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Digestive diseases, also called gastrointestinal diseases, are the diseases that affect the digestive system, which consists of the organs and pathways and processes responsible for processing food in the body.
The digestive system, or digestive tract, includes the mouth, the esophagus, the stomach, the gallbladder, the small intestine, the large intestine, and the anus, all linked as a long twisting tube that starts at the mouth and ends at the anus. It also includes the liver and the pancreas, two organs that produce substances needed for digestion such as enzymes, reaching the intestine through small tubes. The function of the digestive system is to transform ingested food for use by the cells that make up the body. Food enters through the mouth and proceeds to the gut (digestive tract) where it is chemically modified (digestion) for absorption by the body or waste disposal. Digestive diseases are numerous and can affect any part of the digestive system. They can be grouped into the following five broad categories.
Diseases of the esophagus and stomach
- Gastroesophageal reflux disease (GORD). GORD is the result of a malfunctioning lower esophageal sphincter (LES), the ring of muscle at the end of the esophagus that acts like a valve opening into the stomach. GORD prevents its proper closure and stomach contents return (reflux) to the esophagus, causing a burning sensation in the chest or throat (heartburn)
- Gastroparesis. Also called delayed gastric emptying, gastroparesis causes slow digestion and emptying, vomiting, nausea, and bloating
- Peptic ulcer. A sore in the mucosal lining of the esophagus (esophageal ulcer) or stomach (gastric ulcer)
Diseases of the liver, pancreas, and gallbladder
- Budd-Chiari syndrome. A rare liver disease in which the veins that drain blood from the liver are blocked or narrowed
- Cholecystitis. Infection of the gallbladder
- Cirrhosis. A life-threatening disease that scars liver tissue and damages its cells. It severely affects liver
function, preventing it from removing toxins like alcohol and drugs from the blood.
- Hepatitis. Inflammation of the liver that can result in permanent liver damage.
- Non-alcoholic fatty liver disease (NAFLD). Fatty inflammation of the liver related to insulin resistance, obesity, type II diabetes and high blood pressure.
- Pancreatitis. Irritation of the pancreas that can alter its structure and its function
- Primary biliary cirrhosis (PBC). A liver disease that slowly destroys the bile ducts in the liver, thus preventing the release of bile.
- Primary sclerosing cholangitis (PSC). Irritation, scarring, and narrowing of the liver bile ducts. The accumulation of bile in the liver damages liver cells.
Diseases of the small and large intestines
- Appendicitis. Inflammation of the appendix, the small, finger-like structure attached to the first part of the large intestine.
- Celiac disease. Disease that damages the small intestine in people who cannot tolerate gluten, a protein found in wheat, rye, and barley.
- Crohn’s disease. Inflammatory disease that usually occurs in the last section of the small intestine (ileum), causing swelling in the intestines. It can also occur in the large intestine.
- Diverticulosis. Small pouches (diverticula) that push outward through weak spots in the large intestine.
- Diverticulitis. Infection or rupture of the diverticula.
- Duodenal ulcers. Ulcers associated with alcoholism, chronic lung and kidney disease, and thyroid disorders.
- Dysentery. Inflammation of the intestine with severe diarrhea and intestinal bleeding, resulting from eating food or water containing a parasite called Entamoeba histolytica or Shigella bacteria.
- Giardiasis. Infection of the intestine by the parasite Giardia intestinalis The parasite is one of the most common causes of waterborne disease in the United States and can be found in both drinking and recreational water.
- Infectious diarrhea. Illness resulting from bacterial or viral infections. Bacterial diarrhea is most commonly caused by Campylobacter jejuni, Salmonella, Shigella, Escherichia coli O157:H7. Rotavirus is the commonest cause of viral diarrhea in the United States. Other viruses causing diarrhea include Norwalk virus, and cytomegalovirus
- Irritable bowel syndrome (IBS). IBS (also called spastic colon, or irritable colon) is a condition in which the colon muscle contracts more readily than it should.
