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What are the common Gastrointestinal symptoms?

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Human Body

Stomach Pain and Stomach Discomfort

The term stomach pain refers to any discomfort felt in the stomach or abdomen. There are nine sectors in the stomach, which consists of the following: Right hypochondrial, Epigastric, Left hypochondrial, Right flank, Periumbilical, Left flank, Right iliac fossa, Suprapubic, and Left iliac fossa.

Generally, pain indicates a problem with an organ or disease process, with discomfort in different sectors being attributed to different organs and diseases.

Stomach discomfort is the body’s way of alerting you to an issue with an underlying organ or a disease process. Pain is usually caused by two processes: inflammation/infection and colicky abnormal intestinal contractions.

Among other intra-abdominal organs, the gallbladder, stomach, colon, and small intestine may be the source of the pain.

Over-eating

Overeating is when the amount of food consumed is more than what the stomach can hold. This causes pain when the stomach extends.

Gastritis

Gastritis refers to inflammation of lining of the stomach. This is typically brought on by excessive acid production due to stress or smoking, as well as by alcohol-induced damage to the stomach lining. Another significant contributor to gastritis is the bacteria Helicobacter Pylori.

Peptic ulcers

Peptic ulcers are breaks in the lining of the stomach or duodenum. Pain from ulcers is common, and it can be very painful. Bleeding or a through-and-through perforation may arise from ulcers.

Gallstones

Gallstones are stones that form in the gallbladder. They typically cause bloating in the upper abdomen region after eating. The right upper abdomen is where the discomfort is felt when the gallbladder or bile ducts are inflamed.

Lactose Intolerance

Lactose intolerance refers to the inability of the body to completely break down Lactose. Lactose is found in milk and dairy products. Lactose intolerance is common in Asians and manifests as diarrhoea, abdominal bloatedness, abdominal distension and frequent passage of gas through the bottom.

Pancreatitis

Pancreatitis is inflammation of the pancreas, a deep seated organ. Alcohol or gallstones are the two main causes of pancreatitis. Other less common causes are medications and high triglyceride/cholesterol levels.

Cancer

Any organ in the abdomen is susceptible to malignant growths. Cancer can cause pain by blocking, invading nearby tissues, or just by growing larger overall. Bleeding or perforation, appetite loss, and cancerous growth are also possible effects of cancer.

Stomach pain that persists and worsens calls for medical intervention. This is especially true if the pain interferes with sleeping or performing daily tasks. Among the tests used to diagnose stomach pain are CT scans, gastroscopy, and colonoscopy.

Bloating and Excessive Gas

Bloating is a common issue faced by healthy adults. It is caused by air or gas filling the GI system and frequently manifests as a feeling of fullness, pressure, or tightness in the stomach. Bloating can cause anything from mild discomfort to excruciating pain. The feeling of being bloated may pass quickly or not for several hours. Those who encounter digestion issues and hormonal changes may frequently feel bloated.

Excessive intestinal gas usually leads to bloating, and it is typically caused by the metabolism of carbohydrates by gut bacteria in a process called fermentation. The body naturally produces intestinal gas as a result of this process. Too much intestinal gas could indicate a problem with your digestion. Gas that you inhale or consume through carbonated drinks is usually expelled through burping before it reaches your intestines. However, when a large amount of carbohydrates are not properly absorbed during digestion, excessive fermentation occurs, resulting in an increase in intestinal gas.

Conditions associated with bloating and excessive gas
Indigestion can occur when food is consumed too quickly or in excessive amounts, of if an individual ingests a meal that he is intolerant to, or if he has a digestive disorder.

Carbohydrate Malabsorption
Fructose and lactose are carbohydrates that are hard to digest and can cause bloating and gas. A specialist can conduct tests to determine which carbohydrates the patient might be sensitive to. By avoiding or reducing consumption of these carbohydrates, less bloating will be experienced.

Functional Digestive Disorders
Functional digestive disorders include Irritable Bowel Syndrome (IBS) and Functional Dyspepsia. In Singapore, almost one in 10 people have IBS. Some common signs of these conditions include diarrhea or constipation, nausea or vomiting, and bloating in the abdomen.

