Slow digestion weight gain

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FAQs about Peptic Ulcer Disease

What is peptic ulcer disease?

Ulcers are breaks in the protective mucosal lining of the digestive tract that can vary in size (both in diameter and depth) and location.

What causes peptic ulcer disease?

Ulcers are the result of the breakdown of the mucosa, which may occur as a result of excessive gastric acid secretion. One common cause of peptic ulcer disease is infection with Helicobacter pylori bacteria. Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen can also contribute to mucosal injury of the upper digestive tract and lead to peptic ulcer disease.

What are the symptoms of peptic ulcer disease?

Common symptoms of peptic ulcer disease include abdominal discomfort, pain and nausea. The discomfort or pain is sometimes described as gnawing or burning. Antacids may give temporary relief. Gastric ulcer pain is usually aggravated by eating, especially spicy foods. Because eating causes pain, many patients with gastric ulcers avoid meals and consequently lose weight. Duodenal pain may be relieved by food. Patients with duodenal ulcer may have a weight gain.

How is peptic ulcer disease diagnosed?

Peptic ulcer disease is usually suspected in patients with gastric discomfort and pain. Several methods are available to confirm the diagnosis.
A barium X-ray or an upper GI series is a widely available and accepted method to establish a diagnosis of peptic ulcer disease in the stomach or duodenum. It is somewhat limited in that it is less sensitive and accurate in defining the exact nature of the disease or distinguishing benign from malignant ulcer disease and tissue sampling cannot be performed.
Esophagoduodenoscopy (EGD) is the most direct and most accurate method of establishing the diagnosis of peptic ulcer disease. In addition to identifying the ulcer, its location and size, EGD also provides an opportunity to detect and biopsy subtle mucosal lesions to determine the extent of damage. Endoscopic biopsies are indicated for all gastric ulcers because of the risk of underlying cancer, whereas duodenal ulcers are always benign and do not require biopsy.
Laboratory tests also play a role in diagnosing peptic ulcer disease. Blood tests or a urea breath test can determine whether H. pylori is present; gastric acid analysis can determine whether the ulcer is caused by gastric acid hypersecretion (basal acid output exceeding 10 mEq/hr) or decreased mucosal protection; serum gastrin and serum calcium levels can be measured to screen for gastrinoma and multiple endocrine neoplasia.

How is peptic ulcer disease treated?

Treatment for peptic ulcer disease centers around the reduction of hostile factors and increasing and augmenting protective factors. Specifically, the goal of therapy is to relieve symptoms, heal craters and prevent recurrences and complications. Medical therapy should include treatment with drugs and an attempt to accomplish the following:
– Eradicate the H. pylori infection
– Reduce gastric acidity by mechanisms that inhibit or neutralize acid secretion
– Coat ulcer craters to prevent acid and pepsin from penetrating to the ulcer base
– Provide a prostaglandin analogue
– Remove environmental factors such as NSAIDs and smoking
– Reduce emotional stress (in a subset of patients)
Endoscopic therapy is used to treat complications, such as bleeding, that may arise in particularly recalcitrant ulcers.
With the increased success of new acid-reducing and other pH-stabilizing drugs, there has been a decreased need to resort to surgery to treat peptic ulcer disease. The most common reason for surgical therapy in benign gastric ulcers is failure of the ulcer to completely heal after an adequate trial of medical or endoscopic therapy. Surgery is also indicated to treat major complications such as gastrointestinal hemorrhage, perforation or gastric outlet obstruction.

Other symptoms include nervousness or irritability, fatigue or muscle weakness, feeling too hot, problems sleeping, shaky hands, a rapid and irregular heartbeat, diarrhea, and mood swings, the NIDDK says.

2. Persistent depressive disorder

Just as this condition can cause weight gain due to overeating, it can also cause weight loss due to undereating. If you’re grappling with this and other symptoms of persistent depressive disorder or depression, that’s definitely worth noticing.

3. Peptic ulcer disease

Like the condition above, this is on both lists because it can influence your eating habits in a number of ways. Some people find that eating actually makes the pain of peptic ulcers worse, Dr. Lowden says, so they might try to eat as little as possible and lose weight as a result.

4. Diabetes

You might already know that type 1 and type 2 diabetes happen when your blood sugar (glucose) levels are persistently too high, and that diabetes is often associated with obesity.

But diabetes can also cause weight loss, according to the Mayo Clinic, along with issues like increased thirst, peeing often, fatigue, blurry vision, and more. The weight loss comes into play if diabetes makes you pee frequently to get rid of excess sugar in your blood, which can also make you pee out calories, the Mayo Clinic explains.

5. Celiac disease

When you have celiac disease, eating gluten (a protein that’s found in wheat, barley, and rye) triggers a pretty gnarly immune response in your small intestine, according to the Mayo Clinic. Over time, this harms your small intestine’s lining and prevents absorption of nutrients, which can lead to weight loss.

This intestinal damage can also cause diarrhea, fatigue, bloating, anemia, and more, the Mayo Clinic says.

6. Dementia

This actually isn’t a condition, it’s a collection of symptoms. If someone has dementia, neurological changes compromise their ability to think, remember, and reason as well as they used to, the National Institute on Aging explains. So, if someone has a form of dementia such as Alzheimer’s disease, they’ll go through behavioral and personality changes, along with other potential issues like unintended weight loss.

“They may simply forget to eat,” Dr. LePort says. “It may not even register sometimes that they’re hungry, or they don’t know what to do to resolve the issue.” They may also experience reduced smell and taste, trouble swallowing, and distraction while eating, according to the Mayo Clinic—all of which can contribute to weight loss.

7. Inflammatory bowel disease

Oh, inflammatory bowel disease, what could anyone possibly have done to deserve you? Inflammatory bowel disease is a catch-all term for disorders that cause persistent inflammation in your GI system, the Mayo Clinic explains.

One of those disorders is Crohn’s disease. It causes hellish inflammation, typically in the last part of the small intestine and the colon, though it can affect any part of the GI tract, the Mayo Clinic explains. The inflammation frequently spreads deep into the layers of the bowel tissue. Then there’s ulcerative colitis, which is when you have inflammation and ulcers in the lining of your large intestine and rectum, the Mayo Clinic says.

Either type of inflammatory bowel disease can lead to symptoms like abdominal pain, severe and bloody diarrhea, fatigue, mouth sores, and a reduced appetite. Unsurprisingly, if you’re dealing with these symptoms, you’re probably going to lose weight, Dr. LePort explains.

8. Addison’s disease

This lesser-known disorder happens when your adrenal glands don’t produce enough of the hormones cortisol and aldosterone, the Cleveland Clinic says. These hormones influence almost every organ and tissue in your body, according to the Mayo Clinic, and signs that something’s up with them include abdominal pain, abnormal periods, cravings for salty foods, dehydration, depression, diarrhea, loss of appetite, nausea, sensitivity to cold, vomiting, and unexplained weight loss.

The weight loss occurs due to a portion of your adrenal glands called your cortex, the Mayo Clinic explains. The cortex is the outer layer of these glands, and it produces a group of hormones called corticosteroids. Corticosteroids include glucocorticoids, which influence your body’s ability to convert fuel from the food you eat into energy. Without sufficient glucocorticoids, your body has trouble properly utilizing the nutrients you eat, which can lead to weight loss. (As can the nausea, vomiting, and loss of appetite.)

So, when do you see a doctor about unexpected weight gain or loss?

It’s normal for your weight to fluctuate a bit from day to day, or even from morning to night. But a fluctuation that keeps you in a general weight range is different from persistent weight gain or loss over time. If that’s what you’re noticing, it’s time to head to a doctor. That’s especially true if you’re dealing with significant weight changes along with any of the above additional symptoms indicating that something’s wrong.

