Gut Reactions: Understanding Symptoms of the Digestive Tract PDF
Preview Gut Reactions: Understanding Symptoms of the Digestive Tract
W. Grant Thompson Gut Reactions Understanding Symptoms of the Digestive Tract Gut Reactions Understanding Symptoms of the Digestive Tract Gut Reactions Understanding Symptoms of the Digestive Tract w. Grant Thompson, M.D. Professor of Medicine Chief, Division of Gastroenterology and Digestive Diseases Research Unit Ottawa Civic Hospital and University of Ottawa Ottawa, Ontario, Canada Springer Science+Business Media, LLC Library of Congress Cataloging in Publication Data Thompson, W. Grant. Gut reactions: understanding symptoms of the digestive tract I W. Grant Thompson. p. cm. Bibliography: p. Includes index. 1. Irritable colon. 2. Gastrointestinal system-Diseases. 3. Symptomatology. I. Title. RC862.i77T46 1989 89·16048 616.3'42-dc20 OP First Printing-August 1989 Second Printing-April 1990 ISBN 978-0-306-43303-0 ISBN 978-1-4899-6491-5 (eBook) DOI 10.1007/978-1-4899-6491-5 The treatments outlined in this volume are intended to serve only as examples. You should consult your personal physician before beginning any medical treatment regimen. © 1989 W. Grant Thompson Originally published by Plenum Press in 1989. Softcover reprint of the hardcover 1s t edition 1989 All Rights Reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher TO SUE Preface All of us have gut reactions. We often respond to strong emotion or changes in circumstances with such digestive symptoms as nau sea, heartburn, abdominal discomfort, or altered bowel habit. Travel, examinations, public speaking, and dietary indiscretions are familiar provocations. No serious disease accounts for these reactions, which appear to be the way the gut responds, or is per ceived to respond, to its owner's physical and psychosocial envi ronment. Although most people consider them part of life, for others the symptoms may be sufficiently frequent, troublesome, and inexplicable that they are said to have an irritable gut. Thus, the various gut reactions, if frequent and troublesome, are syn dromes of the irritable gut. It seems that at least one third of people suffer with one or more of the irritable gut syndromes that are discussed in this book. Many of these sufferers seek medical care, undergo many tests, and receive treatments that are costly and not often effective. There is a need to demystify the irritable gut or at least make the sufferer more comfortable in contemplating his gut reactions. The truth is, we do not understand them very well. Several facts do stand out. The reactions are very common and affect people most of their lives. They are benign, that is, they do not lead to any serious diseases, nor is there any structural or anatomical ab normality to explain them. They seem to be due to altered phys iology (function) or at least to altered perception of physiology. Lastly, there is no reliable cure. vii viii PREFACE Thus, this book is written for patients, their relatives, and those nurses, physicians, and allied health workers who may wish to understand digestive symptoms better. There are no tests or x rays that will identify these gut reactions, but they are clearly rec ognizable from their symptoms and are not just what is left when organic disease is excluded through many tests. The commonness of these disorders and their positive diagnosis may be comforting to sufferers. It is reassuring for an individual to know that his or her irritable gut is a real entity experienced by other people, and that it does not indicate cancer or other mortal illness. So my purpose in this book is to improve the understanding of gut reactions, because I believe the reader's comprehension and reassurance that no serious disease exists is most important and, in many cases, the only treatment. Certainly, attention to emo tional stress, life-style, and diet may help as well. Furthermore, it is my purpose to dissuade us all, sufferers, physicians and others, from the costly and sometimes harmful notions that many tests are necessary and that there must be a drug to make the patient better. Interpretation of symptoms is the only reliable test, and drugs, even if they seem to help in the short term, are seldom a sensible life-time solution. Part 1 reviews the anatomy and physiology for nonmedical readers, then the definitions of bowel habit and the various irritable gut syndromes. A discussion of the prevalence of these disorders in the community and their considerable cost follows next. Since lack of dietary fiber and emotion are recurring themes thought to be very important in the irritable gut, they are assigned a chapter each. In Part 2, ten chapters describe the various syndromes of the irritable gut. Gut reactions appear