Category Archives: Symptoms Of Digestive Disorders

Regurgitation And Rumination

Regurgitation is the bringing back of swallowed food into the mouth from the esophagus or the stomach.

Unlike vomiting, regurgitation does not involve forceful muscular contractions or a feeling of nausea.

The lower esophageal sphincter, which is a circular muscle situated between the esophagus and the stomach usually acts as a guard preventing food from the stomach re-entering the esophagus. But when the food regurgitated is bitter or sour, it indicates that the food has been in the stomach; the bitterness or sourness caused by the bile and the digestive acids respectively. If there is a blockage in the esophagus, due to narrowing or constriction of the tube, or due to the presence of tumors, regurgitation occurs, but the food particle may not have any taste and may be mixed with mucus.

 Abnormalities in the neuromuscular functioning of the esophagus may result in blockage in the esophagus. Lack of coordination between the opening of the lower sphincter and the movements of the esophagus, for emptying its contents into the stomach, also may cause regurgitation due to blockage.

Rumination is a type of regurgitation which has no identifiable physical cause. It is often observed fifteen minutes to half an hour after a meal. People who have this condition regurgitate small amounts of food from the stomach into the mouth without any difficulty or pain. They chew the particles brought up into the mouth and then swallow it again, much like the ruminants. This is commonly found in infants. People who are emotionally disturbed also show an increased tendency for rumination.

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

Nausea and Vomiting

Nausea is an uneasy feeling in the upper part of the abdomen with a distressing urge to vomit. It may be a temporary sensation felt immediately before a bout of vomiting or it can persist without any vomiting occurring.

Vomiting is the sudden forceful ejection of the contents of the stomach when stomach contracts violently, emptying its contents into the esophagus and out through the mouth in one or several repeated bouts. It usually brings temporary relief from the feeling of nausea. When almost all the contents are emptied, vomiting may bring up clear fluids; it is called dry heaves. Vomiting usually leaves a burning sensation in the throat and the esophagus due to the irritation caused by the stomach acids which were brought up with the contents of the stomach.

Regurgitation is different from vomiting in that, the stomach contents are not forcefully ejected, but brought up slowly, in small quantities, usually without any accompanied nausea. Examples are regurgitation resulting from esophageal disorders such as Zenker’s diverticulum and achalasia, which results from a motility disorder of the esophagus.

The contents of vomit, called vomitus, consist of partially digested food, and digestive juices secreted by the stomach walls and the liver. When the presence of blood imparts a red color to the vomitus, it indicates a recent bleeding and it is called hemetemesis. A coffee grounds-like brown precipitate also indicates bleeding, but of earlier occurrence, the color change being caused by the action of digestive fluids on the blood. Yellowish green clear liquid in the vomitus is bile, which gives it a bitter taste.

Complications: Vomiting may bring temporary relief from nausea, but in addition to causing a burning sensation in the upper digestive tract, it may lead to complications such as:

  • Aspiration of the contents of the vomit
  • Severe loss of fluids leading to dehydration and chemical imbalance.
  • forceful contraction causing tears in the esophageal wall
  • Malnutrition in chronic cases

While vomiting, some of the vomitus may be aspirated when a person takes in a deep breath; it is more common if the patient is not fully conscious. The aspirated vomitus causes irritation to the lungs and may lead to inflammations and infections, even pneumonia.

Repeated forceful contractions of the stomach and the esophagus during vomiting can result in tears in the esophageal wall leading to bleeding. An example is Mallory-Weiss tear. If the tear is very large, and causes severe bleeding, it can be life threatening.

Along with the fluids lost through vomiting, mineral compounds of sodium, potassium, magnesium etc., are also lost, resulting in chemical imbalance which adversely affects various body functions. It can quickly become a life threatening condition, especially in babies and young children.

Vomiting, when it is a chronic condition, results in severe weight loss and malnutrition as in people who have bulimia.


Nausea and vomiting is generally associated with digestive disorders but it can result from the activation of the vomiting center in the brain. Injury to the head, motion sickness, certain drugs and toxins, sickening smells and distressing sights may cause nausea and vomiting.

Various digestive disorders cause vomiting, the most common among them being gastroenteritis which is an inflammation of the stomach due to viral or bacterial infections. Viral gastroenteritis is also called stomach flu which is highly contagious. Bacterial gastro enteritis is usually called food poisoning and it results from consuming food spoiled by bacterial activity.

Toxins ingested with food or otherwise (poisonous mushrooms, poisons contained in some plants of the nightshade family) can result in severe vomiting.

Physical obstructions in the digestive tract also cause vomiting because of the impediment to the smooth movement of food.

Certain disorders in organs connected to the digestive system such as pancreatitis, appendicitis, liver problems etc. may also have vomiting as symptom, in addition to pain.

Drugs used in chemotherapy for cancer, several pain medications like morphine belonging to the opioid group may cause vomiting. Excessive alcohol consumption often results in severe bouts of vomiting and retching which are known to cause esophageal tears.

Disorders of the brain or the nervous system including stroke, concussion due to accidents, inflammatory conditions like encephalitis and meningitis, and presence of tumors, have nausea and vomiting as symptoms.

Metabolic disorders like diabetes, and those resulting from liver and kidney failure, hormonal changes during early pregnancy, are some other reasons precipitating nausea and vomiting.

Damage to the balance keeping mechanism in the inner ear is the cause of vomiting due to motion sickness during travel and rollercoaster rides.

Mental stress or psychologic disorders sometimes result in psychogenic vomiting. Children often react to distressing events like starting or changing school by showing symptoms such as stomach pain and vomiting. People who suffer from anorexia nervosa and bulimia have intentional or habitual vomiting on eating food.


Nausea and vomiting are fairly common, and usually resolve by themselves, without medical intervention. However, vomiting may be a symptom of some serious disorder or damage caused to vital organs like brain, in which case, immediate medical care may help save lives. The warning signs listed below may help determine when medical attention should be sought.

Warning signs: people should seek medical attention when the following warning signs are present:

  • Severe dehydration characterized by reduced production of urine, weakness, dryness of the mouth and throat and excessive thirst
  • Confusion, disoriented feeling, stiffness of neck and severe or uncharacteristic headache indicative of problems with the brain.
  • Acute or recurring abdominal pain or bloating of abdomen
  • Symptoms of peritonitis such as sensitivity or pain while moving or touching the abdomen.
  • When severe vomiting is associated with equally severe diarrhea
  • When bright colored blood is present in the vomit (hemetemesis)
  • Vomiting following an injury to the head or after an accident

When to see a doctor Those who have the above warning signs should seek immediate medical attention. If vomiting persists for more than a day, people should consult a doctor without delay even if the warning signs are absent. People can consult the doctor over the phone so that the doctor can advise them to either come to the hospital or not, depending on their symptoms and medical history. For adult patients, doctor may recommend home remedies such as over the counter medication and taking plenty of fluids.

 For babies and young children, vomiting more than a few times can lead to sudden deterioration of their condition; hence, it is advisable to see a doctor as early as possible and continue to administer oral rehydration therapy. If oral rehydration is not tolerated, it is essential to seek emergency medical care for them.

When a person comes to the doctor with nausea and vomiting, doctor may want to know all the details about the foods and drinks recently consumed, with special emphasis on any change of diet, any change in the source of food and water, recent travel, alcohol usage or any other detail of special interest.

A physical examination is done during which the doctor checks the abdomen for pain, tenderness and bloating. In addition to that, the doctor may check the patient for symptoms of dehydration such as low blood pressure, abnormal increase in heart rate, weakness, dry mouth and cracking lips. Signs of disorientation, confusion, and reduced alertness, are also taken note of, if present.

