Acid reflux causing diarrhea

Treating Chronic Diarrhea

Diarrhea is very common. When you have diarrhea, your bowel movements are loose and watery. In most cases, diarrhea lasts a couple of days. Chronic diarrhea is diarrhea that lasts longer than two weeks. When diarrhea lasts for weeks, it can indicate a serious disorder. Although diarrhea is usually not serious, it can become dangerous or signal a more serious problem. Read on to find out how chronic diarrhea is treated.

1. Replacing lost fluids- Chronic diarrhea is treated by replacing lost fluids and electrolytes to prevent dehydration. Adults with diarrhea should drink water, sports drinks, sodas without caffeine, or fruit juices. Fluid can also be delivered through a vein (intravenously) if the dehydration is severe.
2. The use of medication- Your doctor may prescribe antibiotics and medications that target parasites to treat parasitic or bacterial infections. If a virus is causing your diarrhea, antibiotics won’t help. Pain relief medications can help alleviate fever and pain. Your doctor may also prescribe medications to treat an underlying condition that may be causing your chronic diarrhea.
3. Treating medical conditions- How doctors treat chronic diarrhea depends on the cause. Chronic diarrhea is sometimes caused by an underlying medical condition that requires treatment. Common conditions that cause diarrhea include irritable bowel syndrome, Chrohn’s disease, ulcerative colitis, inflammatory bowel disease, celiac disease, and chronic pancreatitis.
4. The use of probiotics- Your doctor may recommend probiotics to treat diarrhea. Probiotics are good bacteria that are very similar to the bacteria that are already in your body. Probiotics reduce the growth of harmful bacteria and promote a healthy digestive system. If your gastroenterologist recommends probiotics, talk with him or her about how much probiotics you should take and for how long.
Chronic diarrhea can affect your daily activities and make life frustrating and miserable. Don’t hesitate to contact a gastroenterologist about diarrhea. A visit to the gastroenterologist will bring all the relief you need, with little hassle or expense.

When Does a Stomachache Mean Trouble? 8 Answers

So, you have a discomfort in your abdomen. You’re wondering if you should grin and bear it or have it checked.

Let’s take a look at some common stomach conditions and when you should have them checked.

1. You feel:

Pain or burning below your breastbone that sometimes gets worse when you eat or lie down.

You should:

Take an antacid if the discomfort happens only occasionally. If it happens more than a time or two each week, you should see your health care provider. You might be tested for gastroesophageal reflux disease (GERD). With this condition, stomach acid flows up the esophagus (the tube running from mouth to stomach). A medication to reduce stomach acid might be recommended.

2. You feel:

A sore throat that doesn’t go away. Surprisingly, this could be a sign of a stomach problem. A sore throat can be a symptom of acid reflux. GERD is mild form of acid reflux. The stomach acid flowing up the esophagus can cause painful irritation.

You should:

Try an antacid. If you don’t feel relief, visit your health care provider.

3. You feel:

Nausea, gas, cramps, bloating and/or diarrhea a half hour to two hours after eating a food that contains lactose. You could be lactose intolerant.

You should:

Try cutting back on dairy products such as milk, ice cream and cheese. You can try lactose-free products such as lactose-free milk/soy milk. Aged hard cheeses such as cheddar also have lower amounts of lactose compared to soft cheeses.

If you continue to have problems, see your health care provider.

4. You feel:

Nausea, bloating, constipation or diarrhea and lower abdominal cramps. The symptoms may diminish after you have a bowel movement.

You should:

See your health care provider. You may have irritable bowel syndrome (IBS). This is a diagnosis of exclusion, meaning we would want to rule out other possible causes for your symptoms. You could try an over the counter probiotic (good gut bacteria) supplement.

5.You feel:

Burning pain in your stomach. It comes and goes and feels worse when you’re hungry.

You should:

Try to avoid nonsteroidal drugs (such as ibuprofen, Advil, Aleve, naproxen). These drugs can hurt your stomach lining. Then see your health care provider. You could have an ulcer. You can discuss treatment options that may include checking for a stomach bacteria infection called H. pylori. You can also try over the counter antacid medications.

