Stomach pains can hit you at any moment; unfortunately, it usually happens when you least expect it. Whether your stomach pains are caused by food poisoning, irritable bowel syndrome, or just regular stomach aches, it is inconvenient and often embarrassing.

But it is important to understand the cause of your stomach pains; having an upset tummy, though inconvenient, is curable and not long-term. On the other hand, irritable bowel syndrome (IBS) is a chronic condition that, while not curable, is treatable through the management of symptoms.

What is irritable bowel syndrome (IBS)?

Irritable bowel syndrome, commonly referred to as IBS, is a gastrointestinal disorder that is relatively common, affecting 6-18% of people worldwide [1]. Although IBS comprises a variety of symptoms that affect the gastrointestinal tract, a recent study conducted in 2022 found that it does not increase your risk of gastrointestinal cancer [2].

IBS is a functional gastrointestinal disorder or a disorder of the gut-brain interaction. This means there is a problem with how the gut and brain work together, causing the gastrointestinal tract to be highly sensitive, thus affecting the contraction of the bowel muscle, resulting in bloating, constipation, abdominal pain, and diarrhoea.

The main cause of IBS is still unknown and poorly misunderstood. However, several factors have been linked to the development of IBS. These are:

• Intestinal muscle contraction: individuals with IBS tend to have altered intestinal muscle contractions.
• Visceral hypersensitivity: visceral organs, which consist of the organs in your chest, abdomen, and pelvic region, are more sensitive to pain in individuals with IBS. This stems from issues in the nervous system that overreact when the gastrointestinal tract moves and stretches during digestion.
• Infection: a bacterial or viral infection that causes diarrhoea, also known as gastroenteritis, can cause IBS.
• Inflammation: one of the persistent issues seen in individuals with IBS.
• Stress: exposure to stress in the early stages of life can result in numerous IBS symptoms.

What are the symptoms of IBS?

IBS has many symptoms, but it varies from person to person. These symptoms include:

• Abdominal pain or discomfort
• Change in appearance of stools
• Bloating
• Change in frequency of stools (constipation or diarrhoea)
• Acid reflux or heartburn
• Headache
• Muscle aches and pains

These symptoms come and go for varying durations. For example, bloating or gas tends to disappear after a bowel movement. Therefore, IBS is often misdiagnosed as other conditions, such as an upset tummy or even lactose intolerance.

Differences between IBS and upset tummy

While they may have some similar symptoms, there are a few clear-cut ways to tell if you have IBS or just an upset tummy.

Irritable bowel syndrome	Upset tummy
It happens frequently and with greater severity.	It occurs rarely, and symptoms are not as severe.
Pain does not wake you up at night.	Pain is more severe at night and can wake you up, especially in cases of food poisoning.
Pain may affect the whole gastrointestinal tract.	Pain is generalised.
Symptoms usually include constipation, diarrhoea, or both, and lower abdominal pain.	Symptoms usually include nausea, vomiting, and upper abdominal pain.
The intestinal lining appears normal.	The intestinal lining is inflamed.
There are no known causes, but they have been linked to several factors.	It is known to be caused by various bacteria, viruses, food, medication, etc.

How is IBS diagnosed?

If you suspect that you might be experiencing IBS, you should consult with a gastroenterologist who will help you manage your symptoms. IBS is diagnosed if you fulfil the following criteria:

• Unexplained persistent stomach pains that occur three or more times for at least three months in a row with no sinister symptoms 
• Pain or discomfort during bowel movements.
• Change in frequency of bowel movements.
• Change in appearance of stools.

The following diagnostic tests can be conducted if IBS is suspected:

• Complete medical history: your gastroenterologist will ask you questions about your medical history, symptoms, foods that trigger your IBS symptoms, family history of IBS, etc.
• Blood test: this helps to check for anaemia and rule out medical conditions such as coeliac disease.
• Stool test: also done to rule out infections.
• Colonoscopy: a colonoscopy is a procedure involving a thin and flexible tube with a camera and light attached at one end, which is inserted into the anus and led up through the rectum and large intestine for a proper examination.
• Computed tomography scan (CT-scan): a CT-scan is a non-invasive diagnostic imaging tool that uses a combination of X-rays and computer technology to produce cross-sectional, horizontal, or axial images of our body. This helps your gastroenterologist to identify any abnormalities.
• Gastroscopy: a gastroscopy is a procedure involving a thin and flexible tube with a camera and light attached at one end, which is inserted into the mouth and led down through the oesophagus, into your stomach and your small intestine for a proper examination.

