The document discusses digestive issues such as bloating, constipation, and gastric symptoms, affecting 10-30% of adults annually, with most cases being temporary. It outlines potential medical causes, complications, and when to seek medical attention, highlighting the importance of identifying serious symptoms based on age and health history. Recommendations include dietary changes and consulting healthcare professionals for persistent problems.

1. Bloated, Constipated, ‘Gastric’
When should I be worried?
Dr Jarrod Lee 李彪医生
Gastroenterologist 消化专科医生
1

2. • Singapore's only
digestive group
practice
• Regional
authorities in sub-
specialty areas
• Comprehensive &
niche services

3. A Common Problem
• Bloating: 30%
• Constipation: 10%
• ‘Gastric’: 30%
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4. A Common Problem
• Affects 10-30% of adults annually
• 50% self medicate
• 10% see a doctor
• Mostly short duration and resolves spontaneously
• May be chronic or recurrent
• Affects quality of life
• More absent work days
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5. 5
What is Normal?

6. 6
Too Much Gas
• Bloating: subjective feeling that abdomen is full
• Flatus: expelling gas through anus

7. 7
Where Does The Gas Come From?
• Produced by gut
bacteria from
undigested sugars
• Medical conditions
• Blockage
• Weak digestion
• Weak movement
• Sensitivity

8. Medical Causes
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9. Constipation
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10. What is
Constipation?
• Bowel movement < 3
times per week
• Hard stool
• Straining
• Feeling of incomplete
empyting
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11. Top 10
Causes
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12. Medical Causes
12
• Nerve problem: affects
movement of stool
through colon
• Pelvic muscle problem:
affects muscles needed
for passing motion
• Blockage in colon
• Hormonal problems

13. Complications
• Hemorrhoids (Piles):
swollen anal veins
• Fissure: torn anal skin
• Fecal impaction: hardened
stool that is stuck
• Rectal prolapse: rectum
protruding from anus
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14. ‘Gastric’, ‘Indigestion’
• Often used to refer to
nonspecific abdominal
symptoms, usually after
meals
• Variable symptoms,
patterns, location
• Includes cramping, pain
burning, bloating,
fullness, nausea
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15. Causes
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Diagnosis Prevalence
Functional or unknown 70-80%
Acid related: acid reflux, gastritis, ulcers 15-25%
Digestive cancer < 2%
Others: biliary or pancreatic disease,
malabsorption, systemic disease,
parasites, motility disorder, etc
< 2%

16. When
should I be
worried?
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17. 17
Which Symptoms Are Serious?
Based on Common Advice
• Pain
• Cramping
• Bloating
• Flatulence
• Diarrhea
• Constipation
Based on Research
• Age > 45 years
• Weight loss
• Bleeding or anemia
• Swallowing difficulty
• Family history

18. 18
How long can I wait?
Don’t know!!
• If severe, see immediately
• If observing or trying
medication, not more than
6 weeks

19. Serious
Conditions
• Surgical
emergencies
• Severe infections
• Chronic illnesses
• Digestive Cancer
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20. Digestive
Tract
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22. Colonoscopy
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29. Inflammatory Bowel Disease

30. Infection

31. Advanced
Imaging
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32. Flat Polyps
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33. Diet Control
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34. Spicy Food
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35. Spicy Food
• Capsaicin: Active
ingredient in spicy foods
• Stimulates nerves to
cause burning and pain
• In patients with
functional disorder,
causes more severe pain
at smaller amounts
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36. 36

37. 37

38. Daily Fibre
Requirement
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39. Fibre Content per 100g
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40. 40
Water

41. 41

43. FODMAPs
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47. Lifestyle Factors
• Stress & anxiety
• Insufficent sleep
• ufficient exercise
• Studies show coffee,
smoking & alcohol are
not risk factors
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48. Who to see?
• General Practitioner
• Initial consultation
• Gastroenterologist:
• Persistent and
recurrent symptoms
• Further tests
• Dietitian/ Nutritionist
• Diet strategies
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49. Taking Home Message
• Digestive symptoms are very common
• Diet factors most common, but medical causes are
important
• Watch for serious symptoms and age
• See a doctor if severe or persistent symptoms
• Low FODMAP diet, adequate fibre and water, and
avoiding spicy food may help
49

50. • Singapore's only
digestive group
practice
• Regional
authorities in sub-
specialty areas
• Comprehensive &
niche services
Thank You
谢谢