Doctor may ask about the previous medical history, especially about existing conditions such as diabetes, liver disorders, kidney disease, migraines which may have significance in diagnosis as well as in determining the diagnostic tests required. Other conditions of special significance are radiation therapy or chemotherapy the patient may be undergoing as part of the treatment for cancer, and the possibility of a female patient being pregnant.

Certain drugs like acetaminophen and toxins in poisonous mushrooms are late acting and their symptoms such as vomiting may appear only several days later. It is essential that doctor is informed about any such incident in the recent past. Doctor may also be interested in knowing about the incidence of vomiting and diarrhea among the patient’s family and friends which usually indicates viral gastritis.

If the patients have undergone any abdominal surgery previously, it is also important in arriving at a diagnosis as they have an increased risk of developing obstructions in the digestive tract due to adhesions and scar tissue formations.

People, who have conditions like migraine with the usual symptom of vomiting, may be evaluated to see if the present bout of vomiting is due to a new abnormality or just a recurrence of the existing disorder.

Testing: For sporadic incidents of vomiting, tests may not be required and the vomiting may even stop without medication.

People who have had severe vomiting for over a day may have to undergo blood and urine tests to determine liver function and the electrolyte levels in the body. Women and girls of reproductive age are tested for pregnancy in addition to other blood tests and urine tests.

If any abnormality of the digestive system is suspected by the doctor, based on the symptoms and physical examination conducted, viewing tests like upper endoscopy or imaging tests such as x-rays or ultrasound screening are done.


The cause of vomiting is treated with appropriate medications and procedures. If bacterial infections are present, antibiotics may be necessary. To remove ingested poisons, stomach wash or gastric lavage may have to be done.

Rehydration therapy should be started as soon as possible to avoid complication due to dehydration. If oral administration of small amounts of liquid is tolerated, specially prepared rehydration solutions can be given to replenish the body with fluids as well as the electrolytes lost through vomiting. If vomiting continues, oral administration may not be effective and intravenous drips are given. Anti nausea and anti emetic drugs are prescribed to control further vomiting.

 Antihistamines are prescribed for vomiting due to motion sickness. Dimenhydrinate is an antihistamine used to prevent vomiting. Scopolamine patches also may be used.

Metoclopramide and prochlorperazine are other drugs usually prescribed. When vomiting is severe, as in people undergoing chemotherapy, granisetron, dolasetron aprepitant or ondansetron may be given. Pregnant women suffering from morning sickness should not take any antiemetic medication without doctor’s prescription.

When the patient is sufficiently recovered from vomiting, liquid diet can be started in small quantities, an ounce or two at a time; and then gradually increased, depending on the patient’s tolerance. In addition to plain water, weak tea or broth can be given. Alcohol as well as carbonated drinks should not be given during the recuperation period. Solid food can be introduced slowly, and when it is well tolerated, the patient can return to normal diet.

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

Feeling of Lump in Throat When Swallowing (Globus Sensation)

A feeling of  lump in throat when swallowing or even without swallowing, when no such lump exists, is termed as globus sensation.

It is different from dysphagia which is a feeling of difficulty in swallowing  food or drinks. A physical lump in the neck or throat, such as a palpable growth or mass, is also different from globus sensation.  Some people describe globus sensation as a tightening of the throat.


The actual reason for globus sensation has not been fully explained. Excess tension in the throat muscles, especially when a person experiences emotional upheaval such as profound sadness, joy, or anger results in this feeling. People who have  gastroesophageal reflux disorder frequently feel globus sensation.

Having globus sensation is not a cause of worry, as it is not a harmful or an extremely distressing condition in itself. Occasionally, some serious esophageal conditions may be causing a similar symptom which is interpreted mistakenly as globus sensation. Disorders of the esophagus such as spasms, reflux disease, cross webbing in the esophagus etc., and certain tumors, produce symptoms which could be mistaken for globus sensation. Polymyositis, myotonic dystrophy and myasthenia gravis are some neuromuscular disorders causing similar symptoms. Hence, it is important to have a correct diagnosis when a person is having the sensation of lump in throat.


Globus sensation may not need medical attention unless it is accompanied by warning signs such as the ones given below.

Warning signs: When other symptoms listed below are present along with globus sensation, it may be due to a disorder requiring medical attention.

  • Pain in the throat or neck
  • Significant  weight loss without apparent reason
  • Dysphagia or difficulty in swallowing, choking
  • Regurgitation or bringing the swallowed food back up
  • A lump which can be seen or felt
  • General weakness of muscles
  • Sudden appearance of the symptom in people aged over 50 years
  • Symptoms persisting and worsening

When to see a doctor: When any of the warning signs are present along with the sensation of lump in throat, people should seek urgent medical attention. When warning signs are absent, the lump in throat sensation is most probably due to globus sensation; but it is recommended that people should visit the doctor as soon as possible to confirm the diagnosis and to rule out other disorders.

When a person visits the doctor with the complaint of lump in the throat sensation, doctor performs a physical examination of the mouth, throat and the neck. Doctor will ask about the previous medical history of the patient with special emphasis on disorders affecting the upper digestive tract and the chest. Doctor may want to know if there is pain or discomfort during swallowing. It is important to tell the doctor if any of the warning signs are present. Based on the physical examination, details of the symptoms described by the patient, and the previous medical history, doctor may either give a diagnosis or order some diagnostic tests to detect the exact cause.

During physical examination doctor may feel the neck and the floor of mouth for abnormal lumps. A narrow tube with a viewing scope attached, may be inserted into the throat to examine the larynx as well as the back of the throat. A swallow test with fluids and solid foods may be conducted in front of the doctor so that any difficulty associated with swallowing may be detected. It is important to determine if the lump in the throat sensation is associated with ingestion of food or with emotional stress. If the sensation recurs in a patient during periods of distress or grief, and if the act of crying seems to alleviate it, the condition may be assessed as globus sensation without doubt.

Testing:  If the feeling of having a lump in the throat is not associated with any difficulty in swallowing and it is not accompanied by any of the warning signs, and the physical examination by the doctor does not show any abnormality in the throat or neck, the condition may be diagnosed as globus sensation without any further testing.

Imaging tests such as X-rays, or viewing the throat and the esophagus by endoscopy, are some tests which may be conducted to rule out any abnormality or abnormal growth in the region which may be causing the lump in the throat sensation. Tests to measure swallowing time as well as esophageal manometry also may be done.


No treatment is necessary, and no drugs are available, for treating globus sensation. Doctors may explain the benign nature of the condition, and its relation to the emotional state of mind. When the patient realizes that globus sensation has no serious consequence, he may be reassured and relieved.

If motility disorders or physical blocks are found to be the reason for the symptom, they may be treated surgically or with drugs.

If doctor observes signs of depression or behavioral problems in the patient, which may be worsening the condition, he may suggest an evaluation by a psychiatrist or prescribe antidepressants.

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

Loss of Appetite (Anorexia)

Loss of appetite (anorexia) is characterized by a disinclination to eat, due to the absence of hunger or desire for food.

Anorexia is different from anorexia nervosa which is a an eating disorder in people who have low self esteem and fear of gaining weight; due to which they restrict themselves from eating even when they are hungry, or they eat and immediately make themselves vomit.

Causes Of Lost Appetite

Anorexia is not a disease but a symptom caused by other diseases the person may be having. Most people have short bouts of anorexia when they suddenly become ill, but their appetite returns as soon as they recover.

Chronic anorexia lasts for a long period and it is a debilitating condition which results in weight loss, including loss of muscle mass and fat tissue known as cachexia. The reason for chronic anorexia is usually a serious chronic condition such as the following:

  • Diseases such as AIDS, cancers and chronic infections
  • Disorders affecting vital organs such as heart failure, liver or kidney failure
  • Disorders affecting appetite regulating regions of the brain
  • Asthma in children
  • Endocrine disorders
  • Side effect of drugs
  • Depression

Chronic infections and incurable diseases and disorders of the vital organs often result in lost appetite. Children who suffer from frequent episodes of asthma and people with chronic lung disease also experience lack of appetite. Certain endocrine disorders such as Addison’s disease causing adrenal insufficiency result in anorexia. Digoxin used in the treatment of heart disease causes loss of appetite. Some other drugs which have the same side are quinidine fluoxetine and hydralazine. People who are mentally depressed or terminally ill and those near the end of their lives generally display lack of appetite.


