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					   Digestive disorders are
   all too common and
   often cloaked in silence.
   It’s time to start talking –
   and acting – to improve
   our digestive health


   Digestive
     HealtH:

                  Let’s Talk About It
B               on appétit! Prosit! Dig in! Unfortunately, these
                convivial words don’t bring good cheer to the
millions of Canadians living with digestive dysfunction. While
food doesn’t actually cause most digestive disorders, a meal can
                                                                          It is no exaggeration to say that the digestive system orchestrates
                                                                      our overall well-being. While our skin functions as a barrier to the
                                                                      outside world, the lining of the digestive tract has evolved to sample,
                                                                      and selectively choose, what the world has to offer. Like the maestro
certainly bring symptoms to the fore. Ranging from mild to            of a symphony orchestra, the digestive system also communicates
debilitating, symptoms often erode quality of life and may even       with virtually every other system in our body.
threaten life itself.                                                     The term “digestive disease” refers to any medical condition
   The Canadian Digestive Health Foundation (CDHF) seeks to           that involves the digestive tract – the long unbroken tube from
dispel the myths and stigma surrounding digestive disease. The        the mouth to the anus – as well as the organs connected to this
CDHF believes the best defense against digestive disease is for       tube. Unlike many other disease classes, digestive diseases
Canadians to be aware, informed and willing to talk.                  typically strike people in the prime of life, which magnifies their
   The following supplement explores the roots of digestive           social and economic impact. Nearly a third of Canadians have a
dysfunction and, through medical information and patient              digestive disease, with many suffering a reduction in quality of
stories, helps you identify and cope with several specific            life, employability, or even life expectancy. The most serious of
digestive diseases. Perhaps a toast is in order after all: Here’s     these diseases, colon cancer, is expected to strike about 21,500
to your digestive health!                                             Canadians this year, and end the lives of close to 9,000 of them.


                                                       The Canadian Digestive Health Foundation (CDHF) feature on digestive
                                                      health is supported by partners of the CDHF and the following companies:
                                                                 Abbott, AstraZeneca Canada, Ferring Pharmaceuticals,
                           www.CDHF.ca                  Olympus Canada, Schering-Plough, UCB Pharma Canada, and VSL#3.
                                   the Canadian Digestive Health Foundation (CDHF) feature


    For all their impact, digestive disorders lurk at the margins                                evolved in tandem with our digestive tract. They interact with our
of public discourse. Still considered anathema to “polite                                        immune system in a complicated dance that involves our brain
conversation,” digestive complaints that should be discussed                                     and other organs. Untroubled for five million years, they’re now
with a doctor often remain unvoiced. Fearing embarrassment and                                   being perturbed by the changes we’ve imposed on our diet and
discomfort, many people suffer in silence and blame themselves                                   environment in the past 150 years. Many of the so-called diseases
for their digestive ailments, and shy away from potentially life-                                of modern society, including some digestive diseases, are thought to
saving diagnoses such as colonoscopy and treatments.                                             reflect this perturbation.
    To add insult to injury, insurance providers – and even some                                     The gut also “talks” constantly
people in the medical community – may fail to take some
digestive disorders seriously. Pain and discomfort, the need to
                                                                                                 to the brain, using specialized
                                                                                                 neural pathways and hormones as
                                                                                                                                                           DIgest thIs:
                                                                                                                                             • You are not alone: about 60
stay close to a bathroom for fear of having “accidents” hamper                                   agents of communication. Some                 per cent of our population –
many people’s ability to work and socialize.                                                     evidence suggests that the brain              that’s 20 million Canadians
    With digestive disorders increasing in the developed world,                                  “knows” about the arrival of certain          – has some form of digestive
we need to search for root causes embedded in our way of                                         bacteria in the gut within less               dysfunction
living. One place to look is on the grocery-store shelves: Could                                 than an hour. Researchers are now           • In terms of total economic
it be that the rapid changes in dietary habits spearheaded by                                    testing the idea that some of these            burden, digestive diseases
the industrial revolution may play a role in our current burden                                  bacteria may even influence mood.              rank first among illness
of digestive disease? It bears noting that Canada has one of the                                 The converse may also hold true:               classes, accounting for
                                                                                                                                                about 15% or $8 billion of
highest rates of inflammatory bowel disease. In all likelihood,                                  there’s evidence that depressed
                                                                                                                                                all direct health care costs
genetic vulnerability and harmful environmental forces have                                      mice become more vulnerable to
                                                                                                                                                and representing 12% of all
converged to raise the prevalence of this serious condition.                                     inflammation in the bowel.                     hospitalizations
    The environmental hypothesis finds support in the ongoing study                                  All of which is to say that the
                                                                                                                                             • the average loss of work
of the “friendly bacteria” colonizing our intestinal tract. Ten times                            gastrointestinal system cannot be              days attributable to
more numerous than all the cells in our body, these microflora have                              viewed in isolation. It functions              digestive illness is 13.4 days
                                                                                                 both as a transmitter of information           per year or about 18 million
                                                                                                 from the outside world and receiver            days annually
  Myths and realities about digestive disease                                                    of signals from other parts of our          • Individuals with gastro-
  Myth: spicy foods and stress cause stomach ulcers.                                             body. Altering the natural balance             intestinal symptoms miss
  Reality: Almost all stomach ulcers are caused either by infection                              of microflora in our gut, through              nine times as many days
  with a bacterium called helicobacter pylori or by the continued                                dietary excess or overly processed             of work as their unaffected
  use of certain medications, particularly anti-inflammatory drugs.                                                                             counterparts
                                                                                                 food, may be costing us our
  Myth: Bowel regularity means one bowel movement every day.                                     digestive health.                           • Only 5.4% of funds available
  Reality: the normal frequency of bowel movements varies                                            To understand and combat                   for illnesses research is for
  from three per day to three per week; some healthy people even                                                                                digestive diseases.
                                                                                                 digestive disorders, we must banish
                                                                                                                                             sources: Canadian Digestive health
  fall outside this range.                                                                       the lingering stigma that surrounds         Foundation, gastroparesis and
                                                                                                                                             Dysmotilities Association (Canada),
  Myth: Irritable bowel syndrome is “all in the head.”                                           these diseases and the tests used           National Institute of Diabetes and
  Reality: Irritable bowel syndrome is a functional disorder                                     to identify them. We must move
                                                                                                                                             Digestive and Kidney Diseases (U.s.)