Related:

  • The Science on Weight and Health
  • Why Weight Loss Diets Fail
  • Nope, I’m Not Trying to Lose Weight

5. Peptic ulcer disease

Peptic ulcer disease is so awful you might cringe just reading about it. It happens when sores appear on the lining of the stomach or duodenum (the first part of the small intestine immediately beyond your stomach), the U.S. National Library of Medicine says.

Symptoms include pain that starts between meals or during the night, pain that pauses if you eat or take antacids, pain that lasts for minutes to hours, and pain that comes and goes for several days or weeks, the NIDDK says. You may also deal with uncomfortable bloating or burping, feeling sick to your stomach, vomiting, poor appetite, and weight loss.

“Peptic ulcer disease in and of itself does not lead to weight changes, but eating habits may change in an attempt to deal with the pain associated with peptic ulcer disease,” Elizabeth Lowden, M.D., a bariatric endocrinologist at Northwestern Medicine Regional Medical Group, tells SELF. “Some may find they overeat or eat more frequently as that helps with the abdominal pain,” which can lead to weight gain.

6. Cushing syndrome

This disorder occurs when your body makes too much of the hormone cortisol over a long period of time, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Although cortisol is notorious for driving up your stress, this hormone has other tasks on its docket, including regulating the way you metabolize food, the Mayo Clinic says. So, when you produce too much of it, it can interfere with your metabolism and cause you to gain weight, Peter LePort, M.D., a bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, California, tells SELF.

Beyond weight gain, symptoms of Cushing syndrome include deposits of fat-based tissue at the midsection, upper back, face, and between the shoulders, stretch marks due to rapid weight gain, thinning skin prone to bruising, increased body hair, irregular or missing periods, and more, according to the Mayo Clinic.

7. Congestive heart failure

This happens when your heart can’t pump enough blood to meet your body’s needs, the U.S. National Library of Medicine explains. As a result, blood and fluid can build up in your feet, ankles, and legs, which can cause swelling and rapid weight gain. Your abdomen may swell as well, (the Mayo Clinic says) says. Blood and fluid can also back up into your lungs, leading to fatigue and shortness of breath.

Other symptoms of congestive heart failure include a rapid or irregular heartbeat, a persistent cough or wheezing with white or pink phlegm, an increased need to pee at night, difficulty concentrating, and chest pain, according to the Mayo Clinic.

On the flip side, there are plenty of health conditions that could make you lose weight unexpectedly.

Sure, sometimes there’s a simple, non-concerning explanation for your weight loss. But if your lifestyle is the same and you’re still losing weight, it’s time to ask your doctor about whether or not you might have one of the following conditions.

1. Hyperthyroidism

As you might have guessed, hyperthyroidism is basically the opposite of hypothyroidism: Instead of your thyroid gland being underactive, it’s overactive. Having too much of those thyroid hormones circulating can kick your metabolism into overdrive and make you lose weight, Dr. LePort explains.

Other symptoms include nervousness or irritability, fatigue or muscle weakness, feeling too hot, problems sleeping, shaky hands, a rapid and irregular heartbeat, diarrhea, and mood swings, the NIDDK says.

2. Persistent depressive disorder

Just as this condition can cause weight gain due to overeating, it can also cause weight loss due to undereating. If you’re grappling with this and other symptoms of persistent depressive disorder or depression, that’s definitely worth noticing.

3. Peptic ulcer disease

Like the condition above, this is on both lists because it can influence your eating habits in a number of ways. Some people find that eating actually makes the pain of peptic ulcers worse, Dr. Lowden says, so they might try to eat as little as possible and lose weight as a result.

4. Diabetes

You might already know that type 1 and type 2 diabetes happen when your blood sugar (glucose) levels are persistently too high, and that diabetes is often associated with obesity.

But diabetes can also cause weight loss, according to the Mayo Clinic, along with issues like increased thirst, peeing often, fatigue, blurry vision, and more. The weight loss comes into play if diabetes makes you pee frequently to get rid of excess sugar in your blood, which can also make you pee out calories, the Mayo Clinic explains.

5. Celiac disease

When you have celiac disease, eating gluten (a protein that’s found in wheat, barley, and rye) triggers a pretty gnarly immune response in your small intestine, according to the Mayo Clinic. Over time, this harms your small intestine’s lining and prevents absorption of nutrients, which can lead to weight loss.

This intestinal damage can also cause diarrhea, fatigue, bloating, anemia, and more, the Mayo Clinic says.

6. Dementia

This actually isn’t a condition, it’s a collection of symptoms. If someone has dementia, neurological changes compromise their ability to think, remember, and reason as well as they used to, the National Institute on Aging explains. So, if someone has a form of dementia such as Alzheimer’s disease, they’ll go through behavioral and personality changes, along with other potential issues like unintended weight loss.

“They may simply forget to eat,” Dr. LePort says. “It may not even register sometimes that they’re hungry, or they don’t know what to do to resolve the issue.” They may also experience reduced smell and taste, trouble swallowing, and distraction while eating, according to the Mayo Clinic—all of which can contribute to weight loss.

7. Inflammatory bowel disease

Oh, inflammatory bowel disease, what could anyone possibly have done to deserve you? Inflammatory bowel disease is a catch-all term for disorders that cause persistent inflammation in your GI system, the Mayo Clinic explains.

One of those disorders is Crohn’s disease. It causes hellish inflammation, typically in the last part of the small intestine and the colon, though it can affect any part of the GI tract, the Mayo Clinic explains. The inflammation frequently spreads deep into the layers of the bowel tissue. Then there’s ulcerative colitis, which is when you have inflammation and ulcers in the lining of your large intestine and rectum, the Mayo Clinic says.

Either type of inflammatory bowel disease can lead to symptoms like abdominal pain, severe and bloody diarrhea, fatigue, mouth sores, and a reduced appetite. Unsurprisingly, if you’re dealing with these symptoms, you’re probably going to lose weight, Dr. LePort explains.

8. Addison’s disease

This lesser-known disorder happens when your adrenal glands don’t produce enough of the hormones cortisol and aldosterone, the Cleveland Clinic says. These hormones influence almost every organ and tissue in your body, according to the Mayo Clinic, and signs that something’s up with them include abdominal pain, abnormal periods, cravings for salty foods, dehydration, depression, diarrhea, loss of appetite, nausea, sensitivity to cold, vomiting, and unexplained weight loss.

The weight loss occurs due to a portion of your adrenal glands called your cortex, the Mayo Clinic explains. The cortex is the outer layer of these glands, and it produces a group of hormones called corticosteroids. Corticosteroids include glucocorticoids, which influence your body’s ability to convert fuel from the food you eat into energy. Without sufficient glucocorticoids, your body has trouble properly utilizing the nutrients you eat, which can lead to weight loss. (As can the nausea, vomiting, and loss of appetite.)

So, when do you see a doctor about unexpected weight gain or loss?

It’s normal for your weight to fluctuate a bit from day to day, or even from morning to night. But a fluctuation that keeps you in a general weight range is different from persistent weight gain or loss over time. If that’s what you’re noticing, it’s time to head to a doctor. That’s especially true if you’re dealing with significant weight changes along with any of the above additional symptoms indicating that something’s wrong.

Related:

  • The Science on Weight and Health
  • Why Weight Loss Diets Fail
  • Nope, I’m Not Trying to Lose Weight

When everything is flowing smoothly, life is good. And we’re not just talking good hair days or a flawless presentation at work. Your digestive tract counts too. But when it’s out of whack, it could affect — you guessed it — the scale.

