I’m Dr Arjun Prakash. I’m a consultant gastroenterologist, and I see patients here in Milton Keynes every week.<\/p>\n
Many patients come to see me with persistent digestive symptoms after undergoing several investigations. They may have had blood tests, stool tests, ultrasound or CT scans, a gastroscopy or a colonoscopy. The results have been reassuring, although symptoms such as abdominal pain, bloating, nausea, indigestion, constipation or diarrhoea continue.<\/p>\n
This is a common situation in gastroenterology. Tests such as scans and endoscopy are mainly designed to detect structural abnormalities, including inflammation, ulcers, tumours and changes in the lining of the digestive tract. They provide less information about digestive movement, sensitivity and the way the gut responds to food.<\/p>\n
The next step is to review the pattern of symptoms, the investigations already completed and any clinical features that may point towards a particular diagnosis.<\/p>\n
The digestive system depends on coordinated muscular movement, nerve signalling, digestive enzymes, bile acids and communication between the gut and the brain. A disturbance in any of these areas can produce symptoms without creating an abnormality visible during routine endoscopy or scanning.<\/p>\n
Possible explanations include:<\/strong><\/p>\n Several of these conditions can occur together. The history usually provides important clues about which areas require further assessment.<\/p>\n Irritable bowel syndrome<\/a><\/span>, commonly known as IBS, can cause recurrent abdominal pain, bloating and changes in bowel habit. Some people mainly experience constipation, while others have diarrhoea or alternate between the two.<\/p>\n In IBS, the bowel may become more sensitive to stretching caused by food, gas or stool. This is known as visceral hypersensitivity. Bowel movement may also become faster, slower or less coordinated.<\/p>\n IBS is diagnosed from the clinical pattern and appropriate investigations. The extent of testing required varies between patients. Age, family history, duration of symptoms and warning features all influence the assessment.<\/p>\n Persistent diarrhoea may sometimes require investigation for coeliac disease, gut inflammation<\/a><\/span>, microscopic colitis or bile acid diarrhoea before a diagnosis of IBS is made.<\/p>\n Functional dyspepsia commonly causes upper abdominal discomfort, early fullness, nausea, belching and indigestion. Some patients feel full after eating only a small meal. Others develop discomfort or bloating shortly after eating.<\/p>\n Gastroscopy often shows a healthy stomach lining in patients with functional dyspepsia. The symptoms may be associated with increased stomach sensitivity, altered relaxation of the stomach during meals or changes in gastric emptying.<\/p>\n Treatment is selected according to the dominant symptoms. Options may include acid suppression, adjustment of meal size, medication affecting gastric movement or treatment directed towards digestive sensitivity.<\/p>\n A normal gastroscopy can occur in people with gastro-oesophageal reflux disease. Heartburn and regurgitation can arise without visible inflammation in the oesophagus. If you are unsure about testing procedures, it helps to understand how gastroscopy differs from a general endoscopy<\/a><\/span>.<\/p>\n Some patients have reflux hypersensitivity, where ordinary episodes of reflux produce prominent symptoms. Functional heartburn may produce similar symptoms through a different mechanism.<\/p>\n Ambulatory reflux monitoring and oesophageal physiology testing can be considered when symptoms remain troublesome, particularly when treatment has been ineffective or the diagnosis remains uncertain.<\/p>\n Persistent bloating is one of the most frequent reasons for referral to a gastroenterologist. It may be associated with constipation, dietary fermentation, changes in bowel movement or increased sensitivity to normal volumes of intestinal gas.<\/p>\n The sensation of bloating does not always correspond to a large increase in gas. In some patients, coordination between the diaphragm and abdominal wall contributes to visible abdominal distension.<\/p>\n Reviewing bowel habit, meal patterns, medication and dietary triggers can help identify the likely cause.