Do you often experience stomach upset and diarrhoea accompanied by bloating and gas? Or are you often constipated even though you eat lots of fruits and fibre?

Digestive problems may be caused by your diet and lifestyle habits. They could also point to other health issues, such as stress, burnout or cancer of the stomach.

Dr Vikneswaran Namasivayam, Senior Consultant from the Department of Gastroenterology & Hepatology at Singapore General Hospital, gives detailed answers to your questions.​​

Question by lucindacheong

I went for a OGD scope and was told osephagus Hiatus Hernia, other than that all normal. What is this? Can this be cured? Can I leave it as it is or do I need to have an operation to correct it? Do I need to change diet etc?? Many thanks.

Answered by Dr Vikneswaran Namasivayam, Senior Consultant, Department of Gastroenterology & Hepatology, Singapore General Hospital

A hiatus hernia typically refers to a small portion of the stomach moving slightly up into the chest beyond the diaphragm (ie. splinting muscles used for breathing that separates the chest from the abdomen). It may be seen in people who are otherwise healthy.

A hiatus hernia is often seen on endoscopic evaluation of the stomach and you may notice this being mentioned on endoscopy reports. It is not in itself of any major concern. It does not usually require any further treatment and rarely does it give rise to symptoms to warrant surgery. You need to discuss with your endoscopist whether your hiatus hernia needs to be treated but for most people the answer is no.

Question by chrisneo40

Dear Dr,

Since the age of 40, I have been prescribed Domperidone 10mg and Omeprazole 20mg, to be taken twice a day. They helped to regulate my gastric juice production. They prevent bloatedness & gastric reflux. During my consultation with another doctor he told me that it is better not to take these and that I should gradually cut down. He mentioned that these medicine (esp. Omeprazole) worked by suppressing the release of stomach gastric juice & thus my body will not be able to fully absorb all the nutrients. When I tried to reduce the intake, I could feel the bloatedness & gastric reflux, so much so that mouth ulcers begin to form. When I return to the normal dosage, everything went back to normal. So are there any long-term side effects on taking Domperidone & Omeprazole? Are these medicine to be taken for the rest of my life? What really is the root cause of gastric reflux? I noticed that I started having this problem when I hit roughly 40 years old.

Thank you, Christopher Neo.

Answered by Dr Vikneswaran Namasivayam, Senior Consultant, Department of Gastroenterology & Hepatology, Singapore General Hospital

Hi Christopher

Gastric reflux refers to the movement of acid from the stomach up the esophagus (ie. foodpipe). It can cause symptoms of heartburn and acid regurgitation up the throat. This is a benign condition though the symptoms may be chronic and in some instances require long-term medication. In many individuals, medication may be taken as short courses on demand as the symptoms come and go.

Acid blocking medications such as omeprazole are generally safe although some concerns have been raised in a small minority of patients as well as with domperidone which works through a different mechanism. Your doctor is probably being prudent by asking you to minimize your medication intake.

You may experience some “rebound symptoms” upon stopping your medication after having used it for a while as your tummy may have “gotten used” to the medication. Sometimes these symptoms abate after a period.

​If you are still troubled by your symptoms, you may want to consider seeking further evaluation to address your concerns.

Question by dragoonwl

I feel bloated when I eat white bread and cakes. Since young I've disliked drinking milk for its smell and causing me stomach upset, but I love chocolate milk which doesn't cause as much trouble. Are they related to a similar medical condition? Will bloatedness cause any serious condition in the long run if I continue eating stuff which causes it?

Answered by Dr Vikneswaran Namasivayam, Consultant, Department of Gastroenterology & Hepatology, Singapore General Hospital

Abdominal bloating may be caused by a variety of conditions. Abdominal bloating following meals may be a result of several benign conditions such as functional dyspepsia (FD) and irritable bowel syndrome (IBS).

Asians, in particular, may also have lactose intolerance that manifests as GI symptoms following milk consumption. You would need to consult a doctor to determine the exact cause of your symptoms. The impact of bloating depends on the underlying cause. Conditions such as IBS and FD may give rise to intermittent symptoms from time to time but they do not lead to a serious medical condition.

Question by [e]

Hi Dr Vikneswaran, My father, age 59 has recently experienced loss of appetite and bloating which resulted in weight loss of 6-7 kgs over the past 3 weeks. The symptoms started a week after his kneecap surgery and we initially thought the painkillers caused these gastric problems. We went to many GPs and now decided to go to a gastroenterologist who recommended an endoscopy. As my grandfather passed away from pancreatic cancer around 74, i am worried that this could be related to pancreas. Could you please advise? My father has never been diagnosed with pancreatitis and never complained of any pain in stomach area. He did not experience nausea or vomitting now too. I googled the symptoms and checked with him on the following - his stools are lighter coloured and diarrhea-like, his urine is darker than usual. Thanks, your advice is much appreciated. Best regards, Elisa

Answered by Dr Vikneswaran Namasivayam, Senior Consultant, Department of Gastroenterology & Hepatology, Singapore General Hospital

Hi Elisa

Certain painkillers, known as NSAIDS, are very effective in relieving pain from muscles and joints but these may give rise to stomach ulcers. The weight loss is of some concern and requires evaluation. A gastroscopy (scope to look into the stomach) would usually be performed in this setting to look for ulcers and any other serious problems in the stomach and this appears to be the recommendation for your father.

The change in the colour of his urine and stool however is not what you would expect with a stomach problem. It may be due to diseases in the pancreas, liver or bile ducts (ie. drainage system of the liver). As the colour of a patient’s urine and stool can be quite subjective, this is often corroborated with a blood test (known as the liver function test) as a first step to further evaluation. The pancreas, liver and bile ducts are not evaluated during gastroscopy. This usually entails performing a scan such as an ultrasound or CT scan.

The exact tests to be performed will be largely determined by the clinical evaluation and I would urge you to raise to the gastroenterologist’s attention what you have told me to aid better decision making for your father.

Ref: Q15