- Lactose intolerance. The inability to digest significant amounts of lactose, the major sugar found in milk, due to a shortage of lactase, the enzyme produced by the cells lining the small intestine. Lactase breaks down milk sugar into two simpler forms of sugar which are then absorbed into the bloodstream. If not present, lactose is not broken down.
- Ulcerative colitis. Inflammation of the inner lining of the colon, characterized by open sores that appear in its mucous membrane.
Diseases of the anus
- Hemorrhoids. Commonly known as piles, hemorrhoids are characterized by swollen blood vessels that line the anal opening.
- Anal fissures. Splits or cracks in the lining of the anus resulting from the passage of very hard or watery stools.
- Perianal abscesses. These can occur when the tiny anal glands that open on the inside of the anus become blocked and infected by bacteria. When pus develops, an abscess forms.
According to the National Center for Health Statistics, 41.3 million Americans consulted physicians for digestive system disorders in 2005 and 6.9 million were diagnosed with ulcers. In the 1990-1992 period, 1.9 million people were disabled by digestive diseases with 234,000 deaths and over 6 million diagnostic and therapeutic procedures recorded in 2002.
In the United States, 100 million people are affected by acute diarrhea every year. Most diarrhea is believed to be viral and not bacterial in origin, but bacteria remain an important cause, as evidenced by the increasing public health warnings concerning contaminated foods. Nearly half of patients with acute diarrhea must restrict activities, 10% consult physicians, 250,000 require hospitalization, and approximately 3000 die.
The causes of some digestive diseases are well-known, especially for those resulting from viral (hepatitis, CMV), bacterial (diarrhea) or parasitic (gardiasis) infections, because the microorganisms can be clearly identified. Most peptic ulcers are also caused by a type of bacteria called Helicobacter pylori that weakens the protective mucous lining of the gut. As for the non-infectious.
diseases, medical researchers have only recently started to understand their numerous causes. For example, stomach ulcers can also result from the use of anti-inflammatory medications such as aspirin, ibuprofen, or naproxen. Similarly, it is also known that 80% of gallstones consist of hardened cholesterol and form when bile contains too much cholesterol, too much bilirubin, or not enough bile salts. It is also known that chronic alcoholism and hepatitis C are the most common causes of cirrhosis of the liver. As for diverticulitis, strong evidence suggests that it result mainly from a low-fiber diet. Gastroparesis is most often caused by diabetes, smooth muscle disorders and nervous system diseases while pancreatitis most often results from gallstones or alcohol abuse. Lactose intolerance is directly linked to a shortage of the enzyme lactase.
Increasingly however, researchers and physicians are realizing that one of the most common causes of digestive diseases is that people do not have healthy eating habits, and are also not aware of the many sources of food contamination. Besides bacterial or parasite infections, it is now understood that the digestive system can also be damaged by poor diets, prescription drugs, and food additives, especially antibiotics.
Since there are many types of digestive diseases, symptoms can accordingly vary widely, depending on the organ that is affected. Telltale signs are blood in the stool, changes in bowel habits, and weight loss. Additionally, physicians look for symptoms that may include one or more of the following:
- Acute abdominal pain. A sharp pain in the lower right abdomen is one of the symptoms of colitis or Crohn’s disease. A stomach that is very tender to the touch is indicative of diverticulitis or pancreatitis or an ulcer. Acute pain is also a symptom of gallstones.
- Ongoing abdominal pain. Depending on where the pain occurs, it will point to a specific digestive disease. For instance, if the pain goes away after taking antiacid medication, it points to a peptic ulcer. If it starts in the upper middle or upper right abdomen, and occurs after eating greasy or fatty foods, it is indicative of gallstones or infection of the gallbladder. If it occurs after eating milk products, it suggests lactose intolerance. Celiac disease is also accompanied by recurring abdominal pain.
- Bloating. Abdominal bloating is a symptom of lactose intolerance, Celia disease, IBS, and diverticulosis.