Bowel Obstruction
Tumors, scar tissue, strictures, stenosis, or hernias can all clog large and small bowels. The obstruction prevents feces movement and causes air to build up.

Visceral Hypersensitivity
Individuals who have visceral hypersensitivity are those who feel bloated even when their gas levels are acceptable. IBS and abnormalities of the gut-to-brain neural pathways are frequently connected with this illness. In some instances, patients experience an unfavorable reaction that causes their abdominal muscles to protrude outwardly when they have normal levels of gas.

Small Intestinal Bacterial Overgrowth
Bacterial overgrowth in the small intestine happens when a particular population or subtype of bacteria predominates and displaces the normal intestinal flora. This overgrowth can in turn lead to build up of gases.
Weight Gain
You might feel especially bloated after eating a standard meal if you had a recent weight gain at the belly area, because belly weight causes less space for digestion and water retention.

Hormones
Bloating is a common symptom among menstruating women. Feminine hormones can increase your sensitivity to the sense of bloating as well as create bloating.

Bloating should subside on its own, but if it lasts longer than a week or is consistently painful, you should consult a doctor. If the bloating worsens over time and symptoms like fever, vomiting, or bleeding occurs, you should contact your doctor immediately.

Bloating is difficult to cure treat because no single method has been shown to be successful. gastroscopy or colonoscopy procedure might be necessary to determine the root cause of your bloating or any underlying conditions.

Probiotics can help improve intestinal microbial balance in your gut and minimise discomfort. By taking probiotics, the excess gas in your body could be regulated and the balance of bacteria in your gut can be restored. Simethicone, an anti-foaming agent, is another medicine that helps the body to expel gas rapidly.

You may go on an elimination diet to determine which foods are the cause of your bloating. You should experience a proportionately decreased feeling of gassiness and bloating if you avoid ingesting these meals in excess. Complex carbs can also be broken down with the help of some drugs. Reducing your consumption of fiber, especially bran fiber, which is sometimes the cause of abdominal bloating, may help. Moving can also help to reduce bloat, particularly after a meal. This facilitates digestion and lessen bloating.

Blood in Stool

Blood in Stool

Blood in the stool suggests that there is bleeding in the digestive tract somewhere. The cause of bleeding can be determined by looking at the color of the blood. Bright red blood may indicate that the colon or rectum is where the bleeding is located, while dark red blood may indicate that the bleeding is at the colon or small bowel.

The only way to detect blood in some cases is through a faecal occult test because the amount is so small it cannot be seen with the naked eye. A faecal occult test is a type of lab test using stool sample. In such circumstances, patients might not be aware of the bleeding, or they might not have any other symptoms. However, some patients may experience other symptoms like diarrhoea, abdominal pain, vomiting, along with bleeding.

Rectal bleeding could be a sign of a wide range of conditions, from minor to those that require urgent medical attention.

Haemorrhoids
Haemorrhoids, often known as piles, are abnormally big, protruding blood vessels in and near around the anus and lower rectum. Internal hemorrhoids is usually painless and can grow within the anus and occasionally bleed during bowel movements. External hemorrhoids develop near the anus and they don’t bleed unless they rupture. Haemorrhoids typically cause fresh, bright red bleeding.

Anal Fissure
An anal fissure is a tear or cut that extends to the anus’s edge. It occurs in the tissue lining of the anus. It can be very uncomfortable and is frequently brought on by passing large, hard stools. As a person passes motion, bleeding occurs because the stools would stretch the fissure.

Anal Tumours
Anal tumours can cause bleeding during bowel movements and are frequently accompanied by intense pain in the anus. Symptoms of an anal tumour include changes in bowel movements. Eventually, the tumor may even grow large enough to protrude through the anus or invade the skin surrounding the anus.

Diverticular Disease
Diverticula are small, bulging pouches that can form in the lining of your digestive system. It could impact the colon in full or in part. Diverticular rarely causes issues, however they may bleed and swell up. Diverticular disease is a common condition that affects people over the age of 40. Few patients really experience symptoms, and even fewer will need surgery.

Peptic Ulcers
Stomach pain is the most typical sign of peptic ulcers, but some people experience more severe symptoms, like blood in the stools. The blood is typically dark red and/or the stools are tarry.

