A reader who has suffered severe, embarrassing flatulence for two years has been told by a doctor that the problem could stem from a little-known digestive condition called SIBO, or small intestinal bacterial overgrowth.
The question was put to Dr Martin Scurr, a GP who writes a health advice column, by J. Macey of Salisbury, Wiltshire. Scurr said SIBO occurs when too many, or an abnormal mix of, bacteria that are normally found in the large bowel move into the small bowel.
These bacteria ferment carbohydrates from the diet, producing gases including hydrogen, methane and hydrogen sulphide, which causes abnormal bloating and malodorous flatulence. Scurr said the exact cause of SIBO is not fully understood, but it is often linked to another problem, such as surgery or illness, that damages the cells involved in gut motility.
Diverticular Disease and Fibre
Scurr said excess gas can also be caused by diverticular disease, which he noted the reader has. This is where small pouches form in the colon, usually as a result of age and a lack of fibre, and material trapped inside the pouches ferments and produces gas.
He added that the reader's flatulence could even be caused by the extra fibre she had been advised to eat to combat the constipation associated with diverticular disease. For this reason, he said he usually advises patients to increase their fibre intake, from sources such as bran, grains and vegetables, slowly over several weeks or months rather than all at once.
Getting Tested for SIBO
Scurr recommended the reader discuss her symptoms with her GP with a view to being tested for SIBO, which involves a breath test measuring levels of hydrogen and methane.
If SIBO is diagnosed, patients may need to see a dietitian, he said, with one approach being a low FODMAP diet, which involves gradually identifying and then eliminating foods that are not properly absorbed by the small intestine and may cause gas. In exceptional cases, GPs may prescribe antibiotics to reduce bacteria in the intestine.
In the meantime, Scurr suggested trying a more soluble form of fibre, such as psyllium husk, which is available in health food shops. He said it is better tolerated than wheat bran because it undergoes only minimal fermentation by gut bacteria, producing less gas.
A 74-Year-Old's Neck Crepitus
In a separate letter, Debra Arnell of Alicante, Spain, told Scurr she had self-diagnosed crepitus in her neck and that neck exercises hurt every time she did them. She asked whether, at 74, this was simply something to accept, or whether anything could ease the stiffness and ache.
Scurr explained that crepitus refers to crunching, grating or cracking sounds in a joint. In the neck, it is usually caused by cervical spondylosis, age-related arthritis affecting the small joints between the vertebrae. Small bony spurs, known as osteophytes, often develop as the body responds to inflammation in the arthritic joints, and the crunching or grating noise comes from the bones grinding against each other.
Managing the Pain
Scurr noted there is a difference between mild pain during exercise that eases quickly and constant, more severe pain, with the latter being a sign that a doctor should be consulted. He suggested applying heat, such as a hot water bottle wrapped in a towel for 20 minutes before exercising, and said taking two 500mg paracetamol tablets at the same time may also help.
He also recommended the Alexander Technique, a posture-focused approach that uses guided exercises and breathing to improve movement and stance. He said it has encouraging evidence for chronic neck pain and, while it will not reverse arthritic changes, it can reduce muscular tension and improve movement. Scurr said an MRI scan is only needed if the pain worsens, spreads down the arm, or the hands become less dexterous, as these could indicate irritated nerves that need investigating. He said the reader should not simply accept the discomfort, as there are measures that can improve matters.
Why GPs Should Work for the NHS
In a separate comment piece, Scurr argued that GPs should be directly employed by the NHS. He noted that, unlike hospital doctors, GPs are not NHS employees: each GP practice operates as a subcontractor to the state, a small business responsible for its own income and expenditure, contracted to provide services. Each GP is a partner paid a salary out of the practice's profits.
Citing a report by the charity the Health Foundation, Scurr said a GP practice receives £219 per year per patient, which makes up the bulk of its income. He said there are 18,000 GP partners in England, of whom 1,000 pay themselves more than £300,000 a year and 4,000 draw more than £200,000.
Scurr argued that, as with any owner-operated small business, there is an incentive to minimise expenditure to maximise profit. He pointed to the fact that GPs no longer provide out-of-hours care, saying seven-day and night cover had been expensive, and reducing it to a five-day, daytime-only service had freed up funds for higher salaries. He said that if GPs were employed in the same way as hospital consultants, out-of-hours cover might return, as consultants provide such cover, and that the system must change.