- Changes in bowel movements. Yellow and greasy stools that float are indicative of impaired pancreas function or celiac disease. Excess gas and loose, foul-smelling stools are a symptom of gardiasis or various bowel infections. Alternating loose and hard bowel movements are indicative of IBS.
- Bloody stools. Blood in the stools is one of the symptoms of Crohn’s disease, colitis, dysentery and hemorrhoids.
- Dark urine. Dark urine, accompanied by a yellowing of the skin or the eyes is indicative of hepatitis.
- Diarrhea. Watery bowel movements that occur many times throughout the day. If not bacterial or viral, diarrhea can be indicative of celiac disease, Crohn’s disease, gardiasis, or colitis.
- Fever. Fever accompanies several digestive diseases, in particular infectious diarrhea, dysentery, appendicitis, and colitis.
Diagnosis can be very difficult to establish because many digestive diseases share similar symptoms. For instance, celiac disease is commonly misdiagnosed as IBS, Crohn’s disease, or diverticulitis. This is why physicians believe that the key to an accurate diagnosis is careful and detailed history-taking during patient medical interviews. Physicians accordingly combine the patient’s gastrointestinal history to tests that can involve any of the following procedures:
- Barium enema. This test, also called a “lower gastrointestinal (GI) series”, uses x rays to detect abnormal growths, ulcers, polyps, and small pouches (diverticula) in the large intestine and rectum. An enema tube is inserted into the patient’s rectum and a barium solution is allowed to flow in to improve the contrast of the x rays.
- CAT Scan. Technique that uses a computerized x-ray scanner to take multiple views of a patient’s abdominal organs. The information is analyzed by a computer that produces cross-sectional images of the organ of interest. CT is used for viewing the more solid digestive organs such as the liver and pancreas.
- Colonoscopy. Test that allows the physician to look inside the colon using a colonoscope, a long, flexible tube that has a miniaturized color-TV camera at one end. It is inserted through the rectum into the colon, and provides a view of the lining of the lower digestive tract on a television monitor. The test is used to evaluate intestinal inflammation, ulceration, bleeding, diverticulitis, and colitis.
- Endoscopic retrograde cholangiopancreatography (ERCP). ERCP is a technique used to diagnose problems in the liver, gallbladder, bile ducts, and pancreas. It uses both x rays and an endoscope, which is a long, flexible, lighted tube, inserted through the patient’s esophagus, stomach, and duodenum. Using the endoscope, the examining physician can see the inside of the digestive tract, and inject contrast dyes into the bile ducts and pancreas so that they can be seen with x rays.
- Endoscopic ultrasound (EUS). Technique that uses sound waves to create a picture of the inside of the body. It uses a special endoscope that has an ultrasound device at the tip. It is placed in the gastrointestinal tract, close to the area of interest
- Flexible sigmoidoscopy. Technique that allows to look at the inside of the large intestine from the rectum through the last part of the colon, called the sigmoid colon. It is used to investigate diarrhea, abdominal pain, or constipation.
- Stool tests. Collection of stool to identify microorganisms that may be infecting the intestine. Stools are examined under a microscope or analyzed for the substances they contain. For example, normal stool contains almost no fat. But, in certain types of digestive diseases, fat is not completely absorbed and remains in the stool.
- Swallowing test. In this procedure, the patient is asked to drink a solution of barium before the X-ray examination of the upper digestive tract (esophagus, stomach, and small intestine).
The treatment of digestive diseases varies depending on the condition being treated. Almost all treatment seeks the relief of symptoms and combine changes in eating habits with medications specific to the disease. In serious cases, surgical procedures are used, which can involve the complete removal of the affected organ.