  that causes very real abdominal pain and discomfort, though it                                 beyond the arbitrary dividing line
  doesn’t damage the digestive tract.
                                                                                                 between physical and emotional health and view digestive disorders
  Myth: Celiac disease is a rare childhood disease.                                              in the context of the whole person. We must keep hope alive as we
  Reality: Celiac disease, an allergic reaction to ingested gluten,                              seek out the best treatments available. Fortunately, current treatment
  may develop in childhood or adulthood. Because symptoms
                                                                                                 options put good health and high quality of life within reach for the
  overlap with those of so many other conditions, it often goes
                                                                                                 great majority of people with digestive disorders.
  unrecognized or misdiagnosed for years.
                                                                                                     But first, we must give ourselves permission to start a
  Myth: Ostomy surgery (surgical creation of an orifice to discharge
                                                                                                 conversation about digestive health, one that resounds across
  waste) sounds the death knell for sex and reproduction.
                                                                                                 the country, so that we may overcome embarrassment, and
  Reality: In general, ostomy surgery does not interfere with
  sexual or reproductive capabilities.                                                           advocate for our digestive health. This is the system that fuels
          source of information: Institute of Diabetes and Digestive and Kidney Diseases
                                                                                                 our lives. We must respect and protect it – openly, honestly and
                                                                                                 with conviction.
                                                   • Stephen Collins, Professor and Associate Dean of Research and Richard Hunt, Professor,
                                       Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON




                                     www.CDHF.ca
                              the Canadian Digestive Health Foundation (CDHF) feature



                                                                                                                                  GASTROESOPHAGEAL REFLUX DISEASE

                                                                                                                                  Gastroesophageal reflux disease (GERD)
                                                                                                                                  occurs as a result of stomach contents
                                                                                                                                  (including stomach acid) refluxing
                                                                                                                                  (moving in the opposite direction) from
                                                                                                                                  the stomach to the esophagus.
                                                                                                                                  Prevalence
                                                                                                                                  GERD is a chronic condition affecting more
                                                                                                                                  than 4 million Canadians.
                                                                                                                                  Signs and symptoms
                                                                                                                                  Most patients with GERD suffer from
                                                                                                                                  heartburn, which people sometimes
                                                                                                                                  describe as indigestion, and acid reflux.
                                                                                                                                  In about half of patients, the acid in the
  No need to put up with it                                                                                                       esophagus damages the esophageal
                                                                                                                                  lining. Five to 10 per cent of individuals
                                                                                                                                  with GERD develop Barrett’s esophagus, a


