Dr. Radhakrishna Patta

Gastrointestinal bleeding, as the name suggests, is characterized by bleeding in the gastrointestinal (GI) tract and its accessory organs (esophagus, stomach, colon, small intestine, rectum, and anus). The bleeding also referred to as gastrointestinal hemorrhage, is not a disease in itself. However, it may be an indication of a disease, injury or infection in the digestive tract of a person. The bleeding in the GI tract may be mild to chronic (often fatal), depending on the severity of the condition that triggers the bleeding.

What causes the gastrointestinal bleeding?
As stated, the gastrointestinal bleeding may be indicative of some digestive tract disorder. Some of the common conditions that may trigger the bleeding include

• Tumors that are malignant in nature.
• Hemorrhoids (a painful condition where veins around the anus, as well as the lower part of the rectum, swell up)
• Peptic ulcers.
• Diverticulosis (formation of diverticula or pouches in the walls of the large intestine).
• Inflammatory bowel disorder.
• Colon polyps (a small mass of cells that develop on the inner lining of the large intestine or colon).
• There may be problems in the blood vessels (in the digestive tract).
• Anal fissures.
• Esophageal varices (the veins of the stomach or esophagus swell up due to a liver disorder, such as cirrhosis).
• Angiodysplasia (it is a minute vascular malformation that takes place in the gut).
• There may be an inflammation of the gastrointestinal lining.

Symptoms:
The appearance of blood in the stool and vomit is one of the characteristic symptoms of the gastrointestinal bleeding. Other symptoms indicative of a bleeding include

• Weakness and fatigue.
• The stool appears black and tarry.
• A person may complain of uneasiness and shortness of breath.
• The skin appears pale. In some cases, prolonged bleeding that goes unattended may result in anemia.
• Abdominal pain.
• The stool may also appear maroon or bright red (often in the case of bleeding from the lower gastrointestinal part).

Consult a doctor at the earliest if the symptoms persist for more than a week.Timely medical assistance can help to minimize the extent of the damage.

Diagnosis and treatment:
Gastrointestinal bleeding in the colon or the stomach is easy to diagnose. However, the diagnosis of the bleeding that occurs in the small intestine may be tricky and often requires the use of advanced and sophisticated equipment. The diagnosis is often done by

• Physical examination.
• Liver function tests.
• Complete blood count.
• Endoscopy, colonoscopy, and sigmoidoscopy.

Treatment:

• Endoscopic injections (often diluted epinephrine) at the bleeding site provides great relief.
• To close or clamp off a bleeding blood vessel, doctors may use Endoscopic clips.
• Endoscopic intravariceal cyanoacrylate injection is used to treat varices in the stomach effectively.
• There are medications available to treat GI bleeding triggered by ulcers.
• In the case of an acute bleeding, a person may need surgery (Laparoscopy).

Having some fat in your liver is legit. But, if you have too much of fat say more than 5%-10% of the organ's weight then you are at risk of getting fatty liver disease. At the onset, you can do one important thing to help your liver stop drinking. It causes fatty liver disease.

There are two main types of fatty liver disease

• Alcoholic liver disease or ALD
• Non-alcoholic fatty liver disease or NAFLD
• If you are a woman who is pregnant, you can also get fatty liver disease.

1. Alcoholic Liver Disease (ALD)

• You can get ALD from drinking lots of alcohol. ALD can also present itself after a short period of heavy drinking.
• Genetics has a role to play in ALD. Genes can make you hit the bottle and increase your chances of becoming an alcoholic.
• Genes can also impact the way your body breaks down the alcohol you drink.

Other root causes of ALD are:

• Hep C doesn't cause ALD. it is one of the causes of fatty liver.
• Hep B is also a cause of fatty liver. There are certain medications which may be helpful from person to person besides lifestyle management.
• Excess iron in your body
• Obesity

2. Non-alcoholic Fatty Liver Disease (NAFLD)
The cause of NAFLD is not clear, but we know that it tends to run in families.
NAFLD is also more common in the middle-aged and the obese or, those who have high cholesterol and diabetes.

Other risk factors are:

• Certain medicines
• Viral hepatitis
• Auto-immune or inherited liver disease
• Gaining weight fast
• Malnutrition
• Acute Fatty Liver during Pregnancy
• Fat can build up in your liver when you're pregnant, causing this kind of fatty liver disease.
• It’s a serious condition as it can be risky for both you and your baby. It can cause liver or kidney failure in you and your child, both.
• Causes are unknown. But, hormones may play a role.