“Gastrointestinal and digestive issues can definitely have a large effect on the way we eat and how our bodies absorb and digest foods, causing us to gain or lose weight,” says Kenneth Brown, M.D., a board-certified gastroenterologist. “Most digestive problems tend to cause weight loss from poor absorption of food, but there are a few situations in which our intestinal health can contribute to weight gain.”

If the number on the scale is changing and you really aren’t sure why, one of these common digestive issues could be the culprit.

1. Acid Reflux Disease

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Also known as gastroesophageal reflux disease (GERD), this causes a painful burning sensation, or heartburn, in the lower chest when stomach acid rises back up into your esophagus. And for people who suffer from it, the term “comfort food” takes on a whole new meaning because the act of eating can actually help reduce pain. “Eating provides temporary relief because both the food you’re eating, and the saliva from actually chewing that food, neutralizes acid,” explains Brown. The only problem? Once the food’s been digested, all the symptoms — bloating, nausea, and hiccups that won’t disappear — tend to come back, and they’re usually more aggressive because of rebound acid production. But because people want help, Brown says it’s easy to get sucked into a dangerous cycle of overeating that leads to weight gain.

The fix: While plenty of online sources say home remedies like apple cider vinegar or aloe vera can help, Brown says there’s no scientific evidence to support those notions. Instead, he recommends taking an over-the-counter medication, such as Prilosec or Zantac (your doctor can help you choose which is best for you), which don’t have weight gain as a common side effect. And if you still find yourself overeating, try these fixes to help break the cycle.

2. Ulcers

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These uncomfortable sores — also known as duodenal ulcers — usually develop in the lining of the stomach or small intestine, and it’s usually because of too much acid production. And just like with GERD, eating food can improve the painful symptoms — including bloat and constant nausea — because it temporarily coats the ulcer with a protective lining and neutralizes the stomach acid, explains Su Sachar, M.D., a board-certified gastroenterologist who specializes in bariatrics, wellness, and optimal health. And, to re-state the obvious, if you’re eating more frequently, those excess calories can lead to weight gain.

The fix: To banish ulcers, see your doctor about the best remedy for you, which might involve an acid-blocking medication — aka an anti-acid — like Prilosec or Zantec, says Sachar. And stop taking nonsteroidal anti-inflammatory drugs or NSAID pain relievers like ibuprofen or aspirin, as they could cause internal bleeding and be life-threatening to those with ulcers. Instead, opt for acetaminophen, or Tylenol, when you need help with pain management.

3. Constipation

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When you’re stopped up, that weighed-down feeling you get could be weight gain. But there’s good news: your body isn’t actually absorbing more calories, says Brown, so it’s not true weight gain so much as it is extra fecal matter, which is what could be adding a few pounds to the scale. Not to mention that constipation itself doesn’t exactly give us the motivation to hit the gym and crush a workout. Rather, it’s way more likely that you’re feeling sluggish and heavy… and the couch is calling your name.

The fix: To stay, err, regular, Brown suggests sticking to a balanced diet of whole foods that have at least 25 to 30 grams of fiber per day, staying well-hydrated (try to drink one to two liters of water per day), and exercise regularly. If something doesn’t seem quite right, look at these signs for what it could mean, and consider talking with your physician.

4. Bacteria Overgrowth

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Bear with us — this one isn’t quite as gross as it sounds. Basically, your bowel contains both good and bad bacteria, and research shows that the good kind plays a crucial role in your overall health by reducing inflammation and keeping your weight in check. The problem occurs when the amount of bacteria increases, or when the type of bacteria gets thrown off-balance. (For optimal health, it’s best to think of it like a seesaw — best when the good and bad is totally balanced.) When that happens, what’s known as small intestinal bacterial overgrowth (SIBO) can occur, and it can cause weight gain in two ways, says Brown.

First, the bacteria could produce methane gas, which “slows down the overall function of the small intestine, allowing the intestinal villi — small, finger-like projections in the lining of your intestine — to absorb more calories per bite,” he explains. In other words, the exact opposite of what you want to happen. Second, SIBO can slow down metabolism and affect your insulin and leptin resistance, both of which help regulate hunger and satiety. As a result, you’re likely to crave carbs and probably won’t feel full after eating, even if it’s a fully satisfying meal, says Sachar.

The fix: To avoid SIBO, Brown suggests avoiding antibiotics unless absolutely needed (as the name suggests, these medications kill off bacteria, which you only really want if you’re sick to get the seesaw back in balance). If bacteria overgrowth is already happening, though, your doctor may suggest a digestive herbal supplement like Atrantil to help you get back on track.

5. Irritable Bowel Syndrome (IBS)

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The term IBS gets tossed around a lot these days, as “it’s the most commonly diagnosed GI condition, and it often overlaps with other digestive problems like food sensitivities, a leaky gut, and an imbalance of good and bad bacteria,” says Sachar. And like constipation (a symptom of IBS), it can cause bloat and chronic inflammation, which, once again, could lead to weight gain.

The fix: For people who are diagnosed with IBS, it’s about getting to the root of the problem. Your doctor can work with you to build up the good bacteria you need with probiotics, and add digestive enzymes to help break down food so it’s not just sitting around in your gut causing inflammation, explains Sachar. Brown says it could be helpful to try a gluten-free or low gas-producing diet, like FODMAP, as it can help reduce bloating and help get any unnecessary weight gain under control.

6. Crohn’s Disease

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While a smaller appetite and excessive weight loss are common symptoms of Crohn’s disease — an incurable chronic inflammatory conditions — the exact opposite can happen as soon as someone gets put on a treatment that involves steroids, which is usually the first step in trying to find a medication that works for you, says Sachar.

“Steroids tend to increase your cravings for carbs and cause you to hold on to more water and feel bloated,” says Sachar.

Fortunately, it’s usually not too tough to lose the weight once you’re off steroids. That usually happens as soon as a flare-up — or the reappearance of symptoms like diarrhea, constipation, rectal bleeding, and fever — subside and symptoms are better under control.

The fix: First of all, your overall health is more important than a few pounds on the scale, so following your doctor’s orders is imperative. But some doctors do shy away from steroid use, like Brown, as he knows the side effects can be less than desirable. Every patient responds differently to medication, though, so talk with your own physician to see what works best for you.

7. Gastroparesis

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Often associated with those who have type 1 or type 2 diabetes, gastroparesis — also known as delayed gastric emptying — is a disorder that “slows or stops the movement of food from the stomach to the small intestine,” according to the National Institute of Diabetes and Digestive and Kidney Diseases. Because normal digestion isn’t able to occur, it’s common to feel like you’re gaining weight due to fullness and bloating in the stomach area, but the disorder most commonly leads to weight loss in the end.

The fix: According to the American College of Gastroenterology, diet is one of the most important factors in treating gastroparesis. Because fatty and fiber-filled foods take longer to digest, it’s recommended that anyone with the disorder limits or avoids those foods altogether. But since this is a serious condition, it’s best to speak with your doctor to see what the best treatment options are for you.

8. Food Intolerance

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If you’ve noticed your body is easily irritated by certain foods, there’s a good chance you have a food intolerance. Different from a food allergy, which is an immune system response, food intolerance affects the digestive system, making it hard to digest and break down certain foods (the most common being dairy), says the Cleveland Clinic. Those with a food intolerance often experience gas, cramps, and bloating, making it feel like they’re gaining weight. Depending on how severe the food intolerance is, they might also experience diarrhea.

The fix: While you might feel super bloated and uncomfortable throughout the day because of your diet, you might not actually be gaining weight. The Cleveland Clinic recommends avoiding or reducing the foods you think are giving you issues, and if you do end up eating something that bothers your stomach, take an antacid.

