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The Digestive System breaks nutrients into parts small enough for your body to absorb and use for energy, growth, and cell repair (NIDDK, 2017).

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The Mouth is responsible for swallowing food, chewing, and mixing the food which then creates the chemical breakdown of carbohydrates. The food then moves into the pharynx and starts the breakdown of lipids through lingual lipase. Other functions of the mouth include allowing you to moisten and dissolve food which allows you to be able to taste it. The mouth also cleans and lubricates the teeth and oral cavity. Furthermore, the mouth has some antimicrobial activity (Anatomy & Physiology II).

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The Pharynx pushes food from the oral cavity to the esophagus. It also lubricates food and passageways (Anatomy & Physiology II).

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The esophagus pushes the food down to the stomach. As the pharynx does, it lubricates food and passageways (Anatomy & Physiology II).

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The stomach is responsible for blending and stirring food with gastric juices to form chyme. The stomach begins the chemical breakdown of proteins. It also releases food into the duodenum as chyme. Furthermore, it absorbs some fat-soluble substances. The stomach has power over the antimicrobial functions. The stomach also stimulates protein-digesting enzymes. Finally, it hides the necessary factor required for vitamin B12 absorption in the small intestine (Anatomy & Physiology II).

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The small intestine mixes chyme with digestive juices. It moves food at a rate slow enough for digestion and absorption. It also absorbs breakdown products of carbohydrates, proteins, lipids, nucleic acids, vitamins, minerals, and water. Furthermore, the small intestine performs physical digestion through division (Anatomy & Physiology II).

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Organs that are part of the digestive system are the liver, gallbladder, and pancreas. The liver produces bile salt. This causes the combination of lipids to help their digestion and absorption. The gallbladder stores, concentrates and releases bile. Finally, the pancreas produces digestive enzymes and bicarbonate (Anatomy & Physiology II).

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The Large intestine continues to break down food residues. It also absorbs most residual water, electrolytes, and vitamins produced by enteric bacteria. Furthermore, the large intestine pushes the feces toward the rectum. Finally, it eliminates feces (Anatomy & Physiology II).

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Anatomy & Physiology, "Digestive System Processes and Regulation," https://courses.lumenlearning.com/suny-ap2/chapter/digestive-system-processes-and-regulation/, (April 28, 2022)

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Learning Objectives

By the end of this section, you will be able to:

Discuss six fundamental activities of the digestive system, giving an example of each

Compare and contrast the neural and hormonal controls involved in digestion

The digestive system uses mechanical and chemical activities to break food down into absorbable substances during its journey through the digestive system. Table 1 provides an overview of the basic functions of the digestive organs.

Visit this site for an overview of digestion of food in different regions of the digestive tract. Note the route of non-fat nutrients from the small intestine to their release as nutrients to the body.

Table 1. Functions of the Digestive Organs

Organ

Major functions

Other functions

Mouth

Ingests food

Chews and mixes food

Begins chemical breakdown of carbohydrates

Moves food into the pharynx

Begins breakdown of lipids via lingual lipase

Moistens and dissolves food, allowing you to taste it

Cleans and lubricates the teeth and oral cavity

Has some antimicrobial activity

Pharynx

Propels food from the oral cavity to the esophagus

Lubricates food and passageways

Stomach

Mixes and churns food with gastric juices to form chyme

Begins chemical breakdown of proteins

Releases food into the duodenum as chyme

Absorbs some fat-soluble substances (for example, alcohol, aspirin)

Possesses antimicrobial functions

Stimulates protein-digesting enzymes

Secretes intrinsic factor required for vitamin B₁₂ absorption in small intestine

Small intestine

Mixes chyme with digestive juices

Propels food at a rate slow enough for digestion and absorption

Absorbs breakdown products of carbohydrates, proteins, lipids, and nucleic acids, along with vitamins, minerals, and water

Performs physical digestion via segmentation

Provides optimal medium for enzymatic activity

Accessory organs

Liver: produces bile salts, which emulsify lipids, aiding their digestion and absorption

Gallbladder: stores, concentrates, and releases bile

Pancreas: produces digestive enzymes and bicarbonate

Bicarbonate-rich pancreatic juices help neutralize acidic chyme and provide optimal environment for enzymatic activity

Large intestine

Further breaks down food residues

Absorbs most residual water, electrolytes, and vitamins produced by enteric bacteria

Propels feces toward rectum

Eliminates feces

Food residue is concentrated and temporarily stored prior to defecation

Mucus eases passage of feces through colon

Digestive Processes

The processes of digestion include six activities: ingestion, propulsion, mechanical or physical digestion, chemical digestion, absorption, and defecation.

The first of these processes, ingestion, refers to the entry of food into the alimentary canal through the mouth. There, the food is chewed and mixed with saliva, which contains enzymes that begin breaking down the carbohydrates in the food plus some lipid digestion via lingual lipase. Chewing increases the surface area of the food and allows an appropriately sized bolus to be produced.

Food leaves the mouth when the tongue and pharyngeal muscles propel it into the esophagus. This act of swallowing, the last voluntary act until defecation, is an example of propulsion, which refers to the movement of food through the digestive tract. It includes both the voluntary process of swallowing and the involuntary process of peristalsis. Peristalsis consists of sequential, alternating waves of contraction and relaxation of alimentary wall smooth muscles, which act to propel food along (Figure 1). These waves also play a role in mixing food with digestive juices. Peristalsis is so powerful that foods and liquids you swallow enter your stomach even if you are standing on your head.

Digestion includes both mechanical and chemical processes. Mechanical digestion is a purely physical process that does not change the chemical nature of the food. Instead, it makes the food smaller to increase both surface area and mobility. It includes mastication, or chewing, as well as tongue movements that help break food into smaller bits and mix food with saliva. Although there may be a tendency to think that mechanical digestion is limited to the first steps of the digestive process, it occurs after the food leaves the mouth, as well. The mechanical churning of food in the stomach serves to further break it apart and expose more of its surface area to digestive juices, creating an acidic "soup" called chyme. Segmentation, which occurs mainly in the small intestine, consists of localized contractions of circular muscle of the muscularis layer of the alimentary canal. These contractions isolate small sections of the intestine, moving their contents back and forth while continuously subdividing, breaking up, and mixing the contents. By moving food back and forth in the intestinal lumen, segmentation mixes food with digestive juices and facilitates absorption.

In chemical digestion, starting in the mouth, digestive secretions break down complex food molecules into their chemical building blocks (for example, proteins into separate amino acids). These secretions vary in composition, but typically contain water, various enzymes, acids, and salts. The process is completed in the small intestine.

Food that has been broken down is of no value to the body unless it enters the bloodstream and its nutrients are put to work. This occurs through the process of absorption, which takes place primarily within the small intestine. There, most nutrients are absorbed from the lumen of the alimentary canal into the bloodstream through the epithelial cells that make up the mucosa. Lipids are absorbed into lacteals and are transported via the lymphatic vessels to the bloodstream (the subclavian veins near the heart). The details of these processes will be discussed later.

In defecation, the final step in digestion, undigested materials are removed from the body as feces.

Aging and the Digestive System: From Appetite Suppression to Constipation

Age-related changes in the digestive system begin in the mouth and can affect virtually every aspect of the digestive system. Taste buds become less sensitive, so food isn't as appetizing as it once was. A slice of pizza is a challenge, not a treat, when you have lost teeth, your gums are diseased, and your salivary glands aren't producing enough saliva. Swallowing can be difficult, and ingested food moves slowly through the alimentary canal because of reduced strength and tone of muscular tissue. Neurosensory feedback is also dampened, slowing the transmission of messages that stimulate the release of enzymes and hormones.

Pathologies that affect the digestive organs-such as hiatal hernia, gastritis, and peptic ulcer disease-can occur at greater frequencies as you age. Problems in the small intestine may include duodenal ulcers, maldigestion, and malabsorption. Problems in the large intestine include hemorrhoids, diverticular disease, and constipation. Conditions that affect the function of accessory organs-and their abilities to deliver pancreatic enzymes and bile to the small intestine-include jaundice, acute pancreatitis, cirrhosis, and gallstones.

In some cases, a single organ is in charge of a digestive process. For example, ingestion occurs only in the mouth and defecation only in the anus. However, most digestive processes involve the interaction of several organs and occur gradually as food moves through the alimentary canal (Figure 2).

Some chemical digestion occurs in the mouth. Some absorption can occur in the mouth and stomach, for example, alcohol and aspirin.

Regulatory Mechanisms

Neural and endocrine regulatory mechanisms work to maintain the optimal conditions in the lumen needed for digestion and absorption. These regulatory mechanisms, which stimulate digestive activity through mechanical and chemical activity, are controlled both extrinsically and intrinsically.

Neural Controls

The walls of the alimentary canal contain a variety of sensors that help regulate digestive functions. These include mechanoreceptors, chemoreceptors, and osmoreceptors, which are capable of detecting mechanical, chemical, and osmotic stimuli, respectively. For example, these receptors can sense when the presence of food has caused the stomach to expand, whether food particles have been sufficiently broken down, how much liquid is present, and the type of nutrients in the food (lipids, carbohydrates, and/or proteins). Stimulation of these receptors provokes an appropriate reflex that furthers the process of digestion. This may entail sending a message that activates the glands that secrete digestive juices into the lumen, or it may mean the stimulation of muscles within the alimentary canal, thereby activating peristalsis and segmentation that move food along the intestinal tract.

The walls of the entire alimentary canal are embedded with nerve plexuses that interact with the central nervous system and other nerve plexuses-either within the same digestive organ or in different ones. These interactions prompt several types of reflexes. Extrinsic nerve plexuses orchestrate long reflexes, which involve the central and autonomic nervous systems and work in response to stimuli from outside the digestive system. Short reflexes, on the other hand, are orchestrated by intrinsic nerve plexuses within the alimentary canal wall. These two plexuses and their connections were introduced earlier as the enteric nervous system. Short reflexes regulate activities in one area of the digestive tract and may coordinate local peristaltic movements and stimulate digestive secretions. For example, the sight, smell, and taste of food initiate long reflexes that begin with a sensory neuron delivering a signal to the medulla oblongata. The response to the signal is to stimulate cells in the stomach to begin secreting digestive juices in preparation for incoming food. In contrast, food that distends the stomach initiates short reflexes that cause cells in the stomach wall to increase their secretion of digestive juices.

Hormonal Controls

A variety of hormones are involved in the digestive process. The main digestive hormone of the stomach is gastrin, which is secreted in response to the presence of food. Gastrin stimulates the secretion of gastric acid by the parietal cells of the stomach mucosa. Other GI hormones are produced and act upon the gut and its accessory organs. Hormones produced by the duodenum include secretin, which stimulates a watery secretion of bicarbonate by the pancreas; cholecystokinin (CCK), which stimulates the secretion of pancreatic enzymes and bile from the liver and release of bile from the gallbladder; and gastric inhibitory peptide, which inhibits gastric secretion and slows gastric emptying and motility. These GI hormones are secreted by specialized epithelial cells, called endocrinocytes, located in the mucosal epithelium of the stomach and small intestine. These hormones then enter the bloodstream, through which they can reach their target organs.

