The findings, published June 1 in the journal Gastroenterology, highlight an important and understudied area of research, since food insecurity is part of a larger framework of social determinants of health, or the conditions in which people are born, grow, work, live, and age. Difficulty accessing affordable, nutritious foods impacts health outcomes and is an underlying factor that can impact health disparities.

 “Within the field of gastroenterology, food insecurity is both relevant and underappreciated,” said lead author David Leiman, M.D., assistant professor in the Division of Gastroenterology at Duke University School of Medicine.

 “Diets can help manage or treat several GI conditions such as eosinophilic esophagitis, celiac disease, and irritable bowel syndrome,” Leiman said. “The obvious connections between what a person eats and disease control means that having access to the right foods can directly impact health outcomes.”

 Leiman and colleagues focused on how food insecurity has been examined in research studies involving people with digestive conditions other than liver disease. They analyzed more than 1,900 studies and found only 12 in which food insecurity was evaluated as part of the study.

The identified studies focused on five conditions and symptoms, including GI cancers, inflammatory bowel disease, infections causing diarrhea and vomiting, heartburn, and food allergies.

Overall, these studies found that people with GI conditions who had difficulty affording or accessing food:

Were more likely to also report feeling depressed; 

Had higher odds of forgoing, delaying, or making changes to prescription medications, specialist visits, follow-up care, and mental health services compared to cancer survivors who were persistently food secure; 

More often reported financial hardship due to medical bills, financial distress, and medication non-adherence for cost-related reasons. 

Leiman said a better understanding of the impact that food insecurity has on health, and particularly on digestive health, would improve care and help reduce disparities.

The study authors called for more rigorous research into the role food security plays in causing and treating GI conditions; greater awareness that specialized diets might be out of reach for some patients, and ways to address that; and advocacy for policies that support patients at risk of food insecurity.

 “Our analysis demonstrates there is much more to learn,” Leiman said. “This topic is intrinsically important to gastroenterologists and our patients, and it should be a priority given its potential to improve patient outcomes.”

In addition to Leiman, study authors include Katelyn Madigan, Megan Carlin, Sarah Cantrel, and Deepak Palakshappa.

Scientists know that microbiota — the trillions of beneficial microbes living harmoniously inside our gut — can protect people from bacterial infections, but little is known about how they provide protection. Scientists are studying the microbiota with an eye to finding or enhancing natural treatments to replace antibiotics, which harm microbiota and become less effective as bacteria develop drug resistance.

According to a news release from NIH, the scientists observed that microbiota that had experienced prior infection and transferred to germ-free mice helped prevent infection with Kpn. They identified a class of bacteria — Deltaproteobacteria — involved in fighting these infections, and further analysis led them to identify taurine as the trigger for Deltaproteobacteria activity.

Taurine helps the body digest fats and oils and is found naturally in bile acids in the gut. The poisonous gas hydrogen sulfide is a byproduct of taurine. The scientists believe that low levels of taurine allow pathogens to colonize the gut, but high levels produce enough hydrogen sulfide to prevent colonization. During the study, the researchers realized that a single mild infection is sufficient to prepare the microbiota to resist subsequent infection, and that the liver and gallbladder — which synthesize and store bile acids containing taurine — can develop long-term infection protection.

The study found that taurine given to mice as a supplement in drinking water also prepared the microbiota to prevent infection. However, the news release said, when mice drank water containing bismuth subsalicylate — a common over-the-counter drug used to treat diarrhea and upset stomach — infection protection waned because bismuth inhibits hydrogen sulfide production.

Scientists from NIH’s National Institute of Allergy and Infectious Diseases led the project in collaboration with researchers from the National Institute of General Medical Sciences; the National Cancer Institute; the National Institute of Diabetes and Digestive and Kidney Diseases; and the National Human Genome Research Institute.

But if pain and other gut symptoms go on for weeks or longer, something more serious might be wrong. Digestive system diseases and disorders are very common. Around 60 to 70 million people in the U.S. live with a digestive disease.

It’s important not to ignore symptoms in your gut. Many digestive disorders are easiest to treat when they first develop.

