Quit Your Belly Aching (page 2 of 3)

Everybody Hurts

"Stomach pain is part of life," says Douglas Drossman, MD, codirector of the University of North Carolina's Center for Functional GI & Motility Disorders. "If we look at a million people, probably 800,000 of them will have stomach pain in a year. Maybe 100,000 have irritable bowel, and 100 have the more serious inflammatory bowel disease."

Often a stomachache is just a stomachache. But if you've had pain for six months, or experience serious symptoms such as blood in the stool or unexplained weight loss, see a doctor. There are more than 100 possible causes for your pain. Here, how to recognize a few of the most common:

Irritable bowel syndrome. IBS is one of the toughest disorders to diagnose and treat. Your belly aches, you're bloated, and you have constipation or diarrhea (or both), but tests show there's nothing wrong. Is it all in your head? No. It's in your gut, and it's not going away quietly. "Sometimes tests rule out other possibilities, but increasingly we make the diagnosis based on the patient's description of symptoms," says Colin Howden, MD, professor of medicine in the GI division at Northwestern University. Sometimes IBS begins after an infectious disease like traveler's diarrhea.

Once you've been diagnosed, your doctor may suggest dietary changes, such as eating more fiber or taking supplements (increase fiber gradually, since an excess can cause bloating, gas and diarrhea). Keeping a food diary to figure out what triggers symptoms, and then avoiding those foods, helps some people. Doctors may also prescribe antibiotics (to reduce bacteria in the intestinal tract) or probiotics (to shore up healthy bacteria). Zelnorm, a drug that offered relief to many, was pulled off shelves by its manufacturer earlier this year after it was found to increase the likelihood of heart attack and stroke in people with a history of heart disease or those at risk for the condition. But in July, the FDA said women under 55 with chronic constipation or IBS and no history of heart disease can still get the drug. And there are other medications on the horizon that seem to work in a similar way. Some doctors are prescribing the constipation drug Amitiza as a replacement.

Celiac disease. Widely underrecognized in this country but starting to gain notoriety, celiac disease is a sensitivity or allergy to gluten, a family of proteins found mostly in grains, including wheat, barley and rye. Some sufferers also have trouble with oats. It may cause stomach pain, diarrhea, bloating, weight loss, anemia and just a vague not-so-good feeling.

The healthy small intestine is lined with villi, fingerlike projections that absorb nutrients and fluids, says Amy Foxx-Orenstein, DO, president of the American College of Gastroenterology. In celiac disease, the villi get lost or damaged, so your body doesn't absorb much of anything. It all goes rushing through your system, with the aforementioned unpleasant results. When you eliminate gluten from your diet, the villi return and your symptoms go away over time.

Unfortunately, gluten is everywhere: cereal, pasta, bread, cookies and processed foods. Avoiding it can be tough, but more and more gluten-free products are popping up, and there are plenty of cookbooks for the gluten intolerant. If you think you have celiac, see your doctor before you cut out these foods. The tests that clinch the diagnosis can come back negative if you've stopped eating gluten.

Crohn's disease. It's a form of inflammatory bowel disease, a group of conditions in which the GI tract is chronically inflamed. Crohn's symptoms are similar to those of IBS, but unlike IBS, in which there's no detectable damage to the digestive system, Crohn's causes the intestine to be inflamed. This can narrow the end of the small intestine, says Dr. Howden, so it has to work harder to push waste through, causing stomach pain (especially while eating), diarrhea, vomiting and weight loss (you tend not to eat much when it hurts to do so).

What causes Crohn's? Genes may play a role, or the origin may be environmental (something in your diet, a bug). It's diagnosed in many ways: Your doctor may feel a mass in your abdominal cavity, you may have abnormal blood tests, or other tests may reveal nutrient deficiencies or ulcers. Endoscopy, X-rays or an intestinal biopsy can confirm the diagnosis. In the past, the condition was often treated with steroids, but today many doctors prescribe immunosuppressant drugs or IV infusions, which have fewer side effects. Eating more protein and avoiding foods that take a long time to break down (including many fruits and vegetables) can help prevent the pain.

• • Your Medical Care
• • Common Problems
• Healthy Habits
• • Mind & Body

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• Six Symptoms Not to Ignore
• Six instances where you should definitely call your doctor.
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