Chapter Review

The digestive system ingests and digests food, absorbs released nutrients, and excretes food components that are indigestible. The six activities involved in this process are ingestion, motility, mechanical digestion, chemical digestion, absorption, and defecation. These processes are regulated by neural and hormonal mechanisms.

Self Check

Answer the question(s) below to see how well you understand the topics covered in the previous section.

Critical Thinking Questions

1. Offer a theory to explain why segmentation occurs and peristalsis slows in the small intestine.

2. It has been several hours since you last ate. Walking past a bakery, you catch a whiff of freshly baked bread. What type of reflex is triggered, and what is the result?

Glossary

absorption: passage of digested products from the intestinal lumen through mucosal cells and into the bloodstream or lacteals

chemical digestion: enzymatic breakdown of food

chyme: soupy liquid created when food is mixed with digestive juices

defecation: elimination of undigested substances from the body in the form of feces

ingestion: taking food into the GI tract through the mouth

mastication: chewing

mechanical digestion: chewing, mixing, and segmentation that prepares food for chemical digestion

peristalsis: muscular contractions and relaxations that propel food through the GI tract

propulsion: voluntary process of swallowing and the involuntary process of peristalsis that moves food through the digestive tract

segmentation: alternating contractions and relaxations of non-adjacent segments of the intestine that move food forward and backward, breaking it apart and mixing it with digestive juices

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By the end of this section, you will be able to: Discuss six fundamental activities of the digestive system, giving an example of each Compare and contrast the neural and hormonal controls involved in digestion The digestive system uses mechanical and chemical activities to break food down into absorbable substances during its journey through the digestive system.

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IBS is a long-term gastrointestinal disorder that can cause continuous discomfort. IBS affects a part of the GI tract with chronic, irregular, and unpredictable symptoms. Symptoms of IBS include changes in bowel habits, stomach pain, and cramping, a feeling that the bowels are not empty after passing stools, passing mucus from the rectum, and swelling or bloating of the abdomen (Brazier, 2022).
When a person worsens they begin to have flare-ups. This sometimes happens immediately after a meal or it can take longer for others. Some of these flare-up symptoms are similar to the IBS symptoms. These symptoms include stomach pain, constipation, diarrhea, bloating, and mucus in stool (Brazier, 2022).
Other symptoms can include blood in stool, loss of appetite, fever, and weight loss. People who suffer from IBS have an increased risk of colon cancer. Lactose intolerance, suffering from colon cancer, celiac disease, or diverticulitis can cause IBS (Brazier, 2022).

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Brazier, Y. (2022) "All you need to know about Irritable Bowel Syndrome" https://www.medicalnewstoday.com/articles/37063, (May 5, 2022)

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Irritable bowel syndrome (IBS) is a long-term gastrointestinal disorder that can cause persistent discomfort. However, most people will not experience severe complications.

IBS, also called spastic colitis or nervous colon, is a chronic condition with symptoms that change over the years. Symptoms often ease as individuals learn to manage the condition.

IBS is common. As many as 10-15% of people in the United States have it. It affects twice as many females as males. Many factors influence IBS, and suggests that microbes present during infectious gastroenteritis may trigger a long-term reaction.

This article discusses symptoms, causes, treatment, and how diet can affect IBS.

IBS is a functional gastrointestinal disorder. These types of disorders generally affect a part of the GI tract with chronic, sporadic, and unpredictable symptoms.

In IBS, there is a change or disturbance in bowel function. This can cause abdominal pain and changes in bowel movements that can include diarrhea, constipation, or both.

IBS these symptoms without causing any visible damage to the digestive tract.

Healthcare professionals often refer to IBS with diarrhea as IBS-D and IBS with constipation as IBS-C. If IBS causes both diarrhea and constipation, healthcare professionals may call it IBS-A, which stands for alternating bowel habits, or IBS-M, which stands for mixed bowel habits.

Signs and symptoms of IBS may vary from person to person and often mimic symptoms of other conditions.

The most common symptoms of IBS include:

changes in bowel habits

abdominal pain and cramping, which often reduce after passing a stool

a feeling that the bowels are not empty after passing stools

passing mucus from the rectum

swelling or bloating of the abdomen

Symptoms of IBS flares

A flare or flare-up refers to periods when a person's symptoms worsen. Often, a person may experience a flare immediately following a meal, or it can take longer in some people. A person experiencing a flare will have many of the same symptoms associated with IBS, including:

abdominal pain

changes in stool, such as constipation or diarrhea

bloating

mucus in stool

feeling as though a movement did not completely void the rectum

Symptoms in males vs. females

IBS symptoms tend to vary between females and males. shows that women experience more constipation and men experience more diarrhea.

Symptoms in children

Children most commonly experience pain in the abdomen, which often occurs around bowel movements, and changes to their bowel movements such as diarrhea, constipation, or both.

IBS often presents similarly to other conditions. For instance, people may confuse IBS with inflammatory bowel disease (IBD).

While IBS is a syndrome that does not cause visible damage to the gastrointestinal tract, IBD is a group of diseases that occur when the immune system attacks cells in the intestines. This immune malfunction damages the gastrointestinal tract and causes chronic inflammation.

Crohn's disease and ulcerative colitis are two of the most common types of IBD. Similar to IBD, these both cause changes in bowel movements and stomach pain. However, a person with IBD, including Crohn's disease or ulcerative colitis, is more likely than a person with IBS to have the following:

People with IBD also have an increased risk of colon cancer.

Other conditions besides IBD that may cause IBS symptoms include:

Several factors can cause IBS to flare or worsen. The following are some common causes of IBS.

Dietary factors can play a role in triggering IBS symptoms.

Symptoms often worsen after a person consumes certain products. These could include chocolate, milk, or alcohol. They may cause either constipation or diarrhea.

Some fruits, vegetables, and sodas can also trigger bloating and discomfort. It is unclear whether a food allergy or intolerance plays a role.

Common dietary triggers of cramping or bloating include foods that cause flatulence, such as:

Other foods that can trigger flares include:

dairy products

sugar-free gum

some candies

products with caffeine in them (though symptoms with these may be due to sugar, sorbitol, or caffeine intolerance rather than IBS)

2. Microbial imbalance

While the exact causes are unknown, some experts that microbial factors may play a key role. The gut contains what is known as the microbiome, which holds an ecosystem of bacteria and other microbial organisms. Experts believe treatments that target the microbiome may help alleviate symptoms in the future.

3. Food poisoning and infection

Research suggests a link between IBS and food poisoning. In fact, 1 in 9 people who experience food poisoning develops IBS at a later date. The microbes involved in infectious gastroenteritis an impact on the immune system that leads to long-term changes in the gut.

Infections such as gastroenteritis may trigger post-infectious IBS.

4. Stress

Researchers believe there is a connection between the brain and the gut, which means that when a person experiences stress or anxiety, it may trigger or exacerbate their IBS.

IBS may link to mental health. For example, shows that people living with post-traumatic stress disorder (PTSD) have a higher risk of developing IBS.

5. Other factors

Several other factors may play a role in causing IBS symptoms to occur. They can :

genetic factors

hormones

digestive organs with a high sensitivity to pain

response to medication

an unusual response to infection

a malfunction in the muscles that move food through the body

an inability of the central nervous system to control the digestive system

Flare triggers

A common trigger of an IBS flare is eating. A person may find that certain foods have a higher chance of causing symptoms to flare or worsen.

It could be helpful for a person to record what they eat and how their symptoms respond. Taking this step could help them reduce flares in the future by avoiding trigger foods.

Other triggers are similar to triggers of IBS as a whole. They include stress, hormones, or taking certain medications.

Treatment options for IBS aim to relieve symptoms and improve a person's quality of life.

Treating IBS usually involves some dietary and lifestyle changes, as well as learning how to manage stress.

Dietary management

The steps may help relieve IBS symptoms:

avoiding sugar alternatives in some chewing gums, diet foods, and sugar-free sweets, as they can cause diarrhea

consuming more oat-based foods to reduce gas or bloating

not skipping meals

eating at the same time every day

eating slowly

limiting alcohol intake

avoiding carbonated, sugary beverages such as soda

limiting the intake of certain fruits and vegetables

drinking at least 8 cups of fluid per day, for most people

Avoiding gluten can also reduce the risk of flares. Gluten-free food products and alternatives are now widely available.
Learn more about gluten.
Additional dietary steps that can also help a person reduce the risk of a flare include:

only eating until full

limiting coffee, tea, or caffeinated beverages to no more than 2 cups per day

avoiding known trigger foods

Changes in eating habits can help manage symptoms. However, no IBS diet works for every person. A person may need to go through a process of trial and error to find a consistent, comfortable diet that works for them.
Learn more about foods that people living with IBS should avoid.
Psychological therapy

Some people may find psychological therapy useful in reducing IBS flares and the impact of symptoms. Techniques include:

Hypnotherapy: This may help alter how the unconscious mind responds to physical symptoms.

Cognitive-behavioral therapy (CBT): This may help people develop strategies for reacting differently to the condition through relaxation techniques and a positive attitude.

Exercise may also help reduce both symptoms of anxiety and the physical symptoms of IBS in some people.

Medications

The following medications may help IBS symptoms:

Antispasmodic medications: These reduce abdominal cramping and pain by relaxing the muscles in the gut.

Bulk-forming laxatives: These can help a person relieve constipation. However, people should take them with caution.

Antimotility medications: These can reduce diarrhea symptoms. Options include loperamide, which slows down contractions of the intestinal muscles.

Tricyclic antidepressants (TCAs): These often help to reduce abdominal pain and cramping.

Additional medications specific to IBS treatment include:

alosetron (Lotronex) for severe diarrhea-predominant IBS in females

lubiprostone (Amitiza) for constipation-predominant IBS in females

rifaximin (Xifaxan), an antibiotic that can help reduce diarrhea in people with IBS

eluxadoline (Viberzi) for diarrhea and abdominal pain in people who have IBS with diarrhea

These are typically the last line of treatment when other lifestyle or therapeutic interventions have not helped, and symptoms remain severe.

Until recently, there was no specific imaging or laboratory test to support an IBS diagnosis. There is now a blood test that can accurately reveal whether a person has IBS with diarrhea or IBD. However, laboratory testing for this is not yet readily available.

As part of the diagnosis, a doctor will aim to rule out conditions that produce symptoms similar to IBS. They will also follow a procedure to categorize the symptoms.

There are main types of IBS:

IBS-C: A person experiences stomach pain, discomfort, bloating, infrequent or delayed bowel movements, or hard or lumpy stools.

