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Neat Little Guide — 24 minutes

Digestive Disorders

How the Digestive System Works

a spicy soup

Digestion is an organic process that breaks down and transforms the food you eat into nutrients that pass through your intestinal wall to get into your bloodstream. It starts in your mouth, where you grind them and mix with your saliva, and then it continues in your stomach, which secretes digestive juices to break down the food for a few hours.

When the predigested food (or chyme) leave your stomach, your intestine continues to digest them by adding digestive juices from your pancreas and gallbladder. The resulting nutrients cross the wall of your intestine and circulate in your blood to be used by the organism. What has not been absorbed, added to the dead cells of your intestinal wall, turns into fecal matter in your colon.

Causes, Symptoms and Risk Factors

Disorders in the digestive system (gastrointestinal) are all problems and diseases that simultaneously affect several parts of the digestive system, while others only affect one part or one organ. There are many of them, their cause varies and can also be attributed to food allergies or intolerances.

Functional Digestive Disorders or Dyspepsia

Functional digestive disorders are not related to a digestive disease or organic lesion, but to a malfunction of the digestive system. They manifest as stomach digestive disorders, or dyspepsia (loss of appetite, nausea, heartburn, rashes, bloating) or intestinal digestive disorders (bloating, intestinal gas).

Dyspepsia manifests itself in the stomach through difficult digestion that causes bloating, nausea and the impression that your stomach is constantly full.

The causes of functional digestive disorders may include: a big meal that is difficult to digest (e.g., fats, spices, acidic foods), eating food without chewing it enough (eating too fast), drinking soft drinks or abusing alcohol, and excessive stress or emotions.

Aerophagy is caused by a large amount of air in the stomach that causes swelling and pain in the intestine and rash. It usually occurs if you swallow too much air during your meals or when you swallow during the day, or if you chew gum or smoke. Pregnant women are more likely to suffer from aerophagy.

Irritable bowel syndrome (or functional colopathy) manifests as intestinal pain, as well as bloating, flatulence and diarrhea. The triggering factors are often the same as for dyspepsia, and pain is caused by the rate at which food progresses in the colon (too slow or too fast). Certain foods may promote pain (dry vegetables, cabbage, garlic, onion, fennel, celery, radish, leeks, artichokes, fries, fatty meats, sauces and fermented cheeses).

Please Note

Although functional digestive disorders are generally benign, some signs require consultation with your health care provider:

  • Brutal onset of digestive disorders with no obvious cause
  • Very intense abdominal pain
  • If symptoms persist or are too disruptive
  • If symptoms occur after getting back from a trip
  • If symptoms occur after taking a new medication
  • Difficulties with swallowing or pain when swallowing
  • Nausea or vomiting resulting in food intolerance
  • Sudden weight loss
  • Blood in vomit or stool
  • Fever
  • Dehydration (cramps, hollow eyes, infrequent need to urinate)

Risk Factors

We can all suffer from the occasional digestive disorder, but some people are more at risk:

  • Pregnant women (the uterus may touch the intestine and stomach during pregnancy, and hormonal changes often cause constipation, dyspepsia or heartburn)
  • People who are into endurance sports (dehydration, poor diet, vascular disorders)
  • People with anxiety or depression
  • People with other chronic diseases such as type 2 diabetes, migraine and hypothyroidism

Diseases of the Digestive System

There are many diseases of the digestive system and they can be caused by multiple factors. Below is information on the causes, symptoms and complications of the most common diseases.

Gastroesophageal Reflux Pathology (GERD)

It occurs when some of the stomach contents rise into the esophagus (the tube connecting the mouth to the stomach). The stomach produces gastric juices, very acidic substances that help digest food. However, the esophageal wall is not designed to withstand the acidity of the stomach contents. Reflux causes inflammation of the esophagus, resulting in burning and irritation. Over time, it can result in lesions in the esophagus.


An impairment of the lower esophageal sphincter usually causes gastric reflux. Located at the junction of the esophagus and stomach, this sphincter opens to allow the ingested food to pass through and then closes to prevent it from coming back up. When this sphincter dilates at an inopportune time, the stomach content rises to the esophagus and there is a reflux.

