Dr. MJ Bazos MD, Patient Handout
Digestive Diseases: Facts and Fallacies

The digestive tract is a complex system of organs responsible for converting the food we eat into the nutrients we need to live. We would expect a system as well used as the digestive tract to be the source of many problems—and it is. Diseases of the digestive tract are responsible for the hospitalization of more people in the United States than any other group of disorders. Yet, until recently, little was known about the causes, treatment, or prevention of these illnesses.

In recent years, researchers have begun to shed light on some of the more baffling aspects of digestive diseases. Some studies have indicated that those diseases once thought to have been caused by emotional problems may, in fact, be the result of viruses interacting with the body's immune system or disturbances in the motility patterns of the organs. And doctors now know that an ulcer has more to do with the presence of the bacterium Helicobacter pylori than with the level of stress in one's life. Listed below are facts about common digestive diseases.

Hiatal Hernia:
Fallacy: Hiatal hernia causes heartburn.
The fact is, while some people who suffer from heartburn also have a hiatal hernia, heartburn is not caused by the hernia. A hiatal hernia is the protrusion of a portion of the stomach through a teardrop-shaped hole in the diaphragm where the esophagus and the stomach join. The most frequent cause of hiatal hernia is an increased pressure in the abdominal cavity produced by coughing, vomiting, straining at stool, or sudden physical exertion. A majority of people over 60 years have hiatal hernias and, in most cases, the hiatal hernia does not cause problems.

Fact: Chocolate and peppermint cause heartburn in many people.
The fact is heartburn occurs when the lower esophageal sphincter (called the LES), located at the junction of the esophagus and the stomach, either relaxes inappropriately or is very weak . This allows the highly acidic contents of the stomach to back up into the esophagus. Both chocolate and peppermint are thought to cause the LES to relax and allow the contents of the stomach to back up into the esophagus. Other foods associated with heartburn include tomato products, citrus fruits and juices, coffee, and fried or fatty foods.
Fact: Cigarette smoking causes heartburn.
The fact is that studies have shown that cigarette smoking dramatically decreases the LES pressure.
Fact: Nonprescription antacids relieve heartburn.
The fact is that many people have discovered that nonprescription antacids provide temporary or partial relief from heartburn. Long-term use of antacids can, however, result in side effects like diarrhea, altered calcium metabolism, and magnesium retention. (Magnesium retention can be serious for patients with kidney disease.) As with other nonprescription drugs, if prolonged use (longer than 3 weeks) becomes necessary, consult your doctor.

Peptic Ulcer Disease:
Fallacy: Peptic ulcer disease is most prevalent among persons under stress.
The facts are that peptic ulcers are sores in the lining of the stomach or duodenum and occur in many people. According to some studies, ulcers have been found to be more common among people in lower socioeconomic groups.
Fact: Cigarette smokers are about twice as likely to have ulcers as nonsmokers.
The fact is that current research indicates an association between smoking cigarettes and peptic ulcer disease. This applies to both gastric (stomach) and duodenal ulcers and to both men and women. Also, ulcers heal slower and recur more often in cigarette smokers than in nonsmokers.
Fact: People who take aspirin regularly increase their risk of getting a gastric ulcer.
The fact is that people who take aspirin 4 or more days a week for 3 or more months increase their risk of getting a gastric ulcer. Also, aspirin increases the likelihood of bleeding from an ulcer.
Fallacy: Peptic ulcers should be treated with a bland diet.
The fact is that there is little agreement about what the term "bland" means. Also, there is little indication that any particular diet is helpful for all peptic ulcer patients. Although some patients find that coffee or extremely spicy foods are bothersome, each person has to find out for him/herself which foods, if any, cause distress.

Lactose Intolerance:
Fact: Many people cannot drink milk.
The fact is that an estimated 50 million Americans have lactose intolerance. Certain racial and ethnic populations are more affected than others. As many as 75% of African Americans, Jewish, Mexican Americans, and American Indian adults and 90% of Asian American adults have lactose intolerance.
Lactose intolerance is caused by a deficiency of lactase, the intestinal enzyme that digests milk sugar (lactose). Persons with lactose intolerance cannot properly digest milk and milk products when taken in the usual amounts. Some people are even sensitive to extremely small quantities of dairy products. Symptoms of lactose intolerance include cramps, gas, bloating, or diarrhea within 15 minutes to 3 hours after consuming milk or milk products.

Celiac Sprue:
Fallacy: A person with celiac sprue (an inherited disorder affecting the lining of the small intestine) may eat small amounts of food containing gluten (a substance found in wheat, rye, barley, and oats) as long as symptoms do not develop.

The fact is that a person with celiac sprue should avoid all foods containing wheat, rye, barley, and oats (foods containing gluten). Severe damage to the intestines can occur even when there are no symptoms. Some experts think that small amounts of gluten can cause damage to the intestines.

