When your gut is upset: 5 common digestive problems and how to solve them

Flatulence (from the Greek word meaning rising, bloating) is an excessive formation, accumulation of gases in the lumen of the digestive tract. A healthy person's gastrointestinal tract contains about 200 ml of gases. The gases include a mixture of hydrogen, methane, nitrogen, sulfur, and carbon monoxide.

Bloating is a common and unpleasant symptom that sometimes causes a person to suffer more than abdominal pain. Bloating is a subjective sensation of excess gas in the gastrointestinal tract; it is included in the medical concept of flatulence syndrome.

Heartburn

Symptoms

Heartburn is an unpleasant burning sensation in the chest area, sometimes accompanied by a sour taste in the mouth and belching. It’s normal to experience heartburn after a heavy holiday dinner, but if you have a constant burning sensation in the esophagus, you should consult a gastroenterologist.

Why does it occur

With heartburn, the contents of the stomach are partially thrown back into the esophagus. Persistent heartburn is gastroesophageal reflux disease (GERD). It can accompany gastritis, gastroduodenitis, peptic ulcers, dyspepsia, irritable bowel syndrome, dysbacteriosis and other pathologies.

Don't rush into diagnoses. Burning may also occur after:

• cups of coffee;
• cigarettes;
• soda;
• alcohol;
• fatty meat foods;
• dry snack;
• rough food;
• spicy dishes;
• fruit juice.

Excess weight and pregnancy can also cause heartburn.

How to solve a problem

To avoid the reflux of gastric juice into the esophagus, it is better not to lie down, jump or bend over for a couple of hours after eating. It is also important to adjust your diet to support your microbiome, not to overeat or indulge in spicy foods.

There is no need to drink soda or milk if you have heartburn. You can get rid of heartburn at home with the help of antacids - they instantly and safely “extinguish” the attack.

For persistent heartburn, a gastroenterologist may prescribe proton pump inhibitors or H2-histamine receptor blockers. They slow down the production of hydrochloric acid by stomach cells.

If heartburn constantly torments you, you need to contact a gastroenterologist and do a gastric endoscopy (EGD) - this procedure will accurately show whether the mucous membrane is inflamed.

Why does heartburn occur after eating?

The condition of heartburn is closely related to food, as the condition provokes the reverse movement of food from the stomach into the esophagus1. The walls of the stomach are protected from the irritating effects of acid in gastric juice. And the coating of the esophagus is very gentle and is not designed to withstand exposure to an aggressive environment. Therefore, a food bolus from the stomach irritates the walls and can even cause burns3.

The main causes of heartburn after eating:

• eating large amounts of food at once;
• food at night;
• sleeping or lying down after eating;
• preference for fried, hot, spicy, fatty foods;
• consumption of certain foods that provoke the production of acid in the stomach;
• excess weight;
• pregnancy;
• wearing tight belts;
• smoking;
• lifting heavy objects and bending over after eating2.

Most often, the condition develops 15-30 minutes after eating2. If a person has constant insufficiency of the sphincter between the stomach and esophagus, then the connection with food may not be traced. In such people, heartburn may occur even at night due to the horizontal position3.

Even a healthy person may periodically experience a burning sensation behind the sternum due to the reflux of stomach contents. But this does not mean that no measures need to be taken to alleviate the condition.

Bloating

Symptoms

Bloating is flatulence. With it, the stomach expands, it increases in volume, becomes hard. Sometimes you may feel the movement of gases in the intestines, seething and rumbling. When there is a lot of gas in the intestines, it is difficult and even painful to pull in the stomach.

Why does it occur

A small amount of gas in the intestines is normal. If bloating is noticeable to you and those around you, interferes with exercise and causes discomfort, then this is already excessive gas formation.

A common cause of bloating is a person eating a lot of fast food and avoiding whole foods and plant foods. The combo of a burger, fries, and soda can cause abdominal pain, fermentation, and constipation because there aren't enough enzymes and fiber to digest it all and eliminate it from the body.

