Bloated, Constipated, ‘Gastric’ When should I be worried?

Dr Jarrod Lee 李彪医生 Gastroenterologist 消化专科医生

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• Singapore's only digestive group practice

• Regional authorities in sub-specialty areas

• Comprehensive & niche services

A Common Problem

• Bloating: 30%

• Constipation: 10%

• ‘Gastric’: 30%

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A Common Problem

• Affects 10-30% of adults annually

• 50% self medicate

• 10% see a doctor

• Mostly short duration and resolves spontaneously

• May be chronic or recurrent

• Affects quality of life

• More absent work days

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What is Normal?

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Too Much Gas • Bloating: subjective feeling that abdomen is full

• Flatus: expelling gas through anus

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Where Does The Gas Come From?

• Produced by gut bacteria from undigested sugars

• Medical conditions

• Blockage

• Weak digestion

• Weak movement

• Sensitivity

Medical Causes

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Constipation

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What is Constipation?

• Bowel movement < 3 times per week

• Hard stool

• Straining

• Feeling of incomplete empyting

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Top 10 Causes

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Medical Causes

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• Nerve problem: affects movement of stool through colon

• Pelvic muscle problem: affects muscles needed for passing motion

• Blockage in colon

• Hormonal problems

Complications

• Hemorrhoids (Piles): swollen anal veins

• Fissure: torn anal skin

• Fecal impaction: hardened stool that is stuck

• Rectal prolapse: rectum protruding from anus

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‘Gastric’, ‘Indigestion’

• Often used to refer to nonspecific abdominal symptoms, usually after meals

• Variable symptoms, patterns, location

• Includes cramping, pain burning, bloating, fullness, nausea

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Causes

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Diagnosis Prevalence

Functional or unknown 70-80%

Acid related: acid reflux, gastritis, ulcers 15-25%

Digestive cancer < 2%

Others: biliary or pancreatic disease, malabsorption, systemic disease, parasites, motility disorder, etc

< 2%

When should I be worried?

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Which Symptoms Are Serious?

Based on Common Advice

• Pain

• Cramping

• Bloating

• Flatulence

• Diarrhea

• Constipation

Based on Research

• Age > 45 years

• Weight loss

• Bleeding or anemia

• Swallowing difficulty

• Family history

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How long can I wait?

Don’t know!!

• If severe, see immediately

• If observing or trying medication, not more than 6 weeks

Serious Conditions

• Surgical emergencies

• Severe infections

• Chronic illnesses

• Digestive Cancer

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Digestive Tract

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Colonoscopy

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Inflammatory Bowel Disease

Infection

Advanced Imaging

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Flat Polyps

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Diet Control

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Spicy Food

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Spicy Food

• Capsaicin: Active ingredient in spicy foods

• Stimulates nerves to cause burning and pain

• In patients with functional disorder, causes more severe pain at smaller amounts

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Daily Fibre Requirement

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Fibre Content per 100g

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Water

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FODMAPs

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Lifestyle Factors

• Stress & anxiety

• Insufficent sleep

• ufficient exercise

• Studies show coffee, smoking & alcohol are not risk factors

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Who to see?

• General Practitioner

• Initial consultation

• Gastroenterologist:

• Persistent and recurrent symptoms

• Further tests

• Dietitian/ Nutritionist

• Diet strategies

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Taking Home Message

• Digestive symptoms are very common

• Diet factors most common, but medical causes are important

• Watch for serious symptoms and age

• See a doctor if severe or persistent symptoms

• Low FODMAP diet, adequate fibre and water, and avoiding spicy food may help

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• Singapore's only digestive group practice

• Regional authorities in sub-specialty areas

• Comprehensive & niche services

Thank You 谢谢