Symptoms of fatty liver disease
This disease can sometimes cause no symptoms for long. But, the things to look out for are-

• Feeling tired all the time
• Loss of appetite or weight
• General weakness
• Nausea
• Confusion and trouble concentrating
• Your liver can become larger
• Pain in the centre or right upper part of your belly

In ALD, your symptoms get worse after bouts of heavy drinking. Fatty liver disease is diagnosed during routine exams when your doctor notices your enlarged liver. Ultrasound, blood tests to check for certain enzymes and biopsy of the liver are performed to confirm it.

Treatment

• There is no specific treatment for the fatty liver disease.
• You can manage it by managing your diabetes and giving up drinking. If you have ALD and you don’t quit, you get complications like alcoholic hepatitis or cirrhosis.
• Even if you have a non-alcoholic fatty liver disease, alcohol cessation helps.
• Losing weight if you are overweight also helps to manage this disease and having a good balanced diet with exercise also shows benefits.

The build-up of gases in the stomach can be uncomfortable and very embarrassing when it leads to flatulence. Flatulence can be defined as the release of intestinal gas from the anus. This may or may not be accompanied by sound and odour. Both men and women can be affected by flatulence at any age.

Some of the causes of flatulence include:
• Swallowing excessive amounts of air while eating
• Indigestion
• Lactose intolerance

Food that is difficult to digest often triggers the formation of gas such as hydrogen, carbon dioxide, methane and sulphur in the digestive system as a result of the microbial breakdown of this food. Sulphur is largely responsible for the odor that accompanies the release of these gases. Beans, chickpeas, cauliflower and cabbage are some such foods that can trigger flatulence.
Flatulence on its own is not a serious condition and usually resolves itself without medication. However if it triggers severe abdominal cramps, diarrhea, persistent constipation, blood in the stools, nausea and pain in the right side of the abdomen, medical care should be immediately sought.

If flatulence is a problem you suffer from often, take a look at your diet and modify your eating habits. Keep a food diary to determine what food triggers this condition and avoid it. If you are lactose intolerant switch your dairy products for soya substitutes and avoid dairy. Anti-gas compounds that are available over the counter can also provide relief. Chew your food slowly, thoroughly and ensure that your mouth is closed while chewing to prevent swallowing air. For this reason, also avoid chewing gums and fizzy drinks. If you must eat beans, soak them overnight before cooking.

Flatulence can be easily treated with home remedies. Following home remedies can be used
1. Ginger: Ginger aids the digestion process, eases bloating and reduces gas. It also helps stool pass smoothly and helps keep the intestines clear. This does not give stomach gases a chance to build up. Ginger can be consumed in the form of capsules or a tea made by steeping ginger in hot water for a few minutes.
2. Papaya: Along with being rich in antioxidants and flavonoids, papaya contains an enzyme known as papain that helps digest proteins and reduce gas. To benefit from papain, you could eat the papaya fruit or drink a tea made with papaya leaves. Papaya enzymes are also available as supplements.

Feeling bloated or acidic after a heavy meal can take away all the satisfaction the taste of food gave you. Indigestion and gas are some of the most common gastrointestinal problems faced by people around the world. In most cases, indigestion is a result of bad food choices and unhealthy lifestyles. Thus they can simply be relieved at home and do not necessarily need medication. Here are 4 easy steps to lower heartburn, gas and indigestion.

1. Add more fiber to your food: Fiber is crucial to healthy digestion. It is easy to digest and help push waste out of the system by adding bulk. In this way, fiber helps detoxify the system as well. It also prevents diabetes, heart disease, hemorrhoids and other diseases. Add fiber to your diet in the form of whole grains, cereals, fruits, vegetables, nuts and plenty of water. Ideally, a woman should have 25gms of fiber a day and men should have 38 grams of fiber a day.
2. Healthy food eating habits: How you eat also makes a difference to your digestion. Instead of eating on the move, eat mindfully. Chew your food carefully to begin the digestive system. Eating smaller portions can also help improve stomach functioning. Avoid fast foods that are difficult to digest. Ensure that you do not eat anything for at least an hour before going to bed. Lying down immediately after a meal is one of the leading causes of indigestion.
3. Probiotics: Gut bacteria is essential for healthy digestion. This bacteria helps maintain a healthy inner ecosystem and help fight harmful viruses, yeast and other such microorganisms. This balance of gut bacteria can be affected by an unhealthy lifestyle like excessive alcohol consumption, smoking, stress and certain prescription drugs. Supplementing your natural probiotic enzymes with food rich in probiotics like yogurt or probiotic supplements can help make your digestion better.
4. Exercise Regularly: Exercise is necessary not only for a fit body but also for healthy digestion. Exercising also helps fight stress that is one of the leading causes of indigestion. Taking a walk after meals can help regulate the passage of food and gases in your digestive system. This prevents bloating and heartburn. Physical activity also helps stimulate your bowels to prevent constipation and prevent gaseous build up. Some forms of exercise you could try are yoga, swimming and cycling. A word of caution; always ensure that there is at least an hour's gap between exercising and your last meal.