7 Foods That Cause Increased Gas and Bloating

There is also the opposite cause of bloating - food intolerance. Many plant-based and dairy products contain FODMAP carbohydrates, which feed colon bacteria and lead to increased gas, especially in people with irritable bowel syndrome.

How to solve a problem

If you have severe bloating, it is better to get up and move around to help the gas leave the intestines. A sitting position will only worsen the condition - the intestines are pinched in it. During this period, it is better to choose loose clothing.

Medicines with simethicone, which “collapses” gas bubbles in the intestines, will help you feel better. Peppermint tea and other warm drinks may also reduce discomfort.

If you're eating healthy but still suffer from bloating, try identifying your trigger foods using the FODMAP diet and eliminating only those from your menu.

How to avoid developing heartburn after eating?

You can reduce the likelihood of developing heartburn immediately after eating by following these recommendations:

• Eat small meals at least 3-4 times a day. Dinner should be at least 2-3 hours before bedtime.
• Avoid foods that cause heartburn. Add porridge, permitted vegetables, lean meats and fish to your diet.
• Prepare boiled or baked food. Avoid fried foods, limit fatty foods, and don’t get carried away with spices, especially hot ones.
• During the holidays, control the amount you eat and drink. Limit alcohol and carbonated drinks.
• Limit physical activity after meals. Do not bend over, try not to lift heavy things. But lying down is also not recommended, so it’s best to take a walk in the fresh air.
• Give up bad habits: smoking and drinking alcohol. They relax the sphincter between the stomach and esophagus.
• Wear comfortable clothes and do not tighten waistbands or belts too tightly.
• Play sports and normalize your body weight2.

These measures may be enough to prevent heartburn after eating, but they are not 100% guaranteed. If an unpleasant symptom does occur, there is no need to endure it.

Constipation

Symptoms

Delay of feces for more than two days is constipation. It is usually accompanied by a feeling of incomplete emptying and heaviness in the abdomen. The feces become denser, and you have to push hard and for a long time. Constipation can be temporary or chronic.

What to do for constipation: 7 reasons and solutions

Causes

A lack of fiber and water in the diet makes stool hard and making it more difficult to go to the toilet. The situation is complicated by a sedentary lifestyle, in which peristalsis slows down.

Stress, depression, side effects of certain medications, and underlying medical conditions can also cause constipation. Other reasons include being in a rush and not wanting to use public toilets, which makes you have to hold back the urge.

How to solve a problem

Prunes, flax seeds, psyllium (psyllium husk) and prebiotics (inulin, lactulose) are considered natural laxatives. Caffeine also stimulates peristalsis.

Stool softeners: foods that prevent constipation

It is better to avoid preparations with senna extract and other folk recipes - they act harshly, irritating the intestinal receptors and causing it to “evacuate” the contents. As a result, constipation turns into diarrhea with gurgling and pain.

Preparations based on sodium picosulfate or bisacodyl work more gently, but their principle of action is the same. Options with a more gentle mechanism of action are macrogol and prucalopride. But any laxatives should be used according to your doctor's recommendations.

The best way to prevent constipation is to eat a variety of fiber (fruits, vegetables, greens, legumes and mushrooms), eat regularly and at about the same time, and drink more water.

Fiber absorbs water - stool passes through the gastrointestinal tract more easily. It is also important to move more during the day and not put off going to the toilet.

Diarrhea

Symptoms

With diarrhea, you have to go to the toilet more than three times a day, and the stool becomes liquid, unformed, often with undigested food particles. At the same time, the body loses water and electrolytes. There are acute and chronic diarrhea.

Causes

The main causes of diarrhea are food poisoning and intestinal infections. There is also traveler's diarrhea - it is caused by the ingestion of new types of E. coli.

Loose stools may be a consequence of dysbacteriosis. When pathogenic bacteria take precedence over beneficial ones, the intestinal mucosa and its ability to digest food and synthesize vitamins suffer. A lot of gases are also produced, which interfere with the normal formation of feces.

Can a Genetic Test Detect Gluten Intolerance?

