Dr Nadeem Ahmad Afzal

Dr Nadeem Ahmad Afzal
Paediatric gastroenterology
Basingstoke


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Dr Nadeem Ahmad Afzal

Paediatric gastroenterologist in
Basingstoke

MBBS MD MRCP MRCPCH


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Dr Nadeem Ahmad Afzal areas of expertise:

Professional statement

Dr Nadeem Ahmad Afzal is a leading tertiary consultant paediatric gastroenterologist, hepatology and nutrition based in Southampton and Basingstoke. He offers specialist diagnostic and therapeutic paediatric gastroscopies and colonoscopies and his clinical specialities include inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), diarrhoea, food intolerances and allergies, intestinal bleeding, vomiting and reflux. 

Dr Afzal trained across various teaching hospitals, including the prestigious Great Ormond Street, Barts, Royal Free and Kings College hospitals. In 2010, Dr Afzal gained his doctorate from University College London studying the role of nutrition in paediatric inflammatory bowel disease. He serves as a tertiary paediatric gastroenterology specialist in Southampton and has been heavily involved in teaching and leading an active research programme as senior clinical lecturer at the School of Medicine, Southampton since 2010. 

Dr Afzal is also kept busy with additional commitments, including serving as Editor-in-Chief for the World Journal of Gastrointestinal Endoscopy, National secretary for British Paediatric Gastroenterology Hepatology and Nutrition group and currently serves as an expert adviser for the Centre for Clinical Practice at the National Institute for Health and Care Excellence. 

 Credentials

GMC: ‍4456234

 Professional experience

• More than 25 years of experience
• Consultant paediatric gastroenterologist, Southampton University Hospital NHS Trust (2004 - present)
• Honorary consultant paediatric gastroenterologist, Frimley Park Hospital NHS Foundation Trust (2017 - present)
• Consultant paediatric gastroenterologist, BMI Hampshire Clinic (2007 - present)

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 Sub-specialties

• Inflammatory bowel disease (IBD)
• Food intolerances and gut allergies
• Vomiting and Reflux
• Abdominal pain
• Diarrhoea
• Vomiting
• Bloating
• Abdominal Bloating
• Paediatric Endoscopy (diagnostic and therapeutic)
• Irritable bowel syndrome

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 Positions in public associations

• Member of the Board of Trustees, Lagan Foundation (2017 - present)
• Expert adviser for the Centre for Clinical Practice, NICE (2016 - present)
• Convenor, British Society of Paediatric Gastroenterology, Hepatology and Nutrition (2014 - 2017)
• Editor-in-Chief, World Journal of Gastrointestinal Endoscopy (2011 - 2013)

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 Teaching posts

• Honorary senior clinical lecturer, School of Medicine, Southampton University (2010 - present)

 Education

• MBBS, King Edwards Medican University (1992)
• MRCP, Royal College of Physicians (1997)
• MRCPCH, Royal College of Physicians and Child Health (1997)
• MD, Queen Mary's, University of London (2010)

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 Publications and conferences