Polyps
Polyps are small tissue growths that are typically less than 0.5 inches in size and are usually not cancerous. These growths can develop in areas like the uterus or colon, and if left unchecked, they may turn into cancer. To prevent this, it’s important to undergo regular screenings. In cases where polyps are present in the colon, rectal bleeding may occur.

If blood is noticed in your stool, consult a doctor as soon as possible. The doctor may order a set of tests such as the rectal examination, to determine the exact cause.

Depending on your medical history and symptoms, the doctor will request a series of tests that could include a combination of a rectal exam, a fecal occult blood test, blood tests, imaging scans, endoscopy, or a combination of these. A rectal exam or fecal occult blood test can detect abnormalities or blood in the colon. The former is a physical exam, while the latter is a laboratory test of a stool sample used to check for infections and assess their severity.

Blood work can be used to identify signs of anemia, inflammation, or infection. Anemia can cause low levels of hemoglobin, while inflammation and infection can cause an increase in white blood cell count. Imaging scans, such as an abdominal CT scan, may help to locate the source of the bleeding.

Different types of endoscopies, such as colonoscopy, flexible sigmoidoscopy, esophagogastroduodenoscopy, or enteroscopy, are performed to identify obstructions or abnormal growths in the digestive tract. The procedure generally involves inserting a long tube with a camera into the anus or mouth and is often conducted as an outpatient procedure.

Constipation

Constipation is a prevalent problem that affects many healthy individuals, with a higher incidence observed in females compared to males. However, the definition of constipation can vary depending on the individual. Some individuals define it as having infrequent, hard bowel movements, while others define it as passing stools less than once every two to three days.

It is crucial to note that constipation alone is not a concern, particularly if there are no accompanying abdominal symptoms or blood in the stool. It is a common misconception that holding onto feces for an extended period is harmful to the colon and can cause toxicity. However, it is also important to avoid regularly cleansing or douching the colon, as this can cause harm.

In conclusion, experiencing some degree of constipation is normal, as long as it does not cause discomfort or other issues.

Dietary causes
Dietary issues are one of the commonest causes for Constipation. Lack of water intake and lack of fibre intake are the two most common dietary causes for constipation. Lack of water produces hard stools which makes the colonic passage slower and the actual act of passing motion more difficult. Fibre on the other hand is needed to make the stools bulkier but yet fluffier and as such, the lack of fibre produces pellety hard stools. It is important to note that taking fibre alone without adequate water intake can worsen the pre-existing constipation.

Poor toileting habits
Constipation can occur if a person ignores the urge to have a bowel movement. Individuals with busy jobs or limited access to toilets may delay having a bowel movement, leading to weaker and infrequent urges over time. This results in the faeces staying in the rectum for a longer period, becoming harder and drier, and making it more difficult to pass.

Idiopathic and IBS (Irritable Bowel Syndrome)
Despite maintaining a healthy diet and good bathroom habits, a considerable number of individuals experience constipation. This issue may have persisted since their 20s and is usually intrinsic rather than being caused by external factors. Slow bowel transit, as detected by specialised X-ray studies, may also contribute to constipation in some individuals. Others may experience constipation due to irritable bowel syndrome (IBS), often accompanied by symptoms such as abdominal bloating, distension, or the feeling of incomplete evacuation. For such cases, certain pro-motility medications like Prucalopride or Lubiprostone may be beneficial in improving intestinal movement.

Low Thyroid hormone levels (Hypothyroidism)
Constipation can be caused by hypothyroidism, a condition that can be diagnosed through a thyroid function test. Treating hypothyroidism by correcting the levels of thyroid hormone can improve the constipation.

Obstructing Colorectal Cancer
The sudden onset of constipation can indicate an obstructed colorectal tumor. Typically, this is accompanied by acute distension of the abdomen, abdominal pain, and vomiting. Additionally, there may be no bowel movements or passing of gas. These symptoms are indicative of acute intestinal obstruction and require emergency surgery.

Getting advice from a gastrointestinal specialist could be beneficial. Before starting any medical treatment, it’s important to have a colonoscopy to eliminate the possibility of blockages in the colon. Pro-motility medications could be an option to increase bowel movements, and probiotics have been found helpful in easing constipation.