Chronic diarrhea often affects people with irritable bowel syndrome, celiac disease, inflammatory bowel disease, pancreatitis, folate deficiency anemia, or lactose intolerance. Also, the cause of regular diarrhea may be a violation of the intestinal microflora.

How to solve a problem

You need to drink a lot of water and take gel sorbents - they bind and remove toxic substances from the body more effectively than activated carbon. Drugs like loperamide inhibit peristalsis, but do not solve the problem, so they can only be relied on in emergency cases. If diarrhea lasts a day or longer, you need to restore the water-salt balance with rehydration agents.

If you suspect a rotavirus infection, you cannot take antibiotics on your own - sorbents will be enough. If diarrhea does not go away after 4-5 days, you need to call a doctor. The same should be done if diarrhea is accompanied by fever, vomiting or blood in the stool.

Flatulence: norm and pathology

The human gastrointestinal tract, in addition to solid and liquid components, contains a gaseous component in quite significant volumes. Intestinal gases are distributed in a more or less dense mass of chyme and are enclosed in bubbles of various sizes coated with mucus. Increased gas content in the intestines and associated clinical disorders are included in the concept of “flatulence”. An increase in the volume of intestinal gases can lead to symptoms that cause the patient very noticeable discomfort in the form of a feeling of fullness in the abdomen, rumbling and pain. An enlarged abdomen and increased passing of gas may also be observed. Severe flatulence can disrupt a person’s normal lifestyle, significantly affect his mental state, and lead to restlessness, anxiety and even depression. In children of the first year of life, flatulence can lead to disruption of the child’s sleep and nutrition, and affect psychomotor and physical development.

Normally, the intestines of an adult contain about 200 ml of various gases. The composition of these gases is very variable: they include nitrogen (11–92%), oxygen (up to 11%), carbon dioxide (up to 50%), hydrogen (up to 10%), methane (up to 60%), hydrogen sulfide (up to thirty%). ammonia and some others.

A relatively large proportion of gases enter the intestines during swallowing, including nitrogen, oxygen and carbon dioxide. Increased gas in the intestines may be associated with increased swallowing of air (aerophagia) during meals, which is facilitated by rushed eating, talking while eating, drinking through a straw, and chewing gum. A large amount of carbon dioxide enters the gastrointestinal tract with carbonated drinks. Some carbon dioxide may be formed in the stomach as a result of the reaction of food carbonates with hydrochloric acid in the gastric contents. In children in the first months of life, swallowing increased volumes of air during feeding is often observed and is associated with insufficient maturity of the nervous system and an incompletely formed swallowing reflex (especially in premature and immature children at the time of birth), which can cause regurgitation and even excessive vomiting only what food was eaten. Perinatal disorders of the central nervous system also contribute to dyskinesia of the digestive organs, one of the manifestations of which may be aerophagia. In this regard, in order for excess air to escape from the stomach without taking its contents with it, it is recommended that infants be kept in an upright position for some time after feeding. Aerophagia, caused by dietary habits, is relatively physiological and can be fairly easily corrected. At the same time, aerophagia as a symptom of a serious disease of the nervous system and/or digestive organs may require both serious examination and long-term treatment.

Most of the gases from the stomach enter the intestines along with food.

The second important source of intestinal gases is the metabolic activity of intestinal microorganisms, most actively present in the colon. The saccharolytic microflora that predominates in the intestine under normal conditions largely utilizes carbohydrates that are not digested and not absorbed in the small intestine for their energy needs. First of all, we are talking about dietary fiber and some oligo- and disaccharides. As a result of fermentation processes, the microbe receives ATP, and its environment (i.e., intestinal contents) receives a number of metabolites, including gaseous ones.