The treatment of anorexia depends on its cause. When a person comes with the complaint of chronic loss of appetite, doctors subject the patient to detailed investigations to detect the underlying cause. If the cause of anorexia is known, doctor may treat the underlying disorder as far as possible. If it is an incurable condition, measures to lessen the symptom are tried. The following are some of the measures taken to alleviate anorexia:

  • A diet which includes the foods desired by the patient, offers variety, and allows flexibility in quantity and timings
  • A small serving of alcohol half an hour before meals (optional)
  • Appetite stimulating drugs

Low-doses of corticosteroids such as dronabinol and megestrol are sometimes given. Cyproheptadine is another drug used to promote appetite.

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

What Is Dyspepsia (Indigestion )

What Is Dyspepsia ? Pain, discomfort, or a burning sensation, in the upper part of the abdomen is termed dyspepsia and it is generally (and falsely) attributed to indigestion. It is often described by some people as a feeling of fullness or gas accumulation.

Some people may feel the fullness even when they have not had any food. Others feel full with the consumption of very small portions, which is termed early satiety. Postprandial fullness is the condition when people feel as if they have overeaten after having a normal meal. This false feeling of fullness keeps people from eating even normal quantity of food. Paradoxically, some people feel more severe symptoms when they have not eaten anything, and they also get some relief when they eat some food. Nausea, lack of appetite, belching, flatulence, diarrhea and constipation are some of the common symptoms people have along with dyspepsia.

People get used to recurring episodes of dyspepsia which have mild symptoms and they often resort to home remedies unless their symptoms are very severe. Sometimes, when severe dyspepsia appears suddenly; it could be due to some serious disorder.

 Causes Of dyspepsia

Though the symptoms of dyspepsia are generally considered to be the indication of indigestion, in reality, it has nothing to do with digestion.

 Acute dyspepsia may appear soon after drinking alcohol or eating a big meal. Certain drugs such as iron supplements, NSAIDs, erythromycin or bisphosphonates are known to produce symptoms of dyspepsia. In some cases of coronary artery ischemia, resulting from the reduced blood supply to the heart muscle, people may feel it as a discomfort in the upper abdominal area, instead of the typical symptom of chest pain.

Recurrent dyspepsia may be due to the reasons given below:

  • Abnormality of the esophageal muscle /achalasia
  • Esophageal or stomach cancer
  • Medications taken by the person
  • Delayed emptying of the stomach
  • GERD or gastro esophageal reflux disease
  • Peptic ulcer disease or gastritis

Achalasia, which is an abnormality in the movement of the esophageal muscles, usually resulting from a problem with the relaxation of the lower esophageal muscle, causes dyspepsia in some people.

Delayed emptying of the stomach caused by connective tissue disorders, diabetes, or some neurologic abnormality of the stomach may be a reason for dyspepsia.

Dyspepsia is not caused by stress and anxiety but existing dyspepsia may appear to worsen during periods of stress mostly due to the people’s tendency to focus on negative sensations and discomfort.

When physical examination by the doctor, as well as the viewing of the interiors of the stomach and the esophagus thorough an endoscope, have not detected any abnormality in the upper part of the digestive tract, doctor may suspect functional dyspepsia. The reason behind this non-ulcer dyspepsia could be hypersensitivity to contractions of the stomach and the intestines.


When dyspepsia is mild and without any of the other warning symptoms, it may not need medical attention. But, when it is sudden, severe, or accompanied by warning signs, the dyspepsia may be due to some serious disorder which require immediate medical attention and emergency treatment.

Warning signs: the following symptoms, when present along with symptoms of dyspepsia, people may have to seek medical attention:

  • Sweating, rapid heart rate and shortness of breath
  • Increase in discomfort  with exertion, and relief on resting
  • Nausea or vomiting
  • Blood in the stool
  • Pain or difficulty while swallowing
  • Anorexia or lack of appetite
  • Weight loss

When to see a doctor: Sudden occurrence of dyspepsia in people who have no previous history, is always a cause of concern. If a sudden episode is accompanied by certain other symptoms such as sweating, rapid heart rate, or shortness of breath, people should seek immediate medical attention as they may be having acute coronary ischemia which can lead to complications. Chronic dyspepsia, which recurs with physical exertion and disappears with rest, may be indicative of angina. People with this condition should consult a doctor as soon as possible to evaluate their condition and find the exact cause of dyspepsia.

If the dyspepsia appears along with any of the warning signs such as blood tainted stool, pain or difficulty while swallowing or vomiting, should visit a doctor as soon as possible. Severe weight loss and lack of appetite also should be brought to the notice of a doctor so that the reason behind them can be ascertained and treated as early as possible. If no warning signs are present but frequent recurrence of dyspepsia occurs, it should be brought to the attention of your doctor without much delay.

When a person visits the doctor with the complaint of dyspepsia, a physical examination is done. The doctor checks not only the abdomen for abnormal growths but also the general condition of the patient for signs of jaundice, heart disorders etc. The anus and rectum are also examined for evidence of bleeding. cachexia or wasting away of muscle mass and fat tissue, and pallor, are also noted. Doctor specifically checks for symptoms of heart disease such as sweating, rapid heartbeat and breathing difficulty.

The medical history of the patient is very important for making a diagnosis. The patient may be asked about any pre-existing disorder of the heart or the stomach and also about the drugs being taken. Doctor may want a detailed description about the symptoms, and the circumstances surrounding the episode, such as whether it occurred after a large meal or following alcohol consumption, or if difficulty in swallowing or nausea and vomiting are also present etc. Whether it occurred during exertion and subsided with rest, or whether antacids helped relieve the discomfort, are also relevant details.

Patient should tell the doctor if there was any of blood in the vomit or stool, lack of appetite, weight loss without dieting etc. Previous reports of routine investigations regarding diabetes, blood pressure, cholesterol levels etc., also help in deciding the tests required to detect the cause of dyspepsia.


Blood tests and upper endoscopy are usually done to diagnose the reason of dyspepsia. Cancer of the esophagus as well as that of the stomach may precipitate symptoms of dyspepsia. Hence, endoscopic examination of the upper portion of the digestive tract is done to detect the presence of abnormal growths, especially in patients above 45 years of age. If younger people have any symptoms indicative of esophageal or stomach cancer, upper endoscopy is done to rule out the possibility.

 Coronary ischemia, if present, requires emergency medical attention. Blood tests and ECG are done to assess the extent of damage to the heart tissue and appropriate medical treatment is given to minimize damage.

Helicobacter pylori bacteria are known to inhabit the highly acidic environment of the upper digestive tract and cause symptoms similar to dyspepsia. Stool test or breath test is conducted to detect H. pylori infection. Blood tests are also done to detect other abnormalities which may be causing the dyspepsia.

When gastro esophageal reflux disease (GERD) persists even after a few weeks of proton pump inhibitor treatment, an esophageal manometry may be necessary, and the pH of the esophagus is measured. Even after GERD and gastritis are detected and treated successfully, the dyspepsia may sometimes remain, if its cause was some other disorder.


The main focus of treatment is treating the disorder which is found to be causing the dyspepsia. When no such disorders are detected, the doctor may explain to the patient that medications are not necessary. If dyspepsia is causing considerable discomfort, drugs which block acid production are prescribed. Histamine-2 [H2] blockers and proton pump inhibitors prevent excess production of digestive acids.