IBS-D: There is stomach pain, discomfort, an urgent need to go to the toilet, frequent bowel movements, or watery or loose stools.

IBS-A or IBS-M: A person experiences both constipation and diarrhea.

Many people experience different types of IBS over time. A doctor can often diagnose IBS by asking about symptoms, for example:

Have there been any changes in bowel habits, such as diarrhea or constipation?

Is there any pain or discomfort in the abdomen?

How often is there a bloated feeling?

A blood test may help rule out other possible conditions, including:

If specific signs or symptoms suggest a different condition, further testing may be necessary. These include:

localized swelling in the rectum and abdomen

unexplained weight loss

abdominal pain at night

progressively worsening symptoms

significant amounts of blood in the stool

family history of IBD, colorectal cancer, or celiac disease

A 2019 review of 38 studies found that the following characteristics and conditions may increase the risk of IBS:

having gastroenteritis

being younger than approximately 35 years or older than 65 years

a history of anxiety or depression

stress

a family history of IBS

pain

sleep disorders

Can I get IBS from eating gluten?

Some people with IBS sensitivity to gluten. If a person has concerns that gluten may be contributing to their bowel issues, they should ask their doctor for testing.

It is not possible to cure IBS permanently. However, treatment options, including lifestyle and dietary changes as well as medications, can help a person manage and reduce their symptoms.

Is IBS contagious?

While some shows that IBS may be related to bacteria in the small intestine, it is not contagious. However, a person may develop post-infectious IBS after an intestinal illness such as gastroenteritis.

IBS is a gastrointestinal syndrome that does not cause damage to the gastrointestinal tract. However, it can cause uncomfortable and disruptive symptoms.

Though it is common, it can be difficult for a doctor to diagnose IBS due to the lack of tests available to diagnose it and the symptoms it shares with many other conditions.

There is no cure for IBS. However, treatments are available that can help a person manage their symptoms and regain a better quality of life.

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Irritable bowel syndrome (IBS): Symptoms, treatment, and more

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Irritable bowel syndrome (IBS) is a long-term gastrointestinal disorder that can cause persistent discomfort. However, most people will not experience severe complications. IBS, also called spastic colitis or nervous colon, is a chronic condition with symptoms that change over the years. Symptoms often ease as individuals learn to manage the condition.

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Small Intestinal Bacterial Overgrowth (SIBO)

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Small Intestinal Bacterial Overgrowth (SIBO)

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SIBO occurs when an immoderate amount of bacteria populate the small intestine. Symptoms of SIBO include bloating, diarrhea, constipation, and unexplained vitamin deficiencies, especially Vitamin B12 (Eske, 2021).
Though doctors are not always sure about the cause of SIBO, researchers have identified some factors that they believe contribute to SIBO (Eske, 2021)
Low Motility: The person's intestines push bacteria and food through the digestive tract, which then prevents too much bacteria from accumulating in the small intestine (Eske, 2021).
Dysbiosis: The person's microbiome becomes unbalanced and contains too many dangerous species of microbes or not enough helpful species (Eske, 2021).
Hypochlorhydria: The person has low levels of stomach acid. When there is not enough acid, bacteria may move up higher to the digestive tract than usual.
Structural differences: The person has structural differences in the digestive tract (Eske, 2021).
Alcohol use: Excessive alcohol consumption can damage the microbiome , leading to dysbiosis, damage to the intestinal walls and cause inflammation (Eske, 2021)

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GERD is a long-term condition in which acid from the stomach comes up into the esophagus. GERD may result from a weak or damaged valve between the stomach and esophagus. GERD can also result in people who are obese or overweight because of the increased pressure on the stomach. It is also most commonly found in women who are pregnant (40%-85% of pregnant women). Furthermore, it can occur in people who are taking medications including asthma medications, calcium channel blockers, antihistamines, sedatives, and antidepressants. Finally, it is also very common among smokers and those exposed to secondhand smoking. Some lifestyle changes that can help GERD are losing weight, sleeping in an inclined position, changing diet and avoiding food triggers, and avoiding eating meals at least 3 hours before going to bed (Macgill, 2022).

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Gallstones are stones or lumps that develop in the gallbladder or bile duct when certain substances harden. Gallstones form when the chemicals in the gallbladder are out of balance. There are two types of gallstones which are cholesterol gallstones (if there is too much cholesterol in the bile), and pigment gallstones (when the bile has too much bilirubin). Gallstones are common in people who are overweight/obese, more so in women (Felman, 2021).
Symptoms of gallstones are nausea, vomiting, sweating, and restlessness (Felman, 2021).

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Celiac disease is an autoimmune condition that involves the immune system's reaction to gluten. Celiac disease is caused over time when villi in the intestine get damaged. Celiac disease mostly occurs in women and in white people. Family history also plays a role in whether or not a person may have celiac disease. Celiac disease is more common in people with Down syndrome, Turner syndrome, and type 1 diabetes.
Symptoms of celiac disease include abdominal pain, bloating, gas, chronic diarrhea, constipation, nausea, vomiting, pale stool with a foul smell, and fatty stool that floats (Smith, 2021).

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Crohn's disease is a chronic or long-term condition that causes inflammation in the digestive tract. It can be painful and life-threatening. It can also affect any part of the GI tract, from the mouth to the anus. Some symptoms include intestinal ulcers, discomfort, or pain. Other symptoms include mouth ulcers, diarrhea, fatigue, altered appetite, weight loss, anemia, rectal bleeding, and anal fissures. It is not clear what causes Crohn's disease but researchers suggest that it may stem from an abnormal reaction of the immune system. Researchers have also found a link between E. Coli and Crohn's. There is currently no cure for Crohn's disease. Treatment involves medication, surgery, and nutritional supplements (Brazier, 2021).

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Ulcerative Colitis is a long-term condition that causes inflammation of the colon. It is similar to Crohn's disease. The causes are also unclear, but they may involve genetic factors, diet, air pollution, cigarette smoke, or the body may respond to a bacterial infection in a way that causes ulcerative colitis. Symptoms include abdominal pain, bloody diarrhea with mucus, fatigue, weight loss, loss of appetite, anemia, elevated temperature, dehydration, and a constant urge to pass stools (Felman, 2021).

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Brazier, Y. (2021) "All you need to know about Crohn's Disease" https://www.medicalnewstoday.com/articles/151620, (May 5, 2022)

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Crohn's disease is a chronic, or long-term, condition that causes inflammation in the digestive tract. Crohn's disease can be painful, debilitating, and sometimes life threatening.

Crohn's disease is an autoimmune-mediated inflammatory condition. It can affect any part of the gastrointestinal (GI) tract, from the mouth to the anus.

The disease primarily involves the intestinal system, but it also has a variety of other manifestations and can affect the skin, joints, bones, eyes, kidney, and liver.

Symptoms of Crohn's disease can include intestinal ulcers, discomfort, and pain.

Although it typically starts in childhood or early adulthood, it can develop at any age.

Having a supportive network of people who understand life with Crohn's disease is important. IBD Healthline is a free app for people with this condition. The app is available to download from the App Store and Google Play.

In this article, we explain what Crohn's disease is and how it manifests. We also discuss its causes, diagnosis, complications, and treatments, and we offer some dietary tips.

Symptoms of Crohn's disease vary, depending on which part of the gut the condition affects. They often include:

Pain: The level of pain varies from person to person and depends on where the inflammation is in the gut. People tend to experience pain in the lower right side of the abdomen.

Ulcers in the gut: These are raw areas that may bleed. If this happens, a person may find blood in their stools.

Mouth ulcers: These are a common symptom.

Altered appetite: At times, a person may experience appetite loss.

Weight loss: This can result from a loss of appetite.

Anemia: A loss of blood can lead to anemia.

During a flare of Crohn's disease symptoms, a person may also develop:

Symptoms in females

Around of females who develop Crohn's disease do so before the age of 35. It can have some specific symptoms in females, such as:

irregular menstruation, due to effects on hormone function

iron deficiency, as Crohn's affects the absorption of nutrients and can lead to intestinal bleeding

pain during sex, if symptoms affect areas near the anus or vagina

discomfort about sex, as Crohn's can affect a person's libido and body image, as well as causing pain and other types of discomfort

Crohn's disease does not appear to affect fertility, but suggests that it is harder to conceive when the disease is active and after surgery.

Having an inflammatory bowel disease (IBD), such as Crohn's, does not keep a person from becoming pregnant. However, someone with this type of disease is more likely to:

have a preterm delivery

need a cesarean delivery

give birth to an infant with a low birth weight

Here, learn more about how Crohn's disease affects females.
Children with Crohn's disease might need high calorie liquid formulas, especially if the condition affects their growth.

Many people with Crohn's say that the following foods can increase diarrhea and cramping:

When a person's appetite is very low, they may need to feed intravenously for a short period.

A Crohn's disease diet may help.

It is not clear what causes Crohn's disease. suggest that it may stem from an abnormal reaction of the immune system. However, they do not know whether this reaction causes the disease or results from it.

Factors that may increase the risk of inflammation include:

genetic factors

a person's immune system

environmental factors

A bacterium or virus may also play a role. For example, research suggests that there is a link between the bacterium Escherichia coli and Crohn's disease.

Smoking is another risk factor.

A doctor will ask a person about their symptoms. A physical examination may reveal a lump in the abdomen resulting from when loops of inflamed bowels became stuck together.

How to test

The following tests in the diagnosis:

stool and blood tests

sigmoidoscopy, which involves using a short, flexible, tube-like tool, a sigmoidoscope, to investigate the lower bowel

colonoscopy, which involves using a flexible, tube-like tool, a colonoscope, to investigate the colon

endoscopy, which involves inserting a long, thin, flexible tool called an endoscope down through the esophagus and into the stomach to investigate the upper part of the gut

CT scan or barium enema X-ray, which help reveal changes in the bowel

While treatment can help manage Crohn's disease, there is currently . Research continues, and once scientists can identify the causes, it may be possible to find a cure.

Meanwhile, the following information could one day help researchers develop a cure:

Microbacterium avium tuberculosis, or MAP, bacteria appear to be more common in people with Crohn's disease. Scientists are working to clarify the link.

One is that Crohn's disease results from changes in the gut microbiome. Learning more about this could reveal ways of rebalancing microbiota in the gut.

The immune response plays a role in Crohn's disease. As new methods of easing inflammation emerge, more effective ways of managing Crohn's disease could result.

Genetic factors may play a role. Identifying genes that affect the risk of Crohn's disease and learning how to adjust them could lead to a cure.

Implantable devices, regenerative medicine, and stem cells technology are also possible future options.

However, more investigations are needed before any of these can lead to a cure.
Learn more about research into possible cures and treatment options for Crohn's disease.
Treatment for Crohn's disease may involve medication, surgery, and nutritional supplements. The aim is to control inflammation, resolve nutritional problems, relieve symptoms, and reduce the occurrence of flares.

