Free Issue! Try Saltscapes Magazine before you buy. Download Now

Atlantic Canadians don't talk much about their digestive systems: we rarely mention our bowels. Yet colon cancer is the second most likely cancer to kill us. The eastern provinces have the world’s highest incidence of inflammatory bowel disease (IBD), an umbrella term for two chronic illnesses that involve the intestines—Crohn’s disease and ulcerative colitis.

“Nova Scotia, in particular, has the dubious honour of having the highest rate of inflammatory bowel disease in the world,” says Dr. Tony Otley, a pediatric gastroenterologist at the IWK Health Centre in Halifax. “There’s likely some environmental factor that combines with our genetic make-up,” he says, “but we don’t really know why it’s happening and we don’t understand why there has been such a rapid increase in the last few decades.”

The digestive system is prone to a wide range of afflictions—and many of them are more than just a pain in the belly

Atlantic Canadians don't talk much about their digestive systems: we rarely mention our bowels. Yet colon cancer is the second most likely cancer to kill us. The eastern provinces have the world’s highest incidence of inflammatory bowel disease (IBD), an umbrella term for two chronic illnesses that involve the intestines—Crohn’s disease and ulcerative colitis.

“Nova Scotia, in particular, has the dubious honour of having the highest rate of inflammatory bowel disease in the world,” says Dr. Tony Otley, a pediatric gastroenterologist at the IWK Health Centre in Halifax. “There’s likely some environmental factor that combines with our genetic make-up,” he says, “but we don’t really know why it’s happening and we don’t understand why there has been such a rapid increase in the last few decades.”

A specialist in inflammatory bowel disease, Dr. Otley has spent almost two decades studying IBD, and treats more than 300 children and adolescents in New Brunswick, Prince Edward Island and Nova Scotia. “Most GI problems are dealt with by family doctors and pediatricians,” he says. “I see the cases they can’t resolve, so it tends to be the more extreme end of the spectrum.”

Early detection is key

One of the struggles, he says, is early detection and diagnosis of digestive disorders, especially in children and youth, who comprise about 25 per cent of new cases of IBD. “Picking it up early doesn’t help with a cure for Crohn’s,” says Dr. Otley. “There is no cure: it’s a lifetime diagnosis. However, treatment will put the disease in remission, which is especially important for children, because Crohn’s disease can affect growth permanently.”

Detection and diagnosis of digestive disorders in adults can sometimes take years. Allan Stuart, who lives just outside Halifax, got lucky when a routine blood test revealed low levels of iron in his blood; referrals to a hematologist and a gastroenterologist confirmed a diagnosis of celiac disease. “The whole process took only about 10 months,” says Stuart. “From what I understand, the wait is usually much longer.”

Stuart is now vice president of the Nova Scotia chapter of the Canadian Celiac Association, which plays a role in educating and supporting children and adults who have celiac disease, and in promoting celiac awareness and education among health care professionals and the food service industry. After 10 years, his own symptoms are under control thanks to a wife who is a dietician, and a strict gluten-free diet. “The diet is sometimes a nuisance,” he admits, “but the doctor told me it would reduce my chances of colon cancer by 25 per cent. When I think of it in those terms, there’s really no choice.”

Digestive disorders

According to the Canadian Digestive Health Foundation, more than 20 million Canadians suffer from digestive disorders ranging from heartburn and lactose intolerance to gastroesophageal reflux disease (GERD) and cancers of the digestive tract. While many of these conditions present common symptoms such as bloating and diarrhea, they differ greatly in severity and treatment. Here’s a rundown of many common digestive ailments:

Celiac disease is a permanent autoimmune condition that affects the small intestine. It is diagnosed after a blood test and a positive biopsy of the small bowel. Gluten, a protein found in wheat, rye, barley and triticale, acts as a trigger to the immune system, which in turn causes damage to the small bowel. Symptoms can include cramping, diarrhea or constipation, and abdominal pain, but often people have no symptoms at all. Instead, they are found to have iron-deficiency anemia, which may lead to a diagnosis.

“The number of celiac cases seen in the gastrointestinal clinic represents the ‘tip of the iceberg,’ with many more remaining undiagnosed,” says Cynthia King-Moore, a pediatric dietitian at the IWK Health Centre in Halifax. According to the Canadian Celiac Association, about one per cent of Canadians are diagnosed with celiac disease. The only treatment for celiac disease is a strict gluten-free diet for life.

