Abdominal Bloating

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Apthous (mouth) ulcers are common oral sores affecting around 20 to 30 per cent of the population[1]. Mouth ulcers arise from the loss or erosion of the mucous membrane or the lining tissue of the mouth. 

Commonly they are caused by:

• mechanical injuries such as accidentally biting the inside of your cheek
• stress
• hard tooth brushing
• bacterial or fungal infections and 
• deficits in certain vitamins and minerals such as B-12, folate and iron[2]. 

Typically, mouth ulcers are round and white/pink in colour and in most cases although they can be very painful, overall they are harmless. They may resolve themselves, it can take up to 2 weeks. If ulcers are persistent you must see your medical practitioner. 

During the healing process, it is important to manage the affected area. Effective management strategies include[3]:

• Using a soft toothbrush 
• Salt water rinses 
• Avoiding hard foods and foods which irritate/scratch the interior of the mouth
• Drinking cool water and avoiding overly hot foods and drinks
• Applying numbing agents such as topical benzocaine or lidocaine

A natural management strategy is to gargle Herbal Mix Tea for 30 seconds each time.

References

[1] Better Health Victoria. Mouth Ulcers betterhealth.vic.gov.au/health/conditionsandtreatments/mouth-ulcers?viewAsPdf=true

[2] ADA. Aphthous Mouth Ulcers ada.com/conditions/aphthous-ulcers/

[3] Health Direct(2017, November) Mouth sores and ulcers healthdirect.gov.au/mouth-sores-and-ulcers

Cholecystitis (gallbladder inflammation) typically occurs when gallstones block the tube leading out of the gallbladder[1], called the bile duct. The gallbladder is a small organ directly underneath the liver and aids in digestion by storing bile (a fluid produced by the liver). There are two types of cholecystitis[2]:

1. Acute cholecystitis- defined as the sudden inflammation of the gallbladder 

2. Chronic cholecystitis- typically characterised by inflammation of the gallbladder lasting a long time and caused by repeat attacks of acute cholecystitis. 

Cholecystitis presents with symptoms of:

• right abdominal pain
• fever
• nausea and vomiting, and 
• indigestion[3]. 

In many cases inflammation of the gallbladder will settle down on its own with a low-fat diet or medications may be prescribed to dissolve gallstones1. In circumstances where the pain is intolerable, admission into hospital is common with most people having their gallbladder removed laparoscopically (a type of keyhole surgery).  

References

[1] Health Direct (2018, February) Cholecystitis (gallbladder inflammation) healthdirect.gov.au/cholecystitis-gallbladder-inflammation

[2] Harvard Medical School (2019, April) Cholecystitis health.harvard.edu/a_to_z/cholecystitis-a-to-z

[3] Emergency Care Institute (2017, September) Acute cholecystitis aci.health.nsw.gov.au/networks/eci/clinical/clinical-resources/clinical-tools/abdominal-emergencies/acute-cholecystitis

Coeliac disease is a genetic autoimmune disease where the body reacts abnormally to gluten (found in wheat, rye, barley and oats) affecting the lining of the small intestines or bowel. Correct functioning of the small intestines is vital for proper absorption of food nutrients and minerals which prevents nutritional deficiency[1]. In Australia, 50% of the population (both males and females) carry at least one of the genes predisposed to coeliac disease with approximately 1 in every 70 Australians being affected[2].

Although there is no cure for coeliac disease, there are effective management strategies people with coeliac disease can follow. Patients affected with coeliac disease will remain with a lifelong sensitivity to gluten. Treatment initially is to try and omit gluten from your diet, however a graded gradual re-introduction of this may occur. Long term risks of undiagnosed coeliac disease can result in chronic inflammation and poor nutrition.  

References    

[1] Better Health Channel (2019, February). Coeliac disease and gluten sensitivity. Retrieved from betterhealth.vic.gov.au/health/conditionsandtreatments/coeliac-disease-and-gluten-sensitivity

[2] Coeliac Australia. Coeliac Disease. Retrieved from coeliac.org.au/coeliac-disease/

Constipation is defined as the difficulty or the infrequency of bowel movement or stools being hard, dry and difficult to pass[1]. However it is important to note that having infrequent bowel movement does not necessarily indicate an individual is constipated as it is normal to have anywhere from 1 to 3 bowel movements per day[2]. 