• Use of Biosimilars in Paediatric Inflammatory Bowel Disease: An Updated Position Statement of the Paediatric IBD Porto Group of ESPGHAN. de Ridder L, Assa A, Bronsky J, Romano C, Russell RK, Afzal NA, Hauer AC, Knafelz D, Lionetti P, Strisciuglio C, Veres G, Winter H, Wolters VM, Sladek M, Vulto AG, Dias JA; Paediatric IBD Porto group of ESPGHAN. J Pediatr Gastroenterol Nutr. 2018 Aug 30. doi: 10.1097/MPG.0000000000002141. [Epub ahead of print]
• Endoscopy in Pediatric Inflammatory Bowel Disease: A Position Paper on Behalf of the Porto IBD Group of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition. Oliva S, Thomson M, de Ridder L, Martín-de-Carpi J, Van Biervliet S, Braegger C, Dias JA, Kolacek S, Miele E, Buderus S, Bronsky J, Winter H, Navas-López VM, Assa A, Chong SKF, Afzal NA, Smets F, Shaoul R, Hussey S, Turner D, Cucchiara S. J Pediatr Gastroenterol Nutr. 2018 Sep;67(3):414-430. doi: 10.1097/MPG.0000000000002092.
• Is the incidence of paediatric inflammatory bowel disease still increasing? Ashton JJ, Cullen M, Afzal NA, Coelho T, Batra A, Beattie RM. Arch Dis Child. 2018 Nov;103(11):1093-1094. doi: 10.1136/archdischild-2018-315038. Epub 2018 Mar 8.
• Endoscopic and Histological Assessment of Paediatric Inflammatory Bowel Disease Over a 3-Year Follow-up Period. Ashton JJ, Bonduelle Q, Mossotto E, Coelho T, Batra A, Afzal NA, Vadgama B, Ennis S, Beattie RM. J Pediatr Gastroenterol Nutr. 2018 Mar;66(3):402-409. doi: 10.1097/MPG.0000000000001729.
• Challenges of modern day transition care in inflammatory bowel disease: From inflammatory bowel disease to biosimilars. Hakizimana A, Ahmed I, Russell R, Wright M, Afzal NA. World J Gastroenterol. 2017 Jul 7;23(25):4473-4479. doi: 10.3748/wjg.v23.i25.4473.
• Exome Analysis of Rare and Common Variants within the NOD Signaling Pathway. Andreoletti G, Shakhnovich V, Christenson K, Coelho T, Haggarty R, Afzal NA, Batra A, Petersen BS, Mort M, Beattie RM, Ennis S. Sci Rep. 2017 Apr 19;7:46454. doi: 10.1038/srep46454.
• Surgical Management of Crohn Disease in Children: Guidelines From the Paediatric IBD Porto Group of ESPGHAN. Amil-Dias J, Kolacek S, Turner D, Pærregaard A, Rintala R, Afzal NA, Karolewska-Bochenek K, Bronsky J, Chong S, Fell J, Hojsak I, Hugot JP, Koletzko S, Kumar D, Lazowska-Przeorek I, Lillehei C, Lionetti P, Martin-de-Carpi J, Pakarinen M, Ruemmele FM, Shaoul R, Spray C, Staiano A, Sugarman I, Wilson DC, Winter H, Kolho KL; IBD Working Group of ESPGHAN (IBD Porto Group). J Pediatr Gastroenterol Nutr. 2017 May;64(5):818-835. doi: 10.1097/MPG.0000000000001562.
• De novo and rare mutations in the HSPA1L heat shock gene associated with inflammatory bowel disease. Takahashi S, Andreoletti G, Chen R, Munehira Y, Batra A, Afzal NA, Beattie RM, Bernstein JA, Ennis S, Snyder M. Genome Med. 2017 Jan 26;9(1):8. doi: 10.1186/s13073-016-0394-9.
• Genes implicated in thiopurine-induced toxicity: Comparing TPMT enzyme activity with clinical phenotype and exome data in a paediatric IBD cohort. Coelho T, Andreoletti G, Ashton JJ, Batra A, Afzal NA, Gao Y, Williams AP, Beattie RM, Ennis S. Sci Rep. 2016 Oct 5;6:34658. doi: 10.1038/srep34658.
• Identification of Variants in Genes Associated with Single-gene Inflammatory Bowel Disease by Whole-exome Sequencing. Ashton JJ, Andreoletti G, Coelho T, Haggarty R, Batra A, Afzal NA, Beattie RM, Ennis S. Inflamm Bowel Dis. 2016 Oct;22(10):2317-27. doi: 10.1097/MIB.0000000000000890.
