Table Of ContentW. Grant Thompson
Gut Reactions
Understanding Symptoms of the
Digestive Tract
Gut Reactions
Understanding Symptoms
of the Digestive Tract
Gut Reactions
Understanding Symptoms
of the Digestive Tract
w.
Grant Thompson, M.D.
Professor of Medicine
Chief, Division of Gastroenterology
and Digestive Diseases Research Unit
Ottawa Civic Hospital
and University of Ottawa
Ottawa, Ontario, Canada
Springer Science+Business Media, LLC
Library of Congress Cataloging in Publication Data
Thompson, W. Grant.
Gut reactions: understanding symptoms of the digestive tract I W. Grant Thompson.
p. cm.
Bibliography: p.
Includes index.
1. Irritable colon. 2. Gastrointestinal system-Diseases. 3. Symptomatology. I.
Title.
RC862.i77T46 1989 89·16048
616.3'42-dc20 OP
First Printing-August 1989
Second Printing-April 1990
ISBN 978-0-306-43303-0 ISBN 978-1-4899-6491-5 (eBook)
DOI 10.1007/978-1-4899-6491-5
The treatments outlined in this volume are intended to serve
only as examples. You should consult your personal physician
before beginning any medical treatment regimen.
© 1989 W. Grant Thompson
Originally published by Plenum Press in 1989.
Softcover reprint of the hardcover 1s t edition 1989
All Rights Reserved
No part of this book may be reproduced, stored in a retrieval system, or transmitted
in any form or by any means, electronic, mechanical, photocopying, microfilming,
recording, or otherwise, without written permission from the Publisher
TO SUE
Preface
All of us have gut reactions. We often respond to strong emotion
or changes in circumstances with such digestive symptoms as nau
sea, heartburn, abdominal discomfort, or altered bowel habit.
Travel, examinations, public speaking, and dietary indiscretions
are familiar provocations. No serious disease accounts for these
reactions, which appear to be the way the gut responds, or is per
ceived to respond, to its owner's physical and psychosocial envi
ronment. Although most people consider them part of life, for
others the symptoms may be sufficiently frequent, troublesome,
and inexplicable that they are said to have an irritable gut. Thus,
the various gut reactions, if frequent and troublesome, are syn
dromes of the irritable gut. It seems that at least one third of people
suffer with one or more of the irritable gut syndromes that are
discussed in this book. Many of these sufferers seek medical care,
undergo many tests, and receive treatments that are costly and not
often effective.
There is a need to demystify the irritable gut or at least make
the sufferer more comfortable in contemplating his gut reactions.
The truth is, we do not understand them very well. Several facts
do stand out. The reactions are very common and affect people
most of their lives. They are benign, that is, they do not lead to
any serious diseases, nor is there any structural or anatomical ab
normality to explain them. They seem to be due to altered phys
iology (function) or at least to altered perception of physiology.
Lastly, there is no reliable cure.
vii
viii PREFACE
Thus, this book is written for patients, their relatives, and
those nurses, physicians, and allied health workers who may wish
to understand digestive symptoms better. There are no tests or x
rays that will identify these gut reactions, but they are clearly rec
ognizable from their symptoms and are not just what is left when
organic disease is excluded through many tests. The commonness
of these disorders and their positive diagnosis may be comforting
to sufferers. It is reassuring for an individual to know that his or
her irritable gut is a real entity experienced by other people, and
that it does not indicate cancer or other mortal illness.
So my purpose in this book is to improve the understanding
of gut reactions, because I believe the reader's comprehension and
reassurance that no serious disease exists is most important and,
in many cases, the only treatment. Certainly, attention to emo
tional stress, life-style, and diet may help as well. Furthermore, it
is my purpose to dissuade us all, sufferers, physicians and others,
from the costly and sometimes harmful notions that many tests are
necessary and that there must be a drug to make the patient better.
Interpretation of symptoms is the only reliable test, and drugs,
even if they seem to help in the short term, are seldom a sensible
life-time solution.
Part 1 reviews the anatomy and physiology for nonmedical
readers, then the definitions of bowel habit and the various irritable
gut syndromes. A discussion of the prevalence of these disorders
in the community and their considerable cost follows next. Since
lack of dietary fiber and emotion are recurring themes thought to
be very important in the irritable gut, they are assigned a chapter
each.
