Digestive Issues

Irritable bowel syndrome (IBS) is a common and debilitating condition which significantly affects the patient’s quality of life. IBS presents with a cluster of gut symptoms, with the cardinal symptom being abdominal pain with either constipation and/or diarrhoea.

Inflammatory bowel diseases (IBD) are non-specific, chronic inflammatory diseases of the gastro intestinal tract. (GIT). Inflammation may affect any part of the GIT from the mouth to the anus. Crohn’s disease and ulcerative colitis are the most common inflammatory bowel disorders.

Crohn’s disease is chronic inflammation involving all layers of the intestinal wall and any part of the gastrointestinal tract. The disease often presents with a pattern of intermittent remittance and relapses. Nutritional deficiencies due to malabsorption are common and developmental retardation may result in those who develop this disorder during childhood.

Ulcerative colitis is a chronic, nonspecific inflammatory bowel disease involving the mucosa and submucosa of the colon. It usually includes the rectum and is characterised by uniform and continuous ulceration, bloody diarrhoea and rectal bleeding. Recurrent inflammation may eventually lead to shortening of the colon, and with long-standing UC, the surface epithelium may show dysplastic changes. Like Crohn’s disease, ulcerative colitis often presents with a pattern of intermittent remittance and relapses.

Small intestinal bacterial overgrowth (SIBO) refers to a condition in which abnormally large numbers of bacteria are present in the small intestine and the types of bacteria in the small intestine more closely resemble the bacteria of the colon. The types of bacteria within the small intestine are different than the types of bacteria within the colon. Normally, bacteria are moved out of the small bowel into the large bowel via peristalsis and the ileocecal valve prevents movement of bacteria from the colon back into the small intestine. However, disruptions in intestinal motility or physical disturbances inhibit this natural defensive pattern and bacteria begin to accumulate in the small intestine.

SIBO is associated with irritable bowel syndrome and chronic fatigue syndrome. Bacterial overgrowth may break down bile acids, necessary for absorption of fats, thus reducing absorption of fats and fat-soluble vitamins A, D and E. In severe cases, bacteria may damage small intestinal wall thus impairing carbohydrate and protein absorption resulting in malnutrition. Anemia may also develop, when bacteria interfere with B12 reabsorption.

Gastro-oesophageal Reflux Disease (GORD) or acid reflux, is a chronic condition in which the content of the stomach regurgitates (backs up or refluxes) into the oesophagus causing inflammation and damage to the lining of the oesophagus.

Functional dyspepsia( FD ) and Gastroparesis ( GP )are the two most common sensorimotor disorders of the upper GI tract, with shared symptoms of upper abdominal pain, postprandial fullness, early satiety and nausea.

Classifying GORD, FD and GP is confusing as the symptoms and treatments are frequently the same.

Constipation is a condition in which a person has difficult or infrequent passage of faeces. Constipation may be a symptom of underlying pathology or an ongoing problem in itself, lasting days, months, or years. Constipation may occur at any age, and most people will experience constipation sometime in life, but it is more frequent in infancy and old age.

Candidiasis is a general term for the over growth of yeast and fungal infections, most commonly caused by several species of Candida, the most predominant being Candida albicans. Candida is a common commensal (nonpathogenic) organism in the human microbiome that is found in the gut, genitals, skin, throat and mouth. Candida overgrowth occurs and problems arise when the ratio of friendly bacteria to harmful microorganism is disturbed, leading to many disease states and health issues varying from digestive issues to depression.

Coeliac disease (CD) is an autoimmune disease triggered by an abnormal immune response to gluten. Gliadin, one of the two proteins which form gluten, has been found to be the toxic component in coeliac disease which initiates the immune activation. The inflammatory damage as a result primarily affects the small intestine. Systemic manifestations of coeliac disease include fatigue, weight loss, diarrhoea, anaemia, osteoporosis and depression.

Non-coeliac gluten sensitivity (NCGS) is a condition that is neither autoimmune nor allergic, yet leads to subjective symptoms similar to those seen in coeliac disease when gluten is consumed. The condition is characterised by negative antibodies (except, perhaps to gliadin) and normal intestinal mucosa. The cardinal sign is the clinical improvement of symptoms on a gluten-free diet in the absence of antibodies and intestinal mucosal abnormalities.

Wheat allergy is a less common condition than CD and NCGS. It is characterised by an IgE-mediated reaction to gliadins, particularly ω-5 gliadin. Unlike CD, patients with wheat allergy usually do not need to restrict other gluten-containing grains, such as rye, barley, and oats from their diet. The symptoms of wheat allergy are typical of those of an IgE-mediated reaction. Symptom onset after consumption is much more immediate than CD and NCGS, often occurring within minutes of consumption, with acute swelling of the face, skin, respiratory and gastrointestinal tract.