Thus, as a result of homofermentative lactic acid fermentation, characteristic of lactobacilli and streptococci of the colon, lactic acid (up to 90%), carbon dioxide, hydrogen, and water are predominantly formed. Heterofermentative lactic acid fermentation, in which, in addition to lactic acid, other metabolites (including acetic acid) are formed, is characteristic of bifidobacteria. Alcoholic fermentation, leading to the formation of carbon dioxide and ethanol, is a side metabolic pathway in some representatives of lactobacilli and clostridia. Certain strains of Escherichia coli and clostridia obtain energy as a result of formic acid, propionic acid, butyric acid, acetone butyl or homoacetate types of fermentation. In this case, volatile fatty acids, carbon dioxide, hydrogen and water are formed during all fermentation options. Organic acids are utilized by macroorganisms, carbon dioxide is largely converted by other microorganisms into acetate, hydrogen is mainly absorbed and excreted through the lungs. Increased excretion of hydrogen with exhaled air is observed with an increase in the microbial population or with an increase in its saccharolytic activity, for example, with lactase deficiency.

Methane can form in small quantities in the intestines. Its presence in intestinal gases indicates the presence of Methanobrevibacter smithii in the intestinal microbiocenosis. Microbial metabolism of sulfur-containing compounds, primarily proteins (in particular, mucus proteins) causes the presence of hydrogen sulfide, but its high concentrations are associated with excessive activity of the proteolytic flora, often as a result of disruption of the processes of digestion and absorption in the small intestine and the entry of undigested proteins into the large intestine . Also, as a result of microbial metabolism of proteins, ammonia is formed, which easily diffuses through the intestinal wall into the blood of the portal system and is mainly retained by the liver. Normal intestinal microflora helps reduce the diffusion of ammonia into the blood by lowering the pH in the lumen of the colon, as a result of which ammonia is ionized to form ammonium ions, which are bound into salts and excreted in the feces.

Finally, some gases enter the intestinal lumen from the blood, but their volumes are relatively small.

The gas contained in the intestines is mainly evacuated through the anus, although some of it is absorbed into the blood and excreted through the lungs or utilized by the body. A healthy adult person excretes 0.2–2.5 liters of gases per ani during 5–15 passages per day [1, 2].

The main reason for the increased content of gases in the intestines is the increased metabolic activity of the intestinal microflora. Among the physiological reasons for this phenomenon, it should be noted the consumption of fiber-rich foods of plant origin, as well as raisins, beans, peas, black bread, kvass, and beer. Gas formation also increases in many pathological conditions that lead to disruption of the composition of the intestinal microbiocenosis.

An increased content of gases in the intestines leads to intestinal distension, thereby stimulating peristalsis, causing pain symptoms. At the same time, there is no clear correlation between the content of gases in the intestines and the clinical manifestations of flatulence, which is associated with significant individual variability in interoreception. In patients with a low response threshold of intestinal interoceptors, a pronounced clinical picture can be observed with minor gas formation, and in individuals with a high response threshold, complaints are not noted even with significant gas formation in the colon [3, 4].

Changes in the composition of the intestinal microbiocenosis and, as a consequence, the development of flatulence can be facilitated by disruption of the processes of digestion and absorption, as well as changes in intestinal motility. Essentially, with almost any disease of the digestive system, intestinal dysbiosis and flatulence can be observed as a manifestation of the latter.

A common cause of flatulence is lactase deficiency, an intolerance to the milk sugar lactose resulting from a deficiency of the small intestinal enzyme lactase. Normally, lactase breaks down milk sugar into glucose and galactose, which are absorbed into the blood in the small intestine, but with lactase deficiency, milk sugar is not broken down and reaches the colon unchanged, where it is utilized by microorganisms with an increase in gas production. In this regard, one of the tests to detect lactase deficiency is to determine the increased concentration of hydrogen in exhaled air. In addition, undigested lactose in the colon stimulates the secretion of water, which causes the development of loose, foamy stools with a sour odor. All of these symptoms occur only when consuming dairy products containing lactose, primarily whole milk. Fermented milk products contain less milk sugar and can be eaten with a slight decrease in lactase activity. Cottage cheese and cottage cheese do not contain lactose, and their consumption does not cause symptoms. Lactase deficiency can be primary, associated with the genetic characteristics of the individual and inherited, and secondary, that is, arising against the background of diseases of the small intestine, as well as constitutional. The latter is due to the fact that in some people (clinically healthy!) lactase activity in the small intestine decreases with age and they no longer tolerate dairy products. This process can begin as early as the second half of the first year of life and is not considered pathological. There are entire regions and continents in the world (for example, Africa), the adult population of which does not tolerate milk sugar.

