Ir­ri­ta­ble tum? Can’t tol­er­ate gluten? The real prob­lem could be gallstones

Daily Mail - - Good Health - By KATHRYN KELLY

THE on­set of the at­tack last au­tumn was as sud­den as it was vi­o­lent. One minute, I was driv­ing home from the shops; the next, I was barely able to make it through the front door af­ter de­vel­op­ing ex­cru­ci­at­ing stom­ach cramps.

I slumped against a kitchen cup­board, my knees drawn up to my chest, un­able to move be­cause of the pain.

I had been due to start work read­ing the news at a lo­cal ra­dio sta­tion in just two hours’ time, but I couldn’t stand up straight, let alone get be­hind a mi­cro­phone.

I crawled into bed, where I spent the next few days feel­ing sick and fever­ish, with a churn­ing sen­sa­tion in my stom­ach and an in­ter­mit­tent stab­bing pain ra­di­at­ing from my up­per right side to be­tween my shoul­der blades.

I put it down to food poi­son­ing or a se­vere at­tack of ir­ri­ta­ble bowel syn­drome (IBS) — some­thing I be­lieved I’d brought un­der con­trol by chang­ing my diet.

This con­di­tion of the di­ges­tive sys­tem — which can cause bloat­ing, stom­ach cramps and al­ter­nat­ing di­ar­rhoea and con­sti­pa­tion — first af­fected me 18 years ago, when I was preg­nant with my younger daugh­ter and go­ing through a painful di­vorce.

I re­mem­ber walk­ing over Dart­moor one sum­mer af­ter­noon when, out of the blue, I was hit with stom­ach pains so vi­o­lent that I feared I would pass out.

My sis­ter had to help me back to the car so I could get home. A sub­se­quent blood test for coeliac dis­ease — an ad­verse re­ac­tion to gluten, a pro­tein that is found in wheat — proved neg­a­tive.

But my GP di­ag­nosed IBS and ad­vised an ex­clu­sion diet to see if an in­tol­er­ance to a spe­cific food might be caus­ing the con­di­tion in my case.

I had never been one for faddy di­ets, but knew I had to man­age my con­di­tion. As a sin­gle mother, I needed to look af­ter my two young daugh­ters and con­tinue work­ing as a free­lance jour­nal­ist and broad­caster.

NOTIC­ING that I be­came un­well with se­vere stom­ach cramps and di­ar­rhoea af­ter eating bread, pasta, cakes or bis­cuits, I grad­u­ally re­moved gluten from my diet — a te­dious and depressing ex­pe­ri­ence for some­one who en­joys their food.

These days, you can buy de­li­cious, gluten- free foods in most shops and restau­rants, but in the late nineties the op­tions were lim­ited.

Gluten-free bread was of­ten card­board-like in tex­ture and the typ­i­cal choice in a cafe was be­tween a jacket potato and a packet of crisps.

It took me months to work out which foods I could eat and those best avoided ( I learned that highly spiced foods, such as curry, trig­gered my symp­toms, too).

But once I did, I stuck to my diet faith­fully and my symp­toms eased — un­til that fate­ful day in Oc­to­ber last year.

I had never felt as poorly as I did then. The stom­ach cramps and di­ar­rhoea were back, but this time the pain was worse than child­birth and I had an ac­com­pa­ny­ing sick­ness and fever that I’d not ex­pe­ri­enced be­fore.

Af­ter sev­eral days in bed, I vis­ited my doc­tor. An ab­domen exam and some blood tests later, she told me I was suf­fer­ing from bil­iary colic — in other words, acute pain caused by gallstones.

These are small stones, usu­ally made of choles­terol, that form in the gall­blad­der. This sits in the up­per right part of the ab­domen and stores bile, di­ges­tive fluid pro­duced by the liver to break down fatty foods.

Gallstones are very com­mon, af­fect­ing 20 to 30 per cent of the pop­u­la­tion, but of­ten they re­main un­de­tected.

‘ In most cases, gallstones do not cause a prob­lem, but for those who do get symp­toms, it can be very prob­lem­atic,’ says Stu­art Andrews, a con­sul­tant gas­tric sur­geon at Mount Stu­art Hos­pi­tal in Torquay, Devon, who was even­tu­ally to treat me.

Typ­i­cally, it causes pain un­der the ribs on the right hand side, pain be­tween the shoul­der blades and feel­ing sick, of­ten af­ter eating rich foods.

The pain is caused by the gall­blad­der con­tract­ing to re­lease bile and then rub­bing sharply against the stones in­side.

‘How­ever, there is another group of pa­tients whose symp­toms are less ob­vi­ously re­lated to gallstones,’ says Mr Andrews.

They may have, for ex­am­ple, bouts of di­ar­rhoea or con­sti­pa­tion, or stom­ach cramps.

‘ These peo­ple of­ten have di­ag­noses of ir­ri­ta­ble bowel syn­drome or food in­tol­er­ances be­fore gallstones are con­sid­ered.’

