In addition to IBS, gastrointestinal problems may also be caused by other diseases of the digestive tract. In many cases, these must be ruled out before IBS can be diagnosed. Here is a summary of some common gastrointestinal problems.
Heartburn / Reflux Disease
Reflux disease or “heartburn/acid reflux” is a common gastrointestinal problem that affects between 10 to 30% of the European population.
The symptoms are a burning sensation from the chest/throat when gastric juice comes back up from the stomach. You can also have swallowing problems and some people experience a feeling of pressure over the chest. Heartburn is sometimes mistaken for a heart attack or other heart problems. The acid reflux also causes some people to have a dry cough.
Changes in lifestyle and different types of medications that suppress the acid can provide relief.
Gastric ulcer
In gastric ulcers, ulcers form in the duodenum (the small part of the intestine that comes after the stomach) or in the stomach. The wounds are caused by stomach acid damaging parts of the mucous membranes. It can be caused by drugs (for example Ipren and Treo) or infection by the stomach ulcer bacterium Helicobacter pylori (Hp).
Common symptoms include gnawing pain and tenderness in the upper part of the stomach. The problems come and go with discomfort lasting several weeks followed by periods without discomfort. Often, the discomfort decreases when eating (although in some people it can also be aggravated with food) and can be extra difficult at night. For stomach ulcers, you should avoid tobacco, coffee, alcohol, tea, and certain medicines.
A ruptured or bleeding stomach ulcer must be treated urgently in the hospital. Today, there are effective drugs that, together with antibiotics, cure the disease by reducing acid production and giving the wounds a chance to heal simultaneously with the elimination of disease-causing bacteria.
Gallstone attack
Unfortunately, gallstone attacks are quite common. As many as 30% of women and 20% of men over 40 have a gallstone attack at some point and the risk increases if, for example, you are overweight or eat a high-fat diet. A gallstone attack often comes in attacks, i.e. you have periods of more severe pain under the ribs on the right side of the body while it hurts. The pain is often quite high in the abdomen and can radiate to the back and shoulder.
Why then do you get gallstone attacks? Bile is formed in the liver and then stored in the gallbladder. The body then uses bile to be able to atomize fats from food. In connection with eating, bile passes into the intestines from the gallbladder. Gallstone attacks occur when bile from the liver forms such large crystals that the bile finds it difficult to pass out of the gallbladder into the intestines. The pressure in the gallbladder causes the pain.
Painkillers and antispasmodics can provide relief and if you have long-term problems, the gallbladder can be removed. Gallstones can, if you are unlucky, cause inflammation in the gastrointestinal tract (gallbladder, bile ducts, pancreas) that requires urgent care.
Bile Acid Diarrhea
Bile is formed as mentioned earlier in the liver and contains bile salts. These bile salts are important for us to be able to absorb fats from food. Most of the bile salts are reused by being taken up from the intestine and transported back to the liver. However, a small part of the bile salts (approx. 5%) is not taken up again but passes on to the colon where they have a certain laxative effect that can cause gastrointestinal problems.
If the levels of bile salts are high in the colon, you can suffer from diarrhoea. When the salt concentration increases in the colon, more fluid is drawn out into the intestine and several other intestinal functions are affected, which leads to loose stools.
It has been estimated that about 1% of people globally suffer from the so-called bile acid diarrhoea, also called bile acid malabsorption or BAD (Bile Acid Diarrhoea). Among those who suffer from chronic diarrhoea, however, almost every third person suffers from bile acid diarrhoea.
Common symptoms of bile acid diarrhea are watery and recurrent diarrhoea with foul-smelling stools with a yellow tone, often with a “fluffy” appearance, even at night, pain,
gases/bloating and stool leakage (stool incontinence) also occur.
Bile salt diarrhoea may be secondary to other diseases, for example, Crohn’s disease, microscopic colitis, chronic pancreatitis, or amyloidosis, but it can also occur without the associated disease. This form not linked to any other disease or surgery is called idiopathic bile acid diarrhea (type 2) and this can sometimes be misinterpreted as IBS-D (IBS / irritable bowel syndrome with diarrhea).