Another common cause of flatulence is irritable bowel syndrome (IBS), which is manifested by a combination of abdominal pain with a change in bowel habits and/or flatulence. IBS refers to a group of functional disorders of the digestive system, in which the nervous and/or humoral regulation of gastrointestinal motility is impaired, and organic intestinal pathology is not detected. One of the causes of IBS may be a disorder of the intestinal nervous system, expressed in a decrease in the sensitivity threshold of intestinal interoreceptors. Clinical signs in favor of IBS include variability and diversity of complaints, lack of progression, normal weight, increased complaints during stress, absence of symptoms at night, and association with other functional disorders. Most often, pain occurs before defecation and goes away after it.

The main clinical manifestations of IBS include abdominal pain or discomfort for at least 3 months of the last year, which is relieved by bowel movements, accompanied by changes in stool frequency (more than 3 times a day or less than 3 times a week) and/or shape. stool (either hard, dry lumps - like “sheep feces”, or unformed - mushy). In addition to the main ones, there are also additional symptoms: difficulty in defecation or a feeling of incomplete emptying of the rectum, copious mucus secretion, rumbling or bloating.

Based on the nature of stool, there are three main clinical variants of IBS: IBS with pain and flatulence; IBS with constipation; IBS with diarrhea. Flatulence can be observed with any type of IBS, but is most pronounced with the first.

The cause of flatulence in IBS is a violation of intestinal motility, which leads to a change in the composition of the intestinal contents and, as a consequence, the composition of the intestinal microflora. Under certain conditions, the gas-forming activity of the latter increases, which clinically manifests itself in the form of flatulence [3, 4]. On the other hand, it has been shown that the reason for the development of the feeling of “bloating” in the abdomen in IBS may be not only and not so much increased gas filling of the intestines, but a slowdown in intestinal motility. One of the reasons for this slowdown may be a violation of the reflex regulation of motility at the level of the intestinal nervous system, in particular, a violation of the intestinal distension reflex [5, 6].

To effectively eliminate flatulence, you need to understand the reason that causes it. Very often, flatulence is associated with the patient’s dietary habits and regimen, which in most cases can be eliminated. In this regard, regular nutritious meals in a calm environment should be recommended. It is advisable to include Activia probiotic fermented milk products in the diet. Their regular use helps restore the composition and metabolic activity of intestinal microflora, as well as normalize intestinal motor function [9]. In controlled clinical studies, it was shown that regular consumption of these products for 14 days was accompanied by a decrease in the severity of bloating, flatulence, and the appearance of regular (at least 6 times a week) independent bowel movements [10]. The amount of gas-forming products must be selected individually. When gastrointestinal diseases are detected, these diseases should be treated first. The diet for flatulence is determined by the underlying pathological process. In case of lactase deficiency, it is mandatory to follow a lactose-free or low-lactose diet with the exclusion or reduction of milk sugar in the diet. For children of the first year, in this case, low-lactose milk formulas or special lactase preparations should be used. In case of IBS with flatulence, the amount of products of plant origin should be temporarily reduced, it is necessary to consult with a neurologist and psychologist, and antispasmodics can be used as a symptomatic remedy to eliminate pain (in older children and adults, for example, Duspatalin).

In order to correct the composition of the intestinal microflora, the administration of probiotics is indicated - preparations containing live microorganisms that have a positive effect on the microbial balance of the intestine. These preparations may contain Lactobacillus acidophilus, Lactobacillus GG, Lactobacillus fermentum, Streptococcus (Enterococcus) faecium SF68, S. termophilus, Bifidobacterium bifidum, for which the probiotic effect has been proven in double placebo-controlled studies. It is desirable that the strains of microorganisms included in the preparations have antibiotic resistance and are protected from acidic gastric contents. On the other hand, correction of intestinal microbiocenosis can be effectively carried out with prebiotic drugs, the most common component of which is lactulose (Duphalac). Low doses of lactulose help restore intestinal microflora in case of intestinal dysbiosis of various origins, by stimulating the growth of “own” microflora. Doses of the drug Duphalac are selected individually and vary depending on age, and can be divided into two doses (table). In real practice, the combined use of pre- and probiotics is often used.

