Reflux and heartburn
Reflux occurs when stomach contents flow back toward the esophagus. Sometimes this is
acid reflux, and sometimes similar symptoms are not necessarily caused by high acid exposure.
- Typical symptoms
- Heartburn, acid or food regurgitation, cough, hoarseness, a lump sensation in the throat or non-cardiac chest pain.
- Possible tests
- Gastroscopy, pH monitoring, BRAVO capsule and sometimes esophageal manometry before selected treatment decisions.
Chronic constipation
Chronic constipation may be related to bowel habits, medications, background illnesses,
slow bowel transit or difficulty coordinating the pelvic floor muscles during evacuation.
- Typical symptoms
- Hard stools, straining, incomplete evacuation, a blockage sensation, bloating or regular need for laxatives.
- Possible tests
- Blood tests when needed, colonoscopy according to age and warning signs, anorectal manometry and evacuation assessment.
Chronic diarrhea
Persistent diarrhea requires structured evaluation, especially with a new change in bowel
habits, weight loss, bleeding, nighttime diarrhea or a major effect on quality of life.
- Typical symptoms
- Frequent or watery stools, urgency, abdominal pain, bloating, weight loss or a clear relationship to specific foods.
- Possible tests
- Blood and stool tests, fecal calprotectin, celiac evaluation, colonoscopy with biopsies and breath tests when indicated.
Inflammatory bowel disease: Crohn's disease and colitis
Inflammatory bowel diseases are chronic conditions involving inflammation in the digestive
tract. Crohn's disease can affect different parts of the digestive system, while ulcerative
colitis affects the colon.
- Typical symptoms
- Persistent diarrhea, blood in the stool, abdominal pain, weight loss, fatigue, fever, anemia and sometimes symptoms outside the bowel.
- Possible tests
- Blood and stool tests, fecal calprotectin, colonoscopy with biopsies, gastroscopy when needed and imaging such as CT or MR enterography.
Abdominal pain and gas
Abdominal pain, bloating and excess gas may appear even when basic tests are normal.
They may be related to visceral sensitivity, motility changes or food intolerance.
- Typical symptoms
- Recurring pain, bloating after meals, gas, abdominal pressure, changes in bowel habits or relief after bowel movement.
- Possible tests
- Blood and stool tests when needed, breath tests for lactose, fructose and small intestinal bacterial overgrowth (SIBO), and sometimes gastroscopy or colonoscopy.
Achalasia and swallowing disorders
Swallowing disorders may be structural or related to esophageal motility. Achalasia is a
condition in which food passage from the esophagus to the stomach is impaired.
- Typical symptoms
- Difficulty swallowing solids or liquids, food sticking, food regurgitation, chest pain, nighttime cough or weight loss.
- Possible tests
- Gastroscopy, esophageal manometry, barium swallow and EndoFLIP interpretation when additional information is needed.
Gastroparesis
Gastroparesis is delayed stomach emptying without a mechanical blockage. It can occur with
diabetes, after illness or surgery, with certain medications or without a clear cause.
- Typical symptoms
- Nausea, vomiting, early satiety, bloating, prolonged fullness after meals and upper abdominal pain.
- Possible tests
- Gastroscopy to exclude obstruction, gastric emptying scan and blood tests or diabetes assessment according to the clinical context.
EoE
EoE is a chronic inflammatory condition of the esophagus, usually related to an allergic
or immune response. The esophagus can sometimes look nearly normal during endoscopy.
- Typical symptoms
- Difficulty swallowing, food impaction, needing to drink while eating, heartburn that does not respond well to treatment and sometimes an allergic background.
- Possible tests
- Gastroscopy with esophageal biopsies, and sometimes nutritional or allergy assessment according to the clinical picture.
Pelvic floor dyssynergia
In dyssynergia, the abdominal, anal and pelvic floor muscles do not coordinate properly
during evacuation. It is common in patients with constipation and a sense that stool does
not release properly.
- Typical symptoms
- Marked straining, a blockage sensation, incomplete evacuation, prolonged time on the toilet or need for manual assistance.
- Possible tests
- Anorectal manometry, evacuation testing and pelvic floor assessment to guide treatment such as biofeedback and dedicated physiotherapy.
Fecal incontinence
Fecal incontinence is difficulty controlling stool or gas. It is more common than many
people think, and often improves significantly after accurate evaluation of the cause.
- Typical symptoms
- Leakage of gas or stool, strong urgency, difficulty holding bowel movements, staining, reduced sensation or leakage without warning.
- Possible tests
- Clinical examination, anorectal manometry, assessment of sensation and sphincter function, and sometimes pelvic floor imaging or evaluation for chronic diarrhea.
