Anal fissure

What is an anal fissure?

It is a painful crack in the internal lining of anus. This condition is common in all age groups. It is not a cancer.

How is it caused?

In patients who have constipation hard stools may tear the internal lining and cause an anal fissure. Some of these are associated with childbirth. Rarely, it is because of another illness such as tuberculosis or a type of inflammatory bowel disease known as Crohn's disease.

What are the symptoms?

Passing stool is very painful and this pain may persist. Occasionally there is bright red bleeding that may stain the stool or come in drops.

How is this condition treated?

Some fissures get better without any special treatment. However, most require treatment, as it is a very painful condition.

1. Steroid ointments, painkillers, local anaesthetic creams and warm baths relieve pain but do not help in healing.
   
2. Nitroglycerin (0.2%) applied locally twice daily every day for 6 weeks will cure about 70% of these fissures. This ointment is very difficult to obtain in India. The side effects of this ointment application include troublesome headaches and even faintness.
   
3. Quick healing can be achieved by partially dividing the anal sphincteric muscle, but this requires an operation.
   
4. Anal dilatation is a rather crude method of overcoming spasm of the anal sphincter and this may result in complete damage to the sphincter especially in women.
   

When is an operation necessary?

If the fissure does not get better on its own and there is a lot of pain, it is advisable to have an operation called lateral internal sphincterotomy.

In this operation, the surgeon examines the patient under anaesthesia, may take a biopsy if he thinks it is necessary and cuts the anal sphincter partially. Often, a portion of skin that sits just below the fissure called sentinel pile is also removed. Once the sphincter is divided, pain relief is instantaneous and the fissure heals rapidly as the blood flow to that area increases.

What are the problems associated with it?

After this operation minor leakage of stool for a variable length of time may occur. The ability to distinguish between wind and stool may be lost temporarily. There is complete recovery in almost all the cases.

How can fissure development be prevented?

The best way to avoid an anal fissure is to avoid constipation which can be done by taking a diet rich in dietary fibre which includes fruits, green leafy vegetables, wheat flour (atta) and the like.

Peptic Ulcer

What is an ulcer and how is peptic ulcer different?

The definition of an ulcer is a break in the lining, which is more than three millimetres in size. Peptic ulcer is situated in the stomach or the early part of the intestine, which is known as duodenum. Quite often it is called gastric ulcer or duodenal ulcer.

What is the cause of peptic ulcers?

There is constant balance going on in the lining of the stomach and duodenum whereby it is getting destroyed and regenerated. Anything that tips the balance towards more destruction would lead to an ulcer. The commonest cause being an infection by an organism known as H. pylori and there are other causes like excess intake of aspirin and other painkillers, smoking, alcohol, stress and so on.

How does this bacteria cause the problem? How does it get inside the body?

The H. pylori bacterium was discovered in 1984 to be the cause of the peptic ulcer or duodenal ulcer. They enter the body via food or contaminated water. Once they enter a part of the stomach called antrum, they produce antral gastritis or inflammation in the stomach. This inflammation results in excessive acid production in the stomach; this acid then goes to the duodenum and attacks the duodenal lining, which then gets ulcerated. This is the mechanism by which, Helicobacter pylori causes duodenal or gastric ulcer disease, which is predominantly known as peptic ulcer.

What is the difference in behaviour of this ulcer in children and adults?

There is no difference between the ulcer behaviour in children or adults. In children, the infection comes early and that is why they develop symptoms like burning sensation and pain in the empty stomach. The only difference in children and adults is that in adults if the ulcer occurs repeatedly, they may get the narrowing or constriction of duodenum causing duodenal stenosis or these ulcers can bleed massively which is not very common in children, though it can happen in children also.

Is stress a cause of peptic ulcer?

Yes, stress of various kinds like stress of surgery, day-to-day stress due to certain drugs or diseases, can tip the balance of injury versus regeneration. So if regeneration is not taking place in proper time then the ulcer can form and lead to problems.

What are the symptoms of peptic ulcer?

The commonest symptom is pain in the upper part of the abdomen. This pain comes for about two to three hours after meals depending upon the location of the ulcer. People often wakeup at night due to the pain, which can be relieved by taking glucose or biscuits.

Which food products should be avoided in peptic ulcer?

Food products like caffeine and nicotine can delay the natural healing. Everybody at some point of his or her life gets a mild injury in the stomach but not everyone develops an ulcer. The ulcer would only develop if there is a repeated stress, infection or repetitive use of any drug, which tips the balance. It is also a biochemical phenomenon where certain chemicals being produced are inhibited by drugs and the body.

These symptoms are very often similar to other gastric problems; how would a person know that the problem is peptic ulcer specifically?

The symptoms of peptic ulcer can mimic other diseases like oesophageal reflux disease. Gastric cancer can also produce similar symptoms and some sort of gastritis also produces similar symptoms. But there are other symptoms like a burning pain on empty stomach, which increases at night and bleeding may occur sometimes. If the patient gets black coloured stools or vomits two to three hours after meals, then these are the symptoms, which tell that there is a high chance of getting peptic ulcer disease. But final diagnosis can only be done by endoscopy.
Is endoscopy the 100 per cent proof of getting the correct diagnosis?

Yes, endoscopy is the 100 per cent proof of getting the correct diagnosis in peptic ulcer disease. At the same time, one can take the biopsies and confirm the H. pylori infection and differentiate whether one has any other type of gastritis, cancer or lymphoma.

Ten years back my ulcer started bleeding suddenly and I was admitted to the hospital. The bleeding was so profuse that my haemoglobin, which used to be 13, came down to 6.8 in a couple of hours. I was infused with blood and it was diagnosed as ulcer and I was given the treatment for 45 days. A few years later I bled again and had to be hospitalised where my bleeding was controlled within 24 hours. I was given the treatment for H. pylori for 45 days again. But I still feel the pain in my chest. Specially while travelling on a scooter on a bumpy road. Do I have to go for treatment and endoscopy again? Is it an extreme case?