Cytoprotective drugs are also given, which increase the mucus lining of the stomach wall, thereby protecting it against the action of acids and development of ulcers. Erythromycin and metoclopramide are prokinetic drugs usually prescribed to stimulate the muscles of the digestive tract. Some people may need antidepressants.

People usually self- medicate with over-the-counter antacids. Mistaking the symptoms of dyspepsia for indigestion, people may reduce food intake, resulting in weight loss. Food supplements may be necessary to overcome the deficit.

Dyspepsia Video Summary

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

Causes Of Hiccups

Hiccups are caused by the sudden spasmodic contraction of the diaphragm which is immediately followed by a ‘hic’ sound produced by the closure of the glottis.

The dome- shaped muscular wall separating the abdominal cavity from the chest, called diaphragm, effects inhalation of air every time it contracts and exhalation when it relaxes. Normally, breathing is a rhythmic involuntary action which can also be controlled voluntarily. But a hiccup is a completely involuntary action controlled by the reflex arc and it usually repeats itself several times without the person having any direct control over it.

Almost everyone gets hiccups every now and then, though men are found to be more prone to it. Usually, hiccups start suddenly without any warning and stop just as suddenly within a few minutes causing nothing more than a temporary inconvenience and or a little embarrassment. Occasionally, they persist for several days to months at a time. Persistent hiccups not only result in severe distress; they are difficult to treat also. When they do not resolve by treatment, they are called intractable hiccups.

Causes Of Hiccups

The exact causes of hiccups are unknown but it is assumed that it results from a temporary irritation of the nerves supplying the diaphragm or malfunctioning of the centers in the brain responsible for the muscle control of the diaphragm.

Brief hiccups are found to follow the consumption of alcohol or hot liquids, hurried eating, a full stomach etc. even though there is no evidence to prove that the same actions would bring another episode. When people hyperventilate at times of stress, it may often trigger episodes of hiccups. It is attributed to low blood levels of carbon dioxide.

Persistent hiccups are usually caused by some serious problems such as malfunctioning of the control centers in the brain regulating breathing, or surgeries in the stomach or abdomen irritating the diaphragm. Cancers and other tumors in the brain and tissue damage due to stroke are the usual reasons for the malfunctioning of the brain. A toxic condition called uremia resulting from kidney failure and the accumulation of nitrogen compounds in the blood is another reason for hiccups that persist.

Usually, persistent hiccups are very difficult to stop unless the condition which is causing it can be treated and cured. They are also called intractable hiccups when they cannot be treated, as in the case of stroke. Prolonged episodes of hiccups may cause fatigue and loss of sleep. Weight loss is also common, probably because of the disruption to the peristaltic movement caused by hiccups.


There is no need to consult a doctor for hiccups lasting for brief periods. When it persists for more than 48 hours, the person should visit a doctor to determine the cause of the persistent hiccups and to initiate treatment for the underlying disorder. If certain warning signs such as loss of balance, headache or numbness also appear with the hiccups, they may indicate neurological problems behind the hiccups. In such cases, the patient should seek urgent medical care without any further delay.

When a patient visits the doctor with the complaint of persistent hiccups, doctor may do a physical examination and ask the patient about the duration of the condition and whether the patient can associate the episode with any physical activity or consumption of any specific food. The previous medical history of the patient is also important to arrive at a possible diagnosis. Doctors may need to know the following:

  • Difficulty in swallowing
  • Presence of GERD or gastro esophageal reflux disease
  • Recent surgeries undergone
  • Fever or cough indicative of pneumonia
  • Symptoms indicative of malfunctioning of the brain.
  • Presence of kidney related problems
  • Alcohol consumption

During the physical examination, doctor may check for symptoms of neurological abnormalities such as unsteady gait and movement, blurring of speech etc. cachexia or wasting of muscle and fat due to severe weight loss is also assessed.

Testing: To determine the cause of persistent hiccups, the doctor may need to do certain tests including chest x-rays and ECG or electrocardiogram. Blood tests to determine kidney function are also conducted. Imaging tests such as MRI scan of the brain or CT scan of the chest are also done to detect abnormalities causing persistent hiccups.

Treatment:  Brief episodes of hiccup do not usually come under the scope of medical treatment as they usually stop spontaneously without any treatment. However, various home remedies claim to stop it faster. Even though they are not proven to either decrease the severity of the hiccups, or reduce their duration; they are harmless attempts at getting quick relief. Methods like holding the breath for a longer period, or breathing several times into a paper bag and then inhaling from the bag, are attempts at increasing the carbon dioxide levels in the blood.

The vagus nerve is found to be responsible for certain abnormalities which affect the heart rhythm and it may probably affect the contraction and relaxation of the muscles of the diaphragm too, causing it to contract spasmodically. Stimulating the vagus nerve by various maneuvers may be tried to get relief from hiccups. Some of them are:

  • Gulping down water; usually ice cold water is used
  • Extending the tongue and pulling on it
  • Rubbing the eyeballs gently with fingers
  • Swallowing crushed ice or  pieces of dry bread
  • Attempting to startle the person with a sudden exclamation or a loud sound
  • A spoonful of sugar in the mouth for eating quickly

The above actions may help stimulate the vagus nerve and may bring relief.

The main focus of treating persistent hiccups is the treatment and cure of the underlying disease responsible for the occurrence of hiccups. Pneumonia is treated with appropriate antibiotics. GERD is treated with proton pump inhibitors. When these diseases subside, hiccups also disappear.

 When persistent hiccups have a cause which could not be detected or treated, measures to manage the condition is the next option. Most of the remedies which seem to work for stopping brief hiccups may have been tried already without any success. Drug therapy using several drugs such as baclofen, gabapentin, metoclopramide, chlorpromazine etc., is usually tried, but they are not always successful.

The phrenic nerves have the role of controlling the movements of the diaphragm; hence, blocking a phrenic nerve with the injection of a local anesthetic is done and the effect is observed. If blocking any one of the nerves had the effect of stopping the hiccups temporarily, and then if hiccups started again when the effect of the anesthetic wore off, phrenictomy is done thereby permanently blocking off the malfunctioning nerve.

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

Gastrointestinal Bleeding ( GI Bleeding)

Gastrointestinal bleeding includes bleeding from any part of the digestive system between the mouth and the anus, usually as a result of gastritis, ulcers, infections, cancer, anal fissures, hemorrhoids, diverticulitis or some other disorder of the digestive system.

People usually become aware of the bleeding when it is seen in the vomit or in stool. Very small amounts of bleeding may not be visible to naked eye and it is called occult bleeding. It is often detected by stool testing in the laboratory.

Bringing up blood along with vomit is called hematemesis and it is an indication of bleeding in the upper part of the digestive tract. The color of the blood in the vomit is often an indicator of the time and amount of bleeding. Recent bleeding which is continuing still, imparts a bright red tint to the vomit, whereas a brown color precipitate found in vomit indicates a much older episode of bleeding. The discoloration to the blood may have occurred due to the action of digestive acids.

Blood in the stool may be either bright red as in hematochezia or it may have resulted in melena, which is the name given to black, tar-like stools. Usually, hematochezia indicates a recent bleeding in lower part of the digestive tract, but it can also occur due to heavy and rapid bleeding taking place in the upper GI. Melena is generally indicative of bleeding that may have occurred in the upper part of the gastrointestinal tract. The black color of the stool is due to the discoloration of blood, by the action of acids and micro organisms present, as the stomach contents travels through the stomach and the intestines.

If the blood loss is small and limited, people may not have any other symptoms. But significant blood loss may precipitate many symptoms such as low blood pressure, increase in pulse rate, and reduction in urine production. People may feel disoriented, confused or drowsy due to reduced flow of blood to the brain. Their hands and feet, as well as the skin, may feel cold and clammy to touch. People who have ischemia of the heart muscles may develop chest pain or angina due to impaired blood supply to the heart. When there is rapid blood loss, the blood pressure may drop to dangerously low levels, which can lead to shock. Chronic bleeding from the gastrointestinal tract may result in anemia which shows symptoms such as fatigue and dizziness.


