Patient guide

You come with symptoms, not a diagnosis

Most people who book an appointment for a digestive problem do not know the name of their condition. They know they get a burning feeling after meals, their belly swells, or their bowels have been off for months. That is enough. A gastroenterology visit starts with your description, and the clearer it is, the faster the doctor gets close to the cause.

MedlinePlus suggests writing a few things down before the visit rather than trying to recall everything in the doctor’s office. Digestive problems are no exception.

What should you write down?

• Symptoms. When each symptom started, what makes it worse, and what eases it a little. MedlinePlus asks for exactly these three things. If a symptom is linked to eating or to going to the toilet, note that. The symptom diary is made for this.
• Eating habits. NIDDK says you will be asked about what you eat as part of your history. It does not have to be exact; “most nights I eat dinner late” is useful information too.
• All your medicines. Prescription, over-the-counter, herbal, vitamins and supplements. MedlinePlus says to bring a list of medicines and allergies. If you cannot remember a name, the box or a photo of the prescription is enough. Painkillers and sleeping pills count, because some medicines irritate the stomach.
• Family history. When looking into bowel problems, NIDDK asks whether anyone in your family has had coeliac disease, inflammatory bowel disease or colon cancer. If you know, write down that person’s age too.
• Recent events. A serious infection or diarrhoea, travel, or a stressful period just before the problem began. NIDDK includes these in the history as well.
• Previous results. Blood or stool tests, ultrasounds, and endoscopy or colonoscopy reports if you have had them. A photo on your phone is fine.
• Your questions. Anything that worries you, even if it seems silly.

About warning signs

NIDDK names several signs that may point to another problem: anaemia, rectal bleeding, bloody or black stool, and weight loss. If you have any of them, tell the doctor right at the start and do not leave it for the end of the visit. Many of these signs turn out not to be dangerous, but they need to be looked at. A fuller list is in urgent warning signs.

Bring someone with you

MedlinePlus suggests bringing a friend or family member to take notes. When you are talking about stool, bleeding or other personal matters, you may prefer to be alone, and that is fine too. If you need an interpreter, ask in advance whether one can be arranged. For an older person whose child made the appointment, having the child along is usually a big help: they can complete the medicine list and hear the explanations.

In the consultation room

• Be honest, even about smoking, alcohol or food you know is not good for you. MedlinePlus stresses that the doctor needs an accurate picture to help, not the picture you think they would like to hear.
• If you do not understand something, ask again. You can ask for instructions in writing.
• Ask how and when you will get your test results, and whom to contact if you get worse.
• Do not reduce or stop your regular medicines on your own. Show the doctor your list so they can decide.

Tests or endoscopy are not always needed

Many people fear that a first visit means an endoscopy. It does not. NIDDK writes that for a problem like irritable bowel syndrome, no specific test is needed for diagnosis in most cases. Blood or stool tests, and sometimes other checks, are suggested depending on your history and examination, to rule out other causes. NHS also says the doctor may examine your abdomen and ask for blood or stool tests. If further investigation is needed, the doctor will explain why, and the decision is made through a conversation between the two of you.

When you cannot wait for an appointment

If you have a warning sign, do not rely on a routine appointment. Read the list of urgent signs and, if necessary, call 115 (Iran’s emergency number).

Why keep notes?

A digestive problem is usually not like a fever that rises one day and falls the next. It comes and goes, sometimes after a meal, sometimes for no reason. At the visit, few people remember what they ate on “last week’s Tuesday”. A simple sheet of paper fills that gap.

In explaining how irritable bowel syndrome is assessed, NHS says to write your symptoms down beforehand so you do not forget, and lists what the doctor will ask: what symptoms you have, whether they come and go or are constant, when they happen (for example after eating something), and for how long. MedlinePlus also suggests writing down when each symptom started and what makes it better or worse.

What should you write?

For each day, one short line is enough:

• Symptom. What it was (burning, bloating, cramps, nausea, constipation, diarrhoea), when, and how bothersome it was. A number from one to ten for severity is enough.
• Food and drink. Note each meal in terms like “rice and stew” or “sandwich and soda”. The time matters too, especially for dinner.
• Toilet. How many times you went, whether the stool was hard or loose, and whether you saw blood or an unusual colour. Doctors hear this without embarrassment, and it is important information for them.
• Medicines. Any medicine you took, including painkillers and over-the-counter drugs, and the time.
• Other things. Poor sleep, a stressful day, travel, or, for women, what day of the cycle it was. NIDDK also asks about stressful events and recent infections in the history.

