Gastrointestinal Disorder

Gastrointestinal disorders affect millions of people worldwide, disrupting daily life with symptoms ranging from occasional discomfort to chronic pain. Understanding these conditions and how to manage them can make a significant difference in your quality of life.

Table of contents

• What Are Gastrointestinal Disorders?
• Associated Anatomy
• Types of Gastrointestinal Disorders
• Common Gastrointestinal Conditions
• What Causes Gastrointestinal Disorders?
• Common Symptoms
• Diagnosis and Testing
• Treatment Options
• Living with Gastrointestinal Disorders

What Are Gastrointestinal Disorders?

Gastrointestinal disorders are health conditions that affect your gastrointestinal (GI) tract, which is the path food takes through your digestive system from your mouth to your rectum. The system also includes important organs like your liver, pancreas, and gallbladder^[1].

These disorders are very common, affecting about 40% of people worldwide^[14]. In the United States alone, between 60 and 70 million people live with some form of digestive disease^[2]. Some digestive system diseases cause problems that go away relatively fast with treatment, while others cause problems that are more serious and long-lasting^[1].

GI disorders can be classified in two important ways. They can be acute or chronic. An acute GI disease happens suddenly and lasts a short period of time. A chronic GI disease can affect you for many months or years^[1].

Associated Anatomy

• Mouth
• Esophagus
• Stomach
• Small intestine
• Large intestine (colon)
• Rectum
• Anus
• Liver
• Pancreas
• Gallbladder

Your digestive system is made up of many organs that work together. Digestion begins in your mouth, where saliva starts to break down food when you chew. When you swallow, your chewed food moves to your esophagus, a tube that connects your throat to your stomach. Muscles in the esophagus push the food down to your stomach^[16].

Your stomach breaks food down using stomach acids. Then the food moves into the small intestine, where digestive juices from several organs, like your pancreas and gallbladder, break down the food more, and nutrients are absorbed. What’s left goes through your large intestine, which absorbs water. The waste then moves out of your body through the rectum and anus^[16].

Types of Gastrointestinal Disorders

Gastrointestinal disorders can also be classified as either functional or structural. A functional GI disease is when your healthcare provider can’t see any physical or structural issues when they examine your digestive tract. A structural GI disease is when your healthcare provider can see evidence of an issue when they examine you^[1].

Functional Gastrointestinal Disorders

You’ve likely experienced several functional GI problems in your lifetime. Constipation, gas, and diarrhea are examples of functional GI diseases. These types of GI diseases irritate your GI tract and lead to uncomfortable symptoms^[1].

Functional disorders are unusual because they present a normally appearing GI tract that behaves abnormally. These disorders don’t appear to have a physical cause that can be diagnosed with standard testing methods like blood tests, x-rays, or other imaging tests. Instead, functional gastrointestinal disorders are thought to be caused by a combination of abnormal muscle contractions, sensitive nerves, and brain-gut dysfunction, which affects communications between the brain and GI tract^[3].

Some of the most common causes of functional GI problems include eating a diet low in fiber or high in processed foods, not getting enough exercise, traveling or other changes in your typical routine, stress and anxiety, holding your poop or not going as soon as you need to go, taking certain medicines, hormonal changes like pregnancy or during menstruation, and food sensitivities or eating something that didn’t “agree” with you^[1].

Treatment for functional GI diseases usually involves lifestyle changes like eating more fiber-rich foods, getting more physical activity, or avoiding triggers. Sometimes, functional problems go away on their own within a few days^[1].

Structural Gastrointestinal Disorders

Structural GI diseases are typically more complicated. They tend to cause symptoms that last longer and don’t get better with lifestyle changes alone. Structural problems cause issues your provider can see such as inflammation or blockages^[1].

Common examples of structural GI diseases include hemorrhoids, colon polyps, and inflammatory bowel disease. These disorders can be detected with imaging tests and bloodwork. Causes of structural GI diseases are more widespread^[1].