Constipation is a common occurrence in the population but has been shown to be more prevalent in: 

• older age
• taking a large number of medications
• not drinking enough fluids
• a change in routine
• lack of exercise
• low-fibre diet and low caloric intake[3] 

Typically there are three approaches to treating constipation[2]:

1. Changing diet and behaviour. This is the most common approach recommended and consists of increasing the amount of fibre in the diet and attempting to move their bowels at the same time every day

2. Laxatives. In some cases laxatives may be used to soften the stool, add bulk to the stool and absorb water or stimulate the walls of the large intestine causing contraction resulting in stool movement. 

3. Enemas. Other cases may require the use of enemas whereby liquid or gas is injected into the rectum to flush stool out.

It should be noted that use of laxatives and enemas may cause diarrhoea, dehydration and cramps and therefore should be used with caution, and with consultation with your medical practitioner.

Dietary advice: Bulk and roughage stimulate the movement of intestines. Fresh and dried fruits, vegetable, salads, whole grain, cereal, honey, and treacle may all be used. Plenty of fluids, such as fruit juices and water, should be taken each day. 

References

[1] Harvard Health Publishing – Harvard Medical School (2019, April) Constipation and Impaction health.harvard.edu/a_to_z/constipation-and-impaction-a-to-z

[2] Greenberger (2018, May) Constipation in Adults msdmanuals.com/home/digestive-disorders/symptoms-of-digestive-disorders/constipation-in-adults

[3] Jamshed et al (2011, August) Diagnostic Approach to Chronic Constipation in Adults aafp.org/afp/2011/0801/p299.html

At some stage of our lives most people will have some sort of diarrhoea. Often it may self resolve, depending on the cause. Diarrhoea usually occurs when fluid cannot be absorbed from your bowel contents, or when extra fluid leaks into the bowel, causing watery stools[1].

Serious symptoms of diarrhoea where you should consult your medical practitioner immediately are[2]:

• blood in the faeces
• pus in the faeces
• painful passage of faeces
• repeated vomiting
• inability to increase fluid intake
• reduced or absent urination
• fever (temperature greater than 38 ºc)

Diarrhoea is quite often caused by gastroenteritis, an infection of the bowel. This may be due to[3]:

• a virus, eg. norovirus, rotavirus, cytomegalovirus and viral hepatitis
• bacteria eg. campylobacter, Clostridium difficile (C. difficile), Escherichia coli (E. coli), salmonella and shigella. These may all result in food poisoning
• parasites, such as the Giardia or cryptosporidium parasites

Diarrhoea caused by contaminated food or water from a foreign country is known as 'traveller's diarrhoea'.

Other (usually) short-term causes of diarrhoea include[1]:

• food poisoning (due to eating something contaminated or ‘off’)
• emotional upset eg. anxiety
• drinking too much alcohol
• drinking too much coffee
• food allergy
• appendicitis
• damage to the lining of the intestines due to radiotherapy or prescribed medications
• damage to the intestines due to reduced blood supply.

References

[1]  healthdirect.gov.au/what-causes-diarrhoea

[2]  betterhealth.vic.gov.au/health/conditionsandtreatments/diarrhoea

[3]  health.harvard.edu/a_to_z/gastroenteritis-in-adults-a-to-z

Fructose malabsorption or dietary fructose intolerance is a condition characterised by the inability to break down fructose efficiently[1]. Unlike food allergies, food intolerance is not caused by the immune system reacting to food[2].

Fructose is a simple sugar known as a monosaccharide (or carbohydrate) that is naturally present and high in a variety of foods such as:

• Fruits such as apples, grapes, watermelons
• Vegetables such as peas, zucchini and asparagus
• Honey 
• Food sweeteners containing corn syrup – typically found in many processed foods and beverages (soft drinks)
• Table sugar
• Typically, fructose intolerances lead to unexplained gastrointestinal symptoms such as[3]:
• Abdominal bloating
• Nausea 
• Diarrhoea 
• Pain
• Distension  

Fructose malabsorption falls under a variety of poorly absorbed sugars known as FODMAPs (Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols). Individuals may have trouble digesting more than one of these sugars. In patients with fructose intolerance, because this intolerance is very unique to the individual, your diet should be guided by a medical practitioner. 

Foods high in fructose generally do not need to be avoided but rather individuals should reduce the intake of foods that trigger gastrointestinal symptoms and replace these with foods that are tolerated better. 