The course of treatment will depend on:

where the inflammation occurs

the severity of the issue

any complications

a person's response to previous treatments

Some people go for long periods, even years, without experiencing any symptoms. These are periods of "remission." However, symptoms usually flare up again.

As the duration of remission varies greatly, it can be hard to know how effective treatment is and how long remission will last.

Medication

There are many medications for Crohn's disease, :

Steroids: These may include oral steroids, such as prednisone (Rayos) and budesonide (Entocort), or intravenous steroids, such as methylprednisolone (Solu-Medrol). They are for short-term use only, as they can have severe adverse effects.

Antibiotics: These can be useful during Crohn's flare-ups if a person has an abscess or fistula.

Antidiarrheal drugs and fluid replacements: When the inflammation subsides, diarrhea usually becomes less severe. However, a person may still need something to address diarrhea and abdominal pain. It is important to have the choice of treatment guided by a doctor, because some antidiarrheal drugs can mask an infection that needs treating.

Biologics

Biologics are a type of drug that scientists have developed from living organisms. Biologics reduce the body's immune response by targeting proteins that lead to inflammation. They appear to help people with Crohn's disease.

Below are some examples:

anti-tumor necrosis factor agents, such as infliximab (Remicade), adalimumab (Humira), and certolizumab pegol (Cimzia)

integrin receptor antagonists, such as vedolizumab (Entyvio)

anti-interleukin-12 and interleukin-23 therapy, which may include ustekinumab (Stelara)

anti-Janus kinase 1, such as tofacitinib (Xeljanz)

Examples of biologics for Crohn's disease include:

infliximab (Remicade)

adalimumab (Humira)

certolizumab pegol (Cimzia)

Biologic treatments can have side effects, including vomiting, nausea, and weakened resistance to infection.

Some studies suggest that using biologics can reduce the likelihood of needing abdominal surgery within 10 years to 30%. Before the introduction of biologics, researchers put this figure at 40-55%.

Biologics also appear to reduce the risk of adverse effects of corticosteroids.

There are different types of biologic drugs, and each person reacts to these differently. A doctor will recommend a suitable option and suggest alternatives or combinations of drugs if the first choice proves ineffective.

Most people with Crohn's disease may eventually need surgery. This can relieve symptoms that have not responded to medication. It may also help address complications, such as an abscess, perforation, or blockage, as well as bleeding.

Removing part of the intestine can help, but it does not cure Crohn's disease. Inflammation often returns to an area next to the area that was removed. Some people require more than one procedure in their lifetimes.

A person may need a colectomy, in which a surgeon removes the whole colon, or large intestine. This procedure may also involve making a small opening in the front of the abdominal wall and bringing the tip of the end of the small intestine into this opening, forming a stoma, through which feces exits the body. A pouch then collects the fecal matter. Experts confirm that people with stomas can lead typical, active lives.

If the surgeon can remove the diseased section of the intestine and reconnect the healthy areas, no stoma is necessary.

Surgery is not an option for everyone, however. It is also important to know that the disease will recur after the operation.

There is no known cure for Crohn's disease. People can help manage their symptoms using natural treatments that are complementary to prescription medications.

Some natural approaches to Crohn's disease symptoms include:

Dietary changes: During a flare-up, avoid high fiber foods, dairy, sugar, high fat foods, and spicy foods. Between flare-ups, drink more water, eat small meals, boil or steam food instead of frying it, and keep a food diary to track the effects of different foods.

Behavioral changes: Consider quitting smoking, if this applies. And try relaxation practices and techniques, such as meditation, mindfulness, and yoga. Exercise and mental health counseling could be helpful, as well.

Supplements: Certain supplements, including curcumin, probiotics, bromelain, and , may prove effective.

Essential oils: Some essential oils, such as , peppermint, and , may help reduce inflammation.

There is not enough scientific evidence to confirm that any of these approaches are safe and effective.

However, experts say that quitting smoking can help reduce the severity of symptoms and the frequency of flareups. People with Crohn's who continue to smoke are more likely to have intestinal strictures and other complications.

There is currently no cure for Crohn's disease, but treatments and various care strategies can help manage it.

Still, the disease is to affect a person's quality of life. Life expectancy may also be slightly lower for a person with Crohn's disease because it increases the risk of developing other diseases, such as cancer, liver problems, biliary tract complications, and genitourinary tract infections.

Some people with Crohn's need surgery and possibly more than one procedure over time.

Experts do not know exactly why Crohn's disease develops, but one is that it is an autoimmune condition. This means that the immune system mistakenly attacks healthy cells in the body.

In someone with Crohn's disease, bacteria in the digestive tract may trigger an immune response that continues to occur, resulting in ongoing intestinal damage.
Learn more about immune system involvement in Crohn's disease.
Crohn's disease and ulcerative colitis are both types of IBD. But they are different conditions.

Crohn's disease can affect any part of the digestive tract, including the esophagus, stomach, small intestine, and large intestine, which is called the colon. Ulcerative colitis, on the other hand, only affects the colon.

Another major difference is the depth of inflammation in the intestinal wall. In Crohn's disease, the inflammation affects all layers of the intestinal wall. In ulcerative colitis, the inflammation mainly affects the top layer, known as the mucosal layer.

Moreover, in Crohn's disease, there can be healthy areas between diseased parts of the bowels. In ulcerative colitis, the damage appears in a continuous pattern.

In addition, the pain of Crohn's disease pain may be different from the typical pain of other GI diseases, such as irritable bowel syndrome (IBS). In a person with IBS, there will also be no signs of colon inflammation.

There are five types of Crohn's disease. Each affects a different part of the GI tract:

Ileocolitis: This is the most common type, and it affects the small and large intestines. Symptoms include diarrhea, unexplained weight loss, and pain in the lower and middle abdomen.

Ileitis: This only affects the small intestine. The symptoms are the same as those of ileocolitis, but a person with a severe case could develop fistulas or an inflammatory abscess.

Jejunoileitis: This causes spots of inflammation in the upper area of the small intestine, called the jejunum. Symptoms include abdominal cramping after meals, diarrhea, and in severe cases, fistulas.

IBDs, such as Crohn's disease, are in children and adolescents. Crohn's disease affects children and adults in similar ways. Typical symptoms include:

unexplained weight loss

bloody diarrhea

abdominal pain

Children with Crohn's disease may also experience poor growth and anemia. When a doctor is looking at the treatment options, they must consider the possible effects of the disease on a child's growth, development, bone health, and psychosocial functioning.

A 2017 review of 49 pediatric studies in children with Crohn's disease found that up to one-third of children with inflammation developed bowel complications more than 5 years after they received the diagnosis.

The same review notes that 48-88% of the children had received at least one corticosteroid course, and up to one-third had become dependent on steroids. The authors of the review also point to a trend toward lower rates of surgery as the use of immunomodulators and biologicals increases.

If symptoms are severe and frequent, the risk of complications is higher. A person with any of the following complications surgery:

internal bleeding

a stricture, which involves part of the gut narrowing, causing a buildup of scar tissue and a partial or complete blockage of the intestine

a perforation, a small hole in the wall of the gut, which can lead to leakage, infections, and abscesses

fistulas, which involves a channel forming between two parts of the gut

In addition, a person may have:

a persistent iron deficiency

food absorption problems

a slightly higher risk of bowel cancer

Can Crohn's disease be fatal?

Typically Crohn's disease is not life threatening, but it can cause fatal complications, such as colorectal cancer or severe infections.

The life expectancy of someone with Crohn's disease is usually the same as that of someone without it.

Experts determine whether Crohn's disease constitutes a disability on a case-by-case basis, because each person with the condition has a different experience.

A person with Crohn's disease could qualify for disability insurance if it prevents the person from working. Many people with IBD have to go through a series of appeals before the authorities approve their disability claims.

Crohn's disease is a chronic, or long-term, condition that causes inflammation in the digestive tract. It can be painful, reduce the quality of life, and cause complications that can be fatal.

A person with Crohn's disease can manage the symptoms with medication, stress reduction, and other approaches. Some people need surgery, as well.
Read the article in Spanish.

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Crohn's disease: Symptoms, diet, causes, diagnosis, and more

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Crohn's disease is a chronic, or long-term, condition that causes inflammation in the digestive tract. Crohn's disease can be painful, debilitating, and sometimes life threatening. Crohn's disease is an autoimmune-mediated inflammatory condition. It can affect any part of the gastrointestinal (GI) tract, from the mouth to the anus.

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Carr, K. (2022) "Digestive System- Biology and Evolution" https://quatr.us/biology/digestive-system-evolution.htm, (May 10, 2022)

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Before digestive systems...

Starting about 3.8 billion years ago, during the Archaean Era, one-celled creatures were the earliest living things. They just floated in the ocean and took in food in the form of tiny molecules through their cell walls. Most of the living creatures on Earth still get their food this way today.

Digestion inside the cell

By about two billion years ago, during the Proterozoic Era, eukaryote cells developed the ability to extend their cell wall and capture their food in a bubble called a vacuole. That way it was harder for the food to get away from them. To break up the big molecules they captured, eukaryote cells used slave cells called mitochondria that lived inside them.

Bag-shaped creatures

The first animals with more than one cell, like jellyfish or hydras, formed into the shape of bags two cells thick, so ocean water with food in it could reach all the cells on their inside as well as on the outside. That was about 600 million years ago.

Food flowed in through the mouth, and waste (poop) flowed back out again the same way. Inside these bags, small one-celled bacteria lived that helped to digest the hydra's food in exchange for the hydra helping to catch it. All animals since then also have these bacteria.

Tube-shaped creatures

Tiny roundworms, about 548 million years ago, evolved a more efficient system, in the shape of a tube instead of a bag, so that the food always flowed in the same direction, and then the waste left their body through the anus at the other end, the way your poop does. These worms were only a few millimeters long.

More than two cells thick

Three million years later, annelids (segmented worms) divided their digestive tube into three parts: a crop that stored food, a gizzard that used muscles to grind up food, and the intestine. The worms swallowed small stones which collected in the gizzard, and then the gizzard's muscle ground the food against the stones to smash it up.

Then the food went to the intestine, where bacteria broke it down into molecules that entered the circulatory system to be carried to all the body's cells. This solved the problem of how to get food if the animal was more than two cells thick.

When did stomachs evolve?

By the end of the Proterozoic, about 542 million years ago, the first bigger animals, like arthropods (spiders and millipedes), had evolved a much more complicated digestive system. After the food came in through the mouth, it entered a wider part of the digestive tube, the stomach, where bigger chunks of food could be broken down.

From the stomach, the food entered the midgut (like your intestines), where the food broke down into small molecules. On both sides of the midgut there were caecae which probably took out anything poisonous from the food before it went into the blood.