6. You feel:

A sudden loss of appetite.

You should:

See your health care provider if your symptoms persist, especially if you have any unintentional weight loss.

7. You feel:

Severe, sudden pain in your abdomen. It may start around your belly button and radiate to your right lower abdomen. You may have other symptoms such as a fever, loss of appetite, nausea, constipation or diarrhea.

You should:

Go to the emergency room immediately. You may have appendicitis. This is a blockage in the appendix — a small organ attached to the large intestine. If the appendix bursts, it can cause an infection in the abdomen. This is a serious medical condition.

8. You feel:

Nausea, vomiting or pain in the right upper area of the abdomen after eating.

You should:

See your health care provider if the symptoms don’t go away in a few hours. You may be having a gallstone attack. Gallstones are small pea-size to golf ball-size hardened deposits. An attack can happen if gallstones block a duct in the gallbladder.

Other Possibilities

Many of the symptoms we’ve described — abdominal pain, cramps, bloating, constipation, diarrhea — can result from a number of conditions. For example, celiac disease, colitis, Crohn’s disease, and thyroid disease to name a few.

Some conditions are harmless. Some serious. The variety of overlapping symptoms and conditions is why it’s a good idea to see your health care provider if stomach/abdominal discomfort doesn’t go away or you have severe pain. An accurate, timely diagnosis can give you the best possible treatment outcome.

You can find a health care provider online any time. You can also make an appointment online. It’s a good idea to choose a health care provider you’re comfortable with before you need one. Then when you need a health care professional, you’ll know who to see.

Tummy Trouble? Healthy Behaviors Can Help

Promoting healthy digestion

If you’re young, making good choices now can help protect your digestive system as you age (when people are typically more prone to digestive problems). These three general behaviors can make a difference.

  • Eat well. Your digestive system appreciates a diet full of fruits, vegetables, whole grains and lean proteins, such as chicken and fish. Avoid high-fat and processed foods, which can aggravate GERD or IBS symptoms.
    Practice mindful eating, or eating to nourish your body and recognizing the feelings of being full or hungry. Include probiotics in your diet to help maintain a good balance of microorganisms in your gut. Also know that what may work well for one person may not work well for another. Recognize what foods make you feel good or bad, and adjust your diet to keep your digestive system happy.

  • Be active. Aim for at least 30 minutes of moderate physical activity four days a week.
    Being active keeps your digestive system pumping along doing its work. Staying active also helps you maintain a good body weight, whereas being overweight contributes to many problems, ranging from GERD to colon cancer.

  • Live healthy. Making good lifestyle choices helps you maintain good digestive health. If you smoke, quit. Limit your intake of alcohol and caffeine. Stay hydrated by drinking plenty of water.
    There is a strong connection between your digestive system and anxiety and stress, so working to manage those is important. For many people, exercise is a good stress reducer. Yoga, mediation and deep breathing are also helpful.

Taking the time to make good choices and live well now is an investment in your healthy future — one you are certain to appreciate as you age and continue enjoying life to its fullest.

Got digestion problems like irritable bowel syndrome, bloating, or gas? A “low-FODMAP” diet might help.

Never heard of FODMAPs? They are a type of carb. But this is not your typical low-carb diet.

The diet only limits carbs that are “fermentable oligo-, di-, monosaccharides and polyols.” No wonder they came up with a nickname!

For most people, FODMAPs are not a problem unless you eat too much of them. But some people are sensitive to them.

FODMAPs draw water into your digestive tract, which could make you bloated. If you eat too much of them, they can hang around in your gut and ferment.

These types of carbs are FODMAPs:

  • Fructose: Fruits, honey, high-fructose corn syrup, agave
  • Lactose: Dairy
  • Fructans: Wheat, onions, garlic
  • Galactans: Legumes, such as beans, lentils, and soybeans
  • Polyols: Sugar alcohols and fruits that have pits or seeds, such as apples, avocados, cherries, figs, peaches, or plums

Avoiding FODMAPs doesn’t help everyone. But in a study published in the journal Gastroenterology, about 3 out of 4 people with IBS had their symptoms ease right away after starting a low-FODMAP diet and felt the most relief after 7 days or more on the plan.