<\/p>\n Lactose intolerance and sensitivity to fermentable carbohydrates can cause abdominal pain, bloating, wind and diarrhoea. The timing of symptoms after meals is often useful.<\/p>\n A short food and symptom diary may help identify a consistent relationship. Dietary trials should be targeted and reviewed after an agreed period. Foods should be reintroduced methodically to determine which restrictions are genuinely required.<\/p>\n Commercial IgG food intolerance blood tests are not recommended for diagnosing food intolerance. These tests frequently result in patients unnecessarily removing several foods from their diet.<\/p>\n Small intestinal bacterial overgrowth, or SIBO, is commonly searched for by patients experiencing bloating, wind, abdominal discomfort and altered bowel habits.<\/p>\n SIBO is more likely when there are conditions affecting the structure or movement of the small bowel. Previous gastrointestinal surgery, significant motility disorders and certain underlying diseases can increase the risk.<\/p>\n Breath testing may be considered in selected patients. The results require careful interpretation because false-positive and false-negative results occur. Repeated antibiotic treatment should follow a clear diagnosis and assessment of any underlying risk factor.<\/p>\n Bile acid diarrhoea, also known as bile acid malabsorption, can cause frequent watery stools, urgency and occasional bowel incontinence.<\/p>\n It may develop following gallbladder removal or disease affecting the end of the small bowel. Many patients have no obvious preceding cause. The symptoms can resemble diarrhoea-predominant IBS.<\/p>\n Specific investigation or a carefully supervised treatment trial may be appropriate when the clinical history suggests bile acid diarrhoea.<\/p>\n Constipation can occur even when someone opens their bowels every day. Hard stools, straining, incomplete emptying, repeated small bowel movements and the need to return to the toilet are all relevant symptoms.<\/p>\n Constipation commonly contributes to abdominal pain and bloating. Some patients have slow movement through the colon. Others have difficulty coordinating the pelvic floor muscles during defaecation.<\/p>\n The treatment depends on the underlying pattern. Increasing dietary fibre may help, although a rapid increase can aggravate bloating in some people. Laxatives, bowel retraining and specialist pelvic floor treatment may be considered where appropriate.<\/p>\n Gastroparesis can cause nausea, vomiting, early fullness, upper abdominal discomfort and difficulty completing meals. Diabetes, previous upper gastrointestinal surgery and some medications increase the likelihood.<\/p>\n Similar symptoms also occur in functional dyspepsia. Gastric emptying tests are usually reserved for patients whose clinical history suggests delayed emptying.<\/p>\n Medication history is particularly important because opioid painkillers and GLP-1 medicines used for diabetes or weight management can slow gastric emptying and produce gastrointestinal symptoms.<\/p>\n Several commonly prescribed medicines affect the digestive system. These include:<\/p>\n The timing of symptoms in relation to starting or changing medication should be reviewed. Prescribed medication should only be stopped or altered after discussion with the relevant clinician.<\/p>\n Further assessment is particularly important when digestive symptoms are accompanied by:<\/p>\n If bowel habits change or bleeding occurs, your doctor may evaluate the need for a private colonoscopy near me<\/a><\/span>. For abnormal liver blood tests, a private liver scan near me<\/a><\/span> or FibroScan<\/a><\/span> may be discussed. Learn more about what private endoscopy actually involves<\/a><\/span> before committing to any procedure.<\/p>\n The decision to perform additional tests should take account of age, previous results, family history and the development of any new symptoms.<\/p>\n It is also helpful to examine the original reports. Relevant details include whether biopsies were taken during endoscopy, whether coeliac blood tests were performed while gluten remained in the diet and whether the terminal ileum was examined during colonoscopy when clinically indicated.