Gastroesophageal reflux can also be linked to hiatal hernia. In this case, the upper part of the stomach (located at the junction of the esophagus) “comes up” with the esophagus into the rib cage through the orifice of the diaphragm (the hiatal orifice).


  • A burning sensation behind the sternum, that radiates into the throat
  • Regurgitations
  • Acidic or bitter taste in the mouth
  • Hoarse voice, especially in the morning
  • Chronic sore throat
  • Asthma
  • Chronic cough, frequent hiccups
  • Bad breath
  • Loss of tooth enamel


  • Inflammation (esophagitis) causing esophageal lesions which are responsible for ulcers (or wounds) on the wall (may cause hemorrhage)
  • Narrowing of the diameter of the esophagus (peptic stricture), which causes difficulty swallowing and pain
  • Barrett’s esophagus, a replacement of the esophageal wall cells with cells that normally develop in the intestine (risk of esophageal cancer)
  • Chronic cough, hoarse voice
  • Cancer of the esophagus or larynx

Gastroesophageal reflux disease (GERD) treatment

Treatment of GERD is largely based on the frequency and severity of symptoms. For benign cases, diet modification and the use of antacids available over the counter (sodium bicarbonate, sodium alginate, etc.) may be sufficient. If symptoms persist, H2 histamine receptor antagonists (H2 blockers such as cimetidine, famotidine, ranitidine, etc.) also available over the counter can be added. The next step consists of using more powerful agents called proton pump inhibitors (PPIs) such as omeprazole, esomeprazole, pantoprazole, etc. Other physicians, especially in more symptomatic cases, will prefer to start directly with a PPI, although doses should then be gradually reduced and switched to non-prescription drugs. In the most refractory cases, there is an anti-reflux surgery by laparoscopy to strengthen the valve between the esophagus and the stomach.

Gastroduodenal Ulcer

Called a gastric ulcer if it is located in the stomach, and duodenal if it forms in the duodenum (the first part of the small intestine), this ulcer is an erosion that penetrates deeply into the wall of the digestive track. It is often painful because it comes into direct contact with the acid present in the digestive tract.


Helicobacter pylori (H. pylori), a bacterium that survives acidity, is the leading cause of ulcers (causes 60-80% of stomach ulcers and 80-85% of duodenal ulcers). It invades and disturbs the mucus layer that normally protects the stomach and small intestine from acidity.

Non-steroid or NSAID anti-inflammatory drugs (e.g. aspirin, ibuprofen) are the second most common cause of ulcers in the digestive tract. The combination of an H. Pylori bacterial infection and anti-inflammatory use increases the risk of synergistic ulcers (the risk is 60 times greater).

Excessive acid production by the stomach (hyperacidity), due to smoking, excessive alcohol consumption, major stress, or a hereditary predisposition can also cause ulcers.


  • A recurring burning sensation in the upper abdomen
  • In the case of stomach ulcers, the pain is aggravated by eating or drinking
  • In the case of duodenal ulcers, the pain lessens when eating, but increases from 1 to 3 hours after eating and when the stomach is empty (e.g., during the night)
  • The feeling of getting full quickly
  • Rashes and bloating
  • Sometimes there are no symptoms before a hemorrhage occurs


  • The ulcer may cause hemorrhage inside the digestive tract (vomiting of blood or blood in the stool)
  • A hole in the wall of the digestive tract that can worsen and cause peritonitis (medical emergency)

Gastroduodenal ulcer treatment

Treatment with antibiotics is prescribed for a bacterial infection with Helicobacter pylori, the most common cause of gastroduodenal ulcers. Those not caused by H. pylori are treated the same way as cases of gastroesophageal reflux disease (GERD). Typically, the treatment involves diet modifications, stopping the use of nonsteroidal anti-inflammatory agents such as ibuprofen, naproxen and Celebrex, and taking drugs available over the counter such as antacids or histamine h2 antagonists (blockers) such as cimetidine and famotidine. Other cases will require the use of more powerful proton pump inhibitors (PPIs) such as omeprazole, esomeprazole and pantoprazole. Very rarely, surgery may be indicated for medication-resistant ulcers or if gastric cancer is suspected.