T          here are some days you don’t forget, no matter how long you live. For Shawn
           Richarz, 43, the first experience of digestive symptoms ranks as one of those
indelible days.
                                                                                                                                  precancerous condition that progresses to
                                                                                                                                  cancer in a minority of cases.
                                                                                                                                  vomiting, bleeding, unintended weight
   “It was shocking to me,” says Richarz, a lawyer practicing in Cayuga, ON. Twenty years                                         loss or difficulty swallowing call for
                                                                                                                                  medical attention and an endoscopy to
old at the time, Richarz remembers a “sharp burning pain rising from the middle of my chest
                                                                                                                                  view the upper digestive tract.
area. It stopped me in my tracks.” But then he got used to it. “I didn’t even bring it up with
my family doctor – I had the typical male attitude and thought I just had to suck it up.”                                         Diagnosis
                                                                                                                                  A physician can usually diagnose GERD if the
   After five years, Richarz finally underwent a barium swallow radiograph and learned
                                                                                                                                  patient finds short-term relief from persistent
he had a hiatal hernia, a condition that is commonly linked to reflux. “I was told nothing                                        heartburn and regurgitation after taking
could be done about it,” he says. Richarz’s symptoms kept worsening, intruding more and                                           antacids or other acid-reducing medications
more on his daily life. “A few times a month the pain was so bad it felt as though I’d just                                       for short periods. symptom improvement
drunk acid,” he recalls. Relentless concern about the impact of his next meal restricted                                          with a short trial of a proton pump inhibitor
his sense of social freedom. With exhaustion a constant companion, physical activity also                                         (PPI) is the best test to confirm GERD. PPIs
went by the wayside. The disease even affected his nights, with pain or choking often                                             are prescription products that prevent acid
                                                                                                                                  from being produced by the stomach.
intruding on his sleep.
   One day, while surfing the Internet, Richarz chanced on an article describing symptoms                                         treatment and return to health
that matched his own. He went to a clinic, where a specialist told him about gastro-                                              For mild or infrequent symptoms,
                                                                                                                                  intermittent over-the-counter medications
esophageal reflux disease (GERD). “I thought, bingo, this is me.” An endoscopy clinched
                                                                                                                                  (antacids, h2-receptor antagonists) can
the diagnosis and also identified precancerous cells resulting from the chronic, reflux-                                          be very helpful. More frequent or severe
related damage to Richarz’s esophagus. “That’s when I realized my condition wasn’t                                                symptoms may warrant long-term
something to play around with,” he says.                                                                                          treatment with a PPI.
   At his doctor’s suggestion, Richarz enrolled in a six-week study comparing an                                                  Medications for GeRD
undisclosed drug to a placebo in patients with GERD. “Everything changed,” he says                                                •   Antacids including Alka-seltzer,
simply. “It reminded me of when I put glasses on for the first time as a kid.” When                                                   Gaviscon, Maalox, Mylanta, Rolaids, Tums
Richarz learned he had been taking a proton pump inhibitor (PPI), he lost no time in                                              •   h2-receptor antagonists including
getting and filling a prescription for the drug. Richarz says he is now virtually symptom-                                            cimetidine (Tagamet), famotidine (Pepcid),
free and his esophagus healed.                                                                                                        nizatidine (Axid), ranitidine (Zantac)
   With a recent triathlon under his belt, Richarz says he has regained his sense of control
                                                                                                                                  •   Proton pump inhibitors (PPIs) including
                                                                                                                                      esomeprazole (Nexium), lansoprazole
over his life. “I can relax during the day because I know I’ll sleep well.” Calling his                                               (Prevacid), omeprazole (Losec),
treatment “life-changing,” Richarz urges other people with reflux symptoms to advocate                                                pantoprazole (Pantoloc), rabeprazole
for their own health. “There are treatments to take away the pain and discomfort,” he says.                                           (Pariet)
“There’s no need to put up with it.”
                • David Armstrong, Associate Professor, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON
                                 • Naoki Chiba, Associate Clinical Professor, McMaster University, Hamilton, ON and Guelph General Hospital, Guelph, ON




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                                                                          the Canadian Digestive Health Foundation (CDHF) feature



                                            Scoring points against                                                                                                                INFLAMMATORY BOWEL DISEASE
                                            ulcerative colitis                                                                                                                    Inflammatory Bowel Disease (IBD)

                                            E
                                           dmonton Oiler Fernando Pisani wasn’t too concerned when, a few weeks after
                                           finding blood in his stool, a doctor diagnosed him with ulcerative colitis. “I didn’t
                                  give it much thought because my symptoms were manageable,” says the hockey player,
                                                                                                                                                                                  is the umbrella term for a group of
                                                                                                                                                                                  disorders that involve inflammation
                                                                                                                                                                                  of the intestines, notably ulcerative
                                                                                                                                                                                  colitis and Crohn’s disease.
                                  31. “Looking back, I was pretty naïve.”
                                     In July 2007, Pisani’s symptoms took a sharp turn for the worse. Unable to keep                                                              Prevalence
                                                                                                                                                                                  IBD affects over 200,000 Canadians.
                                  any food or fluid down, he made up to thirty trips to the bathroom every day, suffering
                                                                                                                                                                                  though the condition can strike at any age,
                                  dehydration and severe cramping. In his blog, he writes: “I knew something was wrong                                                            it arises most often in the twenties and
                                  with me, but I was kind of embarrassed to see somebody about it.” Why embarrassed?                                                              tends to run in families.
                                                                                       “It’s not one of the most glamorous                                                        Signs and symptoms
                               Fernando Pisani                                         conditions to have,” he says ruefully.                                                     Ulcerative colitis affects only the large
                                                                                           A gastrointestinal specialist put                                                      intestine and causes symptoms such as
                                                                                       Pisani on prednisone, along with                                                           bloody diarrhea, urgency to go to the
                                                                                       acetaminophen to relieve the pain.                                                         bathroom, and abdominal cramping.
                                                                                                                                                                                  Crohn’s disease can affect any part of the
                                                                                       Neither provided much relief. His
                                                                                                                                                                                  intestine – from “gums to bum” – and
                                                                                       doctor advised surgery to remove his                                                       may lead to diarrhea, abdominal pain,
                                                                                       colon, but Pisani didn’t want to go                                                        cramping, and weight loss. some cases
                                                                                       there. “Nobody had ever tried playing                                                      may also involve joint pains, mouth ulcers,
                                                                                       hockey with a [ostomy] bag on, and                                                         and/or eye or skin problems.
                                                                                       I feared it would end my career,” he                                                       Persistent or high fever, intense
                                                                                       says. “I also felt I was too young for                                                     abdominal pain, and/or profuse bloody
                                                                                       such a radical procedure.”                                                                 diarrhea are symptoms that require
                                                                                           Realizing his career and life                                                          immediate medical attention.
                                                                                       depended on finding effective                                                              Diagnosis
                                                                                       treatment, Pisani sought a second                                                          Inflammatory bowel disease is generally
                                                                                                                                                                                  diagnosed based on a combination of
                                                                                       opinion. By this time he felt “drained
                                                                                                                                                                                  history, symptoms, stool and blood tests, and
                                                                                       physically and mentally. As soon as                                                        imaging tests such as a colonoscopy, small
                                                                                       food or drink would hit my lips I was                                                      bowel series or a Ct scan of the abdomen.
                                                                                       running to the bathroom. It got to
                                                                                                                                                                                  treatment and return to health
                                                                                       the point that I didn’t want to eat any                                                    the first goal of treatment for IBD patients
                                                                                       more.” A loss of forty pounds bore                                                         is to reduce inflammation to restore bowel
                                                                                       witness to that sentiment.                                                                 function, the second to prevent recurrent
                                                                                           The new specialist put Pisani on                                                       symptoms. several classes of drugs
                                                                                       a “biologic” drug that thwarts the                                                         may accomplish these aims. surgery to
                                                                                                                                                                                  remove the colon is an option for the most
                                  inflammation process. The results were dramatic. “After about five days I noticed a                                                             serious cases of ulcerative colitis. today’s
                                  change in my appetite,” he recalls. “I was able to hold down my food and drink. I started                                                       treatments allow most patients to return to
                                  to feel more energetic and get my colour back.”                                                                                                 a normal, unrestricted life.
PHOTO: THE CANADIAN PRESS/LARRy MACDOugAL




