Symptoms
Some symptoms, such as diarrhea, constipation, bleeding from the digestive tract, regurgitation, and difficulty swallowing, usually suggest a digestive disorder. More general symptoms, such as abdominal pain, flatulence, loss of appetite, and nausea, may suggest a digestive disorder or another type of disorder.
Indigestion is an imprecise term that is used by different people to mean different things. The term covers a wide range of digestive tract problems, including dyspepsia, nausea and vomiting, regurgitation, and the sensation of having a lump in the throat (globus sensation).
Diarrhea
Diarrhea is the passing of frequent, loose stools. The consistency of the stool can be anything from soft and pasty to watery. The color can range from brown to clear. Black stools may indicate bleeding in the digestive tract. When a black color is caused by blood, the stools are usually tarry and foul-smelling (melena).
Cramping may occur before and with a bowel movement, and sometimes large amounts of gas are passed with the stool. Some people experience nausea, especially if the diarrhea is caused by an infectious organism or a toxic substance.
Constipation
Constipation is infrequent passage of bowel movements. A person with constipation often or always has hard stools that may be difficult to pass. The person also may feel as though the rectum has not been completely emptied.
Constipation can cause abdominal pain if the person strains during a bowel movement; in some people, the pain persists between movements. Constipation can cause nausea and curb appetite. Fecal impaction, in which the stool in the last part of the large intestine and the rectum hardens and blocks the flow from higher in the intestine, sometimes develops in people with severe constipation. Fecal impaction leads to cramps and rectal pain. Often, watery mucus oozes around the blockage, sometimes leading a person to conclude incorrectly that the problem is diarrhea and not constipation.
Constipation can result when the transit of stool through the large intestine is slowed by disease or certain drugs. Sometimes constipation is caused by dehydration or a low-fiber diet. Pain and psychologic conditions such as depression may also contribute to constipation. In many cases, however, the cause of constipation is unknown.
Bleeding From the Digestive Tract
Bleeding may occur anywhere along the digestive tract, from the mouth to the anus. Blood may be visible in vomit (hematemesis). When blood is vomited, it may be bright red if bleeding is brisk and ongoing. Alternatively, vomited blood may have the appearance of coffee grounds if bleeding has slowed or stopped, due to the partial digestion of the blood by acid in the stomach.
Blood may also be passed from the rectum, either as black tarry stools (melena) or as bright red blood (hematochezia). Melena is more likely when bleeding comes from the esophagus, stomach, or small intestine. The black color of melena results from blood that has been exposed for several hours to stomach acid and enzymes and to bacteria that normally reside in the large intestine. Hematochezia is more likely when bleeding comes from the large intestine, although it can result from very rapid bleeding from the upper portions of the digestive tract as well.
Bleeding from the digestive tract can have many causes, including peptic ulcers; abnormal connections between the arteries and veins of the intestines (arteriovenous malformations); dilated veins in the esophagus (esophageal varices); irritation from use of certain drugs, such as aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs); inflammatory bowel disease; and cancer of the digestive system.
Serious and sudden blood loss may be accompanied by a rapid pulse rate, low blood pressure, and reduced urine flow. A person may also have cold, clammy hands and feet. The decreased flow of blood to the brain that can occur with severe bleeding of the digestive tract may lead to confusion, disorientation, sleepiness, and even extremely low blood pressure (shock).
Dyspepsia
Dyspepsia is pain or discomfort in the middle of the upper abdomen often described as a gnawing or burning pain. Dyspepsia has many causes, including stomach ulcers, duodenal ulcers, and stomach cancer. Stomach inflammation (gastritis) may also cause dyspepsia. Helicobacter pylori bacteria may contribute to dyspepsia when they cause inflammation and ulcers of the stomach and duodenum (the first segment of the small intestine). Gallstones, when present in the tubes (ducts) that drain bile from the gallbladder, sometimes produce dyspepsia. Some drugs, especially aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) cause symptoms. In many people, however, no abnormality can be found (functional dyspepsia), and symptoms are linked to increased sensitivity in the stomach or increased contractions (spasms).