Gastrointestinal bleeding is differentiated into three types, according to the location of its origin. The disorders which may be causing the gastrointestinal bleeding also vary depending on the area of origin.

Upper GI bleeding originates from esophagus and stomach and its usual causes include tears in the esophageal lining due to forceful retching and vomiting, termed Mallory-Weiss syndrome. The bleeding may be seen as traces of blood in the vomit or as coal black stool called melena. Ulcers, varicose veins, and cancer of the esophagus are some other causes. Gastritis, dyspepsia, erosions and ulcers on the walls of stomach and the first part of the small intestine (duodenum) also result in upper GI bleeding.

Lower GI bleeding starts in the large intestine or rectum and it may be seen in the stool as traces of bright red blood or as blackened stool. The usual causes of lower GI bleeding are:

  • inflammatory bowel disease affecting the large intestine
  • bleeding from diverticula in the large intestine
  • polyps in the large intestine
  • ischemic colitis
  • cancer of the colon
  • hemorrhoids in the rectum and anus
  • anorectal fissures
  • inflammation of the bowels due to radiation

Bleeding from small intestine is considered a category on its own, though it is rarer than the other two types. A congenital abnormality known as Meckel’s diverticulum is a common cause of bleeding from the small intestine. Tumors, and abnormalities of the blood vessels in the small intestine, also may result in bleeding.

Certain disorders and conditions make some people more prone to gastrointestinal bleeding. They may also enhance the severity of bleeding. Some such conditions are:

  • Chronic hepatitis
  • Alcohol abuse
  • Hereditary blood clotting disorders
  • Anticoagulant and antiplatelet drugs

Warfarin and heparin, which are anticoagulant drugs used for dissolving clots blood vessels, have an adverse effect on intestinal bleeding. Aspirin and other antiplatelet drugs also cause intestinal bleeding. Some NSAIDs or nonsteroidal anti inflammatory drugs negatively affect the lining of the stomach, exposing it to the action of strong stomach acids which may cause erosion and bleeding.


Gastro intestinal bleeding may be due to a serious condition involving heavy blood loss and other complications or it may be the result of comparatively less significant reasons such as an anal fissure or hemorrhoid. Evaluation by a doctor is necessary to determine the extent and seriousness of the condition.

Warning signs: when gastrointestinal bleeding is accompanied by the warning signs given below, it may need immediate medical attention.

  • Severe, continuous bleeding with more than a cupful of blood loss
  • low blood pressure and fainting
  • Increase in heart rate, to more than 100 beats/ minute
  • Excessive sweating

Those who have the above symptoms should see a doctor without delay as severe complications can develop. Hematemesis, which is blood in the vomit, hematochezia, characterized by bright red blood in the stool or melena, which is black, tarry stools, are all symptoms to be taken seriously.

When a person approaches a doctor with the complaint of bleeding from either the mouth or the anus, the doctor may do a physical examination. The abdominal area, as well as the rectum and anus, are checked, to look for abdominal distension and masses and the presence of internal or external hemorrhoids, anorectal fissures, etc.

The general condition of the patient is also checked for any possible complications. Blood pressure, pulse rate as well as the rate of breathing are all checked. High rate of breathing, fast heart rate, paleness, confusion, cold and clammy skin, reduced urine output etc. are all indicative of hypovolemia or lowered volume of circulating blood. It can lead to very low blood pressure and eventually shock.

The patient’s body may be checked for the presence of purple red spots called petechiae or patches of bruised skin or ecchymoses which indicate bleeding problems. Spider angiomas indicating chronic liver disease; enlargement of spleen and veins on the abdominal wall indicative of portal hypertension, are also checked out.

Details about the nature and quantity of the bleeding and other symptoms such as pain and abdominal discomfort or bloating may help the doctor with the diagnosis. Previous medical history of the patient is also important. If the patient complains of blood in the vomit (hematemesis), doctor may need to know whether traces of blood were present with the first mouthful of vomit or whether it was seen only after several bouts of vomiting. If the blood was present in stool, doctor may need to know whether it was bloody diarrhea or hard stool either mixed with blood or coated in blood. Doctor may be able to assess whether the bleeding has been recent or not, from the color of the blood in the vomit or stool. Details of drugs taken, travels recently undertaken, recent weight loss or signs of anemia, presence of liver disease and habits like alcohol consumption are also taken into account before the doctor decides on further testing to detect the exact problem.

Testing: Unless the doctor can identify the exact cause of bleeding, further testing may be necessary to detect the exact reason and the location of bleeding. For example; bleeding hemorrhoids or anorectal fissures are easily detectable; blood in the vomit after several bouts of vomiting, normally indicates an esophageal tear.

Blood tests are conducted to determine platelet count, prothrombin time and partial thromboplastin time, the abnormal readings of which may indicate bleeding and clotting disorders. Low hemoglobin count may indicate chronic bleeding. Stools are also tested for evidence of infections and worm infestations like hook worms, which may cause intestinal bleeding.

The following tests in addition to lab tests of blood and stool may be conducted to determine gastrointestinal bleeding.

For upper GI bleeding, upper endoscopy is done to detect abnormalities in the esophagus, stomach and duodenum. It can detect esophageal cancers and gastric ulcers which may be responsible for the bleeding. Esophageal tears also can be detected.

A nasogastric tube may be inserted through the nose into the stomach to suction out stomach contents which may show the nature of bleeding. Recent and active bleeding may be shown by bright red color of the contents, while dark brown material resembling coffee grounds indicate bleeding which has spontaneously stopped. The tube can remain inside, till active bleeding stops and the contents in the tube become clear. When nasogastric testing indicates upper GI bleeding, an upper endoscopy is done to determine the exact reason and location of the bleeding.

Upper endoscopy involves the insertion of the endoscope into the esophagus, the stomach and the first portion of the small intestine called duodenum, via the mouth. It is a viewing scope which allows doctors to examine the interiors of upper part of the digestive tract for abnormalities which may be causing the bleeding. It can also help stop the bleeding by cauterizing bleeding ulcers.

For lower GI bleeding, a similar endoscope called sigmoidoscope is inserted via the anus to view the interiors of the anal canal, rectum and the lower part of the large intestine to detect diverticula or hemorrhoids which may be causing the bleeding. Colonoscopy also may be done to view the whole of the large intestine, for the presence of colon cancer.

Enteroscopy is an endoscopic testing of the small intestine. It is usually conducted when both upper GI bleeding and Lower GI bleeding are ruled out through respective endoscopic examinations.

In case of severe, uncontrollable bleeding, angiography may be performed; during which a radioopaque dye is injected into the artery in the affected region and x-rays are taken. In addition to detecting upper GI bleeding, this procedure enables stopping of the bleeding by specific treatments like embolization and injection of a vasoconstrictor to stop the blood supply to the bleeding site. Radionuclide scanning also may be done, in which a special camera picks up red blood cells infused with radioactive markers, to locate the site of bleeding.

In a diagnostic procedure called capsule endoscopy, a capsule containing a miniature camera is swallowed, which captures the internal images while passing down the digestive tract. it is especially useful for the viewing of the small intestines.


Stopping the bleeding is the immediate focus of treatment. On many occasions, the bleeding may stop on its own. When the bleeding continues, several treatments are possible to stem it. For upper GI bleeding, electrocautery using an endoscopic device may be used to stop bleeding from peptic ulcers. Injection sclerotherapy and laser therapy are some other endoscopic measures to stop bleeding; but if they are not effective, surgery may be necessary. When injection sclerotherapy is not effective, bleeding from varicose veins in the esophagus and stomach are treated with endoscopic banding, or TIPS shunting, to reduce portal vein hypertension which may be causing the varices.