                                     Pisani still hadn’t left the woods, though. “I had to rebuild my strength from about                                                         Medications for inflammatory
                                  zero,” he says. Accustomed to bench-pressing 230 pounds before his illness, he                                                                  bowel disease
                                  backtracked to lifting a 45-pound bar – and then collapsing with exhaustion. After                                                              •   Mesalamine (Asacol, Dipentum, Mesasal,
                                  missing 26 games, Pisani stepped back on the ice in December 2007. “I’ll never forget                                                               Mezavant, Pentasa, Salofalk)
                                  how my fans cheered when I first played on home ice. I felt they were right with me.”                                                           •   Corticosteroids (Budesonide, Prednisone)
                                     The biologic medication he receives every 8 weeks continues to do the job for Pisani.
                                                                                                                                                                                  •   Biologic agents (Humira, Remicade,
                                                                                                                                                                                      Cimzia*)
                                  “I have no symptoms or side effects and can eat whatever I want,” he says. What got him                                                         •   in maintenance stage:
                                  through his experience with his sanity intact, Pisani figures, is that “I never lost hope and                                                       6-mercaptopurine (6-MP), azathioprine
                                  my doctor had a game plan. With this disease, a combination of a good doctor and the                                                                (Imuran), mesalamine and/or biologics
                                  right treatment can work wonders.”                                                                                                              * not yet approved by health Canada for use in Canada

                                              • Brian Bressler, Gastroenterologist, University of British Columbia, Vancouver, BC • Alain Bitton, Gastroenterologist, Inflammatory Bowel Disease Clinic, McGill University, Montreal, QC
                                                                               • Remo Panaccione, Gastroenterologist, Director, Inflammatory Bowel Disease Clinic, University of Calgary, Calgary, AB




                                                                           www.CDHF.ca
                                   the Canadian Digestive Health Foundation (CDHF) feature



Small sacrifice, big gains                                                                                                             CELIAC DISEASE