It does not need to be exact or neat. A small notebook or a phone note are both fine.

How many days is enough?

One to two weeks is enough to start. If your symptoms return monthly, recording one full cycle is more useful. You do not need to wait for this before the visit. If the appointment is close, write down those few days and say “I have just started”.

What patterns should you look for?

When you go over the sheet, ask yourself these questions:

• Roughly how many hours after which meal does the symptom usually come?
• Does it get better after going to the toilet? NIDDK counts abdominal pain with a change in how often you go or in the form of the stool as a symptom of irritable bowel syndrome.
• Is it worse at night or when lying down? For nighttime reflux, NIDDK says to finish eating at least a few hours before bed, and this pattern can be seen in your notes.
• Does the thing you suspected really cause symptoms every time?

The conclusion is yours to draw, but the final judgment belongs to the doctor. A two-week note does not prove a cause; it only moves the discussion from guesswork to data.

Watch out for one thing

Note-taking is meant to bring clarity, not fear. If you find you are logging every meal anxiously, or you have cut most foods from your diet for no good reason, put the sheet aside and talk to your doctor. NIDDK says it is better to change your diet with guidance from a doctor or dietitian, and that these changes take weeks to show their effect. Removing foods on your own, without guidance, may restrict you for no reason.

Where to take the sheet

Bring it to the visit and show it at the start. If you have to summarize, say these three lines: since when, what pattern, and what changes it. The doctor will ask about the rest.

Come even without notes

If you have written nothing, do not wait. What matters is that you come. For warning signs such as blood in the stool, black tarry stool or unexplained weight loss, see the list of urgent signs, and do not fill in a diary for any of them; let the doctor know.

Know this first

This text is a general guide, not your preparation instructions. Every centre that performs endoscopy has its own preparation sheet: fasting hours, type of numbing or sedation, and notes about medicines. If this guide differs from the centre’s sheet or your doctor’s words, follow the centre and your doctor. If you have any question, ask them before the day of the endoscopy.

What is an upper endoscopy?

NIDDK describes it as a soft, flexible tube with a small camera that shows the oesophagus, stomach and the start of the small intestine from the inside. NHS gives examples of why it is done: to find the cause of heartburn or indigestion, swallowing problems, stomach pain and sometimes vomiting blood. A tissue sample can be taken during it (biopsy), and some problems can also be treated. Not everyone needs an endoscopy; the doctor asks for it when its result will help decide on treatment.

Before the day of the endoscopy

• Tell them your history and medicines. NIDDK says to tell the doctor your medical history, allergies and symptoms, and to give a list of all medicines, vitamins and supplements. In particular, mention painkillers, blood thinners and iron.
• Blood thinners and diabetes medicines. The decision about these is the doctor’s. Be sure to coordinate with your doctor or the centre before the day of the endoscopy, and do not stop or reduce anything on your own. NIDDK writes that most medicines usually continue but some may need a temporary change, and NHS says to follow the hospital’s instructions about medicines. Which medicine applies to you and how is something only your doctor and the centre can tell you.
• Fasting. You usually must not eat for several hours before the endoscopy, and drinking is limited too. The centre sets the exact time, so follow that.
• A companion. If you receive sedation, NHS says someone must take you home and stay with you for up to 24 hours. NIDDK also says you cannot drive afterwards. Arrange a companion in advance.
• Pregnancy. NHS says to tell the centre if you are pregnant.

What does it feel like?

NIDDK says it usually takes a few minutes to under half an hour, and you lie on your side. A throat spray or liquid may be given to reduce gagging, and a sedative is usually given through a vein. Many people fall asleep and remember nothing, and some people have it done without sedation. The tube does not interfere with your breathing. The air put into the stomach may cause a feeling of fullness. If you are uncomfortable, signal at that moment.

“Numbing”, “sedation” and “anesthesia” are not the same thing. Ask which one your centre uses before the day of the endoscopy.

After the endoscopy

• NIDDK says about an hour of rest is usually needed. Bloating, nausea or a sore throat stays for a few hours and then passes.
• NHS says that after the throat spray, do not eat or drink for an hour. For up to 24 hours after sedation, avoid alcohol, driving, operating machinery and signing important papers.
• Results of some parts are given the same day. Biopsy results may take a few days or more. Ask how and when you will get them.
• Read the centre’s written instructions and keep them.