9. Ulcerative Colitis

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Although Crohn’s disease can pop up anywhere between the mouth and the anus, UCLA Health says ulcerative colitis stays in the colon, resulting in a constantly inflamed digestive tract that can initially lead to weight loss. Like Crohn’s, though, the treatment for the inflammatory bowel disease — steroids — could make your body gain weight.

“An oral steroid like Prednisone can also cause your body fat to redistribute itself, so instead of it being in your stomach or glutes, it could move to the face or neck,” says Sachar.

Even though you may notice a difference in your weight during treatment, everything should go back down to normal as soon as you’re able to get off the steroids.

The fix: After speaking to your doctor, find a treatment plan that’s right for you and the severity of your ulcerative colitis — one that may or may not involve steroids. While more moderate to severe forms might be treated with steroids, 5-aminosalicylates and immunosuppressant drugs are also options. Whatever you end up using, know your wellbeing is top priority. If that involves gaining a few pounds to better your health, it’s worth it.

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A higher BMI is associated with several different types of digestive symptoms, but most people tend to assume that either the weight itself causes the digestive problems, or that the root cause of both is a lousy diet.

But weight obviously isn’t the only cause of gastrointestinal problems (plenty of thin people have them), and gut symptoms can actually have causes that you might miss if you’re only looking at questions like “what foods irritate the gut?” or “What am I having trouble digesting?” Sometimes, it’s not quite as simple as “you need to eliminate __________.”

So here are some suggestions for what could be causing gut problems other than foods that directly irritate the gut, especially if you’re also having trouble with your weight. Thyroid disease and ENS dysfunction can affect digestive symptoms and weight at the same time. They’re both still food-related, but more complicated than just “something irritating the gut,” and they’re easy to miss if you’re not looking for them.

Digestive Symptoms, Weight Gain, and Thyroid Problems

This study went over all the ways that thyroid problems can cause digestive symptoms – some people with chronic digestive problems might not realize that what they actually have is a thyroid problem. The study went over the symptoms of overactive and underactive thyroid. To name a few of them:

Hyperthyroidism (overactive thyroid):

  • Trouble swallowing (dysphagia)
  • Gastritis
  • Vomiting
  • Pylori infection
  • Diarrhea
  • Lactose intolerance
  • Liver problems and hepatitis
  • Weight loss (or more rarely, weight gain)

Hypothyroidism (underactive thyroid):

  • Trouble swallowing (dysphagia)
  • Dyspepsia (chest/upper abdomen discomfort)
  • Low stomach acid (which can cause digestive and absorption problems)
  • Constipation
  • SIBO (bacterial overgrowth in the small intestine)
  • Symptoms of Irritable Bowel Syndrome (gas, bloating, constipation, and/or diarrhea)
  • Liver problems and hepatitis
  • Gallstones
  • Non-Alcoholic Fatty Liver Disease
  • Weight gain
  • Anemia

The study noted that many patients show up with only GI symptoms, and that their thyroid problems might fly under the radar – it’s just not very common for people to make the mental leap from “I can’t lose weight and my digestion really stinks” to “I must have a thyroid problem.”

Thyroid Disease and Celiac Disease

And one more thing from that study: autoimmune thyroid disease is associated with much higher rates of Celiac Disease than in the general population. People with Celiac Disease also have much higher rates of autoimmune thyroid disorders than healthy people. There may be a common genetic link between the two diseases. The study claims that malabsorptive digestive diseases, like Celiac Disease, are one of the most common reasons why patients might have hypothyroidism that doesn’t respond to treatment.

That points to a huge tangle of gut-weight issues: someone could have Celiac symptoms and try to treat them with a gluten-free diet, but not realize they also have a thyroid problem causing both weight gain and digestive problems. But if you even suspect this might be you, ask your doctor, not the internet.

Digestive Symptoms, Weight Gain, and ENS Problems

Another problem that might be behind digestive symptoms and weight gain (or trouble losing weight) is something damaging the enteric nervous system. The enteric nervous system (ENS for short) is the network of nerves in your gut, or your “gut brain.”

The ENS controls the movement of food through the small intestine, secretion of digestive enzymes, and pain perception. Damage to the ENS can cause diarrhea, constipation, maldigestion, nausea, and/or chronic digestive pain. Causing constipation could then go on to cause SIBO and other gut problems further down the line. Problems with a particular type of ENS cells, called glial cells, can also affect Inflammatory Bowel Disorder and other types of gut inflammation.

ENS dysfunction is connected to weight, but it’s not necessarily because the ENS problems themselves cause weight gain. It’s that some of the same issues that make it hard to lose weight can also damage the ENS, so both problems (digestive and weight symptoms) might be reflecting the same root cause, often something more complicated than one particular food that you are or aren’t eating. Just to name two examples:

  • Psychological stress. If you’re already familiar with the gut-brain axis, you know that your mood and psychological well-being have all kinds of effects on gut health. The brain in your head “talks” to the nervous system in your gut through the vagus nerve, and long-term problems like psychological stress can significantly affect GI symptoms. Just to take one example, guess what’s associated with bloating and IBS symptoms in general among women? Psychological stress. In general, chronic stress signals from the brain slow digestion and can cause constipation (although acute stress signals can cause diarrhea). GABA, a neurotransmitter involved in anxiety, also has significant effects on gut motility and function.
  • Diabetes and high blood sugar. High blood sugar can damage the ENS in the same way it damages any other nerves, and gastrointestinal problems are actually one of the major symptoms of diabetes. Damage to the ENS can cause diarrhea and/or constipation. High blood sugar also makes motion sickness worse.

Many of the things that damage the ENS are also strongly linked to weight gain. Chronic stress can wreck your metabolism faster than you can say “I just don’t have time to sleep these days.” Diabetes and high blood sugar are both pretty obvious candidates for reasons why weight loss might be difficult. There are also other diseases that can damage the ENS, like Parkinson’s disease and HIV, but these are more typically connected to uncontrolled weight loss than uncontrolled weight gain.

So if you’re struggling to lose weight and also having trouble with digestion, try thinking about your stress and blood sugar levels before embarking on a 30-day trial of a combined AIP/low-FODMAP/low-histamine/low-salicylate diet. It might get you further.

Summing it Up

All of this is interesting, because it suggests some reasons behind chronic gut symptoms that go beyond “you ate the wrong thing, and now your gut is unhappy.” For some people, that’s really how it works (you have lactose intolerance, but you stop eating dairy, and now your gut is happy again). But for other people, chronic digestive trouble + slow weight loss could indicate a problem that started outside the gastrointestinal system, and the solution might be a little more than just eliminating particular foods or taking particular supplements.

Instead of looking for more and more foods to restrict, it might be worthwhile to consider a different cause, especially if you’re struggling with your weight as well as your digestion. Thyroid function and ENS dysfunction are both related to weight problems as well as gastrointestinal symptoms. And both of them are related to food and diet, but it’s not as simple as “eliminate this.”

Colon cancer risk factors

  • Unexplained nausea and/or vomiting. If you are experiencing nausea and vomiting accompanied by absence of stools or diarrhea.
    Why: this may indicate intestinal obstruction but not necessarily related to a tumor.

  • Severe anemia and/or fatigue. If you are affected by chronic fatigue and/or severe anemia.
    Why: blood loss, malnutrition, metastases affecting the liver and many other factors.

  • Unexplained sexual urge, urinal obstruction. If you are a man and experience a continuous sexual urge or have unexplained difficulty urinating.
    Why: a tumor may be putting pressure on the prostate gland, bladder and/or urethra.