Anxiety can cause or worsen dyspepsia--possibly because anxiety can increase a person's perception of unpleasant sensations, so that minor discomfort becomes very distressing. Sometimes, anxiety may worsen the abnormal stomach sensitivity and contractions or cause a person to sigh or gasp and swallow air (aerophagia).
The pain or discomfort in the upper abdomen varies in intensity and quality. Most people describe it as burning or gnawing. For some people, eating makes the pain worse; for others, eating relieves the pain. Other symptoms may include a poor appetite, nausea, constipation, diarrhea, flatulence, belching, and loud intestinal sounds (borborygmi).
Regurgitation
Regurgitation is the spitting up of food from the esophagus or stomach without nausea or forceful contractions of abdominal muscles. A ring-shaped muscle (sphincter) between the stomach and esophagus normally helps prevent regurgitation. Regurgitation of sour or bitter-tasting material can result from acid coming up from the stomach. Regurgitation of tasteless fluid containing mucus or undigested food can result from a narrowing (stricture) or a blockage of the esophagus. The blockage may result from acid damage to the esophagus, cancer of the esophagus, or abnormal nerve control that interferes with coordination between the esophagus and its sphincter at the opening to the stomach.
Regurgitation sometimes occurs with no apparent physical cause. Such regurgitation is called rumination. In rumination, small amounts of food are regurgitated from the stomach, usually 15 to 30 minutes after eating. The material often passes all the way to the mouth where a person may chew it again and reswallow it. Rumination occurs without pain or difficulty in swallowing. Rumination is common in infants. In adults, rumination most often occurs among people who have emotional disorders, especially during periods of stress.
Difficulty Swallowing
Difficulty swallowing (dysphagia) is the sensation that food is not moving normally from the throat to the stomach or that it has become stuck on the way down. A swallowing difficulty can result from impediments to the movement of liquids and solids by mechanical blockage of the throat, esophagus, and nearby organs, as is the case with esophageal cancer. A swallowing difficulty can also be caused by problems in the nervous system or muscles. Finally, a swallowing difficulty may be imagined (psychogenic).
Globus Sensation
Globus sensation (previously called globus hystericus) is the sensation of having a lump in the throat when there is no lump. Globus sensation may result from abnormal muscle activity or sensitivity of the esophagus. It sometimes occurs when stomach acid and enzymes flow backward from the stomach into the esophagus (gastroesophageal reflux). Globus sensation also may occur with frequent swallowing and drying of the throat brought on by anxiety or another strong emotion or by rapid breathing.
The feeling produced by globus sensation is similar to that experienced when feeling all choked up, such as during events that trigger grief, anxiety, anger, pride, or happiness.
Abdominal Pain
Abdominal pain can be an indication of problems in the digestive tract or elsewhere in the abdomen. Elderly people tend to have less abdominal pain than younger adults, and the pain develops more gradually. Abdominal pain also affects children.
Pain can arise from any of several causes, including infection, inflammation, formation of sores (ulcers), perforation or rupture of organs, muscle contractions that are uncoordinated or blocked by an obstruction, and lack of oxygen needed by digestive tract muscles.
Examples of disorders that result in abdominal pain include a perforated stomach ulcer, irritable bowel syndrome, infection and inflammation of the appendix (appendicitis) or pancreas (pancreatitis), and cancer. Some of these disorders are relatively minor; others may be life threatening.
Characteristics of abdominal pain vary depending on the cause of the pain. For example, pain that accompanies irritable bowel syndrome is often described as a dull aching or cramping, whereas pain produced by a peptic ulcer is often characterized as burning. The description of the pain's location may vary, from a vague sense of being present everywhere to being felt in one specific spot. For example, pain that accompanies diverticulitis is often limited to the lower left portion of the abdomen, whereas pain caused by inflammation of the lining of the abdominal cavity (peritonitis) is frequently felt throughout the abdomen.
Abdominal pain may be affected by a change in position or by functions such as eating or having a bowel movement. For example, inflammation of the pancreas (pancreatitis) often produces pain that is worsened by rolling over in bed and is relieved somewhat by sitting upright and leaning forward.