M                arc Legel would rather be tinkering with computer networks or going on
                 a Sunday drive than worrying about his digestive health. But when Legel,
23, began to experience gas, bloating, rumbling, general discomfort in his stomach –
                                                                                                                                       Celiac disease stems from a
                                                                                                                                       specific negative interaction between
                                                                                                                                       gluten – a protein that gives grain-
                                                                                                                                       containing foods their elasticity –
and worst of all, extreme fatigue – he had to put his high-tech passion aside and find out
                                                                                                                                       and the immune system, leading
what was wrong. He underwent a barrage of tests, which all came back negative. “At one                                                 to small-intestine damage and
point, my doctor thought I might have cystic fibrosis, which really scared me,” he said.                                               bothersome symptoms.
   Finally, two full years after his first symptoms, a gastroenterologist diagnosed Legel
                                                                                                                                       Prevalence
                                                           with celiac disease. This actually
                                                                                                                                       Present in up to 1 per cent of the North
                                                           puts him ahead of the curve, as many                                        American population, celiac disease
                                                           celiac patients wait several years                                          is greatly underdiagnosed. having an
                                                           longer before getting a diagnosis.                                          affected first-degree relative raises the
                                                           During the waiting period, “I missed                                        odds of having celiac disease by as much
                                                           a lot of school,” says Legel. Even                                          as ten-fold.
                                                           when he was able to drag himself                                            Signs and symptoms
                                                           to class, “I had a hard time paying                                         typical symptoms include diarrhea,
                                                           attention.” Holed up at home most                                           bloating, abdominal pain and weight loss.
                                                           evenings, the gregarious Legel ached                                        the nutritional deficiencies associated
                                                                                                                                       with celiac disease can lead to anemia and
                                                           for his formerly active social life.
                                                                                                                                       osteoporosis. In early childhood, growth
                                                               Once diagnosed, Legel was                                               failure after the introduction of dietary
                                                           informed about gluten and the foods                                         grain is recognized as a classical symptom
                                                           he needed to avoid. The long list                                           by the majority of health practitioners.
                                                           included all prepared foods, which                                          if symptoms persist or recur after
  For the vast majority of patients, “pretty much ruled out eating out,”                                                               the introduction of a gluten-free diet,
 symptoms and intestinal damage he says. “I had to learn to cook                                                                       medical attention is required.
    show remarkable improvement again.” The discovery of a grocery                                                                     Diagnosis
      with the elimination of gluten- store that stocked gluten-free pasta                                                             A simple, widely available blood test called
      containing foods (e.g., wheat, and bread helped ease him through                                                                 anti-tissue transglutaminase can highly
                                                                                                                                       suggest or rule out the diagnosis in most
             rye, barley) from the diet. the transition.                                                                               patients. Confirmation with an endoscopic
                                                               “When my stomach settled and my
fatigue lifted, I realized that these small sacrifices were definitely worthwhile,” he says.                                           biopsy is generally recommended. In
                                                                                                                                       recent years, the delay between symptom
In the two years since receiving his diagnosis, “I’ve never gone off the wagon.” His
                                                                                                                                       onset and diagnosis has been reduced
family makes the job easier by preparing foods he can eat. “My mom bakes a mean                                                        from nine to four years.
gluten-free bread.” He’s even found a way to “eat out” again. “I eat something before
                                                                                                                                       treatment and return to health
going out, and while my friends are
                                                                                                                                       For the vast majority of patients, symptoms
eating I just sip a drink,” he says.
   Now symptom-free, Legel says                             Celiac disease-friendly foods*                                             and intestinal damage show remarkable
                                                                                                                                       improvement with the elimination of
that “life is good. I love my job and          • Potatoes, rice and corn                                                               gluten-containing foods (e.g., wheat,
want to move up in the company.”               • grain products made without gluten                                                    rye, barley) from the diet. Immune-
                                                                                                                                       suppressing drugs such as prednisone
His parting words of advice to other
                                               • All plain (fresh, frozen, canned or dried)                                            or azathioprine are occasionally used in
people who suspect they might                     fruit and vegetables                                                                 difficult cases.
have celiac disease: “Keep a log of
symptoms and foods eaten, and don’t
                                               • Milk, yogurt and cream; aged cheeses
be afraid to talk to people about your         • Fresh meat, poultry, fish and shellfish
dietary needs if you do end up having          • soy protein meat substitutes, dried peas
the disease. Most people are very                 and beans, nuts
supportive and accommodating.”                 * Many processed foods contain small amounts of gluten. If in doubt,
                                                            labels should be checked or manufacturers contacted.


         • Jamie Gregor, GI Program Director, London Health Sciences Centre, London, ON • Donald R. Duerksen, Associate Professor of Medicine, St. Boniface General Hospital, Winnipeg, MB




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Piecing the puzzle together                                                                                                        IRRITABLE BOWEL SYNDROME


