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).

Gastrointestinal Bleeding - How It Can Be Treated?

The liver is the engine of the human body. It is basically composed of 2 types of cells (a cell is the basic building block of the human body)   hepatocytes (liver cells) and cholangiocytes (bile duct cells). It also has other supporting tissue and their respective cells. The hepatocytes are by far the most numerous cell type, not surprisingly tumours (otherwise called mass or lump.  Tumor  means lump in Latin), of this cell form the majority of abnormal growths in the liver. Abnormal growths can be benign (that is, they do not grow rapidly, spread to other parts of the organ or to other parts of the body) or malignant (grow rapidly, spread to other parts of the organ and to other parts of the body, i.e. cancer). These abnormal growths from liver cells are Focal nodular hyperplasia (FNH), Adenomas (the benign variety) and hepatocellular cancer (otherwise called Hepatoma/HCC, the cancerous type). What we need to recognize is that certain adenomas can turn into HCC, over a period of time. The other type of growths in the liver are those that have originated elsewhere in the body and spread to the liver, for example a growth of the breast spreading to the liver. These are in fact the commonest tumours of the liver. I will discuss these at a later date.

Benign growths of the liver

Common benign growths are Haemangiomas, FNH and Adenoma. Most of these are identified when a scan is performed as investigation for some other problem. Accurate diagnosis of the nature of these lumps is important to determine the type of treatment needed. This can be ascertained by a carefully selected scan like an Ultrasound, CT scan or an MRI. The technology of these scans is continuing to evolve and get better year on year. There are different types of Ultrasound, CT and MRI scans with different applications, based on whether contrast is used or not, the different phases of scanning, the type of MRI scanning sequence etc. Therefore, these scans although commonly available and used very frequently, need to be performed under the supervision of a team involving Liver doctors and radiologist who is well versed in the diagnosis of liver lumps, for accurate diagnosis without the need for unnecessary tests (Box 1).

Haemangiomas are by far the commonest. It is estimated that 5% of the adult population harbor this lump in their livers! They occur in both sexes and at all ages but are commonest between 30 to 50 years in women. Most of them are small, less than 4-5 cms in diameter and are are identified on Ultrasound. MRI and its various applications is the scan of choice for accurate diagnosis. This is crucial as most of them do not need treatment.

Focal Nodular Hyperplasia (FNH) are the second most common liver lumps. They are usually single and small (less than 4 cms) and occur in women between 35   50 years of age. About 2.5-3% of population harbor this lump in their livers. Special MRI techniques using special contrast agents is diagnostic and the findings are quite distinct from haemangiomas. Again treatment is not recommended apart from selected circumstances. Assessment in a dedicated Liver team is recommended for accurate diagnosis and a proper management plan to be formulated.

Hepatic adenomas (Hepatocellular adenoma, HCA) are rare lumps and occur in 0.2 to 0.3% of the population, again occurring mostly in young women during their reproductive period. They are again solitary and most usually 3-4 ms in diameter.

There are a couple characteristics which make this lump different from the previous 2, there is a strong relation between hormones the development of HCA and some of these HCA can turn into the malignant Hepatocellular carcinoma (HCC). Therefore, accurate characterization and diagnosis of these HCA is essential. Sometimes biopsy of the lump, molecular and genetic tests maybe necessary to determine if the HCA has a high chance of progressing to HCC. Imaging tests are generally adequate, contrast MRI Liver and its different techniques is accurate in diagnosing HCA and sub-typing it, however CT and contrast-enhanced Ultrasound is sometimes necessary along with MRI.

Generally, a HCA in a male is recommended for surgical resection. While in women, discontinuation of the OCP pill/ any other such hormone is recommended for a period of 6 months, if the HCA does not have any worrying features and size is less than 5 cms. IF HCA is larger than 5 cms and has features suggestive of a high risk for change to HCC, surgery is advised. Again these decisions have to be made as a part of a Multi-disciplinary team (Box 1)