Knowingly or unknowingly, people often end up consuming food items that affect their digestive health negatively, instead of providing health benefits. Yes, the majority of people think that they can digest any kind of food and won't suffer from any side effects at all. But in reality, based on the preparation, processing, and ingredients present in them, some foods end up triggering digestive problems.

Let's take a look at some such foods that can be bad for the digestive health.

1. Processed Foods: Processed or packed foods are high in carbohydrates, and can cause various digestive issues, such as bloating, cramping, gas formation, hypertension, and diabetes, when consumed in large amounts.
2. Alcohol: Technically speaking, alcohol may not be a food; but if you consume alcohol every time you eat, it can be counted as a food item. When the consumption of alcohol is moderate to high, it can cause acid reflux or heartburn, inflammation in the stomach lining, stomach cramps, and even diarrhea.
3. Artificial Sweeteners: Artificial sweeteners may work great for keeping your blood sugar in control but may affect your digestive system adversely. Artificial sweeteners contain ingredients that can increase the chance of bloating, gas, diarrhea and inflammation.
4. Fried and Greasy Foods: Fried foods and greasy food are not only difficult to digest but they can also cause minor digestive problems, which later lead to intense stomach conditions such as acid reflux, heartburn, bloating, tummy upset, belching, etc.
5. Chocolates: Are you fond of eating chocolates? Having a sweet tooth can cost you your digestive health. From heartburn to an upset stomach, eating too many chocolates or candies can result in loose stools and diarrhea.
6. Foods Rich in Spice: Eating too much of spicy foods and those that contain chilli peppers for a tangy flavour can often lead to heartburn and acidity. While you may enjoy eating something delicious with a tangy and spicy taste, the damage it may cause to your digestive health can be a cause of concern.
7. Too Much of Caffeine: Drinking too much coffee or drinks with a high caffeine content cannot only irritate the stomach but also damage the smooth functioning of the digestive system. Heartburn, inflammation, constipation and dehydration are some of the common digestive problems posed by coffee.
8. Raw Vegetables and Acidic Fruits: While consuming too many acidic fruits can cause acid reflux and stomach inflammation, eating raw vegetables leads to cramps, diarrhea, bloating and gas as they pass through the digestive system undigested.

For those who are concerned about their digestive health, consulting a doctor is recommended. In case you already have a stomach related ailment or disorder or have suffered from any in the past, a doctor can suggest and advice you and what are the best foods to incorporate in your diet.

The human body is an intricate mechanism that functions amazingly. And when there is any trouble it does not fail to show signs of trouble, and all we need to do is, to notice it and solve our problems. This is applicable to all types of health issue, including a perianal abscess.

What is perianal abscess?
The extremely painful condition of anal abscess occurs when one cavity in the anus starts getting filled up with pus. Very often it appears as a painful swelling similar to boil just near the anus. Usually, it appears red in color as well as slightly warm to touch. If the location of the anal abscesses is in the deeper tissue, then it might be less visible and it occurs in people suffering from inflammatory bowel disease.
The worst part is that in certain cases, anal abscesses might lead to more painful anal fistulas. Generally, fistulas occur only if the abscesses fail to heal and break open on the skin’s surface. Therefore, it is important that the abscess heals properly or else it may lead to intolerable pain and may even require surgery.

How do you know if it is a perianal abscess?
The immediately noticeable and probably the most common anal abscess symptom is constant and throbbing pain around the anal area. Swelling accompanies the pain and its rate increases during bowel movements. Various other common signs include bleeding or rectal discharge, constipation, fatigue, etc. Besides swelling or tenderness, the affected individual might also suffer from skin irritation all around the anus.
Patients with deeper abscess might also show symptoms such as chills, fever, malaise, etc. Various reports state that certain people also feel a lump or nodule at their anus’s rim. Facing difficulty while urinating might also be experienced by some people affected by perianal abscess.