No it’s not an extreme case. In the present era, complications of ulcers bleeding and perforation are seen more often than they were seen earlier, because most early ulcers are being treated very well by medications. Bleeding is a life-threatening situation, where the caller was rightly endoscoped. Quite often doctor’s give the injection around the ulcer endoscpically and stop the bleeding. There is a standard protocol, which we follow and after a certain criteria is reached, we declare that the medical treatment has failed therefore a surgical option is required. But in the patient's case, the medical treatment has worked very well. If he is continuing to have symptoms, he could see a gastroenterologist.

I am 22 years old. I am suffering from peptic disease. There is a continuous pain in the food pipe. I do not smoke or drink. What should I do?

Your symptoms are of gastro-oesophageal reflux disease. Generally, there is a one-way traffic from the food pipe to the stomach and the contents of the stomach are not allowed to go into the food pipe. But when the acid from the stomach goes into the food pipe, it produces pain and burning sensation in the chest. This is aggravated by heavy meals or food items like chocolate, coffee, or excess of smoking. Sometimes this problem gets aggravated if the person is overweight. The cause of reflux disease is weakness of the muscle at the end of the food pipe or hiatus hernia, which allows free passage into the oesophagus. These symptoms can be controlled by diet manipulation. You should have small frequent meals, avoid coffee and chocolates, do not lie down for two to three hours after the meals. If your symptoms disappear with these adjustments, its very good. But if this lifestyle modification is not adequate, then you need a medical treatment to suppress the acid in the stomach like proton pump inhibitor or H2-receptor blockers. In case the disease is severe, you need an operation.

I am suffering from severe peptic disease for the past one year. I have tried various medicines like Nxpro, Mucaine gel and many other gels. But no ulcer was found in the endoscopic examination. However, there was a positive test for H. pylori. But despite continued medication, I have severe pain in the food pipe. I have a lot of discomfort. I do not smoke or drink, I don't eat chocolates or drink coffee and neither am I overweight. I work in a call centre so I have a night scheduled job. Please help me.

Firstly, the bacteria should be eradicated. Secondly, she has the symptoms of gastro-oesophageal reflux disease rather than those of ulcer. For that, the gastroenterologist would need to go into the details of her history. If that is the case, then some modifications in the medication would be required.

Her symptoms can be labelled as non-ulcer dyspepsia. She has dyspeptic symptoms but there is no documented ulcer on endoscopy. In this situation, lifestyle modification helps a lot.

What is the treatment of peptic ulcer? Does medication help? At what stage is surgery required?

Firstly, we need to find out an established cause. There could be an infection or the patient would be taking aspirin or other medications, intake of alcohol, smoking, etc. The cause has to be removed, because one cannot continue smoking and expect medicines to work. The medicines have undergone a revolutionary change. The present day medications are excellent and very few patients have to go for an operation. Failed medical treatment requires surgery. Surgery is required only when there is perforation of the ulcer or uncontrolled bleeding. If the ulcer has narrowed the passage from where the food moves forward, then we have to make an alternate passage.

Can drinking alcohol and smoking be continued after treatment?

The incidence of ulcer coming back after restarting smoking or drinking is quite high, so one should avoid it completely.

I am suffering from oesophageal reflux from the last 20 years. I am taking symptomatic treatment, which is responding well. Please suggest some remedies and precautions because I am diabetic. I am non-smoker and non-alcoholic.

Since he is suffering from reflux disease and the medications are helping him, the general plan is to have a lifestyle modification. One should take small frequent meals and not lie down, do not have spicy food and do not have colas and chocolates. The medications should be taken in the full dose six to twelve weeks. The medications can be reduced after six to twelve weeks of complete healing. The medicines should be brought to a minimum level when symptoms are not there. If it is completely asymptomatic on a low dose of medication for six months, he can be taken off the medication. But if his requirement of medication is continuous for 20 years, I would suggest evaluation for laparoscopic surgery by which the reflux disease can be reduced.

I am 21-year-old student. I have been living in the hostel for the past three years; therefore, my eating timings are not regular especially for lunch. Whenever I wakeup in the morning I get burning sensation in the solar plexus area. I showed it to a doctor, who said that this probably is the beginning stage of an ulcer. He told me to take Rabeprazole sodium. What is the efficacy of the medicine? Do I need diet restriction or do I have to take medication all my life? How can stop this from becoming a chronic problem?

Your symptoms are suggestive of peptic ulcer disease. Rabeprazole sodium is a good medication to improve peptic ulcer. But to completely eradicate the ulcer, it is better to treat the H. pylori infection. Once the infection is eradicated completely, the chances of ulcer becoming chronic are less than one to two per cent. You should avoid NSAID’s (Non-steroidal anti-inflammatory drugs) like aspirin, ibuprofen. You need to take small frequent meals. Don’t keep your stomach empty for a long time, this will help you to improve your symptoms. To completely eradicate the ulcer it is better to undergo endoscopy to confirm whether you have H. pylori infection. Then get it treated completely.

PSEUDOMEMBRANOUS COLITIS

Background: Pseudomembranous colitis (PMC) is a disease process commonly associated with hospitalization and prior antibiotic exposure. Initially thought to be caused by staphylococcal infection, PMC is now believed to be caused almost exclusively by toxins produced by Clostridium difficile. The identification of C difficile as a common etiologic agent has guided many of the current diagnostic and therapeutic measures for PMC. This condition may also be called antibiotic-associated colitis, C difficile colitis, or C difficile diarrhea, reflecting the range of severity of this disease from mild diarrhea to life-threatening colitis. Although C difficile can cause antibiotic-associated diarrhea, this term is usually reserved for milder disease that is not caused by C difficile or its toxins.