Potential Causes

One of the most serious gut disorders is inflammatory bowel disease (IBD).This occurs when immune system cells in the gut overreact to a perceived threat to your body. Often, that “threat” is the normal bugs that make up the microbiome—the microscopic creatures like bacteria, fungi, and viruses—that live in your gut. This overreaction can damage the digestive (gastrointestinal or GI) tract.

The two main types of IBD are ulcerative colitis and Crohn’s disease. “Crohn’s can occur anywhere in the digestive tract, from the mouth to the anus,” says Dr. Judy Cho, an IBD expert at Mount Sinai. Ulcerative colitis happens only in the large intestine.

These two diseases also differ in how deeply they can damage tissue. “Ulcerative colitis causes damage in the gut lining,” explains Dr. Dermot McGovern, who studies IBD at Cedars-Sinai. “Crohn’s disease can go all the way through the gut.” Severe cases of Crohn’s can lead to narrowing of the intestines and even holes in the gut.

Other conditions can harm the lining of the stomach and lead to a type of inflammation called gastritis. The most common cause of gastritis is infection with bacteria called Helicobacter pylori. Other causes include the long-term use of some pain medications. If left untreated, gastritis can lead to painful ulcers.

It can be tricky to diagnose a digestive disease because they share a lot of symptoms.

Twelve percent of people in the U.S. have irritable bowel syndrome (IBS). “This is a very common disorder. It’s characterized by abdominal pain, bloating, and changes in bowel habits,” says Dr. Anthony Lembo, an IBS researcher at Beth Israel Deaconess Medical Center.

Researchers don’t understand exactly what causes IBS. It may have different causes in different people. Sometimes it involves problems with how the brain and gut work together.

Other things that can cause pain and discomfort in the GI tract are acid reflux or food sensitivities.

Pinpointing the Problem

It can be tricky to diagnose a digestive disease because they share a lot of symptoms, explains Cho. The National Institutes of Health (NIH) explain that symptoms of many gut conditions include pain, gassiness, bloating, and diarrhea.

“But for IBD, there are several red-flag symptoms,” she says. These are blood in the stool, weight loss, and signs of inflammation found in a blood test. A sign of IBD in children is failure to grow, Cho adds.

IBS can give some people diarrhea and others constipation. Some people go back and forth between the two.

Gastritis and food sensitivities can also cause long-term gut discomfort. To figure out what’s causing gut troubles, doctors may need to run a variety of tests. These can include blood tests and a stool test to look for infection.

Some people may have an imaging test, such as a CT scan. Others may need to have an endoscopy. Endoscopy uses a long, flexible tube with a tiny camera on the end to look in the intestines or stomach.

While symptoms for different gut disorders can be similar, treatments vary widely. For gastritis caused by bacterial infection, antibiotics are used to kill the germs. If medications are causing gastritis, switching to a different kind of drug will usually allow the stomach to heal.

Food sensitivities can be managed by changing your diet. A nutritionist can help you figure out what foods might be irritating your gut. Acid reflux can also often be improved by changes in your diet and medication.

Treatment isn’t one-size-fits-all for IBS, Lembo explains, because it can have different causes. Some people can get some relief by adjusting their diet. Foods that commonly cause gut problems include: dairy products, caffeine, carbonated drinks, sugar, candy and junk food, fruit juices, beans and cruciferous vegetables such as broccoli and cauliflower.

“We also tell patients to eat two to three meals a day, maybe have a snack or two. But don’t eat all day long. Give your gut a chance to rest,” he says.

And while stress doesn’t cause IBS, it can trigger flare-ups of symptoms in many people, says Lembo. Stress reduction strategies and cognitive behavior therapy—a type of talk therapy—can help some people manage symptoms of IBS.

IBD is harder to treat than most gut disorders. “It’s impossible to cure IBD right now,” says Cho. Treatments focus on stopping inflammation long enough to allow the gut tissue to heal, she explains.

Some medications used for IBD control inflammation. Other newer drugs suppress the immune system. But these newer drugs can have serious side effects and are usually only used when others don’t work.

“Research has discovered that the earlier you use these medications, the more likely you are to respond,” says McGovern. So, people with high-risk disease may get these drugs first now, he explains.