Remember, FODMAPs aren’t bad. Many foods that are rich in them encourage the growth of good bacteria in the gut.

If you have come into our FODMAP Everyday® community this far you were probably motivated by the suffering that you or a loved one has experienced or you have heard about the Low FODMAP diet and want to know more.

You have been suffering with IBS pain and debilitating symptoms and are tired of feeling that way! You want your life back. You’ve tried diets and supplements and maybe even meditation and medication, but you have not achieved the amount of relief that you seek.

Often times you are even scared to eat because it seems like your symptoms emerge so randomly that you never know when they will hit. For many people they get to the point where they think there is no answer and that they just have to live this way. YOU DON’T! You can live pain-free with your IBS and we are here to help you.

A low FODMAP diet is not for everyone – for a variety of reasons. But it just might be the solution for you. Take our test below by answering some simple questions:

  • Do you experience digestive symptoms such as abdominal pain, diarrhea and/or constipation, excess gas and/or bloating?
  • Have you been tested for celiac disease and has it been ruled out?
  • Has a gastroenterologist diagnosed you with irritable bowel syndrome (IBS)?
  • Has your doctor diagnosed you with irritable bowel disease (IBD), small intestinal bacterial overgrowth (SIBO), gastroesophageal reflux disease (GERD) and/or non-celiac gluten sensitivity (NCGS)?
  • After evaluation has your doctor suggested looking into a low FODMAP diet?
  • Have you tried dairy-free and gluten-free diets and experienced seemingly positive yet random results?
  • Are you ready to try a whole new way of eating that just might provide you with complete symptomatic relief?

Okay, if you said yes to most (or all) of those questions, read on. Let’s take it step by step.

Do you experience digestive symptoms such as abdominal pain, diarrhea and/or constipation, excess gas and/or bloating?

If your body is reacting to FODMAPs then any of these symptoms, or a combination of them, are very likely part of your everyday experience, but they do not have to be. By following a low FODMAP diet most, and possibly all, of your symptoms might be relieved. But first, it is recommended that you work with your doctor or dietitian.

Have you been tested for celiac disease and has it been ruled out?

It is estimated that 2.5 million people in the U.S. are still undiagnosed with celiac disease. When someone with celiac disease eats gluten – a protein found in foods such as wheat, rye and barley – their body mounts an immune response that attacks the small intestine. These attacks lead to damage to the villi, the small fingerlike projections that line the small intestine. In turn, nutrients will not be absorbed properly, which leads to life threatening symptoms. The only current treatment for celiac disease is a strict, gluten-free diet.

Has a gastroenterologist diagnosed you with irritable bowel syndrome (IBS)?

It is vital to work with your medical professionals. Most likely your general practitioner (GP) will not be well versed with the low FODMAP diet. We highly suggest working with a gastroenterologist or registered dietitian who is; not all are, although that is changing as the FODMAP diet becomes more mainstream. Best-case scenario is that your doctor isn’t satisfied with telling patients that they “have IBS”. As Dédé’s gastroenterologist, Dr. Tassoni, explained that just means your gut isn’t happy and we need to find out WHY! Up to 75% of patients with IBS respond favorably to a low FODMAP diet. Maybe you will too!

Has your doctor diagnosed you with inflammatory bowel disease (IBD), celiac disease, small intestinal bacterial overgrowth (SIBO), gastroesophageal reflux disease (GERD) and/or non-celiac gluten sensitivity (NSGS)?

Now it gets a little trickier. At this time it is not believed that a low FODMAP diet can induce or maintain remission in patients with Crohn’s disease or ulcerative colitis, however, and this is a big BUT, a low FODMAP diet might be able to help manage symptoms and provide a better quality of life. And that’s what we at FODMAP Everyday are all about!

As far as celiac disease is concerned, it is estimated that about 20% to 25% of those diagnosed with celiac disease and who are following a gluten-free diet still experience debilitating symptoms. This could mean that there is concurrent IBS, which might be addressed by the low FODMAP diet.

