Apple and glass of wine


Intestinal disorders can derail lives. As with any condition, problems with the gastrointestinal (GI) tract should be handled sooner than later to prevent them from becoming chronic and harder to treat. Dr. Fred Williams with Gateway Gastroenterology says when someone comes in with a GI complaint, an accurate diagnosis is critical. “If someone has difficulty swallowing, we have to rule out a tumor and then get at the cause because if it’s not corrected, food can get stuck,” he says. “Long-standing heartburn can lead to Barrett’s Esophagus, a pre-cancerous condition that must be monitored; but any cause of heartburn should be treated. We’ve seen a rise in heartburn mirroring the rise in obesity.”

Williams says if abdominal pain is combined with bloating and occurs in an older woman, he would be concerned about ovarian cancer. Generally, the older the patient, the higher the likelihood of something serious. Symptoms that should be checked out include change in bowel habits, blood in the stool, weight loss or fever. “The No. 1 reason people come to see me is some type of colon dysfunction,” he says. “Irritable bowel syndrome (IBS), or spastic colon, causes diarrhea, abdominal pain and cramping and usually starts young, but is definitely treatable with dietary changes, medication and counseling for anxiety issues. With IBS, we want to rule out celiac disease or lactose intolerance, which are both on the rise.”

A different type of condition, inflammatory bowel disease (IBD), may be broken down into ulcerative colitis and Crohn’s disease, Williams says, adding that IBD was thought to be a young person’s disease, but more diagnoses are occurring later in life, into the 60s and 70s. Of the two, ulcerative colitis affects the colon only, but Crohn’s disease can affect the entire GI system from the mouth to the anus. IBD also is highly treatable. Patients can go into remission but it is a disease that is more manageable than curable.

Dr. Charlene Prather, a SLUCare gastroenterologist, says she has heard the term ‘leaky gut’ thrown around. While not recognized by the medical profession as diagnosis, leaky gut is a problem with the mucosal barrier of the GI tract. For some, leaky gut often equates to IBS, but it may also be associated with malabsorption, caused by gluten intolerance. If gluten is malabsorbed in the small intestine, fluid can leak into the bowel as diarrhea. When these patients are gluten-free, the antibodies to it in the blood go way down and symptoms subside.

When the true diagnosis of leaky gut is IBS, it is often chronic and typically episodic. Curiously, between 20 and 30 percent of patients diagnosed with IBS had a prior intestinal infection. It is also found more often in women and in those with high psychosocial stressors. “Stress can make IBS worse, but doesn’t necessarily cause it,” says Prather. “About 50 percent of patients have had bowel infections or are genetically predisposed to it. What’s interesting, though, is that the gut has its own nervous system and we can experience abnormalities at the gut level, when the brain is normal. Ninety percent of our serotonin is in the gut, not the brain.”

Prather adds IBS can also be present with constipation. Increasing fiber and fluids only help if the patient is actually dehydrated, she says. She suggests the use of probiotics—good bacteria—for treating gut problems. There is a new drug for IBS with constipation that costs $200 a month. The right probiotic might cost only $30 a month. “I’d rather give a patient a $30 probiotic than a frightfully expensive prescription with possible side effects,” Prather says. “There are very specific organisms that the patient needs in the probiotic and they should be obtained from a manufacturer with good quality control.”