• Nutritional perspectives of children with Crohn's disease: a single-centre cohort observation of disease activity, energy expenditure and dietary intake. Wiskin AE, Haggarty R, Afzal NA, Batra A, Wootton SA, Beattie RM. Eur J Clin Nutr. 2016 Oct;70(10):1132-1137. doi: 10.1038/ejcn.2016.107. Epub 2016 Jun 22.
• pANCA and ASCA in Children with IBD-Unclassified, Crohn's Colitis, and Ulcerative Colitis-A Longitudinal Report from the IBD Porto Group of ESPGHAN. Birimberg-Schwartz L, Wilson DC, Kolho KL, Karolewska-Bochenek K, Afzal NA, Spray C, Romano C, Lionetti P, Hauer AC, Martinez-Vinson C, Veres G, Escher JC, Turner D; paediatric IBD Porto group of ESPGHAN. Inflamm Bowel Dis. 2016 Aug;22(8):1908-14. doi: 10.1097/MIB.0000000000000784.
• Utilisation of magnets to enhance gastrointestinal endoscopy. Rahman I, Patel P, Boger P, Thomson M, Afzal NA. World J Gastrointest Endosc. 2015 Dec 25;7(19):1306-10. doi: 10.4253/wjge.v7.i19.1306.
• Colectomy in pediatric ulcerative colitis: A single center experience of indications, outcomes, and complications. Ashton JJ, Versteegh HP, Batra A, Afzal NA, King A, Griffiths DM, Beattie RM, Stanton MP. J Pediatr Surg. 2016 Feb;51(2):277-81. doi: 10.1016/j.jpedsurg.2015.10.077. Epub 2015 Nov 6.
• Endoscopic Versus Histological Disease Extent at Presentation of Paediatric Inflammatory Bowel Disease. Ashton JJ, Coelho T, Ennis S, Vadgama B, Batra A, Afzal NA, Beattie RM. J Pediatr Gastroenterol Nutr. 2016 Feb;62(2):246-51. doi: 10.1097/MPG.0000000000001032.
• The role of magnetic assisted capsule endoscopy (MACE) to aid visualisation in the upper GI tract. Rahman I, Afzal NA, Patel P. Comput Biol Med. 2015 Oct 1;65:359-63. doi: 10.1016/j.compbiomed.2015.03.014. Epub 2015 Mar 24. Review.
• Exome analysis of patients with concurrent pediatric inflammatory bowel disease and autoimmune disease. Andreoletti G, Ashton JJ, Coelho T, Willis C, Haggarty R, Gibson J, Holloway J, Batra A, Afzal NA, Beattie RM, Ennis S. Inflamm Bowel Dis. 2015 Jun;21(6):1229-36. doi: 10.1097/MIB.0000000000000381.
• Presenting phenotype of paediatric inflammatory bowel disease in Wessex, Southern England 2010-2013. Ashton JJ, Coelho T, Ennis S, Batra A, Afzal NA, Beattie RM. Acta Paediatr. 2015 Aug;104(8):831-7. doi: 10.1111/apa.13017. Epub 2015 May 20.
• Therapeutic upper gastrointestinal tract endoscopy in Paediatric Gastroenterology. Rahman I, Patel P, Boger P, Rasheed S, Thomson M, Afzal NA. World J Gastrointest Endosc. 2015 Mar 16;7(3):169-82. doi: 10.4253/wjge.v7.i3.169. Review.
• Pharmacological treatment of children with gastro-oesophageal reflux. Tighe M, Afzal NA, Bevan A, Hayen A, Munro A, Beattie RM. Cochrane Database Syst Rev. 2014 Nov 24;(11):CD008550. doi: 10.1002/14651858.CD008550.pub2. Review.
• Parental knowledge of coeliac disease. Tomlin J, Slater H, Muganthan T, Beattie RM, Afzal NA. Inform Health Soc Care. 2015;40(3):240-53. doi: 10.3109/17538157.2014.907806. Epub 2014 Apr 30.
• Rising incidence of paediatric inflammatory bowel disease (PIBD) in Wessex, Southern England. Ashton JJ, Wiskin AE, Ennis S, Batra A, Afzal NA, Beattie RM. Arch Dis Child. 2014 Jul;99(7):659-64. Epub 2014 Apr 12.
• Surgery for children with Crohn's disease: indications, complications and outcome. Blackburn SC, Wiskin AE, Barnes C, Dick K, Afzal NA, Griffiths DM, Beattie RM, Stanton MP. Arch Dis Child. 2014 May;99(5):420-6. doi: 10.1136/archdischild-2013-305214. Epub 2014 Jan 6.
