Bloating, heartburn, irregular bowels, sudden cramps—gut disorders are incredibly common in adults. Some problems are functional (the gut looks normal but functions abnormally), like irritable bowel syndrome (IBS); others involve inflammation, ulcers, or infection, like H. pylori or inflammatory bowel disease (IBD). Knowing what to watch for, which tests actually help, and when to see a specialist can save you months of trial-and-error.
At Asad Choudhry Medical Centre (ACMC), Gujranwala, our GI & Liver team uses guideline-based pathways to separate self-manageable issues from those that need targeted treatment—including endoscopy and non-invasive tests when indicated.
1) GERD (acid reflux)
What it feels like: burning behind the breastbone, sour taste, chronic cough, worse after large/fatty meals or lying down.
First steps: For adults with classic heartburn/regurgitation without alarm symptoms (bleeding, anemia, weight loss, dysphagia), guidelines support an 8-week trial of a proton-pump inhibitor (PPI) alongside lifestyle changes (avoid late meals, elevate head of bed, weight loss if overweight). If symptoms persist or red flags exist, upper endoscopy or ambulatory reflux testing may be needed.
2) H. pylori gastritis & peptic ulcer disease
Clues: burning epigastric pain, nausea, anemia, or ulcers on endoscopy. Helicobacter pylori is a major cause of ulcers and some gastric cancers—test and treat if suspected.
Testing & treatment (2024 ACG): When H. pylori is confirmed, the preferred empiric therapy is optimized bismuth-based quadruple therapy for 14 days (in areas without susceptibility testing), and avoid routine clarithromycin-triple therapy unless sensitivity is proven. Always confirm eradication (stool antigen or urea breath test) after therapy.
Where ACMC helps: Same-day stool antigen, urea breath test (where available), endoscopy if red flags or bleeding.
3) Irritable Bowel Syndrome (IBS)
What it feels like: recurrent abdominal pain related to defecation plus altered stool frequency/form (constipation, diarrhea, or mixed). Diagnosis uses Rome criteria after excluding alarms (blood in stool, weight loss, nocturnal symptoms, age >50 with new onset).
Evidence-based care: The ACG IBS guideline supports limited testing (e.g., celiac serology for IBS-D), dietary therapy (low-FODMAP with professional guidance), gut-directed psychotherapy, and targeted medications (e.g., rifaximin for IBS-D; secretagogues/GC-C agonists for IBS-C).
4) Inflammatory Bowel Disease (IBD: Crohn’s disease & ulcerative colitis)
Red-flag picture: persistent diarrhea, rectal bleeding, nocturnal stools, weight loss, anemia, fevers, or family history.
Diagnosis: IBD requires endoscopic confirmation with biopsies; ulcerative colitis typically starts in the rectum and extends proximally; Crohn’s can involve any GI tract segment with skip lesions. Fecal calprotectin and CRP help distinguish IBD vs IBS and track inflammation. After diagnosis, colonoscopy and imaging guide treatment and cancer surveillance timelines.
Care at ACMC: Colonoscopy for diagnosis/surveillance; coordinated nutrition, medication, and vaccination plans.
5) Celiac disease (gluten-driven autoimmune enteropathy)
When to suspect: chronic diarrhea/bloating, iron-deficiency anemia, weight loss, dermatitis herpetiformis, family history, or associated autoimmune disease.
First-line test: tTG-IgA with total IgA (to exclude IgA deficiency). Positive screens usually proceed to duodenal biopsies while still eating gluten; lifelong gluten-free diet is the treatment.
6) Lactose intolerance & other carbohydrate malabsorptions
Typical story: bloating, gas, cramps, or diarrhea 1–3 hours after dairy. Many adults in South Asia have lactase non-persistence.
Diagnosis: The hydrogen breath test is the most common non-invasive test; some clinicians use a lactose tolerance blood test. Trial of lactose reduction and/or lactase enzyme can be both diagnostic and therapeutic.
7) Small intestinal bacterial overgrowth (SIBO)
Clues: bloating, gas, discomfort, sometimes nutrient deficiencies—especially after surgeries, with motility disorders, or systemic diseases.
Diagnosis & care: Guidelines discuss breath testing (glucose/lactulose for hydrogen; methane for intestinal methanogen overgrowth) and targeted antibiotics in symptomatic, confirmed cases—always alongside root-cause management (motility, adhesions, diet).
