That Feeling in the Pit of Your Stomach

Kathleen Martin, MD, treats all kinds of abdominal pain at KentuckyOne Health’s Gastroenterology Associates

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LEXINGTON “My tummy hurts.” It’s not just a tried-and-true way for kids to get out of a day of school. It’s also a severe and sometimes chronic health issue for many people. There are many causes and, these days, seemingly even more solutions.

In the old days, chicken noodle soup might have been recommended. Recently, probiotics have become a popular treatment. So, what’s next? How about a stool transplant? As odd as it might sound to some, it’s proving to be a trustworthy treatment for many gastrointestinal disorders.

“Especially for inflammatory bowel diseases like ulcerative colitis and Crohn’s disease, researchers have been doing fecal microbiota transplant – basically stool transplants,” says Kathleen Martin, MD, KentuckyOne Health Gastroenterology Associates at Saint Joseph East. The transplants are most commonly done for refractory C. difficile infection, but that is the only indication that the FDA will allow for a non-research setting. “Sometimes they are given via enemas, sometimes by a tube through the nose, and also poop pills. It’s stool that’s been donated to a stool bank and then frozen, and people take these frozen pills to get the gut bacteria.”

Martin points out that a key to the success rate of the fecal transplant is the presence of adherence molecules that allow the bacteria to live and grow. The absence of these adherence molecules results in the newly introduced bacteria being gone from the gastrointestinal tract about a week after taking the probiotic.

“The probiotics that we have now on the market may not be the best ones for us,” says Martin, who attended medical school at Penn State Health Milton S. Hershey Medical Center and completed her residency in Louisville. “The reason that a probiotic doesn’t work is it probably doesn’t have enough of the different types of bacteria, and there may be some adhesion molecules that are missing from the probiotics. If you do a stool transplant, those bugs are there for a long time.”

Martin says research shows that only one in four of the over-the-counter probiotics actually includes active bacteria. The hope is to one day get the right mix of bacteria and adherence factors to allow patients to avoid the unpleasantness of a stool transplant.

Women and GI Disorders

Martin and partners Lori Haas, MD, and Susie Jennings-Conklin, MD, deal with conditions that most would deem “unpleasant” every day. They started the practice together in 2001 and then became part of the KentuckyOne Health umbrella five years ago. Today, they treat patients for gastrointestinal disorders such as acid reflux, irritable bowel syndrome, and inflammatory bowel disease. Approximately 75 percent of their patients are women.

Women are twice as likely to get gallbladder disease, Martin says, and are particularly vulnerable after childbirth. Fertility is one of the risk factors for gallbladder disease, commonly known as “The Four F’s” — female, forty, fertile, and fat. Martin suggests that a fifth “F” — family history — might also be a contributing factor.

Women are also more likely to seek treatment for irritable bowel syndrome, though not necessarily more likely to suffer from it.

“The theory is that it might be a cultural reason,” Martin says. “It’s actually more common in men in other cultures. But in the US the culture of seeking help for that type of problem is more acceptable for women than men, so men are more likely to be untreated.”

Genetics, diet, and the bacterial flora in the small bowel and colon are all contributing factors to irritable bowel syndrome, Martin says. She recommends her patients follow a low FODMAP (Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols) diet. This has people avoid food that is fermented by the intestinal bacteria.

“It’s not strictly a low carb diet but it does have people avoid the carbohydrates that are bothersome,” Martin says. “For example, healthy foods such as apples have fructans that get digested by the intestinal bacteria and actually are fermented, producing irritating chemicals and gas that make people uncomfortable.”

Martin says that, for IBS sufferers, stone-centered fruits such as pears, apples, and cherries are less tolerable than fruits like bananas and berries. Martin also recommends her patients stay away from wheat, milk, yogurt, and softer, wetter cheeses, all of which can be triggers for IBS.

“I’ll usually have people be very strict with the diet at first and then gradually add back in things that by their own perception are not a trigger, so they aren’t so limited,” Martin says, noting that many of her patients also deal with celiac disease and gluten sensitivity.

Martin notes that causes of IBS can range from diet and lifestyle, to hereditary factors, to even our broad use of antibiotics. Small bowel bacteria provide tolerance for certain foods. Antibiotics could be altering that bacteria and ultimately the patient’s food tolerance.

“People will say, ‘I was never allergic to eggs and all of the sudden I am allergic to eggs,’”

Martin says. “It might be the small bowel bacteria have been altered by antibiotics or diet and that has made them not have the bacteria they need to have the tolerance to those foods.”

There are several other factors – such as stress and smoking – that can intensify the symptoms of IBS. Martin points out another, less obvious, antagonist is medication.

“A lot of our patients with inflammatory bowel disease are given NSAIDs (nonsteroidal anti-inflammatory drugs),” Martin says, noting that it’s tempting to do because a patient might be dealing with arthritis or a knee injury in addition to their IBD. “But in the long run, the NSAIDs worsen their IBD. I had one patient that had pericarditis and was given indomethacin for the pericarditis. And she had ulcerative colitis, and the indomethacin caused her colon to perforate. She was in the ICU and had to have an emergency colectomy. It’s a serious problem that can lead to life-threatening complications.”

Another serious concern for Martin’s patients is cancer. Their symptoms have them worried, adding to their stress and intensifying their condition. A breast cancer survivor herself, Martin fully understands the fear.

“A lot of my patients are afraid that they have cancer,” Martin says. “I try to address that up front so they can get that out of their head. I know I won’t be able to get them feeling better until they get that out of their head.

I’ll do whatever it takes to address those fears.” Just like chicken noodle soup for that child with a tummy ache, a little TLC can help make the patient feel a lot better.