Common Gastrointestinal Conditions

Healthcare providers who specialize in gastrointestinal diseases are called gastroenterologists^[1]. They treat many different conditions affecting the digestive system.

Constipation causes hard-to-pass or infrequent bowel movements. You may strain or push hard to get your poop out. You can treat your constipation at home by drinking more water and eating more fiber. Over-the-counter laxatives can also be helpful^[1].

Irritable bowel syndrome (IBS) is where your intestinal muscles contract more or less often than normal. Abdominal pain, gas, and bloating are common symptoms. Treating IBS can involve changing your eating habits or taking medication that your provider prescribes^[1].

Hemorrhoids are swollen veins in your anus or rectum. Straining when having a bowel movement is the most common cause, but you can get them other ways, too. Avoiding constipation and activities that cause straining can help hemorrhoids. Your healthcare provider can also remove large, painful, or persistent hemorrhoids^[1].

Diverticular disease occurs when small pouches called diverticula form in the wall of your large intestine. When they become infected, it’s called diverticulitis. This can lead to bleeding and bowel obstruction. Treatment could involve eating more fiber, taking antibiotics, or having surgery^[1].

Gastroesophageal reflux disease (GERD) refers to severe, chronic acid reflux caused by stomach acid coming back up your esophagus. Symptoms of GERD include stomach pain, heartburn, chest pain, nausea, and regurgitation, which is when food comes back up your esophagus and into your throat or mouth^[3].

Crohn’s disease is a chronic disease that causes inflammation and irritation mainly in the small and large intestines. Common symptoms include abdominal pain and cramping, weight loss, and diarrhea^[3].

Ulcerative colitis is another chronic inflammatory disease, but it mainly affects the large intestine, or colon. Symptoms include abdominal pain and cramping, bloody stools, diarrhea, and constantly feeling the urge to have a bowel movement even if your bowel is empty^[3].

Stomach ulcers, also called peptic ulcers, are sores that form in the lining of your stomach or the first part of your small intestine. Symptoms of these ulcers include nausea, vomiting, bloating, severe stomach pain, and feeling full early in a meal or after eating^[3].

What Causes Gastrointestinal Disorders?

The causes of gastrointestinal disorders are varied and complex. They arise due to alterations in brain-gut communication and can involve changes in gut sensitivity, motility (the contraction of muscles that move contents through the GI tract), microbiota (the collection of helpful bacteria and other organisms living in your gut), immune functioning, and central nervous system processing^[14].

For functional gastrointestinal disorders, several lifestyle and health factors can disrupt the smooth functioning of the GI tract. These include eating a diet low in fiber or high in processed foods, low physical activity levels, changes in routine such as during travel, high dairy consumption, stress, delaying bowel movements often due to hemorrhoids, overuse of anti-diarrheal medications, and hormonal changes^[1].

Stress can have a major impact on your digestive system. Anxiety and worry can upset the delicate balance of digestion. In some people, stress slows down digestion, causing bloating, pain, and constipation, while in others it speeds it up, causing diarrhea and frequent trips to the bathroom. Some people lose their appetite completely. Stress can also worsen digestive conditions like stomach ulcers and irritable bowel syndrome^[21].

Smoking can weaken the muscle that controls the lower end of the food pipe and allow acid from the stomach to travel in the wrong direction back up, a process known as reflux. Smoking is also an important risk factor for stomach cancer^[21].

If you’re overweight, your belly fat puts pressure on your stomach and can cause heartburn. Losing weight may relieve digestive symptoms like heartburn and other acid-related stomach complaints^[21].

Common Symptoms

Gastrointestinal disorders cause chronic symptoms throughout the gut, all of which are made worse by maladaptive patient behaviors, stress, and psychological comorbidity^[14]. The symptoms vary widely depending on the specific problem.

Common symptoms of gastrointestinal disorders include nausea, vomiting, abdominal pain, diarrhea, and constipation^[3]. You may also experience gas, bloating, heartburn, bloody stools, difficulty swallowing, or unintentional weight loss^[6].