W             hen a bout of diarrhea and stomach pains assailed Madeleine Auger (a
              pseudonym) ten years ago, she shrugged it off as indigestion. It was only
when the symptoms continued for six months, waxing and waning unpredictably, that
                                                                                                                                   Irritable bowel syndrome (IBS)
                                                                                                                                   is an intestinal disorder that causes
                                                                                                                                   abdominal pain and discomfort.
                                                                                                                                   It can cause significant psychological
Auger, 33, grew concerned. “The doctor told me I had a hard stomach,” says Auger, who
                                                                                                                                   distress and leave patients unable
lives with her partner and baby daughter in St. Georges de Beauce, Quebec. “I thought,                                             to fully participate in school, work
‘what’s a hard stomach?’” A barium enema, blood tests, and endoscopy followed,                                                     and social life.
yielding no information about what might be wrong.
                                                                                                                                   Prevalence
    Meanwhile, the stomach pains and diarrhea persisted. “Everybody had an opinion
                                                                                                                                   IBs affects 10 to 20 per cent of the North
about it,” she recalls. It’s stress. I know someone who had the same thing and then stopped                                        American population and about twice as
eating X and was fine. My aunt started taking supplement Y and her symptoms disappeared.                                           many women as men.
Auger’s doctor sent her for more testing, once again coming up empty-handed.
                                                                                                                                   Signs and symptoms
    Finally she got a diagnosis that made sense. “I was told I had Irritable Bowel Syndrome,                                       People with IBS may experience
IBS, that my bowel wasn’t working properly, and that stress could make it worse,” she says.                                        abdominal pain, bloating (distention)
Advised to modify her eating habits, she set out to add fibre-rich foods to her diet and avoid                                     with constipation, diarrhea or alternating
bloat-inducing foods such as cabbage or beans. Though she put in a full day’s work as the                                          constipation and diarrhea. these
director of an assisted-living facility, she made time to hit the gym, take walks, and play                                        symptoms may improve with defecation.
golf to keep her stress levels in check. All this added up to a noticeable improvement in                                          Indigestion and heartburn may also occur.
symptoms, with flares subsiding to a day or two per month.                                                                         involuntary weight loss, rectal bleeding,
    Pregnancy threw a monkey wrench into Auger’s routine, and stress came back with                                                fever and the onset of symptoms after
a vengeance when she learned that her infant daughter would eventually require cardiac                                             age 50 may signal that another disease
                                                                                                                                   coexists with iBs.
surgery. A bad relapse sent her back to a gastroenterologist’s office for advice on “how
to live better with IBS.” He suggested probiotics and a lower endoscopy, options Auger                                             Diagnosis
intends to explore in the near future.                                                                                             the cause of IBs is not known and
                                                                                                                                   diagnosis is based on symptoms. If other
    For the time being, she says “things are going well. Every once in a while I have a
                                                                                                                                   gastrointestinal conditions have been
relapse that lasts three or four days, but most of the time I feel fine.” On the advice of                                         ruled out, the abdominal discomfort
a naturopath, she cut milk products from her diet, finding this measure to reduce the                                              has been present for a long time, and
severity of her symptoms. A laxative helps keep her regular.                                                                       symptoms improve with defecation,
    With the benefit of hindsight, Auger urges other IBS patients to “rely on professionals                                        IBs is the likely culprit. If the diagnosis
but also on your own instincts. Be attentive to your own body, choose foods you tolerate                                           is in question, laboratory testing and
well, and try not to put too much – either food and stress – on your plate.”                                                       colonoscopy may be required.
                                                                                                                                   treatment and return to health
      symptoms may improve with a healthy diet,                                                                                    As IBs does not progress to more serious
                                                                                                                                   conditions, reassurance goes a long
    including dietary fibre, and stress management.                                                                                way toward alleviating patients’ distress.
                                                                                                                                   symptoms may improve with a healthy
                                                                                                                                   diet, including dietary fibre, and stress
                                                                                                                                   management. Drugs may alleviate specific
                                                                                                                                   symptoms such as abdominal pain,
                                                                                                                                   constipation and diarrhea.
                                                                                                                                   Medications for irritable bowel
                                                                                                                                   syndrome
                                                                                                                                   •   Fibres and osmotic laxatives for
                                                                                                                                       constipation
                                                                                                                                   •   Loperamide for diarrhea
                                                                                                                                   •   Antispasmodics and low-dose tricyclic
                                                                                                                                       antidepressants for abdominal pain




               • Flavio Habal, Gastroenterologist, University Health Network, Toronto, ON • Pierre Paré, Gastroenterologist, CHAUQ-Hôpital du St. Sacrement, Quebec City, QC




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                                   the Canadian Digestive Health Foundation (CDHF) feature



Committed to colonoscopy                                                                                                                 COLORECTAL CANCER


W               ith both his parents having
                succumbed to colorectal
cancer (CRC), Richard Grzymek knows
                                                                                                                                         A mix of genetic and environmental
                                                                                                                                         factors can cause cells in the lining
                                                                                                                                         of the bowel to turn cancerous. A
                                                                                                                                         collection of abnormal cells called
that genes aren’t on his side. Still, when
                                                                                                                                         a polyp is often the first step in this
he noticed a bit of blood in his stool two                                                                                               transformation.
years ago, he assumed his hemorrhoids
                                                                                                                                         Prevalence
were simply acting up. His annual
                                                                                                                                         In 2008, an estimated 21,500 Canadians
scheduled colonoscopy proved him                                                                                                         will be diagnosed with colorectal cancer
wrong, revealing a large polyp close                                                                                                     (CRC) and about 8,900 will lose their lives
to his anus. A surgeon looked over the                                                                                                   to the disease, making CRC the second-
images and said, “I’m going to open you                                                                                                  leading cause of cancer deaths in Canada.
up like a book,” recalls the Edmonton                                                                                                    Signs and symptoms
resident, 62.                                                                                                                            While polyps and early CRCs may bleed,
    Concerned about this extreme                                                                                                         symptoms of CRC don’t usually become
measure, Grzymek sought a second                                                                                                         apparent until the disease has reached a
opinion and was told the polyp could                                                                                                     more advanced stage.
probably be removed piece by piece.                                                                                                      CRC in its earliest stages produces
“He took it out in twenty different                                                                                                      little or no symptoms. However, a
samples, then cauterized the area,” says                                                                                                 change in bowel habits, unexplained
                                                                                                                                         rectal bleeding, abdominal pain, an
Grzymek. The removed tissue was biopsied, and Grzymek got the good news he had
                                                                                                                                         abdominal mass, and/or unexplained
hoped for: no cancer in the polyp. “The doctor told me it could have turned cancerous in                                                 iron-deficiency anemia can be caused
another six to eight months,” he says. “In hindsight, I should have taken action as soon as                                              by a variety of conditions and warrant
I noticed the blood in my stool.”                                                                                                        medical attention.
    Six months after the removal of the polyp, a sigmoidoscopy – a visual examination                                                    Screening/diagnosis, treatment
of the lower third of the colon with a tubular instrument called a sigmoidoscope – gave                                                  and return to health
Grzymek a clean bill of health. But a more recent sigmoidoscopy identified “a bit of a                                                   early colorectal cancer is more than
growth,” says Grzymek, currently awaiting biopsy results. He keeps anxiety at bay by                                                     90 per cent curable with endoscopic
reminding himself that “I’m in good medical hands.”                                                                                      removal or surgery. Prevention through
    Now committed to a diet rich in grains and vegetables and a daily regimen of aerobic                                                 regular screening – essential in catching
                                                                                                                                         a cancer early – remains a greatly
and strength training, Grzymek traded his high-stress position in a coatings company for
                                                                                                                                         underused strategy, with fewer than 20
                                               a series of “interesting and varied jobs. Someone                                         per cent of eligible Canadians making
                                               would ask me to help them out, I would do it, then
  Know your risK                               move on to the next thing.”
                                                                                                                                         use of it. everyone 50 or over should get
                                                                                                                                         screened, even in the absence of any
  the following factors increase                   Aware that colonoscopy has probably saved                                             symptoms.
  the risk of developing CRC:                  his life, Grzymek feels no hesitation about                                               For people without a family history of
  • Age (50 or over)                           undergoing the procedure. He understands how                                              colon cancer, screening can be performed
  • Family history of CRC                      other people might, though. Musing that “the fear                                         in several ways including a test for hidden
                                                                                                                                         blood in the stool (FOBt), or colonoscopy.
  • Prior diagnosis of polyps or               of ‘finding something’ may cause people to bury
                                                                                                                                         Patients with a positive FOBT require
      early-stage CRC                          their heads in the sand” and noting the excellent
                                                                                                                                         colonoscopy to detect, biopsy or remove
  • Inflammatory bowel disease                 prognosis of early colorectal cancer, Grzymek
                                                                                                                                         any potential polyps or cancers.
      (ulcerative colitis or Crohn’s           argues that “people at high risk should be more
      disease)                                 afraid of not having a colonoscopy than of having
                                               one.” The preparation is a little uncomfortable, he                                        everyone 50 or over
  If you are at high risk, talk to
  your doctor about screening                  concedes, but “the procedure isn’t as intrusive as                                         should get screened,
  and prevention.                              it may sound. And when you consider the benefits,                                          even in the absence
  Information from Colorectal Cancer screening
  Initiative Foundation (www.ccsif.ca)
                                               the discomfort is not even a bump on the road –                                            of any symptoms.
                                               not even a ripple.”
       • Alaa Rostom, Gastroenterologist, Associate Professor, University of Calgary, Calgary, AB • Clarence Wong, Gastroenterologist, Associate Professor, University of Alberta, Edmonton, AB