Researchers are searching for new ways to prevent and manage gut disorders. Lembo, for example, is testing whether peppermint oil can help the gut muscles relax in people with IBS.

Existing treatments for IBD only work for about a third of people who try them. And even then, McGovern says, they may lose their effects over time.

Both Cho and McGovern are working to understand the genetics of IBD. This information could be used at all stages of the disease, explains Cho. For example, if a test could identify children at higher risk of developing IBD later in life, “theoretically it could be prevented,” she says. Strategies could include giving anti-inflammatory drugs before IBD develops or changing the gut microbiome to prevent an immune attack.

For more information about health issues, click here to visit the NIH website.

The findings, supported by the National Institutes of Health (NIH), challenge current treatment guidelines, which suggest the opposite: that the surgery may worsen urgency urinary incontinence in women with both forms, also called mixed urinary incontinence. The study appears in the Journal of the American Medical Association.

“Women with mixed urinary incontinence may have more bothersome symptoms than women with either stress or urgency urinary incontinence alone,” said Donna Mazloomdoost, M.D., study author and program director of the NICHD Pelvic Floor Disorders Network. “The findings show promise in treating a condition that can be hard to manage under existing practices.”

Roughly one-third to one-half of all women with urinary incontinence have mixed urinary incontinence. Urgency urinary incontinence results from the spontaneous contraction of bladder muscles, leading to a strong and sudden need to urinate. Stress urinary incontinence occurs when urine leaks out after abdominal pressure increases following a sneeze, cough, laugh or movement, which squeezes the bladder.

Standard treatment guidelines for mixed urinary incontinence often involve treating the two forms of incontinence independently. Urgency urinary incontinence often is first treated with behavioral techniques, such as trying to delay urinating for a brief period after feeling the urge, reducing liquid consumption, exercises to strengthen muscles around the bladder (involving pelvic floor physical therapy) and with medication. Surgery is not usually recommended early on. The second kind, stress incontinence, also can be treated with exercises, and many women experience symptom improvement. However, in women who do not improve or opt out of the exercises, surgery may be offered.

“Current practice guidelines may be unnecessarily delaying surgery for women with mixed urinary incontinence.”

The Effects of Surgical Treatment Enhanced with Exercise for Mixed Urinary Incontinence (ESTEEM) study is a randomized clinical trial that recruited 480 women with mixed urinary incontinence at centers across the United States. All participants underwent mid-urethral sling surgery, a well-established method that places a thin strip of mesh under the urethra; this helps prevent urine from leaking out during an exertion, such as a sneeze or cough. Participants were randomized to surgery alone or surgery with behavioral and pelvic floor muscle therapy, which included six visits with a trained health professional. They were followed for one year.

The women responded to a questionnaire, the urogenital distress inventory (UDI), which inquired about urinary symptoms. Symptoms are ranked from 0-300 points, depending on severity. They also responded to surveys on quality of life and perceptions of surgical success.

The study team found that both groups had significant improvements in their incontinence symptoms after surgery. The average UDI score for the surgery alone group was 176.8 before surgery and 40.3 a year after surgery; for the surgery and therapy combined group, the UDI score dropped from 178.0 to 33.8. According to the researchers, because the post-treatment UDI scores between the two groups did not differ greatly, adding behavioral and pelvic floor muscle therapy to the treatment may not result in better clinical outcomes.

However, the study team did find differences in other self-reported outcomes. The combined surgery and physical therapy group had fewer instances of incontinence a year after surgery and were less likely to receive additional treatment for urinary tract symptoms, suggesting they had more quality of life improvement than the surgery alone group.

“Current practice guidelines may be unnecessarily delaying surgery for women with mixed urinary incontinence,” said Vivian W. Sung, M.D., M.P.H., the study’s lead author and a professor at the Warren Alpert Medical School of Brown University in Providence, Rhode Island. “We hope these findings will improve how patients are counseled and treated.”

The researchers called for additional research to identify which patients with mixed urinary incontinence are at risk for continued symptoms after surgery and to identify effective treatments for them.