References

[1] Olsen (2018, October) What is Fructose Malabsorption? healthline.com/health/fructose-malabsorption#:~:text=Fructose%20malabsorption%2C%20formerly%20called%20dietary,from%20fruit%20and%20some%20vegetables.

[2] Healthy Eating Advisory Service. Food intolerance heas.health.vic.gov.au/early-childhood-services/allergy-and-intolerance/food-intolerance

[3] Fedeaw and Rao (2015, January) Dietary fructose intolerance, fructan intolerance and FODMAPs doi: 10.1007/s11894-013-0370-0

Gastro oesophageal reflux disease (GORD) is one of the commonest gut health conditions affecting approximately 10-15% of the Australian population[1]. While acid reflux happens to almost everyone from time to time, diagnosis of GORD requires symptoms to occur at least one day a week[2].

Although a multi-faceted condition, there is strong evidence to suggest the main factor causing GORD is a defective function in the lower oesophageal sphincter[3] (the muscle surrounding the exit of the oesophagus going into the entrance of the stomach). The lower oesophageal sphincter controls the flow of gastric acid or stomach acid from oesophagus to the stomach[4]. Backward travel of gastric acid from stomach to oesophagus due to dysfunction in the lower oesophageal sphincter can result in symptoms such as:

• heartburn/indigestion
• chest pain
• regurgitation
• pain, and 
• difficulty swallowing[3] 

However, there are effective treatments and strategies to combat this. These includes both medical and non-medical treatments such as:

1. Weight loss
2. Reducing coffee and alcohol intake
3. Avoiding large meals
4. Reducing fatty foods and spicy foods
5. Medications, and 
6. Smoking cessation[5]

GORD may bother patients for sometimes, and not at others, and may only be transient, however in many cases it can become a chronic long term issue.

Dietary Advice

To relieve the discomfort of indigestion it is advisable to follow these simple rules for healthy eating. Meals should be unhurried, small/moderate in quantity, chewed thoroughly and taken at regular intervals. Keep you fluid levels up during the day (unless advised otherwise). Smoking and drinking alcohol on an empty stomach will tend to aggravate the symptoms. Certain foods are irritating to the stomach and bowels and some tend to produce gases during digestion - these are listed below and you should try to avoid them. 

Foods to avoid

• All fried foods. 
• Rich, highly seasoned and twice cooked or tough meats. 
• Sausages. 
• Vinegar, pickles, chutney, mayonnaise, horseradish, mustards, spices, curry and pepper. 
• Gravies and soups, particularly those rich in meat extract. 
• Smoked and fried fish, fatty fish, sardines and anchovies. 
• Strong cheeses.
• Biscuits and cereals. 
• Pastry and rich heavy puddings. 
• Cakes. 
• Raw, unripe and dried fruits. Pips, skin and peel of all fruits (also in jams). 
• Melon and pineapple. 
• Alcohol, strong tea and coffee. 
• Very acidic and very cold foods. 
• Any foods which are known to disagree with you.

References

[1] Keung, C, Hebbard, G (2016, February) The management of gastro-oesophageal reflux disease. Australian Prescriber Vol 39 (1) 6-10. doi:10.18773/austprescr.2016.003

[2] Royal Australian College of General Practitioners (2004, December). Gastro-oesophageal reflux disease – Current concepts in management. Australian Family Physician Vol 33 (12) 987-991. racgp.org.au/afpbackissues/2004/200411/20041128piterman.pdf

[3] Health Direct (2018, September) GORD (reflux). healthdirect.gov.au/gord-reflux

[4] Mittal, R, Goyal, R (2006, May) Sphincter mechanisms at the lower end of the esophagus. GI Motility online. doi:10.1038/gimo14

[5] Gut Foundation Australia (2016, February). Treatment of gastro-oesophageal reflux disease in adults & children.

Herpes Labialis (cold sores) are small blisters that typically form on the lips and skin around the mouth, nose and the chin. As cold sores are contagious the moment you feel a tingling sensation, it is important to adhere to good prevention strategies such as not sharing items that come into contact with the cold sore and refraining from kissing whilst having a cold sore. 

