THU

7.6 digestive health and disorders

• The GI tract is essential for nutrient absorption needed daily.
• It serves a protective role against disease-causing organisms and contaminants.
• While generally functioning well, the GI tract can experience issues leading to discomfort.
• Common concerns include minor issues like heartburn and more serious conditions such as stomach ulcers and colon cancer.

food allergies

• Attention to individual reactions to foods is crucial in identifying adverse effects.
• Approximately 3.5 to 4 percent of the general population has food allergies.
• Many individuals may misidentify food sensitivities or intolerances as allergies.
• Food allergies involve an immune system response mistakenly attacking food proteins.
• Diagnosis often relies on skin-prick tests or blood tests, though these can be unreliable.
• The most effective diagnostic method is the Double Blind Placebo Controlled Food Challenge (DBPCFC).
• Food sensitivity or intolerance does not engage the immune system but can cause similar symptoms.
• Allergy symptoms typically arise within minutes to two hours and may vary in severity.
• Common symptoms include headaches, throat swelling, breathing difficulties, hives, cramps, and in severe cases, death.
• There are no definitive treatments for food allergies, and epinephrine is used for severe reactions.
• The best prevention is strict avoidance of allergenic foods, which commonly include milk, eggs, peanuts, tree nuts, fish, shellfish, wheat, sesame, and soy.

celiac disease

• Celiac disease is an autoimmune disorder affecting the small intestine, caused by an immune reaction to gluten found in wheat, barley, and rye.
• Consumption of gluten leads to the destruction of small intestine villi, causing malabsorption of nutrients despite adequate food intake.
• It affects approximately 1 in 100 people globally, with a genetic predisposition; about 3% of those with the relevant genes will develop the disease.
• Symptoms can vary widely and include gastrointestinal issues, weight loss, and in children, failure to grow. Symptoms can manifest at any age.
• Diagnosis involves blood tests to detect antibodies and a biopsy to assess damage to the intestines.
• Treatment requires a lifelong gluten-free diet, necessitating careful avoidance of foods with hidden gluten.
• Safe alternatives to gluten include corn, millet, buckwheat, rice, quinoa, and oats, though some people may react to oats due to cross-contamination.
• With a gluten-free diet, the small intestine tissues typically heal within six months.

gastroesophageal reflux disease

• Gastroesophageal reflux disease (GERD) is a chronic form of acid reflux occurring more than twice a week, affecting 20% of the US population.
• Common symptoms include regular heartburn, regurgitation, upper abdominal or chest pain, frequent coughing, respiratory issues, and difficulty swallowing.
• GERD is caused by the weakening or relaxation of the lower esophageal sphincter, allowing stomach contents to backflow into the esophagus.
• Factors contributing to sphincter weakness include obesity, pregnancy, certain medications, and smoking.
• Treatment begins with dietary and lifestyle changes, such as weight loss, avoiding trigger foods (like chocolate, alcohol, and spicy dishes), eating smaller meals, quitting smoking, and remaining upright after meals.
• Medications for GERD include antacids, histamine (H2) blockers, and proton-pump inhibitors; surgery is an option when other treatments fail, primarily reinforcing the esophageal sphincter.

peptic ulcers

• A peptic ulcer is an open sore in the esophagus, stomach, or upper small intestine due to a damaged protective mucus layer.
• It exposes the lining to gastric acids, leading to ulcer formation.
• Long-term use of NSAIDs (e.g., aspirin, ibuprofen) can decrease the mucus layer, contributing to ulcer development.
• The H. pylori bacteria are a common cause, damaging the mucous layer and allowing for exposure to harm.
• H. pylori can be effectively treated with antibiotics.
• The primary symptom of a peptic ulcer is a dull or burning stomach pain.
• Serious signs include red blood in stools or black stools, warranting immediate medical attention.

gallstones

• Gallstones are hard particles that form in the gallbladder, varying in size from a grain of sand to a golf ball.
• They can be singular or multiple, and may result in sudden pain in the upper right abdomen during gallbladder contractions.
• Gallstones form due to imbalances in bile components like cholesterol, bilirubin, and calcium, which can block bile flow to the small intestine, affecting fat absorption.
• The cause of these imbalances is currently unknown.
• Many gallstones are asymptomatic, requiring no treatment; however, painful cases typically necessitate gallbladder removal surgery.
• The gallbladder is not essential for life, and individuals can function normally without it.
• Post-surgery, bile flows directly from the liver to the small intestine instead of being stored in the gallbladder.

irritable bowel syndrome

• Irritable bowel syndrome (IBS) affects the large intestine with symptoms such as abdominal pain, bloating, gas, constipation, and diarrhea.
• IBS does not cause permanent structural damage to the intestine unlike more serious disorders like celiac disease.
• It affects 7-15% of the population, being more common in women.
• The cause of IBS is unclear, believed to involve altered gut microbiota, visceral hypersensitivity, GI motility changes, and low-grade inflammation.
• Diagnosis involves ruling out other conditions through tests like stool analysis, blood tests, x-rays, endoscopy, or colonoscopy.
• IBS symptoms significantly impact quality of life; initial treatments focus on diet and lifestyle modifications to reduce triggers.
• Common triggers include large meals, fatty foods, sugars, wheat, rye, barley, peppermint, chocolate, caffeine, and alcohol; stress and depression exacerbate symptoms.
• Recommendations for management include keeping a food journal, eating slower, increasing fiber intake, drinking more water, and exercising.
• The low FODMAP diet is a research-based dietary treatment gaining popularity for its efficacy.
• Over-the-counter medications are available, and some patients may be prescribed antidepressants or colon-relaxing drugs for treatment.

FODMAP diet

• FODMAPs are short-chain carbohydrates and polyols that are highly fermentable but poorly absorbed.
• Normal fermentation by intestinal bacteria can cause issues for individuals with IBS, leading to symptoms such as gas, bloating, cramping, diarrhea, and constipation.
• The FODMAP diet consists of two phases: an elimination phase to restrict high FODMAP foods, followed by a gradual reintroduction of specific FODMAPs.
• Research indicates that the FODMAP diet can significantly reduce IBS symptoms and improve quality of life.
• Although promising, caution is advised as the research is still emerging and long-term effects are unknown.
• The diet is complex and restrictive; therefore, supervision by a registered dietitian nutritionist or gastroenterologist is recommended to prevent nutritional deficiencies.

probiotics and prebiotics

• Bacteria are prevalent in the human body, outnumbering human cells 10 to 1.
• The gut microbiota consists mainly of microorganisms in the large intestine, many of which are beneficial to health.
• Key functions of gut bacteria include vitamin production, nutrient metabolism, and immune stimulation.
• Probiotics are live microorganisms that confer health benefits and can be found in fermented foods such as yogurt, kefir, and kimchi.
• Common probiotic groups include Lactobacillus and Bifidobacterium, each with various species and strains.
• Probiotics may aid in digestive health by maintaining gut microbiota, protecting the GI tract, and enhancing immune response.
• Preliminary research shows probiotics can prevent antibiotic-associated diarrhea and improve IBS symptoms, though benefits are strain-specific.
• Caution is advised when purchasing probiotics due to variability in effectiveness and research still being in early stages.
• Prebiotics are indigestible food components that support the growth of beneficial gut bacteria, including dietary fibers like inulin and galactooligosaccharides.
• Increasing dietary intake of prebiotics can be achieved through fruits, vegetables, and whole grains, with examples including bananas, garlic, and asparagus.
• Foods that contain both probiotics and prebiotics are known as synbiotics, and synbiotic meals can be created by combining foods rich in both, such as yogurt and bananas.