What is the best treatment for IBS?

The best treatment for IBS depends on what works for you; IBS treatment for you may be different from IBS treatment for someone else. Here are some treatment options that you may try to help yourself with IBS:

• Regular physical activity/exercise
• Reduce or avoid caffeinated drinks
• Consume small meals
• Minimise stress by doing yoga or relaxation techniques
• Try the low FODMAP diet (a diet plan that restricts carbohydrates)
• Take probiotics to improve gut bacteria

Your gastroenterologist can prescribe several medications:

• Antidepressants for patients with depression or anxiety
• Medications to relieve constipation or diarrhoea
• Pain medications to alleviate or manage pain

The first line of treatment for IBS would be remedies you can try at home, such as lifestyle changes. However, if severe symptoms persist, medications can be prescribed to help manage them.

In conclusion, IBS is very different from an upset tummy. IBS is a chronic, incurable condition, while an upset stomach is an acute, curable condition. There are no known causes of IBS, but several causes of an upset tummy, such as gastroenteritis, food poisoning, etc. 

So, next time you have any stomach pains, remember when it happens, how frequently it happens, and what the symptoms are. If it happens again within the next few days, weeks, or months, you could be developing IBS. 

If you suspect you have IBS, book an appointment with us today, and we can help you manage your symptoms.

References

1. Ami D Sperber, D. D.-Y. (2017). The global prevalence of IBS in adults remains elusive due to the heterogeneity of studies: a Rome Foundation working team literature review. Gut, 1075-1082.
2. Shanshan Wu, C. Y. (2022). Irritable Bowel Syndrome and Long-Term Risk of Cancer: A Prospective Cohort Study Among 0.5 Million Adults in UK Biobank. The American Journal of Gastroenterology, 785-793.

Not many people know this, but lactose intolerance is not the same as a milk allergy – although they may sound the same. Lactose intolerance is not dangerous, but a milk allergy could be life-threatening. Read on to learn more about this modern-day conundrum.

What is lactose intolerance?

Lactose intolerance is an issue of the digestive system that occurs when an individual’s small intestine does not produce or does not produce enough lactase – an enzyme necessary for the breakdown of lactose. Lactose is a type of sugar specifically found in milk and other dairy products like chocolate, yoghurt, cheese, ice cream, and butter.

Digesting lactose does not pose any problem for most people because lactase breaks down lactose into glucose and glycogen, which are then absorbed into our bloodstream and transported to all body parts to be used as energy.

For people who are lactose intolerant, lactose cannot be broken down, so it travels down to the colon, where it gets fermented by bacteria, resulting in bloating, diarrhoea, and abdominal cramps.

Fortunately, although lactose intolerance is inconvenient and, at times, embarrassing, it is not a life-threatening condition.

What are the causes of lactose intolerance?

We already know that lactose intolerance is caused by insufficient or a complete lack of lactase. But why do some individuals lack this enzyme?

• Congenital lactase deficiency: some individuals may produce little or no lactase since birth.
•  Injury: some medical conditions, such as Crohn’s disease or coeliac disease, cause injury or damage to the small intestine, resulting in reduced lactase production.
• Lactase nonpersistence: this occurs when the small intestine slows down lactase production as time goes by — this is why some people only develop lactose intolerance when they are adults.
• Premature birth: the small intestines in babies born prematurely may not produce enough lactase initially. This condition is known as transient lactose intolerance as it usually corrects itself as the baby grows older.

What are the symptoms of lactose intolerance?

Symptoms of lactose intolerance usually appear 30-60 minutes after consuming dairy products; symptoms include:

• Bloating
• Diarrhoea
• Abdominal cramping
• Gassiness
• Nausea
• Vomiting
• Gurgling or rumbling in the stomach

The severity of symptoms depends on two things:

• How much dairy was consumed
• How well your body can tolerate lactose (based on whether your body produces lactase at all or whether your body produces insufficient lactase)

These symptoms are brief and will be alleviated once the dairy products have been removed from your digestive system.

What is a milk allergy?

A milk allergy, like all types of allergies, is an issue of the immune system where the body over-reacts to one or more proteins present in milk and other dairy products. This results in an allergic reaction with symptoms ranging from mild (rashes) to severe/life-threatening (anaphylactic shock).