- Gastroesophageal reflux disease GORD. Treatment may involve lifestyle changes, such as avoiding alcohol, loosing weight and eating smaller meals. Antacid medication, such as Alka-Seltzer, Maalox, Mylanta, Pepto-Bismol, Rolaids, and Riopan, can also relieve heartburn. Other drugs, such as foaming agents (Gaviscon), work by covering the stomach contents with foam to prevent reflux. H2 blockers, such as cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), and ranitidine (Zantac 75), can also reduce acid production. Proton pump inhibitors such as omeprazole (Prilosec), lansoprazole (Prevacid), pantoprazole (Protonix), rabe-prazole (Aciphex), and esomeprazole (Nexium) are now considered more efficient. Surgery is an option when medications do not work. A standard surgical treatment is fundoplication which wraps the upper part of the stomach around the LES to strengthen it and prevent acid reflux.
- Gastroparesis. When related to diabetes, treatment seeks to control the blood sugar levels with insulin and oral medications, such as metoclopramide (Reglan) to stimulate stomach muscle contractions which helps empty food. In severe cases, intravenous feeding may be required to bypass the stomach entirely. This is achieved by inserting a jejunostomy tube through the skin of the abdomen into the small intestine. The procedure allows nutrients and medication to be delivered directly into the small intestine.
- Peptic ulcer. Ulcers caused by Helicobacter pylori are treated with drugs to kill the bacteria, reduce stomach acid, and protect the stomach lining. Antibiotics are usually prescribed. The acid-suppressing drugs commonly used are H2 blockers and proton pump inhibitors. Medications such as bismuth subsalicylate are also used as protectors in the case of stomach ulcers. Surgery may also be required, such as a vagotomy, a procedure that cuts parts of the vagus nerve that transmits messages from the brain to the stomach. This interrupts messages to produce acid, hence reducing acid secretion.
- Budd-Chiari syndrome. Treatment usually involves sodium restriction, diuretics to control the accumulation of fluid in the abdominal cavity (ascites), and prescription of anticoagulants such as heparin and warfarin. Surgical shunts that divert blood flow around the obstruction or the liver may be required. In very serious cases, liver transplantation is the only effective treatment.
- Cholecystitis. If acute, treatment may require hospitalization to reduce stimulation to the gallbladder. Antibiotics are usually prescribed to fight the infection as well as acid-suppressing medications. In some cases, the gallbladder may be surgically removed (cholecystectomy).
- Cirrhosis. Treatment depends on the cause of the cirrhosis and on the complications that may be present. Alcoholic cirrhosis is first treated by completely abstaining from alcohol. Hepatitis-related cirrhosis is treated with medications specific to the different types of hepatitis, such as interferon for viral hepatitis and corticosteroids for autoimmune hepatitis. Treatment also includes medications to help remove fluid from the body. When complications cannot be controlled or when the liver becomes so damaged that it can no longer function, a liver transplant is required.
- Non-alcoholic fatty liver disease NAFLD. No single truly effective treatment has yet been found. If obese or overweight, patients are encouraged to loose weight and to follow a balanced diet. Increasing physical activity and avoiding alcohol is also recommended.
- Pancreatitis. If no complications occur, pancreatitis usually improves on its own. Treatment seeks to support body functions and prevent complications with hospitalization usually required to replace body fluids intravenously.
- Primary biliary cirrhosis. No treatment has been shown to be beneficial in slowing the progression of PBC. Patients are usually prescribed vitamins and calcium to help prevent loss of bone (osteoporosis), a common complication.
- Primary sclerosing cholangitis. There is no cure for PSC, but effective treatment is available for symptoms, such as the itching resulting from too much bile in the bloodstream, which can be controlled with drugs such as Questran or Actigall. Swelling of the abdomen and feet, due to fluid retention, can be treated with diuretics. In some cases, surgical procedures may be used to open major blockages in bile ducts. In the most severe cases, a liver transplant is performed.
- Infectious diarrhea. In healthy people, usual practice is to let the illness take its course, which can last from a few days to a week. Drinking plenty of liquids is required and medications such as Pedialyte, Cera-lyte, and Infalyte can be provided to replace electrolyte losses. Treatment with antibiotics is increasingly complicated by the bacteria having developed drug resistance.
- Celiac disease. The only treatment for celiac disease is a gluten-free diet.
