The above mentioned problems are quite common in its occurrence and many a times can be seen in clusters. This is because some of the underlying causes are the same. The good thing about it is that most of the times they are functional, meaning there is no serious underlying organic disease. This means that they are due to deviation in the normal function of any of the digestive organs. The root cause of most of these functional problems is our lifestyle. The Lifestyle includes our eating habits, substance abuse i:e smoking or alcohol, our work habits, our sleep pattern, our physical activity and our mental health i:e our stress levels. So people with these problems need to go deeper to find out whats wrong in their lifestyle and correct it.
The worrying thing with these symptoms is that it could be due to disease of the digestive organs, sometimes grave problems like cancer also, and it is not possible to rule this out without thorough investigations. To add to these problems, many of the different disease of many of different digestive organs present with these similar complaints. Hence many a times to rule out that nothing is wrong or to find out what is wrong, multiple tests are needed. Let me give you an example, bloating and heartburn can be due to no so serious problem like deviation in your digestive process and can get better with change in lifestyle and some simple medications. But occasionally, very rarely it can be due to acid reflux disease, achalasia cardia, peptic ulcer disease, gallbladder stone disease, or worse cancer of either stomach, esophagus, gallbladder or pancreas. It also can be due to chronic pancreatitis.
So what should be done? Should we panic with the occurrence any of the above symptoms and get all the investigations done? No the answer is no. First we should look into the root causes i.e. lifestyle changes and seek the opinion of a doctor, who will most probably give simple medications and things should be fine. But it the problems persists after these measures then you need a thorough investigation. The problem is we don't seek medical attention even if the symptoms are there for years altogether. There is our general tendency to not get alarmed by the problems that are there for quiet some time, we learn to live with it, and that is really dangerous. Also there are some red flag symptoms that should make your doctor suggest investigation at an early stage before starting medications.
These red flag symptoms are blood in stool, blood in vomit, anemia, jaundice, weight loss, difficulty in swallowing or if any of your close family member had any abdominal organ cancer at an early age.
If any of these red flag symptoms are there then as a prophylactic measure further investigations should be done. You need to understand that there are different investigation for different disease of different organs, so multiple tests may be needed. Which tests should be done is upto your doctor to decide depending on the whole presentation. Many a times a doctor needs to advice more investigation depending on the reports of the previous investigations. Many a times this is taken as a lack of doctors knowledge or understanding about your problem but most of the times it is not so. Always some primary or simple investigations like blood test and ultrasound are advised first and further investigations are advised based on the findings in these tests. This is done in good faith to avoid unnecessary tests or to get the best possible information by selecting the most appropriate test from the many available investigations. Many a times its a test of your patience and your faith in your doctor.
We also need to understand the fact that a large portion of these test would be normal and only a few patients from all those who are subjected to investigations will have disease. This is so because to diagnose the disease in early stage we need to keep a low threshold for getting the investigations done. We also need to be humble to understand that we including all the doctors and today's technology and medical science are not above nature, so even with all that we do we may still miss a disease which would be detected at a later stage where outcomes many not be very promising.