Malignant growths beginning within the Liver

As mentioned earlier, usually malignant growths which are seen in the liver spread to it from elsewhere in the body. Hepatocellular cancer/Hepatoma (HCC) is the commonest malignant tumour beginning within the liver, as apposed to those that spread to the liver from elsewhere. It occurs between 40-70 years of age and occurs commonly in men. It is estimated that 17000 new patients develop this tumour every year in India. The vast majority (> 80%) of these develop in patients who have chronic liver disease (cirrhosis). Importantly the number of HCC cases is increasing year on year as cirrhosis due to fatty liver disease, Hepatitis B (3% of Indian population carry this virus, ie nearly 40 million individuals) and alcohol are continuing to increase in India. Nearly overall it is the 4th or 5th most common cause of cancer and the second most common cause of cancer-related death. This is continuing to increase too. We do not have a national policy in India to screen and diagnose these lumps in the liver at an early stage. Most patients present at a late stage when effective treatment is not possible.

Hepatitis B is a vaccine-preventable disease, there are good drugs to treat it and decrease the risk of cirrhosis and HCC in HBV patients, therefore it is important to test for this virus infection. The fatty liver disease can cause chronic liver damage and HCC, regular exercise and consuming a balanced diet can reduce the risk of fatty liver disease.

The usual mode of detection of these growths is when a scan is done for some other reason. Occasionally patients can develop pain in the abdomen or jaundice which leads to an investigation. The treatment of HCC depends on the extent of tumour, the extent of the chronic liver disease (the stage of cirrhosis) and the overall condition of the patient. These patients are best seen, assessed and treated in a team (Box 1) which specializes in the treatment of Liver disease.

The best treatment for HCC is surgery. However, this is suitable only for certain carefully selected patients. This can take the form of liver resection (where a portion of the liver with tumour is removed) or liver transplantation (where the whole liver is removed and a donated liver (full or partial) is replaced into the patient. Indeed surgical has excellent survival rates; more than 75% of patients survive for more than 5 years after resection or transplantation making treatment for these cancers one of the most satisfactory.

Other treatments which can be combined with surgery in selected patients or can be combined with patients not suitable for surgery are different types of Interventional radiological therapy   chemotherapy or radiotherapy delivered through fine catheters introduced into the blood vessels of the liver (TACE: Transarterial chemotherapy, TARE: Transarterial radiotherapy) and or heat energy delivered to the tumour area by means of carefully placed needles/probes (RFA: radiofrequency ablation, MWA: microwave ablation).

HCC is unique cancer as its treatment should be tailored to the patient, the treatments are varied and range from catheter-based non-invasive treatment to major surgery and transplantation. This necessitates that HCC patients are best managed in a multidisciplinary team which is highly skilled in and specializes in the management of liver diseases.

Box 1: A liver tumour multidisciplinary team   Integrated Liver Care team

The team should be one with expertise in the management of benign liver lesions and should include a Hepatologist, a Hepatobiliary & Transplant surgeon, Diagnostic and Interventional radiologists, Medical oncologist and a Pathologist.

Each member of the team must hold specific and relevant training, expertise and experience relevant to the management of benign liver lesions.

The team should be one with the skills required not only to appropriately manage these patients but also to manage the rare but known complications of diagnostic or therapeutic interventions.

The Increasing Problem Of Liver Tumours In India!

Homeopathy can very well dissolve gall stones of small and medium sizes, and relieve the gall bladder and body permanently from the pain, suffering and complications coming from gall stones. One of the benefits of homeopathic treatment for gall stones is that your gall bladder does not need removal, and being an important organ for producing digestive enzymes, it is better to keep it in your body. The other benefit is that you get a side effect-free treatment, which is completely efficient and practical, and costs really low compared to other modes of treatments and surgeries.

But before one goes for a homeopathic treatment, a complete evaluation of the patient s case history must be done so that the right medicine can be given as per the case, history, severity etc. Here is a quick look at the commonly used homeopathic medicines, which doctors, depending on your case history, may prescribe for your gall stone.

