Check your symptoms
"Something's stuck in my throat" - globus
Occasionally, after an infection or perhaps after eating something that disagrees with us, a sensation can develop in the upper oesophagus (around the level of the notch at the bottom of the neck and at the top of the breastbone) of something being stuck there or a constant irritation. It may feel worse when swallowing food, but importantly it does not block swallowing so there is no choking or vomiting up of food. This is called 'globus' and is due to sensitive nerves in the upper oesophagus. This is not a disease, and usually these symptoms will wax and wane over time, and eventually disappear. Gastroscopy is only required if actual difficulty swallowing occurs (see below).
Difficulty swallowing - dysphagia
Oesophageal dysphagia refers to food getting stuck somewhere between the throat and the stomach. It may cause discomfort, choking, and/or regurgitation of food and/or saliva. It is never normal. If it is of recent onset and occurs with all meals then it is a symptom of great concern and merits an urgent gastroscopy. Oesophageal dysphagia that is occasional and infrequent more likely represents a benign process like gastroesophageal reflux, but in the majority of cases should be investigated with gastroscopy if one has not been performed recently.
Burning in the upper abdomen - dyspepsia
Dyspepsia is the sensation of a usually burning discomfort in the epigastrium, that area in the abdomen just below the breast bone. It is often associated with the sensation of feeling full quickly when eating, or having a heavy feeling for an excessive period of time after a meal. It will usually fluctuate in severity and should not progressively worsen. It is usually due to an excessively sensitive stomach. The best way to manage this is to avoid alcohol and excessively fatty foods when symptoms are worse, and have smaller meals until symptoms improve. If you have gained weight in recent years, then trying to lose that will likely help as well.
If this problem continues to get worse without improvements, is associated with unintended weight loss, anaemia, difficulty swallowing or persistent vomiting, then you should have a gastroscopy to exclude more serious causes.
Heartburn - Gastroesophageal reflux
Gastroesophageal reflux is a normal occurrence after meals that in some people can be excessive and cause symptoms (GORD). It may present as heartburn, chest pain much like angina, or regurgitation of acid or even food into the mouth. Sometimes it may be the cause of a chronic dry cough. Weight gain with age is the commonest cause of an increase in GORD, and the development of a hiatal hernia as we get older can increase the chances of developing these symptoms.
GORD usually responds to simple measures such as avoiding alcohol or coffee for a period, or antacids such as Gaviscon or Mylanta. It is often advocated that if GORD symptoms are worse at night then the head of your bed should be propped up so you are lying with a head-up tilt. Meals sizes, particularly the evening meal, should be reduced, and you should avoid eating late in the evening. Reducing alcohol and foods that trigger symptoms is advised. If symptoms are persistent and troublesome then a course of acid suppressing drugs such as ranitidine, omeprazole or pantoprazole might be required. Although there has been a tendency in the past for doctors to prescribe acid suppressing drugs longterm, it is now recommended that after an initial course to get symptoms controlled, these medications should be used only in short courses of a few days at a time in most people.
As a general rule, heartburn symptoms on their own that come and go are benign and don't require any investigation. In certain situations, however, a gastroscopy is advisable. If there is ever any difficulty in swallowing food then a gastroscopy is important to rule out more serious pathology. In males of Caucasian ethnicity there is an increased risk of Barrett's oesophagus and dysplasia in those with frequent heartburn or other GORD symptoms, and a gastroscopy after the age of 50 may be advisable.
If GORD symptoms are particularly troublesome, especially if food or stomach fluid refluxes into the mouth frequently, then a surgical operation called a fundoplication might be helpful. In that case a gastroscopy is usually required to inspect the oesophagus and stomach first, and then your Gastroenterologist can refer you to a specialist Upper Gastrointestinal Surgeon.
Gaseous bloating of the abdomen when it fluctuates day to day and throughout the day is due to only a few causes. In some people disordered breathing patterns can lead to air swallowing (aerophagia) which is usually accompanied by persistent belching. This can be brought on by stress or anxiety, and exercises from a physiotherapist or speech language therapist are usually helpful in resolving it.
Bloating associated with increased passing of wind (flatus) is generally caused by a combination of bacterial fermentation of food creating gas in the colon, altered muscle tone in the diaphragm and abdominal muscles, and sometimes altered transit of the gas in the bowel. A combination of daily gentle aerobic exercise and dietary manipulation is the best initial intervention. Gas production by bacterial fermentation in the colon is promoted by the consumption of foods that contain high levels of sugar and sugar-like molecules called FODMAPs, and this is often accompanied by looser bowel motions. Foods with the highest levels of these FODMAPs include apples and pears, large amounts of other fruit (more than you can hold in the palm of a hand), the onion family (onions, garlic, spring onions, shallots, leeks), honey, wheat, fructose and the artificial sweeteners sorbitol, xylitol and mannitol (commonly found in sugar-free gums and mints). Restricting consumption of these will often reduce bloating symptoms considerably. A dietician is often a good source of more information.
Bleeding from the bowel
Bleeding from the bowel, when it is red in colour or clots is usually from haemorrhoids (‘piles’), which are large veins in and around the anus. Bleeding from haemorrhoids is typically seen on the toilet paper or even dripping into the toilet, can appear quite dramatic, and will occur at one motion or several consecutive motions but then stops. If this bleeding is very infrequent then it should be of little concern. Bleeding with significant pain on passing a stool usually indicates an anal fissure, a split in the lining of the anus usually caused by passing a very hard stool that should heal over days to a few weeks.
Bleeding that is present all or most of the time or is clearly mixed into the stool needs checking out if you have not had a recent colonoscopy as this may represent a large polyp or even cancer. Bleeding of blood that is much darker or even black and foul-smelling indicates blood from higher up and this needs to be checked by your doctor.
Loose motions - diarrhoea
Everyone experiences loose motions at some time, usually due to an infection, or perhaps after eating something that disagrees, or too much fruit. Usually your bowels return to normal within a few days, and most people would not expect to have loose motions all the time. Irritable Bowel Syndrome is a condition that can cause people to have loose motions frequently, but again it is not usually all the time. If you have loose motions all or most of the time then you should talk to your GP about it.