Fallacy: Bowel regularity means a bowel movement every day.
The facts are that the frequency of bowel movements among normal, healthy people varies from three movements a day to three a week, and perfectly healthy people may fall outside both ends of this range.
Fallacy: Nonprescription laxatives are always safe and always cure constipation.
The fact is that, although short-term use of laxatives is usually effective in relieving temporary constipation, long-term use of laxatives impairs the natural muscle actions required to have a bowel movement. Also, overuse of mineral oil, a popular laxative, may reduce the absorption of certain vitamins (A, D, E, and K). Mineral oil also may interact with some drugs, causing undesirable side effects. Consult your doctor if you need to use a laxative for longer than 3 weeks. And, if you are on medication, check with your doctor before taking any laxative.
Fact: Habitual use of enemas eventually leads to loss of normal bowel function.
The fact is that habitual use of enemas usually is not necessary and will eventually lead to an inability of the bowels to function normally. As with laxatives, overuse of enemas can impair the natural muscle actions of the bowel.

Irritable Bowel Syndrome:
Fallacy: Irritable bowel syndrome (spastic colon, mucous colitis) is a serious disease that often leads to ulcerative colitis.

The fact is that irritable bowel syndrome (IBS) is a common functional disorder characterized by gas, abdominal pain, and diarrhea or constipation or the cyclical occurrence of both. IBS, although often causing considerable discomfort, generally does not lead to other gastrointestinal disorders.

Fallacy: IBS frequently leads to cancer of the colon.
The fact is that there is no evidence that IBS is a precursor of cancer.

Diverticulosis and Diverticulitis:
Fallacy: Diverticulosis always causes a serious problem.

The fact is that diverticulosis is a condition in which little sacs (diverticula) develop in the wall of the colon. In the United States, the majority of people over the age of 60 years have diverticulosis. Most people do not have symptoms and would not know that they had diverticula unless an x-ray or intestinal examination were done. Only about 20% of patients with diverticulosis develop complications such as diverticulitis, bleeding, or perforation.

Inflammatory Bowel Disease:
Fallacy: Inflammatory bowel disease (Crohn's disease and ulcerative colitis) is caused by personality disorders.
The fact is that the cause of inflammatory bowel disease (IBD) is not known. IBD is a name for a group of disorders in which various parts of the intestinal tract become inflamed. Currently, researchers speculate that IBD may be caused by a viral or bacterial agent interacting with the body's immune system. There is no evidence to support the theory that IBD is caused by tension, anxiety, or other psychological factors or disorders.

Fallacy: Patients with IBD require a special diet.
The fact is that there is no evidence that the inflammation of the intestines is affected by specific foods. Many patients tolerate all varieties of food and require no dietary restrictions. Others, particularly when their disease is active, find a diet low in fiber and spicy foods easier to tolerate. Maintaining good general nutrition, however, is more important than emphasizing or avoiding any particular foods.

Gallbladder Disease:
Fallacy: Gallbladder disease always causes severe pain.
The fact is that about 10% of the American population has gallstones, but many do not have symptoms. However, when gallbladder pain occurs, it is usually sudden, severe, and steady and is felt in the upper abdomen.

Fact: The pancreas is a digestive organ.
The fact is that the pancreas, a gland that is located next to the duodenum, produces enzymes and hormones that aid in digestion.
Fallacy: Pancreatitis (inflammation of the pancreas) is always caused by alcoholism.

The facts are that approximately one-third of all cases of pancreatitis are due to unknown causes, and many attacks of acute pancreatitis are associated with gallstones.

Fallacy: Chronic alcoholism is the only cause of cirrhosis of the liver.

The fact is that cirrhosis has many causes. In the United States, three-fourths of the cases are due to chronic alcoholism. In those parts of the world where viral hepatitis is common, hepatitis is the leading cause of cirrhosis. In children, cirrhosis may be caused by a host of inherited disorders including cystic fibrosis, alpha-l antitrypsin deficiency, biliary atresia, glycogen storage disease, and other rare diseases. In adults, cirrhosis may be caused by hepatitis B or a host of rare diseases, such as primary biliary cirrhosis, abnormal storage of metals by the body, severe reactions to prescribed drugs, and prolonged exposure to environmental toxins.

Fact: You may have cirrhosis of the liver and not know it.
The fact is that onset of cirrhosis is often "silent," having few specific symptoms. In fact, cirrhosis may not cause symptoms until the disease is far advanced.

Fallacy: Hemorrhoids are the only cause of bright red bleeding from the rectum.

The fact is that, although most cases of bright red bleeding from the rectum are due to hemorrhoids, polyps and cancer of the rectum also can cause a similar type of bleeding. Any bleeding from the rectum should be evaluated by a doctor.

Ostomy Surgery:
Fact: Ostomy surgery is a common procedure.
The fact is that about 100,000 ostomy surgeries are performed each year and about 1 million persons have ostomies. Although ostomies create great changes for the patient, they are rather simple procedures. Ostomy surgery is a procedure in which the affected part of the small or large intestine is removed, an opening (stoma) is created on the body's surface, and a portion of the intestine is brought out through the opening. A pouch is worn to collect the body's waste.

Fallacy: Men become impotent following ostomy surgery.
The fact is that men who have ostomy surgery may have full potency (the ability to have an erection and orgasm) or complete impotence (the inability to have an erection).

Fallacy: After ostomy surgery, women experience impaired sexual function and cannot become pregnant.
The fact is that, in general, having an ostomy does not lessen a woman's sexual or reproductive capabilities. In a few cases, the condition that necessitates ostomy surgery also may necessitate additional surgery such as hysterectomy. Hysterectomies make it impossible to conceive but have no effect on sexual desire or the ability to have sexual relations.