Homeopathic medicines used for treating gall stones

Calcarea carbonica: If you have a family history of kidney and gall stones, are anxious and slow, overweight with high deposits of triglycerides and cholesterol, then you would be given this medicine.
Chelidonium: If you get pain in any or both of the two patterns pain originating under your right shoulder blade and pain in the upper right abdomen, which spreads to the back, you will be prescribed this one.
Lycopodium: This medicine is usually recommended in case you have a family history of stones in kidney and gall bladder, along with other complications like, chronic digestive disorders, high cholesterol, gastric problems, constipation, peptic ulcers, gas and bloating. The patient may usually get biliary colic pains late in the afternoon. He or she may also get irritated easily, and hate contradicting opinions.
Natrum sulphuricum: The patient may have any or some of the problems like chronic diarrhea, gall stone pain, asthma, chronic obstructive pulmonary disease, depression, obesity and problem in joints. On top of that the patient may be too sensitive to changes in humidity and weather. In such a case, Natrum sulphuricum is given.
Nux vomica: If a patient suffers from nausea, colic pains, spasmodic pains, heartburn and acidity, gas and bloating, and takes too much of rich and oily food and drinks, then this medicine is used to treat gall stones for him or her.
As you can see, there is a remedy for all types of patients. Hence in case of small to medium sized gall stones, you can always retain the gall bladder, avoid surgeries, and keep patience with systematic homeopathic treatment from an expert doctor. You will get positive results soon.

Gallbladder Stone - Can Homeopathy Treat it?

Irritable bowel syndrome is a disorder of the large intestine. It may cause abdominal pain, bloating, diarrhea and constipation. The condition is not life threatening in nature and does not make you susceptible to colon disorders such as Crohn's disease, ulcerative colitis and colon cancer, however, symptoms of IBS may act as deterrents in leading a normal life.

Symptoms
The symptoms of irritable bowel syndrome are: 
1. You may experience symptoms of constipation
2. Frequent episodes of diarrhea
3. Abdominal cramps especially on the lower part of the abdomen
4. Constant bloating
5. Abnormal stool structure 
6. You belly might stick out 
In some cases, you may experience sexual problems and urinary problems. In addition, if you also suffer from stress related disorders then it might aggravate the symptoms.

Causes
The primary cause is that the colon becomes very sensitive such that small stimulation may cause it to react. When the food passes through the colon, it tends contract strongly and leads to complications, such as bloating and constipation. It may also lead to weak contractions of the colon which leads to hardened stool.
There are certain things which may symptoms of IBS, they are: 

1. Stress: Any type of stress tends to aggravate symptoms of irritable bowel syndrome.

2. Foods: Certain foods such as chocolate, spices, cabbage, milk and carbonated beverages may trigger symptoms of IBS.

3. Hormones: Hormonal changes such as the ones during menstrual cycles may aggravate symptoms of IBS. 

4. Illnesses: Various illnesses such as diarrhea or conditions such as overproduction of bacteria in the intestines may lead to symptoms of irritable bowel syndrome.

Women are more likely to be affected by symptoms of IBS as are people who are below 45 years of age. If someone in your family has irritable bowel syndrome, then you are also likely to develop this disorder. It may also aggravate symptoms of hemorrhoids, along with aggravating symptoms of stress.

All About Irritable Bowel Syndrome

Bloating is a condition in which the abdomen swells up and the affected person starts feeling uneasy. It affects both children and adults. Gas is a condition which is characterized by bloating, burping and pain in your abdomen. It usually forms when swallowed air reacts with the gases created by the stomach bacteria breaking down the undigested food in your large intestine. Excessive gas by itself can also lead to bloating of the stomach.

Gas can also cause a lot of problems if not treated on time, such as:

Acute and sudden abdominal pain.

Vomiting due to dizziness caused by gas.

Weight loss if gas formation or bloating becomes chronic.

Fainting can also be an early symptom of excessive gas build up.

Bleeding from the anus in severe cases.

Bloating and gas can be cured by homeopathic remedies:

Homeopathic medicines are very efficient in treating bloated abdomen. Sourced from natural substances, Homeopathic remedies are very beneficial in treating cases of bloatedness. Homeopathy provides complete recovery from bloatedness. The Homeopathic treatment for bloated abdomen is also of great help in releasing the wind from abdomen, thereby providing relief to the patient. The pain in the abdomen, burning and other associated symptoms also disappear with the use of natural Homeopathic medicines. Some of the most common homeopathic medicines for bloating and gas are:

Carbo-Vegetabilis: This is possibly the most commonly prescribed medication for common gas and bloating related disorders. This medication is effective in treating bloating and gas formation in the upper abdominal region. Symptoms where this medication may be prescribed include sour burping with a burning sensation, relief with passing wind and even slight difficulties in breathing.

