August 19, 2019

Digestive issues: Hard to talk about but possible to treat

Gas, bloating, constipation, belching and reflux. These digestive troubles are an almost universally occurring issue, but rarely discussed or even fully understood by the people they affect.

Melissa Phillips, a Registered Dietitian Nutritionist for the UW Health Digestive Health Center, treats patients who have lived with digestive symptoms for years and tried multiple treatments on their own. One of the first steps for these patients is pinpointing exactly what their symptoms are, which, according to Phillips, can be surprisingly difficult. And the symptoms - like gas and stomach pains - can be misidentified, partly because people may hesitate to discuss them in detail, even with medical professionals. 

“Many people will say they have constipation, for instance, when really they are having regular bowel movements, but they might be difficult to pass,” Phillips says, adding that people may use the term bloating and distention to describe the same thing even though they mean specific things. Bloating is a feeling of fullness in the belly, as though there was an inflated balloon inside the stomach area. Distention is when the stomach area is visibly swollen.

“A lot of times, the process starts with defining what they’re really feeling and understanding what it means for them,” she says.

Diagnosing possible causes of digestive upset

Understanding what and where the symptoms occur can begin to point to the underlying issues. Some symptoms such as gas or stool problems can indicate issues in the lower gastro-intestinal (or GI) area, while upper GI symptoms such as belching may be related to reflux.

Lower GI issues

Depending on the severity of symptoms, certain tests may be done first – such as a colonoscopy or testing for celiac disease via blood test and endoscopy – to rule out potential diseases. If those tests do not point to another condition, an elimination diet may be recommended to determine whether there is an intolerance to certain types of foods.

FODMAPs and how they affect digestive health

FODMAPs – or Fermentable, Oligosaccharides, Disaccharides, Monosaccharides and Polyols – are naturally occurring sugars and fibers in foods that are highly fermentable and osmotic, and eating them can result in symptoms like gas and bloating. Individuals may experience some relief from symptoms by maintaining a diet that is low in certain types of FODMAPs, or avoids them entirely.

The low-FODMAP diet begins with an elimination phase, which should be done under the direction of a dietitian. While there are apps and guides identifying what foods should be avoided during the elimination phase, it is not always an easy diet to follow. It requires preparation and planning. After the three or four week elimination phase, the different FODMAP groups are carefully re-introduced one group at a time to help determine whether they may be an issue.

“This is a learning diet,” Phillips says. “It removes suspect foods and slowly adds them back in. It’s really important to do it under professional guidance, because it must be done in a very systematic fashion.”

Many patients will come to an office visit after having tried elimination diets such as a low-FODMAP diet on their own, she adds.

“The change I’ve seen in last five years is people have tried a lot of things already on their own,” she says. “But there’s so much information out there that may be outdated. It’s important for them to try it again under the guidance of a skilled dietitian.” 

Upper GI

Another common digestive concern is reflux, belching, or gas, which occurs in the upper GI track.

With these patients, lifestyle changes are often the first step in looking for ways to relieve symptoms. For patients experiencing reflux, steps may include weight loss and avoiding potential triggers such as citrus, caffeine and alcohol. Other steps to try include:

  • Eating slowly and not close to bedtime

  • Wearing looser-fitting pants that are not tight around the waist

  • Taking a walk around the block after dinner to give the body a chance to digest

  • Sleeping with the head of the bed raised

“Eating quickly is a habit that can be difficult to change. Rushed eaters may experience more reflux,” says Phillips. “But if changing doesn’t help symptoms, we highly recommend they see a provider for further evaluation.”