• A very high amylase can be benign in paediatric Crohn's disease. Venkataraman D, Howarth L, Beattie RM, Afzal NA. BMJ Case Rep. 2012 Jul 10;2012. pii: bcr0220125917. doi: 10.1136/bcr.02.2012.5917.
• Next generation exome sequencing of paediatric inflammatory bowel disease patients identifies rare and novel variants in candidate genes. Christodoulou K, Wiskin AE, Gibson J, Tapper W, Willis C, Afzal NA, Upstill-Goddard R, Holloway JW, Simpson MA, Beattie RM, Collins A, Ennis S. Gut. 2013 Jul;62(7):977-84. doi: 10.1136/gutjnl-2011-301833. Epub 2012 Apr 28.
• No relation between disease activity measured by multiple methods and REE in childhood Crohn disease. Wiskin AE, Wootton SA, Cornelius VR, Afzal NA, Elia M, Beattie RM. J Pediatr Gastroenterol Nutr. 2012 Feb;54(2):271-6. doi: 10.1097/MPG.0b013e318236b19a.
• Nutrition and inflammatory bowel disease: primary or adjuvant therapy. Tighe MP, Cummings JR, Afzal NA. Curr Opin Clin Nutr Metab Care. 2011 Sep;14(5):491-6. doi: 10.1097/MCO.0b013e328349eb4d. Review.
• Constipation in children. Afzal NA, Tighe MP, Thomson MA. Ital J Pediatr. 2011 Jun 13;37:28. doi: 10.1186/1824-7288-37-28. Review.
• A British Society of Paediatric Gastroenterology, Hepatology and Nutrition survey of the effectiveness and safety of adalimumab in children with inflammatory bowel disease. Russell RK, Wilson ML, Loganathan S, Bourke B, Kiparissi F, Mahdi G, Torrente F, Rodrigues A, Davies I, Thomas A, Akobeng AK, Fagbemi A, Hyer W, Spray C, Vaish S, Rogers P, McGrogan P, Heuschkel RB, Ayub N, Fell JM, Afzal NA, Green M, Murphy MS, Rao P, Shah N, Ho GT, Naik S, Wilson DC. Aliment Pharmacol Ther. 2011 Apr;33(8):946-53. doi: 10.1111/j.1365-2036.2011.04603.x. Epub 2011 Feb 22.
• Body composition in childhood inflammatory bowel disease. Wiskin AE, Wootton SA, Hunt TM, Cornelius VR, Afzal NA, Jackson AA, Beattie RM. Clin Nutr. 2011 Feb;30(1):112-5. doi: 10.1016/j.clnu.2010.07.014. Epub 2010 Aug 21.
• Recognition and treatment of genitourinary complications in paediatric Crohn's disease using Infliximab. Afzal NA, Shenoy MU, Haque S, Wilcox D, Shah N. Acta Paediatr. 2010 Jul;99(7):1042-6. doi: 10.1111/j.1651-2227.2010.01731.x. Epub 2010 Feb 23.
• Linezolid an oral treatment option for staphylococcal liver abscess in chronic granulomatous disease. Erlewyn-Lajeunesse M, Walker W, Basarab A, Eren E, Afzal N, Godfrey K, Faust SN. Pediatr Infect Dis J. 2009 Nov;28(11):1036-7. doi: 10.1097/INF.0b013e3181ba6caa.
• Impact of disease activity on resting energy expenditure in children with inflammatory bowel disease. Wiskin AE, Wootton SA, Culliford DJ, Afzal NA, Jackson AA, Beattie RM. Clin Nutr. 2009 Dec;28(6):652-6. doi: 10.1016/j.clnu.2009.05.007. Epub 2009 Jun 9.
• Current pharmacological management of gastro-esophageal reflux in children: an evidence-based systematic review. Tighe MP, Afzal NA, Bevan A, Beattie RM. Paediatr Drugs. 2009;11(3):185-202. doi: 10.2165/00148581-200911030-00004. Review.
• Erythema ab igne and Crohn's disease. Tighe MP, Morenas RA, Afzal NA, Beattie RM. Arch Dis Child. 2008 May;93(5):389. doi: 10.1136/adc.2008.137968.
• Latent coeliac disease in childhood? Morenas RA, Tighe MP, Moore I, Afzal NA, Beattie RM. Gut. 2008 May;57(5):715-6. doi: 10.1136/gut.2007.148064.
• Medium-term outcome of endoluminal gastroplication with the EndoCinch device in children. Thomson M, Antao B, Hall S, Afzal N, Hurlstone P, Swain CP, Fritscher-Ravens A. J Pediatr Gastroenterol Nutr. 2008 Feb;46(2):172-7. doi: 10.1097/MPG.0b013e31814d4de1.
