When You Get Cramping And Bloating

By Dr Harold Gunatillake - Health Writer

Why some people suffer from tummy cramps and bloating accompanied with loose motions or constipation frequently?

Most people seems to ignore these chronic gastric upsets, or when they feel better by taking some antacids or other over the counter medications. There are others who feel embarrassed to talk about their symptoms and put off resolving them.

Your doctor will investigate on your visit if you have any chronic recurrent gastro-intestinal upset and he will take immediate measures to find out the cause. There are two conditions to evaluate; they are coeliac disease and Irritable bowel Syndrome (IBS).

Your doctor will do a physical examination and request for barium meal studies, endoscopies (gastroscopy and colonoscopy), stool examination and blood studies for screening. He will ask you to keep eating food containing gluten, such as food cooked with wheat, barley and Rye, etc. A bowel biopsy may be done to confirm diagnosis. Today, Gene testing for "HLA genes" is a new test to check on any genetic connection of the disease.

Coeliac disease is serious with lifelong implications. Therefore a definitive diagnosis to confirm the disease is necessary. Gluten free diet with change of lifestyles and learning new skills such as reading and interpreting food labels at the supermarket may be required. If the disease is ignored it can lead to osteoporosis, cancer, infertility and even certain autoimmune diseases such as diabetes.

Gluten is protein composite found in wheat and related grains, including barley and rye. Gluten gives elasticity to dough, helping it rise and keeps its shape and often gives the final product a chewy texture. It is used in cosmetics, hair products, and other dermatological preparations. If investigations reveal that you do not suffer from coeliac disease, you doctor may perform more tests.

HLA Gene test is done when the diagnosis of coeliac disease is unclear. Over 99% of people affected by coeliac disease have the HLA DQ2, HLA DQ8, or parts of these genes. Therefore, a negative test for these genes effectively rules out coeliac disease. The gene test on its own cannot diagnose coeliac disease – only 1 in 30 people who have HLA DQ2 or HLA DQ8 will develop coeliac disease. A gluten free diet should only be started after confirmation of coeliac disease by small bowel biopsy.

Irritable Bowel Syndrome (IBS)
IBS affects the large bowel and causes irritability and discomfort. The exact cause is not known, but considered as a way the gut contracts (hyper-motility) when digesting food. These IBS contractions may be stronger and moves faster than they do under normal situations. In some cases the gut moves slower leading to dry and hard stools.

The disease is life-long and cannot be cured but can be controlled with selective diet (see below), medications and supplements, including lifestyle changes. The large bowel becomes rigid and spastic and it may be seen on barium enema X ray studies. It is also referred to as a spastic colon. The common symptoms are bloating, abdominal pain, discomfort, and alterations in bowel habits. Diarrhoea and constipation may alternate in this disease. The diagnosis is made clinically after ruling out other inflammatory diseases like ulcerative colitis, Crohn's disease, coeliac disease, fructose intolerance among others. The symptoms in IBS and coeliac disease are similar though caused by different issues.

Treatment guidelines
For patients with IBS-C (constipation), the American Gastroenterological Association (AGA) guideline recommends linaclotide (Linaclotide is a peptide agonist of the guanylate cyclase 2C enzyme that is undergoing clinical trials for use in treating abdominal pain in patients with irritable bowel syndrome accompanied by constipation), over no drug treatment, and it grades it as a strong recommendation supported by high-trials for use The AGA suggest using lubiprostone (Lubiprostone (rINN, marketed under the trade name Amitiza) is a medication used in the management of chronic idiopathic constipation, predominantly irritable bowel syndrome-associated constipation in women and opioid-induced constipation.

It was initially approved by US Food and Drug Administration (FDA) in 2006 over no drug treatment in patients with IBS-C), but they class this as a conditional recommendation based on moderate-quality evidence. The AGA suggests using laxatives over no drug treatment in patients with IBS-C, but they class this as a conditional recommendation based on low-quality evidence. For patients with IBS-D (diarrhoea), the AGA guideline has no strong recommendations.

The guideline suggests using rifaximin over no drug treatment in patients with IBS-D, and it classes this as a conditional recommendation supported by moderate-quality evidence.

To improve global symptoms in patients with IBS-D, the guideline suggests using alosetron over no drug treatment and classes this as a conditional recommendation supported by moderate-quality evidence. The guideline also suggests using loperamide over no drug treatment in patients with IBS-D, but it classes this as a conditional recommendation supported by very low-quality evidence. Antidepressants and antispasmodics for IBS The AGA guideline suggests using tricyclic antidepressants over no drug treatment in patients with IBS and classes this recommendation as conditional, supported by low-quality evidence.
The guideline recommends against using selective serotonin reuptake inhibitors for patients with IBS, and it classes this as a conditional recommendation supported by low-quality evidence. The guideline suggests using antispasmodics (over no drug treatment) in patients with IBS, and classes this as a conditional recommendation supported by low-quality evidence. (Ref: Medical News Today)

The Low-FODMAP diet
Recent team at Monash University developed a diet control gastro-intestinal upsets associate with IBS and other gastro-intestinal disorders.

