Abdominal ('stomach') symptoms

'Stomach' , i.e. abdominal pain, bloating, diarrhoea, constipation and reflux are most common.

The term irritable bowel syndrome (IBS) refers to chronic and recurring abdominal pain with changes in bowel habits, i.,e. stool patterns. These include diarrhoea and/or constipation, but there are many other possible accompanying symptoms, such as bloating, feeling of fullness and of being unwell.

The term 'leaky gut' refers to an increased permeability of the intestinal wall. This is seen with inflammation of the intestines and may also play a role in the irritable bowel syndrome. This has, however, not yet been scientifically proven to be relevant in every case of IBS.

This syndrome is characterised by a feeling of fullness, early satiety (loss of hunger) or pain in the stomach after eating. Other conditions should already have been exuded before this diagnosis is attributed.

The symptoms attributed to a bacterial overgrowth of the small intestine (SIBO) are generally those described in irritable bowel syndrome, functional dyspepsia or food intolerances. These are very likely overlapping syndromes associated with increased intestinal fermentation and an altered gut microbiome.

Yes, they are very relevant in my practice and they are especially important in patients referred to me for a specialist opinion. Changes in the skin, joints, muscles, brain or heart function can be indications for disorders of the digestive system.

The brain-gut-microbiome axis refers to the close and integrated communication between the brain, the gut and the gut microbiome ('flora'). All players in this axis are implicated in disorders of the digestive system, including stress, nutrition, inflammation and changes in the gut microbiota.

Chronic inflammatory bowel disease (IBD) was less common 50 years ago, but it was also more difficult to discover. The risk factors for IBD are multi-factorial, but environmental and genetic factors are both implicated. There are indications that the composition of our food may play a role.

Gastritis is often seen during endoscopy, but a treatment is not always necessary. Common causes are non-steroidal painkillers (NSAIDS) or aspirin, the bacterium Helicobacter pylori and also autoimmune disorders.

The gut microbiome is involved in virtually all functions of the intestines: transport (motility), absorption, inflammation, sensation and immune reactions and much else. Many aspects are still under investigation, but it is clear that in IBS the microbiome does play an important role.

I often see diverticulae during endoscopy, but to give a short answer, their underlying cause remains unclear. They are not primarily associated with constipation. It is likely that a weakening of connective tissue after inflammation is implicated.

No diagnostic tests can diagnose IBS. The basis of this diagnosis is the conscientious exclusion of other disorders and a careful evaluation of your symptoms.

I employ endoscopy to investigate symptoms, especially when there are 'red flags' (such as bleeding, weight loss, strong pain), mineral or vitamin deficiencies and for screening. My goal is to avoid unnecessary endoscopies.

Careful history-taking is most important to me. That is why the I am grateful for your returning of the completed questionnaire we give you. Conformation of a food intolerance is achieved using the validated breath tests and, when indicated, blood samples and biopsies during endoscopy.

Bacterial overgrowth of the small intestine (SIBO) is diagnosed in our practice using the glucose breath test. The lactulose breath test is an older alternative, although less exact.

Identifying the cause of the symptoms is most important for the correct choice of treatment. This is why specific investigations are important before implementing a treatment.

Many patients with so-called IBS actually have an underlying food intolerance. This is the reason I often initially test for food intolerances in IBS, and then refer to a dietician and prescribe probiotics. IBS can be alleviated with lifestyle changes and medication (plant-based or pharmaceutical). The treatment plan must be tailored to your individual needs.

There is much ongoing research regarding the complex and interesting topic of the intestinal microbiome. Specific adaptation of the intestinal microbiome is not yet possible, but probiotics (healthy bacterial strains) and prebiotics (fermentable dietary fibre or chains of sugar, such as fructans) are useful approaches.

In case of significant symptoms, such as bloating, stomach cramps, stool changes, probiotics would be my first choice. Antibiotics can be helpful in reducing symptoms in a subset of individuals, but responses are generally short-lasting. A low-FODMAP diet is a further useful approach.