Hiatal Hernia

Hiatal hernia occurs when the stomach comes up in part through a small opening called the esophageal hiatus, located in the diaphragm, the respiratory muscle that separates the chest cavity from the abdomen. There are two main types of hiatal hernia:

  • Sliding hiatal hernia or type I, which accounts for about 85 to 90% of cases. The upper part of the stomach, the junction between the esophagus and the stomach known as the “cardia”, rises into the chest, causing a burning sensation related to gastroesophageal reflux.
  • Paraesophageal or rolling hernia or type II. The junction between the esophagus and stomach remains in place below the diaphragm, but the largest part of the stomach “rolls” over and passes through the esophageal hiatus, forming a kind of pocket. This hernia usually causes no symptoms, but can be severe in some cases.


The exact causes of hiatal hernia are not clearly known. In some cases, it is congenital (present at birth) and caused by an abnormality of the hiatus that is too broad, or the entire diaphragm that is poorly enclosed. However, the vast majority of these hernias appear at some point in life and are more frequent among the elderly. The elasticity and stiffness of the diaphragm seem to decrease with age and the hiatus tends to widen, allowing the stomach to rise more easily. In addition, structures that attach the cardia (the gastroesophageal junction) to the diaphragm, and that keep the stomach in place, also change with age.

Certain risk factors, such as obesity or pregnancy, may also be associated with hiatal hernia.


Sliding Hiatal Hernia

It can sometimes cause or worsen gastroesophageal reflux, so its symptoms are similar to reflux:

  • Burning sensations that come up along the esophagus (acid reflux)
  • Bad taste in the mouth
  • A recurring cough
  • Sore throat or hoarseness

Paraesophageal Hiatal Hernia

It does not cause heartburn, no other symptoms or only intermittent discomfort.

The most common symptoms are:

  • Chest or gastric pain, such as stomach cramps
  • A feeling of heaviness and bloating after meals giving the impression of having eaten too much
  • Respiratory discomfort, shortness of breath caused by compression of the lungs through the stomach
  • Anemia caused by minimal but continuous bleeding

Hiatal hernia treatment

The most common sliding type hiatal hernia treatment is the same as the treatment of gastroesophageal reflux disease (GERD). Diet modifications and over-the-counter antacids (sodium bicarbonate, sodium alginate, etc.) are often effective. If not, H2 histamine receptor antagonists (H2 blockers) such as cimetidine, famotidine and ranitidine can be used. More effective drugs called “proton pump inhibitors” (PPIs) such as omeprazole, esomeprazole and pantoprazole are also available. The rarely occurring and less symptomatic paraoesophageal type of hiatal hernia can, however, necessitate surgery. This surgical treatment consists of gradually moving back the stomach in the abdominal cavity and closing the hiatus to prevent the stomach from re-herniating.

Vesicular Lithiasis and Biliary Colic

Vesicual lithiasis is the formation of stones within the gallbladder, the organ that stores bile secreted by the liver. Theses stones look like little pebbles. In most cases, they are composed of crystallized cholesterol.

The shape, size and number of stones (there may be several hundred) differ from one individual to another. They can be as small as a grain of sand or as large as a golf ball.

Biliary lithiasis, or gallbladder stones, is quite widespread and affects 2 to 3 times more women than men. Starting at age 70, 10% to 15% of men are affected, as well as between 25% and 30% of women. The risk of gallbladder stones increases with age, reaching almost 60% after age 80, likely due to decreased effectiveness of bladder contractions. Stones only result in complications for 20% of people.

A hepatic colic or biliary colic attack is caused by the passage of a gallstone into the gallbladder, temporarily blocking it and momentarily preventing the bile from draining. These attacks can last an average of 30 minutes to 4 hours. Pain fades when the gallstone dislodges itself, allowing the bile to flow again. An attack can occur at any time of day with no triggering event.


Cholesterol gallstones are formed when:

  • There is too much cholesterol in the bile
  • There is not enough bile salt in the bile
  • The gallbladder does not contract regularly (the bladder is referred to as “lazy”)

It is not clear what triggers the formation of the gallstones, but various risk factors have been identified, with obesity being the most common.


In the vast majority of cases, biliary lithiasis does not cause symptoms. Gallstones are therefore discovered when examining the bladder, most often with an ultrasound.