Pathophysiology: PMC is believed to result from an inflammatory reaction of the bowel wall to luminal toxins produced by C difficile. Disease-producing C difficile may be newly acquired or may represent endogenous overgrowth following disruption of the normal flora, usually by antibiotic therapy. Presence of pseudomembranes strongly suggests a toxin-mediated process secondary to C difficile. These pseudomembranes represent a mixture of inflammatory cells, fibrin, and bacterial and cellular components, which exude from the bowel mucosa.

C difficile causes an inflammatory reaction by producing 2 potent toxins:
Toxin A is an enterotoxin that binds to known receptors in the bowel wall. This process leads to activation of the inflammatory cascade, cytoskeletal derangements, and disruption of the intercellular tight junctions, causing fluid secretion, mucosal injury, edema, and inflammation.

Toxin B is a cytotoxin for which a receptor has not been found in the human bowel mucosa; however, this cytotoxin also appears to act as a cytoskeletal disruptor, leading to further mucosal injury. Toxin B may play a role in activating the inflammatory cascade

History:
Critical elements for the development of PMC include the following:
History of antibiotic exposureSymptoms can develop as early as a single day after exposure, although they typically develop approximately 5-10 days after the initiation of antibiotic therapy. Symptoms can occur as late as 10 weeks after cessation of antibiotic therapy.Commonly implicated antibiotics include clindamycin, ampicillin and other penicillins, and third-generation cephalosporins; however, some reports implicate nearly all antibiotics, including fluoroquinolones and some antineoplastic agents that have antibacterial activity.Some patients may develop PMC without a clearly identified antibiotic exposure.Colonization with C difficileGenerally, colonization occurs following ingestion of acid-resistant spores.In the hospital environment, the spores are common contaminants from patients harboring C difficile. The organism can be transmitted via fomites or the hands of health care providers.C difficile is also ubiquitous in the environment and can be found in asymptomatic individuals, especially neonates.Agents or events affecting gut motilityAgents that impact the bowel, including enemas, stool softeners, and opioids, are identified as risk factors for disease development.Patients who have had abdominal surgery with subsequent ileus are also at increased risk.The clinical presentation of C difficile–associated disease can range from diarrhea to severe colitis with pseudomembrane formation complicated by development of toxic megacolon or colonic perforation. The most common presentation is cramping abdominal pain with profuse, mucoid, greenish, malodorous watery stools.

Clinical signs:
Diarrhea (mild and self-limited or severe with more than 20 stools per day)
Leukocytosis (50-60% of patients)
Fever (30-50% of patients)
Abdominal pain or cramping (20-33% of patients)Other findings
Nausea
Malaise
Anorexia
Hypoalbuminemia
Anasarca
Electrolyte disturbances
Occult colonic bleeding

DehydrationColitis can be present without accompanying diarrhea, particularly in patients with right-sided colonic involvement. Patients with right-sided disease often present with fever and right lower-quadrant (RLQ) pain, often postoperatively when taking antiperistaltic or opiate medications.

Extraintestinal manifestations are rare and include the following:
Bacteremia, generally polymicrobial
Splenic abscess
Osteomyelitis

Reactive arthritis or tenosynovitisPhysical:
The diagnosis of PMC primarily relies upon an appropriate suggestive history. Physical examination findings for PMC include fever, abdominal pain, and diarrhea. The abdominal pain can manifest in various ways. Sometimes generalized, diffuse, and cramping, it can also manifest as focal pain mimicking an acute abdomen. Evidence of peritoneal signs should immediately raise the possibility of fulminant colitis and toxic megacolon.

In cases of severe diarrhea, physical signs suggestive of dehydration (eg, dry mucous membranes, decreased skin turgor, orthostasis) may be present as well.

Causes: More than 90% of cases with pseudomembranes are directly linked to toxigenic C difficile. Other potential causes include infection with Staphylococcus species or enterotoxigenic Clostridium perfringens. Data supporting these agents as causes of PMC are limited

Medical Care:
Initial management
The initial management of PMC involves discontinuation of antibiotics or other potentially inciting agents and supportive care for the diarrhea, including repletion of fluid and electrolyte losses. Up to 25% of cases resolve without further treatment. The remainder generally require specific therapy for C difficile infection, particularly if antibiotic therapy cannot be discontinued.

Test confirmation of C difficile involvement is indicated prior to treatment, provided the patient is not critically ill.

Implement enteric (contact) isolation precautions to reduce the spread of C difficile to other hospitalized patients. Measures include proper hand washing and disinfection of potential fomites.Oral metronidazole at a dose of 500 mg tid or 250 mg qid for 10 days is the first-line therapy for PMC associated with C difficile. Because of concerns regarding the development of vancomycin-resistant enterococci, cost, and equivalent efficacy, oral vancomycin is reserved for use in the following situations:Patients failing to respond to metronidazole

Organisms resistant to metronidazole: Recurrence of disease is not commonly associated with resistance and thus should be treated with a second course of oral metronidazole.

Patients who cannot tolerate metronidazole
Patients who are pregnant or younger than 10 years
Patients who are critically ill secondary to C difficile infection (toxic megacolon, colonic perforations)
Evidence that diarrhea is secondary to Staphylococcus aureus infection (staphylococcal enterocolitis)Recommended doses of oral vancomycin are 125 mg qid for 10 days. In the setting of ileus, higher doses (500 mg qid) may be needed to deliver adequate antibiotic doses to the affected intestines.
Second-line agents include the following:Oral bacitracin (not readily available)
Teicoplanin (not available in the United States)
Fusidic acid (not available in the United States)
Anion-exchange resin agents (eg, cholestyramine, colestipol)Despite the lack of conclusive clinical trials, intravenous metronidazole, 500 mg q6h, is generally recognized as adequate therapy for patients who cannot tolerate oral therapy (although failures have been documented).

Intravenous vancomycin therapy is not adequate because no significant delivery of vancomycin to the bowel lumen occurs.

