Digestive troubles, what to do?

Have you been suffering from digestive disorders for a while and want it to stop?

You are not alone: ​​according to the CREGG (Reflection Club of Cabinets and Hepato-Gastroenterology Groups), “ functional intestinal disorders are the most frequent reason for consultation. They are due to multiple factors : motor disorders of the digestive tract, visceral hypersensitivity, changes in the mucous membrane and intestinal immune functions, changes in the intestinal microbiota and the central nervous system. ”

Red flags

First of all, I invite you to consult a healthcare professional , especially if:

• • You are over 50
  • Your symptoms appeared after travelling abroad
  • Your symptoms are present at night
  • You have observed other associated changes (unexplained weight loss, presence of blood in the stool, fever, etc.)
  • There is a history of colorectal cancer, celiac disease, or IBD in your family
  • You have frequent vomiting 

It is essential to rule out the possibility of a disease such as celiac disease, hyperthyroidism, food allergies, parasitic infection, cholelithiasis, IBD (Crohn’s disease or ulcerative colitis).

If your blood tests are normal , it is very possible that you have irritable bowel syndrome or functional bowel disease  .  There are, however, a number of possible tests that you will likely be prescribed. IBS is a set of symptoms whose diagnosis is essentially based on the exclusion of known pathologies, as well as on the Rome IV criteria.

Examples of tests:

• Colonoscopy and fibroscopy. Biopsies are usually taken during these exams.
• Stool testing for a parasite or blood that may originate from a benign or malignant polyp
• Laproscopy , a surgical technique used to diagnose or rule out endometriosis
• Serological test to determine the presence of IgA antibodies or transglutaminase antibodies. A positive result may indicate celiac disease. The diagnosis should be confirmed by a biopsy. This test can be false negative if you have stopped consuming gluten before.
• Fecal calprotectin . This protein is synthesized by the white blood cells of the immune system and makes it possible to indicate the presence of lesions in the digestive mucosa. It therefore makes it possible to exclude or measure the activity and severity of IBD.
• Thyroxine . This test can rule out hyper or hypothyroidism.
• Biopsy of the small intestine : sample of tissue for analysis. Mainly used to rule out cancer or detect villous atrophy (present in celiac disease).

• Colon biopsy : analysis of tissue to diagnose or rule out the presence of malignant diverticula, IBD, or cancer.
• HLA-QD2 and HLA-QD8 genetic tests . These genes are associated with celiac disease. However, you can be a healthy carrier, that is, have these genes but not develop the disease. In contrast, a negative test is almost 100% reliable (no celiac disease).
• Respiratory tests. The purpose of these tests is to measure the exhaled gases in order to evaluate a malabsorption – depending on the tests – of lactose, fructose, sorbitol or a SIBO (as with glucose or lactulose tests). Only the lactose test is approved by the entire scientific community. Note that according to Monash Unisversity, the terms “fructose intolerance” or “fructose malabsorption” should be banned. Rather, it should be explained that a positive result can be caused by IBS, and that certain foods induce these symptoms.

These tests, coupled with a history (interview with a gastroenterologist), are therefore intended to rule out celiac disease, endometriosis, hyper or hypothyroidism, cancer, IBD, endocrine disease, pancreatic insufficiency, biliary malabsorption or a pelvic floor disorder.

Other tests

Several alternative tests are starting to appear on the “market”: the microbial fecal analysis , the fecal determination of short-chain fatty acids , the IgG tests of food intolerance, the salivary IgA test and the hyper-permeability test. intestinal .

However, these tests have their limits : many bacterial species cannot be cultured in laboratories (the conditions are not suitable), and the analysis therefore does not objectively reflect the microbiota. In addition, research is still in its infancy, and the results are difficult to use. We know the possible benefits or risks in the presence or absence of certain species, but the way in which they coexist and interact with each other is complex. However, it is known that the composition of an individual’s microbiota can influence the choice of treatment and predict the response.

Regarding food intolerance tests, their reliability is questionable because the presence of IgG is not always synonymous with food intolerance. It can mean a “standard” physiological immune response.

There are no medications for IBS because it is not a disease itself. However, that doesn’t mean you have to come to terms with your troubles.

If you have seen several specialists (which is very common in suffering people but we keep telling them that “it’s in their head”), I advise you to create a file referencing all your analyzes and the tests that you have to realize.

Management of IBS

Once your gastroenterologist diagnoses you with IBS, management will address three pillars:

• • Diet, and more generally, eating behaviour
  • The mind (management of emotions, stress …) by means of techniques and soft methods (acupuncture, hypnosis, cardiac coherence or other method of breathing, visualization …)
  • The physical , including physical activity

Certain medications such as antispasmodics, painkillers, anti-diarrhea drugs, etc. may be prescribed. However, I think it’s best to favor herbal supplements or probiotics in the majority of cases (and depending on the stage / course of IBS)

Caution

Before embarking on a drastic diet and avoidance, it is important to start by adopting good hygiene and behavioral habits . This is why I strongly invite you to consult a dietitian nutritionist or other health professional specializing in this care.

Indeed, you may be tempted to start a diet low in FODMAPs , or digestive savings, to remove gluten, lactose … I’m not saying that it will not be beneficial, but it’s a bit like starting a book through the middle of the story without reading the beginning .

And what is the subject of the first chapter?

The digestion !

It all starts with what we put in our mouth and how we will digest these foods.

If you want any help, please feel free to contact me.

Take care,

Juliette