How about jaws and teeth?

Fish, which evolved about 420 million years ago in the Silurian period, had a big advantage over other animals because they had jaws and teeth. Some fish still had gizzards to break down their food. But with teeth, fish could eat bigger, tougher things and chew them up.

What does a liver do?

Unlike earlier animals, fish also have livers and kidneys, which take the poisons out of their food. Because these specialized parts prepared the food for the cells, the cells were able to get more energy out of the food with less work. That left more energy profit for the cells, and the cells used that energy to swim faster, move around more, and grow bigger smarter brains than earlier animals.

Evolution of tongues and spit

By 375 million years ago, in the Devonian period, the first frogs developed. Frogs had tongues to help catch and digest their food. Frogs also added a pancreas, a gallbladder, and separate large and small intestines, and they separated their poop from their urine (pee).

Again, the tongue and saliva helped to pre-digest food so that the cells could get more energy from each molecule of food, and so frogs had more energy to spare than fish. Frogs used that energy to jump and to move on land, where it is harder to get around.

Birds lose their teeth

Reptiles (including dinosaurs) and birds, and mammals like us, digest their food much the same way as frogs do. One difference is that all birds have gizzards rather than teeth. Birds' ancestors had teeth, but birds have lost their teeth and have evolved to have beaks instead (every once in a while, a bird mutates back and does have teeth, which is why we have the expression "scarce as hen's teeth"). Without teeth, the birds would get less energy out of their food, but they use gizzards to replace their teeth.

People cook their food

People have an additional energy advantage over most other animals, because by around 200,000 years ago we began to pre-digest our food even before we ate it by cooking it over a fire. Cooking food softens it and breaks it down, so that we can get more of the energy out of it more easily.

Bibliography and further reading about the digestive system:

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Digestive System - Biology and Evolution

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Digestive system: A hydra eating: the mouth is where all the tentacles come together,near the center of the picture.The hydra is eating the round bug in its stomach. Before digestive systems... Starting about 3.8 billion years ago, during the Archaean Era, one-celled creatures were the earliest living

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Eske, J. (2021) "What to know about SIBO and its treatment" https://www.medicalnewstoday.com/articles/324475, (May 5, 2022)

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Small intestinal bacterial overgrowth (SIBO) is a condition that occurs when an excessive number of bacteria colonize the small intestine. It can cause bloating, diarrhea, or constipation.

Usually, the large intestine contains most of a person's gut microbiome, and the small intestine does not contain many bacteria. As a result, the small intestine is not able to handle a large number of bacteria growing inside it. When a person eats, these bacteria begin to ferment the food. In some people, this causes symptoms.

SIBO appears to be related to irritable bowel syndrome (IBS). People with IBS are more likely to have SIBO than the rest of the population. However, not everyone with an IBS diagnosis tests positive for SIBO.

In this article, we discuss the symptoms, risk factors, and complications of SIBO. We also look at the best diets to relieve the symptoms.

The symptoms of SIBO can vary from person to person, depending on how mild or severe the overgrowth of bacteria is and whether someone has any coexisting conditions.

However, the symptoms may include:

The type of microbe that is overgrowing may also determine the symptoms. Research suggests that hydrogen-producing bacteria are more associated with diarrhea, while methane-producing species are more associated with constipation.

Doctors are not always sure what causes SIBO. So far, researchers have identified the following factors that may contribute to SIBO:

Low motility: Usually, the intestines push food and bacteria through the digestive tract, which prevents too much bacteria from accumulating in the small intestine. However, if someone has low motility, this mechanism slows down, allowing food to ferment in the small intestine.

Dysbiosis: Dysbiosis is when a person's microbiome becomes imbalanced, containing too many harmful species of microbes or not enough beneficial species. Research into how different species of microorganisms influence digestion is still ongoing, but previous studies suggest that people with IBS often have less diversity, fewer beneficial species, and higher amounts of methane-producing species in their microbiome, which can slow motility.

Hypochlorhydria: This term describes low levels of stomach acid. When someone does not have sufficient stomach acid, it may be possible for bacteria to migrate further up the digestive tract than usual, as the environment is not acidic enough to kill them. Researchers believe that people who take proton pump inhibitors (PPIs), have autoimmune gastritis, or have undergone a gastrectomy have an increased risk of hypochlorhydria and SIBO. However, there is a lack of conclusive evidence on this, and low motility may be a more important risk factor.

Structural differences: Sometimes, SIBO occurs because a person has structural differences in the digestive tract. Examples include small bowel diverticulosis, fistulas, and a shortened colon. According to a , people who have undergone a colectomy are more at risk of developing SIBO.

Alcohol abuse: Excessive alcohol consumption can damage the microbiome, leading to dysbiosis, damage to the intestinal walls, and inflammation.

People with certain underlying conditions are more likely than other people to get SIBO. These people include those with:

SIBO is also more common in older adults, possibly due to slower digestive motility. There is a higher prevalence among females, too, but the reasons for this are unclear.

A small 2017 study found that people with obesity were 11 times more likely to have SIBO than those without obesity. It is unclear why this was the case, as the risk was higher in participants who had healthy digestive motility and pH levels. More research is necessary to understand the link.

A doctor will diagnose SIBO by asking about a person's symptoms and medical history. They may feel the abdomen for signs of excess gas or bloating. If they suspect SIBO, they will recommend testing.

Breath testing

A lactulose breath test measures the concentration of hydrogen and methane in a person's breath. The results of this test can confirm a SIBO diagnosis and reveal the extent of the overgrowth. They also show whether the overgrowth consists mainly of hydrogen- or methane-producing microbes.

A person has to fast for 24 hours before the test. They then drink a sugary solution containing lactulose, which is a sugar that only gut bacteria can break down.

When bacteria break the sugar down, they produce gases, which enter the bloodstream and travel to the lungs. A breath test measures these gases as a person exhales.

Glucose vs. lactulose breath testing

Some doctors perform glucose breath testing instead of lactulose breath testing. Some scientists have criticized this method, as the body can absorb glucose quickly, which means that it might not reach the area of overgrowth.

However, others argue that this rapid absorption can be an advantage, as it makes it less likely that the sugar will reach the colon, where it would generate a false positive result by feeding a large number of bacteria there.

Small bowel aspirate and culture

This is the gold standard for SIBO testing, but it is a more invasive test. Small bowel aspirate tests involve a doctor performing an endoscopy, which means inserting a small, thin camera through the mouth and down into the stomach.

When the device reaches the duodenum, which is where the stomach joins up with the small intestine, doctors use the endoscope to take a tissue sample. They then send the sample to a laboratory, which analyzes the bacteria present.

It is worth noting that with small bowel aspirate testing, as well as breath testing, there is no universally accepted threshold for what constitutes a positive SIBO result. This makes diagnosis more difficult for those who have less conclusive test results.

Other tests

The existing tests for SIBO are not always precise, so a doctor may recommend other tests to get a better picture of someone's digestive health. These could include:

blood tests to detect markers of autoimmunity or inflammation

a mobility test to determine whether someone has any structural problems in the small intestine

an intestinal permeability test, which assesses whether the intestinal lining is "leaky"

stool tests to analyze the gut microbiome

As SIBO can occur for complex reasons, it can be difficult to treat. Various treatment options are available, including antibiotics, fecal microbiota transplants, and dietary changes.

Antibiotics

This is the main treatment for SIBO. Doctors may use one type of antibiotic or a combination to remove the overgrowth.

A popular option is rifaximin (Xifaxan). Previous studies suggest that this antibiotic works best for people with hydrogen-dominant overgrowths. Neomycin, or a combination of rifaximin and neomycin, may be better for those with methane-dominant SIBO. However, research into the best ways of treating SIBO is still ongoing.

Recurrence rates after SIBO treatment are relatively high. For this reason, alongside taking antibiotics, it is essential to address the underlying cause of the SIBO to reduce the risk of the overgrowth coming back.

Depending on the root cause, this may mean taking medications to speed up motility, stopping PPI treatment, or treating other conditions that might be contributing.

Probiotics and fecal microbiota transplants

The role of probiotics in SIBO treatment is controversial. While some studies have shown that specific species can improve motility and reduce hydrogen in the breath, others have shown that probiotics may cause SIBO.

If a person has low motility and takes probiotics, it is possible that they may make an overgrowth more likely or worsen an existing one. The results can vary from person to person.

A fecal microbiota transplant (FMT) is a fairly new treatment that involves a doctor transplanting a donor's gut flora into a patient via the rectum. Again, research has produced mixed results on using this procedure as a treatment for SIBO. Some case studies have noted that FMT seems to cause SIBO. Currently, the Food and Drug Administration (FDA) has not approved this treatment.

Diets cannot cure SIBO, but they can lessen the symptoms. What works can vary from person to person, but a popular option is the low FODMAP diet.

The low FODMAP diet limits the intake of fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. These are substances that the human body does not break down, which means that bacteria can feed on them. Limiting high FODMAP foods may reduce gas, bloating, constipation, and diarrhea.

Both the type and amount of foods a person eats are important in the low FODMAP diet. As it is fairly complex and can involve major dietary changes, it is best to work with a dietitian to implement it. A professional can ensure that a person gets all the nutrients they need.
Learn more about the low FODMAP diet.
In cases where SIBO is severe or not well-controlled, a person may have significant diarrhea or constipation. These symptoms can lead to complications, such as:

These complications can affect many aspects of health, including a person's energy levels, hormones, and mental health. Additionally, living with SIBO can be challenging, which may cause stress, anxiety, and low mood.
Learn more about chronic illness and depression.
It is not always possible to prevent SIBO, but people can take steps to look after their gut health. These include:

Eating a nutritious and varied diet: Eating a wide variety of foods can help increase gut flora diversity, which may reduce the chances of dysbiosis. Fruits, vegetables, and whole grains are especially beneficial.

Stopping smoking: Cigarettes and other products that contain nicotine can change the composition of a person's gut flora. This may play a role in dysbiosis.

Taking prokinetics: Prokinetics are a type of drug that speeds up digestive motility. They may reduce the risk of SIBO in people with an increased risk of developing it, such as those who have underlying conditions or take PPIs. A found that people who took prokinetics and PPIs together were less likely to receive a SIBO diagnosis that those who took PPIs alone.

Treating hypochlorhydria: If a person has low stomach acid, addressing this issue may reduce the risk of SIBO, although there is a need for more studies to confirm this link. How a doctor treats hypochlorhydria will depend on the cause.

Managing other conditions: If a person has conditions that are associated with SIBO, such as hypothyroidism or diabetes, then effectively managing these conditions may reduce the impact they have on the digestive system.

SIBO occurs when bacteria from the large intestine migrate into the small intestine. It can cause symptoms such as bloating, diarrhea, and constipation. Doctors can diagnose SIBO by carrying out a lactulose breath test or a small bowel aspirate and culture test.