Lower GI bleeding resulting from angiomas or diverticula can be stopped with electrocauterization, or by coagulation using a heater probe, while conducting a colonoscopy. A wire snare is often used to remove polyps. Sometimes, epinephrine injection is also used to stop bleeding. Severe bleeding which cannot be controlled by the above measures may require stopping of blood supply to the bleeding site by blocking or constricting the blood vessel supplying the area. Embolization in the supply vessel may be achieved by introducing a wire coil, or pieces of gelatin sponge, by angiography. Vasopressin is used to constrict the blood vessel to reduce blood flow to the site of bleeding. Surgical intervention may be necessary if the above mentioned minimally invasive procedures are not effective in stopping the bleeding. Transfusion of platelets or fresh plasma and vitamin K injections may be necessary to stem the bleeding in people who have problems with blood clotting.

Bleeding from hemorrhoids usually does not require emergency measures. If it does not stop, doctor may use rubber bands to cut off blood supply to the hemorrhoids.

Replacement of the fluid lost through bleeding by appropriate means of rehydration is concurrently initiated to avoid complications. If blood loss has been severe, or if it is associated with vomiting or diarrhea, and the patient has developed low blood pressure due to the decreased blood volume, fluids are given intravenously. Occasionally, blood transfusion may be necessary.

Preventing further bleeding is the next step, which usually involves the treatment of underlying disorders. If bleeding is found to be caused by the use of drugs, they are either stopped or replaced by suitable alternatives. Gastritis and peptic ulcers are treated; polyps, diverticula and tumors are surgically removed, if necessary. Hemorrhoids which may cause bleeding in future are destroyed using electrocautery, cryosurgery or rubber band treatment.

Essentials for Older People

Older people may have reduced tolerance to gastrointestinal bleeding; they must get immediate medical attention at the very first sign of bleeding. The usual causes of GI bleeding in older people are diverticulitis, peptic ulcers, abnormal blood vessels and hemorrhoids. Bleeding in older people with no such previous history, may point to cancer of the colon or rectum. Investigative tests are done as soon as possible to determine the cause of bleeding so that appropriate treatment can be initiated without delay and before complications develop.

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

Abdominal Distension or Gas in the Stomach (bloating)

Air swallowed with food or gases produced during the digestive process may cause abdominal distension or gas in the stomach. When this gas is brought out through the mouth, it is called belching. When it passes out via anus, it is known as flatus or more commonly, fart.

The main symptoms of gas are:

  • Distension of the abdomen
  • Eructation or belching
  • flatus or farting

Small amounts of air get swallowed with every mouthful of food, especially if a person is eating in a hurry. This causes distension of the stomach. When the stomach gets filled up with food, the air accumulated in there is usually brought up through the mouth. This is the usual reason for belching soon after a meal.

Some people may belch following a stressful situation. Hyperventilation during stress causes some air to be swallowed and this air gets expelled as belching. Tightness in the abdomen or chest, or discomfort, due to the accumulation of gas, is often relieved by belching.

Newborn babies and infants ingest large amounts of gas when they feed on milk, whether it is bottle feeding or breast feeding. Soon after feeding, they have to be winded by holding them in a position which makes it easy for the air to be expelled. Colic, which is very common in infants, is no longer considered to be due to gas accumulation in the stomach, as tests have not shown the presence of excess amounts of gas during episodes of colic. However, no alternative explanation is given for colic, either.

The gas expelled by flatus or farting is usually produced in the intestines during the digestive process. Almost all people have flatus, but the frequency as well as the amount of gas expelled during each flatus may vary from person to person. Typically, fifteen to twenty farts a day is normal. The gas expelled through the anus may be malodorous or not, depending on the composition of the gas.

The flatus usually contains hydrogen gas and methane, both of which are flammable but flatus is not known to pose any additional risk to fire safety even while working near or handling flames. But there were occasional reports of explosions caused, when electrical cauterization was done during colonoscopy, when the intestines have not been emptied properly prior to the procedure. The foul smell associated with flatus is due to the presence of methane gas and it is worsened when sulfur compounds are also present. Hydrogen and carbon dioxide are the odorless constituents of the flatus. The substances present in the food and the types of bacteria acting on them are responsible for the chemical composition of the flatus.


The causes of the different symptoms of gas are also different.

Belching is usually caused by external reasons such as:

  • Air swallowed along with food or while chewing gum
  • Carbonated drinks releasing the gas inside the stomach
  • Aerophagia or ingestion of large amounts of air

Air gets swallowed in small quantities whenever food or drink is swallowed. It accumulates in the stomach till it gets completely or almost completely filled with food. The air, being lighter, stays at the upper part of the stomach causing distension which is usually felt as a discomfort in the chest or upper part of the abdomen. When the air is expelled through the mouth by belching, it relieves the discomfort.

On reaching the stomach, the carbonated drinks release the carbon dioxide gas they contain, and it comes out forcefully through the mouth soon afterwards. Some people like this sensation, and others, who do not, can avoid taking carbonated beverages.

Swallowing large amounts of air is termed aerophagia and some people unconsciously do this especially in stressful situations. Hyperventilation or increased rate of breathing during stress is very common and some of the air inhaled gets swallowed and reaches the stomach. During smoking too, a lot of air is ingested when long draughts are taken. Excess salivation associated with nausea, gastropharyngeal reflux, wearing dentures especially if they are ill-fitting, or usage of certain drugs, also result in aerophagia due to the frequent swallowing of spit.

Some people develop a peculiar habit of taking in a bit of air only to bring it out as a belch in a futile attempt to bring up gas from their stomach, to get relief from an abdominal or chest discomfort. But since the ingested air only goes down into the esophagus before coming up again, it doesn’t help in relieving the discomfort.

Almost all of the air swallowed is expelled through belching, but a small quantity may reach the small intestine mixed with the food, and it gets absorbed into the blood and later passes out along with exhaled air. Swallowed air is not responsible for flatus.

Flatus is the result of internal processes associated with the digestion of food. The digestive system, especially the large intestine is host to a large number of microorganisms which help in the breakdown of many complex molecules in the food. Various gases such as carbon dioxide, methane and hydrogen are produced during this process and these byproducts are mopped up by some other bacteria. Some kind of balance often exists between these two processes. But sometimes more gas is formed, which upsets the delicate equilibrium, due to certain disorders or temporary situations such as:

  • Consumption of food items which are not easily digestible
  • Motility disorders which affect the muscles of the digestive tract
  • Change in the quantity and composition of intestinal flora
  • malabsortion or the inability of the intestines to absorb certain substances

Certain complex carbohydrates rich in dietary fiber such as those found in cabbage and beans are not easily digestible. While fiber adds bulk to the food and helps in relieving constipation; they also cause excess production of gas. Excess amounts of fat in the food, sugar alcohols like sorbitol used in special foods for dieters, as well as fructose sugar, cause gas formation. Flatulence is very common in people who consume plenty of fruits and vegetables.

Some people lack an enzyme called lactase which is essential for the breakdown of lactose sugar present in milk and other dairy products. When such people consume lactose rich foods, they cannot be digested and excess gas is produced. People with gluten sensitive enteropathy, celiac disease or wheat allergy also develop bloating when foods containing gluten are consumed. Consumption of substances a person is specifically allergic to, also results in bloating. Tropical sprue and pancreatic insufficiency are some of the malabsorption disorders which result in flatus.

The gas formation and resultant flatulence in some people may be due to motility disorder of the intestines. If the food passes through the stomach and intestines too fast, digestion of food and absorption of nutrients may not be complete. Undigested food in the large intestine leads to formation of gas.