Rectal vancomycin by colonic infusion via a catheter has been anecdotally reported. This treatment has usually been limited to adjunctive therapy with intravenous metronidazole. Concomitant therapy with rifampin has also been reported; however, conclusive data are lacking.
Avoidance of antimotility agents, including loperamide, diphenoxylate hydrochloride with atropine, and opioids, is necessary because these agents can adversely affect recovery and ability to clear the toxins.

Patients generally respond to 7-10 days of metronidazole or vancomycin therapy; however, patients with severe colitis or underlying GI conditions (eg, irritable bowel syndrome, lactose intolerance) may require prolonged courses of therapy.Surgical Care: Surgical intervention is usually indicated for patients whose conditions are complicated by toxic megacolon with subsequent risk for perforation or existing perforation. The frequency of surgical intervention is low, reported at 0.39-3.6% of cases of C difficile–associated colitis. Various approaches can be used, including diverting ostomy of the affected segment or subtotal colectomy. The overall mortality rate for patients requiring surgery is reportedly as high as 30-35%.

Consultations:
Gastroenterologist: For endoscopy (if indicated)General surgeon: If toxic megacolon or perforation is present or possible

Haemorrhoids (Piles)

What are Haemorrhoids (Piles) ?
Haemorrhoids (often known as Piles) are enlarged, engorged blood vessels in or around the back passage (anus). They may be associated with pain, bleeding, itching and the feeling of a lump or bump is hanging down.

Most episodes of trouble from haemorrhoids come and go quite quickly. If simple measures do not help or the problem is lasting, keeps returning or worsening, then you should see your doctor.

Examination
Your doctor will ask a few questions and is likely to examine you and may want to feel inside the anus with a gloved finger. Sometimes he will look inside with a metal instrument. This enables him or her to confirm the diagnosis, and to rule out other, more serious problems such as cancer.

What are the causes of hemorrhoids (piles) ?
Haemorrhoids are very common. People most at risk of developing haemorrhoids are those who have more causes for raised abdominal pressure, such as:

• - Those chronically straining with constipation.
• - After or during pregnancy.
• - Overweight people.
• - People with heavy lifting jobs.
  

What is the treatment for hemorrhoids ?

1. Piles at times will settle down over a matter of days without any treatment.
2. Cream or suppositories (bullet-shaped tablets to be inserted into the anus) may be bought over the counter, or your doctor may prescribe one. These soothe itching and pain, and cause swelling and bleeding to diminish.
3. Cold compresses, even ice can be helpful.
   

If you do not get better with these approaches, your doctor may ask a specialist to see you who may suggest various methods to cure your hemorrhoids:-

1. Put little rubber bands round the haemorrhoids, which will cause them to shrivel and wither away.
2. Inject a substance into the haemorrhoids which causes them to wither away (sclerotherapy).
3. Surgical Procedure - Cut away the problem, usually under a general anaesthetic.
   

Today, in the “Colorectal Surgical Clinic” hemorrhoids are not cut. Under the expertise fo the surgeon, they are dealt with the latest “State of Art” staple gun.

What are the commonly done surgeries for hemorrhoids (piles) ?
Stapled Anopexy / Stapled Hemorrhoidectomy / Open Hemorrhoidectomy

Constipation

What is constipation?
Constipation is the infrequent and difficult passage of stool. It ranges from three movements a day to three a week. If more than three days pass without a bowel movement, the intestinal contents may harden. A person may have difficulty or even pain during stool elimination. Straining during bowel movements or the feeling of incomplete evacuation may also be reported as constipation.

What are some of the causes of constipation?
Constipation is a symptom, not a disease. Most people have experienced an occasional brief bout of constipation that has corrected itself with diet and time. The following is a list of some of the most common causes of constipation:

• Poor Diet
• Irritable Bowel Syndrome (IBS)
• Irregular Bowel Habits
• Laxative Abuse.
• Other causes are:
• Hormonal Disturbances, Pregnancy, Fissures and Hemorrhoids, Specific Diseases (multiple sclerosis, tumor, cancer, Parkinson’s disease, stroke), Loss of Body Salts, Nerve Damage, certain medications, and altered bowel habits
  

What causes constipation in older adults?
Older adults are five times more likely than younger adults to report problems with constipation. Poor diet, insufficient intake of fluids, lack of exercise, the use of certain drugs to treat other conditions and poor bowel habits can result in constipation. Other causes of constipation are: prolonged bed rest after an illness and dependence heavily on laxatives, which can be habit-forming.

What diagnostic tests can help determine the causes of constipation?
In addition to routine blood, urine, and stool tests, a proctoscopy may help detect problems in the rectum. This procedure can be done in the doctor’s office. The doctor inserts a lighted instrument through the anus to examine the rectum. The doctor may perform a colonoscopy to inspect the entire colon. A barium enema X-ray can provide similar information. If required certain highly specialized techniques are also available.

When is medical attention needed?
The doctor should be notified when symptoms are severe, last longer than three weeks, are disabling, or when any of the complications listed above occur.

Colorectal cancer

What is colorectal cancer?
In this type of cancer malignant or cancer cells are found in the colon or rectum.

