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Dr Stephen John Middleton MA MD FRCP FAHE

Consultant Gastroenterologist
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Symptoms suggesting gastrointestinal disorders
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The location of pain can give a clue to its cause.
Chest pain can be produced by oesophageal disorders such as muscular spasm of the oesophagus and reflux of acid into the oesophagus. Also, if there is a partial obstruction of the oesophagus such as a narrowing this can cause pain. It is very important to make certain where chest pain is coming from and one of the most important causes to exclude is heart disease such as angina and heart attacks which can cause chest pain of various types. Once the heart has been excluded as the cause investigations can proceed to find other causes. Gall bladder disease can also cause chest pain but the main gastrointestinal causes are oesophageal disorders.

Abdominal pain can be diffuse or localised, and affect upper lower or all the abdomen (tummy). Well localised pain often suggests a well localised problem in the gut such as an ulcer. More diffuse pain might suggest a condition such as irritable bowel syndrome, but the interpretation of this symptom requires face to face consultation with a GP, who can refer on to a specialist as required.

Pain at night which causes somebody to wake from their sleep is usually not IBS and suggests another cause such as inflammation in the intestine or stomach.

If the pain is related to or eased by eating it is more likely to be arising from the GI tract. Likewise if a bowel movement relieves it the pain might well be coming from the large intestine.
The feeling of an unpleasant burning sensation behind the central rib cage in the front is described as heartburn. This is caused by fluid in the stomach coming up into the oesophagus (gullet) and irritating the oesophageal lining. The fluid usually contains acid but can also occasionally be predominantly bile. Reflux can also cause a tight feeling at the top of the throat, which sometimes gives the sensation that something is stuck in the throat (globus). 
Recently it has also been realised that Reflux can cause dental erosion, dissolving away the enamel of the teeth. It can also aggravate asthma and some believe it might be the cause of asthma in some patients. Some patients develop a condition called Barrett’s oesophagus (see photograph below) which makes it slightly more likely to develop oesophageal cancer and these patients are screening with endoscopy depending upon how much Barrett’s they have.
An endoscopic view of Barrett’s oesophagus, the lighter pink is the normal lining.
This term is usually used to describe the passage of bowel motions (stools) which are more frequent and looser than usual. Its character can often give doctors a clue as to the cause. For instance pale stools suggest malabsorption of fat.
Bloating is often caused by the presence of gas. This can be produced by fermentation of food by bacteria in the intestine or by the swallowing of air. IBS is commonly associated with bloating.
Flatulence & Eructation
The expulsion of gas in a downward (flatulence) or upward (eructation) direction is normal but if excessive can be inconvenient. Excessive eructation is often caused by air swallowing and people with Reflux often get this. Flatulence can be increased by eating certain foods and in people with lactose intolerance milk products can cause it.
The passage of hard stools with difficulty and discomfort or less frequently than usual is often described as constipation. Some describe constipation as the passage of less than one stool in 3 days, but it is the change in bowel habit which may indicate a problem in the bowel and when lasting longer than a few weeks should prompt individuals to seek medical advice. If there has been a definite change in bowel habit it is better to consult a doctor than use over the counter medicines as it may be possible to find the cause of the problem and sometimes these symptoms are caused by more serious conditions that require prompt treatment.
Swallowing problems
When food gets stuck or feels slow going down after trying to swallow this is called dysphagia. People who experience this should always seek medical advice straight away. There are many causes and mostly they are not very serious and can be treated effectively. Occasionally, especially in older people, swallowing problems can be the sign of a more serious condition which is why medical advice should be sought at an early stage.