The diagnosis and treatment of SIBO is an evolving science. In brief, if there is an overgrowth of bacteria in the small intestinal, IBS-like symptoms can result. Antibiotic treatment is currently typically recommended but a low FODMAP diet might prohibit a relapse after the course of medication. Right now the evidence is mostly anecdotal. Consult with your doctor and/or registered dietitian to see if a low FODMAP diet might be worth trying. If it is, then we are here at FODMAP Everyday to help you.

GERD is widespread. Not everyone who has GERD has IBS but many of those with IBS also have GERD. There isn’t conclusive evidence why a low FODMAP diet might help GERD symptoms but many of those with GERD who have tried a low FODMAP diet have reported fewer symptoms. It might be that smaller portions of food or generally healthier food choices reduce acid reflux or maybe because there is less bloating there is also less upward pressure on the diaphragm. In any event, the low FODMAP diet might be worth discussing with your doctor as a possible approach to symptomatic relief.

NCGS, which stands for non-celiac gluten sensitivity, is an acronym that you might not have heard of. For years Dédé reacted badly to gluten even though she wasn’t diagnosed with celiac disease. Many people (not medical professionals) even told her that if she wasn’t celiac then her condition wasn’t “real”. Sound familiar? While there is no biomarker for testing for NCGS, it appears to be a widespread issue.

Some researchers believe that the FODMAPs in certain grains might be the key to symptoms as opposed to the actual gluten itself being the culprit. This is why the low FODMAP diet isn’t gluten-free per se. Another way of understanding this is that ingesting wheat might affect you, and maybe you always thought it was the gluten in the wheat, but there is a possibility that it is because of the FODMAPs (specifically the fructans) in the grains.

Again, for any of these conditions, working with your doctor and/or registered dietitian is key.

  • After evaluation has your doctor suggested trying a low FODMAP diet?
  • Have you tried dairy-free and gluten-free diets and experienced seemingly positive yet random results?
  • Are you ready to try a whole new way of eating that just might provide you with complete symptomatic relief?
What are you waiting for?

For years Dédé tried medication and various diets (raw, vegetarian, vegan, GF, Paleo, etc.) and none of them offered reliable relief. It took a hospital stay and extreme pain to get her to say ENOUGH! She was ready to try anything. When you first look at the low FODMAP elimination diet it appears to be horribly restrictive and you might be discouraged. But that’s what we are here for! To show you how you CAN do this! Read The Low FODMAP Diet as your first step to living pain-free and eating delicious whole foods that your whole family will enjoy. FODMAP Everyday is here to not only help you get by, but to THRIVE!

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Living With IBS and GERD

In the alphabet soup of digestive disorders, IBS and GERD aren’t just problematic on their own — they often occur together.

Irritable bowel syndrome, or IBS, causes belly pain along with changes in bowel habits, either diarrhea or constipation. Gastroesophageal reflux disease, or GERD, causes acid reflux, commonly referred to as heartburn. Having one of these conditions can be bad enough, but many people have to deal with both.

Several studies have found a strong link between GERD and IBS. A 2010 study published in the World Journal of Gastroenterology looked at data on more than 6,000 people and found that about 63 percent of those diagnosed with IBS also had GERD symptoms. The research also showed that having both GERD and IBS was more common in women, and that having both conditions made all symptoms worse.

“Is there a link between IBS and GERD? Absolutely,” said Maged Rizk, MD, a gastroenterologist and director of the Chronic Abdominal Pain Center at the Cleveland Clinic in Ohio. “I see it all the time in our clinic. If you combine the results of all the studies, GERD is probably about four times more common in people with IBS.”

Stephanie Sikora, a 23-year-old university student from Calgary, Alberta, Canada, is one of those people who has both IBS and GERD. “My symptoms consist of heartburn, severe stomach cramps, constipation, bloating, gas, and sometimes nausea,” she said. “They began back in January 2010, shortly after I recovered from a case of the flu. After various diagnostic tests and emergency-room visits for the pain, I was finally officially diagnosed in April 2012 with IBS and GERD. I am also a migraine sufferer, and I find that my digestive symptoms and migraines often go hand-in-hand.”