to result from abnormal func tion or abnormal perception of function at all levels of the gut. Although we know that symptoms are seated in the esophagus, stomach, small or large intestine, we know little about their gen esis. No one sufferer will have all of these syndromes, but many will have more than one. Thus, an understanding of the whole picture may help the sufferer cope with his or her own gut reac- PREFACE ix tions. Certainly the key chapter in this section is "The Irritable Bowel," Chapter 13. The five chapters in Part 3 discuss topics that are important to those patients with gut reactions. Diverticula occur in half the population by age 60. It is a popular misconception that the di verticula themselves cause symptoms. They don't, but an irritable bowel may be coincidentally present. Laxatives and other drugs cause many gut symptoms and the sufferer should recognize these. Chapter 21, "Clinical Trials and the Placebo Response," demon strates that most drugs used for gut reactions have very little sci entific justification. We accept too easily the notion that there must be a drug out there that will help. In this context, an understanding of the placebo response is a fundamental issue. The final chapter describes some of the tests irritable gut patients commonly undergo. Most gut reactions reported to a physician require an x ray, an endoscopy, or a stool collection, and it is helpful if the sufferer knows what to expect. I hope that the reader will recognize gut reactions as important medical problems, not only for the discomfort and worry they en gender but also for their great prevalence and the cost of their investigation and treatment. As threats to humanity, they cannot claim the profile of cancer or heart disease, but they do cause dis comfort in many people and can divert resources from the detection and care of more serious diseases. On these grounds, research into how the gut functions and how we perceive its function is im portant. Meanwhile, we can only combine what few facts we have about gut reactions with common sense, and resolve that we will not permit our zeal for tests and cure to exceed reason or to do harm. The bibliography is brief and confined to key or review articles that should satisfy the need of most readers to seek out the original references. Much of the material prior to 1979 is referenced in my previous book, The Irritable Gut. Lest one think I refer excessively to my own work, it should be clear that most original references for the material in this book are contained therein. Gut reactions are part of the human condition. The classical x PREFACE references and quotes from the old medical literature serve, I hope, to emphasize the timeless humanity of these disorders. Although they are said to be products of Western civilization, I believe all mankind is liable. Gut reactions occasionally inspire humor, for the gut has always been a source of mirth. Those sufferers who regard their symptoms very seriously should not be offended by this, for with humor comes recognition of the human condition, and from thence compassion. W. Grant Thompson Mont Tremblant, Quebec Acknowledgments This book owes much to my recently deceased parents, George and Florence Thompson, who oversaw my education and insisted that my experience should be as broad as possible. Of course, the completion of the book would have been impossible without the support of my wife, Sue, who helped edit the manuscript, and the good-humored patience of my children, Julie, Jennifer, and Eric. Jennifer prepared the Index. Another key person is Helen Kierczak, whose Tandy word processor actually created the manuscript, and who, when I de spaired of completion, always had a cheerful word of encourage ment. James Harbinson's illustrations speak for themselves. The x-rays that are in the book are due to the courtesy of Dr. Hardy Tao, Department of Radiology, Ottawa Civic Hospital. Pho tographs were taken by Stuart Joyce and Tom Devecseri of the Civic Hospital's Audio Visual Department. The ideas for this book have developed over 20 years. During that period I have been privileged to discuss the irritable gut with many colleagues from several countries. Special mention is due to Dr. K. W. Heaton of Bristol, England, and Dr. D. A. Drossman of Chapel Hill, North Carolina. The irritable gut has made us good friends. I cannot forget the support and encouragement of many colleagues at the University of Ottawa-Dean Gilles Hurteau and Dr. Dilip Patel, to name two. Finally, I needed and am grateful for the stimulus provided by students and junior physicians who sel dom failed to ask embarrassing questions that forced me to think further. The answers are elusive. xi
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