Ranitidine is an over-the-counter (OTC) and prescription drug. Ranitidine is an H2 (histamine-2) blocker, which decreases the amount of acid created by the stomach. Over-the-counter Ranitidine is approved to prevent and relieve heartburn associated with acid ingestion and sour stomach. Prescription Ranitidine is approved for multiple indications, including treatment and prevention of ulcers of the stomach and intestines and treatment of gastroesophageal reflux disease. The FDA has been investigating NDMA and other nitrosamine impurities in blood pressure and heart failure medicines called Angiotensin II Receptor Blockers (ARBs) since last year. In the case of ARBs, the FDA has recommended numerous recalls as it discovered unacceptable levels of nitrosamines.

Patients are encouraged to report adverse reactions to the FDA.

In its Medwatch release, the FDA said it is not calling for people to stop taking ranitidine “at this time”; however, patients taking prescription ranitidine who wish to discontinue use should talk to their health care professional about other treatment options. People taking OTC ranitidine could consider using other OTC medicines approved for their condition. There are multiple drugs on the market that are approved for the same or similar uses as ranitidine.

Healthcare professionals and patients are encouraged to report adverse events or side effects related to the use of these products to the FDA’s MedWatch Safety Information and Adverse Event Reporting Program:

Complete and submit the report online  or call 1-800-332-1088 to request a reporting form.

Your digestive system is busy. When you eat something, your food takes a twisty trip that starts with being chewed up and ends with you going to the bathroom. A lot happens in between. The health of your gut plays a key role in your overall health and well-being. You can make choices to help your body stay on tract.

Your digestive, or gastrointestinal (GI), tract is a long, muscular tube that runs from your mouth to your anus. It’s about 30 feet long and works with other parts of your digestive system to break food and drink down into smaller molecules of nutrients. The blood absorbs these and carries them throughout the body for cells to use for energy, growth, and repair.

With such a long GI highway, it’s common to run into bumps in the road. About 60 to 70 million Americans are affected by digestive diseases, like gastroesophageal reflux disease (GERD) or irritable bowel syndrome (IBS). GERD happens when your stomach acid and/or contents come back up into your esophagus (swallowing tube) or throat. This causes uncomfortable symptoms like heartburn and indigestion. IBS is a group of symptoms that includes pain in the abdomen and changes in bowel habits. People with IBS may have constipation, diarrhea, or both. Many more people have other digestive problems, like bloating and stomach pain.

“There are many factors that can impact gut health,” says Dr. Lin Chang, a GI expert at the University of California, Los Angeles. How your body’s built, your family and genetic history, how you manage stress, and what you eat can all affect your gut.

“I see a lot of lifestyle-related GI issues, and there are often no quick fixes for that,” she says. “In general, people do well when they create a more routine schedule, eat a healthy diet and smaller more frequent meals, add in some exercise, and get a good amount of sleep.”

Chang studies the connection between stress and IBS. Her research group has found that people who have early life stress are more likely to develop IBS. “However, this increased risk for IBS went down when people confided in someone they trust about the stress they experienced,” she explains. “Finding healthy ways to manage stress is important for GI health, and your health overall.”

What you eat can help or hurt your digestive system, and influence how you feel. “Increasing fiber is really important for constipation,” says Chang. “Most Americans do not eat a lot of fiber so you have to gradually increase the fiber in your diet. Otherwise you might get gas and more bloating, and won’t stick with [the changes].”

Chang says you should eat at least 20–30 grams of fiber a day for constipation. You can spread out your fiber in small amounts throughout the day. Start with small servings and gradually increase them to avoid gas, bloating, and discomfort.

Try to eat fruits and vegetables at every meal. A variety of fruits, vegetables, whole grains, and nuts can provide a healthy mix of different fibers and nutrients to your diet. An added benefit is that the more fiber and whole foods you eat, the less room you’ll have for less healthy options.

But some fiber-rich foods, called high FODMAP foods, can be hard to digest. Examples include certain fruits and vegetables, dairy products, and wheat and rye products. If you have IBS, your doctor may recommend a diet low in FODMAPS.