The diagnosis of bile salt diarrhea can be made with a so-called “75Se HCAT test”. In this test, the patient takes a capsule with a test substance and then follows how the substance is metabolized in the body. Since the method involves a low radiation dose, the examination is not performed on pregnant women. Some other examination methods may be relevant to establish the diagnosis of bile salt diarrhoea.
Bile acid diarrhoea is primarily treated with bile acid binding agents (Questran or Lestid) which are considered to be effective. Patients are also advised to reduce the amount of fat in their diet.
Gastrointestinal problems due to food intolerance ( food allergy )
It is relatively common for various foods to cause gastrointestinal problems.
Lactose intolerance
Suffering from lactose intolerance means that you are sensitive to the sugar in milk – lactose. However, it is not an allergy because you do not get an allergic reaction. In lactose intolerance, you lack the enzyme that normally breaks down lactose in the intestines – lactase, which makes you hypersensitive to milk sugar. Lactose intolerance in itself is harmless.
This intolerance is quite common in Europe with the highest prevalence in the Southern and Eastern countries.
Congenital lactose intolerance (primary congenital lactase deficiency) is extremely rare and is usually detected during infancy because the infant then needs special breast milk replacement. These patients need to live their entire lives with lactose-reduced or lactose-free dairy products.
Other cases of lactose intolerance (secondary lactase deficiency) may be temporary and occur after other intestinal diseases that damage the intestinal mucosa in some way (intestinal infection, gluten intolerance, Crohn’s disease, etc.). Often a diet of reduced lactose can help alleviate the symptoms of diarrhoea and the extra gases that are formed when the intestinal bacteria break down the lactose. However, the disease that causes temporary problems must be treated first. Then you will most likely be able to eat lactose again.
Lactose intolerance can be diagnosed by a healthcare professional by simply testing what happens when you remove or add lactose to your diet. You might also undergo lactose intolerance tests. If you start excluding dairy products from your diet, you may need other supplements to get enough calcium and Vitamin D. Otherwise you might increase the risk of osteoporosis and bone fractures.
Gluten Intolerance (Celiac Disease)
Gluten is a protein found in flour products. Gluten intolerance is a more serious problem than, for example, lactose intolerance because the function of the bowels can be damaged. Celiac disease patients often suffer from impaired nutrient uptake and various gastrointestinal problems such as flatulence, stomach pain, and diarrhoea. By excluding gluten from the diet, you can get rid of these problems. Read more about gluten and celiac disease.
Inflammatory bowel disease (IBD)
Ulcerative colitis
Ulcerative colitis is an incurable chronic inflammation that usually begins in the 20s and 30s and affects the intestines (colon and/or rectum). The inflammation impairs the function of the intestines. Common symptoms of ulcerative colitis are blood in the stool, abdominal pain that decreases after visiting the toilet, and other gastrointestinal problems such as diarrhea. The disease typically lasts a lifetime but it can come and go in periods.
It is not known today why some people suffer from ulcerative colitis, but there are treatments (surgery and medication) that often reduce the symptoms considerably. Reduced stress, more sleep, and adjusting diet also usually improve the symptoms. If you have had widespread ulcerative colitis for a long time, there is an increased risk of developing bowel cancer.
Crohn’s disease
Crohn’s is a disease that can affect the entire gastrointestinal tract from mouth to anus, although the lower part of the small intestine and the large intestine are the ones most often affected. The most common symptoms are abdominal pain, diarrhea, bloody stools while losing weight, and fatigue.
Crohn’s usually appears between the ages of 18-30 years and affects men and women equally. The victims should avoid smoking as smoking can aggravate the course of the disease. Smoking also increases the risk of getting the disease. Today, some drugs reduce the symptoms of Crohn’s, which means that many people can live normally. Sometimes, however, medication does not help and fistulas or blockages can occur, which means that you may need surgery.