• Outcome of childhood ulcerative colitis at 2 years. Howarth LJ, Wiskin AE, Griffiths DM, Afzal NA, Beattie RM. Acta Paediatr. 2007 Dec;96(12):1790-3. Epub 2007 Oct 30.
• Infliximab delays but does not avoid the need for surgery in treatment-resistant pediatric Crohn' disease. Afzal NA, Ozzard A, Keady S, Thomson M, Murch S, Heuschkel R. Dig Dis Sci. 2007 Dec;52(12):3329-33. Epub 2007 Sep 5.
• Topical application of mitomycin-C in oesophageal strictures. Rosseneu S, Afzal N, Yerushalmi B, Ibarguen-Secchia E, Lewindon P, Cameron D, Mahler T, Schwagten K, Köhler H, Lindley KJ, Thomson M. J Pediatr Gastroenterol Nutr. 2007 Mar;44(3):336-41.
• Inflammatory bowel disease. Beattie RM, Croft NM, Fell JM, Afzal NA, Heuschkel RB. Arch Dis Child. 2006 May;91(5):426-32. Review.
• Colonic Crohn's disease in children does not respond well to treatment with enteral nutrition if the ileum is not involved. Afzal NA, Davies S, Paintin M, Arnaud-Battandier F, Walker-Smith JA, Murch S, Heuschkel R, Fell J. Dig Dis Sci. 2005 Aug;50(8):1471-5.
• Endoluminal gastroplication in children with significant gastro-oesophageal reflux disease. Thomson M, Fritscher-Ravens A, Hall S, Afzal N, Ashwood P, Swain CP. Gut. 2004 Dec;53(12):1745-50.
• Diagnostic role of upper gastrointestinal endoscopy in pediatric inflammatory bowel disease. Castellaneta SP, Afzal NA, Greenberg M, Deere H, Davies S, Murch SH, Walker-Smith JA, Thomson M, Srivistrava A. J Pediatr Gastroenterol Nutr. 2004 Sep;39(3):257-61. Erratum in: J Pediatr Gastroenterol Nutr. 2005 Feb;40(2):244. Srivistrava, Anshu [added].
• Improvement in quality of life of children with acute Crohn's disease does not parallel mucosal healing after treatment with exclusive enteral nutrition. Afzal NA, Van Der Zaag-Loonen HJ, Arnaud-Battandier F, Davies S, Murch S, Derkx B, Heuschkel R, Fell JM. Aliment Pharmacol Ther. 2004 Jul 15;20(2):167-72.
• Constipation with acquired megarectum in children with autism. Afzal N, Murch S, Thirrupathy K, Berger L, Fagbemi A, Heuschkel R. Pediatrics. 2003 Oct;112(4):939-42.
• Portal Vein Thrombosis and Pancreatic Failure. Afzal N, Brueton M, Fell J, Baker A. Int J Gastrointest Cancer. 2001;29(2):107-112.
• Diarrhoea and gastroenteritis in the infant and young child. Afzal N, Thomson M. J Fam Health Care. 2002;12(6):146-50. Review.
• Use of unlicensed and off-label medications in paediatric gastroenterology with a review of the commonly used formularies in the UK. Dick A, Keady S, Mohamed F, Brayley S, Thomson M, Lloyd BW, Heuschkel R, Afzal NA. Aliment Pharmacol Ther. 2003 Feb 15;17(4):571-5.
• Refeeding syndrome with enteral nutrition in children: a case report, literature review and clinical guidelines. Afzal NA, Addai S, Fagbemi A, Murch S, Thomson M, Heuschkel R. Clin Nutr. 2002 Dec;21(6):515-20. Review.
• Diverticular disease in adolescence. Afzal NA, Thomson M. Best Pract Res Clin Gastroenterol. 2002 Aug;16(4):621-34. Review.
• A child with oesophageal strictures. Afzal NA, Albert D, Thomas AL, Thomson M. Lancet. 2002 Mar 23;359(9311):1032. No abstract available.
• Portal vein thrombosis and pancreatic failure. Afzal NA, Brueton MJ, Fell JM, Baker A. Int J Pancreatol. 2001;29(2):107-11.
• Complementary medicine use in children and young adults with inflammatory bowel disease. Heuschkel R, Afzal N, Wuerth A, Zurakowski D, Leichtner A, Kemper K, Tolia V, Bousvaros A. Am J Gastroenterol. 2002 Feb;97(2):382-8.