  • PMS-like symptoms. If you are a woman and experience PMS-like abdominal cramps, particularly past menopause.
    Why: a tumor may be putting pressure on the genitourinary organs located in the same abdominal cavity.

  • Abdominal wall stiffness. If your abdominal wall suddenly becomes stiffer, as if you‘ve been exercising your abs.
    Why: it may indicate tumor growth, colon obstruction, metastases or ascites — the accumulation of fluid in the peritoneal cavity caused by cancer. Also may suggest ovarian cancer.

  • Unexplained weight gain. If you are gradually gaining weight without any changes in diet.
    Why: extra weight may reflect intestinal obstruction caused by the overgrown tumor, and/or ascites (accumulation of fluids in peritoneal cavity, not necessary related to colon cancer.)

  • Unexplained weight loss. If you begin losing weight without any changes in diet.
    Why: the liver may be affected by a cancer, and is unable to assimilate dietary fat, protein, and carbohydrates, or a tumor itself may cause protein and fat wasting.

  • Keep in mind that some or all of the above symptoms may also accompany genitourinary cancers and some other conditions. This seems like a lot of reasons, and it is. If you wish to avoid them — and most people under 50 easily can — study and follow recommendations in this section, on this site, and in Fiber Menace.

    IBS and Weight Gain – What you Need to know

    There’s nothing fun about living life with Irritable Bowel Syndrome (IBS).

    Not only can IBS cause weight gain (sometimes significant weight gain, at that), but it’s also going to make you feel bloated, make you feel sluggish and fatigued, because you to visit the bathroom a lot more frequently than you’re likely comfortable with – and that’s just the tip of the iceberg.

    Worse, getting IBS under control can feel like a real uphill battle as well. It isn’t all that uncommon to feel like you are a little bit behind the eight ball when it comes to keeping your IBS in check.

    Finding a way to tackle IBS and weight gain issues is a big piece of the puzzle to helping you regain a little bit of your health and happiness. Let’s dig right in.

    What is IBS?

    Irritable Bowel Syndrome (IBS) is defined as a medical condition that causes individuals to experience and contend with gastrointestinal issues on a pretty much everyday basis.

    These issues can include (but certainly are not limited to):

    • Bloating
    • Constipation
    • Diarrhea and Nausea
    • Gas and Stomach Discomfort
    • Stomach Cramps and Pain

    … And that’s just the tip of the iceberg!

    It’s also not uncommon for IBS to range from something rather mild that can be ignored for the most part to issues so severe that you have to know where the bathroom is located everywhere you go, and carefully plot your course to the bathroom in the event of an emergency situation every time you find yourself somewhere new.

    Interestingly enough, unlike other gastrointestinal issues (including ulcerative colitis and Crohn’s disease) it’s very unlikely that you’re going to contend with IBS and weight loss issues as opposed to weight gain problems.

    Gaining Weight with IBS

    According to information published by the Cleveland Clinic, IBS is one of the most commonly diagnosed gastrointestinal disorders that attacks the normal function of our GI tract. As many as 20% of all adults in the United States today have reported living with symptoms linked to IBS on a constant or chronic basis.

    And while the root causes that trigger IBS remain unknown for the most part researchers have discovered that it’s a lot less likely to lose weight when you are dealing with IBS and instead much more likely to put on weight – which is the reverse of what usually happens when you’re gastrointestinal tract is under attack.

    New research indicates that there is a very close link between the hormones that regulate our weight being produced inside of our digestive tract. That means that when IBS is active and messing with normal gastrointestinal operations these hormones are triggered differently than they would have been while you are healthy.

    This creates a lot more body fat, maintains body fat even the face of regular dieting and exercise, and makes biochemical changes throughout the body that can really make losing weight rather difficult.

    Losing Weight with IBS

    The best way to lose weight while living with IBS is to attack it from a daily diet standpoint.

    For starters, you’ll want to try and eat a little more fiber than you likely are already. People with IBS can be a little gun shy about adding extra fiber to their diet just because it may cause more gas and worsened IBS symptoms.

    But as long as you slowly add between 2 g and 3 g of fiber to your daily diet (with plenty of water consumed at the same time) you should be able to minimize gas and bloating while at the same time improve your digestive capabilities – helping you lose weight by shuttling waste out of your body more efficiently.

    It’s also a good idea to cut back on your overall caloric intake when you’re trying to lose weight with IBS.

    Diet Plans for IBS Sufferers

    Higher protein, lower carbohydrate, and moderate dietary fat diets can work wonders on IBS. Something like the paleo diet has been described as the best weight loss diet for IBS sufferers.

    You do want to make sure that you cut down the amount of dietary fat you’re taking with this dietary approach, however, as to much dietary fat on a daily basis can make your IBS symptoms even worse.

    Fruit, lactose-free dairy products, lean proteins, and plenty of vegetables are the way to go. You’ll get all of the nutrients you need to fuel your body without adding any “IBS triggers” to your daily intake.

    You’ll also be able to keep your calorie count low while still feeling full throughout the day, helping you increase your overall metabolic activity so that you melt fat around-the-clock.

    At the end of the day, figuring out how to master IBS weight loss is always going to be a bit of a cat and mouse kind of game.

    You’re going to have to try different foods, see how you react, and then try different options – or different quantities – over a couple of months to see what triggers the best weight loss results.

    Can IBS cause weight gain?

    You bet it can!

    But armed with the inside information we highlighted above (and a little bit of tinkering with your daily diet and exercise routines) and you’ll never have to worry about any of that extra weight gain becoming permanent.

    You’ll be able to melt it off faster than you ever thought possible all while still enjoying most of your favorite foods and snacks along the way!

    Can Digestive Health Conditions Make It Hard to Lose Weight?

    Everyday Health: It makes sense that there are connections between digestive health and weight loss because some digestive conditions cause people to unintentionally lose weight. Are there any digestive health conditions that actually make it more difficult to lose weight?

    Mark Babyatsky, MD (mssm.edu)

    While most gastrointestinal (digestive health) conditions are associated with weight loss, a notable exception includes severe liver disease and liver cirrhosis. In severe liver disease, patients can look very thin but gain weight because the liver normally makes an important protein known as albumin. As liver disease progresses, it can no longer make much albumin. Since albumin keeps water and other liquids in the bloodstream, its loss results in leaking of fluid from the blood to the belly and legs, causing these parts of the body to increase in size, sometimes by a lot. Even though advanced liver patients appear very ill along with thin faces and arms, they actually gain weight due to the fluid in the legs and abdomen. While weight gain is rare, some patients with duodenal ulcers receive relief by eating more to neutralize the acid made by their stomach, although this appetite rarely leads to weight gain.

    Kenneth Brown, MD (kennethbrownmd.com)

    Most digestive problems tend to cause a loss of weight from poor absorption of food, but there are a few situations in which our intestinal health can contribute to weight gain. One problem that I frequently see is when an individual has acid reflux or even an ulcer, they tend to eat frequently to decrease the pain temporarily. The pain briefly is alleviated as both the saliva and food neutralize the acid temporarily, but once the food is digested there is even more pain from rebound acid production.

    Another very intriguing area of research is the role of small bowel bacterial overgrowth (SIBO) possibly contributing to weight gain, due to the production of methane gasses which may slow the motility down and ultimately lead to more absorption of calories. There are studies underway now looking into the role of bacterial manipulation for potential weight loss.

    Christine M. Esters (adventureinwellbeing.com)

    Weight gain is an accumulation of toxins in certain organs. Toxic colon is the first place to cleanse since our colon is our sewage system. The second organ to cleanse is the liver, which is filtering fat soluble toxins, and the third organ is our kidneys that eliminate water soluble toxins. Disease related to colon, like constipation, candida, parasites, heavy metal or related to liver or related to kidney make losing weight difficult to impossible.

