Gastrointestinal conditions

Irritable bowel syndrome (IBS) is the most common functional disorder estimated to affect approximately 5-12% of the population. The condition is usually characterised by recurrent episodes of abdominal pain, bloating and altered bowel habits but can also include other gastrointestinal complaints. The exact cause of IBS is not known. There is no cure for IBS and treatment is limited to symptom management strategies.

Three common approaches to control symptoms associated with IBS include pharmacological agents, psychological treatments and dietary therapies. The two psychological treatments with the greatest evidence of effectiveness are gut-directed hypnotherapy and cognitive behavioural therapy. The first line dietary therapy for IBS is the low FODMAP diet. Fructose malabsorption and lactose intolerance identified by hydrogen breath testing may also be considered in FODMAP restriction.

Inflammatory bowel disease (IBD) principally comprises Crohn’s disease and ulcerative colitis. Crohn’s disease is characterised by inflammation and ulceration of any part of the gastrointestinal tract from the mouth to anus but most commonly affects the small intestine and/or colon. In ulcerative colitis the inflammation only occurs only in the colon. The exact cause of IBD is not known but a combination of genetic, environmental and immunological factors are thought to play a role in disease development.

The ways in which IBD affects an individual is highly variable but common symptoms tend to include abdominal pain, diarrhoea, faecal urgency, fever, loss of appetite and weight loss. Management of IBD mainly involves the use of pharmacological agents where psychological and dietary therapies are less commonly applied. Nutritional absorption and requirements may also be altered in IBD. A frequent challenge in the care of patients with IBD is differentiating gastrointestinal symptoms due to IBD and those caused by IBS. Symptoms of IBS are known to be more common in patients with IBD. However, given that IBS is a common disorder, whether this overlap is due to the co-existence of both conditions is unknown. What is clear is that IBD patients will often report symptoms without evidence of ongoing disease activity. This can lead to the increased use of anti-inflammatory medications. As a result, management strategies for IBD patients with symptoms suggestive of IBS can also be highly beneficial.

Pain from inside the abdomen or the outer muscle of the abdominal wall is referred to as abdominal pain. Abdominal pain can have causes that aren’t due to underlying disease such as constipation, wind, overeating or stress. The pain may be constant or can come and go. 

Pelvic pain can arise from the digestive, reproductive, or urinary systems and is usually experienced in the lowest part of the abdomen or pelvis. Pelvic pain can also have causes that aren’t due to underlying disease. Examples include constipation, menstruation, or trauma. The pain can range from a sharp jab to a dull ache. 

The management of abdominal and pelvic pain often includes dietary based therapy as well as working from a biopsychosocial model to alter the pain response, improve pain coping skills and provide strategies to overcome the chronic pain experience.

Bloating is a subjective sensation that is often accompanied by the abdomen visibly distending. It is not entirely known what causes functional bloating and distension, but it can be triggered by an overlapping gastrointestinal disorder, dietary intolerances, or psychological disorders. It is more commonly seen in females than males. There are several ways of managing functional bloating which often include dietary intervention, and/or modulation of the brain-gut axis.

Gastro-oesophageal reflux disease (GORD) describes a condition when too much acid is secreted into the stomach and the acid travels up into the oesophagus. Acid reflux is a normal bodily function but becomes GORD when it leads to physical complications to symptoms which begin to impact on a person’s well-being. GORD most commonly occurs in adults aged 40 and over. The condition is characterised by symptoms of heartburn, chest pain or discomfort after eating, regurgitation and dysphagia (difficulty swallowing).

Management of GORD usually involves pharmacological agents or dietary therapies. Psychological treatments are less commonly applied but can be trialled when pharmacological or dietary therapies are ineffective.

Functional dyspepsia can be very distressing and can have notable impacts on a person’s quality of life, but it has no long-term impact on mortality. It affects approximately 10% of the population and is more common in women. Symptoms of functional dyspepsia often include the inability to finish a meal (early satiety), fullness, epigastric pain and/or burning. There are many treatment options available and these usually include reassurance, medication (where necessary), dietary modification, and/or psychological therapy.

Coeliac disease is an immune mediated disease that is triggered by exposure to dietary gluten. It is a relatively common disease affecting approximately 1% of the Australian population. Symptoms of coeliac disease can be similar to those of IBS but can also involve other non-gastrointestinal presentations such as weight loss, osteoporosis, dermatitis herpetiformis, depression and cognitive impairment, amongst many others. Patients with coeliac disease can also be symptom free.

The only treatment for coeliac disease is a strict life-long gluten-free diet. The gluten-free diet should be taught by an experienced dietitian. Psychological treatments are not specifically applied to patients with coeliac disease but can be useful in those who continue to experience gastrointestinal upset despite following a strict gluten-free diet or in patients who find the disease is making them feel depressed, stressed or anxious.

Aerophagia is the term used to describe excessive and repetitive air swallowing. While it is normal to ingest some air when we eat, talk, or laugh, people with aerophagia gulp so much air it results in uncomfortable symptoms. These symptoms usually include abdominal bloating, distension, and belching. It is not known exactly what causes people to excessively swallow air, but it can be a combination of various factors such as eating too quickly, talking while eating or exercise. The best ways of managing aerophagia are firstly to become conscious of air gulping, behavioural modifications, diaphragmatic breathing, and/or psychological therapies.

Functional nausea and/or vomiting are broad terms used to describe people who have chronic nausea and/or vomiting for which there is no apparent cause, despite extensive exploration. An extension of this includes cyclic vomiting syndrome which presents with stereotypical episodes of acute nausea and vomiting that may be severe. People are generally well between attacks. Treatments most often include medications to help reduce symptoms and psychological support.

Faecal incontinence is the inability to control bowel movements which results in involuntary leakage from the bowel. This includes diarrhoea and/or constipation. People may also have excessive wind or staining in their underwear. Faecal incontinence can be caused or made worse by long term straining, medications, lifestyle, pelvic floor dysfunction, bowel disease, diarrhoea and/or constipation. The management of faecal incontinence is usually determined by the suspected cause. 

Disordered eating is a disturbed and unhealthy eating pattern that can include restrictive dieting, compulsive eating or skipping meals. Disordered eating is often seen in irritable bowel syndrome (IBS) as a way of avoiding or preventing symptoms. The difference between disordered eating and an eating disorder is the severity of behaviours, motivation driving the behaviour and negative medical or psychological effects caused by the behaviours. Treatment usually requires a multidisciplinary approach which means excellent communication between gastroenterology, dietetics, psychology, and psychiatry (where necessary). The aim is always to support our disordered earing patients as best we can and work with them to achieve positive outcomes.