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 Prizes and awards

• The Southampton paediatric GI services has been cited as a best practice example for standard 9 of Facing the Future: Standards for acute general paediatric services. https://www.rcpch.ac.uk/resources/immediate-telephone-specialist-advice-wespghan
• Timothy Martin Postgraduate Award. 1st prize for best research and presentation at the annual research meeting at Surrey and Sussex healthcare.
• 1st Prize for best presentation at the Royal Society of Medicine.
• 2nd prize for poster presentation ‘Electronic paediatric gastroenterology information for the primary and secondary healthcare professional’
• Distinction in Pharmacology & Therapeutics (2nd year MBBS)
• Bronze Medal for third position in FSc (A-level equivalent) Federal Board examinations. Awarded Merit Scholarship (Awarded to top 20 students of nearly 700 institutions in Pakistan and abroad all under Federal Board).

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 Professional membership

• ESPGHAN IBD Porto Group
• BSPGHAN IBD Group

Languages spoken

  • English
  • Hindi
  • Punjabi
  • Urdu

Diseases, Medical Tests and Treatments

Abdominal pain

What is abdominal pain? Abdominal pain can be a symptom of many conditions. It is the name given to pain that radiates between the chest and the gr ...

Endoscopy

What is it? Endoscopy is the use of cameras to relay images from inside the body.  The device used, known as an endoscope, is a long thin flexible ...

Food allergies

What are food allergies? When the body’s immune system reacts unusually to specific foods, it is called a food allergy. The body mistakenly produce ...

Gastric reflux

Gastroesophageal reflux is a digestive disorder where acid from the stomach leaks back into the oesophagus. It usually occurs because of weakness in t ...

Inflammatory bowel disease (IBD)

Inflammatory bowel disease (IBD) is used to refer to chronic diseases affecting the intestine. the most common are Crohn’s disease (CD) and ulcerative colitis (UC).   ...