In general, you should see your doctor if you have blood in your stool, changes in bowel habits, severe abdominal pain, unintentional weight loss, or heartburn not relieved by antacids^[6].

Living with chronic and unpredictable gastrointestinal symptoms can be stressful and can affect work, relationships, and your overall quality of life^[13]. The personal nature of these disorders and their associated, socially unacceptable symptoms can cause individuals with digestive diseases to struggle with chronic feelings of isolation, shame, guilt, and a sense of “otherness”^[20].

Diagnosis and Testing

To diagnose gastrointestinal disorders, your healthcare provider will ask about your symptoms and medical history. They may perform a physical examination and order various tests^[1].

Several diagnostic procedures can help identify GI disorders. These include endoscopy, which uses a thin, flexible tube with a camera to view the inside of your digestive tract. During an upper endoscopy, your doctor examines the esophagus, stomach, and first part of the small intestine. Colonoscopy allows your doctor to examine the large intestine and rectum^[11].

Other diagnostic tests include blood tests, stool tests, imaging tests such as X-rays, CT scans, MRI scans, and ultrasound. A barium swallow or barium enema uses X-rays to see the digestive tract after you swallow or receive a contrast material. Endoscopic retrograde cholangiopancreatography (ERCP) uses an endoscope and X-rays to locate and treat conditions of the pancreas, pancreatic duct, and bile duct^[6].

Your provider may also use specialized tests to assess how well your digestive system is working. These can include breath tests for conditions like lactose intolerance or small intestinal bacterial overgrowth^[6].

Treatment Options

Treatment for gastrointestinal disorders depends on the specific condition, its severity, and how it affects your daily life. Management involves a biopsychosocial approach, which means addressing biological, psychological, and social factors. This includes changes in lifestyle and diet, addressing coexisting psychological comorbidity, and using medication to treat underlying causes^[14].

Lifestyle Changes

Depending on your GI disorder, you may be able to manage your symptoms through changes in your routine. These include avoiding foods and drinks that trigger your symptoms, such as those high in caffeine, fat, or sugar, losing weight and maintaining a healthy weight, and managing stress^[11].

Following some basic rules for good eating habits can help prevent problems. Don’t rush your food—take the time to eat slowly and chew each mouthful well. Don’t overeat—reduce the size of your portions at mealtimes, or try eating four to five small meals instead of three large ones. Eat regularly and try not to skip meals. Avoid eating a big meal just before you go to bed. Eat your last meal at least two to three hours before lying down. Make sure you have plenty of water to drink^[21].

Regular exercise helps by reducing bloating and improving how well your bowels function. It also helps reduce stress, which in turn keeps you from having as many symptoms^[23].

Dietary Modifications

Dietary changes can help ease the symptoms of many digestive disorders. Different digestive disorders have distinct nutritional requirements. For gastroesophageal reflux disease, avoid eating or drinking things that make heartburn worse, such as coffee, spicy foods, alcoholic beverages, and high-fat foods. For celiac disease, avoid foods and drinks with gluten, which is a protein found in barley, rye, and wheat^[17].

For irritable bowel syndrome, large meals can trigger cramping and diarrhea, so eat small meals throughout the day. A diet low in fat, high in protein, and low in certain types of carbohydrates called FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) can help relieve symptoms. These include wheat, garlic, certain fruits, and onions. High-fiber foods, pre- or probiotics, and medication also can help^[17].

Keeping a food diary by writing down what you eat can help you learn which foods cause you trouble. This is especially helpful for disorders such as IBS and Crohn’s disease. Record how much you consume and at what time. Write down what symptoms you have and when they occur. Share your food diary with your healthcare provider^[17].

Medication

Your doctor may recommend prescription or over-the-counter medications to treat your GI disorder or manage your symptoms. Pharmacological treatment with antispasmodics, neuromodulators, motility agents, and antidepressants is effective^[14].

The specific medications depend on your condition. For example, antibiotics may be used to treat infections, while laxatives can help with constipation. Anti-diarrheal medications can slow down bowel movements. Acid-reducing medications can help with GERD and ulcers^[1].

