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Heartburn

Heartburn is a painful burning sensation in the chest, just behind the breastbone. It is caused by acid in the stomach backing up into the esophagus, the tube that carries food from your mouth to your stomach. When you swallow, food or liquids pass down the esophagus. At the bottom of the esophagus there is a band of muscle, a sphincter, that relaxes and allows the food to pass into the stomach. Once the food has passed the sphincter tightens again. If this sphincter is weak, acid in the stomach can wash back up into the esophagus and cause burning and pain.

A number of things can cause acid to reflux into the esophagus. For some people, the sphincter at the base of the esophagus is naturally weak and acid is free to flow out of the stomach. This may occur particularly when bending over or lying down. Over eating will increase pressure in the stomach and can prevent the sphincter from fully closing, resulting in acid backing up. Certain foods can also affect the sphincter, such as spicy foods, fried foods, peppermint, chocolate, and alcohol. Viagra and Cialis can also cause heartburn.

Acid reflux causes a burning pain in the chest behind the breastbone. It may start or get worse after eating, or when bending over or lying down. Chronic reflux can cause significant damage including narrowing of the esophagus, making it difficult to swallow; ulcers in the esophagus; and in some cases cancer.

There are several tests a doctor might do to diagnose acid reflux, but the most common is endoscopy. During an endoscopy you will be partially sedated and a tube with a small camera at the end will be inserted into your mouth, down your throat, and into your esophagus. This will allow the doctor to view the lower esophagus and stomach, and look for signs of acid backing up.

Heartburn is treated by partially neutralizing the acid in your stomach. Once the lower esophageal sphincter is weakened it is difficult to repair. Rather than trying to stop the contents of the stomach from backing up, treatments aim to neutralize the acid, so when it does back up it causes less damage to the esophagus. There are a number of over-the-counter antacids that you can use on your own to relieve symptoms. You doctor may also prescribe H-2 blockers or proton-pump inhibitors that will decrease the amount of acid in your stomach.

The best way to prevent heartburn is to maintain a healthy weight and avoid things that trigger heartburn such as over eating, and fatty or spicy foods. Avoid lying down after a meal as this may allow stomach acid to flow back into the esophagus. If you struggle with heartburn, try elevating the head of your bed. Again, this can help keep the acid from flowing back.

Stomach ulcers

Stomach ulcers are sores in the lining of the stomach. The stomach produces acid to help digest food; to protect itself against the acid the stomach also produces mucous which provides a protective coating over the walls of the stomach. When the mucous and stomach lining are eroded in one spot a painful sore develops. With the mucous gone, the sore is further irritated by direct exposure to stomach acid.

What causes the sore to begin with? Most stomach ulcers are caused by a bacterium known as Helicobacter pylori. This bacterium is frequently found living in the mucous layer of the stomach. Sometimes it can cause local areas of inflammation in the stomach wall, leading to erosion of the lining and mucous, creating an ulcer. Frequent use of some pain relievers such as aspirin, ibuprofen, and naproxen can also cause stomach ulcers. There is no evidence that anxiety or stress cause stomach ulcers.

The most common symptom of a stomach ulcer is a burning or gnawing pain in the middle of the upper abdomen, just below the breastbone. Because stomach acid irritates the ulcer, the pain may be worse with an empty stomach. Food will buffer the acid, so eating can relieve the pain, as will antacids.

Although stomach ulcers may heal themselves, some get progressively worse and cause serious complications. Ulcers may bleed, either suddenly or slowly and steadily. Sudden bleeding may cause people to vomit blood. A slow, steady bleed may be less dramatic, but can result in low hemoglobin (anemia) causing fatigue. People with this type of bleeding may also notice black, tarry bowel movements. Chronic ulcers can also cause swelling and scarring, and depending on their location in the stomach, can block the passage of food into the small intestine. Rarely, ulcers may erode right through the wall of the stomach, resulting in perforation and leakage of stomach contents into the abdomen; this is life threatening.

Stomach ulcers may be diagnosed in several ways, but the most common is by endoscopy. During an endoscopy, you will be partially sedated and a tube with a small camera at the end will be inserted into your mouth, down your throat, and into your stomach. This will allow the doctor to view the lining of your stomach and look for ulcers. Biopsies, small pieces of tissue, will most likely be taken from the stomach wall and sent to the lab for examination, particularly to see if Helicobacter pylori is present.

Treatment of stomach ulcers depend on the cause. Ulcers caused by Helicobacter pylori require a combination of antibiotics to kill the bacteria, along with additional medication to reduce stomach acid and allow the ulcer to heal. Sometimes acid reducing medications alone are sufficient. These can be prescribed by your doctor. Ulcers resulting from frequent use of aspirin, ibuprofen, or naproxen require a new strategy for pain management.