Diverticulitis (infected intestinal pockets)
When feces get stuck in bulges of the intestinal mucosa (so-called intestinal pockets), an infection can occur when the intestinal mucosa is simultaneously weakened/damaged. Inflamed intestinal pockets are also called diverticulitis and are often located in the lower part of the colon. Intestinal pockets are common, especially the older you get, and usually cause no problems unless an inflammation occurs in one or more of them. You can experience stomach pain, and fever, feel nauseous, and vomit.
Pain is usually in the lower abdomen, often on the left side. It can also happen that you get other gastrointestinal problems such as a sluggish or loose stomach and bloating. Intestinal pockets are not usually treated, but in some cases, antibiotics or surgery may be necessary.
Read more about diverticulosis and diverticulitis
Constipation
The most common reason why the stool becomes hard and makes it difficult to empty the bowel is that you drink too little fluid. Similarly, you most likely do not consume enough fiber.
Other causes of constipation can be various medications, certain diseases, and certain foods. Women can also experience temporary constipation during pregnancy and at the end of the menstrual cycle. Constipation can lead to other ailments such as nausea, stomach pain, and hemorrhoids.
Common advice for easing constipation is to drink more, eat high-fiber food, exercise more, and create daily routines for toilet visits. Longer-lasting constipation should always be investigated by a doctor.
Read more about common treatments for chronic constipation
Gases
Everyone has gas in the stomach and intestines. The gas comes from the air we swallow/drink (carbon dioxide) or from bacteria that live in our intestines. It is the gases that make us belch and fart.
Some foods can increase gas production (for example fiber) and cause pain. Many times, regular toilet visits and increased exercise can alleviate these symptoms.
Tumor Diseases – e.g. Colon Cancer
One of the most common forms of cancer that affects the gastrointestinal tract is colon cancer. Colon cancer develops in the lining of the intestine where there is already an injury or other malformation (polyp). Symptoms that are common with colon cancer are gastrointestinal problems in the form of more frequent toilet visits, difficulties in emptying the bowels – that you never finish using the toilet, that you bleed from the bowels, and that the stool is bloody and slimy. Abdominal pain, fatigue, and palpitations are also common.
Most people who suffer from colon cancer are elderly, and colon cancer relatively rarely affects people under the age of 30. It can also be hereditary to some extent and the risks of being affected increase with some gastrointestinal diseases such as ulcerative colitis.
Treatment of colon cancer usually consists of surgery where an attempt is made to remove the tumor, often combined with chemotherapy. As with many other cancers, the earlier the disease is detected, the easier it is to treat.
If you have blood mixed with your stool and notice new gastrointestinal problems, you should seek care directly at a health center or emergency room. This should also be done if you have severe stomach pain.
Appendicitis
In appendicitis, it often hurts around the navel and in the lower right part of the stomach. From the beginning, the pain may be mild but gradually increases. You often get a fever, poor appetite, and nausea.
Appendicitis occurs when the so-called appendix (part of the large intestine just after the small intestine) becomes inflamed.
An untreated appendicitis can cause complications such as peritonitis or ruptured appendix. The most common age to suffer from appendicitis is in adolescence (between 10 and 20 years of age). Appendicitis is usually treated by surgery, today often by a laparoscopic appendectomy surgery during which the appendix is removed.
When should you contact healthcare directly?
Some signs that generally indicate that you should contact healthcare directly for your gastrointestinal problems are:
- lose weight fast and/or have no appetite
- suddenly get a lot of pain in the upper abdomen
- severe abdominal pain that does not subside
- vomit and stomach contents look like ground coffee or contain blood
- have black/bloody stools
- have a stomach ache and at the same time, for example, fever or nausea
- are older than 50 years and have stomach problems that you have not had before
The information on this page can never replace a visit to a doctor or other healthcare professional who can provide customized advice, diagnosis, and treatment.