Bil­iary colic oc­curs when one or more stones block the bile ducts con­nect­ing the liver with the gall­blad­der. It causes sud­den pain which, as I was rapidly dis­cov­er­ing, can be se­vere and very de­bil­i­tat­ing. none­the­less, the news that I had gall­blad­der dis­ease was a rev­e­la­tion and put my gas­tric is­sues into per­spec­tive.

It wasn’t an en­tirely sur­pris­ing di­ag­no­sis — the con­di­tion can run in fam­i­lies. My ma­ter­nal grand­mother had her gall­blad­der re­moved in her 60s and my mother and my sis­ter have gall­blad­der prob­lems. How­ever, I seem to be the only one of us who has had IBS-type symp­toms as a re­sult.

not only did I have mul­ti­ple gallstones, as a scan con­firmed, but, ap­par­ently, my gall­blad­der had more or less stopped func­tion­ing. A key­hole op­er­a­tion to re­move it was the only op­tion.

By that stage, I was feel­ing ill all the time, with nau­sea, wind and a con­stant dull ache un­der the ribs.

As I counted down to the surgery, my diet be­came even more re­stricted as even cheese, but­ter, cream and milk and any­thing con­tain­ing fat made me feel vi­o­lently sick.

Meals con­sisted of pep­per­mint tea, wa­tery por­ridge, sushi and lightly steamed veg­eta­bles.

On the day of the op­er­a­tion in Fe­bru­ary, I went into hos­pi­tal at 8am and a cou­ple of hours later, it was all over — I was free to leave at lunchtime.

Mr Andrews told me my bile ducts were clear, but my gall­blad­der had been badly in­flamed and con­tained nu­mer­ous small stones, to­gether with a large one, sev­eral cen­time­tres in di­am­e­ter.

I’d been for­tu­nate not to have been an emer­gency case.

But I soon felt clear-headed and bet­ter than I had for years. My di­ges­tive sys­tem adapted very quickly, all my IBS symp­toms dis­ap­peared and I was back at work af­ter a month.

But the icing on the cake, so to speak, was that I found that I could eat gluten again.

On the ad­vice of a friend who’d had a sim­i­lar ex­pe­ri­ence, a cou­ple of days af­ter the op­er­a­tion I gin­gerly ex­per­i­mented with half a slice of bread. Pre­vi­ously, I would have felt pain within a cou­ple of hours, but I suf­fered no ill­ef­fects what­so­ever.

Em­bold­ened, I grad­u­ally rein­tro­duced the banned sub­stance into my diet — af­ter so many years of de­pri­va­tion, it felt sim­ply won­der­ful to eat a slice of Vic­to­ria sand­wich again.

I came to the con­clu­sion that my IBS and gluten in­tol­er­ance had been caused by my gall­blad­der prob­lems all along.

For years, it seems I had been in­ad­ver­tently con­trol­ling the symp­toms of slowly de­vel­op­ing gall­stone dis­ease with my diet, un­til my gall­blad­der be­came so full of stones that it stopped func­tion­ing al­to­gether.

MY CASE is not un­usual, says An­ton Em­manuel, a con­sul­tant neuro-gas­troen­terol­o­gist at Univer­sity col­lege Hos­pi­tal, Lon­don.

‘It is rea­son­ably well-recog­nised that the symp­toms of gall­stone dis­ease can of­ten be missed and a false di­ag­no­sis of ir­ri­ta­ble bowel syn­drome made,’ he says.

‘IBS is rather a slack def­i­ni­tion, in as much as it is one of ex­clu­sion. The re­al­ity is that it is of­ten reached for af­ter blood tests have con­firmed that noth­ing sin­is­ter is go­ing on.’

Mr Em­manuel says that IBS symp­toms will of­ten dis­ap­pear af­ter gall­blad­der surgery.

The im­pact of diet can vary from per­son to per­son, he says, and while there are no con­sis­tent find­ings, some pa­tients find tem­po­rary re­lief by fol­low­ing a gluten-free reg­i­men.

This is be­cause a diet heavy in wheat can place ex­tra strain on a di­ges­tive sys­tem which is se­verely com­pro­mised by a gall­blad­der that’s no longer work­ing prop­erly.

At my fol­low-up ap­point­ment with Mr Andrews, I men­tioned that I was now able to eat a nor­mal diet.

As it turns out, I was not the first pa­tient of his to report this un­ex­pected bonus, though the ev­i­dence re­mains anec­do­tal.

What I know for sure is that af­ter years of pain and the ex­pense and in­con­ve­nience of fol­low­ing a spe­cial diet, I am en­joy­ing life to the full.

It’s the sim­plest treats that bring me the great­est plea­sure — an al­mond crois­sant with a cap­puc­cino or a home-baked scone with clot­ted cream and jam.

S L I M E I S O R : e r u t c i P

En­joy­ing life: Kathryn is now able to have a var­ied diet

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