What are the symptoms of colorectal cancer?
The following are the most common symptoms of colorectal cancer. People who have any of the following symptoms should check with their doctor, especially if they are over 40 years old or have a personal or family history of the disease:

• A change in bowel habits such as diarrhea or constipation
• Rectal bleeding or blood in the stool
• Cramping or gnawing stomach pain
• Decreased appetite
• Vomiting
• Weakness and fatigue
• Jaundice (yellowish coloring) of the skin or sclera of the eye
  

The symptoms of colorectal cancer may resemble other conditions, such as infections, hemorrhoids, and inflammatory bowel disease. It is also possible to have colon cancer and not have any symptoms. Always consult your doctor for a diagnosis

What are the methods of screening for colorectal cancer:

• Digital rectal examination (DRE) – your surgeon at the colorectal clinic will insert a gloved finger into the rectum to feel for anything unusual or abnormal.
• Fecal occult blood test - a sample of stool is examined for blood.
• One of the following- Sigmoidoscopy, colonoscopy, barium enema with air contrast (Also called a double contrast barium enema)
  

What is the treatment for colorectal cancer?
Specific treatment for colorectal cancer will be determined by your surgeon based on:

• Your age, overall health, and medical history , Extent of the disease , Your tolerance for specific medications, procedures, or therapies

Treatment choices for the person with colon cancer depend on the stage of the tumor - if it has spread and how far.

How an early Detection Can Prevent Colorectal Cancer?
Bowel habits are not something most people talk about, so they choose to avoid the topic altogether. With proper screening, almost all colon and rectal polyps can be found before they turn into cancer. Polyps are precancerous masses that form on the lining of the colon or rectum. Left untreated, certain polyps can become cancerous. Men and women aged 50 or older should get regular screening exams such as a colonoscopy.

What can we to lower the risk of colorectal cancer?

• Make early detection a priority.
• Get yourself checked by your surgeon at the Colorectal clinic.
• Two of the primary risk factors for colorectal cancer are age and family history.
• Watch for physical changes. Consult your surgeon if you observe have bloody stool, persistent changes in bowel habits, unexplained weight loss or unusual stomach pain.
• Adopt a healthy lifestyle. Research has shown that diets high in fat, protein, meat and alcohol may increase colorectal cancer risk. It's better to eat a lower-fat diet filled with colorful and leafy vegetables - they offer the most beneficial nutrients - and high-fiber foods such as coffee atta, daliya, beans and citrus fruits. Fiber-rich diets help keep your digestive tract healthy, stabilize blood sugar levels and control cholesterol.
  

What are the commonly done surgeries for Colorectal cancer?
Rectum
Rectal biopsy, Hartman’s procedure, Abdomino-perineal resection Examination under anaesthesia, Laparoscopic abdominal rectopexy, Laparoscopic anterior resection

Anal
Anal dilation, Anal canal reconstruction, Excision of perianal nodule, Core excision of fistulous tract, Anal polypectomy.

Anorectal abscess

What is Anorectal Abscess?
An anorectal abscess is a collection of pus in the anal or rectal region.

What are the causes of anorectal abscess?
Infection of an anal fissure, sexually transmitted infections, and blocked anal glands are common causes of anorectal abscesses. Deep rectal abscesses may be caused by certain intestinal disorders.

What are the following factors, which increase your risk for an anorectal abscess?
Diabetes, A weakened immune system, engaging in anal sex, inflammatory bowel disease (Crohn's disease and ulcerative colitis)

What is the treatment?
Commonly done surgeries are Incision and drainage of perianal abscess, Incision and drainage of ischiorectal abscess.

Anal fistula

What is anal fistula?
Anal fistulae originate from the anal glands, which are located between the two layers of the anal sphincters and which drain into the anal canal. If the outlet of these glands becomes blocked, an abscess can form which can eventually point to the skin surface. The tract formed by this process is the fistula. Definitive treatment of a fistula aims to help stop its recurrence.

What are the commonly done surgeries?
Laying open of low fistula in ano, Laying open of high fistula in ano + seton tie, Seton revision, Seton Removal, Excision of fistula-in-ano.

Anal fissure

What is anal fissure?
An anal fissure is a small tear or cut in the skin lining the anus which can cause pain and/or bleeding.

What are the symptoms of an anal fissure?
Extreme pain during defecation and red blood streaking the stool. A patient may try to avoid defecation because of the pain.

What causes an anal fissure?
A hard, dry bowel movement can cause a tear in the anal lining, resulting in a fissure. Other causes of a fissure include diarrhea and inflammation of the anorectal area.

How can a fissure be treated?
An acute fissure is managed with non-operative treatments and over 90% will heal without surgery. Bowel habits are improved with a high fiber diet, plenty of fluids to avoid constipation. Warm baths for 10-20 minutes several times are recommended. A chronic fissure (lasting greater than one month) may require additional treatment.

What is surgical procedure for anal fissure ?
Surgery usual consists of a small operation to cut a portion of the internal anal sphincter muscle. This helps the fissure to heal by decreasing pain and spasm. Commonly done surgery: Lateral sphincterotomy, Excision of anal fissure.

Constipation and Bloating

Constipation can have a host of unpleasant symptoms, like irritability, for example, or lethargy. Most of all, however, many sufferers experience bloating as well.

In fact, apart from not being able to go to the loo, bloating is the number one symptom of constipation.

In a recent study, 84% of respondents said they suffered bloating with constipation*.

Besides feeling bloated, you can also have a slightly swollen tummy, sometimes you even want to loosen your belt.

Being constipated is bad enough without bloating, so it helps to know what causes this uncomfortable side effect.

What causes bloating?

When you get constipated, over time, the waste in your lower intenstines can literally build up. When this happens, gases are released, which are trapped in your bowel. This build-up of gases along with constipation is what produces that bloated feeling - and it can be quite painful, too.

Bloating can also have other causes such as IBS or lactose intolerance. If you suffer frequently and are experiencing a lot of discomfort, do not hesitate to consult your GP.

What can you do?

Bloating in the lower gastro-intestinal tract is often caused by constipation.

The best way to deal with bloating is to try to prevent constipation through a fibre-rich diet, drinking lots of fluids and regular exercise.

If you are constipated, however, there are many constipation remedies which will help your digestive system regain its natural balance.

Senokot Dual Relief is one constipation remedy that deals with both. Its natural actives, including senna leaves and fennel seeds, help the body overcome the symptoms of constipation and bloating, providing effective relief.

Always read the label and ask your pharmacist for advice.