The treatment for SIBO usually involves taking one or more antibiotics to remove the overgrowth of bacteria. The effectiveness of other treatments, such as probiotics, is less clear. Newer options, such as FMT, are not fully understood and may carry risks.

People should speak with a gastroenterologist who is knowledgable about SIBO and related digestive disorders if they are experiencing persistent symptoms.

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SIBO: Symptoms, causes, treatment, and diet

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Small intestinal bacterial overgrowth (SIBO) is a condition that occurs when an excessive number of bacteria colonize the small intestine. It can cause bloating, diarrhea, or constipation. Usually, the large intestine contains most of a person's gut microbiome, and the small intestine does not contain many bacteria.

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Felman, A. (2021) "Everything you need to know about Gallstones" https://www.medicalnewstoday.com/articles/153981, (May 5, 2022)

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Gallstones are stones or lumps that develop in the gallbladder or bile duct when certain substances harden.

The gallbladder is a small sac located on the right-hand side of the body, on the underside of the liver. Some of the chemicals that exist in the gallbladder can solidify into either one large stone or several small ones.

There are approximately 20 million Americans with gallstones. A 2008 study revealed that the prevalence of gallstones in adults in industrialized countries was around and appeared to be rising.

The majority of people with gallstones experience no symptoms at all. This is because the stones stay in the gallbladder and cause no problems.

Sometimes, however, gallstones may lead to cholecystitis, or an inflamed gallbladder.

The primary symptom is pain that comes on suddenly and quickly gets worse. This pain can occur on the right side of the body, just below the ribs, between the shoulder blades, or in the right shoulder.

Other symptoms include:

Doctors only treat gallstones if they have caused gallbladder inflammation, blockage of the bile ducts, or if they have moved from the bile ducts into the intestines.

Treatments for gallstones include:

Cholecystectomy

Cholecystectomy means the surgical removal of the gallbladder. This is usually performed with laparoscopic surgery. Laparoscopic surgery is not possible for about 10 percent of people, who will need open cholecystectomy.

With open cholecystectomy, a large cut is made in the abdomen. People who undergo open surgery require a longer hospital stay and recovery time. If a person's gallbladder is severely inflamed, they generally will need open surgery.

For a large proportion of those who undergo a cholecystectomy, gallstones come back within a year. To help prevent this, doctors give many people with gallstones ursosdeoxycholic acid, which is the acid found in bile.

Ursodeoxycholic acid

Ursosdeoxycholic acid lowers the cholesterol content of bile, making it less likely that stones will form.

If a gallstone is made of cholesterol, it can sometimes be slowly dissolved with ursodeoxycholic acid. This type of treatment, known as dissolution, may take up to 24 months to be effective. It is not as effective as surgery but is sometimes the only choice for people who cannot have a general anesthetic.

Endoscopic retrograde cholangiopancreatolography

When a person with gallstones cannot have surgery or ursodeoxycholic acid, they may undergo endoscopic retrograde cholangiopancreatolography (ERCP), which requires a local anesthetic.

A doctor places a flexible fiber-optic camera, or endoscope, into the person's mouth, then passes it through the digestive system and into the gallbladder.

An electrically heated wire widens the opening of the bile duct. The doctor can then remove the stones or leave them to pass into the intestine.

Lithotripsy

A doctor aims ultrasonic shock waves at the gallstones to break them up. If gallstones become small enough, they can then pass safely in a person's stools. This type of treatment is uncommon and is only used when there are few gallstones present.

In many cases, a medical professional will discover a person's gallstones by accident when treating the person for a different condition. A doctor may suspect gallstones after a cholesterol test, an ultrasound scan, a blood test, or even an X-ray.

The doctor may use blood tests to look for signs of infection, obstruction, pancreatitis, or jaundice.

Other diagnostic tests include:

Cholangiography

A medical professional injects a dye either into the bloodstream, so that it concentrates into the bile ducts or gallbladder, or straight into the bile ducts using an ERCP. The dye shows up on X-rays.

The doctor will then be able to look at the X-rays and identify possible gallbladder or bile duct disorders, such as pancreatitis, cancer of the pancreas, or gallstones. The X-rays will indicate to the doctor whether the dye is reaching the liver, bile ducts, intestines, and gallbladder.

If the dye does not move into one of these areas, it generally means that a gallstone is causing a blockage. An expert will have a better idea of where the gallstone is located.

The medical professional can also use ERCP to locate and remove stones in the bile duct.

CT scan

This is a non-invasive X-ray that produces cross-section pictures of the inside of the human body.

Cholescintigraphy (HIDA scan)

A medical professional injects a small amount of harmless radioactive material into the patient. This is absorbed by the gallbladder, which the medical professional then stimulates to contract. This test may diagnose abnormal contractions of the gallbladder or an obstruction of the bile duct.

It used to be the case that doctors would advise people with gallstones who were not yet ready for surgery to follow an extremely low-fat diet to prevent gallstone growth.

Researchers have recently concluded this approach is less helpful than previously thought, as rapid weight loss can cause gallstones.

Instead, the recommendation is that people with gallstones eat a balanced diet with regular meals. This will not cure gallstones, but it can have a positive impact on any symptoms and pain.

Avoiding foods high in saturated fats such as butter, hard cheese, cakes, and cookies can help reduce the risk of gallstones developing. Cholesterol is thought to have a role in forming gallstones.

People can also make positive dietary steps changes to help prevent the condition, such as eating more nuts and consuming less alcohol.

Gallstones may form when the chemicals in the gallbladder are out of balance, such as cholesterol, calcium bilirubinate, and calcium carbonate.

There are two main types of gallstones.

Cholesterol gallstones may form if there is too much cholesterol in the bile. They are the main type of gallstones in the United States.

Pigment gallstones form when the bile has too much bilirubin. They are more common among people with liver disease, infected bile tubes, or blood disorders, such as sickle-cell anemia.

Experts are not completely sure why some people develop the chemical imbalance in their gallbladder that causes gallstones, while others do not.

However, gallstones are more common among people with obesity, especially women. A study revealed that having a waist size of 36 inches or more almost doubles a woman's chances of developing gallstones and the need for surgery to remove them.

Other risk factors for gallstones include:

having been pregnant

having a family history of gallstones

having recently lost lots of weight

taking oral contraceptives

being sedentary

undergoing high-dose estrogen therapy

having a gene variant that significantly increases the risk of developing gallstones

having a high intake of dietary fat

being over 60 years of age

having Native American heritage

taking cholesterol-lowering drugs called statins

having diabetes

More women get gallstones than men. In addition, men who intentionally lost weight rapidly and then regained it may have an increased risk for gallstones later in life.

Additionally, research has linked hormone replacement therapy (HRT) for women during menopause to a higher risk of gallbladder problems. A study found that HRT administered by skin patches or gels poses a smaller risk than HRT taken orally.

Below is a 3-D model of gallstones, which is fully interactive.

Explore the model using your mouse pad or touchscreen to understand more about gallstones.

If the bile duct or duodenum are blocked by gallstones, it can block the flow of digestive juices to the pancreas. This can cause jaundice and acute pancreatitis. Treatment usually involves the surgical removal of the gallbladder.

It is common for people who have had their gallbladder removed to experience feelings of bloating and indigestion, especially when they have a high-fat meal. Some may pass stools more often than before.

Living without a gallbladder

A person can survive without a gallbladder. The liver produces enough bile to digest a normal diet. If a person's gallbladder is removed, the bile reaches the small intestine from the liver via the hepatic ducts, rather than being stored in the gallbladder.

A small proportion of people who have had their gallbladder removed will experience softer and more frequent stools for a while because their bile flows into the small intestine more often.

Other complications

Other potential complications of gallstones include:

Biliary colic

When a stone gets stuck in the opening of the gallbladder and will not easily pass through, the contraction of the gallbladder may cause severe pain. When this happens, an individual may experience a painful condition called biliary colic.

The pain is felt in the upper part of the abdomen, but can also exist in the center or to the right of the abdomen. Pain is more common about an hour after eating, especially if an individual has had a high-fat meal.

The pain will be constant, last a few hours, and then subside. Some people will experience non-stop pain for 24 hours, while others may experience waves of pain.

Infection

If the gallstones have caused a gallbladder infection, the person with the condition may have a fever and experience shivering. In the majority of gallstone infection cases, people will be hospitalized for the removal of the gallstone.

Jaundice

If a gallstone leaves the gallbladder and gets stuck in the bile duct it may block the passage of bile into the intestine. The bile will then seep into the bloodstream, causing signs of jaundice.

In most cases, this complication will require the surgical removal of the gallstone. For some people, the gallstone eventually passes into the intestine.

Pancreatitis

If a small gallstone passes through the bile duct and blocks the pancreatic duct, or causes a reflux of liquids and bile into the duct, an individual may develop pancreatitis.

A person can't change some of the factors that can increase their risk of developing gallstones, such as age, sex, and ethnic origin.

However, it is possible that following a vegetarian diet may reduce the risk of developing gallstones. Vegetarians have a significantly lower risk of developing gallstones compared with people who eat meat.

Many experts say that a diet low in fat and high in fruit and vegetables, including plenty of dietary fiber, also may help protect people from developing gallstones.

A person may also try controlling body weight to help prevent the formation of gallstones. However, crash dieting and rapid weight loss increase the risk of developing gallstones.
Read the article in Spanish.

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Everything you need to know about gallstones

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Gallstones are stones or lumps that develop in the gallbladder or bile duct when certain substances harden. The gallbladder is a small sac located on the right-hand side of the body, on the underside of the liver. Some of the chemicals that exist in the gallbladder can solidify into either one large stone or several small ones.

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Felman, A. (2021) "All you need to know about Ulcerative Colitis" https://www.medicalnewstoday.com/articles/163772, (May 5, 2022)

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Ulcerative colitis: Symptoms, diet, treatment, and more

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Ulcerative colitis is a type of inflammatory bowel disease that causes inflammation in the large intestine. Here, find out what it involves and how to treat it.

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Macgill, M. (2022) "GERD(persistent acid reflux): Symptoms, treatments, and causes" https://www.medicalnewstoday.com/articles/14085, (May 5, 2022)

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Gastroesophageal reflux disease (GERD) is a long-term condition where acid from the stomach comes up into the esophagus.

Many people occasionally experience gastroesophageal reflux (GER).

However, if an individual experiences persistent acid reflux that occurs more than twice a week, they may be diagnosed with GERD. In other words, GERD is the long-term, regular occurrence of GER.

This page covers information about the symptoms, causes, diagnosis, and treatment of GERD.

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If the sphincter at the top of the stomach does not close properly, stomach contents can flow upward.

Gastroesophageal reflux disease is a condition where stomach acid persistently and regularly flows up into the esophagus.

The esophagus may also be referred to as the food pipe or gullet and is the tube that transports food from the mouth to the stomach.

