takes her three to four tries to completely empty but she feels better afterwards
But she knows this pattern
It’s going to happen again and she doesn’t know what to do to deal with it
At times however she finds that she has to go multiple times in one day
The stool is a little thin and she knows after going once there’s going to be more but it just doesn’t want to come out
Typically what happens is she goes first thing in the morning has breakfast goes a second time finishes but then in another hour she has to go a third time
This also happens in the evening typically after dinner and typically it takes three times for her to feel clean inside
She also notices a blood when she wipes
There’s also a little lump that she has to push back inside she’s been told it’s a hemorrhoid
If this sounds like you maybe it’s time for a gut check.
Constipation Type 2
David has a different constipation problem
David is a 55 years old sales manager at a car dealership
He also has problems with constipation
David knows he goes everyday
But every day is difficult
Everyone knows when David goes to the bathroom he’s there for a while
Generally he takes a newspaper or his phone to help pass the time
David knows he has to push a lot and he also has to push hard
In the past he’s pushed up it too hard and he developed a painful cut in his anus
Luckily the doctor was able to treat it without complications
Nowadays he doesn’t push too hard at least he hopes it’s not too hard
It’s not uncommon that he sees blood
He knows if he takes his time eventually it’ll come out
Generally it’s hard and dry
He seems to have gotten worse recently but this has been an ongoing problem for David
He just takes longer than most people
But that’s okay he’s got his newspaper, book or phone
Sometimes he has explosive diarrhea
All of a sudden there could be a lot of gas and a lot of liquid that comes out very quickly
Luckily he can get to the toilet in time and not soil himself
After 20 minutes to half an hour whatever he’s finally done
Generally he feels a lump below that he has to push in
At times the lump comes out by itself but always goes back in
David is worried that this is just going to continue
If this is you, maybe it’s time for a GUT CHECK.
Hemorrhoids are the most common reason why people have bleeding
At first it starts off as spotting especially when you wipe after bowel movement
Soon there is blood dripping after a BM and colouring the water red. This can be quite alarming
Also patients feel a lump protruding from the anus
At first it slides back in by itself over time you have to push it in yourself
And then later it just comes out even after you push it in
There are many over-the-counter medications ointments and creams
They are designed to shrink the size of your hemorrhoids
They don’t generally work very well and ultimately without treatment the Hemorrhoid will progress
Other options include freezing banding the hemorrhoid
The surgeon performing this procedure tries to remove a portion of the hemorrhoid using either one of these techniques
They have complications such as infection pain and even bleeding
Their long-term results are poor
Finally you can have the hemorrhoids removed surgically
This can be painful as well
Long-term results are also poor
GUT CHECK’s approach is to figure out exactly why you’ve developed these hemorrhoids in the first place
Then to teach you exactly how to make sure that they never ever come back
Hint: After she knows they started after giving birth to a baby, she knows what a hemorrhoid is
Allison knows she has a problem with bleeding
She has multiple episodes of fresh blood when she has a bowel movement
She doesn’t notice any pain but when she wipes there’s almost always some blood
Plus she notices that there is a lump that has to be pushed in afterwards
She never has any pain in her bum area
She first noticed the hemorrhoids after the birth of her second child
She thought they would go away but they never did
Because she has a family history of colon cancer she’s already been seen by her family doctor and a specialist
She has tried many over the counter medications but they really haven’t helped
After undergoing colonoscopy The Specialist even tried to inject or bend her hemorrhoids
That stopped the bleeding for about 3 months but eventually both the hemorrhoid and the bleeding returned
She doesn’t think that there’s a problem with her bowel movements
Yes at times she has a bit of difficulty but the vast majority of the time she’s following her normal routine
Her family doctor has mentioned that her hemoglobin has dropped a little but it’s not dangerous
She’s tired of looking at the bowl and seeing more blood all the time
She just wants things fixed and is thinking about having surgery
Her mom had the surgery many years ago but eventually the hemorrhoids came back
Before embarking on surgery, maybe it’s time for a GUT CHECK