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