8) Diverticular disease (left-sided cramps, tenderness)
What it is: small pouches (diverticula) in the colon that can inflame (diverticulitis).
Today’s approach: Many cases of mild, uncomplicated diverticulitis can be managed as outpatients, with selective (not automatic) antibiotics and close follow-up; colonoscopy is often scheduled after recovery if age-appropriate or no recent exam.
Red flags you should not ignore
- Unintentional weight loss, anemia, fever
- Blood in stool or black, tarry stools
- Persistent vomiting, progressive trouble swallowing
- Nocturnal diarrhea, severe or worsening pain
- Age ≥45–50 with new symptoms (consider endoscopy/colonoscopy based on local screening policy and clinical judgment)
Any of these warrants a priority visit with a gastroenterologist.
How doctors figure it out (tests that actually help)
1) Basic labs: CBC (anemia), CRP/ESR (inflammation), CMP, iron studies, B12/folate.
2) Stool tests: fecal calprotectin (to separate IBS from IBD activity), occult blood, culture/ova/parasites when indicated.
3) Condition-specific tests:
- H. pylori stool antigen or urea breath test (and confirm eradication).
- Celiac: tTG-IgA + total IgA, followed by endoscopic biopsies if positive.
- Lactose intolerance: hydrogen breath test or structured elimination/re-challenge.
4) Scopes & imaging: Upper endoscopy for alarm GERD/dyspepsia or ulcers; colonoscopy for suspected IBD, bleeding, or age-appropriate screening; CT for suspected diverticulitis depending on severity. Ambulatory reflux testing when diagnosis of GERD remains uncertain.
What you can do now (care that works)
For reflux (GERD):
- Smaller meals, avoid late-night eating, weight loss if overweight, limit trigger foods (spicy/fatty), raise head of bed, 8-week PPI trial if no alarms—then re-evaluate.
For IBS:
- Keep a symptom–food diary; consider a low-FODMAP trial with re-introduction phases under clinician/dietitian guidance; targeted meds per subtype; consider gut-directed psychotherapy (e.g., CBT).
For H. pylori/ulcers:
- Complete the full 14-day quadruple regimen if prescribed and confirm eradication 4+ weeks after finishing antibiotics and 2 weeks off PPI (per lab protocol).
For celiac disease:
- Do not start a gluten-free diet before testing (can cause false negatives). If confirmed, work with a dietitian; follow antibody trends and address bone, iron, folate, B12.
For lactose intolerance:
- Try lactose-reduced intake, lactase enzyme as needed, and ensure calcium/vitamin D from other sources. Consider a hydrogen breath test if uncertainty remains.
For IBD:
- See a specialist early; plan for vaccinations, nutrition, and regular colonoscopic surveillance according to disease extent/duration.
• Need GI & Liver Clinic — endoscopy/colonoscopy, IBD care, reflux testing? Here’s your go to place.
FAQs (based on real search intent)
1) How do I tell IBS vs IBD at home?
You can’t diagnose at home. IBS often fluctuates with stress/foods and lacks bleeding, weight loss, or nocturnal symptoms. IBD frequently has inflammation signs (blood, fever, weight loss). Doctors use fecal calprotectin, labs, and colonoscopy to tell the difference.
2) When should reflux symptoms lead to a scope?
If you have alarm features (bleeding, anemia, weight loss, trouble swallowing), risk for Barrett’s, or no response to an 8-week PPI trial, your doctor may recommend endoscopy or reflux testing.
3) What’s the most accurate H. pylori treatment now?
In 2024 guidance, the default empiric choice is bismuth-based quadruple therapy for 14 days, with post-treatment confirmation of cure. Avoid clarithromycin-triple therapy unless sensitivity is known.
4) Do I need a gluten-free diet if I feel better avoiding bread?
Not necessarily. Test first (tTG-IgA + total IgA). If you remove gluten before testing, results may turn false-negative. Only confirmed celiac disease requires lifelong strict elimination.
5) How is lactose intolerance confirmed?
Most commonly by a hydrogen breath test; some use a lactose-challenge blood test. Many adults simply reduce lactose and see improvement—then formalize testing if needed.
6) I had left-sided abdominal pain—was told “diverticulitis.” Do I always need antibiotics?
Not always. For mild, uncomplicated cases, selective outpatient management with careful follow-up is reasonable; antibiotics are used case-by-case per guideline updates. Discuss the plan with your clinician.