How Are IBS and GERD Linked?

One link is that both IBS and GERD are extremely common. You may be diagnosed with IBS, which affects up to 20 percent of the population, if you have symptoms of abdominal pain at least three times a month for at least three months, and that pain cannot be explained by any disease or injury. GERD causes acid reflux and regurgitation; about 7 percent of the population experiences it on a daily basis.

“The links between GERD and IBS are mostly hypothetical, but probably involve an increased sensitivity of the digestive system,” Dr. Rizk said. “People with GERD and IBS become uncomfortable at a lower threshold than people without these conditions. We call that visceral hypersensitivity.”

Another link between IBS and GERD symptoms may be gastrointestinal motility, referring to the process of moving food through the digestive system. If the movements are disordered, it’s called motility disorder. Some experts now consider both IBS and GERD to be motility disorders.

“Stress and food sensitivities may be other links,” Rizk said. “There is a strong link between mental stress and digestive stress. Stress is a known trigger for both IBS and GERD symptoms.”

“My symptoms are triggered by a combination of stress and food,” Sikora said. “Food is the main culprit. For the first three years after the symptoms began, I could only eat an extremely bland and simple diet, often living off applesauce and rice cakes for weeks at a time.” However, she also has an anxiety disorder that became apparent about the same time as the IBS and GERD. “I find that stress does play an important role, as these conditions definitely feed off of each other,” she said.

Symptoms Management for GERD and IBS

Rizk said that diet and lifestyle changes that reduce stress should benefit both IBS and GERD. “An elimination diet that starts with very bland and simple foods, and then introduces new food groups in stages, may help identify foods that trigger symptoms,” Rizk said. “Each condition may also be treated separately with medications. Antacid and acid-blocking medications are often used for GERD; antispasmodic medications and anti-anxiety medications may be used for IBS.”

That’s in line with Sikora’s treatment. “I manage through a combination of diet, medication, and lifestyle changes,” she said. “I am on a proton-pump inhibitor twice a day for the GERD, and always carry a supply of over-the-counter antacids. The IBS has improved a lot since I began taking a medication for my anxiety. However, I still rely on antispasmodic medication and heating pads for my bad IBS days.”

Despite her conditions, Sikora has managed to get both IBS and GERD under control enough to resume an active life — working part-time as a preschool teacher and pursuing a master’s degree in psychology.

“I am able to eat a greater variety of foods these days, but still have trouble with spicy, acidic, processed foods, nuts, and high-fat foods,” she said. “I do my best to avoid those trigger foods and to add probiotics and fiber to my diet, which seems to help both the IBS and GERD.”

But there’s more. “I’ve also learned not to sweat the small stuff,” Sikora said. “Maintaining a lifestyle that is as healthy and as stress-free as possible helps keep both conditions more or less in check.”

Heartburn Drugs May Lead To Serious Diarrhea

When it comes to taking up residence in your intestines, Clostridium difficile, like these, may get some help from common heartburn drugs. Janice Carr/CDC hide caption

toggle caption Janice Carr/CDC

When it comes to taking up residence in your intestines, Clostridium difficile, like these, may get some help from common heartburn drugs.

Janice Carr/CDC

If that case of diarrhea just doesn’t get better, your heartburn drug could be the reason.

The Food and Drug Administration just warned doctors and consumers that popular medicines called proton pump inhibitors may raise the risk for chronic diarrhea caused by Clostridium difficile, a bacterium that you’d rather not have colonizing your intestines.

The drugs include Nexium and Protonix and over-the-counter remedies Prilosec and Prevacid. If you’re taking these drugs (or others in tables 1 and 2 here) and have diarrhea that won’t let up, the FDA says you should see your doctor right away.

These drugs suppress stomach acid, which may help protect against infection with the germ. Your doctor can test to see if you’ve got an infection with C. difficile, the agency says, and treat it.

Why did the FDA issue this advice now?

After looking at a database of problem reports for the drugs and various published studies, the agency concluded that “the weight of evidence suggests a positive association between the use of PPIs and C. difficile infection and disease.”