Several types of bacteria inhabit the intestines, majority of them in the large intestine, and they operate in complex ways to further break down the undigested or partially digested substances. Different gases are produced during these processes and most of these gases are absorbed by other bacteria present. The action and composition of this intestinal flora keep changing, for example; during illnesses and antibiotic treatments. The type and amount of intestinal flora present in a person’s gut also may be responsible for variations in flatus.

Bloating is the condition characterized by the swelling or distension of abdomen, often accompanied by some amount of discomfort and less often pain. Bloating can result from gastroparesis due to abnormalities of the muscles and nerves of the intestines leading to incomplete emptying of the bowels, or from obstructive conditions like fecal impaction. People with cancer of the colon or ovary also may have distention of abdomen. A feeling of bloating and the need to belch may be felt by some people when they have a heart attack.

Bloating may result from excess gas accumulation in the stomach due to swallowing of excess air or from the consumption of aerated drinks. But a bloated feeling may be present even in the absence of gas accumulation. It is found that even small amounts of gas, usually considered normal, may give a feeling of bloating to some people, especially those with irritable bowel syndrome. People who have certain disorders such as bulimia or anorexia may have a faulty perception of bloating which may add to their stress. Hence, bloating may be real or perceived; and it may be due to gas or some other reason or maybe even unrelated to the digestive system; but due to its normal association with gas and acidity, over the counter antacids are liberally used when people have the feeling of bloating.


Symptoms such as bloating, belching and flatulence related to gas are very common, and often temporary, and may not require medical intervention. But when certain other symptoms appear along with symptoms of gas, it may be a cause for concern. The following warning signs may help people evaluate their condition and decide how urgently they need to seek medical attention.

Warning signs: When the following symptoms are present concurrently with the symptoms of gas, it may be an indication of some other underlying disorder.

  • Pain in the chest
  • Traces of blood present in stool
  • Recent loss of weight without any apparent reason

When to see a doctor:  When chest pain is present along with a sensation of bloating, it may indicate heart disease, and the patient should get immediate medical help, as it may be the only sign of a heart attack in some people. Those who have weight loss, or diarrhea with blood in the stool, also need to visit a doctor without delay. If the bloating causes too much discomfort, and frequent belching and flatus is disconcerting, people may consult a doctor.

When people approach a doctor with gas-related complaints, a physical examination is done to check distention of the abdomen and other signs which may indicate the presence of some stomach disorder. The medical history of the patient and detailed description of the symptoms, including the frequency, and any obvious association with foods taken, may help the doctor with diagnosis.

When the main complaint is frequent belching, doctor may look for reasons in the pattern of chewing and swallowing of food, which may cause excessive swallowing of air. Other habits such as gum chewing, smoking, frequent consumption of carbonated beverages are also taken note of. Doctor may check for possible reasons for hyper salivation.

If the patient has a complaint of frequent passing of gas, especially malodorous flatulence, doctor may ask details of dietary habits to find out the reason for the gas formation as well as to detect any possible food allergies. The color, texture and smell of feces are important details necessary for diagnosis of underlying disorders which may be causing the gas. Doctor may prescribe further testing, if malabsorption syndromes are suspected.

Recent changes in the diet such as inclusion of extra fiber, dairy or gluten rich foods (made of wheat, barley and rye), and any change in medications, including antibiotic therapy and regular intake of NSAIDs such as aspirin are taken into account. If warning signs such as weight loss and bloody diarrhea are present, rectal examination and pelvic examination for women may be conducted to detect the presence of obstructions or cancerous tumors

Testing: Tests may be necessary to determine the exact cause when doctor suspects disorders such as malabsorption, when the stool is loose or smelly or when fat globules are present. Blood tests for specific markers, indicative of lactase insufficiency and gluten intolerance, are done to detect such conditions. When recently developed symptoms of gas, especially distension of abdomen are present in older people, image testing and or colonoscopy is done to detect cancers of the colon or ovary.


When belching, bloating and flatulence are not associated with any other serious disorders, treatment is unnecessary and often ineffective. Doctors may help the patients understand that it is not abnormal or harmful to have belching after meals or flatulence fifteen to twenty times a day except for the risk to social acceptance.

If people could control the amount of air swallowed by altering their eating patterns, it may help reduce belching. But usually, the swallowing of air is an unconscious habit and people hardly notice it, and even when made aware, find it difficult to change. Avoiding hurried eating and slow chewing may reduce the amount of air swallowed. Gum chewing and consumption of aerated drinks as well as smoking are modifiable habits which may help in reducing belching. Developing a habit of breathing from the diaphragm has been found to be effective in reducing the swallowing of air.

If excessive flatulence is found to be associated with any specific food item, avoiding the same will help reduce the frequency. The offending food item can be identified by an elimination process starting from the usual known culprits such as cabbage, beans, fresh fruits, raw vegetables etc. some people find the inclusion of fiber rich bran or psyllium husk beneficial, while others find it worsening their symptoms.

Drug treatment: Anticholinergic drugs like simethicone or bethanechol may be prescribed, but their effectiveness is not proven. Malodorous flatulence can be modified by the use of tablets of activated charcoal, though it has the side effect of staining the mouth. Underwear lined with activated charcoal may help control the foul smell associated with some farts.

Use of probiotics, which contain beneficial bacteria and create an environment conducive to the proliferation of useful bacteria, may help reduce symptoms of gas such as bloating and flatulence. People who have disorders of the upper abdominal area such as dyspepsia or gastroesophageal reflux may get relief from bloating with the use of antacids. Those with frequent anxiety attacks may find the prescription of mild antidepressants helpful.

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

Difficulty In Swallowing (Dysphagia)

Difficulty in swallowing food or drink is termed dysphagia. People with dysphagia get the feeling that food is getting stuck somewhere between the throat and the stomach. It is different from the feeling of having a lump in the throat which is called globus sensation.

The digestive tract is a continuous tube from the mouth to the anus. The food taken in through the mouth gets swallowed at the pharynx or the throat. From the throat it travels down the esophagus to reach the stomach where the main digestion of food takes place. It is in the esophagus that the food seems to be getting stuck, when people have dysphagia.

Complications: Pneumonia is a serious complication which may develop in people with dysphagia resulting from aspiration of food, drink or saliva into the respiratory canal. When aspiration is a frequent occurrence, it may result in a chronic form of lung disease. Weight loss and malnourishment are very common in people with dysphagia.


Swallowing is a process involving the synchronized activity of several muscles and nerves in the mouth, throat and esophagus. It is the brain which controls the sequential contractions and relaxations of these muscles, effectively forcing the food down, starting from the mouth. Muscles and nerves have to work in tandem to bring about the contractions as well as the relaxation which should follow it. Dysphagia can be caused by any of the following reasons.

  • Neurological disorders
  • Muscular dysfunction
  • Disorders causing disruption in the esophageal movement
  • Blockage in the esophagus

People who have disorders affecting the brain or the nervous system usually have difficulty in swallowing food and drink. Amyotrophic lateral sclerosis or ALS in short, and multiple sclerosis, are two of the abnormal conditions affecting the nervous system which cause dysphagia in addition to various other difficulties. Those who have Parkinson’s disease or those who have suffered damage to the brain due to stroke, also have varying degrees of difficulty in swallowing food.

Muscle weakness due to inherited conditions like muscular dystrophy, autoimmune diseases like myasthenia gravis, or a connective tissue disease called dermatomyositis which affect the skin and the muscles, may cause dysphagia.

Any abnormal growth in the esophagus, including esophageal cancer, can cause difficulty in swallowing due to physical obstruction to the movement of food. Esophageal scarring caused by chronic gastro esophageal reflux disease (GERD) or by the ingestion of corrosive substances like acid may precipitate dysphagia. Compression on the esophagus by a large bulge or aneurysm of the aorta arising from the heart, tumors in the chest or by the abnormal enlargement of the thyroid gland also may offer obstruction to the smooth movement of food.