The acid in the esophagus causes heartburn and other symptoms, as well as possible tissue damage.

The American College of Gastroenterology says that at least 15 million Americans, or of the American population, experience heartburn every day.

Occasional acid reflux is quite common, often occurring as a result of overeating, lying down after eating, or eating particular foods.

However, recurrent acid reflux, diagnosed as GERD, typically has other causes and risk factors and can have more serious complications.

Gastroesophageal reflux disease occurs in people of all ages, and sometimes for unknown reasons.

In short, GERD occurs when the sphincter at the bottom of the esophagus becomes weak, or opens when it should not.

GERD occurs more commonly in people who are:

overweight or obese because of increased pressure on the abdomen

pregnant, due to the same increased pressure

taking certain medications, including some asthma medications, calcium channel blockers, antihistamines, sedatives, and antidepressants

smoking, and being exposed to second-hand smoke

Hiatal hernia is a condition where an opening in the diaphragm lets the top of the stomach move up into the chest. This lowers the pressure in the esophageal sphincter and raises the risk of GERD.

The main symptom of GERD is heartburn.

Heartburn is discomfort felt behind the breastbone as a burning sensation. It tends to get worse if the person lies down or bends over, and also after eating food.

However, not all people with GERD experience heartburn, and there are other possible symptoms:

nausea or vomiting

respiratory problems

difficulty or pain when swallowing

decay

GERD can worsen and turn into other conditions if left untreated.

These include:

Esophagitis: This is an inflammation of the esophagus.

Esophageal stricture: In this condition, the esophagus becomes narrow, making it difficult to swallow.

Barrett's esophagus: The cells lining the esophagus can change into cells similar to the lining of the intestine. This can develop into cancer.

Respiratory problems: It is possible to breathe stomach acid into the lungs, which can cause a range of problems including chest congestion, hoarseness, asthma, laryngitis, and pneumonia.

Anyone who is experiencing frequent acid reflux symptoms should talk to their doctor, who may refer them to a specialist in gut medicine known as a gastroenterologist for further investigation.

There are several possible tests to diagnose GERD, including:

Esophageal pH and impedance monitoring: This measures the amount of acid in the esophagus while the body is in different states, such as while eating or sleeping.

Upper gastrointestinal (GI) endoscope: This is a tube with a camera attached, which is used to inspect the esophagus. A small sample of tissue may also be taken at the same time in a biopsy.

Upper GI series: This is a type of X-ray that shows up certain physical abnormalities that might cause GERD.

Esophageal manometry: This measures muscle contractions in the esophagus during swallowing. It can measure the strength of the sphincter.

Bravo wireless esophageal pH monitoring: In this test, a small temporary capsule is attached to the esophagus. This measures the acidity continuously for around 48 hours.

GERD will often be treated with medications before attempting other lines of treatment.

Proton pump inhibitors are one of the main pharmaceutical treatment options for people with GERD. They decrease the amount of acid produced by the stomach.

Other options include:

H2 blockers: These are another option to help decrease acid production.

Antacids: These counteract the acid in the stomach with alkaline chemicals. Side effects can include diarrhea and constipation. Antacids are available to purchase online.

Prokinetics: These help the stomach empty faster. Side effects include diarrhea, nausea, and anxiety.

Erythromycin: Ths is a type of antibiotic that also helps empty the stomach.

Surgical options

If lifestyle changes do not significantly improve the symptoms of GERD, or medications do not have the desired effect, a gastroenterologist may recommend surgery.

Surgical treatments include:

Fundoplication: The surgeon sews the top of the stomach around the esophagus. This adds pressure to the lower end of the esophagus and is generally successful at reducing reflux.

Endoscopic procedures: This is a range of procedures include endoscopic sewing, which uses stitches to tighten the sphincter muscle, and radiofrequency, which uses heat to produce small burns that help tighten the sphincter muscle.

Other lifestyle and behavior changes can help relieve GERD include:

Eat moderate amounts of food and avoid overeating.

Stop eating 2 to 3 hours before sleeping.

Quit or avoid smoking.

If a person is overweight, losing weight can help prevent symptoms.

Do not wear clothing that is tight around the abdomen.

Sleep at a slight angle with the head slightly elevated.

Certain foods may trigger GERD symptoms in some people.

These include:

greasy foods

spicy foods

chocolate

peppermint

foods containing tomato products

alcoholic drinks

If you are avoiding these types of food and still experience regular heartburn, it is important to visit a doctor as there may be other underlying issues causing the symptoms.

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Gastroesophageal reflux disease (GERD) is the long-term, regular occurrence of acid reflux. This can cause heartburn and tissue damage, among other symptoms. Smoking and obesity increase a person's risk of GERD. It is treatable with medication, but some people may need surgery. In this article, learn more about GERD.

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NIDDK. (2017) "Your Digestive System and how it works" https://www.niddk.nih.gov/health-information/digestive-diseases/digestive-system-how-it-works#:~:text=Your%20digestive%20system%20breaks%20nutrients,%2C%20growth%2C%20and%20cell%20repair. (May 5, 2022)

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National Institute of Diabetes and Digestive and Kidney Diseases

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What is the digestive system?

The digestive system is made up of the gastrointestinal tract-also called the GI tract or digestive tract-and the liver, pancreas, and gallbladder. The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus. The hollow organs that make up the GI tract are the mouth, esophagus, stomach, small intestine, large intestine, and anus. The liver, pancreas, and gallbladder are the solid organs of the digestive system.

The small intestine has three parts. The first part is called the duodenum. The jejunum is in the middle and the ileum is at the end. The large intestine includes the appendix, cecum, colon, and rectum. The appendix is a finger-shaped pouch attached to the cecum. The cecum is the first part of the large intestine. The colon is next. The rectum is the end of the large intestine.

The digestive system

Bacteria in your GI tract, also called gut flora or microbiome, help with digestion. Parts of your nervous and circulatory systems also help. Working together, nerves, hormones, bacteria, blood, and the organs of your digestive system digest the foods and liquids you eat or drink each day.

Why is digestion important?

Digestion is important because your body needs nutrients from food and drink to work properly and stay healthy. Proteins, fats, carbohydrates, vitamins, minerals, and water are nutrients. Your digestive system breaks nutrients into parts small enough for your body to absorb and use for energy, growth, and cell repair.

Proteins break into amino acids

Fats break into fatty acids and glycerol

Carbohydrates break into simple sugars

MyPlate offers ideas and tips to help you meet your individual health needs.

Your digestive system breaks nutrients into parts that are small enough for your body to absorb.

How does my digestive system work?

Each part of your digestive system helps to move food and liquid through your GI tract, break food and liquid into smaller parts, or both. Once foods are broken into small enough parts, your body can absorb and move the nutrients to where they are needed. Your large intestine absorbs water, and the waste products of digestion become stool. Nerves and hormones help control the digestive process.

The digestive process

How does food move through my GI tract?

Food moves through your GI tract by a process called peristalsis. The large, hollow organs of your GI tract contain a layer of muscle that enables their walls to move. The movement pushes food and liquid through your GI tract and mixes the contents within each organ. The muscle behind the food contracts and squeezes the food forward, while the muscle in front of the food relaxes to allow the food to move.

The digestive process starts when you put food in your mouth.

Mouth. Food starts to move through your GI tract when you eat. When you swallow, your tongue pushes the food into your throat. A small flap of tissue, called the epiglottis, folds over your windpipe to prevent choking and the food passes into your esophagus.

Esophagus. Once you begin swallowing, the process becomes automatic. Your brain signals the muscles of the esophagus and peristalsis begins.

Lower esophageal sphincter. When food reaches the end of your esophagus, a ringlike muscle-called the lower esophageal sphincter -relaxes and lets food pass into your stomach. This sphincter usually stays closed to keep what's in your stomach from flowing back into your esophagus.

Stomach. After food enters your stomach, the stomach muscles mix the food and liquid with digestive juices. The stomach slowly empties its contents, called chyme, into your small intestine.

Small intestine. The muscles of the small intestine mix food with digestive juices from the pancreas, liver, and intestine, and push the mixture forward for further digestion. The walls of the small intestine absorb water and the digested nutrients into your bloodstream. As peristalsis continues, the waste products of the digestive process move into the large intestine.

Large intestine. Waste products from the digestive process include undigested parts of food, fluid, and older cells from the lining of your GI tract. The large intestine absorbs water and changes the waste from liquid into stool. Peristalsis helps move the stool into your rectum.

Rectum. The lower end of your large intestine, the rectum, stores stool until it pushes stool out of your anus during a bowel movement.

Watch this video to see how food moves through your GI tract.

How does my digestive system break food into small parts my body can use?

As food moves through your GI tract, your digestive organs break the food into smaller parts using:

motion, such as chewing, squeezing, and mixing

digestive juices, such as stomach acid, bile, and enzymes

Mouth. The digestive process starts in your mouth when you chew. Your salivary glands make saliva, a digestive juice, which moistens food so it moves more easily through your esophagus into your stomach. Saliva also has an enzyme that begins to break down starches in your food.

Esophagus. After you swallow, peristalsis pushes the food down your esophagus into your stomach.

Stomach. Glands in your stomach lining make stomach acid and enzymes that break down food. Muscles of your stomach mix the food with these digestive juices.

Pancreas. Your pancreas makes a digestive juice that has enzymes that break down carbohydrates, fats, and proteins. The pancreas delivers the digestive juice to the small intestine through small tubes called ducts.

Liver. Your liver makes a digestive juice called bile that helps digest fats and some vitamins. Bile ducts carry bile from your liver to your gallbladder for storage, or to the small intestine for use.

Gallbladder. Your gallbladder stores bile between meals. When you eat, your gallbladder squeezes bile through the bile ducts into your small intestine.

Small intestine. Your small intestine makes digestive juice, which mixes with bile and pancreatic juice to complete the breakdown of proteins, carbohydrates, and fats. Bacteria in your small intestine make some of the enzymes you need to digest carbohydrates. Your small intestine moves water from your bloodstream into your GI tract to help break down food. Your small intestine also absorbs water with other nutrients.

Large intestine. In your large intestine, more water moves from your GI tract into your bloodstream. Bacteria in your large intestine help break down remaining nutrients and make vitamin K. Waste products of digestion, including parts of food that are still too large, become stool.

What happens to the digested food?

The small intestine absorbs most of the nutrients in your food, and your circulatory system passes them on to other parts of your body to store or use. Special cells help absorbed nutrients cross the intestinal lining into your bloodstream. Your blood carries simple sugars, amino acids, glycerol, and some vitamins and salts to the liver. Your liver stores, processes, and delivers nutrients to the rest of your body when needed.

The lymph system, a network of vessels that carry white blood cells and a fluid called lymph throughout your body to fight infection, absorbs fatty acids and vitamins.