Chest or Back Pain
Chest or back pain that occurs as soon as a person swallows food or liquid may resemble the pain of heart disease; both are often perceived as a burning sensation or a tightness under the breastbone (sternum). Alternatively, the chest pain associated with esophageal disorders may be perceived as severe squeezing that occurs along with difficulty swallowing hot or cold beverages. This type of pain may result from esophageal muscle disorders, damage to the inner lining (mucosa) of the esophagus, infections (bacterial, viral, or fungal) of the throat, or tumors.
Flatulence
Flatulence is the presence of a large amount of gas in the digestive tract. Excess gas is expelled through the mouth (belching) or through the anus (flatulence), or it is absorbed through the walls of the digestive tract into the blood and then excreted by the lungs. Bacteria in the digestive system also break down (metabolize) some gases into a simpler, more easily excreted form.
Air is a gas that can be swallowed while eating (aerophagia). Swallowing small amounts of air is normal, but some people unconsciously swallow large amounts. Most swallowed air is later belched up, so only some of this air moves from the stomach into the rest of the digestive system. If large amounts of air are swallowed, the person may belch excessively or pass the air through the anus.
Other gases are produced in the digestive system by several means. Hydrogen, methane, and carbon dioxide are produced as bacteria break down and process food in the intestine (bacterial metabolism). People who have deficiencies of the enzymes that break down certain sugars, such as the sugar found in milk (lactose), also tend to produce large amounts of gas when they eat foods containing the sugars. Almost anyone who eats large amounts of proteins or fruits will develop some degree of flatulence.
Flatulence is often accompanied by abdominal pain and bloating. Some people are particularly sensitive to the effects of gas in the digestive system; others can tolerate large amounts without developing pain or bloating.
Loss of Appetite
Loss of appetite (anorexia) can result from many different digestive disorders. Anorexia implies that hunger is absent; a person with anorexia has no desire to eat. Anorexia can result from inflammation or infection of the digestive tract in disorders such as gastritis and gastroenteritis. Anorexia can occur when the digestive tract is obstructed. Cancer can also cause anorexia.
Diseases affecting other parts of the body can also cause or contribute to anorexia. Disorders that affect the part of the brain where appetite is regulated can cause anorexia as well.
Nausea
Nausea is an unpleasant feeling that may include dizziness, vague discomfort in the abdomen, an unwillingness to eat, and a feeling that the person will vomit. Nausea results when the vomiting center in the brain is activated. Nausea commonly occurs with any dysfunction of the digestive tract. Some people become nauseated from the movement of a boat, car, or airplane. Nausea may also occur during pregnancy, particularly in the early weeks and especially in the morning. Many drugs, including opioid analgesics, such as morphine, and chemotherapy drugs can cause nausea.
Vomiting
Vomiting is the forceful contraction of the stomach that propels its contents up the esophagus and out through the mouth. Vomiting usually occurs with nausea and can be caused by any of the conditions that cause nausea. Vomiting serves to empty the stomach of its contents and often makes a person with nausea feel considerably better, at least temporarily.
An obstruction of the intestine eventually causes vomiting, because food and fluids back up into the stomach from the blockage. Also, irritation or inflammation of the stomach, small intestine, or gallbladder can cause vomiting. Psychologic problems also can cause nausea and vomiting (functional, or psychogenic, vomiting). Such vomiting may be intentional--for instance, a person with bulimia vomits to lose weight. Or it may be unintentional--a conditioned response to address psychologic distress, such as to avoid going to school.
Vomitus--the material that is vomited up--can look like almost anything, usually reflecting what was recently eaten. Sometimes it contains chunks of food. When blood is vomited, the vomitus is usually bright red (hematemesis). When bile is present, the vomitus is green.
Even normal vomiting can be violent. A person who is vomiting typically doubles over and makes considerable noise during the process. Severe vomiting can project food many feet (projectile vomiting). Vomiting greatly increases pressure within the esophagus, and severe vomiting can tear the lining of the esophagus. People who are unconscious can inhale their vomitus. The acidic contents of the vomitus can severely irritate the lungs.
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