Irritable bowel syndrome (IBS)

Irritable bowel syndrome (IBS) is a disorder of the large intestine. It is characterised by abnormal movements in the muscles of the intestine, which causes discomfort and abnormal functioning, as well as constipation and diarrhoea alternately. The cause is still unknown, although there is evidence that stress increases the symptoms. This condition is often confused with inflammatory bowel disease (IBD), which differs because IBD presents an abnormal structure of the colon. Its diagnosis is necessary to discard other diseases and although there is no cure, being a chronic condition it is recommended to follow a series of measures like reducing stress, avoiding foods that can aggravate like caffeine, tea, fried foods, alcohol and soft drinks. ...

Bloated stomach

What is a bloated stomach? A bloated stomach is when the tummy is stretched and puffy, leaving a person feeling uncomfortable. The most common cause of a bloated stomach is gas and air, as gas builds up in the digestive tract when undigested food gets broken down, or from swallowing too much air when eating too fast. For some people, it can be from overindulging but for others, there could be an underlying medical reason such as a food intolerance or irritable bowel syndrome.   What are the symptoms of a bloated stomach? As a bloated stomach is only temporary, it is different from gaining fat mass around the stomach. It is built-up gas in the digestive system that makes the stomach uncomfortable and extends outward. Some people have described it as looking ‘pregnant’. There may be a pain in the abdomen, which should be checked if there are other symptoms occurring in the body. Other symptoms to check for include: • Fever • Hives • Watery eyes and itchy throat (allergic reaction) • Constipation • Diarrhoea • Vomiting • Blood in the stool • Weight loss • Fatigue • Irregular periods • Haemorrhoids What causes a bloated stomach? A bloated stomach is mostly caused by air becoming stuck around the abdomen and is normally a problem to do with digestion. There are lots of different underlying reasons that could cause a swollen abdomen, including allergies, hormonal imbalances, thyroid dysfunction and in rare cases, cancer. The possible causes include: • Lactose intolerance • Acid reflux • Constipation • Stomach flu • Premenstrual syndrome • Celiac disease • A hiatal hernia • Ovarian cyst • Gallstones • Urinary tract infection (UTI) • Stomach cancer • Crohn’s disease How is a bloated stomach treated? In many cases of a bloated stomach, lifestyle changes can help diminish or prevent it from recurring. As the main cause of a bloated stomach is gas and air, in order to reduce swallowing too much air you can: • Avoid chewing gum to stop swallowing extra air • Avoid fizzy drinks • Avoid foods known to cause gas such as lentils, beans and vegetables like cabbage, broccoli and sprouts. • Avoid eating quickly, be mindful of chewing more slowly • Cut back on dairy products If lifestyle changes, particularly with the diet, don’t help in relieving or improving a bloated stomach, then the doctor may find a medical cause. The doctor may recommend medical treatment, which depends on the condition and the reason behind the abdominal pain. ...

Coeliac

Coeliac disease is a condition characterised by permanent intolerance to gluten, a glycoprotein present in wheat, barley, rye and oats. It occurs in genetically predisposed individuals suffering from atrophy in the villi of the small intestine, so they have difficulty absorbing the nutrients of some foods. Depending on the degree of intolerance, the patient may show some symptoms or none at all. The most common symptoms of this condition are gastrointestinal problems, iron deficiency and colitis. ...