When gallbladder stones cause symptoms, you may feel:

  • Hard, intense and ongoing pain, grinding or twisting in nature, felt in the middle or upper right hand corner of the abdomen. Pain may radiate towards the right shoulder and shoulder blade
  • Nausea and vomiting

Vesicular lithiasis and biliary colic treatment

Most cases of asymptomatic vesicular lithiasis (gallstones) do not need treatment. Occasional (hepatic colic) or constant and severe pain (cholecystitis) can be treated with analgesics (pain killers) or, at times, with antibiotics (cholecystitis), anti-spasmodics or anti-emetics. Surgery will be eventually needed to remove the gallbladder and gallstones (cholecystectomy). This surgery can be performed through small incisions in the abdomen that allow the insertion of a tiny video camera and surgical tools (laparoscopy). In some cases, one large incision is preferred (open cholecystectomy). For non-urgent cases, an oral treatment with a gallstone-dissolving drug (ursodiol) is also available but may require up to two years to break up all stones.

Diverticulosis and Diverticulitis

From the age of 40, diverticula can form in the large intestine. These are small outer protrusions, like small “pockets” the size of a marble, located in different locations in the large intestine. Diverticulosis mainly affect the colon or large intestine. However, diverticula can be found throughout the entire digestive tract, including the esophagus, stomach and small intestine.

Diverticulitis is an inflammation of the diverticula associated with an infection. Diverticulosis is a common phenomenon, and in western countries it is found in about 50% of people over the age of 60. Most of the time, diverticula do not cause any symptoms. They are often discovered during a routine examination for other digestive problems. However, diverticulitis (inflammation and infection of a diverticula) causes severe pain.


Diverticula form when areas of weakness in the colon wall stretch under pressure. If the pressure causes a small lesion on the wall of the diverticula, an infection may occur. A sedentary lifestyle with no physical activity and a diet with not enough fibre are often involved.



There are no symptoms with diverticulosis. However, when a diverticula gets inflamed or infected, it is called diverticulitis.


Intense and sudden pain at the bottom of the abdomen on the left hand side. Sometimes the pain is moderate, variable and gradually increases over several days

  • Abdominal sensitivity
  • Fever
  • Nausea
  • Constipation or diarrhea.

Diverticulosis and diverticulitis treatment

Asymptomatic diverticulosis does not require treatment. Increasing the fibre content of the diet is, however, recommended. Seventy-five percent of patients with diverticulitis will be treated with oral anti-pain and oral (at home) or intravenous (at the hospital) antibiotic drugs. In 25% of cases, surgery will be required to remove the diseased part of the colon. This surgery often necessitates creating a bowel connection through an opening in the abdomen (stoma) which will allow the attachment of a collection bag. The stoma can be removed in most cases within six months after surgery but can also be permanent in some cases. Rectal bleeding typically resolves by itself but may occasionally require a colonoscopy and other interventions.


Appendicitis is a sudden inflammation of the appendix — a small worm-shaped protrusion located at the beginning of the large intestine, on the lower right side of the abdomen. It most often occurs between the ages of 10 and 30. It affects one in 15 people, and slightly more often in men than in women.

Appendicitis must be treated promptly or the appendix could burst. This can cause peritonitis, which is an infection of the peritoneum, the thin wall that surrounds the abdominal cavity and contains the intestines. In some cases, peritonitis can be fatal and requires emergency medical treatment.


Appendicitis is often the result of a fecal or mucous obstruction. The appendix then becomes swollen, colonized with bacteria and may eventually become necrotic.