Complications and warning signs

NIDDK considers the overall risk low. Rare but possible complications are: a reaction to the sedative, bleeding and a tear in the wall. Most bleeding is minor and stops by itself. If any of these happen after the endoscopy, do not wait; contact the centre or call 115 (Iran’s emergency number):

• Shortness of breath
• Worsening throat pain or trouble swallowing
• Vomiting, especially with blood or looking like coffee grounds
• Chest or abdominal pain that gets worse
• Black tarry stool or bloody stool
• Fever, or feeling hot and shivery

NHS also suggests contacting the centre for fever and chills, and suggests emergency care for persistent vomiting, vomiting blood, shortness of breath and severe chest or abdominal pain. Do not drive yourself.

If you are afraid

Fear is natural. Many people say the endoscopy itself was easier than the waiting. Share your worry with the centre. You can ask what you will feel, who will be with you and what to do if you become uncomfortable.

Know this first

For a colonoscopy, more important than anything else is the instructions of the centre doing it. The diet in the days before, the type and timing of the bowel-cleansing medicine, and the time you must stop drinking differ from one centre to another. This guide is for understanding the general picture. If it differs from the centre’s sheet or your doctor’s words, follow those. NHS also stresses taking the cleansing medicine exactly as the hospital instructs, otherwise the test may not go ahead.

What is a colonoscopy for?

A soft, thin tube with a camera shows the inside of the rectum and the large bowel. NHS and NIDDK list these reasons: rectal bleeding or blood in the stool, persistent diarrhoea or constipation, abdominal pain, unexplained weight loss or tiredness, and checking for polyps, Crohn’s disease or bowel cancer. NIDDK says it is also used for screening. If a polyp is seen, it is usually removed on the spot and the patient feels nothing. Not everyone with a bowel problem needs a colonoscopy; the doctor decides based on symptoms and history.

The hard part: bowel preparation

To see the bowel wall, the bowel must be empty and clean. NIDDK and NHS both say this:

• Diet in the days before. NIDDK says that for a few days beforehand you may be asked to skip foods high in fibre, for example whole grains, raw vegetables, beans and nuts. Then comes a day or more on a clear liquid diet, such as water, strained broth, juice without pulp, and tea or coffee without milk. Red or purple drinks and milk or cream are usually not allowed. The centre gives the exact list.
• Bowel-cleansing medicine. It is usually taken the night before and the morning of the procedure, and it causes diarrhoea. NHS says diarrhoea starts a few hours after the first dose, so stay near a toilet. NIDDK says finishing it matters. If a side effect such as severe nausea gets in the way, contact the centre or your doctor and do not abandon it.
• Fasting and the time to stop drinking. The centre gives the time. Following it keeps the test valid.

A simple tip: get your clear drinks ready ahead of time and do not plan to be out of the house that day.

Diabetes and blood-thinning medicines

Take this section especially seriously. Neither of these two sources gives a general instruction about diabetes medicines or blood thinners; for these medicines they say to ask your doctor or the hospital. So:

• If you have diabetes, or take a blood-thinning medicine, or any heart medicine or other important medicine, before starting the preparation coordinate with your doctor or the centre doing the procedure. The same applies if you have kidney disease or heart failure, or take iron tablets.
• Do not stop, reduce or increase anything yourself. The decision about every medicine belongs to the doctor.
• Bring a list of all your medicines and supplements.

Pain relief and a companion

NHS says the test should not be painful, and if you have pain, tell the staff. Depending on the centre, there are options such as painkillers, sedatives or a special gas, and not every centre has all of them. NIDDK says medicine is given through a vein so you feel no pain. If you receive a sedative, someone must take you home. NHS says not to drive for 24 hours. Arrange a companion in advance, and if you are pregnant, NHS says to inform the centre.

After the colonoscopy

• Mild bloating and cramps are normal for a few hours. NHS says 2 to 3 hours.
• NIDDK says most people go back to their normal diet the next day. A little bleeding from the rectum is possible after polyp removal or a biopsy. NHS says it may last a day or two.
• The doctor can explain the findings after you wake up, and you can invite your companion to hear them too. Results of samples usually come later; ask when and how.
• Keep the centre’s written instructions.

Signs that cannot wait

NIDDK considers the risk of complications low but says bleeding and a tear in the bowel are rare but possible, and delayed bleeding can occur up to two weeks later. If you see any of these, contact the centre right away or call 115 (Iran’s emergency number):

• Severe abdominal pain
• Fever or chills
• Heavy bleeding, or bleeding from the rectum that does not stop
• Bloody stool that does not improve
• Dizziness or weakness
• Vomiting you cannot control, or chest pain

Do not drive yourself. Take your medicines with you.