Heavy alcohol use can damage the mucous coating of the stomach, and so contribute to ulcers. Alcohol should always be consumed in moderation. You should also avoid over use of aspirin, ibuprofen, and naproxen. Acetaminophen (Tylenol) does not contribute to the formation of stomach ulcers.

Diarrhea

Diarrhea is common, it happens to everyone at some point. In fact, most people will experience a bout of diarrhea up to four times every year. Diarrhea is defined as three or more loose or watery bowel movements per day. In the majority of cases, diarrhea resolves on its own within a couple of days. If you have prolonged diarrhea, or diarrhea accompanied by fever or bloody bowel movements, you should see a doctor.

There are many causes of diarrhea. Infection is a common cause and may be due to viruses (such as Norwalk virus), bacteria (such as Salmonella, Shigella, Campylobacter), or parasites (such as Giardia). These are transmitted person-to-person, usually by people not washing their hands after using the toilet, but can also be transmitted during sex, particularly by rimming. Some medications, like antibiotics, can disrupt the bowel resulting in diarrhea. Lactose intolerance, irritable bowel, and inflammatory bowel disease, including Crohn’s and Colitis, can also result in diarrhea

The symptoms of diarrhea include loose or watery bowel movements, three or more times a day, often accompanied by abdominal cramping and an urgent feeling that you need to get to the toilet right away. More serious symptoms include fever and blood in your stool. If you have frequent runs and are not drinking enough fluids to compensate you may become dehydrated. This may lead to an increased heart rate, headache, or feelings of dizziness or lightheadedness. If the diarrhea does not start to subside within 2-3 days, or if you have fever, blood in your stool, or significant abdominal pain you should see a doctor.

Diarrhea is diagnosed based on symptoms, and if it goes away on its own in a few days the cause may never be determined. Sometimes your doctor may ask you to collect samples of your diarrhea. To do this, your doctor or the lab will provide you with a plastic upside-down hat to poo in, and containers to transfer the stool to. The stool can then be tested for bacteria and parasites. Sometimes people with chronic diarrhea require a colonoscopy. During a colonoscopy you will be partially sedated, and a tube with a small camera at the end will be inserted into your anus and up into your bowel. This will allow the doctor to view the lining of your bowel and look for inflammation or other causes for the diarrhea. Biopsies, small pieces of tissue, may be taken from the wall of the bowel and sent to the lab for examination.

The treatment for diarrhea depends on the cause. As mentioned, most cases of diarrhea resolve itself with no specific treatment. Many of these may be due to viruses that your body gets rid of. Rarely are antibiotics required, but they may be prescribed in certain situations such as persistent fever, or if you have a weakened immune system. If the diarrhea is due to an underlying bowel condition, such as Crohn’s or Colitis, you will likely need to see a specialist, as special medications may be needed.

If you have diarrhea, the most important thing is to stay hydrated. Sports drinks like Gatorade or diluted fruit juices are good options. Anti-diarrhea medications, such as Imodium or Lomotil, can be used and are generally safe, as long as you do not have fever or blood in your stool. These medications do not treat the cause of the diarrhea, but will reduce the number of bowel movements. Frequent bowel movements and wiping can also make the area around your anus sore. Warm baths and showers can help with that.

Preventing diarrhea is all about washing your hands, cooking your food, and immediately refrigerating leftovers.

Food poisoning

Food poisoning is a bit of a misnomer as it doesn’t involve poison. Food poisoning occurs when people eat food that is contaminated with harmful organisms, usually bacteria. Contamination can occur at any point along the way, including while food is being grown, when it is being processed, during shipping and storage, and while it is being prepared at home or in a restaurant. This can be particularly important for food that is eaten raw, ready-to-eat processed foods like deli meats, and dairy products as these foods are not cooked. Cooking will kill harmful organisms. Some typical bacteria that cause food poisoning include Salmonella, Campylobacter, Shigella, E. coli, Listeria, Staphylococcus aureus, and Clostridium. Food poisoning can also be caused by some viruses such as Noroviruses and Rotovirus.

The symptoms of food poisoning will vary somewhat depending on the contaminating organism and how much of it is ingested. Usual symptoms include nausea, vomiting, diarrhea, and abdominal cramps. Symptoms can begin within hours to a couple days after eating the contaminated food, and generally last a few hours to several days.

More serious symptoms include fever and blood in your stool. If you have frequent runs and are not drinking enough fluids to compensate you may become dehydrated. This may lead to an increased heart rate, headache, or feelings of dizziness or lightheadedness. If your symptoms do not start to subside within 2-3 days, or if you have fever, blood in your stool, or significant abdominal pain, you should see a doctor.

