When to get your gut checked

The gastro-intestinal (GI) tract is the source of many common medical and surgical complaints. While most cases of GI upset are benign, self-limiting, and do not require surgery, symptoms should always be considered in the context of age, personal and family history, and how they develop over time. Unfortunately, more serious conditions often go unnoticed because these symptoms are frequently ignored.

Proper evaluation starts with a visit to your doctor or surgeon for a thorough history and physical exam. Based on their assessment, your physician may recommend tests to confirm a clinical diagnosis.

Recognising common symptoms can help you know when it’s important to have your gut checked.

1. CONSTIPATION

Every person has a bowel action pattern that is normal for them. For most people, this may range from three times a day to three times a week. Many note a bowel action following their morning meal or traditional hot drink.

Changes to this routine are also common, often caused by factors such as diet, water intake, medications, and ageing. However, new-onset constipation may be a sign of undiagnosed colon cancer (cancer of the large intestine).

Both men and women aged 45 and over, with new-onset constipation should be investigated for colon and rectal cancer.

This change may be as subtle as moving from a daily bowel movement to every other day – and, as a result, it is often overlooked.

Interestingly, constipation interrupted by episodes of small-volume, mucus-like “diarrhoea”can also be a warning sign for cancer. Your physician may recommend a test called an endoscopy – a procedure where a flexible camera is introduced via the “back-passage” (rectum) to visualise the inner lining of the large intestine. It is usually done as a day-case procedure and often under sedation.

2. BLOOD IN THE STOOL

Bleeding from the back-passage, termed haematochezia, comes in many forms. It may present as small streaks of blood coating the stool or tissue, or as heavier bleeding with clots.

Far too often, doctors and patients alike empirically attribute this bleeding to haemorrhoids – commonly known as piles – without proper workup or investigation. This is a mistake.

Blood in the stool is a common symptom with a wide range of causes, of which haemorrhoids is only one.

Inflammatory bowel diseases, diverticular disease, and cancer are just some of the other possibilities.

It’s important to note that non-cancerous causes remain the most common. However, when paired with other symptoms like altered bowel habits, weight loss, and/or a family history of colon cancer – suspicion should be heightened.

As with constipation, the presence of blood in the stool will typically prompt your doctor to request an endoscopy.

3. UPSET STOMACH/INDIGESTION

Upper abdominal pain or discomfort after eating – commonly referred to as indigestion or dyspepsia, is a frequent complaint. Jamaicans call this “gas” pain.

Many people self-diagnose it as gas bloat or “ulcer stomach,” and while these issues are indeed common, such assumptions are often made without proper medical evaluation. Stomach ulcers, in particular, are relatively prevalent in Jamaica due to our high incidence of smoking, but they too, require confirmation by endoscopy – this time with the camera introduced through the mouth.

This procedure is especially important for patients over 40, particularly when indigestion is accompanied by other symptoms such as early satiety, weight loss, recurrent vomiting, or dark, tar-coloured stools.

Your doctor may also request testing for H. pylori – a specific bacteria that is found in as much as 60 per cent of persons with indigestion, and is associated with the development of ulcers and cancer. If found, this will require oral antibiotic treatment.

4. NO SYMPTOMS AT ALL

Screening for cancer is incredibly important. Far too often, we Jamaicans are reactive rather than proactive – waiting until symptoms are advanced before seeking medical attention. Yet, even in the absence of any symptoms, the Association of Surgeons in Jamaica recommends that the average adult begin colon cancer screening at age 45.

This may be done using endoscopy, a CT scan, or stool-based tests. Individuals with a personal or family history of cancer – or with certain other risk factors – may require earlier or more frequent testing. In such cases, it’s best to discuss your options with a gastroenterologist (GI specialist) or general surgeon.

I would like to stress again that while the vast majority of these common problems are not caused by cancer or other serious conditions, they all require proper clinical evaluation by your doctor.

Dr Matthew-Anthony Lyew is a consultant general surgeon at Kingston Public Hospital and Island Medical Specialists. Send your questions for consideration via DM on Instagram @drmatthewlyew or email surgicalconsult@gleanerjm.com.