Intestinal disorders

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Everyone has intestinal pain or discomfort sometimes. Maybe you ate something you didn’t like. Or you had an infection that made you sick for a few days.

But if pain and other bowel symptoms persist for weeks or longer, something more serious may not be working. Diseases and disorders of the digestive system are very common. About 60 to 70 million people in the United States live with digestive disease.

It is important not to ignore the symptoms in your gut. Many digestive disorders are easier to treat when they first develop.

Potential causes

One of the most serious bowel disorders is inflammatory bowel disease (IBD), although it is not very common. IBD occurs when immune system gut cells overreact to a perceived threat to your body. Often that “threat” is the normal bugs that make up the microbiome – the microscopic creatures like bacteria, fungi, and viruses – that live in your gut. This overreaction can damage the digestive tract (gastrointestinal or GI).

The two main types of IBD are ulcerative colitis and Crohn’s disease. “Crohn’s disease can occur anywhere in the digestive tract, from the mouth to the anus,” says Mount Sinai IBD expert Dr. Judy Cho. Ulcerative colitis only occurs in the large intestine.

These two diseases also differ in the depth to which they can damage tissue. “Ulcerative colitis causes damage to the intestinal lining,” says Dr. Dermot McGovern, who studies IBD at Cedars-Sinai. “Crohn’s disease can cross the gut.” Severe cases of Crohn’s can lead to narrowing of the intestines and even holes in the intestine.

Other conditions can damage the stomach lining and lead to a type of inflammation called gastritis. The most common cause of gastritis is infection with bacteria called Helicobacter pylori. Other causes include long-term use of certain painkillers. If left untreated, gastritis can lead to painful ulcers.

Twelve percent of people in the United States have irritable bowel syndrome (IBS). “It’s a very common disorder. It’s characterized by abdominal pain, bloating, and changes in bowel habits,” says Dr. Anthony Lembo, IBS researcher at Beth Israel Deaconess Medical Center.

Researchers don’t understand exactly what causes IBS. It can have different causes in different people. Sometimes it involves problems with how the brain and gut work together.

Other things that can cause pain and discomfort in the gastrointestinal tract are acid reflux or food sensitivities.

Identify the problem

Diagnosing digestive disease can be difficult because they share many symptoms, Cho says. Symptoms of many bowel conditions include pain, gas, bloating, and diarrhea.

“But for IBD, there are several warning symptoms,” she says. These are blood in the stool, weight loss, and signs of inflammation found in a blood test. One sign of IBD in children is stunted growth, adds Cho.

IBS can give some people diarrhea and others constipation. Some people go back and forth between the two.

Gastritis and food sensitivities can also cause long-term bowel discomfort. To determine what is causing intestinal upset, doctors may need to perform a variety of tests. These may include blood tests and a stool test to check for infection.

Some people may undergo an imaging test, such as a CT scan. Others may need to have an endoscopy. Endoscopy uses a long, flexible tube with a small camera at the end to look into the intestines or stomach.

Treat pain and discomfort

Although the symptoms of different bowel disorders can be similar, treatments vary widely. For gastritis caused by bacterial infection, antibiotics are used to kill the germs. If medications are causing gastritis, switching to another type of medication will usually allow the stomach to heal.

Food sensitivities can be managed by changing your diet. A nutritionist can help you determine which foods might irritate your gut. Acid reflux can also often be improved by changes in your diet and medications.

Treatment isn’t one-size-fits-all for IBS, says Lembo, because it can have different causes. Some people can get some relief by adjusting their diet. (See the Smart Choices box for foods that can trigger gut symptoms.)

“We also tell patients to eat two to three meals a day, maybe a snack or two. But don’t eat all day. Give your gut a chance to rest,” he says.

And while stress doesn’t cause IBS, it can trigger flare-ups of symptoms in many people, Lembo says. Stress reduction strategies and cognitive behavioral therapy, a type of talk therapy, can help some people manage IBS symptoms.

IBD is more difficult to treat than most bowel disorders. “It’s impossible to cure IBD right now,” says Cho. Treatments aim to stop the inflammation long enough to allow the intestinal tissue to heal, she explains.

Certain medications used to control the inflammation of IBD. Other newer drugs suppress the immune system. But these new drugs can have serious side effects and are usually only used when others don’t work.

“Research has found that the earlier you use these drugs, the more likely you are to react,” McGovern says. So people with high-risk disease can now get these drugs first, he says.

In search of better treatments

Researchers are looking for new ways to prevent and manage gut disorders. Lembo, for example, is testing whether peppermint oil can help intestinal muscles relax in people with IBS.

Existing treatments for IBD only work for about a third of people who try them. And even then, says McGovern, they can lose their effects over time.

Both Cho and McGovern are working to understand the genetics of IBD. This information could be used at all stages of the disease, Cho says. For example, if a test could identify children at higher risk of developing IBD later in life, “theoretically it could be prevented,” she says. Strategies could include administering anti-inflammatories before IBD develops or modifying the gut microbiome to prevent an immune attack.

“And what we’re all interested in is: can we use some of these genetic signatures to identify new drug targets for IBD?” adds McGovern. It could also potentially help predict who would most likely benefit from a drug, he says.

One of the new drugs being tested for IBD was based on a genetic discovery, Cho says. “There is an increasing precision in processing,” she says. “Using genetic knowledge to help choose therapies for IBD is something that I think is feasible within the next five to 10 years.”

For now, talk to your doctor if bowel discomfort or pain is impacting your quality of life. Available treatments can help most people get their bowels in order.

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