As an additional means to eliminate the symptom of flatulence and alleviate the patient’s condition, preparations containing simethicone, a mixture of dimethsiloxane polymer with silicon dioxide, have been widely used for many years. Simethicone is insoluble in water, quickly spreads across the media interface and displaces foaming agents from the surface layer of the film. At the same time, it destroys the membranes of gas bubbles in the intestinal contents and promotes the removal of gases from the intestines. Simethicone quickly and effectively eliminates signs of increased gas filling in the intestines, has no side effects and no age restrictions. The effectiveness and safety of simethicone has been proven in a number of studies, and drugs based on it are recommended for use in many conditions accompanied by flatulence, in particular, in functional disorders [7, 8]. Since in almost all cases of flatulence there are disturbances in the digestive processes, it is advisable to combine simethicone with pancreatic enzymes, which significantly increases the effectiveness of eliminating flatulence. Enzymatic drugs can be prescribed independently (for example, Creon) or as part of drugs combined with simethicone (Pankreoflat).

The positive effect of pancreatic enzymes is due to an improvement in digestion processes, which is reflected in the functional state of the intestinal microflora and a decrease in the entry into the colon of underdigested, in particular, gas-forming components. The use of microspherical preparations (Creon) turns out to be more effective compared to conventional tablet preparations, firstly, due to the high degree of activity of the original substrate (pancreatin), and secondly, the special dosage form of the drug (microspheres 1–1.2 mm in size) , ensuring uniform mixing with gastric contents; thirdly, a pH-sensitive shell of microspheres, protecting the enzyme from destruction in the stomach and ensuring its maximum release in the duodenum [10–13].

Creon should be taken with meals. The dose is selected individually, the daily dose depends on the severity of exocrine pancreatic insufficiency. In pediatric practice, to make it easier to take the drug, the capsule can be carefully opened and the microspheres can be taken without chewing, with a small amount of water. If microspheres are mixed with food, they should be taken immediately after mixing; otherwise, damage to the enteric coating may occur.

Thus, increased gas formation can be associated with a wide variety of reasons and, therefore, the approach to correcting this condition should be strictly individual. In general, the main directions of this correction are diet therapy, treatment of the underlying disease (if one is identified), correction of microbiocenosis and symptomatic therapy with the inclusion of drugs containing simethicone.

For questions regarding literature, please contact the editor.

A. A. Kovalenko , Candidate of Medical Sciences T. V. Gasilina , Candidate of Medical Sciences S. V. Belmer , Doctor of Medical Sciences, Professor of the Russian State Medical University , Moscow

Stomach ache

Symptoms

When they say that the stomach hurts, they usually mean colic and cramps. They can be barely noticeable, or they can literally twist your stomach. In this case, the stomach is usually swollen or tense. It is from such colic that babies often wake up and cry.

Causes

Sleep and microbiota: how appetite and digestion relate to sleep quality

One possible reason is flatulence. Excess gases stretch the intestinal walls and thereby cause pain as they move along the tract. People with sensitive guts are especially susceptible to this pain.

Also, the stomach may hurt due to stress or a disrupted daily routine, in which you have to snack chaotically or endure hunger, and then eat too much late in the evening.

Another reason is inflammation of the intestinal mucosa caused by intestinal flu or other infection. Colic and cramping may also be due to a chronic condition such as gastroparesis, irritable bowel syndrome, Crohn's disease, or liver damage.

Irritable bowel syndrome: how does stress affect digestion?

In babies, there can be several causes of colic: developing microflora, lack of enzymes, increased sensitivity of the intestines, intolerance to formula feeding, swallowing air.