- Crohn’s disease. There is no cure available, and the goal of treatment is to control inflammation in the intestine and reduce the symptoms of pain, diarrhea, and bleeding. Medications prescribed to reduce inflammation include Azulfidine (sulfasalazine), mesalamine or 5-ASA agents such as Rowasa, Pentasa or Asacol. Serious cases usually require more powerful drugs such as prednisone, antibiotics, or drugs that weaken the body’s immune system such as Imuran (azothioprine), Purinethol (6-mercaptopurine, 6-MP), Methotrexate or Remicade (Infliximab).
- Lactose intolerance. Removing milk products from the diet is the standard treatment. Lactase enzymes can also be added to milk or taken in capsule or chewable tablet form.
- Appendicitis. Surgery is performed to remove the appendix with prescription of pain medication.
- Ulcerative colitis. Treatment seeks to control acute attacks, prevent new attacks, and promote healing of the colon. Corticosteroids are usually prescribed to reduce inflammation. Medications prescribed to decrease the frequency of attacks include mesalamine, azathioprine and 6-mercaptopurine. In severe cases, the colon may be removed surgically.
- Diverticulosis. Besides a fiber-rich diet, treatment depends on symptoms. When diverticulitis occurs, simple bowel rest and antibiotics are prescribed. In severe cases, patients may require intravenous antibiotics or surgery to remove the affected portion of the colon.
- Dysentery. Rest and drinking plenty of fluids is the usual treatment. Hospitalization may be required for intravenous therapy.
- Giardiasis. Anti-infective medications such as metronidazole (Flagyl, Protostat) or quinacrine may be used. In pregnant women, treatment is not started until after delivery, because the drugs can be harmful to the fetus.
- Irritable bowel syndrome. IBS has no cure and treatment is based on diet changes, medication and stress relief therapy.
- Hemorrhoids. Corticosteroid creams and lidocaine ointments are used to reduce itching, pain and swelling. For severe cases, surgical removal of the hemorrhoids may be performed (hemorrhoidectomy).
- Anal fissures. Treatment may include the application of a hydrocortisone cream to the anal area to help relieve irritation, oral pain-killers such as acetaminophen, a stool softener such as Colace or Surfak to prevent constipation until the fissure heals, soaking the anal area in a warm chamomile infusion for 20 minutes to prevent infection and provide soothing relief, and avoidance of strenuous effort to pass stool. If a fissure does not respond to conservative treatment, surgery may be required, involving an operation that removes the area of the fissure and any underlying scar tissue.
- Perianal abscesses. Treatment involves surgical drainage of the abscess as antibiotics are ineffective. A small incision is made over the area and pus is expelled with manual pressure. The wound is packed with iodophor gauze, removed after 24 hours, and the patient is instructed to take Sitz baths 3-4 times a day for some two weeks.
- Gastroesophageal reflux disease. Diets recommended for GORD are usually low-fat and include the basic food groups of cereals, vegetables, fruits, dairy products, and meats. A vitamin C supplement may be needed if the patient does not tolerate lemons, oranges, tomatoes, and grapefruits.
- Gastroparesis. Patients are asked to avoid foods that are high in fat and normally delay the emptying of the stomach. High fiber foods such as broccoli and cabbage also tend to stay in the stomach and are also restricted when symptoms are severe. Liquids always leave the stomach faster than solid food, so liquid foods are recommended.
- Peptic ulcer. In the past, physicians advised people with ulcers to avoid spicy, fatty, or acidic foods. Research has shown however that such diets are ineffective for treating ulcers. In most patients, no particular diet has emerged as being particularly helpful.
- Budd-Chiari syndrome. A low-sodium diet is required for the control of ascites.
- Cholecystitis. A low-fat diet is usually recommended with research showing that the pectin in apples may be beneficial, as well as the cellulose contained in celery and other crisp fruits and vegetables.
- Cirrhosis. Regardless of the type of cirrhosis, a healthy low-sodium diet is usually prescribed with total avoidance of alcohol.