Your body uses sugars, amino acids, fatty acids, and glycerol to build substances you need for energy, growth, and cell repair.

How does my body control the digestive process?

Your hormones and nerves work together to help control the digestive process. Signals flow within your GI tract and back and forth from your GI tract to your brain.

Hormones

Cells lining your stomach and small intestine make and release hormones that control how your digestive system works. These hormones tell your body when to make digestive juices and send signals to your brain that you are hungry or full. Your pancreas also makes hormones that are important to digestion.

Nerves

You have nerves that connect your central nervous system-your brain and spinal cord-to your digestive system and control some digestive functions. For example, when you see or smell food, your brain sends a signal that causes your salivary glands to "make your mouth water" to prepare you to eat.

You also have an enteric nervous system (ENS)-nerves within the walls of your GI tract. When food stretches the walls of your GI tract, the nerves of your ENS release many different substances that speed up or delay the movement of food and the production of digestive juices. The nerves send signals to control the actions of your gut muscles to contract and relax to push food through your intestines.

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.

What are clinical trials, and are they right for you?

Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.

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Your Digestive System & How it Works | NIDDK

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The digestive system is made up of the gastrointestinal tract-also called the GI tract or digestive tract-and the liver, pancreas, and gallbladder. The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus.

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About 3.8 billion years ago, one-celled creatures were the first of living things. They floated in the ocean and took in food in the form of tiny molecules through their cell walls. Most of the living creatures on Earth still get their food the same way today (Carr, 2022).

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About 2 billion years ago, eukaryote cells created the ability to enlarge their cell wall and obtain their food in a bubble called a vacuole. With this ability they created, it was easier for the food to stay with them. In order to break up the big molecules that were captured, eukaryote cells used slave cells called mitochondria that lived inside them (Carr, 2022).

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About 600 million years ago, animals like jellyfish or hydras would form in the shape of bags. This way ocean water with food in it would reach all the cells on their inside as well as on the outside (Carr,2022).

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About 548 million years ago, tiny roundworms about a few millimeters long, evolved into the shape of a tube rather than a bag. This way, the food always flowed in the same direction, and the waste would leave the body through the anus at the other end (Carr, 2022).

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Smith, J. (2021) "What to know about Celiac Disease" https://www.medicalnewstoday.com/articles/38085, (May 5, 2022)

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Celiac disease is an autoimmune condition that involves the immune system reacting to gluten. Gluten is a general name for a group of proteins in cereals such as wheat, barley, and rye.

In a person with celiac disease, exposure to gluten causes inflammation in the gut. Repeated exposure gradually damages the small intestine, which can lead to problems absorbing minerals and nutrients from food.

Celiac disease affects around 1 in 100 people worldwide, and many have the condition without knowing it. As many as 2.5 million people in the United States may have undiagnosed celiac disease.

The only way for someone with celiac disease to avoid the symptoms is to keep gluten out of their diet.

Below, we explore the symptoms of celiac disease in detail, as well as the diagnostic process, the risk factors, and gluten-free diets.

The symptoms of celiac disease can range from mild to severe. They can change over time, and they vary from person to person.

Some people have no symptoms or only experience them later in life. A person may not know that they have celiac disease until they develop a nutrient deficiency or anemia.

Children are more likely to develop digestive symptoms than adults. These symptoms include:

abdominal pain

bloating

gas

chronic diarrhea or constipation

nausea

vomiting

pale stool with a foul smell

fatty stool that floats

Symptoms of celiac disease that are not digestive can include:

People with celiac disease may develop nutrient deficiencies as damage to the gut gradually limits the absorption of nutrients such as vitamins B12, D, and K. For the same reason, a person may also develop iron deficiency anemia.

Beyond malnutrition, celiac disease can also cause damage to the large intestine and more subtle damage to other organs.

Variations in symptoms may :

age

damage to the small intestine

the amount of gluten consumed

the age at which gluten consumption began

how long the person was breastfed, as symptoms tend to appear later in those who were breastfed for longer

Health issues such as surgery, pregnancy, infections, or severe stress can sometimes trigger celiac disease symptoms.

Symptoms in children

When celiac disease limits or prevents a child's body from absorbing nutrients, this can lead to developmental or growth problems, including:

failure to thrive, in infants

delayed growth and short height

weight loss

damaged tooth enamel

mood changes, including impatience or annoyance

late-onset puberty

Switching to a gluten-free diet early can prevent these issues. Intestinal damage can begin to heal within weeks of removing gluten from the diet.

As time goes by, children may experience spontaneous remission and remain free from symptoms of celiac disease until later in life.

A doctor can often diagnose celiac disease by considering the medical histories of the person and their family and ordering tests such as blood tests, genetic tests, and biopsies.

Doctors check the blood for the presence of antibodies common in people with celiac disease, including antigliadin and endomysial antibodies.

If other tests indicate celiac disease, a doctor may perform an intestinal biopsy by using an endoscope to take samples of the intestinal lining. Usually, they take several to increase the accuracy of the findings.

Celiac disease can be difficult to diagnose because it shares symptoms with other conditions, including:

For most people with celiac disease, switching to a gluten-free diet greatly improves the symptoms, and a person may notice improvement in days or weeks.

In children, the small intestine usually heals in . In adults, full healing can take several years. Once the intestine heals, the body is able to properly absorb nutrients from food again.

Having a gluten-free diet is easier than ever in some parts of the world, where gluten-free options are becoming more widely available.

The key is to understand which foods and products such as toothpaste tend to contain gluten. A qualified dietitian can help.

What to eat and avoid

Gluten occurs naturally in wheat, rye, and barley. Most cereals, grains, and pasta, as well as many processed foods, contain gluten. Beers and other grain-based alcoholic drinks can also contain it.

It is crucial to check labeling because gluten can be an ingredient in some unexpected products.

Foods that do not contain gluten include:

meat and fish

fruits and vegetables

some grains, including rice, amaranth, quinoa, and buckwheat

rice flour

cereals such as corn, millet, sorghum, and teff

pasta, bread, baked goods, and other products labeled "gluten-free"

A person can also eliminate gluten from recipes by substituting ingredients and sometimes by adjusting the time and temperature of baking.

In the past, experts recommended that people with celiac disease avoid oats. However, now suggests that moderate amounts of oats are generally safe, provided that the oats have not touched gluten during processing.

According to the Food and Drug Administration (FDA), manufacturers must not label a food product as gluten-free unless it contains less than 20 parts per million of gluten - the lowest level that tests can reliably detect.

It is worth keeping in mind while traveling that regulations about labeling vary from country to country.

Many processed foods can contain gluten, including:

canned soups

salad dressings

ketchup

mustard

soy sauce

seasonings

ice cream

candy bars

processed and canned meats and sausages

Nonfood products can also contain gluten, including:

some prescription and over-the-counter medications

vitamin products

toothpaste

cosmetics, including lipstick, lip gloss, and lip balm

postage stamps

communion wafers

Read more about what a gluten-free diet contains here.
Should everyone follow a gluten-free diet?

Gluten-free diets have become more popular in recent years. However, research does not suggest that this diet benefits people who do not have celiac disease or non-celiac gluten sensitivity.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, "No current data suggests that the general public should maintain a gluten-free diet for weight loss or better health."

Foods that contain gluten can be important sources of vitamins and minerals, including fiber, iron, and calcium. Speak with a healthcare provider before eliminating these foods, as doing so can lead to nutrient deficiencies.

Most people find that eliminating gluten from their diets greatly improves their symptoms. It allows the intestine to heal.

If a person has dermatitis herpetiformis, medications such as diaminodiphenyl sulfone (Dapsone) can reduce the symptoms. This does not heal the intestine, however, so a gluten-free diet is still crucial.

People with celiac disease may also benefit from taking vitamin and mineral supplements to prevent or address deficiencies.

Researchers continue to work on drug therapies to reduce the burden of living with celiac disease and improve the long-term outlook.

The Celiac Disease Foundation offer more information about possible future treatments.

In a person with celiac disease, repeated exposure to gluten damages the intestinal lining. This can result in nutrient deficiencies that can cause issues such as:

Researchers have linked celiac disease with some types of cancer, including lymphoma, which develops in white blood cells. However, the association is rare, and most people with celiac disease never develop related cancer. A gluten-free diet can reduce the risk.

Some people develop refractory celiac disease, which involves the body not responding to a gluten-free diet for 12 months or more. This is rare, affecting 1-2% of people with celiac disease. People who have it are almost always over 50 years old.

Celiac disease is an autoimmune disorder. When a person who has it eats gluten, their immune system attacks and damages their small intestine.

Over time, finger-like projections in the intestine that absorb nutrients, called villi, get damaged, limiting the overall absorption. This can lead to a number of health issues.

Celiac disease can develop in anyone. It is more common in white people and in females.

Also, it runs in families. A person with a parent or sibling who has celiac disease has a 1 in 10 chance of developing it, too.

Celiac disease is more common in people with other conditions, including:

Celiac disease is an autoimmune condition. Exposure to gluten causes the body to attack cells in the small intestine.

There is no cure, but a person can ease or relieve the symptoms by switching to a gluten-free diet.

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Celiac disease: Symptoms, diagnosis, diet, and treatment

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Celiac disease is an autoimmune condition that involves the immune system reacting to gluten. Gluten is a general name for a group of proteins in cereals such as wheat, barley, and rye. In a person with celiac disease, exposure to gluten causes inflammation in the gut.

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Three million years later, annelids split their digestive tube into three parts. The three parts included a crop that stored food, a gizzard that used muscles to grind up food, and the intestine. The worms would consume small stones and collect them in the gizzard, and then the gizzard's muscle would ground the food against the stones to break it into pieces (Carr, 2022).

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About 542 million years ago, the first bigger animals such as spiders and millipedes evolved a much more complicated digestive system. After the food was swallowed into the mouth it would enter a larger part of the digestive tube, the stomach. This way bigger chunks of food could be broken down (Carr, 2022).

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About 420 million years ago, fish evolved. Fish had a big advantage over other animals because they have jaws and teeth. With teeth, fish were able to eat larger meals, and chew tougher things. Unlike other animals, fish also have a liver. The liver removes the poison from their food. The fish were able to get more energy from the food, with less work. The fish used this newfound energy to swim faster, move around more, and grow bigger and smarter brains than earlier animals (Carr, 2022).

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375 million years ago, the first frogs developed. Frogs had tongues that allowed them to catch and digest food. Frogs also had other organs such as a pancreas, a gallbladder, and a small and large intestine. They also separated their feces through their urine (Carr, 2022).

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Through evolution birds once had teeth, but now have beaks. Birds use gizzards in place of teeth and are able to digest their food (Carr, 2022).

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200 thousand years ago, humans began to pre-digest their food before it was eaten. Humans began cooking it over the fire, which would soften the food and break it down. By doing so, humans will get more energy out of it in an easier way (Carr, 2022).