Milk allergies can affect anyone but are one of the most common allergies in children and babies, affecting approximately 0.5-2.5% of children [1],[2],[3],[4]. Milk allergies usually occur in response to dairy products that contain cow’s milk.

What are the causes of a milk allergy?

For individuals with a milk allergy, their immune system recognises one or more proteins in milk as a foreign invader. As a response, the immune system releases the antibody – immunoglobulin E (IgE), which then signals the body to release histamine and other chemicals responsible for the allergic symptoms.

Two proteins in cow’s milk can trigger an allergic reaction:

• Whey: the liquid that remains when milk curdles.
• Caesin: the solid part of milk when it curdles and the most common trigger of milk allergies.

Your likelihood of developing a food allergy such as a milk allergy significantly increases if one or both of your parents have allergies to food or other particles [5].

Types of milk allergies and their symptoms

	lgE-mediated	Non-IgE mediated
What is it	IgE is an antibody the immune system produces when it recognises milk protein as a foreign invader. It causes immediate symptoms.	Involves other aspects of the immune system other than IgE. Symptoms develop later and are usually confused with the symptoms of lactose intolerance.
Symptoms	Rashes or hivesWheezingCoughingBreathlessnessItching around the mouthSwelling of the lips, mouth, or tongue Vomiting	Abdominal crampsRunny noseWatery eyesDiarrhoea (may contain blood)Colic

Do I have lactose intolerance or a milk allergy?

Apart from identifying your symptoms, diagnostic tests must be carried out to confirm if you have lactose intolerance or a milk allergy.

Tests for lactose intolerance include:

• Hydrogen breath test: a hydrogen breath test measures the amount of hydrogen in your breath after consuming dairy products. Elevated hydrogen levels in your breath may suggest digestive issues like lactose intolerance.
• Lactose intolerance test: your blood sugar level is measured after consuming dairy products. Your blood sugar level will not rise if you have lactose intolerance since your body cannot break down lactose into glucose and glycogen which are then absorbed by the bloodstream.
• Genetic testing: tests for any genetic causes of lactose intolerance.
• Stool acidity test: most commonly used for babies where the acidity levels of their stool are tested. A lower pH level (more acidic) signals lactose intolerance.
• Lactase activity at the jejunal brush border: this is an invasive but accurate test involving a biopsy of the jejunal brush border – part of your small intestine.

Tests for a milk allergy include:

• Blood test: a blood sample will be taken and sent to a laboratory. Milk proteins are then introduced to your blood sample, and the levels of IgE are measured. High levels of IgE present signals a milk allergy.
• Skin prick test: a part of your skin will be cleaned and pricked with a small amount of fluid containing milk proteins. After 15 minutes, the test area is examined to check for any skin discolouration, raised skin, or itchy skin. A reaction signals a milk allergy.
• Graded oral challenge: a small amount of milk is ingested in a controlled environment. Your doctor will examine you for an allergic reaction.

Conclusion

Lactose intolerance and milk allergy are different, even down to the way each one is diagnosed. Lactose intolerance is a digestive system issue, while milk allergy is an immune system issue. The former is not life-threatening, while the latter can be.

Fortunately, both can be treated, and symptoms can be avoided simply by steering clear of dairy products. It is essential to get properly tested so you can live comfortably and healthily.

References

1. Julie D Flom, S. H. (2019). Epidemiology of Cow’s Milk Allergy. Nutrients, 1051.
2. AA Schoemaker, A. S.-P. (2015). Incidence and natural history of challenge-proven cow's milk allergy in European children--EuroPrevall birth cohort. Allergy, 963-972.
3. Junichiro Tezuka, 1. M. (2021). Possible association between early formula and reduced risk of cow’s milk allergy: The Japan Environment and Children’s Study. Clinical and Experimental Allergy, 99-107.
4. Rachel L Peters, J. J.-L. (2018). The Prevalence of Food Sensitization Appears Not to Have Changed between 2 Melbourne Cohorts of High-Risk Infants Recruited 15 Years Apart. The Journal of Allergy and Clinical Immunology in Practice, 440-448.
5. Kanika Kanchan, S. C. (2021). Current insights into the genetics of food allergy. The Journal of Allergy and Clinical Immunology, DOI:https://doi.org/10.1016/j.jaci.2020.10.039.