Diarrhoea

Irritable Bowel Syndrome (Diarrhoea)

Almost everyone experiences diarrhea at some point in their life, and its definition may vary from person to person. Generally, diarrhoea is characterised by an increase in bowel movements, watery or poorly formed stools, or both. In addition to these symptoms, diarrhea may also cause abdominal pain, nausea, vomiting, fever, and dizziness, indicating dehydration. Bloody stools may also be a sign of diarrhoea.

Infective diarrhoea
Infectious diarrhoea can result from viral or bacterial causes. Some common bacterial causes include E.coli, Salmonella (which can lead to typhoid fever), and Campylobacter, among others. Common viral causes of infectious diarrhoea include enterovirus and rotavirus. Most cases of infective diarrhoea are caused by ingestion of contaminated food or water, or what is commonly known as Food Poisoning. Thankfully, most cases of Infective Diarrhoea are self limiting and will resolve in a few days. The most important thing to note is to keep oneself hydrated during the period of diarrhoea.

Diet-related diarrhoea
The second most frequent cause of diarrhoea is linked to food consumption and can be attributed to certain dietary items such as dairy products (lactose intolerance) and spicy foods. Typically, this condition resolves on its own and does not result in any lasting effects. Celiac disease, on the other hand, is a medical condition that arises from consuming gluten, a substance that those with celiac disease are intolerant to. Symptoms of celiac disease include diarrhoea, abdominal bloating, pain, nausea, and vomiting. Unlike other food-related causes of diarrhoea, celiac disease can lead to long-term complications such as malabsorption and nutrition deficiencies. Avoiding gluten completely is the only certain way to prevent this condition.

Bacterial overgrowth-related diarrhoea
Bacterial overgrowth can occur in the small intestine. This can occur in the context of long term antibiotic usage and celiac disease among others. With bacterial overgrowth, the digestion and absorption of nutrition is affected, leading to a watery and explosive diarrhoea that persists.

Irritable Bowel Syndrome (IBS)
Irritable Bowel Syndrome is a gastrointestinal condition that is not cancerous. It is characterised by changes in bowel movements and discomfort in the abdominal area. These changes in bowel movements can result in either diarrhoea (IBS-D) or constipation (IBS-C). When an individual experiences diarrhoea as part of their IBS, they may have more frequent bowel movements and looser stools, particularly when triggered by dietary or stress-related factors. However, these symptoms may be confused with those of colorectal cancer, which is a more serious condition.

Colorectal Cancer
Diarrhoea is a potential symptom of colorectal cancer and may be confused with other causes of diarrhoea. In colorectal cancer, diarrhea occurs due to a tumor that is blocking the normal passage of stools. This results in stool stasis and eventually leads to the liquefaction of stools, which causes diarrhoea. The diarrhoea associated with colorectal cancer can be mistakenly diagnosed as IBS-Diarrhoea. Therefore, it is crucial to conduct a thorough investigation before making a diagnosis of IBS, as other serious conditions such as colorectal cancer need to be ruled out.

Inflammatory Bowel Disease (IBD)
Inflammatory Bowel Disease is a condition in which the gastrointestinal tract becomes chronically inflamed. There are two types of IBD, namely Crohn’s Disease and Ulcerative Colitis. If someone has undiagnosed IBD, they may experience symptoms such as chronic diarrhoea, which may contain blood, weight loss, anemia and nutritional deficiencies.

If you have had diarrhoea for more than two weeks, it’s important to seek medical advice from a specialist. This is especially important if you are aged 30 or over. It’s essential to rule out serious conditions such as IBD and colorectal cancer, among other possible causes. Typically, a colonoscopy will be required to eliminate these conditions.

For individuals with sudden-onset diarrhoea, it’s crucial to ensure that they stay hydrated by drinking sufficient fluids. If the person is vomiting and unable to drink fluids, or if the diarrhoea is too frequent, they may require intravenous fluids and anti-emetic medication.

Difficulty Swallowing

Dysphagia

Having trouble swallowing, also known as dysphagia in medical terms, is a painful condition where it takes more effort to move food and drink from the mouth to the stomach. In severe cases, swallowing can become impossible.