* Research conducted by Ipsos-Focus 2006

Via: http://www.constipationadvice.co.uk

Facts and Fallacies About Digestive Diseases

• Ulcers
• Heartburn
• Coeliac Disease
• Bowel Regularity
• Constipation
• Irritable Bowel Syndrome
• Diverticulosis
• Inflammatory Bowel Disease
• Cirrhosis
• Ostomy Surgery

Researchers have only recently begun to understand the many, often complex diseases that affect the digestive system. Accordingly, people are gradually replacing folklore, old wives' tales, and rumors about the causes and treatments of digestive diseases with accurate, up-to-date information. But misunderstandings still exist, and while some folklore is harmless, some can be dangerous if it keeps a person from correctly preventing or treating an illness. Listed below are some common misconceptions (fallacies), about digestive diseases, followed by the facts as professionals understand them today.

Ulcers

Spicy food and stress cause stomach ulcers.

False.

The truth is, almost all stomach ulcers are caused either by infection with a bacterium called Helicobacter pylori (H. pylori) or by use of pain medications such as aspirin, ibuprofen, or naproxen, the so-called nonsteroidal anti-inflammatory drugs (NSAIDs). Most H. pylori-related ulcers can be cured with antibiotics. NSAID-induced ulcers can be cured with time, stomach-protective medications, antacids, and avoidance of NSAIDs. Spicy food and stress may aggravate ulcer symptoms in some people, but they do not cause ulcers.

Ulcers can also be caused by cancer.

Heartburn

Smoking a cigarette helps relieve heartburn.

False.

Actually, cigarette smoking contributes to heartburn. Heartburn occurs when the lower oesophageal sphincter (LES)—a muscle between the oesophagus and stomach—relaxes, allowing the acidic contents of the stomach to splash back into the oesophagus. Cigarette smoking causes the LES to relax.

Coeliac Disease

Coeliac disease is a rare childhood disease.

False.

Coeliac disease affects both children and adults. About 1 in 200 people in the United States have coeliac disease. Sometimes coeliac disease first causes symptoms during childhood, usually diarrhoea, growth failure, and failure to thrive. But the disease can also first cause symptoms in adults of any age. These symptoms may be vague and therefore attributed to other conditions. Symptoms can include bloating, diarrhoea, abdominal pain, skin rash, anaemia, and thinning of the bones (osteoporosis). Coeliac disease may cause such nonspecific symptoms for several years before being correctly diagnosed and treated.

People with coeliac disease should not eat any foods containing gluten, a protein in wheat, rye, and barley, whether they have symptoms or not. In coeliac disease, gluten destroys part of the lining of the small intestine, which interferes with the absorption of nutrients. Even a small amount of gluten can cause damage, and sometimes no symptoms will be apparent.

Bowel Regularity

Bowel regularity means a bowel movement every day.

False.

The frequency of bowel movements among normal, healthy people varies from three a day to three a week, and some perfectly healthy people fall outside both ends of this range.

Constipation

Habitual use of enemas to treat constipation is harmless.

False.

Habitual use of enemas is not harmless. Over time, enemas can impair the natural muscle action of the intestines, leaving them unable to function normally. An ongoing need for enemas is not normal; you should see a doctor if you find yourself relying on them or any other medication to have a bowel movement.

Irritable Bowel Syndrome

Irritable bowel syndrome is a disease.

True.

Irritable bowel syndrome is a disease, although it is also called a functional disorder. Irritable bowel syndrome involves a problem in how the muscles in the intestines work and pain perception in the bowel. It is characterised by gas, abdominal pain, and diarrhoea or constipation, or both. Although the syndrome can cause considerable pain and discomfort, it does not damage the digestive tract as organic diseases do. Also, irritable bowel syndrome does not lead to more serious digestive diseases later, such as cancer.

Diverticulosis

Diverticulosis is a serious but uncommon problem.

False.

Actually, the majority of Americans over age 60 have diverticulosis, but only a small percentage have symptoms or complications. Diverticulosis is a condition in which little sacs or out-pouchings called diverticula develop in the wall of the colon. These sacs tend to appear and increase in number with age. Most people have no symptoms and learn that they have diverticula after an x ray or intestinal examination. Less than 10 percent of people with diverticulosis ever develop complications such as infection (diverticulitis), bleeding, or perforation of the colon.

Inflammatory Bowel Disease

Inflammatory bowel disease is caused by psychological problems.

False.

Inflammatory bowel disease is the general name for two diseases that cause inflammation in the intestines, Crohn's disease and ulcerative colitis. The cause of the disease is unknown, but researchers speculate that it may be a virus or bacteria interacting with the body's immune system. No evidence has been found to support the theory that inflammatory bowel disease is caused by tension, anxiety, or any other psychological factor or disorder.

Cirrhosis

Cirrhosis is caused only by alcoholism.

False.

Alcoholism is just one of many causes of cirrhosis. Cirrhosis is scarring and decreased function of the liver. In the United States, alcohol causes less than one-half of cirrhosis cases. The remaining cases are from diseases that cause liver damage. For example, in children, cirrhosis may result from cystic fibrosis, alpha-1 antitrypsin deficiency, biliary atresia, glycogen storage disease, and other rare diseases. In adults, cirrhosis may be caused by hepatitis B or C, primary biliary cirrhosis, diseases of abnormal storage of metals like iron or copper in the body, severe reactions to prescription drugs, or injury to the ducts that drain bile from the liver. In adults, cirrhosis can also be caused by nonalcoholic steatohepatitis (NASH), which is becoming the most common liver disease in the United States, affecting 2 to 5 percent of Americans.

Ostomy Surgery

After ostomy surgery, men have erectile dysfunction and women have impaired sexual function and are unable to become pregnant.

False.