  • Initial pain symptoms usually occur near the navel and gradually progress to the lower right hand side of the abdomen
  • Pain gradually increases over a period of 6 to 12 hours. It ends up halfway between the navel and pubic bone on the right side of the abdomen.
  • When you press on the abdomen near the appendix and suddenly release the pressure, the pain gets worse. Coughing, exertion such as walking or even breathing can also worsen the pain

Pain is often accompanied by the following symptoms:

  • Nausea or vomiting
  • Loss of appetite
  • Low fever
  • Constipation, diarrhea or gas
  • Bloating or rigidity of the abdomen

Acute appendicitis treatment

A ruptured appendix and peritoneal infection are serious complications of acute appendicitis. Removal of the appendix by surgery (appendicectomy) constitutes the most efficient way to treat acute appendicitis. An appendicectomy can be performed through a large abdominal incision (laparotomy) or through smaller incisions that allow the insertion of a small video camera and surgical instruments (laparoscopy) into the abdomen. Antibiotics given before and after surgery complete the treatment. The recovery after an appendicectomy is usually very short (a few days). Certain medical centres (mainly European) tend to treat simple appendicitis cases with antibiotics alone instead of performing surgery. However, such treatment leaves in place an appendix that carries a very significant risk (up to 40%) of being re-infected again.

Chronic Inflammatory Bowel Diseases (IBD)

IBD is a term used to define chronic inflammatory bowel disorders, including:

Crohn’s disease, a chronic inflammatory disease of the digestive system, which develops in spurts (or attacks) and remission phases. It is characterized primarily by abdominal pain and diarrhea, which can last for several weeks or months. Fatigue, weight loss and even malnutrition may occur if no treatment is undertaken. In some cases, non-digestive symptoms that affect the skin, joints or eyes may be associated with the disease.

In the case of Crohn’s disease, inflammation can affect any part of the digestive tract, from the mouth to anus. But most often, it settles at the junction of the small intestine and colon (large intestine).


The exact causes of inflammation are unknown and there are likely several, involving genetic, autoimmune and environmental factors.

Genetic Factors

Although Crohn’s disease is not entirely genetic, some genes may increase the risk of developing it. As with many other diseases, it appears that a genetic predisposition combined with environmental or lifestyle factors triggers the disease.

Autoimmune Factors

Like ulcerative colitis, Crohn’s disease has characteristics of autoimmune disease. Researchers believe that inflammation of the digestive tract is linked to an excessive immune response of the body against viruses or bacteria in the intestine.

Environmental Factors

It has been noted that the incidence of Crohn’s disease is higher in industrialized countries and has been increasing since 1950. This suggests that environmental factors, likely related to the Western lifestyle, might have a significant influence on the onset of the disease. However, no specific factors have yet been identified. However, several avenues are under consideration.


  • Frequent abdominal pain and cramps, which worsen after meals
  • Chronic diarrhea (lasting more than 2 weeks)
  • Fatigue and general discomfort
  • Low appetite and weight loss, even with a balanced diet
  • Blood in the stool, sometimes in large quantities (hemorrhaging)
  • Mucus in the stool. This mucus is threaded and has the consistency of an egg white
  • Nausea and vomiting.
  • A mild fever (38ºC to 40ºC)
  • Joint pain

Crohn’s disease treatment

The treatment of Crohn’s disease depends on many factors including age, disease severity and personal resistance to drug side effects. Typically, various oral anti-inflammatory drugs such as glucocorticoids (budesonide, prednisone) and sulfasalazine are used first. More severe cases will require the use of stronger immunomodulating agents (azathioprine, 6-mercaptopurine) including biologicals such as infliximab. Fifty percent of patients with Crohn’s disease will need surgery during their lifetime to relieve strictures, correct fistulas or remove diseased sections of the colon.

Ulcerative colitis

Llike Crohn’s disease, ulcerative colitis is a chronic inflammatory bowel disease (IBD) of the colon and rectum. Whereas Crohn’s disease can occur anywhere in the digestive tract and reach deep tissues, ulcerative colitis has a superficial impact on the mucous membrane, which begins in the rectum and moves up the colon.

The disease is diagnosed mostly in people between the ages of 30 and 40, but can occur at any age. Both men and women are affected in nearly the same proportion.


Ulcerative colitis is caused by an impairment of the immune system that attacks the cells of its own body.

Scientists believe that the inflammation of the colorectal mucosa is caused by an excessive immune response against viruses or bacteria in the gut. The most likely hypothesis is that this autoimmune reaction would be directed against the “harmless” bacteria normally present in the digestive tract (intestinal flora).

Ulcerative colitis may also be linked to unclear environmental factors. Food stress and intolerance can trigger symptoms in some people, but these factors are not the cause of the disease.