Psychological Interventions

Cognitive behavioral therapy (CBT) is a form of psychotherapy that has consistently been shown to be effective in reducing the symptoms of functional digestive disorders. Psychotherapy in motivated individuals is equally effective as medication^[14].

CBT can be a helpful tool in teaching individuals how their thoughts and behaviors can impact their symptom experience. It emphasizes patients’ understanding of their condition, the role of stress, and the impact of their thoughts, emotions, and behaviors on their symptoms. Patients learn skills to help change their physiological, cognitive, and behavioral responses to both GI symptoms and stress^[13].

Unlike CBT for depression or anxiety, CBT for functional GI disorders targets the GI symptoms, rather than treating the psychological distress associated with these symptoms. Treatment is typically four to seven sessions, with one session every other week. Most patients see significant symptom improvement by the end of the course of treatment^[13].

Procedures and Surgery

Many of the procedures used to diagnose GI disorders can also be used to treat them. During an endoscopy, your doctor can remove polyps, stop bleeding, or relieve blockages. Endoscopic retrograde cholangiopancreatography can relieve blockages in bile ducts, including those caused by gallstones^[11].

In some cases, surgery may be necessary. This might include removing part of the intestine, repairing structural problems, or removing organs like the gallbladder. The specific surgical procedure depends on your condition and its severity^[1].

Living with Gastrointestinal Disorders

Being diagnosed with a digestive disorder is a life-changing event. Receiving a specific diagnosis can yield feelings of relief, validation, embarrassment, devastation, and isolation^[20]. However, with proper management, most people with GI disorders can live full and active lives.

Seek Quality Healthcare

If you suspect you may have a digestive disorder or have already been diagnosed, it’s important to ensure you have the right healthcare providers. Prioritize check-ups, lab work, and required tests and treatments. A specialist may be necessary to assist with managing specific diagnoses. Finding a primary care physician who is aware of and sensitive to the needs of individuals with digestive disorders is crucial^[20].

Having a good relationship with your health provider is important. Being able to ask questions and receive answers and information in a supportive manner helps alleviate the discomfort of discussing topics such as bloating, gas, diarrhea, and various other digestive-related symptoms^[20].

Know Your Diagnosis

Knowledge truly is power. You can’t accept or manage what you don’t know. Ask questions about your specific disorder including what treatment is available, how to manage symptoms, what foods or activities should be included and excluded, and what to expect in the future^[20].

Prioritize Self-Care

It is okay to take care of yourself. Making time to explore and plan diet-friendly meals and snacks is a first step. Because certain types of exercise can aggravate and others can help certain digestive disorders, knowing what types of activity are right for you and incorporating them into your daily routine are nurturing acts of self-kindness. Taking time to practice relaxation techniques such as deep breathing, progressive muscle relaxation, and using visualization and guided imagery can be helpful^[20].

Address Mental Health

Patients who have gastrointestinal disorders also have high rates of mental health conditions. It is not uncommon for individuals with a digestive disorder to experience mental health issues such as anxiety or depression. Because anxiety and depression can aggravate digestive disorders, and digestive disorders can lead to anxiety and depression, it is vitally important to attend to mental health symptoms if they present^[20].

Develop a Support Network

Living with a GI disorder is difficult. Facing these challenges is much easier when you have a team supporting you. This team may consist of family, close friends, and your healthcare team. Having a support team in place can also help alleviate stress, which can be a major contributor to symptom flare-ups^[23].

Plan Ahead

Unpredictability is one of the greatest struggles of life with GI disorders. You never know when you’re going to have an extreme urge to go to the bathroom, so you may avoid public places where toilets aren’t easily available. If you exercise outside or at the gym, take extra time to notice where the bathrooms are located^[23].

Success of treatment is increased by a good doctor-patient relationship, and this needs to be taken into account during the consultation^[14]. Most gastrointestinal diseases can be prevented or treated. If those living with GI disorders get timely and effective treatment, they can go about their regular activities without worry and dramatically improve the quality of their lives^[1].