    Lisa Ganjhu, DO (wehealnewyork.org)

    Losing weight for the most part is really basic math. In order to lose weight you have to burn more calories than you consume. There really aren’t any digestive disorders that make losing weight difficult. Actually since the digestive tract is responsible for getting nutrients from food, disorder in the digestive tract may cause malnutrition and weight loss. There are certain endocrine disorders that make weight loss difficult. The main reason people gain weight is that they eat too much and exercise too little.

    Lisa Pichney, MD (stopcoloncancernow.com)

    Digestive conditions such as Crohn’s disease or ulcerative colitis are often treated with steroids; steroid use can cause weight gain. Also, patients with GERD (gastroesophageal reflux disease) or PUD (peptic ulcer disease) often feel better when there is food in their stomach to soak up excess acid. This sometimes results in patients feeding their disease and therefore weight gain can result. The added weight can also contribute to worsening of reflux.

    Sutha Sachar, MD (susacharmd.com)

    A lot of people confuse abdominal distension from bloating as fat. The reality is that there are certain causes of bloating, such as lactose intolerance, celiac sprue, food allergies, irritable bowel syndrome, and small intestinal bacterial overgrowth which make an individual feel as if they can’t lose the weight even though they may be. Seeing a gastroenterologist who specializes in bloating can rule out these causes and optimize body image and comfort.

    Albert Snow, ND (holisticgastroenterology.com)

    Yes, that can essentially be true about any inflammatory bowel condition — such as IBS or colitis. What all of those conditions have in common is that the sufferer has had antibiotics. This medication destroys the mucosal lining in that gut, which I call the “software” (the “hardware” being the flesh that makes up the GI tract). This software is what identifies which food group you have swallowed and the calories within it. Without the mucosal lining your digestion will not work properly and therefore not process calories properly. This is the most fundamental cause of weight gain: mismanagement of calories. Everything else that we do wrong regarding food and exercise is compounded by the lack of this fundamental principle. That is why so many efforts to manage weight appear to be futile. Conversely, replace the “software,” process calories better, lose weight. This is something that should get everyone’s attention. Having a healthy, well — developed mucosal lining will not only prevent IBD (irritable bowel disease) but will also allow you to eat rich foods and not gain weight. It is nature’s “erasure,” managing our mistakes, including poor diet, by keeping our pH level at a perfect 6.5. My version is the probiotic diet.

    AA Starpoli, MD (starpoli.com)

    I would consider depression, iatrogenic causes (those effects of certain medications taken by a patient), and hypothyroidism (low thyroid function) as causes of weight gain.

    William Chey, MD (med.umich.edu)

    I am not aware of any common GI problems that cause patients to gain weight. Ironically, successfully treating a number of common GI problems can be associated with unintended weight gain. For example, patients with gastroesophageal reflux disease (acid reflux) or irritable bowel syndrome (IBS) will often gain weight after food — related symptoms like heartburn, abdominal pain, diarrhea, and constipation are improved with appropriate therapy. In addition, the use of certain medications such as antidepressants can stimulate appetite and lead to weight gain.

    Jacqueline Wolf, MD (drjacquelinewolf.com)

    Medications used for digestive health conditions can have a major impact on one’s weight. Anyone who is taking corticosteroids (prednisone, prednisolone) will find it hard to lose weight and usually will gain weight. Corticosteroids are given for conditions such as ulcerative colitis, Crohn’s disease, and autoimmune liver disease. The weight gain is both water weight and absolute weight. It causes the face to balloon out and weight gain around the abdomen. Those on this medication usually don’t see the effects reversed until they are on a very low dose of or even off the medication for several months.

    Other medications used for digestive conditions may make it more difficult to lose weight or cause someone to gain weight. These include the SSRIs and the tricyclic antidepressant medications (amitriptyline, nortriptyline, desipramine) used in irritable bowel syndrome or hormones used for endometriosis.

    Patients who have a low albumin (malabsorption or problems with the lymphatics) or liver disease may get fluid in their legs or abdomen that may be difficult to lose.

    If you asked 10 people with acid reflux disease why they have GERD symptoms, 9 of them would tell you it’s too much acid in the stomach. That is not only wrong but also it is a dangerous misconception that leads to risky treatment decisions. The only reason for GERD symptoms is due to a weakened or damaged lower esophageal sphincter (LES), which has lost it ability to provide a barrier between the stomach and the esophagus. So let’s look at how the LES gets damaged in the first place resulting in GERD symptoms.

    The lower esophageal sphincter

    In an article titled; What causes heartburn? The role of the LES, we describe the LES and its role in detail. Basically, it is a band of muscles located slightly above the point where the esophagus connects with the stomach. Its basic function is to remain closed until called to open during swallowing – then it opens momentarily. For most adults, this involuntary band of muscles functions without any thought and very reliably. The image below, courtesy of the National Institute of Health, Patient Information on Acid Reflux, illustrates the lower esophageal sphincter and its location relative to the diaphragm and the stomach.

    What is the role of stomach acid?

    Stomach acid is not only normal but also essential for good digestion. Dr. Para Chandrasoma wrote a very good article on stomach acid titled; Reflux myths: Excess stomach acid causes GERD. In some unusual conditions that result in overproduction of stomach acid (Zollinger-Ellison syndrome) or underproduction of acid, the symptoms are typically severe inflammation of the stomach lining, abdominal pain, nausea, or stomach ulcers. As Dr. Chandrasoma highlights at the end of his article, GERD is ONLY a result of a damaged or weakened lower esophageal sphincter.

    If acid does not cause GERD, why do doctors always recommend PPIs?

    Acid does not cause GERD, but it is the primary factor in GERD symptoms. When the lower esophageal sphincter is compromised, the highly acidic stomach contents may reach the esophagus resulting in heartburn. PPI medications stop the production of acid, thus making the stomach contents less acidic and reducing or eliminating heartburn. Many PPI users believe the drug has cured their disease, but the reality is that only their symptoms are masked by the medication. Reflux continues and GERD can progress to more serious complications.

    How does the lower esophageal sphincter become damaged?

    For a specific individual that is a difficult question to answer, however, when we look at the entire adult population, research has determined that the primary driver is being excessively overweight (BMI between 27 and 30), or obese (BMI of 30 or higher). For some, it could be due to frequently eating large meal portions, a hiatal hernia, use of certain medications, pregnancy, smoking, excessive use of alcohol, or a combination of these factors. However, the research on excessive weight and obesity is very clear – it is the driver of both GERD and the progression of more serious complications.

    How does excessive weight or obesity cause GERD?

    Doctors Para Chandrasoma MD and Tom DeMeester, in their definitive work on this disease, GERD; Reflux to Esophageal Adenocarcinoma, discuss how enlarging the stomach, either through frequent overeating or due to obesity, results in a shorter and weaker lower esophageal sphincter. They note that a normal, healthy LES is 3 to 5 cm, and as this muscle band becomes shorter, it becomes weaker. Dr. Chandrasoma described this process using the example of a balloon:

    “It is important to understand what shortening of the sphincter means. Where does the shortened part of the sphincter go? The mechanism is best illustrated by taking a standard round balloon where the long neck is the sphincter and the collapsed part is the empty stomach. As the balloon is blown up, the collapse part fills to capacity; there is little resistance to this phase of filling because there is no significant pressure increase. This is the equivalent of a normal meal and illustrates the reservoir function of the stomach. When air is blown in excess of this its capacity, the balloon distends and pressure increases, the neck shortens by a mechanism in which the most distal part of the neck is “taken up” into the contour of the throat to an extent that is directly related to the amount of the distension. Anyone who has blown up a balloon will remember how the neck of the balloon shortens as the balloon distends. The neck has not disappeared, it is now part of the contour of the distended part of the balloon.”