Researchers are coming to understand the complex community of bacteria and other microbes that live in the human GI tract. Called gut flora or microbiota, these microbes help with our digestion. But evidence has been growing that gut microbes may influence our health in other ways too. Studies suggest that they may play roles in obesity, type 2 diabetes, IBS, and colon cancer. They might also affect how the immune system functions. This can affect how your body fights illness and disease. Recent studies have found that microbes’ effects on the immune system may impact the development of conditions such as allergy, asthma, and rheumatoid arthritis.

You might have heard that probiotics—live microbes that are similar to those found in the human gut—can improve your gut health. These are also called “friendly bacteria” or “good bacteria.” Probiotics are available in dietary supplements and in certain foods, such as yogurt.

There is some evidence that probiotics may be helpful in preventing diarrhea associated with antibiotics and improving symptoms of IBS, but more needs to be learned. Researchers still don’t know which probiotics are helpful and which aren’t. They also don’t know how much of the probiotics people would have to take or who would most likely benefit from them.

Certain food additives called emulsifiers are something else that may affect your gut health. Emulsifiers are added to many processed foods to improve texture and extend shelf life. But studies show they can affect our gut flora.

“Our work and other research indicate that emulsifiers and other food additives can negatively impact the microbiota and promote inflammatory diseases,” says Georgia State University’s Dr. Andrew Gewirtz. His group has been studying the relationships between food additives, gut bacteria, and disease in mice. The team also plans to examine how different food additives may affect people.

Based on what his team and others have found, Gewirtz advises, “The take home message: Eat a balanced diet and less processed foods.”

“The GI system is complicated and such an important part of our health,” Chang says. “It takes a real partnership between patient and doctor to get to the root of issues. Everyone has to find a healthy routine that works for them.”

She encourages you to take an active role in finding a doctor who makes you feel comfortable. The right doctor will listen carefully to your health history and symptoms. You can help keep your gut in check by talking with your doctor and—together—making the right choices for you.

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NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, click here.

Constipation can emerge due to a number of factors, such as the medications you take (opioids, calcium channel blockers, iron supplements and others), being inactive, pregnancy, travel, diet, and health conditions that slow digestion (such as disorders and injuries that affect the brain and spinal cord, hypothyroidism and diabetes).

People who are constipated for long periods of time may also experience additional complications like hemorrhoids, anal fissures, rectal prolapse (rectum protrudes out of the anus) or fecal impaction (hardened stool stuck in the rectum).

Luckily, what helps constipation is as simple as paying closer attention to your nutrition intake. And remember, you should always talk to your doctor about any medical issues or concerns you have!

So what are some remedies for constipation?

You may need more fiber! Most Americans don’t get enough dietary fiber.

But what exactly is fiber? Fiber refers to the undigested parts of food, the NIDDK says. It helps make stool soft so it can move smoothly through your intestines.

There are two types of fiber — soluble and insoluble. Soluble fiber dissolves in water and is found in beans, fruit and oats. Insoluble fiber does not dissolve in water and is found in whole grains and veggies. Both kinds help prevent constipation, the NIDDK says. (Find more examples of fiber-rich foods here and here.)

Most Americans eat 16 grams of fiber a day, but should be getting 22-34 grams a day. But it’s not only the amount of fiber that matters, but also the rate at which you increase your fiber. Ramping it up full tilt can cause gas, bloating and cramps. Be sure to add fiber to your diet slowly so your body can adjust.

Also, make sure you are drinking plenty of fluids (water, fruit and veggie juices, clear soups) to help the fiber work better. And make sure you’re not eating foods that are making constipation worse.

What foods should you avoid if you’re constipated?

If you are constipated, foods with little to no fiber may be working against you, the NIDDK says. You may want to try avoiding cheese, chips, fast food, ice cream, meat, prepared frozen meals/snack foods, and processed foods like “TV dinners” or hot dogs, and see if your constipation improves.

Still facing digestive issues and feel like nothing works?

It’s time to test — don’t guess! Let’s get to the root of the issue with a GI (gastrointestinal) test. You also may want to consider a nutrition test to see if your body is getting and absorbing the nutrients it needs.

Enjoy Your Healthy Life!