The diagnosis of food poisoning is based on symptoms, how long you have been sick, and what you have eaten recently. A major clue is when people you have shared food with also have the same or similar symptoms. Often symptoms resolve themselves and the offending organism that contaminated the food you ate is never identified. Depending on the severity of your symptoms your doctor will check you for dehydration, may do some routine blood tests, and ask you to collect stool samples for examination in the lab. To do this, your doctor or the lab will provide you with a plastic upside-down hat to poo in, and containers to transfer the stool to. The stool can then be tested for bacteria and parasites.

As mentioned, most often food poisoning resolves on its own, within hours to a few days. Antibiotics are rarely required, but may be prescribed depending on the organism you have ingested, if your symptoms persist, or if you have a weakened immune system. The most important thing is to stay hydrated, sports drinks like Gatorade or diluted fruit juices are good options.

Prevention is your best defence against food poisoning; always wash your hands before handling and preparing food. Bacteria are everywhere in the environment, and certain pets like birds and reptiles can carry Salmonella. Produce that is eaten raw like spinach, bean sprouts, berries, and the like should be washed thoroughly before eating; they can become contaminated when being grown, or during shipping and storage. Deli meats and dairy products must be kept refrigerated at all times. When shopping, preparing, and storing food keep uncooked meats, poultry, and fish separate from produce and other ready-to-eat foods to avoid cross-contamination. Always wash your hands after handling uncooked meat, poultry, and fish. Never use the same utensils or cutting boards to prepare these and other foods without first washing the utensils and boards in hot, soapy water. Meat and poultry should be cooked through. Hamburger should not appear pink after cooking; if it does, return it to the grill, pan, or oven and cook it longer. Never consume unpasteurized dairy products, including cheeses. Leftovers should always be refrigerated right away, as bacteria will grow and multiply at room temperature.

Constipation

The consistency of your bowel movements and how often you go will vary depending on your diet and activity level. Most people go once or twice a day, but there is a great deal of variability. Constipation means having fewer than 3 bowel movements per week. With infrequent bowel movements the stool also becomes hard and more difficult to pass.

Many things can cause constipation. A change in your diet or activity level can result in fewer bowel movements. Particularly, a low fiber diet or eating a lot of cheese and dairy products can lead to constipation. Excessive use of antacids can have the same effect. High levels of stress and anxiety can also lead to infrequent bowel movements. Some people may also resist the urge to move their bowels due to pain from hemorrhoids or fissures (tiny tears in the skin of the anus). Other causes of constipation include irritable bowel and sometimes colon cancer.

Symptoms of constipation include having fewer bowel movements than normal, generally less than 3 per week. The stools may also be small and hard. Constipation may lead to straining or bearing down hard in an effort to move your bowels. Some people may push on their lower abdomen in an effort to get things out, but are still left with a feeling that they have not emptied their bowels.

The diagnosis of constipation is based solely on symptoms, but diagnosis of the underlying cause may be more challenging. Your doctor will start by examining you, and may suggest a few simple lifestyle changes like changes in your diet and activity. Often blood tests will be done. Sometimes you may require a colonoscopy or “transit studies” to determine how long it takes for food to pass through your digestive tract.

The treatment of constipation may vary depending on the cause, but almost always involves changes in diet and lifestyle. Eat a well-balanced diet with plenty of high fiber foods such as fruits, vegetables, and whole-grain breads and cereals. Drink plenty of water to remain hydrated. Water plus fiber will help keep you regular. Physical activity is important, and don’t resist the urge to go to the bathroom when you feel the need.

If diet and lifestyle changes do not solve the problem laxatives may be required. These should be a last resort. There are many different kinds of laxatives including fiber supplements, stool softeners, intestinal stimulants, and “osmotics” which help retain water in your colon. Talk to your doctor about the different options, and which ones may be best for you.   

Irritable bowel

Irritable bowel syndrome (IBS) is a fairly common chronic condition. It is characterized by abdominal cramps, bloating, and alternating diarrhea and constipation. IBS is not life threatening, but can have significant effects on daily life.

What causes IBS is not known, but the muscles in the large intestine appear to be affected. Normally the muscles lining the walls of the large intestine contract with a regular rhythm moving food through the bowel. In people with IBS these muscles appear to function in a less coordinated manner, and sometimes spasm or go through periods of reduced activity.

The symptoms of IBS can vary from person to person, but generally include abdominal cramps, bloating, and alternating bouts of diarrhea and constipation. Some people may suffer from only diarrhea or only constipation. Often, people with IBS will go through periods when their symptoms are worse and times when their symptoms improve.

The diagnosis of IBS is based on symptoms and by excluding other causes of abdominal symptoms. Your doctor may look for Celiac disease, gluten allergy, or lactose intolerance. Stool tests to rule out infections, blood tests to check your thyroid and pancreas, and a colonoscopy may all be required.

