Medical Reviewers and Editors: Jay W. Marks, MD, and Melissa Conrad Stöppler, MD
Researchers have only recently begun to understand the many, often complex, diseases that affect the digestive system. Accordingly, people are gradually replacing folklore, old wives' tales, and rumors about the causes and treatments of digestive diseases with accurate, up-to-date information. But misunderstandings still exist, and, while some folklore is harmless, some can be dangerous if it keeps a person from correctly preventing or treating an illness. Listed below are some common misconceptions (fallacies), about digestive diseases, followed by the facts as professionals understand them today.
Myth # 1 Ulcers: Spicy food and stress cause stomach ulcers.
The truth is, the majority of stomach ulcers are caused either by infection with a bacterium called Helicobacter pylori (H. pylori) or by use of pain medications such as aspirin, ibuprofen, or naproxen, the so-called nonsteroidal antiinflammatory drugs (NSAIDs). Most H. pylori-related ulcers can be cured with antibiotics. NSAID-induced ulcers can be cured with time, stomach-protective medications, antacids, and avoidance of NSAIDs. Now that it is appreciated that H. pylori and NSAIDs are the cause of most ulcers and patients are being managed appropriately, the ulcers that are coming to medical attention are increasingly likely to be unrelated to H. pylori or NSAIDs. Spicy food and stress (except when associated with extreme medical conditions) may aggravate ulcer symptoms in some people, but they do not cause ulcers.
Ulcers can also be caused by cancer.
Myth # 2 Heartburn: Smoking a cigarette helps relieve heartburn.
Actually, cigarette smoking may contribute to heartburn. Heartburn occurs when the lower esophageal sphincter (LES) - a muscle between the esophagus and stomach - relaxes, allowing the acidic contents of the stomach to splash back (reflux) into the esophagus. People who smoke more frequently have inflammation of the esophagus (esophagitis), presumably caused by increased reflux of acid, that is the basis of heartburn. The increased reflux is believed to be due to the fact that cigarette smoking causes the LES to relax.
Myth # 3 Celiac Disease: Celiac disease is a rare childhood disease.
Celiac disease affects both children and adults. About 1 in 200 people in the United States have the genetic predisposition for celiac disease although not all of them have the disease. Sometimes celiac disease first causes symptoms during childhood, usually diarrhea, growth failure, and failure to thrive. But the disease can also first cause symptoms in adults of any age. These symptoms may be vague and therefore attributed to other conditions. Symptoms can include bloating and abdominal distention, flatulence, diarrhea, and abdominal pain due to the involvement of the small intestine as well as skin rash, anemia, and thinning of the bones (osteoporosis) due to malabsorption of nutrients by the diseased intestine. Celiac disease may cause such nonspecific symptoms for several years before being correctly diagnosed and treated.
People with celiac disease should not eat any foods containing gluten, a protein in wheat, rye, and barley, whether they have symptoms or not. In celiac disease, gluten provokes an inflammatory reaction by the body that destroys the lining of the small intestine, which interferes with the absorption of nutrients. Even a small amount of gluten can cause damage, and sometimes no symptoms will be apparent.
Myth # 4 Bowel Regularity: Bowel regularity means a bowel movement every day.
The frequency of bowel movements among normal, healthy people varies from three a day to three a week, and some perfectly healthy people fall outside both ends of this range. Nevertheless, even three bowel movements a day can be abnormal in someone who usually has one bowel movement a day. People with irritable bowel syndrome (IBS) may have fluctuating numbers of stools each day as well as fluctuating consistency of their stools.
Myth # 5 Constipation: Habitual use of enemas to treat
constipation is harmless.
It is not clear whether or not habitual use of enemas is harmless since there has been very little study of the effects of enemas or laxatives over the long term. Early studies showed that laxatives might injure the colon if taken chronically by impairing contraction of the colonic muscles, and this finding was extrapolated to include enemas. The data from the studies is not strong, however. In fact, some physicians feel that enemas are preferred over laxatives since they are a more "natural" means of stimulating a bowel movement. (Enemas mimic a large amount of stool in the rectum, the usual stimulus for a bowel movement.) An ongoing need for enemas is not normal; you should see a doctor if you find yourself relying on them or any other medication to have a bowel movement.
Myth # 6 Diverticulosis: Diverticulosis is a serious but uncommon problem.
Actually, the majority of Americans over age 60 have diverticulosis, but only a small percentage have symptoms or complications. Diverticulosis is a condition in which little sacs or out-pouchings called diverticula develop in the wall of the colon. These sacs tend to appear and increase in number as individuals age. Most people have no symptoms and learn that they have diverticula after an X-ray or intestinal examination (for example, colonoscopy, barium enema) that is being done for a purpose unrelated to the diverticulosis. Less than 10 percent of people with diverticulosis ever develop complications such as infection (diverticulitis), bleeding, or perforation of the colon.
Myth # 7 Inflammatory Bowel Disease (Ulcerative Colitis and Crohn's Disease): Inflammatory bowel disease is caused by psychological problems.
Inflammatory bowel disease is the general name for two diseases that cause inflammation in the intestines, Crohn's disease and ulcerative colitis. The cause of the disease is unknown, but researchers speculate that it may be a virus or bacteria interacting with the body's immune system. No evidence has been found to support the theory that inflammatory bowel disease is caused by tension, anxiety, or any other psychological factor or disorder, although these can aggravate the discomfort caused by the disease.
Myth # 8 Cirrhosis: Cirrhosis is caused only by alcoholism.
Alcoholism is just one of many causes of cirrhosis. Cirrhosis is scarring and decreased function of the liver. In the United States, alcohol causes less than one-half of cirrhosis cases. The remaining cases are from diseases that cause liver damage. For example, in children, cirrhosis may result from cystic fibrosis, alpha-1 antitrypsin deficiency, biliary atresia, glycogen storage disease, and other rare diseases. In adults, cirrhosis may be caused by hepatitis B or C, primary biliary cirrhosis, diseases of abnormal storage of metals like iron or copper in the body, severe reactions to prescription drugs, or injury to the ducts that drain bile from the liver. In adults, cirrhosis can also be caused by nonalcoholic steatohepatitis (NASH), which is becoming the most common liver disease in the United States, affecting 2 to 5 percent of Americans. NASH is associated with the increasing prevalence of obesity and diabetes.
Myth # 9 Ostomy Surgery: After ostomy surgery, men have erectile dysfunction and women have
impaired sexual function and are unable to become pregnant.
Ostomy surgery does not, in general, interfere with a person's sexual or reproductive capabilities. Ostomy surgery is a procedure in which the diseased part of the small or large intestine is removed and the remaining intestine is attached to an opening in the abdomen. Stool is collected in a bag taped to the skin over the opening. Alternatively, an internal pouch that collects the stool may be formed from a portion of the intestine. The pouch then can be emptied by insertion of a catheter at regular intervals.
Although some men who have had radical ostomy surgery for cancer lose the ability to achieve and sustain an erection, most men do not, or, if they do, it is temporary. This is caused by damage to the nerves innervating the penis. If erectile dysfunction persists, a variety of solutions are available. A urologist, a doctor who specializes in such problems, can help find the best solution.
In women, ostomy surgery does not damage sexual or reproductive organs, so it is not a direct cause of sexual problems or sterility. Factors such as pain and the adjustment to a new body image may create temporary sexual problems, but they can usually be resolved with time and, in some cases, counseling. Unless a woman has had a hysterectomy to remove her uterus, she can still bear children.
Reference: National Digestive Diseases Information Clearinghouse (NDDIC); "Facts and Fallacies About Digestive Diseases." NIH Publication No. 04–2673