Joy Stephenson-Laws is founding and managing partner of Stephenson, Acquisto and Colman (SAC), the healthcare industry’s premier litigation firm. In this role, Ms. Stephenson-Laws leads a diverse team of over 100 professionals that includes attorneys, doctors, nurses, technology and healthcare provider operations specialists. This interdisciplinary approach to representing clients such as Stanford University Hospital, UCLA Medical Center and UC Irvine Medical Center has resulted in SAC’s recovering over $1 billion for its clients while consistently receiving high marks for client satisfaction for such innovations as SACLINK, a proprietary, interactive, paperless document management system.

The pH (Proactive Health) professional health care team includes recognized experts from a variety of health care and related disciplines, including physicians, health care attorneys, nutritionists, nurses and certified fitness instructors. To learn more about the pH Health Care Team, click here. Check out their new book Minerals – The Forgotten Nutrient: Your Secret Weapon for Getting and Staying Healthy. 

Well, such a cure does exist, and it comes from a rather unexpected place: the cannabis plant.

That’s right, smoking marijuana can cure your hiccups – no lemon or pinching or sugar involved.

The finding comes from a 1998 study published in the Lancet journal, in which doctors used marijuana to treat an AIDS patient with intractable hiccups, a medical condition that causes hiccups to span hours, days, or even weeks. In this case, the hiccups developed after a minor surgery and lasted for a full nine days.

Doctors unsuccessfully tried a wide variety of treatments on the patient, including acupuncture, lidocaine injections, and valproate, a prescription medication used to treat epilepsy, among other conditions. They resorted to even stranger methods – including removing a hair from the tympanic membrane in the inner ear, and flooding the ear canal with the anesthetic Marcaine – before administering marijuana.

The first dose temporarily cured the hiccups, and the second made them go away for good.

Though it’s highly unlikely that your case of the hiccups is intractable (intractable hiccups are estimated to affect only 1 in every 100,000 people), this finding combined with other studies on marijuana provide good reason to believe that marijuana can treat your everyday hiccups.

Several studies show that marijuana is proven to reduce the intensity and frequency of muscle spasms, and a case of the hiccups is just a series of inconvenient spasms of the diaphragm muscle.

So, experiencing a stubborn case of the hiccups that you just can’t shake? You may want to reach for a lighter before reaching for that lemon.

“Because the lungs continuously and automatically draw air, and any number of environmental agents, into the body, the composition and balance of microbes in the lungs may have a profound effect on many respiratory conditions,” said Dr. Patricia Finn, the Earl M. Bane Professor of Medicine at the University of Illinois at Chicago.

The research from Finn and her colleagues in the UIC College of Medicine suggests that the lung microbiome plays a significant role in asthma severity and response to treatment.

In a group of clinically similar patients with asthma, researchers identified two asthma phenotypes by assessing the microbiome and airway inflammation. The patients were ages 18 to 30 with mild or moderate atopic asthma.

These two phenotypes, called asthma phenotype one and two, or AP1 and AP2, are distinguished by the prevalence and dominance of different bacteria in the lung. When compared, patients in the two groups performed differently on pulmonary function tests.

AP1 was associated with less severe asthma; AP2 was associated with increased more severe asthma.

“This tells us the microbiome has relevance beyond the gut, and that it is a potential biomarker for asthma,” said Dr. David Perkins, professor of medicine and surgery at UIC, who jointly operates the lab with Finn.

“The data suggest that further study of the microbiome may help to develop more personalized treatment recommendations for patients with asthma,” said Finn, the senior author on the paper, which is published in PLOS ONE.

Finn says that asthma research has increasingly focused on the differences between seemingly similar patients, and that this study adds to the growing body of evidence that patients benefit from precision medicine approaches to common chronic diseases, such as asthma.

“If we can better understand how the individual’s lung microbiome affects asthma and identify likely microbial culprits, we may get to a point where we can predict and control asthma development and severity by shifting the microbiome early in life,” Finn said. “This could be as simple as diet, probiotics or medication.”

A second study from the Finn-Perkins lab at UIC, recently published in the American Journal of Respiratory Cell and Molecular Biology, showed that even prior to birth, exposure to specific compositions of bacteria may elicit an inflammatory immune response that could predispose individuals to asthma.