Now, that’s not ironclad proof, but the agency says it’s strong enough to tell the world about. The agency says the studies show that using PPIs may raise the risk for infection by 1.4 to 2.75 times.

FDA said it wants makers of the drugs to add information about the risk to the instructions for the drugs.

Hints about problems with PPIs have been mounting for a while. Some studies published two years ago in the Archives of Internal Medicine highlighted the possible heightened risk of infection with C. difficile for people taking the drugs.

“The increases in the risk of Clostridium difficile infection with PPIs are not at all modest,” an accompanying editorial said at the time. And the editorial advised doctors to think it over before prescribing PPIs.

Update 6:30 p.m.:

I asked AstraZeneca, maker of some of the best-selling PPIs, about the FDA’s action. A company spokeswoman emailed a statement saying, “AstraZeneca remains confident in the positive benefit-risk and safety profiles of Nexium, Prilosec and Vimovo.”

AstraZeneca is working with the FDA to add information about the increased risk of C. difficile infection to the labels of those drugs, the statement said.

“Patients should speak directly to their physicians if they have questions or concerns about their treatment,” the company said. And it took note of the FDA’s advice to patients: They shouldn’t stop taking PPIs before talking to their doctors.

Skepticism About a Rare Disorder

Reading the report and reviewing the CT scan, Brozinsky was initially skeptical that she had something more rare than Crohn’s. Elevated eosinophils can be seen in Crohn’s, although not usually as high as this young woman’s. Still, an unusual presentation of a common disease was much more likely than even a classic presentation of an unusual disease, and Crohn’s was a whole lot more common than EGE. But now that he’d met the patient, he reconsidered the possibilities. He wasn’t sure if Crohn’s made sense. She needed to be scoped, and the biopsies obtained from her esophagus and stomach would give them an answer.

The next day, Brozinsky advanced the scope down the patient’s esophagus. Everything looked normal there, but in the stomach he saw patches of tissue densely dotted with tiny red splotches, like bits of blood caught just below the surface. It looked as if she had some kind of rash on the inside of the stomach and the closest parts of the small intestines. Brozinsky took samples of tissue from these “rashy” areas, as well as from the areas where her gut appeared normal. The tiny samples were loaded with eosinophils, up to 100 of the cells per high-powered microscopic field. Normal is around five. A diagnosis of EGE is given for counts over 30. The young woman had eosinophilic gastroenteritis.

EGE is thought to be an unusual type of allergic reaction to foods. Food exposure triggers the recruitment of eosinophils to the gut, but once they have a toehold, repeated exposure isn’t necessary to keep them there. The disorder was first described in a series of patients in the United States in 1993 but since then has been found to occur throughout the developed world. Because it’s a relatively new disease, and because our understanding of allergy is still emerging, it’s not well understood. As recognition of the disorder expands, so, too, do the number of cases. Patients are usually started on an elimination diet and given steroids to further suppress the immune system. An elimination diet — one in which the foods most frequently linked to allergic reactions, like milk, eggs and wheat, are not consumed — has been shown to be helpful up to 90 percent of the time. About half of those with EGE have some other type of allergic disorder as well, either asthma like this patient’s, or eczema or a history of other food sensitivities.

With treatment, symptoms usually resolve — at least temporarily. There is growing evidence that EGE is a chronic disease, and most patients will have relapses as time goes by.

Looking For the Culprit

The patient was started on the diet and on prednisone, a steroid. The response was immediate. She was able to keep down the food she was allowed to eat within 48 hours of starting the prednisone. The steroids were slowly tapered after several weeks, and eventually the patient was able to add foods back to her diet, one at a time. But no culprit was found. This is not unusual. For most people with EGE, no single food is identified. The patient thinks the problem was caffeine and alcohol. She hasn’t tried them since this most recent attack. She understands there is a chance that she will have symptoms again. But if she does, she is confident that she will recognize it right away.

This January, the patient was able to start medical school half a year late. She just completed the first semester. It was tough but exhilarating to finally get to start on the path she has been working toward for so long./•/

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