If you feel embarrassed

The staff who do colonoscopies do this every day. What feels embarrassing to you is routine work for them. If you are worried about the preparation or anything else, contact the centre before the day and ask.

There is no single diet for everyone

Ask anyone “what should I eat?” and you will get an answer. The truth is a little simpler and a little more disappointing: what causes trouble for one person has no effect on another. In explaining reflux, NIDDK writes that triggers differ from person to person. So the aim of this page is not a “forbidden list”; it is a few low-cost habits that are usually worth trying, and what you should leave to your doctor.

For heartburn and reflux

NIDDK and NHS agree on these points:

• Gap before bed. If you burn at night or when lying down, finish dinner at least a few hours before bed. NIDDK says three hours and NHS says three to four hours.
• Smaller meals. NHS suggests smaller, more frequent meals instead of two or three heavy ones.
• Possible triggers. Acidic foods such as citrus and tomato, alcohol, chocolate, coffee and caffeine, fatty food, mint and spicy food. Do not remove all of them forever, and do not believe all of them either. Cut back one at a time and see what happens. The symptom diary is useful for this.
• Weight. NIDDK and NHS both say that if you are overweight, losing weight may reduce symptoms.
• Smoking and alcohol. NHS recommends stopping smoking and cutting down on alcohol.
• Clothing. NHS advises against wearing tight clothes around the waist.
• Head of the bed. NHS says to raise the head of the bed by about ten to twenty centimeters, and not to add extra pillows instead, because they increase pressure on the abdomen.

One important point: NHS says not to stop a prescribed medicine without talking to your doctor. If heartburn is present most days, or has not improved with over-the-counter medicines and changes in habits, a doctor needs to see you. NHS gives these as reasons to see a doctor too, as well as food sticking in the throat, repeated nausea and unexplained weight loss.

For bloating, constipation, diarrhoea and irritable bowel

In explaining food for irritable bowel syndrome, NIDDK names several approaches that a doctor may suggest:

• Increase fibre gradually. A sudden increase brings gas and bloating. Soluble fibre (fruit and oat products; beans make bloating worse for some people) may help more than insoluble fibre.
• Gluten. Sometimes a doctor suggests cutting back on wheat, barley and rye for a while to see the effect, even without coeliac disease.
• Low-FODMAP diet. This is a diet that sets aside certain slowly digested carbohydrates for a few weeks and then brings them back gradually to find out which ones you tolerate.
• A dietitian. NIDDK says the doctor may suggest working with a dietitian.
• Patience. A change in food takes a few weeks to show its effect, and what works differs from person to person.

Strict restrictions, such as removing several food groups at once, may lead you to malnutrition and fear of food if done without guidance. Go through these with your doctor or a dietitian.

For stomach ulcers

NIDDK states clearly that diet does not cause stomach ulcers, does not prevent them and does not treat them, and it does not recommend any particular diet. The common causes of ulcers are Helicobacter pylori and certain painkillers, and treatment is with medicine. See the article on the H. pylori result. Food is for your own comfort, not for treating the ulcer.

For fatty liver

NIDDK says that for fatty liver, a healthier diet and smaller portions help, and gradual weight loss helps reduce liver fat. Regular exercise is useful too, even without weight loss. NIDDK warns that rapid weight loss and malnutrition make liver disease worse, so go slowly. Do not take herbal remedies and supplements without asking your doctor either, because some can harm the liver. See the article on fatty liver.

Stress and sleep

For reflux, NHS also suggests ways to relax, and when taking the history for irritable bowel syndrome NIDDK asks about stressful events. On its own, stress is not the cause of most digestive diseases, but it can make symptoms worse, and many people feel worse on hard days. Walking, regular sleep and talking with someone you trust are harmless and sometimes help. If stress or anxiety has gotten out of control, that too is a medical problem and needs help.

Things you do not need

• You do not need a “detox” or miracle teas and supplements. None of them is recommended in these sources.
• Try each change one at a time, not all together, so you can tell which one has an effect.
• If your symptoms do not improve with these changes, or get worse, see your doctor. Food does not replace an assessment.

Signs that food will not solve

If you have black tarry or bloody stool, vomiting blood, food getting stuck, unexplained weight loss or severe pain, food is not your problem. Read the list of urgent signs.