In Part 2, ten chapters describe the various syndromes of
the irritable gut. Gut reactions appear to result from abnormal func
tion or abnormal perception of function at all levels of the gut.
Although we know that symptoms are seated in the esophagus,
stomach, small or large intestine, we know little about their gen
esis. No one sufferer will have all of these syndromes, but many
will have more than one. Thus, an understanding of the whole
picture may help the sufferer cope with his or her own gut reac-
PREFACE ix
tions. Certainly the key chapter in this section is "The Irritable
Bowel," Chapter 13.
The five chapters in Part 3 discuss topics that are important
to those patients with gut reactions. Diverticula occur in half the
population by age 60. It is a popular misconception that the di
verticula themselves cause symptoms. They don't, but an irritable
bowel may be coincidentally present. Laxatives and other drugs
cause many gut symptoms and the sufferer should recognize these.
Chapter 21, "Clinical Trials and the Placebo Response," demon
strates that most drugs used for gut reactions have very little sci
entific justification. We accept too easily the notion that there must
be a drug out there that will help. In this context, an understanding
of the placebo response is a fundamental issue. The final chapter
describes some of the tests irritable gut patients commonly
undergo. Most gut reactions reported to a physician require an x
ray, an endoscopy, or a stool collection, and it is helpful if the
sufferer knows what to expect.
I hope that the reader will recognize gut reactions as important
medical problems, not only for the discomfort and worry they en
gender but also for their great prevalence and the cost of their
investigation and treatment. As threats to humanity, they cannot
claim the profile of cancer or heart disease, but they do cause dis
comfort in many people and can divert resources from the detection
and care of more serious diseases. On these grounds, research into
how the gut functions and how we perceive its function is im
portant. Meanwhile, we can only combine what few facts we have
about gut reactions with common sense, and resolve that we will
not permit our zeal for tests and cure to exceed reason or to do
harm.
The bibliography is brief and confined to key or review articles
that should satisfy the need of most readers to seek out the original
references. Much of the material prior to 1979 is referenced in my
previous book, The Irritable Gut. Lest one think I refer excessively
to my own work, it should be clear that most original references
for the material in this book are contained therein.
Gut reactions are part of the human condition. The classical
x PREFACE
references and quotes from the old medical literature serve, I hope,
to emphasize the timeless humanity of these disorders. Although
they are said to be products of Western civilization, I believe all
mankind is liable. Gut reactions occasionally inspire humor, for
the gut has always been a source of mirth. Those sufferers who
regard their symptoms very seriously should not be offended by
this, for with humor comes recognition of the human condition,
and from thence compassion.
W. Grant Thompson
Mont Tremblant, Quebec
Acknowledgments
This book owes much to my recently deceased parents, George
and Florence Thompson, who oversaw my education and insisted
that my experience should be as broad as possible. Of course, the
completion of the book would have been impossible without the
support of my wife, Sue, who helped edit the manuscript, and the
good-humored patience of my children, Julie, Jennifer, and Eric.
Jennifer prepared the Index.
Another key person is Helen Kierczak, whose Tandy word
processor actually created the manuscript, and who, when I de
spaired of completion, always had a cheerful word of encourage
ment. James Harbinson's illustrations speak for themselves.
The x-rays that are in the book are due to the courtesy of Dr.
Hardy Tao, Department of Radiology, Ottawa Civic Hospital. Pho
tographs were taken by Stuart Joyce and Tom Devecseri of the Civic
Hospital's Audio Visual Department.
The ideas for this book have developed over 20 years. During
that period I have been privileged to discuss the irritable gut with
many colleagues from several countries. Special mention is due to
Dr. K. W. Heaton of Bristol, England, and Dr. D. A. Drossman of
Chapel Hill, North Carolina. The irritable gut has made us good
friends. I cannot forget the support and encouragement of many
colleagues at the University of Ottawa-Dean Gilles Hurteau and
Dr. Dilip Patel, to name two. Finally, I needed and am grateful for
the stimulus provided by students and junior physicians who sel
dom failed to ask embarrassing questions that forced me to think
further. The answers are elusive.
xi