Indigestion

Common symptoms include feeling full fast during a mean, a slicing pain, burning or tightness between your breastbone and navel or bloating. The tricky thing with indigestion is that it can be triggered by something else that is worse. Persistent indigestion may be a side effect of a medication, caused by smoking, thyroid disease, ulcers, infection, or gastroesophageal reflux disease (GERD). “If you rarely have indigestion and feel funny or discomfort after a spicy meal that may go away on it’s own. However, if indigestion is a daily occurrence for more than 2 weeks and is coupled with trouble swallowing, fatigue or weakness then absolutely see your doctor to be sure it isn’t due to something more serious,” advises Sam.

Lactose Intolerance

When the small intestine fails to product enough lactase, an enzyme that digests milk sugar (lactose) food reaches the colon before it has been processed and absorbed. Undigested lactose interacts with normal bacteria in the colon leading to diarrhea, nausea, bloating, cramping, gas and sometimes even vomiting. These symptoms usually begin 30 minutes to two hours after consuming foods or drinks with lactose. Sam explains that the challenge with lactose intolerance is that it often leads to calcium deficiency so it’s always a good idea to see your doctor to create a plan that explores which foods trigger discomfort and which are still okay.

Kidney Stones

According to Sam, kidney stones don’t cause symptoms until they pass on from the kidney towards your bladder. That’s when there may be cloudy or foul smelling urine that can appear brown, or pink. There may also be a frequent need to urinate but the ability to urinate small amounts. Nausea and vomiting along with fever and chills are also symptoms. Usually when lower back pain is so severe sleeping and even sitting is difficult the patient seeks medical attention. “When you have kidney stones you just know something isn’t right, yet sometimes it takes people longer to see several symptoms before they seek medical attention,” Sam says.

Gallstones

Gallstones are stones that form in the gallbladder, a tiny sac that hangs out under the liver, emptying bile as needed to digest fats. These stones cause swelling and can block the duct into the intestine, resulting in pain. Gallstone pain tends to strike the right side of the upper abdomen, particularly after fatty meals triggering the gallbladder to contract. “If the gallbladder is inflamed, any contraction of that nature will be amplified and typically will cause pain to the patient,” Sam explains.

Appendicitis

While it’s more common to people ages 10-20 it can strike at any age. Typical symptom is pain specifically in the lower right quadrant of the abdomen; however, half of those with appendicitis have pain elsewhere. Also not everyone has his or her appendix in the same place making the pain site vary. “This is why it is important to monitor symptoms closely. Many of the symptoms are similar to ones associated with other conditions such as kidney stone, Crohn’s disease even ectopic pregnancy,” Sam says. She further explains that the patient can expect several tests (blood, urine, MRI, CT or ultrasound) to confirm diagnoses. Some doctors don’t want to risk waiting for test results and based on how the patient describes his or her own symptoms may opt to surgically remove the appendix.

Medication Side Effects

“No drug is without side effects and sometimes that includes abdominal pain. Oral bisphosphonates, a popular class of drugs that helps preserve bone density and prevent osteoporosis, can cause swelling—and therefore pain—in the lower esophagus,” says Sam. Pain medications known as NSAIDs (nonsteroidal anti-inflammatory drugs) such as ibuprofen and aspirin can also cause swelling in the stomach lining and may even lead to ulcers.

The Rule of Thumb

Trust the gut. When something feels more serious, it usually is. Some stomach issues can either be symptoms of other more serious issues or if left unaddressed, can escalate into something worse. “Whenever you’re feeling prolonged discomfort and sharp pain it’s worth seeing your doctor,” advises Sam.

Dr. Gina Sam, MD/MPH, is an Assistant Professor in the Division of Gastroenterology, Department of Medicine at Mount Sinai School of Medicine, New York. She is the Director of the Mount Sinai Gastrointestinal Motility Center specializing in achalasia, gastroesophageal reflux, functional disorders, irritable bowel syndrome, gastroparesis, and anorectal disorders including pelvic floor dyssnergia and fecal incontinence.