Is Digestive Discomfort a Relevant Health Issue?

Introduction

While the general population may well employ such terms as “indigestion” or “bad stomach” to describe occasional or even recurrent digestive upsets, these complaints have largely gone unheard by the medical or scientific communities, at least until very recently. For a variety of reasons, the concept of “digestive comfort,” or its corollary “digestive discomfort,” has gradually crept into the medical literature of late and has even emerged as a topic for clinical investigation. The cynic will say that this sudden interest in issues that previously were most likely dealt with by the sufferer without recourse to medical attention (and thus without troubling the health care budget) is a creation of the pharmaceutical, functional food, and “alternative” medical industries who seek to convince the man (or woman) in the street that their occasional burp or bloat are deserving, not only of more serious consideration, but also of treatment by their particular product that is, of course, guaranteed to restore “digestive comfort.” In wandering into the over-the-counter, food, and complementary medical (health food store) arenas, one is, to some extent, entering a domain where regulation, at least in the past, has been less draconian and claims, accordingly, more extravagant and less evidence-based. Is the consumer being duped into ascribing a significance to “tummy upsets” that is baseless or is there some real merit to the concept of “digestive comfort”? Are we creating diseases where none actually exist and in so doing unnecessarily alarming the public and inflicting more costs on a creaking health care system?

Abstract

For a variety of reasons, some related to health care policy, some commercial, some scientific, the concept of digestive comfort or, more commonly, its corollary, digestive discomfort have come to be widely referred to in both the lay and medical press. Are these well defined entities? I would contend that an attempt to define digestive comfort, other than in terms of the absence of digestive discomfort, is an impossible task; the focus of this review, therefore, will be on the latter concept: digestive discomfort. The various complaints that may contribute to digestive discomfort will be discussed and their potential importance to, and impact on, the individual and society reviewed. Unfortunately, the detection of digestive discomfort, or its constituent symptoms, in the community has a limited potential to lead to the early diagnosis of serious gastrointestinal conditions or prevent their future occurrence. Furthermore, with the notable exception of heartburn and constipation, our ability to dramatically alleviate many of these symptoms is currently limited pending a more detailed understanding of their pathogenesis and the advent of specific and more effective therapies. What is needed above all is a greater understanding of what digestive discomfort means to an individual sufferer, what generates this discomfort and how we can successfully intervene.

Keywords

digestive comfort, digestive discomfort, irritable bowel syndrome, heartburn dyspepsia, constipation, bloating, gastroesophageal reflux, functional gastrointestinal disorders