The basics of Gut Pathology

Many patients come to see me with undiagnosed gut issues.

The cardinal gut symptoms are abdominal pain, diarrhoea, constipation and bloating. Reflux/dyspepsia and excessive wind are also common problems.

Most of my patients have already attended other doctors, and serious conditions such as coeliac disease, ulcerative collitis, Crohn’s disease and even bowel cancer have been excluded, so I will not discuss the integrative management of these conditions in this blog.

My work is therefore largely functional gut disorders- which simply means that a gastroscopy/colonoscopy does not show anything abnormal. These patients are often told that there is ‘nothing wrong’ with them in spite of debilitating symptoms. There are actually three main categories of problems which my patients have- parasitic infection, dysbiosis, and digestive problems. These issues can co-exist.

Parasites are usually protozoal and cause the spectrum of gut symptoms. Parasitic infection was dismissed as a cause of gut symptoms until quite recently, and it is vital that the G.P. order a stool test which specifies  PCR analysis, rather than a simple culture of the stool, or the pick up rate is very low. If a parasite is detected, I always eradicate it before focusing on other gut pathology, since it is not possible to correct dysbiosis or repair permeability whilst the parasite is inhabiting he gut wall. Parasites are not easy to eradicate, and the antibiotics used conventionally have a very poor clearance rate and are the most devastating to the healthy gut flora. Integrative doctors utilise antibiotics that are well known and utilised overseas but do not have a big enough market here for drug companies to brand and market them. When the parasite has been cleared, 70% of patients find that their symptoms are significantly improved.

In the absence of a parasite most patients have digestive problems or dysbiosis. Digestive problems can be generalised or specific and can often be elicited from history Alternatively, formal testing with a range of breath tests can quantify enzyme deficiencies. The cornerstone of treatment is  dietary manipulation with enzyme supplementation as appropriate.

Dysbiosis is a surprising common condition which simply means an imbalance in the bacterial constituency of the gut. Due to the work of a microbiologist in Melbourne,Henry Butt, who has been studying the gut for decades and always has ten PhD students working for him, we know a great deal about the range and numbers of bacteria which should inhabit the bowel. Too many or little of any of these will create various gut symptoms. The diagnosis of ‘irritable Bowel’ has often be given erroneously to people who have dybiosis. I send stool samples to Melbourne for analysis and then a precise programme of prebiotics, probiotics and antibiotics can be prescribed to establish a new balance . The results from this are excellent, and whilst the success can be quantified with repeat analysis, it is often not required because the symptomatic relief speaks for itself.

Gut permeability or ‘Leaky Gut’ is another diagnosis only recently accepted by mainstream medicine. Leaky gut usually occurs because of injury to the gut wall- but sometimes my patients have suffered from symptoms for a long time and the original insult has been forgotten. There are very effective regimens to reduce this problem. Not only do these patients have significantly reduced symptoms, but they also reduce the risk of future illness, such as autoimmune disease, due to exposure to toxic substances from the gut.

I am very grateful to have so many tools to help patients with gut symptoms, many of whom have been dismissed by local G.Ps. The results are extremely satisfying.

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