    As the stomach distends, it pulls that portion of the LES down and into the stomach. If this is done often enough, or for those excessively overweight or obese, the damage can result in more frequent and severe symptoms. More importantly, this damage is irreversible; the LES cannot return to its former strength.

    Does research support this connection between excessive weight and GERD?

    Q1: Does stomach distention shorten the LES resulting in a weaker muscle?

    One research study measured the length and strength of the LES before and after gastric distension via pumping air into the stomach. The study confirmed a reduction of the LES from 4.0 cm to 2.6 cm after infusing 750 ccs of air, and a loss in the strength (pressure) of the LES from 27.4 to 23.4 mm Hg.

    Q2: Is BMI a good indicator to measure the risk of GERD?

    The NIH published a paper titled; Association between body mass index and GERD symptoms in both normal weight and overweight women, the researchers concluded: “In summary, our findings suggest that, beyond being overweight or obese, the risk of GERD symptoms rises progressively with increasing BMI, even among normal weight individuals. This appears true for all degrees of symptom severity and duration, as well as for nocturnal symptoms. Notably, weight loss was associated with a decreased risk of symptoms.”

    Q3: Is BMI a factor in disease progression and esophageal cancer?

    A research article by Hashem El-Serag MD MPH titled The Association Between Obesity and GERD: A Review of the Epidemiological Evidence, the connection between excessive weight and GERD was clear and convincing: “This meta-analysis indicated that obesity was associated with a significant 1.5- to 2-fold increase in the risk of GERD symptoms and erosive esophagitis, and a 2- to 2.5-fold increase in the risk of esophageal adenocarcinoma as compared to individuals with normal BMI.”

    Q4: Is losing weight a strategy to reducing symptoms?

    An article published in the peer-reviewed Journal of Gastroenterology and Hepatology quoted a study by researchers (also published in the NEJM) stated: “ …losing approximately 10–15 pounds decreases the occurrence of frequent heartburn by approximately 40%.

    What is the healthy and safe path to reduced GERD symptoms?

    We know that the current status quo treatment for daily long-term use of PPIs for some may be necessary, but for many, these medications represent a substantial risk. Research has proven that anyone who is excessively overweight or obese should immediately focus on weight loss as the top priority. Even for those who have gained a few extra pounds, achieving a healthy BMI can have a noticeable positive impact. Our recommendation for anyone in the early stages of acid reflux disease is as follows:

    BMI

    Description

    Recommendation

    24 or less Normal

    GERD-friendly meals, lifestyle changes, less powerful antireflux medications as necessary.

    24.1 to 26.9 Overweight GERD-friendly meal plan, lifestyle changes, less powerful antireflux medications as necessary, and moderate weight loss as presented in Recipe for Relief.
    27 to 29.9 Excessively overweight In addition to the above, aggressive weight loss as presented in Scale Down for Relief.
    30 or higher Obese

    Immediate aggressive weight loss as presented in Scale Down for Relief or bariatric surgery for those with a BMI over 35.

    Check your BMI now – for the NIH BMI calculator

    Don’t delay – start down your path to relief and good health today

    If you have an elevated BMI and you have been diagnosed with GERD, the clock is running. This is a progressive disease that will not improve unless you take action. YOU are the primary factor that will determine your health, and your quality of life, tomorrow. If you want to learn more about what you can do, learn about Scale Down for Relief. There you can or even set up a time for us to call you to discuss our programs in more detail. Don’t wait – do it now!

    GERD (Gastroesophageal Reflux Disease) in Children

    What is GERD in children?

    GERD, or gastroesophageal reflux disease, is a long-term (chronic) digestive disorder. It happens when stomach contents flow back up (reflux) into the food pipe (esophagus) and cause symptoms or problems.

    GERD is a more serious and long-lasting form of gastroesophageal reflux (GER).

    GER is common in babies under 2 years old. Most babies spit up a few times a day during their first 3 months. GER does not cause any problems in babies. In most cases, babies outgrow this by the time they are 12 to 14 months old.

    It is also common for children and teens ages 2 to 19 to have GER from time to time. This doesn’t always mean they have GERD.

    When GER becomes GERD

    Your baby, child, or teen may have GERD if:

    • Your baby’s symptoms prevent him or her from feeding. These symptoms may include vomiting, gagging, coughing, and trouble breathing.

    • Your baby has GER for more than 12 to 14 months

    • Your child or teen has GER more than 2 times a week, for a few months

    What causes GERD in a child?

    GERD is often caused by something that affects the LES, the lower esophageal sphincter. The LES is a muscle at the bottom of the food pipe (esophagus). The LES opens to let food into the stomach. It closes to keep food in the stomach. When the LES relaxes too often or for too long, stomach acid flows back into the esophagus. This causes vomiting or heartburn.

    Everyone has reflux from time to time. If you have ever burped and had an acid taste in your mouth, you have had reflux. Sometimes the LES relaxes at the wrong times. Often your child will just have a bad taste in his or her mouth. Or your child may have a short, mild feeling of heartburn.

    Babies are more likely to have a weak LES. This makes the LES relax when it should stay shut. As food or milk is digesting, the LES opens. It lets the stomach contents go back up to the esophagus. Sometimes the stomach contents go all the way up the esophagus. Then the baby or child vomits. In other cases, the stomach contents only go part of the way up the esophagus. This causes heartburn or breathing problems. In some cases there are no symptoms at all.

    Some foods seem to affect the muscle tone of the LES. They let the LES stay open longer than normal. These foods include:

    • Chocolate

    • Peppermint

    • High-fat foods

    Other foods can bring on symptoms because they are acidic. These foods include:

    • Citrus foods

    • Tomatoes and tomato sauces

    Other things that may lead to GERD include:

    • Being obese

    • Medicines, including some antihistamines, antidepressants, and pain medicines

    • Being around secondhand smoke

    Which children are at risk for GERD?

    GERD is very common during a baby’s first year of life. It often goes away on its own. Your child is more at risk for GERD if he or she has:

    • Down syndrome

    • Neuromuscular disorders such as muscular dystrophy and cerebral palsy

    What are the symptoms of GERD in a child?

    Heartburn, or acid indigestion, is the most common symptom of GERD. Heartburn is described as a burning chest pain. It begins behind the breastbone and moves up to the neck and throat. It can last as long as 2 hours. It is often worse after eating. Lying down or bending over after a meal can also lead to heartburn.

    Children younger than age 12 will often have different GERD symptoms. They will have a dry cough, asthma symptoms, or trouble swallowing. They won’t have classic heartburn.

    Each child may have different symptoms. Common symptoms of GERD include:

    • Burping or belching

    • Not eating

    • Having stomach pain

    • Being fussy around mealtimes

    • Vomiting often

    • Having hiccups

    • Gagging

    • Choking

    • Coughing often

    • Having coughing fits at night

    Other symptoms may include:

    • Wheezing

    • Getting colds often

    • Getting ear infections often

    • Having a rattling in the chest

    • Having a sore throat in the morning

    • Having a sour taste in the mouth

    • Having bad breath

    • Loss or decay of tooth enamel

    GERD symptoms may seem like other health problems. Make sure your child sees his or her healthcare provider for a diagnosis.

    How is GERD diagnosed in a child?

    Your child’s healthcare provider will do a physical exam and take a health history. Other tests may include:

    • Chest X-ray. An X-ray can check for signs that stomach contents have moved into the lungs. This is called aspiration.

