Experienced gastroenterologists need to know two things:
- Where the problem lies;
- Whether the problem lies in the gut lining (which is called the mucosa/ like a hardware issue) or underlying the mucosa and is a problem with function (sub mucosal layer / like a software problem) or perhaps the connections to the brain.
Four quick steps to an answer:
1. History
To identify where the problem lies they need to ask a few questions (take a history) about the gut feeling.
For this you need a consultation and answer some questions, like what are your symptoms and where do you feel they are coming from and how long has the problem been going on? These diagrams show the likely location of common symptoms:
Oesophagus
Heartburn, swallowing difficulty.
Stomach
Indigestion (dyspepsia), feeling like being sick (nausea), upper abdominal bloating, feeling full without eating much (early satiety), belching, anaemia, loss of appetite.
Small intestine
Diarrhoea, greasy stool, mid abdominal pain/discomfort, bloating, anaemia, weight loss.
Large intestine
Mid and lower abdominal discomfort or pain, cramps, unpredictable bowel habit, diarrhoea, constipation, bleeding from bottom (rectal bleeding), bloating, anaemia.
2. Video Capsule
Once the possible location has been identified from the history, an investigation will probably be needed to distinguish the nature of the problem. (Is it mucosal or sub-mucosal?)
For this the gastroenterologist will likely want to take a look – imaging with video capsule (or a virtual colonoscopy or possibly a traditional endoscopy).
If they discover something in the gut lining (i.e. a mucosal problem), they will be able then to suggest a treatment.
If there is nothing to see, then the problem is likely to be sub-mucosal and require further investigation.
3. Breath Testing
To assess a functional, sub-mucosal problem, you will probably be invited to undertake a breath test.
The results of this test will either lead to a suggestion of treatment, if it is not definitive, a further test.
4. Lifestyle Assessment
In the absence of findings from imaging and breath testing, it may be that a solution can be found in the connections between the gut and the brain. These can be illuminated by heart rate variability (HRV) monitoring and an assessment on lifestyle implications be made.