What to do if you suspect a perianal abscess?
One must immediately seek medical if they experience any of the above-mentioned signs or symptoms. Clinical evaluation along with digital rectal exam is sufficient for the proper diagnosis. But, in some cases, patients might need other tests to screen for rectal cancer, diverticular disease, inflammatory bowel disease and sexually transmitted infections. Your physician might also suggest for a CT scan, an MRI or an ultrasound.
Just after the diagnosis, a prompt surgical drainage would be carried out by the doctor before the abscess erupts. Deeper or larger abscess might require hospitalization as well as an anesthesiologist’s assistance. In most cases, patients are prescribed certain medications for pain relief just after the procedure. Antibiotics are mainly given to those people who have comparatively weaker immunity or suffer from diabetes.

Be aware of your body and report any unusual occurrence to your doctor and follow the advice avoid any complications.

Cancer is one of the most fatal diseases in the world. Stomach cancer is also known as 'Gastric cancer'. Like other diseases, it is crucial that it gets identified in the early stages and gets treated before it reaches the incurable stage. Like other forms of cancer, the exact cause of stomach cancer is still not yet known. However, certain things make stomach cancer more likely to happen.

The possible causes of stomach cancer are given below:

Some of these causes apply to nearly all forms of cancer. However, some of them only apply to stomach cancer.

1. Smoking
2. Obesity
3. Bad diet
4. Stomach surgery for an ulcer
5. Type-A blood
6. Epstein-Barr virus infection
7. Genetics
8. Asbestos
9. Exposure to certain materials in certain industries
10. Helicobacter pylori bacteria
11. Gastritis
12. Anemia
13. Polyps 

Some of the symptoms of stomach cancer are:

Stomach cancer like all other forms of cancer has various stages and it is crucial that it is diagnosed in the early stages so that the progression of it is stymied. At first, the symptoms of stomach cancer include indigestion, loss of appetite, slight nausea, heartburn and the feeling of being bloated after a meal.

However, indigestion and heartburn, doesn't always mean that you have stomach cancer, but if these conditions persist, you should visit a doctor to rule out the possibility of stomach cancer.

The growth of the tumor in your stomach can lead to various serious symptoms too, such as:

1. Stomach pain
2. Heartburn
3. Blood in your stool
4. Weakness or exhaustion
5. Vomiting
6. Diarrhea and constipation
7. Weight loss for no apparent reason
8. Swelling in your stomach
9. Trouble in swallowing
10. Eyes and skin turn yellowish

Anal fissures are the small tears formed in the anal lining. They are also known as anal ulcers. An anal fissure causes a lot of pain and bleeding during your bowel movements. Usually a fissure heals automatically in a few days time. It can be treated with simple home remedies as well.

Causes:

1. You can suffer from an anal fissure if you pass hard and large stools. 
2. Also strained childbirth or suffering from violent spells of diarrhea might get you an anal fissure. 
3. Chronic constipation may also be cause of a fissure. 
4. Other rare causes may be anal cancer, HIV, tuberculosis or herpes. 

Individuals of all age groups can suffer from anal fissures. It is not a very serious problem and heals on its own in a few weeks. Although it can heal itself, there are certain treatments which can help relieve the pain you get from an anal fissure.

Symptoms:
An anal fissure has quite a lot of symptoms for you to understand what you are suffering from:

1. There will be a very visible tear around the anal region. You will be able to spot the tear on the skin very easily.
2. A small lump of skin may form next to the tear.
3. When you will be undergoing your bowel movements, you will feel a very sharp pain in the anal region.
4. You will find spots of blood on the stool passed.
5. You will also feel a burning or an itching sensation in the anal region.

Treatment:
Although most fissures do not require treatment, there are a few remedies that will help cure them faster:

1. Stool softeners: You get certain medicines at the chemist, which are known for their stool softening functions. These stool softeners help to soften the hard stools and initiates smooth bowel movements.
2. Eat fibrous foods: Eat foods rich in fiber like fruits, whole grain cereals, raw vegetables, etc.
3. Take warm baths: Take a bath in warm water as it relaxes your anal muscles, helps to relieve irritation in the region, and increases blood flow in the anorectal region.
4. Use ointment: Apply nitroglycerin ointments and topical pain relievers to promote blood flow to the anal region and to relieve discomfort from the region respectively.