    • Upper GI series or barium swallow. This test looks at the organs of the top part of your child’s digestive system. It checks the food pipe (esophagus), the stomach, and the first part of the small intestine (duodenum). Your child will swallow a metallic fluid called barium. Barium coats the organs so that they can be seen on an X-ray. Then X-rays are taken to check for signs of sores or ulcers, or abnormal blockages.

    • Endoscopy. This test checks the inside of part of the digestive tract. It uses a small, flexible tube called an endoscope. It has a light and a camera lens at the end. Tissue samples from inside the digestive tract may also be taken for testing.

    • Esophageal manometry. This test checks the strength of the esophagus muscles. It can see if your child has any problems with reflux or swallowing. A small tube is put into your child’s nostril, then down the throat and into the esophagus. Then it measures the pressure that the esophageal muscles make at rest.

    • pH monitoring. This test checks the pH or acid level in the esophagus. A thin, plastic tube is placed into your child’s nostril, down the throat, and into the esophagus. The tube has a sensor that measures pH level. The other end of the tube outside your child’s body is attached to a small monitor. This records your child’s pH levels for 24 to 48 hours. During this time your child can go home and do his or her normal activities. You will need to keep a diary of any symptoms your child feels that may be linked to reflux. These include gagging or coughing. You should also keep a record of the time, type of food, and amount of food your child eats. Your child’s pH readings are checked. They are compared to your child’s activity for that time period.

    • Gastric emptying study. This test is done to see if your child’s stomach sends its contents into the small intestine properly. Delayed gastric emptying can cause reflux into the esophagus.

    How is GERD treated in a child?

    Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

    Diet and lifestyle changes

    In many cases, diet and lifestyle changes can help to ease GERD. Talk with your child’s healthcare provider about changes you can make. Here are some tips to better manage GERD symptoms.

    For babies:

    • After feedings, hold your baby in an upright position for 30 minutes.

    • If bottle-feeding, keep the nipple filled with milk. This way your baby won’t swallow too much air while eating. Try different nipples. Find one that lets your baby’s mouth make a good seal with the nipple during feeding.

    • Adding rice cereal to feeding may be helpful for some babies.

    • Burp your baby a few times during bottle-feeding or breastfeeding. Your child may reflux more often when burping with a full stomach.

    For children:

    • Watch your child’s food intake. Limit fried and fatty foods, peppermint, chocolate, drinks with caffeine such as sodas and tea, citrus fruit and juices, and tomato products.

    • Offer your child smaller portions at mealtimes. Add small snacks between meals if your child is hungry. Don’t let your child overeat. Let your child tell you when he or she is hungry or full.

    • If your child is overweight, contact your child’s provider to set weight-loss goals.

    • Serve the evening meal early, at least 3 hours before bedtime.

    Other things to try:

    • Ask your child’s provider to review your child’s medicines. Some may irritate the lining of the stomach or esophagus.

    • Don’t let your child lie down or go to bed right after a meal.

    • Always check with your baby’s provider before raising the head of the crib if he or she has been diagnosed with gastroesophageal reflux. Place all babies, including babies with GERD, on their backs for all sleeping until they are 1-year-old. This is for safety reasons and to reduce the risk for SIDS and other sleep-related infant deaths.

    Medicines and other treatments

    Your child’s healthcare provider may also recommend other options.

    Medicines. Your child’s provider may prescribe medicines to help with reflux. There are medicines that help reduce the amount of acid the stomach makes. This reduces the heartburn linked to reflux. These medicines may include:

    • H2-blockers. These reduce the amount of acid your stomach makes by blocking the hormone histamine. Histamine helps to make acid.

    • Proton pump inhibitors. These help keep your stomach from making acid. They do this by stopping the stomach’s acid pump from working.

    The provider may prescribe another type of medicine that helps the stomach empty faster if it’s clear that your child has a stomach-emptying delay. If food doesn’t stay in the stomach as long as normal, reflex may be less likely to occur.

    Calorie supplements. Some babies with reflux can’t gain weight because they vomit often. If this is the case, your child’s healthcare provider may suggest:

    • Adding rice cereal to baby formula

    • Giving your baby more calories by adding a prescribed supplement

    • Changing formula to milk- or soy-free formula if your baby may have an allergy

    Tube feedings. In some cases tube feedings may be recommended. Some babies with reflux have other conditions that make them tired. These include congenital heart disease or being born too early (premature). These babies often get sleepy after they eat or drink a little. Other babies vomit after having a normal amount of formula. These babies do better if they are constantly fed a small amount of milk. In both of these cases, tube feedings may be suggested. Formula or breastmilk is given through a tube that is placed in the nose. This is called a nasogastric tube. The tube is then put through the food pipe or esophagus, and into the stomach. Your baby can have a tube feeding in addition to a bottle feeding. Or a tube feeding may be done instead of a bottle feeding. There are also tubes that can be used to go around, or bypass, the stomach. These are called nasoduodenal tubes.

    Surgery. In severe cases of reflux, surgery called fundoplication may be done. Your baby’s provider may recommend this option if your child is not gaining weight because of vomiting, has frequent breathing problems, or has severe irritation in the esophagus. This is often done as a laparoscopic surgery. This method has less pain and a faster recovery time. Small cuts or incisions are made in your child’s belly. A small tube with a camera on the end is placed into one of the incisions to look inside. The surgical tools are put through the other incisions. The surgeon looks at a video screen to see the stomach and other organs. The top part of the stomach is wrapped around the esophagus. This creates a tight band. This strengthens the LES and greatly decreases reflux.

    What are the complications of GERD in a child?

    Some babies and children who have GERD may not vomit. But their stomach contents may still move up the food pipe (esophagus) and spill over into the windpipe (trachea). This can cause asthma or pneumonia.

    The vomiting that affects many babies and children with GERD can cause problems with weight gain and poor nutrition. Over time, when stomach acid backs up into the esophagus, it can also lead to:

    • Inflammation of the esophagus, called esophagitis

    • Sores or ulcers in the esophagus, which can be painful and may bleed

    • A lack of red blood cells, from bleeding sores (anemia)

    Adults may also have long-term problems from inflammation of the esophagus. These include:

    • Narrowing, or stricture, of the esophagus

    • Barrett’s esophagus, a condition where there are abnormal cells in the esophageal lining

    How can I help my child live with GERD?

    Many babies who vomit outgrow it by the time they are about 1 year old. This happens as the LES gets stronger. For other children, taking medicines and making lifestyle and diet changes can reduce reflux, vomiting, and heartburn.

    When should I call my child’s healthcare provider?

    Call you child’s healthcare provider if your baby or child:

    • Has reflux and is not gaining weight

    • Has signs of asthma or pneumonia. These include coughing, wheezing, or trouble breathing.

    • Has vomiting that continues or is vomiting blood

    Key points about GERD in children

    • GERD is a long-term (chronic) digestive disorder.

    • It happens when stomach contents come back up into the food pipe (esophagus).

    • Heartburn or acid indigestion is the most common symptom of GERD.

    • Vomiting can cause problems with weight gain and poor nutrition.

    • In many cases, GERD can be eased by diet and lifestyle changes.

    • Sometimes medicines, tube feedings, or surgery may be needed.

    Next steps

    Tips to help you get the most from a visit to your child’s healthcare provider:

    • Know the reason for the visit and what you want to happen.

    • Before your visit, write down questions you want answered.

    • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.

    • Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.

    • Ask if your child’s condition can be treated in other ways.

    • Know why a test or procedure is recommended and what the results could mean.

    • Know what to expect if your child does not take the medicine or have the test or procedure.

    • If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

    • Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.

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