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Dr Helen Webberley MBChB MRCGP MFSRH
GMC no 3657058
Abdominal bloating and IBS
This is a common symptom described by patients and is often characterised by a sensation of abdominal discomfort, with a feeling of fullness and even some visible distension of the abdomen. Women often describe the sensation as ‘feeling pregnant’!
The symptom is usually intermittent but any persistent symptoms should be reported to the family doctor.
It is one of the commonest symptoms described in irritable bowel syndrome (IBS)
It probably arises from the build-up of gases in the small and large intestine either as a result of increased fermentation of gut products by commensal (host) bacteria or as result of poor coordination of gut peristalsis or motility.
Upper abdominal bloating frequently occurs in acid reflux (GORD) but may also be a symptom of gallstones (or cholelithiasis). Upper abdominal bloating is frequently associated with a sensation of feeling full quickly when eating (early satiety), nausea and burping (eructation). It can also be experienced in much rarer conditions associated with delayed gastric emptying such as diabetes, scleroderma or a blockage to the outflow tract of the stomach by ulcers or even tumours.
Mid and lower abdominal bloating is commonly associated with constipation, irritable bowel syndrome and excess flatus production but can also be associated with more uncommon conditions, such as lactose intolerance, inflammatory bowel disease and coeliac disease.
Another more serious condition that may mimic the sensation of bloating, is ascites. This is the build up of fluid in the abdominal cavity. This can arise as a result of chronic liver disease, chronic pancreatitis, heart failure, severe malnutrition, or even intra-abdominal or pelvic cancer. The symptoms are always persistent and progressive and usually associated with weight gain and should be reported urgently to the GP.
Treating straight-forward bloating is not always easily achieved. Managing constipation with high fibre diets or laxatives may help, as do antispasmodic medications such as mebeverine (colofac) and peppermint oil. Dietary exclusion and even low dose antidepressants are also shown to be beneficial.
Leaky gut syndrome
This condition often crops up on the Health pages of glossy women’s magazines and in alternative medicine journals.
It is purportedly characterised by increased permeability of the gut to toxins, allowing these toxins which have either been ingested, or alternatively manufactured by bacteria or fungi in the gut, to pass through the normal barriers and defence mechanisms in the gut wall and into the blood stream. It has been proposed that these circulating toxins can worsen or even cause conditions such as chronic fatigue syndrome, fibromyalgia and even multiple sclerosis.
Untrained ‘nutritionists’ and alternative medicine practitioners are the main exponents of this condition.
The vast majority of Gastroenterologists and dietitians do not hold these views and do not believe that the condition really exists in particular because there is no evidence base for the claims. Although it is true that certain diseases of the gut, such as inflammatory bowel disease (ulcerative colitis and Crohn’s disease), dysenteries and bowel malignancy, may damage the normal defence mechanisms of the gut, there is no evidence that toxins can pass more easily pass into the blood stream and certainly no evidence of a link with the above conditions has ever been made. In fact the converse is true in that serum and proteins may leak out of the blood and tissues into the gut when these conditions are severe.
As such, there is no recognisable treatment for this condition which is largely managed with alternative medicine products and dietary exclusion
Irritable bowel syndrome
This is probably the commonest presenting condition to Gastroenterology clinics. It is interesting in that there does not seem to be a recognisable cause for the symptoms or indeed, pathological process that seems to be responsible for the symptoms.
No obvious abnormality has been detectable in the bowel and the condition probably arises from incoordination of bowel motility, although food intolerances (NOT allergies) may also be partly responsible.
A syndrome is group of symptoms and signs that collectively go together to describe a medical condition. In the instance of irritable bowel syndrome the symptoms comprise the following;
- Diarrhoea or constipation or both
- abdominal bloating and distension
- excess mucus production
- acid reflux
- often cyclical with menstruation
- can be associated with bladder instability and urinary frequency
The symptoms are frequently aggravated by stress, mental illness, poor sleep pattern (shift work etc) and chronic pain.
Unfortunately these symptoms may also be seen in other more serious conditions and therefore patients with IBS frequently undergo a plethora of normal investigations before the diagnosis is eventually reached!
As the cause of IBS is likely to be multifactorial (and often brought on by the stresses of daily living), no single treatment appears to be effective. The following treatments have been found to be effective in some patients but unfortunately there is no panacea!
- dietary exclusion,
- stress management,
- anti-spasmodic drugs (such as mebeverine, peppermint oil)
- low dose tricyclic antidepressants
For more information or queries regarding treatment please ask here
Dr.Helen Webberley in the news!
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“Everyone must be vigilant to symptoms which include dizziness, headaches, breathlessness and loss of consciousness.”
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