Struggling to swallow doesn’t always signify a medical issue. It’s normal to experience occasional difficulties with swallowing, but if it persists, it could indicate a serious medical problem. This condition can affect anyone, but it’s more common among elderly people.

The National Institute of Deafness and Other Communication Disorders (NIDCD) indicated that there are 50 pairs of nerves and muscles that work together to facilitate the process of swallowing. Any issues with these nerves or muscles can cause difficulties with swallowing.

Gastroesophageal Reflux Disease (GERD)
GERD, or gastroesophageal reflux disease, is a condition characterised by acid reflux occurring at least twice a week. Acid reflux happens when the contents of the stomach flow up into the esophagus, causing a painful burning sensation in the chest. One of the symptoms of GERD is experiencing difficulty and discomfort while swallowing.

Oesophageal Cancer
When cancer cells form in the oesophagus, they begin in the inner layer and spread throughout the other layers of the oesophagus and other parts of the body. There are two main types of oesophageal cancer: one that affects the squamous cells lining the inner oesophagus and can develop along the entire oesophagus, and another that arises from gland cells that have replaced the squamous cells lining the oesophagus. The presence of cancerous tumours in the oesophagus can cause it to narrow, making swallowing increasingly difficult as the cancer progresses. Conversely, radiation therapy employed to treat the cancer can cause inflammation and scarring of the oesophagus, leading to swallowing difficulties.

Oesophageal Strictures
Acid reflux can harm the tissues in the oesophagus and lead to a constriction in the lower oesophagus. This constriction can cause discomfort and difficulty when trying to swallow food or liquids. Individuals with an oesophageal stricture may experience a sensation of obstruction or blockage in their throat.

Achalasia
Achalasia is a rare medical condition that affects approximately 1 in 100,000 individuals, regardless of gender or age. This disease primarily affects the lower oesophageal sphincter, where the muscles fail to relax and transport food into the stomach. Consequently, people with this condition often experience difficulty swallowing and must adapt their diet by consuming liquid-based foods. In addition, weakened muscles in the lower oesophageal sphincter can also occur due to the formation of scar-like tissues. This can result in acid reflux and heartburn.

Neurological Conditions
Swallowing difficulties related to neurological conditions stem from impaired sensorimotor function during the oral and pharyngeal phases of swallowing. Neurological conditions such as stroke (the most frequent cause of neurogenic dysphagia), traumatic brain injury, cerebral palsy, Parkinson’s disease, and degenerative neurological disorders like Lou Gehrig’s disease, Huntington disease, and multiple sclerosis are known to cause dysphagia.

Eosinophilic Esophagitis
Eosinophilic Esophagitis (EoE) is an uncommon chronic condition affecting the oesophagus, where there is an accumulation of a type of white blood cell called eosinophils, leading to inflammation and damage. The exact cause of EoE is not yet known, but scientists suggest that it could be an immune system or allergic response triggered by specific foods or environmental substances, such as dust mites, pollen, and moulds. It is important to note that some individuals who believe they have GERD may actually have EoE, as the symptoms can be similar.

Zenker’s Diverticulum
Zenker’s diverticulum (ZD) is a rare condition in which a pouch or sac forms in the wall of the oesophagus, where it meets the throat, leading to the accumulation of mucous, food, and liquid instead of allowing the contents to pass through into the stomach as they normally would.

It is important to seek immediate medical attention if you encounter difficulties in breathing, sudden muscle weakness or paralysis, or if you are unable to swallow at all. In addition, if you suspect that something is obstructing your throat, leading to painful or difficult swallowing, it is recommended to consult a healthcare professional to identify the underlying cause.

In order to diagnose the cause of swallowing difficulties, a healthcare provider may conduct a thorough examination and ask about any relevant medical history. Various tests may also be performed, such as a nasoendoscopy to check the nasal passage, throat, and voice box, or an endoscopy to examine the oesophagus and take samples to identify any inflammation or tumours. Additionally, a manometry test can be used to assess the pattern and pressure of oesophagal contractions to diagnose functional causes like achalasia or diffuse spasm. Other imaging studies such as X-rays or CT scans, and barium swallow studies, may also be recommended to identify mechanical obstructions like tumours or strictures.