Diverticular disease consists of two conditions: diverticulosis and diverticulitis. Diverticulosis occurs when sac-like protrusions, called diverticula, form in the colon. Diverticulitis occurs if the pouches become inflamed. The likelihood of getting diverticular disease increases roughly every 10 years after age 40. About half of people between the ages of 60 and 80 have it, and almost everyone over 80 has it.

Dyspepsia is the pain, belching, nausea, bloating and discomfort—also known as indigestion—that sometimes accompanies snacks and meals. Often associated with gastroesophageal reflux disease (GERD), dyspepsia is treated with changes to lifestyle and diet as well as acid-suppressing drugs, both over-the-counter and prescription.

Gastroenteritis is an inflammation of the lining of the intestines caused by a virus, bacteria or parasites. Symptoms include fever, stomach cramps, bloating, diarrhea and vomiting. Often, when people refer to having a “stomach flu, ” they are suffering gastroenteritis—not a type of flu at all.

Gastroesophageal reflux (GER) occurs when stomach contents reflux, or back up, into the esophagus during or after a meal. It occurs in people of all ages, and is normal for infants, however, it does sometimes lead to GERD (see below) and require treatment. For more information about GER and kids, go to gastrokids.org.

Gastroesophageal reflux disease (GERD) is diagnosed when acid reflux is persistent; it can affect people of all ages. Treatment to prevent permanent damage to the esophagus ranges from over-the-counter medications to exercise, changes in diet, prescription medications and surgery.

Heartburn is a feeling of pain in the chest or throat; it occurs when digestive juices and acid from the stomach back up into the esophagus toward the throat, creating a burning sensation and, over time, damaging the lining of the esophagus. If you experience heartburn more than twice a week, you may have GERD.

Inflammatory bowel disease (IBD) is comprised of separate disorders that cause inflammation and ulceration of the small and large intestines:

• Crohn’s disease is an inflammation of the digestive system tract that often affects the lower part of the small intestine called the ileum. Symptoms include abdominal pain, diarrhea, joint pain, skin problems and weight loss. Treatment usually involves drug therapy, but there is no single treatment that works for everyone.

• Ulcerative colitis is a chronic condition that, unlike Crohn’s, attacks only the innermost lining of the large intestine (colon) and rectum. A chronic disease, it is often characterized by false urges to have a bowel movement. Other common symptoms include decreased appetite, weight loss, severe diarrhea, abdominal pain, nausea and anemia. There is no cure, but some treatments can dramatically reduce the symptoms and even bring about a long-term remission.

Irritable bowel syndrome (IBS) is a condition of the gastrointestinal tract which affects five million Canadians. Symptoms include bloating, abdominal pain, irregular bowel movements, nausea and heartburn. Treatment includes over-the-counter medications, exercise and changes to diet. Obesity enhances the severity of IBS symptoms.

Lactose intolerance is experienced by roughly seven million Canadians. It is the inability to absorb the lactose (sugar) in milk products. When present in the colon, lactose causes bloating, diarrhea, abdominal cramps and flatulence. Treatment options include either excluding lactose from the diet or dietary supplements to help with the digestion of lactose.

Pancreatitis is an inflammation of the pancreas gland which affects more than one million Canadians. One third suffer from chronic pancreatitis, a long-term condition often leading to permanent damage to the gland. Two thirds experience pancreatitis in its acute form. Both acute and chronic pancreatitis cause pain, usually in the upper abdomen, spreading to the middle of the back and is frequently accompanied by nausea and vomiting.

Peptic ulcer is an umbrella term for gastric ulcer (a defect in the lining of the stomach) and duodenal ulcer (a defect the upper part of the small intestine, in an area called the duodenum). More than a million Canadians suffer from peptic ulcers. The most common cause is infection of the stomach by bacteria called Helicobacter pylori (H.pylori). Symptoms include nausea and abdominal pain. Treatment involves a combination of medications to kill the H. pylori bacteria (if present) and to reduce acid levels in the stomach.

After 10 years, his own symptoms are under control thanks to a wife who is a dietician, and a strict gluten-free diet. “The diet is sometimes a nuisance,” he admits, “but the doctor told me it would reduce my chances of colon cancer by 25 per cent.”

Other Stories You May Enjoy

Social Media and Medicine

Connecting online helps patients share information, but it doesn't replace face-to-face contact.

Deep Trouble With Deep-Fried Foods

Deep-fried French fries, golden battered fish, crispy chicken, juicy hamburgers – few would argue that these foods don't taste good, but these delicious flavours come at a cost.

The Art of the Good Long Country Walk

Community programs are being geared to public needs, but rural residents are still challenged to find ways to exercise regularly.