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                          the Canadian Digestive Health Foundation (CDHF) feature




Finding her way back                                                                                                        PROBIOTICS AND DIGESTIVE DISORDERS


A            dolescent girls should be worrying about friends, final exams, and what to
             wear to the next party – not ulcerative colitis. But when Robyn Black of
Athabasca, AB, was diagnosed with the disease at the end of Grade 6, she had no energy
                                                                                                                             Probiotics are living microscopic
                                                                                                                             organisms (microorganisms) that
                                                                                                                             research has found beneficial to
                                                                                                                             health. Most often bacteria – some
left for teenage angst. The following year, intense stomach pains kept Robyn out of
                                                                                                                             of them similar or identical to the
school for long stretches at a time. “One minute I’d be fine, then I’d eat something and                                     “friendly bacteria” in your body,
feel awful,” recalls the teen, now 16. “I had to go to the bathroom almost every time I                                      particularly in the gut – they may also
ate and was always afraid of having an accident.” On the days she made it to school, “I                                      be other organisms such as yeasts.
                                                         often had to spend a long time in                                   The most common probiotic bacteria
                                                         the bathroom, and kids sometimes                                    come from two groups, Lactobacillus
                                                         made fun of me.”                                                    and Bifidobacterium.
                                                             Robyn’s gastroenterologist                                      After a long period of stagnation, scientific
                                                         prescribed a barrage of                                             interest in probiotics has exploded in the
                                                         medications, which yielded only                                     past couple of decades. the probiotics in
                                                         modest relief – and less than                                       some foods (yogurt and cheeses, for
                                                                                                                             example) help sustain good health. Doctors
                                                         modest side effects. “The steroids
                                                                                                                             are now looking at using specific probiotics
                                                         she was taking delayed her puberty                                  to treat diseases such as irritable bowel
                                                         and caused mood swings,” says her                                   syndrome, Crohn’s disease, ulcerative colitis,
                                                         father, Bill. “We had to explain to                                 and some forms of diarrhea. Indeed, research
                                                         her younger sister that Robyn                                       has shown that probiotics can reduce not only
                                                         might not be herself at times.”                                     the risk of getting diarrhea after antibiotics,
                                                                                                                             but its duration. even ostensibly healthy
                                                             At the start of Grade 9, Robyn’s
                                                                                                                             people may benefit from the health effects
                                                         doctor learned about a study of                                     of probiotics.
                                                         probiotics being conducted at
                                                                                                                             Caveat emptor
            Doctors are now looking at                   the University of Alberta and                                       Considered foods rather than drugs,
      conducting clinical trials using encouraged her to join. The year-                                                     probiotics aren’t subject to the same
           specific probiotics, in larger long study required Robyn to take                                                  regulations that govern prescription
                                                                                                                             medications. Whether in foods or
       quantities than those found in three packages of a powdered                                                           supplements, only preparations containing
      foods, to treat diseases such as probiotic supplement every day.                                                       live or active bacteria qualify as probiotics.
 irritable bowel syndrome, Crohn’s She makes no bones about the taste.                                                       Anyone considering a specific probiotic
        disease, ulcerative colitis, and “It’s pretty nasty,” she says. After                                                should read up on it, discuss it with a
                some forms of diarrhea. experimenting with a variety of                                                      doctor, and obtain the probiotic from a
                                                         strategies to make the stuff go                                     reputable source. Because there are
down more easily, she finally settled on stirring it into water or yogurt.                                                   different kinds of probiotics, it is important
   To participate in the study, Robyn had to keep a diary of everything she ate, when                                        to use the right probiotic for specific
                                                                                                                             health benefits.
she went to the bathroom, and what came out. Describing his daughter as sensitive
and shy, Bill says “it was especially hard for her when study investigators asked her                                        Probiotics with support from
questions about bowel movements or female development.” But something was                                                    randomized clinical trials
definitely happening: she was gaining weight, feeling better, and spending less and
                                                                                                                             •   Activia® for regularity and control of
                                                                                                                                 intestinal transit time
less time in the bathroom.                                                                                                   •   Florastor® for diarrhea caused by
   All told, Robyn did so well in the study that she decided to continue taking the                                              antibiotics and Clostridia difficele
probiotic after the study ended. “I now take just one package a day,” she says, “and my                                      •   tuZen® for irritable bowel syndrome
bathroom habits are back to normal.”                                                                                         •   VSL#3® for “pouchitis” (inflammation
   When he looks at pictures of Robyn from two years ago, Bill says he sees “a very                                              of the internal pouch in patients who
                                                                                                                                 have part of their colon removed)
skinny girl with sunken eyes.” He can hardly believe how far she’s come since that
                                                                                                                                 and ulcerative colitis
time. “She takes the school bus and travels with her friends,” he says. “She’s no longer
afraid to leave home. Part of that is just growing up, but a big part, I believe, is that the
probiotics have helped her get better.”
                               • Richard Fedorak, President, Canadian Digestive Health Foundation, Professor, University of Alberta, Edmonton, AB