Flatulence and Burping/Belching and Bad Breath (Halitosis)

Gas is a normal bodily process that is expelled from the body through either burping (via the mouth) or flatulence (via the anus). Burping is typically caused by air being swallowed during eating, drinking, or talking, and may also be a result of carbonated drinks. The frequency and amount of burping varies from person to person and situation to situation.

Bad breath, or halitosis, can also be a result of gas expelled through the mouth, and may be caused by certain foods or underlying medical conditions such as acid reflux or poor oral hygiene.

Flatulence, on the other hand, is a more complex process involving a combination of food, gut bacteria, and colon transit time. Certain foods are known to be common culprits of excessive flatulence production, including vegetables, dairy products, beans, fruits, wholegrain foods, and soft carbonated and fruit drinks. However, the amount of gas produced from these foods can vary from person to person. Smelly flatulence is usually not indicative of a serious underlying medical condition.

Gastroesophageal Reflux Disease (GERD)
GERD is a condition in which the contents of the stomach, including partially digested food, reflux back into the lower esophagus, and in severe cases, up to the throat or mouth. This deposition of gastric contents in the mouth and throat can cause bad breath or halitosis.

Esophageal or Pharyngeal pouch
Pouches, also known as diverticula, are abnormal outward protrusions of the esophagus or pharynx wall. The presence of these pouches creates a space where food can accumulate instead of passing down the esophagus, leading to partial digestion and breakdown of the food material. This can result in the production of noxious gases, which can cause bad breath or halitosis.

Irritable Bowel Syndrome (IBS)
Irritable Bowel Syndrome (IBS) is a gastrointestinal condition that affects the normal contractions of the intestines and increases sensitivity to pain and gas distension. Common symptoms experienced by patients with IBS include bloating, abdominal distension, and frequent flatulence. The rate of intestinal transit can affect the frequency of flatulence passage, with accelerated transit causing more frequent passage and slower transit allowing for more time for the breakdown of faecal matter in the intestines.

Peptic Ulcers
Peptic ulcers are sores that form in the stomach or duodenum. When an ulcer bleeds, the blood is partially digested as it passes through the digestive tract, resulting in black, tarry stool with a distinct foul odor. This may lead to the production of smelly flatulence.

Lactose Intolerance
Many individuals of East Asian descent have a higher prevalence of lactose intolerance than other populations. This is because they have lower levels of lactase, an enzyme that breaks down lactose found in dairy products, in their small intestine. As a result, undigested lactose reaches the colon where it is fermented by bacteria, leading to symptoms such as abdominal pain, bloating, flatulence, and diarrhoea, which can also have a characteristic foul smell.

Constipation
Constipation occurs when faeces remain in the digestive tract for an extended period, particularly in the colon and rectum. This prolonged exposure to gut bacteria can result in excessive production of flatulence, which may have a distinct odour.

Belching or flatulence that occurs frequently is generally not a serious concern. However, if these symptoms are causing significant discomfort to the patient, seeking medical attention may be necessary. Halitosis, on the other hand, may indicate an underlying problem. If bad breath is sudden or becomes worse, medical attention should be sought. The presence of additional symptoms such as abdominal bloating, discomfort, diarrhoea or black stools also warrant medical attention.

Gastric Pain

Gastritis

Gastric pain usually refers to pain that is felt in the upper central part of the abomen underneath the lowest point of the sternum. This is the area that most people asscociate with ‘Gastric’ pain. Despite the use of the word ‘Pain’, there are other sensations that can be experienced in this area.

Bloatedness and Distension is often described by patients. Some will also describe it as ‘Indigestion’ or a sensation of food remaining in the stomach. Some patients may also describe a Burning sensation or a Squeezing-type pain.

Gastric pain can arise from various causes, some of which arise from the stomach and others from organs around the stomach.

Gastritis
Gastritis occurs when the stomach makes too much acid and the stomach lining gets weaker. Things that can cause gastritis include stress, smoking, drinking alcohol, taking certain painkillers or medicines, and a germ called Helicobacter Pylori.

