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The following is an Editorial Resource from YourTotalHealth.

ulcerative colitis
questionShould I see the doctor?

I have been dealing with stomach "issues" for about three years now. My mother, grandmother and cousin were all diagnosed with Crohn's disease around the age of 21. I'm almost 29, so I thought if it was Crohn's disease, I would have had problems much earlier.

I am always gassy and bloated. Sometimes it can get painful. Some days I can have up to three or four bowel movements a day. I always thought this was due to the fact that I drink so much seltzer water (up to 64 ounces per day or more) and I chewed a lot of sugar-free gum (up to 20 pieces per day). About four months ago I gave both up entirely, but there was no change in the gassiness.

Are these the symptoms of a disorder warranting a visit to the doctor or something that I could correct at home? I exercise regularly and my diet is probably best categorized as low-fat and carbohydrate heavy. The symptoms are never worse after any certain type of food.


AnswerIt is common for young people with GI symptoms to attribute them to their diet or be told that they have an irritable or nervous bowel. However, it is important that persistent symptoms be evaluated by a specialist so that your condition can be clarified and more serious problems be ruled out. Bloating is a nonspecific symptom that is usually due to an accumulation of gas in the small intestine. Gas in the small intestine can be due to swallowing air, which can occur from being a smoker, snoring, or eating and talking at the same time. Gas in the small intestine can also be due to an excessive build up of bacteria in the small intestine, and the bacteria-producing gas will then mix with the food you eat. This can occur if you have a tendency towards constipation or have had previous surgery with scar tissue that leaves loops of bowel stagnant and therefore prone to excessive bacteria. The other symptoms you described are also nonspecific and therefore hard to pin down. 

Having a family history of Crohn's disease is of interest and quite important. Although the risk of you having Crohn's disease yourself if your sister has Crohn's disease is only about 30 percent, that still is a significant risk. And the risk for of having Crohn's with a grandmother and a cousin with the disease is definitely lower.  Their diagnosis at a younger age than you is important, but does not avoid your need for a careful evaluation and further workup.

Dietary management can certainly help in some of these situations. Lactose intolerance is a common problem that can cause bloating in many patients. As you note, so can excessive intake of sorbitol and other sugar substitutes. Although it is commonly recommended that you not drink carbonated beverages, this is less likely the problem in many people than other causes.

My recommendation is that you see a gastroenterologist who can examine you and decide whether you should have a colonoscopy to look for other causes of your condition, and discuss diagnostic tests that might be helpful. Dietary elimination can improve some symptoms, but as you know from firsthand experience, can also be quite frustrating and in worse case scenarios result in malnourishment without getting to the cause of your problem. Inflammatory conditions and immune mediated conditions should be pursued as well.

—Dr. Rubin

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Review Date: August 10, 2009


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