DorlandHealth

Three fallout effects when the complex digestive circuit falls from a state of balance. Exploring irritable bowel syndrome, diverticular disease and pancreatitis.

Historically, the gastrointestinal tract has been taken for granted. In fact, our collective gastrointestinal tracts have been much abused — we see a food or drink, we want it, we ingest it, and we expect to digest it without incident. Only when this highly sensitive set of organs decides to rebel do we acknowledge their existence, and realize that we should be nurturing them as steadfastly as any other organ set in our bodies.

What You See Isn’t What You Get

The most common affliction affecting the gastrointestinal tract, and the most frequent reason patients visit the gastroenterologist’s office is irritable bowel syndrome (IBS). A functional bowel disorder and a symptomatic disease process without an underlying structural cause, it is a chronic, episodic condition characterized by abdominal pain and alternating bowel function that flips between constipation and diarrhea. Although the exact causes of IBS remain obscure, the most common theory is that it is caused by a miscommunication between the brain and the gastrointestinal tract. Medical conditions commonly associated with IBS include headaches, depression, inflammatory bowel disease (IBD), and endometriosis.

Approximately 10 percent of all Americans greater than 40 years of age will have developed diverticulosis. As it becomes increasingly more common with age, by 60, some 50 percent of the population will have formed these small pouches that bulge outward through weak portions of the intestinal lining. Typically caused by a progressive build-up of pressure within the colon due to constipation, they are most commonly found in the large intestine. Diverticulosis is typically asymptomatic. On the other hand, approximately 10 to 25 percent of all patients afflicted will develop diverticulitis, an infection in one or multiple of these pouches, according to research presented in the Journal of Clinical Gastroenterology.

10% OF ALL AMERICANS GREATER THAN 40 YEARS OF AGE WILL HAVE DEVELOPED DIVERTICULOSIS

The most common symptom of diverticulitis is abdominal pain. It most commonly presents as tenderness in the lower left side of the abdomen, as diverticulosis most often occurs in the sigmoid colon. Complications can lead to bleeding, infection, perforation and blockages. Detected most commonly during colonoscopy, a high fiber diet and pain medications are the primary treatment modalities of choice. Fiber intake can be increased by increasing dietary fiber with such foods as whole-grain breads and cereals, fruits such as apples and pears, vegetables such as peas, spinach and squash, and starchy vegetables such as kidney beans and black beans. It can also be increased by taking daily dietary fiber supplements such as methylcellulose (Citrucel) and psyllium (Metamucil). Severe cases of diverticulitis might require hospitalization and possible surgical intervention.

Sticks and Stones

Pancreatitis, an inflammation of the pancreas, occurs when digestive enzymes become active inside the pancreas and damage the pancreatic tissue. It can present as either acute or chronic, either manifestation being serious. An affliction that occurs more often in men than women, in severe cases it leads to bleeding, infection, and permanent damage to the pancreas.

The pancreas is a large gland located in the upper part of the abdomen, behind the stomach and between the upper portion of the small intestine (the duodenum) and the spleen. Serving multiple functions, it plays a significant role in both digestion and metabolism. The pancreas secretes enzymes that combine with bile to aid in the digestion of food, while also releasing hormones into the bloodstream that regulate the body’s glucose concentrations.

Common causes of pancreatic disorders are gallstones, biliary sludge and heavy alcohol use. Alcohol causes the pancreas to release digestive enzymes sooner than required, and increases the permeability of the ducts within the pancreatic tissue that transport the pancreatic enzymes. This can lead to permanent pancreatic tissue damage. Excessive alcohol ingestion over time can also cause the formation of protein plugs, which can potentially result in blockages of the pancreatic duct.

The gastrointestinal tract controls the ingestion, digestion, absorption and elimination of food and nutrients. ABUSED, it will malfunction and have a negative impact upon all the body’s systems. NURTURED, it will function optimally and serve us well throughout our lives.

Presenting symptoms of pancreatitis include abdominal pain, nausea and vomiting, fever, a swollen abdomen that is tender to the touch, weakness, lethargy, irritability, confusion, a rapid pulse, and an increased heart rate. A severe bout of acute pancreatitis can lead to dehydration, hypotension, and heart, lung or kidney failure.

Acute pancreatitis occurs suddenly and will usually resolve after several days of medication and rest of the gastrointestinal tract. Pain is usually felt in the upper middle or upper left portion of the abdomen, and can feel as if it is radiating to the back. It often becomes worse after meals and increases when lying in the supine position. The patient is hospitalized, and fluids, pain medication and antibiotics are administered intravenously, as the bowel is deliberately kept empty in order to promote healing.

Gallstones, the most common cause of acute pancreatitis, are small, pebble-sized formations of hardened bile that irritate and inflame the pancreas as they pass through the biliary ducts. The other most common source of acute pancreatitis is the long-term, heavy ingestion of alcohol. Other causes include hereditary disorders of the pancreas, genetic abnormalities of the pancreas, cystic fibrosis, high levels of calcium in the bloodstream, high cholesterol, certain autoimmune conditions, some medications, as well as trauma to the abdomen, infection and tumors. Many times the etiology of the episode will remain undetectable.

Since the pancreas is located deep within the body, making a diagnosis is often a challenge. Possible testing performed in order to achieve a diagnosis might include an abdominal ultrasound, a CT scan, an MRCP, or an endoscopic ultrasound (EUS). An abdominal ultrasound utilizes sound waves to visualize organs and, in this instance, pinpoint the location of possible gallstones that could potentially be causing pancreatic inflammation. A CT, or computerized tomography, scan is a noninvasive radiological procedure that displays a three-dimensional picture of various portions of the body — in this situation, the biliary system, where it can potentially demonstrate gallstones and extent of pancreatic damage. An MRCP, short for magnetic resonance cholangiopancreatography, is another noninvasive exam that displays cross-sectional images of various portions of the body. After dye is injected, the pancreas, gallbladder, and pancreatic and biliary ducts are visualized. An endoscopic ultrasound (EUS) is a more invasive, endoscopic procedure that once again utilizes sound waves to visualize the pancreas and biliary ducts.

Bloodwork will be drawn and analyzed as a benchmark of pancreatic function, since the enzymes produced by the pancreas to aid in digestion, such as amylase and lipase, will be elevated. Additionally, bloodwork can demonstrate the presence of infection, anemia and dehydration. Fat will be improperly absorbed or digested, so a fecal stool exam will evaluate the amount of fat the body is excreting instead of absorbing. A glucose tolerance test also might be performed in order to measure the level of damage to the insulin-producing cells of the pancreas.

Gallstones that cause an episode of acute pancreatitis require surgical removal of both the stones and the gallbladder. Since the severity of acute pancreatitis can run the gamut from mild discomfort to life-threatening, treatment options are varied and altered accordingly. If the bout of pancreatitis is mild, both the stones and the gallbladder can be removed immediately with the removal of the gallbladder (Cholecystectomy). If severe, an ERCP (endoscopic retrograde cholangiopancreatography) is performed endoscopically for the immediate extraction of stones, and the surgical removal of the gallbladder is delayed until such time as the pancreas is no longer acutely inflamed and it is safer to perform a surgical procedure.