Achalasia is an abnormal condition in which the normal peristaltic movements of the esophagus become irregular or slow down considerably and the lower esophageal sphincter does not relax to allow the passage of food into the stomach. Dysphagia may be caused by this disorder of the esophagus, or by a similar motility disorder caused by systemic sclerosis.

Often dysphagia causes only minor discomfort, especially when it is caused by a chronic condition such as GERD or acid reflux disease. But some cases of dysphagia require immediate medical attention, particularly when there are other symptoms present. Some such warning signs are given below.

Warning signs: When people have the following symptoms accompanied by difficulty of swallowing, they should seek urgent medical care.

  • Absolute inability to swallow. Drooling may be present as even saliva cannot be swallowed.
  • Odynophagia or pain at the time of swallowing.
  • Swallowing difficulty due to a newly developed nerve weakness.
  • Coughing or choking on food and drink.
  • Severe weight loss due to insufficient intake of food

When to see a doctor: The presence of any of the above warning signs, except weight loss, indicates an urgent need for medical intervention. Those who have no warning signs along with dysphagia, and those with only the symptom of weight loss, need to consult a doctor within a few days.

When a person visits a doctor with dysphagia, a thorough medical examination is conducted to detect the possible reasons for the condition. A detailed description of the symptoms, as well as the previous medical history of the patient, is also necessary to assess the condition and to determine what further investigations are required.

The doctor may want to know minute details about the way the patient eats and drinks; whether there is drooling or uncontrollable spilling of food, or whether coughing and choking while eating, or frequent incidents of food spilling from the nose, are present. Doctor may also ask if the person is having difficulty in swallowing either food or drink or both. Motility disorder of the esophagus is the usual cause if the patient has difficulty with both solids and liquids.

If the dysphagia had started with solids and have gradually worsened into difficulty with liquids also, it may be due to a growing tumor in the esophagus.

If there is drooling or spilling of food from the mouth while eating, or food particles coming out through the nose, the dysphagia may be due to a muscular or neurologic disorder.

The physical examination involves the not only the examination of mouth, throat, neck and such other parts directly involved in swallowing, but the general physical condition of the patient also, with special focus on the muscular and neurologic functions.

  • Strength of facial muscles including that of mouth and eyes
  • Presence of tremors during activity or at rest
  • gait and balance while walking
  • The capacity to perform actions like counting or blinking eyes which are repetitive in nature
  • Bulging of the neck due to enlargement of thyroid gland or tumors
  • Wasting away of muscles, fasciculation or twitching of muscles under the skin
  • Changes in the texture of skin, thickening of finger tips, presence of rash etc.

Testing: Doctors may want to do some investigative tests to determine the exact cause of dysphagia.

If there is almost total or absolute blockage, an emergency endoscopic evaluation, with a flexible viewing tube or endoscope inserted into the esophagus, is done to detect the cause of the blockage.

If the blockage is partial, usually a radio opaque imaging test is done first. The test involves the ingestion of radio -opaque barium liquid followed by x-ray imaging. The patient may also be given barium liquid mixed with food particles for swallowing. If there is any evidence of a physical blockage in the esophagus, endoscopic examination may follow to ascertain the nature of block; it may be scarring, presence of cross webs or rings in the esophagus or esophageal cancer or other benign growths.

When no physical blockage is detected in the barium swallow test, the possibility of esophageal motility disorder is investigated. The patient is given a narrow tube embedded with several tiny pressure sensors and while it is being swallowed, the contractions and relaxations of the esophagus are detected. From the data provided by the pressure sensors, it is possible to determine motility disorders of the esophagus and the inability of the lower esophagus to relax to help the food move into the stomach.


The treatment of dysphagia is effective when the cause of the condition can be treated. Eating very small manageable amount of food with each bite and chewing it thoroughly may help relieve the symptoms when the cause cannot be cured, as in the case of Parkinson’s disease. Certain measures prescribed by rehabilitation specialists such as tongue exercises, re-training of the muscles involved in swallowing, altering the position of head while eating etc. may help people who have had a stroke, to achieve better control and ease of swallowing.

A feeding tube which is fixed on the abdomen and opening into either the stomach or into the small intestine may be necessary for people who have a high chance of aspiration of food or choking while eating through the mouth.

Essentials for Older People

With aging, the general motor function declines due to the degeneration of muscles and slower neurotransmission in the nerves. This affects the muscles and nerves of the face, neck and mouth too. The various components of the process of eating food, such as chewing, turning the food around in the mouth with the tongue for effective mixing with saliva and swallowing down the throat, require the precise coordination of muscles and nerves in the tongue, mouth, throat, jaws and neck. As people age, the strength of muscles decrease and coordinated movements slow down. It may cause their swallowing of larger particles of food, increasing the chances of choking on the food. The dentures more frequently used by older people also contribute to their difficulty in manipulating the food in the mouth.

Muscular and neurologic disorders are most often caused by other age-related disorders such as Parkinson’s disease, stroke or diabetes. Certain drugs used in the treatment of many other disorders such as diuretics or anticholinergics adversely affect the production of saliva. Chemotherapy as well as radiotherapy employed in the treatment of cancer, which also results in the reduced secretion of saliva, can precipitate or worsen dysphagia. Hyposalivation greatly impairs the capacity to swallow, as saliva has the important function of wetting the food and lubricating the throat for smooth movement of food.

The treatment and management of dysphagia in older people may involve specialists from several medical fields such as gastroenterology, rehabilitative medicine, prosthetic dentistry etc., in addition to the general physicians treating them.

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS

What Is Fecal Incontinence

Fecal incontinence is the involuntary passage of feces, gas or mucus from the anus, resulting from loss of bowel control.


Fecal incontinence may be very common when a person is having severe diarrhea or when there is leakage of liquid stool or mucus from around a fecal impaction in the rectum (paradoxic diarrhea). But they are temporary conditions which get resolved quickly as soon as the cause is removed. Injuries to the spinal cord resulting in abnormal functioning of the nerves controlling the anus, prolapse of the rectum into the anus and diabetic neuropathy are some other usual causes of fecal incontinence. Direct injury inflicted to the anus, or general injury to the pelvic area at the time of childbirth, and tumors present in the anus, also cause fecal incontinence.

Diagnosis and Treatment

If you are incontinent, Physical examination of the anus and the rectum is done to detect any structural abnormality present. The anus and the surrounding area may be checked for sensations to detect any neurologic abnormality that may be present. A sigmoidoscopy is usually done to detect any abnormality inside the rectum and the anal passage. Imaging tests such as ultrasound scan or MRI scan are also done. Tests to assess the muscular and neurologic function of the pelvic area also may be necessary.

Establishing regularity in bowel movements and bulking up of the stool with extra fiber in the diet are measures which usually help in controlling fecal incontinence. If the problem persists, the drug loperamide, which has the property of slowing down the movements of the digestive track, may help. Strengthening the muscles of the anal sphincters by alternate contraction and relaxation exercise often helps in achieving bowel control. A majority of people with fecal incontinence are benefitted by biofeedback; a technique to sensitize the rectum and to re-train the anal sphincters. Structural defects in the anus can be surgically corrected to achieve continence. Tumors in the anus or the rectum can also be removed by surgery.

If none of the above measures bear fruit, a surgical procedure called colostomy may have to be done. It involves the stitching up of the anal opening to stop the passage of feces via the anus, while providing another outlet from the large intestine to wall of the abdomen. The plastic tube attached to the outlet drains into a plastic bag which can be emptied manually.

Share and Enjoy

  • Facebook
  • Twitter
  • Delicious
  • LinkedIn
  • StumbleUpon
  • Add to favorites
  • Email
  • RSS
You might also likeclose