They called it the low FODMAPdiet that can help as a solution to most gut conditions causing bloating and abdominal discomfort. It stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols

Fermentable means molecules are broken down or fermented by bacteria in the large bowel. Oligosaccharides mean few sugars. These molecules are made up of individual sugars joined together in chains. Disaccharides mean a double sugar molecule, such as fructose, table sugar etc. Monosaccharides is a single molecule as in glucose. Polyols are sugar alcohols that does not lead to intoxication.

All carbohydrates are not created equal when it comes to people with digestive problems. Gastroenterologists have coined the term FODMAPs to encompass specific carbohydrates found within many different foods that have a greater potential for causing gastrointestinal distress. Different foods that fit into the above classification are many and it is best to discuss your situation with a dietician.

These fermentable saccharides are poorly absorbed in the small intestine. These are insufficiently digested and poorly absorbed short chained carbs. Stagnation of such indigestible carbs tends to ferment by the gut bacteria to produce gaseous distension. These carbs when converted into sugar through gut enzymes exert an osmotic effect, increasing the fluid content and movements of the large bowel. So, it is believed that these undigested or incompletely digested carbs cause major IBS symptoms such as gas, pain and diarrhoea.

These groups of short chained carbohydrates referred to as FODMAPs are found in a wide range of foods. These low FODMAP diets need to be on trial for six to eight weeks to get results. Foods that cause symptoms need to be strictly removed and alternate foods need to be substituted under the guidance of a nutritionist.

Most high FODMAP diets are healthy though they contribute to IBS symptoms. It is ironical that healthy foods become 'unhealthy' and intolerant for those having this gastro-intestinal disorder. Majority of people can tolerate high FODMAP foods causing no food digesting disorders, but it is the smaller numbers that are intolerant consuming high FODMAPs and present with the symptoms.

Further analysing to find out what causes IBS, it is assumed that small intestinal bacterial overgrowth may be contributing to the development of functional gastric disorders (FGDs): Certain pathogenic bacteria in the gut can cause excessive fermentation of these stagnant short chained carbs, resulting in increased production of gas, and further proliferation of these specific pathogenic bacteria. In other cases the syndrome can be caused by lack of adequate enzymes that digests these carbs and may not be due to bacterial causes.

Foods to avoid
Certain fruits, such as apples, cherries, peaches and nectarines; some green vegetables, such as peas, cabbage, broccoli and Brussels sprouts; artificial sweeteners are unsuitable for those who suffer from these conditions . Foods high in lactose, such as milk, ice cream, cream cheeses, chocolate and sour cream.

If you wish to try a low-FODMAP diet, you should discuss this with a dietician. It is difficult to cut down on so many foods, and keep eating a healthy diet without specialist advice. Your GP can arrange a referral to a dietician, and they can help you eat the right things.

Inflammatory bowel disease (IBD)
There are two diseases to consider if an inflammatory cause is suspected. Ulcerative colitis and Crohn's disease are similar inflammatory diseases but there are important differences. Ulcerative colitis affects the inner lining of the large bowel and rectum causing it to become inflamed and develop many ulcers. Water seems to be less absorbed and diarrhoea seems to be an early symptom. If the lining of the colon is damaged mucus and blood appear in the stools.

Treatment for Ulcerative colitis: Treatment for ulcerative colitis depends mainly on how bad the disease is. It usually includes medicines and changes in diet. A few people have symptoms that are long-lasting and severe, in some cases requiring more medicines or surgery. You may need to treat other problems, such as anemia or infection. Treatment in children and teens may include taking nutritional supplements to restore normal growth and sexual development.

Crohn's disease affects any segment of the gut, which may include any part extending from the mouth to the anus, but most commonly it is a disease of the small bowel and the proximal part of the large gut. The inflammation affects the full thickness of the gut and usually involves the entire bowel wall, whilst only the inner lining is affected in ulcerative colitis.

Treatment: Crohn's disease is an immune system disease. It cannot be cured. Symptomatic medication is given for bloating, discomfort and stomach cramps. If infection is present a course of antibiotics are given. In severe cases cortisone preparations are tried. Surgery may be required for complications such as obstructions or abscesses, or if the disease does not respond to drugs within a reasonable time. However, surgery cannot cure Crohn's disease by any means – it involves removing the diseased part of the intestine and rejoining the healthy ends, as Crohn's disease tends to recur after surgery.

Probiotics
Probiotics are organisms such as bacteria or yeast that are believed to improve health. They are available in supplements and foods. The idea of taking live bacteria or yeast may seem strange at first. After all, we take antibiotics to fight bacteria. But our bodies naturally teem with such organisms.

There is myriads of good and bad bacteria in our gut. Probiotics help the good bacteria to get more strength and defend against the pathogenic (bad) bacteria. Most of the gut disorders occur as in the diseases mentioned in this article due to an imbalance of friendly bacteria in the intestines and to their disturbance. Probiotics seems to improve intestinal functions and maintain the integrity of the lining of the gut.

Enjoying a cup of sugar free yogurt daily may minimize disorders of the intestines. If you suffer from any chronic recurrent gastro-intestinal issues see your doctor and obtain early medical assistance. Remember, cancer of the bowel can mimic the same symptoms

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