- Hepatitis. Stimulating the liver can stress the liver and stimulants such as colas, chocolate, coffee, and tea are restricted. Fruit juices also, because they contain high levels of concentrated sugar which stress the digestive process and the pancreas, while feeding the virus.
- Non-alcoholic fatty liver disease NAFLD. A healthy diet controlling elevated cholesterol, triglycerides, and blood sugar is considered beneficial.
- Pancreatitis. Dietary guidelines recommend foods low in fat and high in carbohydrates and protein to decrease the work load of the pancreas. Pancreas stimulants such as coffee, alcohol, spicy and gas-forming foods are also restricted.
- Primary sclerosing cholangitis. A low-sodium diet is usually recommended to reduce fluid retention.
- Celiac disease. Patients work with a dietician to design a diet plan that is totally gluten-free. This means not eating foods that contain wheat, rye, and barley. Restrictions include most pasta, cereal, and processed foods.
- Infectious diarrhea. Diarrhea causes the body to loose too much fluid (dehydration) and electrolytes. Drinking plenty of water is accordingly extremely important. Broth and soups that contain sodium, and fruit juices, soft fruits, or vegetables that contain potassium, are required to restore the electrolyte levels.
- Lactose intolerance. If milk is removed from the diet, other sources of calcium are added, such as fermented milk products like yogurt that can usually be tolerated. Non-dairy foods that are high in calcium include fruits and vegetables such as kale, col-lard greens, broccoli, and oranges. Foods fortified with added calcium, such as soy milk, juices, cereals, and pasta, are also good sources of calcium.
- Colitis. Patients are advised to eliminate any foods or beverages from their diet that seem to make symptoms worse. This usually includes limiting dairy products, a low-fat diet high in fibers, eating small meals and drinking plenty of water.
- Diverticulosis. Since the lack of fiber and bulk in the diet is the major cause of diverticular disease, adding fiber and bulk to the diet is accordingly considered very important. Foods rich in fiber, such as bran cereals, whole wheat breads, a variety of beans, and fresh fruits and vegetables help keep the stools soft and bulky.
- Dysentery. Patients are asked to fast as long as acute symptoms are present, taking only orange juice and water or buttermilk. After the acute phase, rice, curd, fresh ripe fruits, especially banana and pomegranate and skimmed milk are allowed. Solid foods are reintroduced very carefully in the diet depending on the pace of recovery.
- Giardiasis. Drinking water to prevent dehydration is recommended, as well as replenishing the electrolytes lost as a result of diarrhea.
- Irritable bowel syndrome. People with IBS are usually asked to avoid food that is high in fat, insoluble fiber, caffeine, coffee, carbonated sodas, and alcohol.
- Hemorrhoids, anal fissures and perianal abscesses. A high-fiber diet consisting of fruits, vegetables, bran, whole-wheat grains with fiber supplements such as Metamucil, Citrucel, Fibercon is usually recommended along with a daily intake of plenty of water to prevent stool hardening.
Prognosis for some digestive diseases is excellent, for example the infectious diseases that clear up once the infectious agent is destroyed. Outcomes for most of the other diseases depends on the severity of complications and the underlying causes.
A healthy diet can help to prevent some digestive diseases altogether, such as diverticulitis, and lessen chances of developing others, such as colitis or alcoholic cirrhosis. Healthy nutrition is based on eating foods that meet the Recommended Dietary Allowances (RDA) of the National Research Council. These foods should be from the four major food groups: dairy products, meat and nuts, cereals and grains, and fruits and vegetables. It is also recommended to drink eight glasses of water per day to help eliminate ingested toxins and maintain the pH balance of the stomach.
Another important prevention area is being careful about food contamination, directly responsible for all the digestive infectious diseases. These diseases can be avoided by simple precautions such as washing fruits and vegetables, cooking meat thoroughly, drinking only water from trusted sources, and basic hygiene.
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Monique Laberge, Ph.D.