<\/p>\n The consultation should establish which diagnosis or combination of diagnoses best explains the symptoms. Any further investigation should answer a defined clinical question.<\/p>\n Treatment can then be directed towards the dominant problem. This may involve managing constipation or diarrhoea, adjusting diet, treating reflux, improving gastric movement or reducing digestive sensitivity.<\/p>\n Changes should usually be introduced in a structured manner. Introducing several treatments simultaneously makes it difficult to identify which one has been effective. A planned clinical review allows progress to be assessed and the treatment plan to be adjusted.<\/p>\n Persistent digestive symptoms following reassuring investigations are common. A detailed review of the symptoms and previous results can often identify a reasonable explanation and provide a clear direction for treatment. If you are searching for a private digestive clinic near me in Milton Keynes<\/strong>, targeted care is available locally. For an overview of care options, explore how a gut health specialist in Milton Keynes<\/a><\/span> can guide your treatment path.<\/p>\n Can I have IBS if my colonoscopy is normal?<\/strong> Can acid reflux occur with a normal gastroscopy?<\/strong> Why am I bloated when all my tests are normal?<\/strong> Should I be tested for SIBO?<\/strong> Can constipation cause bloating even if I open my bowels daily?<\/strong> When should I see a gastroenterologist?<\/strong> Written and clinically reviewed by Dr Arjun Prakash This article provides general medical information. It cannot replace assessment and advice based on your individual symptoms and medical history. Last clinically reviewed: 6 September 2026.<\/em><\/p>\n Fancy stopping the guesswork? Book a consultation with the team at Harmony Digestive & Liver Wellness<\/a><\/span><\/strong> in Milton Keynes, and let’s sort your reflux out together.<\/p>\n Book your consultation with Harmony Digestive & Liver Wellness Centre<\/a><\/strong><\/span> today \u2013 expert gut and liver care, without the long wait.<\/p>\n Book a consultation or screening today: Click Here<\/strong><\/span>.<\/a><\/p>\n To book a private liver or gut consultation or second opinion, Get in touch with us<\/a><\/strong><\/span>.<\/p>\n\n
Irritable Bowel Syndrome<\/span><\/b><\/h3>\n
Functional Dyspepsia<\/span><\/b><\/h3>\n
Acid Reflux Following a Normal Gastroscopy<\/span><\/b><\/h3>\n
Bloating and Excessive Wind<\/span><\/b><\/h3>\n
Food Intolerance<\/span><\/b><\/h3>\n
Small Intestinal Bacterial Overgrowth (SIBO)<\/span><\/b><\/h3>\n
Bile Acid Diarrhoea<\/span><\/b><\/h3>\n
Constipation and Incomplete Emptying<\/span><\/b><\/h3>\n
Gastroparesis and Delayed Stomach Emptying<\/span><\/b><\/h3>\n
Could Medication Be Contributing?<\/span><\/b><\/h3>\n
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When Should Further Investigation Be Considered?<\/span><\/b><\/h3>\n
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What Should Happen After Normal Digestive Tests?<\/span><\/b><\/h3>\n
Frequently Asked Questions<\/span><\/b><\/h3>\n
\nYes. IBS affects bowel function and sensitivity. A colonoscopy examines the bowel lining and is often normal in people with IBS. The diagnosis is based on the pattern of symptoms and appropriate exclusion of other conditions.<\/p>\n
\nYes. Many people with gastro-oesophageal reflux have no visible inflammation during gastroscopy. Reflux monitoring may be considered when the diagnosis remains uncertain.<\/p>\n
\nBloating can be associated with constipation, food intolerance, dietary fermentation, altered bowel movement, visceral hypersensitivity or changes in the coordination of the abdominal wall and diaphragm.<\/p>\n
\nSIBO testing is most useful when symptoms occur alongside recognised risk factors. Breath-test results require clinical interpretation and are unlikely to explain every case of bloating.<\/p>\n
\nYes. Daily bowel movements can occur alongside incomplete emptying or retained stool. Stool consistency, straining and the sensation of incomplete evacuation are also important.<\/p>\n
\nSpecialist assessment may be helpful when symptoms persist despite initial treatment, the diagnosis remains uncertain, symptoms substantially affect daily life or warning features are present.<\/p>\nFinal Thoughts<\/span><\/b><\/h3>\n
\nConsultant Gastroenterologist<\/p>\n