Gastro-esophageal reflux disease (GERD)
GERD is connected to Gastritis and the two conditions often happen at the same time. GERD typically causes symptoms like a burning feeling in your chest (also known as heartburn) and stomach acid flowing back up into your throat and mouth.

Gallstones
Many people don’t know this, but the signs of gallstones can be similar to those of stomach pain. These signs can include feeling bloated, having trouble digesting food, and experiencing stomach pain. Usually, the pain caused by gallstones starts after eating a heavy or greasy meal.

Pancreatitis
Pancreatitis is a condition characterised by inflammation of the pancreas, with the two most frequent triggers being gallstones and alcohol consumption. Pancreatitis is a serious illness that may result in multiple organ failure.

Heart attack
Sometimes, cardiac pain and heart attacks may present themselves as indigestion or gastric pain. Therefore, it’s crucial to assess any sudden onset of gastric pain thoroughly to rule out any potential heart-related issues.

If you experience any intense gastric pain or pain that persists for more than a week, it’s essential to seek medical advice. Other symptoms that may accompany gastric pain, such as fever, vomiting, cold sweats, and shortness of breath, are also indicators that medical attention is necessary.

Typically, investigations for most cases of gastric pain involve a series of tests, including blood tests, an ultrasound scan of the liver and gallbladder, ECG, and Gastroscopy.

Heartburn and Reflux

The point where the esophagus meets the stomach is called the cardio-esophageal junction. This junction is regulated by a valve-like structure called the lower esophageal sphincter, which allows food to pass into the stomach and prevents stomach contents from flowing back up into the esophagus.

In individuals with Gastroesophageal reflux disease (GERD), the lower esophageal sphincter may not close tightly enough, leading to the regurgitation of stomach contents and digestive juices into the lower esophagus.

One of the main symptoms of GERD is heartburn, which is described as a burning sensation or discomfort behind the breastbone, located in the center of the chest. It may also be accompanied by a sour or acidic taste in the mouth due to the reflux of stomach contents.

The most frequent symptoms of Gastroesophageal Reflux Disease (GERD) are heartburn and a sour taste in the mouth. This condition is a digestive disorder that affects the valve at the end of the oesophagus, which is also known as the lower oesophagal sphincter (LES). When the LES fails to close properly, stomach contents can flow back up into the oesophagus and cause discomfort.

Oesophageal Stricture
This is the narrowing of the lower oesophagus which then makes it difficult and painful to eat or drink normally. A narrowed lower oesophagus can make you feel like the food is stuck at the lower part of the chest and can result in vomiting

Oesophageal Ulcer
This is an open sore caused by gastric acid wearing away the tissue in the oesophagus. Recurrent esophageal ulcers can lead on to strictures. Barrett’s Esophaghus is a condition where long term damage from acid reflux causes abnormal changes in the lining. This condition is associated with an increased risk of oesophageal cancer.

Gastro-Esophageal Reflux Disease
Gastroesophageal Reflux Disease (GERD) is characterised by frequent acid reflux that causes a burning sensation that rises from the stomach to the lower chest and neck. This sensation typically occurs after eating and can persist for up to two hours. The symptoms can sometimes mimic chest pain, which can be mistaken for a heart attack. Aside from heartburn, other symptoms may include difficulty in swallowing, nausea, bad breath, breathing difficulties, chronic cough, or vomiting. Several factors can increase the risk of GERD, including obesity, pregnancy, consuming late meals, drinking alcohol, smoking, and hiatal hernia. Hiatal hernia is a condition where the upper part of the stomach moves upwards into the chest through a small opening in the diaphragm. This can make it easier for stomach contents to travel back up into the oesophagus.

Types of Hiatal Hernia
Hiatal hernias are generally not treated surgically. The symptoms of GERD can often be alleviated with anti-acid medications and adjustments to one’s lifestyle. However, if surgery is required to correct both the hiatal hernia and GERD, a combination of corrective procedures will be needed to address both issues appropriately.

Heartburn can sometimes be mistaken for heart pain, but any chest discomfort should not be overlooked. It is important to seek medical advice if one experiences persistent heartburn that does not improve with over-the-counter medication, or if the symptoms change in frequency or intensity. Other signs that warrant medical attention include acid reflux that interferes with daily activities or quality of life, difficulty swallowing, nausea or vomiting, and unexplained weight loss. Typically, symptoms that persist for more than two weeks should be evaluated by a doctor.