Constipation by itself is not a disease but it a condition in which your bowel movement is infrequent and the stools are hard and difficult to pass.
Constipation happens to most of us at one time or the other and then it goes away naturally. Chronic constipation is constipation which is long-term and it usually signals a deep-rooted medical problem which requires intervention.

Symptom of constipation
While fewer bowel movements is a foremost symptom of constipation, other common symptoms are-

1. Trouble passing stools
2. Pellet-like hard or small stools
3. A sense of being full even after a bowel movement
4. Flatulence, swollen belly
5. Belly pain
6. Throwing up

Causes
Medicines like antacids that contain calcium or aluminium

1. Changes in your lifestyle and usual diet like travelling
2. Having too much of dairy
3. Colon cancer
4. Eating disorders
5. Irritable bowel syndrome or IBS
6. Neurological conditions like Parkinson's disease and multiple sclerosis
7. Inactive lifestyle
8. Less water and fibre in diet
9. Overusing laxatives
10. Pregnancy
11. Problems with the muscles and nerves in the digestive system
12. Drugs like pain medications and narcotics, antidepressants, or iron pills
13. Stress
14. Hypothyroidism

What should you do?
Constipation can be handled by taking simple steps like:

1. Drinking four extra glasses of water a day over your normal intake.
2. Drinking warm water in the morning.
3. Adding more fibre to your diet by eating more fruits and vegetables.
4. Eating more bran cereal and brown rice.
5. You can use a very mild over-the-counter stool softener and laxatives like magnesium hydroxide. But take care to not use them for more than two weeks at a time. If you don’t get any relief, it’s time to call your doctor.

You should not wait to consult a doctor, however, if you have sudden constipation with abdominal pain or extreme cramping and you aren’t able to pass any gas or stool.
Also, call your doctor if:

• Constipation happens out of the blue and is not a new problem for you.
• You see blood in your stool.
• You are losing weight.
• You are experiencing severe pain during bowel movements.
• Your constipation is more than two weeks old.
• You are getting pencil-thin stools.

Diagnosis
The following tests are recommended to unearth the reasons behind chronic constipation:

• Blood tests to check hormone levels
• Barium studies a kind of test which looks for blockages in your colon
• Colonoscopy which again looks for blockages in your colon

A type of constipation which is due to pelvic floor /outlet dysfunction. This may need biofeedback therapy. At times some kind of minor surgery

Prevention
Constipation really is very amenable to diet and lifestyle changes. Eat a well-balanced diet and go for light, regular exercise to prevent chronic constipation. Also, drink two quarts of water every day to keep yourself regular.

There may be times when we get completely drained and fatigued and may feel like our insides could jump out because of the pain that we have in our stomachs. We may dismiss the issue as unimportant or due to a stressful day at work, and may think the stomach pain could be because of the extra spicy food we love to have every once in a while. However, a lot of people may tend to ignore this symptom and that is when stomach ache may turn out to be actually because of a peptic ulcer.

Peptic ulcer or stomach ulcer is a common occurrence and happens to a lot of people; however, it must be understood that not treating the problem in time may be troublesome in the long run and increase the recovery time. In order to be able to identify the peptic ulcers and to take the right treatment measures, it may be important for you to understand the problem and know how it is caused, and how it may be treated.

What causes peptic ulcers?
A peptic ulcer is diagnosed as inflammatory sores on the lining of the stomach or the food pipe, which transfers food to the stomach or even in the intestine. There are a number of factors that can cause inflammatory sores in the stomach region. The factors are as follows:

1. The use of medicines that are meant to be painkillers or anti-inflammatory drugs. The acid levels of the stomach and the food pipe may get disturbed because of these medicines and may give rise to ulcers.
2. In a lot of cases, the ulcers may also take place because of the presence of a tumour or a gastrinoma in the stomach that imbalance the levels of acid in the stomach.
3. High alcohol consumption may also lead to the formation of sores on the stomach lining.
4. Using tobacco or smoking are some other factors that contribute to the acid imbalance in the stomach.
5. In the case of some serious illnesses, a lot of people may fall prey to peptic ulcers.
6. Those who may have undergone radiation treatment around the stomach may also experience ulcers.

Though it may be known that excessive pain in the abdominal region may be due to stomach ulcers, it is important to understand that it happens due to bacterial infections, and when there is a bacterial infection in the body, you may have to undergo proper treatment. The treatment for this problem includes the use of medications as suggested by a qualified doctor, surgery in some severe cases, and most importantly lifestyle changes. In case you have a concern or query you can always consult an expert & get answers to your questions!