Top Five Digestion Misconceptions
Last reviewed on January 26, 2011
By Robert H. Shmerling, M.D.
I saw a patient the other day who asked me if it was true that heartburn is just another name for ulcers. As I started to answer, it occurred to me that problems with the digestive system are not only very common but medical terminology about them seems particularly confusing. So when it comes to matters of digestion, don't trust your gut (sorry, couldn't resist). Here's a quick guide to common symptoms and conditions related to digestion to help you understand what your doctor is saying and make sure your doctor understands you.
Consider all the terms doctors and patients use to describe "an upset stomach": indigestion, heartburn, dyspepsia, reflux, gastritis, esophagitis, ulcer (or peptic ulcer), epigastric distress, and my personal favorite, pyrosi. It's not rare for these terms to be used loosely, interchangeably and incorrectly (or, in the case of pyrosis, not at all). For example, while not all stomach upset is due to ulcer disease, many people describe any discomfort in the upper abdomen as "My ulcer's kicking up."
And not all "stomach upset" is due to a problem in the stomach at all! An ulcer in the duodenum (the first part of the small intestine into which the stomach empties) and esophagitis (inflammation of the esophagus) are good examples, but it's commonly assumed that anything amiss in the upper abdomen is due to stomach trouble.
Here's a quick review of each of these terms and conditions:
While these terms overlap extensively, doctors generally favor one over another when referring to a specific condition, its symptoms, and exam findings. Making the right diagnosis is key because the treatment, complications, and monitoring of these different conditions may differ dramatically. For example, indigestion is a symptom people with GERD, ulcer disease or gastritis may experience. But an ulcer must meet certain criteria and is generally easy to distinguish from gastritis with appropriate diagnostic testing.
It's easy to confuse these two conditions. The cause of each is unknown, symptoms may overlap, and the common acronyms (IBS and IBD) differ by only one letter. But they are quite different.
Treatment of these conditions also differs dramatically. For example, dietary changes and an anti-spasmodic medication, such as dicyclomine (Bentyl), may be the mainstay of treatment for patients with IBS. IBD, on the other hand, may be treated with anti-inflammatory, antibiotic, and immune suppressive medications and sometimes surgery is required.
Doctors and patients use the term "bowel movement" in much the same way. But while it may be the polite way to describe the event, the term is not entirely accurate.
The bowels are nearly always moving, churning and propelling their contents along the intestinal tract. There are times, however, when the bowels are at near or total rest. After major surgery, for example, it's common to develop a condition called "ileus" during which there is little or no action in the intestines for a day or more not even rumbling or passing gas (flatus). A patient's discharge from the hospital may even be delayed until the bowels "wake up" and start moving again. Doctors know this when they listen to the abdomen with a stethoscope and hear rumbling, even if you're not having a bowel movement.
During my medical training, a patient told me she had never had a medical problem except for "piles." I never heard this term before, so I asked her what she meant. "You know, piles!"
Well, I didn't know and looking it up wasnt easy either. But I found an older physician who told me that piles are a lay term for hemorrhoids. According to my medical dictionary, the term probably comes from from the Latin "pila" or ball, referring to a hemorrhoid's shape.
A hemorrhoid is a swelling near the anus that contains blood vessels (especially veins), muscle and elastic lining tissues. They can be outside (an external hemorrhoid) or inside the rectum (an internal hemorrhoid) and may be a source of pain, itching, burning or bleeding. In general, they're associated with conditions in which pressure in the abdomen is high, such as pregnancy, repeated straining to have a bowel movement (as with chronic constipation), or obesity.
This term refers to any severe inflammation of the intestines, usually within the colon and usually caused by an infection. The term is attributed to Hippocrates, and originates from "dys," meaning bad or abnormal, and "entera," referring to the intestines or bowels.
Common symptoms include pain, diarrhea, and stools containing blood and mucus. While the term is often used to describe highly contagious infections that spread among people living in poverty and unsanitary conditions, anyone can develop dysentery. For example, contaminated drinking or bathing water may cause outbreaks in third world countries, but examples of dysentery affecting soldiers, schoolchildren and tourists are not rare.
Common infections that may cause dysentery include bacteria (Shigella, Salmonella, E. coli species, to name a few) and parasites (including amoeba). Perhaps the most recognized example of dysentery is cholera, explosive watery diarrhea caused by the toxin-producing bacteria called Vibrio cholerae.
While we may have invented confusing terminology to describe the many ways things can wrong in the digestive tract, it's worth noting how amazing this complex organ system is and how well it works with very little maintenance.
From mouth to anus, the digestive tract spans more than 25 feet and must absorb key nutrients while keeping out harmful toxins and infectious agents. It must also keep the body's metabolic, nutritional, and fluid needs in balance. Perhaps the biggest surprise is that things don't go wrong more often.
You can help keep your digestive tract healthy with relatively little effort:
Don't be surprised if your doctor uses slightly different lingo than you when talking about your digestive tract. Ask questions until it's clear that you are both talking about the same thing.
While there are no guarantees of perfect digestive health, the simple steps above will increase the chances that your digestive tract will do just fine.
Robert H. Shmerling, M.D., is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program.