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                                   the Canadian Digestive Health Foundation (CDHF) feature



Weight, nutrition and digestive health
                                                                                                 The following tips from Health Canada can help you get on a
                                                                                                 sound nutritional path:
                                                                                                 • Follow Canada’s Food Guide to reduce risk of chronic illnesses
                                                                                                   (www.healthcanada.com)
                                                                                                 • Get regular physical activity that fits easily into your routine
                                                                                                 • Moderate the amount of food that you eat; watch portion sizes
                                                                                                 • Avoid high-calorie and high-fat foods and beverages
                                                                                                 • Use nutrition labels to make informed choices
                                                                                                 • Ask your health professional for an assessment of your weight
                                                                                                   and health risks
                                                                                                 • Avoid fad diets


C         ontrary to school-yard myth, it doesn’t take seven years
          to digest chewing gum. But there’s nothing mythical
about the relationship between nutrition and digestive health. In
                                                                                                                Health risk according to BMi (kg/m2)
                                                                                                    Classification                   BMi range
                                                                                                                                                            Risk of developing
                                                                                                                                                            health problems
fact, about two-thirds of people report that specific foods trigger                                 Underweight                      < 18.5                 Increased
their digestive problems.
                                                                                                    Normal weight                    18.5 – 24.5            Least
   Experts agree that a healthy digestive system begins with
good nutrition, which means both healthy amounts and types                                          Overweight                       25.0 – 29.9            Increased
of food. Obesity, defined as a body mass index (BMI)* of 30 or                                      Obese class I                    30.0 – 34.9            High
over, raises the odds of developing a host of digestive diseases                                    Obese class II                   35.0 – 39.9            Very high
from reflux to irritable bowel syndrome and even colon cancer.
                                                                                                    Obese class III                  ≥ 40.0                 extremely high
Fat build-up in the liver, found in 60 to 70 per cent of obese
individuals, can progress to liver cell injury in some cases.                                    * Body Mass Index calculation:
   Excessive or unexplained weight loss can also signal digestive                                                                         weight in kilograms
                                                                                                                 BMi =
trouble such as celiac disease, IBD or cancer. An unexplained                                                                    (height in metres) x (height in metres)
                                                                                                         OR
loss of more than 5 to 10 percent of usual body weight warrants                                                                         weight in pounds x 703
medical evaluation.                                                                                              BMi =
                                                                                                                                  (height in inches) x (height in inches)
                                                              • Johane Allard, Gastroenterologist, University of Toronto, Toronto, ON
                                            • Leah Gramlich, Gastroenterologist, Associate Professor of Medicine, University of Alberta, Edmonton, AB




Improving the digestive health of Canadians drives the activities of the CDHF. Each day we strive to:
                   Reduce the incidence of digestive disease
                   Improve the quality of life for people living with digestive disease
                   Support people suffering from digestive diseases and the professionals who care for them
                   Enhance Canadian digestive health research and education




                  Respect it. Protect it.
                  Learn more about it.
                  We can help.

                  The CDHF is the official foundation of the Canadian Association of Gastroenterology                                                                     CDHF.ca
The CDHF is supported by
donors, government and
Priority Partners, including:

				
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