Ostomy surgery does not, in general, interfere with a person's sexual or reproductive capabilities. Ostomy surgery is a procedure in which the diseased part of the small or large intestine is removed and the remaining intestine is attached to an opening in the abdomen. Although some men who have had radical ostomy surgery for cancer lose the ability to achieve and sustain an erection, most men do not, or, if they do, it is temporary. If erectile dysfunction persists, a variety of solutions are available. A urologist, a doctor who specializes in such problems, can help find the best solution. In women, ostomy surgery does not damage sexual or reproductive organs, so it is not a direct cause of sexual problems or sterility. Factors such as pain and the adjustment to a new body image may create temporary sexual problems, but they can usually be resolved with time and, in some cases, counselling. Unless a woman has had a hysterectomy to remove her uterus, she can still bear children.

The Gluten-Free Diet

A gluten-free diet means not eating foods that contain wheat (including spelt, triticale, and kamut), rye, and barley. The foods and products made from these grains are also not allowed. In other words, a person with coeliac disease should not eat most grain, pasta, cereal, and many processed foods. Despite these restrictions, people with coeliac disease can eat a well balanced diet with a variety of foods, including gluten-free bread and pasta. For example, people with coeliac disease can use potato, rice, soy, amaranth, quinoa, buckwheat, or bean flour instead of wheat flour. They can buy gluten-free bread, pasta, and other products from stores that carry organic foods, or order products from special food companies. Gluten-free products are increasingly available from regular stores.

Checking labels for "gluten free" is important since many corn and rice products are produced in factories that also manufacture wheat products. Hidden sources of gluten include additives such as modified food starch, preservatives, and stabilizers. Wheat and wheat products are often used as thickeners, stabilizers, and texture enhancers in foods.

"Plain" meat, fish, rice, fruits, and vegetables do not contain gluten, so people with coeliac disease can eat as much of these foods as they like. Recommending that people with coeliac disease avoid oats is controversial because some people have been able to eat oats without having symptoms. Scientists are currently studying whether people with coeliac disease can tolerate oats. Until the studies are complete, people with coeliac disease should follow their physician's or dietitian's advice about eating oats. Examples of foods that are safe to eat and those that are not are provided in the table below.

The gluten-free diet is challenging. It requires a completely new approach to eating that affects a person's entire life. Newly diagnosed people and their families may find support groups to be particularly helpful as they learn to adjust to a new way of life. People with coeliac disease have to be extremely careful about what they buy for lunch at school or work, what they purchase at the grocery store, what they eat at restaurants or parties, or what they grab for a snack. Eating out can be a challenge. If a person with coeliac disease is in doubt about a menu item, ask the waiter or chef about ingredients and preparation, or if a gluten-free menu is available.

Gluten is also used in some medications. One should check with the pharmacist to learn whether medications used contain gluten. Since gluten is also sometimes used as an additive in unexpected products, it is important to read all labels. If the ingredients are not listed on the product label, the manufacturer of the product should provide the list upon request. With practice, screening for gluten becomes second nature.

Imperforate Anus (Anal Atresia)

Imperforate anus or anal atresia is a congenital abnormality in which the anorectal region is abnormal or incompletely developed. In some cases, the rectum may end and not connect with the anus, or it may connect in the wrong spot. For example, it may connect to the urethra, bladder, or vagina. (See the section on fistulas). In other cases, the anus may be very narrow or missing altogether. The result is that stool cannot pass out of the colon. Imperforate anus occurs in about 1 in 5,000 infants.

Another malformation that results in absence of a functioning anus is congenital cloaca. In patients with this abnormality, the anal muscles and vagina fail to form and the result is a large, ill-defined opening that represents the rectum as well as the vagina and bladder, depending on the extent of the defect. Cloaca deformity of the anus usually requires a colostomy but may be correctable with a surgical procedure that transfers a muscle from another part of the body to create a functioning sphincter at the anus.

Symptoms of imperforate anus include

• no bowel movement within 24 to 48 hours after birth
• a missing or misplaced anal opening
• stool that comes out of the vagina or urethra
• abdominal swelling (distention)

Imperforate anus is usually found when the infant is first examined after birth. Imperforate anus is categorized on the basis of the location of the end of the rectum in relation to the muscles that support the rectum and other organs in the pelvis, called the levator ani muscles. These location categories are

• high: the rectum ends above the muscles
• intermediate: the rectum ends at the level of the muscles
• low: the rectum ends below the muscles

In all cases of imperforate anus, surgery is necessary to reconstruct the anus. Low imperforate anus is corrected through a minor procedure just after birth. High imperforate anus may require surgery to separate the rectum from the other organs if the rectum is connected with them. The outcome is usually very good, but some infants may not develop good bowel control after surgery because the anal muscles may not form. A child with high imperforate anus often has other GI problems, such as malrotation and intestinal atresia

Factors that affect the outcome of treatment include the location of the abnormality, the patient's sex, and the age at which the surgery is done. Surgery to correct low imperforate anus in boys usually has an excellent outcome. Correcting cloaca in girls requires a more difficult procedure and is more prone to complications.

Small Bowel and Colonic Intussusception

Intussusception is a condition in which one section of the bowel tunnels into an adjoining section, like a collapsible telescope. Intussusception can occur in the colon, the small bowel, or between the small bowel and colon. The result is a blocked small bowel or colon.

Intussusception is rare in adults. Causes include

• benign or malignant growths
• adhesions (scarlike tissue)
• surgical scars in the small bowel or colon
• motility disorders (problems with the movement of food through the digestive tract)
• long-term diarrhoea

Some cases of intussusception have been associated with viral infections and in patients living with AIDS. It can also occur without any known cause (idiopathic).

In infants and children, intussusception involving the small bowel alone, or the small bowel and the colon, is one of the most common causes of intestinal obstruction. Malrotation is a risk factor. Intussusception affects boys more often than girls, with most cases happening at 5 months and at 3 years of age. Most cases in children have no known cause, but viral infections or a growth in the small bowel or colon may trigger the condition. In the past, cases of intussusception appeared to be associated with a childhood vaccine for rotavirus, a common cause of gastroenteritis (intestinal infection). That vaccine is no longer given.