Antacids are sometimes effective for managing reflux and heartburn, but your healthcare provider may prescribe proton pump inhibitors or other medications to reduce stomach acid levels. Most cases of GERD can be managed with dietary and lifestyle changes, and long-term medication or surgery is rarely necessary. For instance, avoiding heavy meals close to bedtime or lying down immediately after eating can aid digestion. If certain foods trigger reflux and heartburn, you may need to limit or eliminate them from your diet.

Further investigation may be needed to determine the underlying cause of GERD. A gastroscopy is often recommended for this purpose. In some cases, a 24-hour pH study may be performed to measure the amount of acid in the stomach and oesophagus for persistent symptoms.

Nausea and Vomiting

Gastroenteritis

Nausea is a sensation of discomfort that typically leads to the urge to vomit. Vomiting involves coordinated muscle contractions of the abdominal muscles and the stomach, while regurgitation is the passive flow of stomach contents into the mouth without forceful expulsion. Unlike vomiting, regurgitation does not typically cause a sensation of nausea beforehand.

Nausea and Vomiting are natural body responses to any noxious or unpleasant stimuli. Due to the wide variety of stimuli, Nausea and Vomiting are fairly non-specific symptoms and can be associated with a variety of conditions. Nausea and Vomiting are often discussed together as the underlying causes are similar. The causes are more easily understood by dividing into Digestive system and Non-Digestive system causes.

Gastritis and Peptic Ulcer
Gastritis is an inflammation of the stomach lining and is commonly known as ‘gastric’. Typical symptoms include upper abdominal pain, nausea and vomiting. Peptic ulcer is an ulcer that develops in the stomach and is often a progression of worsening gastritis. The symptoms are similar to those of gastritis, with the addition of black stools due to bleeding from the ulcer.

Gallstones
Gallstones are small stones that can be found in the gallbladder. Sometimes they don’t cause any symptoms, but other times they can lead to nausea and vomiting, as well as pain in the upper middle and right side of the abdomen. If the symptoms are more severe, the individual may experience a fever and yellowing of the skin and eyes.

Acute appendicitis
Appendicitis is when the appendix becomes infected and inflamed. The appendix is a small organ attached to the colon on the right side of the body. Symptoms of appendicitis include feeling sick, having pain in the middle of the tummy, loss of appetite, vomiting, having a fever, and experiencing sharp pain on the right side of the lower abdomen.

Gastroenteritis (Food Poisoning)
Gastroenteritis, or Food Poisoning, is an infection in the digestive and gastrointestinal systems caused by viruses or bacteria. Symptoms include abdominal pain, cramps, nausea, vomiting, and diarrhoea. A variant of Food Poisoning is Gastric Flu. Gastric flu is actually a viral infection causing gastritis. It can be caused by a variety of viruses, the commonest being the cold and flu viruses.

Headaches and Migraines
Headaches and migraines can be accompanied by nausea and vomiting, as well as visual disturbances such as blurred vision, flashing lights, and sensitivity to light. It is important to note that headaches can sometimes indicate a serious underlying condition in the brain, such as a brain tumour or arterial aneurysm, or an arteriovenous malformation (AVM).

Urinary Tract Infection (UTI)
Nausea and vomiting are common symptoms of Urinary Tract Infection (UTI), which is an infection of the urinary system. Back pain and pain during urination are also common symptoms of UTI.

Medications and Chemotherapy
Nausea and vomiting are common side effects of many medications. It is possible to manage these symptoms by taking the medications before bedtime, having a smaller meal, or taking anti-nausea medication. Chemotherapy drugs are also known to cause these symptoms, which may require the use of intravenous anti-nausea medication.

It is crucial to seek medical assistance promptly when experiencing persistent nausea and vomiting as they may indicate various medical conditions. Vomiting can cause dehydration, which can eventually lead to kidney failure. A wide range of investigations may be required to identify the underlying cause of nausea and vomiting. These investigations may include blood tests, ultrasounds, CT scans, and endoscopies. Additionally, it’s essential to consider potential causes beyond the digestive tract.