Occasional heartburn is one thing, but recurring symptoms can indicate a more serious problem.
Everyone has experienced the occasional bout of indigestion, heartburn or bloating commonly associated with digestive upset. So how are you supposed to know the difference between when your gastrointestinal (GI) symptoms are a temporary inconvenience and when they’re indicative of a more serious digestive disorder?
“For the majority of symptoms that people come in with, we can find an identifiable cause,” says gastroenterologist Dr. Richard Denicola. “We all tend to get heartburn every now and then, but when it ends up being more than twice a week, that’s something you really should be seeing a GI doctor for.”
Even though GI disorders are common, many people are reluctant to talk about their symptoms, even with their doctor. GI problems can be uncomfortable and disruptive. For example, irritable bowel syndrome, one of the most common GI disorders, is a leading cause of people missing work.
While you might be reluctant to talk about diarrhea or bloody stools, your doctor is not. He or she has seen it all and then some. Those cringe-worthy signs are actually important clues as to what’s going on in your body. By not sharing them, you risk having your doctor miss a potentially serious problem. In fact, GI problems are not the only cause of abdominal symptoms—conditions affecting the uterus and ovaries can produce similar warning signs. If you’re still uncomfortable talking about the details, try writing them out and give the list to your doctor. Seeking medical attention can relieve your discomfort, improve your quality of life and address the underlying cause of the problem.
Excessive burping, Dr. Denicola says, is an annoying, slightly embarrassing symptom that, while not life-threatening, also shouldn’t be ignored. “There could be issues with the stomach not emptying appropriately, or you could be burping from the esophagus because of bad reflux.”
When should you see a doctor?
Everyone experiences the occasional bout of GI misery, especially if we are under stress or eat something that doesn’t quite agree with us. However, if symptoms persist, or disrupt your daily activities, it’s time to see the doctor.
Some symptoms should trigger an immediate visit to the doctor.
“Rectal bleeding, for example,” Dr. Denicola says. “I think that in certain circumstances, some people do ignore this, thinking it’s probably just a hemorrhoid. But these people come into the office and upon examination I don’t see a hemorrhoid. It could be a polyp, or you could have cancer forming. It’s definitely a symptom that needs to be evaluated.”
Says Dr. Denicola, “Ask yourself, ‘how disruptive is this to my daily life? Is this preventing me from going to work? Is this preventing me from interacting with my family, from taking care of myself?’ If yes, that’s a huge problem and you should see a doctor.”
Serious GI symptoms require prompt medical attention. These include:
- Blood in your stool
- Change in bowel habits
- Persistent heartburn (acid reflux)
- Difficulty swallowing
- Nausea or vomiting (especially if you have blood in your vomit)
- Unexpected weight gain or loss
The Age Factor
As we age, it’s especially important not to let these symptoms go untreated, Dr. Denicola adds. “As we get older, we have a higher propensity for cancer to form. It gets concerning that you could go 50 or 60 years without any symptoms, then you suddenly have frequent heartburn. That prompts us to recommend an endoscopy or a CAT scan sooner, as opposed to a 20-year-old who’s coming in with heartburn because they eat a lot of pizza.”
Difficulty swallowing is always concerning, but is especially important to have checked after age 55. If you feel like your food is getting stuck in your throat or it hurts as it’s going down, that can be a sign of something serious, the biggest concern being esophageal cancer. “Trouble swallowing or as we call it, dysphasia, is a serious thing, and one of our major indications for wanting to do an endoscopy,” Dr. Denicola says.
Esophageal cancer is more common in adults over 55 and is three or four times more likely to occur in men than women, according to the Centers for Disease Control and Prevention. Other things that can cause discomfort when you swallow include an infection, an ulcer, a sore or scar tissue (which can develop if you have chronic acid reflux). In addition, a growing number of people are being diagnosed with eosinophilic esophagitis (EOE), a chronic allergic inflammatory disease that is a major cause of swallowing issues.
Weight loss when you haven’t changed your diet or exercise habits is a common symptom of many serious illnesses, including cancer. “Cancer is definitely the big one there,” Dr. Denicola says. “When I have somebody referred to me for weight loss, I’m not only doing a colonoscopy, but I’m probably also doing an endoscopy to look at both ends.”
See a doctor if you’ve dropped 5% or more of your body weight within six to 12 months. Although it is a symptom of some types of cancer, a 2014 study published in the journal American Family Physician found that in patients over 65, such weight loss is often due to other causes, like peptic ulcers, celiac disease, inflammatory bowel disease or an overactive thyroid. “You always have to check the thyroid, to make sure it’s not hyperactive,” Dr. Denicola says. “We’ll also take biopsies in the stomach, to make sure that there’s no bad bacteria in there, and also biopsies of the duodenum, to make sure they’re absorbing nutrients appropriately. But cancer’s the big one with weight loss, that’s very concerning to us.”
While there are a number of medications to treat GI symptoms such as heartburn and gastroesophageal reflux disease (GERD), Dr. Denicola warns that for chronic use it’s important to only take them under the supervision of a physician. Proton pump inhibitors, including Prilosec, Nexium and Prevacid, along with H2 receptor blockers such as Zantac 360 and Pepcid, can cause side effects, including headache, nausea, diarrhea and constipation. “Those are all good medications and they work very well,” he says. “But if you’re going to be on these therapies for a long time, it’s important to talk with your gastroenterologist or primary care doctor to make sure you’re not going to suffer from any of those side effects.”
[Main photo credit: iStock.com/Prostock-Studio]