Digestive symptoms are among the most common complaints presenting in primary medical practice. The interpretation and treatment of these symptoms has sometimes been based on misunderstanding how the gastrointestinal tract responds to food. The gastrointestinal tract is a sensing, reactive device that monitors the material flowing through it. Symptoms arising from this system provide information about its dysfunction.
Seven basic symptoms alert the patient to gastrointestinal tract displeasure with food choices - nausea, heartburn, vomiting, bloating, pain, constipation and diarrhea.
Over-the-counter medications for gastrointestinal tract symptoms is a multi-billion dollar industry and patients often self-medicate when symptoms are mild or infrequent. Patients may first present with acute abdominal pain either in the office or emergency room and require an expensive work-up to rule out more serious disease. Ulcer pain tends to be distinctive with discrete pain localized to the epigastrium, and increased with an empty stomach, waking the patient at night and the pain is relieved by food and antacids. Other abdominal pain can be more difficult to assess.
Food allergy is associated with almost every conceivable pain pattern, but is most often associated with bloating and changes in stool consistency and/or frequency. Episodes of crampy abdominal pain with diarrhea are often food-related and may be diagnosed as "food-poisoning" if infrequent. Women especially complain of bloating and often describe major abdominal distention associated with diffuse abdominal discomfort. As symptoms settle into a recurrent or chronic pattern, the diagnosis of irritable bowel syndrome is often made and medications are prescribed to alter acid secretion or gut motility. This symptomatic approach is often not adequate. Symptoms arising from the gastrointestinal tract should suggest::
Two basic principles of gastrointestinal tract management:
The Major Symptoms
Nausea & Vomiting ranges from feeling a little squeamish to feeling very sick, ready to vomit at any moment. A sick intense episode of nausea will follow the ingestion of a reactive food, or food containing toxins, as in staphylococcal food poisoning. If nausea is associated with profuse watery salivation, vomiting soon follows. Patients with food problems will often report chronic low-grade nausea. They often wake up feeling sick and describe a variety of uncomfortable abdominal sensations as the day proceeds. Their nausea is not related to eating any one food, but disappears when complete diet revision is successful. Nausea and vomiting are also associated with migraine headaches caused by food allergy and "abdominal migraine" places the pain in the abdomen and not the head.
Bloating is distention of the abdomen from excess gas in the digestive tract. Gas can accumulate from the fermentation of food materials and from air-swallowing. Food allergy can cause rapid, dramatic bloating by a mechanism that is not understood but probably involves increased blood flow through the small intestine with transfer to blood gases. Women patients will describe feeling "6 months pregnant" 1 to 2 hours after eating a reactive meal.
Constipation consists often decreased frequency of bowel movement, often with harder stools that are difficult to pass. Skipping bowel movements for several days will usually result in abdominal bloating and tenderness. Constipation suggests a slowing of peristalsis, with accumulation of feces in the colon. Often the muscle of the colon will contract in a spastic manner blocking the passage of stool. A "spastic colon" is often painful and will produce hard, pelleted stools. Many patients report alternating constipation and diarrhea. They will describe days with no bowel movements followed by a burst of loose or watery stool often with crampy pain.
Diarrhea is increased frequency of bowel movements with stools that are loose to watery. Some have defined diarrhea as more than 3 loose to watery stools per day. Often diarrhea contains increased mucous. The colon is somewhat like the nose in its tendency to secrete protective mucous with food allergy. The term "mucous colitis" has been used in the past to describe mucoid diarrhea. As diarrhea increases in frequency, the diagnosis of celiac disease or inflammatory bowel disease is considered. If blood appears with the diarrhea, ulcerative colitis is likely. With prolonged diarrhea nutritional deficiencies from malabsorption of nutrients becomes increasingly likely.
Abdominal pain comes in assorted patterns and intensities. Crampy pain occurs with muscle spasms of the various abdominal organs. Severe crampy pain is often called "colic" and ranges from the distress of a milk-allergic infant to the acute suffering of a person passing a stone through a small, muscular tube, such as a bile duct or ureter. Small intestinal spasm presents as crampy pain around the navel. Colon spasm is off to the side and made be high or low, right or left. Sudden, crampy pain is often accompanied by diarrhea if food allergy is the cause. Distention of GIT produces more continuous or aching pain. Inflammation of GIT is associated with continuous pain and distinct tenderness, often aggravated by movement. All patterns of pain occur in patients with who improve with diet revision. We often see women patients with mysterious pelvic pain who improve with diet revision. Several had unnecessary surgery and suffered prolonged loss of normal sexual life because of food-related pain.