Symptoms appear in attacks:

  • Painful abdominal cramps, especially in the lower belly
  • Blood in the stool
  • Chronic diarrhea
  • Frequent bowel movements, even at night
  • An urgent need to defecate, even if there are few or no stools to evacuate (rectal tenesmus)
  • Weight loss due to reduced appetite and poor absorption of nutrients into the intestine
  • Fatigue
  • Fever

Possible Complications

  • An obstruction of the digestive tract. Chronic inflammation may cause thickening of the digestive tract wall, leading to partial or total blockage of the digestive tract
  • Ulcers in the wall of the digestive tract
  • Colon dilation and puncture
  • Wounds around the anus (fistulas, deep cracks or chronic abscesses)
  • Rare but sometimes severe bleeding in the digestive track
  • People with Crohn’s disease in the colon have a slightly increased risk of developing colon cancer
  • Delayed growth and puberty in children and adolescents
  • Iron-deficiency anemia
  • Other health problems such as arthritis, skin conditions, inflammation of the eyes, oral ulcers, kidney stones or gallstones

Ulcerative colitis treatment

Ulcerative colitis treatment is similar to the treatment for Crohn’s disease. Contrary to Crohn’s disease, which can affect the entire digestive tract, ulcerative colitis affects mainly the lower colon and rectum. Various anti-inflammatory agents such as mesalamine and glucocorticoids (prednisone) in suppositories or rectal suspension can therefore be used efficiently. More severe cases will require the use of strong immunosuppressants (azathioprine, 6-mercaptopurine, infliximab, etc.). Medication-resistant cases will eventually require surgery consisting of removing the colon, rectum and sometimes the anus with, in the latter cases, the creation of a permanent stoma.

Celiac Disease

Celiac disease is a chronic bowel disease triggered by gluten consumption, a mixture of protein contained in certain cereals (e.g. wheat, barley, rye). For a person with this disease, gluten ingestion causes an abnormal immune response in the small intestine, which causes inflammation and damage to the intestinal wall. If inflammation persists, the damaged intestine becomes unable to absorb certain nutrients, vitamins and minerals. Malnutrition can result despite normal nutrition.

The term “gluten intolerance” is often used to describe it, but celiac disease is not food intolerance, it is an abnormal immune system response.


The causes of celiac disease are not yet fully known. An impairment of the immune system linked to a genetic predisposition appears to promote its development. Gluten exposure to the intestine, known as the primary trigger, triggers an immune process that damages the intestinal mucosa, resulting in nutrient malabsorption.

Based on current research, almost all individuals with celiac disease have the HLA-type genes DQ2 or DQ8, but other genes may also be responsible.


Without the adoption of a gluten-free diet, celiac disease, in its most serious forms, can have several health consequences. The most common complications are related to poor absorption of nutrients in the intestine:

  • Malnutrition (caused by nutrient malabsorption in the intestine)
  • Lactose Intolerance
  • Anemia (caused by poor iron absorption)
  • Osteoporosis (caused by poor absorption of calcium and vitamin D)
  • Kidney stones (low risk of kidney stones which are caused by abnormal oxalate absorption)

Celiac disease treatment

Because celiac disease involves an immune reaction to gluten, treatment is based on strictly avoiding products containing gluten (i.e. rye, barley, wheat and oats because of cross-contamination with cereals containing gluten). Individuals with celiac disease should avoid exposure to flour dust containing gluten. Although many websites can be consulted, the advice of a dietician is important to facilitate the identification of less evident products containing gluten (e.g. prepared foods, drugs, diet supplements, cosmetics, etc.). A dietitian will also be able to identify and correct nutritional imbalances caused by the disease. Susceptibility to develop celiac disease is largely inherited. Therefore, it is indicated to screen first-degree relatives of every individual with celiac disease.


Gastroenterology is the medical specialty responsible for the study and management of the digestive tract. In research, major advances have been made in recent years in the diagnosis, treatment and exploration of digestive diseases.

Biron offers all the state-of-the-art medical radiology tests needed to help your health care provider diagnose your digestive disorders.

If you have any questions or would like more information, please do not hesitate to contact Biron Groupe Santé customer service at 1 833 590-2712.