Read this first

This page is for when you are worried about a symptom and do not know whether to wait. Most digestive problems are mild, but a few signs should not be handled with a routine appointment. If you have any of the signs below, or are even in doubt, call 115 (Iran’s emergency number) or get yourself to the nearest emergency department. If you are outside Iran, call your local emergency number. Do not worry about bothering anyone; emergency staff are there for this. This list is not a substitute for an examination and cannot cover every situation. If something outside this list worries you, that worry alone is reason enough to ask.

If you are going to the emergency department: do not drive yourself. NHS also says to ask someone to take you or to call an ambulance. Take your medicines with you.

Chest pain that could be from the heart

Do not assume burning or pressure in the chest is digestive. In explaining indigestion, NIDDK lists chest pain, and pain that spreads to the jaw, neck or arm, among the signs that should be shown to a doctor immediately. NHS says a heart attack can feel like indigestion, with a burning feeling in the chest and a sense of fullness and bloating. If your chest feels tight or heavy, pain spreads to your arm, neck or jaw, or you have shortness of breath, sweating, nausea or pallor, call 115 right now. Read more in the article on heartburn or heart.

Vomiting blood

Vomit with bright red blood, or vomit that looks like coffee grounds. In explaining stomach ulcers and stomach ache, NHS lists both under “emergency”. In explaining indigestion, NIDDK also counts repeated vomiting or blood in vomit among the signs a doctor should see immediately.

Black tarry stool, or bleeding from the rectum

Black, sticky, foul-smelling stool, or a lot of blood from the rectum. NHS lists black sticky stool and heavy bleeding as emergencies, and says to call emergency services for bleeding that will not stop or for large clots. A small amount of bright red blood on tissue, if it happened once and is painless, can have other causes, but you still need to tell a doctor. NHS says black or dark red stool and bloody diarrhoea need an urgent appointment.

If the bleeding comes with fainting, severe dizziness, a racing heart or pallor, or you take a blood thinner or have liver disease, do not delay: call 115.

Sudden severe abdominal pain

NHS lists abdominal pain that starts suddenly and is severe as an emergency. The same goes for being unable to pass any stool or gas at all, or an abdomen that is painful to touch. Severe, constant pain in the upper abdomen or under the right ribs, especially with vomiting, can be the gallbladder or another problem. NHS also treats pain that spreads to the back together with vomiting as an emergency. Green vomit, being completely unable to pass urine, or struggling to breathe with abdominal pain are also emergencies (NHS). Abdominal pain in pregnancy needs an urgent appointment.

Jaundice with fever

Yellowing of the skin or the whites of the eyes, with dark urine and pale stool. NHS says jaundice needs to be seen the same day, because it can be a sign of a serious liver problem. If jaundice comes with a very high temperature or feeling shivery, or with severe pain in the upper abdomen, NHS (in explaining gallstones) says to seek emergency care. If you are confused or vomiting blood, call 115 immediately.

Unable to swallow

You cannot swallow saliva or fluids, food gets stuck and will not go down, you cough or choke while eating, or you become short of breath after eating. NHS treats any swallowing problem as a reason to be seen the same day. NIDDK also counts difficulty or pain when swallowing among signs that should be seen early. If you cannot breathe or you are choking, call 115.

Severe dehydration

If diarrhoea or vomiting continues and you cannot keep fluids down. NHS lists the early signs as thirst, dry mouth, dizziness, dark or little urine, and weakness. Worse signs that need emergency care: pale, blue, grey or blotchy skin, lips or tongue, cold skin, fast breathing, confusion, and severe drowsiness. Older people, children and people with diabetes are at greater risk.

A few special situations

• Liver disease: confusion, unusual drowsiness, or an abdomen that has swollen quickly.
• Crohn’s, colitis or medicines that weaken the immune system: bloody diarrhoea with fever, a racing heart or severe pain.
• Swallowing poison, a corrosive substance, a battery or a sharp object. NHS also advises emergency care for swallowing something poisonous.

Signs that need checking in the coming days

These are not instant emergencies and do not need 115, but they should not be left for weeks or months. See a doctor at the first available appointment:

• Unexplained weight loss, anaemia or unusual tiredness
• A lasting change in toilet habits, stool thinner than usual
• Stomach burning or pain that does not improve with treatment, or feeling full too early
• Difficulty swallowing that gradually gets worse

NHS (about bowel cancer) says most people with these signs do not have cancer, but they need to be checked.

If you are not sure

Ask. If you do not know whether your symptom is serious and cannot reach a doctor, call 115 and describe what you see. The decision is then up to the medical staff. This list is meant to help you recognize signs, not to replace a doctor’s judgment.