Magnesium Phosphorus: An effective remedy if you are have pain in your lower abdomen due to the accumulation of gas. The pain might be a constant cramping pain or it may come and go. Hiccups and belching may also accompany the episodes of stomach pain.

Natrum Carbonicum: Some people have to stay on very restrictive diets for most of their lives due to the fear of gas and bloating. Certain food items may suddenly trigger the painful build up of gas and also cause bloating. Milk products can cause diarrhea with these people as well. Natrum Carbonicum works wonders in such cases.

Nux Vomica: If your bloating is caused by indigestion then Nux Vomica is one of the best options out there to correct this problem.

Lycopodium: If you have a tendency to of bloating or gas after consuming onion or garlic, Lycopodium is a great remedy.

Pulsatilla   Neither commonly used medication, pulsatilla is use when you have slow digestive system and bloating is caused by eating sweet products such as ice-creams or cakes and fatty food in general.

These are just a few of the commonly used Homeopathic remedies and are mentioned only to create awareness about the effectiveness of Homeopathic medicines for bloating and gas. It is not advisable to resort to self-medication for any disease.

Homeopathic Remedies for Bloating and Gas

Anal fistula presents itself as a nodular swelling in perianal region. Off and on pus discharge is also seen from this swelling. When pus gets accumulated it gives rise to pain which subsides once the pus discharges out. Usually surgery (Fistulectomy/ VAAFT/ MAFT/ Laser etc.) is advised to manage Anal Fistula. But it is not a good choice as the chances of recurrence of Fistula are very high after these procedures. Whereas Anal Fistula can be completely treated by Graded KsharsutraTM Treatment. 

Clinical trials conducted by Indian Council of Medical Research (ICMR) at AIIMS - New Delhi and PGI - Chandigarh; have confirmed that Ksharsutra treatment is more convenient and more effective than surgery in patients suffering from Anal Fistula. 

What is Graded KsharsutraTM Therapy? How does it Works?

The Ksharsutra therapy is a specialized procedure of Ayurvedic surgery. Ayurvedic surgeon has to first evaluate the anal fistula by clinical examination and if required MRI Fistulogram may be done. Graded KsharsutraTM treatment involves the use of a specialized medicated thread which is placed in Fistula tract. Before placing the Graded KsharsutraTM; it is mandatory to define the fistulous tract properly by careful probing and MRI Fistulogram. 

Medicine released from Graded KsharsutraTM debrides the fistula tract and induces healing. This medicine works for 5-7 days. So, old Ksharsutra needs to be replaced by a new one at a week or 10 days interval till fistula heals completely.

Why Graded KsharsutraTM Therapy Better Than Surgery/VAAFT?

  In appox. 20% cases fistula recurs after surgery however chances of recurrence of Fistula after Graded KsharsutraTM Therapy are predictably NIL.

  Fistula surgery is done under spinal or general anesthesia. So, anesthesia related complications like headache, backache, effect on brain, urinary retention etc. are usually seen while Graded KsharsutraTM is done under local anesthesia which is comparatively safe and there is no complication in it.

  Complications like stool incontinence (inability to hold stool) etc. are seen in surgery. Such complications are not seen in Graded KsharsutraTM Therapy.

  Other complications like pain, bleeding, infection etc. are also seen after surgery. There is no fresh tissue injury in Graded KsharsutraTM so such complications are not seen.

  Hospitalization is necessary in surgery for Anal Fistula. However, Graded KsharsutraTM Therapy is an OPD procedure and hospitalization is not necessary.

  Surgery is followed by bed rest. Bed rest is not required in Graded KsharsutraTM Therapy and patient can continue his normal daily routine activities as usual during this treatment.

  Graded KsharsutraTM Treatment is also more economical and convenient than Surgery. 

Therefore, patients suffering from Anal Fistula are advised to SAY NO TO SURGERY and opt for a better treatment i.e. Graded KsharsutraTM.

Anal Fistula - Why Is Graded Ksharsutra Therapy Better Than Surgery/VAAFT?

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