Constipation

What is constipation? The term “constipation” refers to infrequent bowel movements or difficulty passing stool. Constipation is usually defined as when a patient makes less than three bowel movements a week. These bowel movements may be difficult, even painful, and the individual may strain themselves trying to go. Occasional constipation is common, and can be related to change of routine, going on holiday, or while taking medication. The body usually readjusts quickly and normal defecation rhythm is resumed. However, some people experience chronic (ongoing) constipation, which may require an examination by a doctor to rule out an underlying illness.   What are the symptoms of constipation? The key symptoms of constipation are: Less than three bowel movements a week (apart from young infants – it is quite normal for breastfeeding babies to go a week without pooing) Poo is larger than usual and difficult to push out Poo is dry, hard, and lumpy Constipation can also cause general discomfort, with sufferers feeling bloated, sick, or getting stomach aches. Some patients cause further discomfort by straining to push stools out. If the patient successfully defecates, they may feel as though they haven’t completely emptied their rectum.   Causes of constipation There are many possible causes of constipation in adults, and sometimes there is no obvious cause. Common causes include: Lack of fibre in the diet Not drinking enough fluid Sedentary lifestyle/not getting enough exercise Frequently not going to the toilet when you need to Changes to routine or diet Psychological factors, e.g. stress, anxiety, depression Side-effects of medication Constipation is relatively common during and up to six weeks following pregnancy. In rarer cases, it may be caused by an underlying medical condition. Such conditions include: Blockages of the colon or rectum – bowel obstructions, anal fissures and even tumours can block the passage of stool. Neurological problems – nerve diseases, including Parkinson’s and multiple sclerosis can affect the nerves controlling the muscles in the digestive tract that push faecal matter towards and out of the rectum. Problems with the muscles involved in bowel movements – weakened pelvic muscles or disorders that mean they don’t contract and relax in a coordinated way Conditions that affect hormones – certain conditions, including diabetes and even pregnancy affect the balance of fluids in the body, and this can lead to constipation.   Can constipation be prevented? Leading a healthy lifestyle, with a diet rich in fibre can help prevent constipation. It is also advisable to drink plenty of fluids (about two litres of water a day), exercise regularly and go to the bathroom when you feel the urge to defecate, instead of holding it.   What is the treatment for constipation? In most cases, lifestyle changes will resolve the problem: Increase the amount of fibre in your diet, e.g. cereals, fruit, vegetables Increase fluid intake Exercise more Try to establish a regular toilet routine, and, if possible, don’t hold it in; go when you have the urge. If these measures don’t work, the doctor may recommend laxatives to help stimulate bowel movements. ...

Diarrhoea

Diarrhoea is characterised by a greater fluidity and volume of regular bowel movements, which can sometimes contain blood, mucus, pus and undigested food. ...

Vomiting

Vomiting involves the “throwing up” of the contents of your stomach. Rather than a condition in itself, vomiting is a symptom of a wide variety of illnesses. What can cause vomiting? There are many conditions which can cause vomiting, so it can be difficult to know for certain. In children, vomiting is commonly a reaction to motion sickness, over-eating, a milk allergy, food poisoning, or viral infection. If you find yourself vomiting after a meal, it could be a result of food poisoning, gastritis, or a stomach ulcer. Vomiting as part of morning sickness occurs in 25-55% of women who are pregnant . Other things which can cause vomiting include: gallbladder disease intense pain medication concussion having too much alcohol brain tumour norovirus migraine urinary tract infection How long does vomiting last? Vomiting shouldn’t last more than 1-2 days and is generally harmless. It’s important to see a GP if you are still experiencing symptoms after 2 days. It’s important to see a GP if you or your child are still experiencing symptoms after 2 days. You should also see you’re a doctor if you or your child: are unable to keep fluid down have green or yellow vomit are still dehydrated after using oral hydration sachets (see below) Finally, take your child to the GP if they have a high temperature (over 38C) or are unable to keep fluid down. How can vomiting be prevented? You can reduce your chances of feeling nauseous by eating smaller meals through the day rather than a few large meals, eating slowly, and keeping your head elevated after eating. If you feel nauseous already you can help by resting in a sitting position and drinking small amounts of liquids, avoiding citric juices like orange juice. How is vomiting treated? You can do a lot to treat vomiting yourself and make sure you stay hydrated. It’s important to: get lots of rest drink water or squash in small sips if necessary eat when you feel you can avoid fruit juice or fizzy drinks If your baby is vomiting, carry on giving them breast or bottle feeds, in smaller but more frequent measures. It can also help to give them small sips of water between feeds. You might also find it helpful to take a painkiller such as paracetamol or ibuprofen. Don’t give aspirin to children under 16. If you are still vomiting after 24 hours, a pharmacist might recommend oral rehydration sachets, which you mix with water. The GP may also prescribe medication if vomiting is associated with pregnancy or motion sickness. ...

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