Cold sores are caused by the herpes simplex virus and the infection persists throughout life normally in a dormant state[1]. However, there are multiple factors which contribute in causing the virus to become active again. These include[2]:

• A break in the skin near the affected area
• Emotional upset or stress
• Periods
• Tiredness and fatigue
• Colds, flu or fever 

Treatment of cold sores include topical agents and in some cases oral antiviral therapy[3]after review by your medical practitioner. In order to relieve any pain or discomfort, health care professionals suggest cold compresses on the affected area, intake of cold foods and drinks and ensuring pain relief[4]. 

References

[1] Better Health Victoria (2017, July) Cold sores betterhealth.vic.gov.au/health/conditionsandtreatments/cold-sores

[2] Health Direct (2018, August) Cold sores healthdirect.gov.au/cold-sores

[3] SA Health – Government of South Australia. Cold sores (herpes simplex type 1) – including symptoms, treatment and prevention sahealth.sa.gov.au/wps/wcm/connect/Public+Content/SA+Health+Internet/Health+topics/Health+conditions+prevention+and+treatment/Infectious+diseases/Cold+sores+Herpes+simplex+type+1/Cold+sores+herpes+simplex+type+1+-+including+symptoms+treatment+and+prevention

[4] Kids Health (2019, February) Cold Sores (HSV-1) kidshealth.org/en/teens/cold-sores.html

Polyps are small abnormal growths of cells in the body and can develop in many areas of the body such as the uterus, throat, bladder, stomach and colon. Majority of polyps which grow are harmless (benign) but in some cases can become malignant (cancerous)[1]. One of the common sites for polyps to grow includes the gastrointestinal tract, specifically the colon and rectum. Although the exact cause is unknown, it is thought factors such as lifestyle and genetics contribute to the growth of colorectal polyps[2]. 

Common symptoms of colorectal polyps include: 

• abdominal pain
• diarrhoea or constipation and 
• blood or clear mucus in the stool. 

In most cases, colorectal polyps are removed using colonoscopy or flexible sigmoidoscopy techniques. It is important to get tested regularly for polyps as there is a higher chance of developing more polyps if you have had them prior[3]. 

References 

[1] Cancer Council Australia (2017, May 22). Polyps. cancer.org.au/about-cancer/types-of-cancer/polyps.html 

[2] Better Health Channel (2014, August). Polyps. betterhealth.vic.gov.au/health/conditionsandtreatments/polyps

[3] National Institute of Diabetes and Digestive and Kidney Diseases (2017, September). Treatment for Colon Polyps. niddk.nih.gov/health-information/digestive-diseases/colon-polyps/treatment 

Xerostomia (dry mouth) is a condition characterised by not having enough saliva to keep the mouth wet and moisturised. Saliva plays an important role in ensuring bacteria is kept under control in the mouth, aiding in digestion, helping defend against tooth decay and acts as a vehicle in strengthening tooth enamel[1]. Although everyone experiences a dry mouth from time to time, persistent feelings of dry mouth may be a sign of xerostomia. 

Symptoms which persist in this condition include[2]:

• A sticky and dry feeling in the mouth
• Cracked lips
• Bad breath
• Trouble chewing, swallowing or speaking
• More frequent tooth decay
• Gum irritation 

There are a number of factors thought to cause dry mouth such as[3]:

• Prescription medications
• Autoimmune disorders such as Sjogren’s syndrome 
• Chemotherapy in cancer treatment
• Anxiety and stress

Fortunately there are treatments and strategies in place to reduce the discomfort from dry mouth. As dry mouth increases the chances of tooth decay, it is crucial to protect your teeth by visiting the dentist regularly, using a soft toothbrush and mouth rinse and avoiding sugary or acidic foods. 

Furthermore, staying hydrated and avoiding foods that irritate the mouth have been found to ease the discomfort of dry mouth[4].

References

[1] Queensland Government – Queensland Health (2008, April) Healthy teeth for life fact sheet. health.qld.gov.au/__data/assets/pdf_file/0023/154076/htfl_dry_mouth_v2.pdf 

[2] Colgate. Dry Mouth colgate.com/en-us/oral-health/conditions/dry-mouth 

[3] Better Health Victoria (2017, February) Dry Mouth Syndrome betterhealth.vic.gov.au/health/conditionsandtreatments/dry-mouth-syndrome

[4] Health Direct (2018, April) Dry Mouth Syndrome healthdirect.gov.au/dry-mouth-syndrome