There is no single treatment for IBS. Usually it takes some time and effort to determine the best treatment plan for each individual. Diets high in fiber as well as good hydration by drinking plenty of water are usually helpful. Caffeine generally should be avoided. Some people’s symptoms are triggered by specific foods, so knowing these triggers and avoiding them is important. There are some medications that may help, but they are not effective for everyone. Fiber supplements (such as Metamucil) can help with constipation, and laxatives or antidiarrheal medication (such as Imodium) may be used when needed. Some people benefit from cholestyramine, a medication that binds bile acids in the intestine. Others respond to antidepressants. In addition to helping cope with the symptoms, antidepressants may also affect the nerves that control the intestines. If you suffer from IBS open a dialogue with your doctor. Symptom management is important; usually this is achieved through trial and error, so be patient.

Colon cancer

Colon cancer (or colorectal cancer) occurs when cells within one part of the large intestine or the rectum begin to grow abnormally. As they continue to grow and divide these cells form a clump or mass called a tumor. Cancerous cells of the colon and rectum can also spread through the blood to other parts of the body. Colorectal cancer is the second most common cancer diagnosed in Canada, with 26,000 Canadians being diagnosed in 2016.

The risk of developing colon cancer increases as we get older. Most people who are diagnosed with colon cancer are over the age of 50. There is also a hereditary link. If someone in your family has or had colon cancer your risk may be higher. Other things that can contribute to the development of colon cancer include a high fat low fiber diet, physical inactivity, obesity, alcohol, smoking, and inflammatory bowel disease.

Tumors in the colon and rectum may not cause any symptoms until they become fairly large. Some early symptoms may include unexplained weight loss, blood in your stool, and anemia (low hemoglobin) causing fatigue. As the tumor gets bigger it can cause diarrhea or constipation, abdominal discomfort, and bloating. In some cases the tumor can become large enough to cause a blockage and prevent food from getting through the intestine. This will cause abdominal pain and vomiting.

Cancer cells from the colon and rectum can spread to other parts of the body forming additional tumors. The new tumors are called metastases. Colorectal cancer typically spreads to nearby lymph nodes, other locations throughout the abdomen, as well as to the liver and lungs. In these cases, symptoms may include abdominal pain or discomfort, jaundice (yellow colour of the eyes and skin), or breathing difficulties.

If there is a concern for colon cancer, your doctor will examine you and do some routine blood tests. He or she may also check your stool for low levels of blood (occult blood). You will also require a colonoscopy. During a colonoscopy you will be partially sedated. The doctor will pass a long tube with a camera at the end into your anus and up through your large intestine. This will allow your doctor to look for tumors or any signs of cancer. During the colonoscopy, your doctor will take biopsies. These are small pieces of tissue from the wall of the large intestine that are sent to the lab to determine if the cells are abnormal. You may also have a chest x-ray or CT scan (CAT scan) to see if there are any signs of metastases.

The treatment of colon cancer includes both surgery and chemotherapy. Following the diagnosis of colon cancer, the tumor will be graded as low or high grade, and the extent of disease will be staged, meaning how far it has spread. If caught early, the tumor may not have spread at all and remains only at the inner surface of the large intestine. The stage increases as the tumor grows through the wall of the intestine (stage 1), spreads locally, and eventually causes metastases (stage 4).

The overall treatment plan will depend on the location and stage of the colon cancer. Surgery is an important part of treatment. During surgery a portion of the large intestine, including the tumor as well as local lymph nodes, will be removed. Sometimes, after removing a piece the colon can be reconnected. Sometimes it cannot and the end of the colon is connected to the outside through an opening made by the surgeon in the stomach wall. This is called a colostomy. A colostomy may be temporary or permanent.

Chemotherapy is commonly used in the treatment of colorectal cancer. It is often used after surgery if the cancer has spread. It may also be used before surgery to shrink the tumor and make it easier to remove. The overall approach will be individualized to your specific needs, and will be discussed with you by your doctors.

Survival rates for individuals diagnosed with colorectal cancer are good, particularly when it is caught early. If the tumor has not spread beyond the large intestine the 5-year survival rate is 90%. The further the cancer has spread, the less good the outcome. This is why screening for colon cancer is so important. If you are over the age of 50, you should have a stool test every 2 years. To do this, you will receive a card and instructions from your doctor. At home, you smear a small amount of stool on the card and then mail it to the lab. The lab will look for small amounts of blood in your stool that could suggest the presence of cancer. If there is colon cancer in your immediate family, or if your stool test is positive, you should have a colonoscopy. This will allow your doctor to examine the inside of your large intestine for cancer. Your doctor will also look for polyps. These are small abnormal growths that are not cancer, but if left untreated can develop into cancer. If you have polyps they will be removed during the colonoscopy and your doctor will likely suggest follow up with another colonoscopy in the future to keep an eye on things.