In adults with intussusception, symptoms can last a long time (chronic symptoms) or they can come and go (intermittent symptoms). The symptoms will depend on the location of the intussusception. They may include

• changes in bowel habits
• urgency—needing to have a bowel movement immediately
• rectal bleeding
• chronic or intermittent crampy abdominal pain
• pain in a specific area of the abdomen
• abdominal distention
• nausea and vomiting
• Children with intussusception may experience
• intermittent abdominal pain
• bowel movements that are mixed with blood and mucus
• abdominal distention or a lump in the abdomen
• vomiting bile
• diarrhoea
• ever
• dehydration
• ethargy
• shock (low blood pressure, increased heart rate requiring immediate attention)

If intussusception is not diagnosed promptly, especially in children, it can cause serious damage to the portion of the bowel that is unable to get its normal blood supply. A range of diagnostic tests may be required. X rays of the abdomen may suggest a bowel obstruction (blockage). Upper and lower GI series will locate the intussusception and show the telescoping. CT scans can also help with the diagnosis. When intussusception is suspected, an air or barium enema can often help correct the problem by pushing the telescoped section of bowel into its proper position.

Both adults and children may require surgery to straighten or remove the involved section of bowel. The outcome of this surgery depends on the stage of the intussusception at diagnosis and the underlying cause. With early treatment, the outcome is generally excellent. In some cases, usually in children, intussusception may be temporary and reverse on its own. If no underlying cause is found in these cases, no specific treatment is required.

Collagenous Colitis and Lymphocytic Colitis

What are collagenous colitis and lymphocytic colitis?

Inflammatory bowel disease is the general name for diseases that cause inflammation in the intestines, most often referring to Crohn’s disease and ulcerative colitis. Collagenous colitis and lymphocytic colitis are two other types of bowel inflammation that affect the colon. The colon is a tube-shaped organ that runs from the first part of the large bowel to the rectum. Solid waste, or stool, moves through the colon to be eliminated. Collagenous colitis and lymphocytic colitis are not related to Crohn's disease or ulcerative colitis, which are more severe forms of inflammatory bowel disease.

Collagenous colitis and lymphocytic colitis are also called microscopic colitis. Microscopic colitis means there is no sign of inflammation on the surface of the colon when viewed with a colonoscopy or flexible sigmoidoscopy two tests that let a doctor look inside your large intestine. Because the inflammation isn’t visible, a biopsy is necessary to make a diagnosis. A doctor performs a biopsy by removing a small piece of tissue from the lining of the intestine during a colonoscopy or flexible sigmoidoscopy.

What are the symptoms?

The symptoms of collagenous colitis and lymphocytic colitis are the same—chronic, watery, non-bloody diarrhoea. Abdominal pain or cramps may also be present. People with collagenous colitis and lymphocytic colitis may suffer from ongoing diarrhoea while others have times when they are symptom free.

What causes collagenous colitis and lymphocytic colitis?

Scientists are not sure what causes collagenous colitis or lymphocytic colitis. Bacteria and their toxins, or a virus, may be responsible for causing inflammation and damage to the colon. Some scientists think that collagenous colitis and lymphocytic colitis may result from an autoimmune response, which means that the body's immune system destroys healthy cells for no known reason.

Who gets collagenous colitis and lymphocytic colitis?

Collagenous colitis is most often diagnosed in people between 60 and 80 years of age. However, some cases have been reported in adults younger than 45 years and in children. Collagenous colitis is diagnosed more often in women than men.

People with lymphocytic colitis are also generally diagnosed between 60 and 80 years of age. Both men and women are equally affected.

How are they diagnosed?

Some scientists think that collagenous colitis and lymphocytic colitis are the same disease in different stages. The only way to determine which form of colitis a person has is by performing a biopsy.

A diagnosis of collagenous colitis or lymphocytic colitis is made after tissue samples taken during a colonoscopy or flexible sigmoidoscopy are examined with a microscope.

Collagenous colitis is characterised by a larger-than-normal band of protein called collagen inside the lining of the colon. The thickness of the band varies; so several tissue samples from different areas of the colon may need to be examined.

With lymphocytic colitis, tissue samples show an increase of white blood cells, known as lymphocytes, between the cells that line the colon. The collagen is not affected.

Treatment

Treatment for collagenous colitis and lymphocytic colitis varies depending on the symptoms and severity of the case. The diseases have been known to resolve on their own, although most people suffer from ongoing or occasional diarrhoea.

Lifestyle changes are usually tried first. Recommended changes include reducing the amount of fat in the diet, eliminating foods that contain caffeine and lactose, and avoiding over-the-counter pain relievers such as ibuprofen or aspirin.

If lifestyle changes alone are not enough, medications can be used to help control symptoms.

• Treatment usually starts with prescription anti-inflammatory medications, such as mesalamine (Rowasa or Canasa) and sulfasalazine (Azulfidine), in order to reduce swelling.
  
  
• Steroids, including budesonide (Entocort) and prednisone are also used to reduce inflammation. Steroids are usually only used to control a sudden attack of diarrhoea. Long-term use of steroids is avoided because of side effects such as bone loss and high blood pressure.
  
  
• Anti-diarrhoeal medications such as bismuth subsalicylate (Pepto Bismol), diphenoxylate atropine (Lomotil), and loperamide (Imodium) offer short-term relief.
  
  
• Immunosuppressive agents such as azathioprine (Imuran) reduce the inflammation but are rarely needed.

For extreme cases of collagenous colitis and lymphocytic colitis that have not responded to medication, surgery to remove all or part of the colon may be necessary. However, surgery is rarely recommended. Collagenous colitis and lymphocytic colitis do not increase a person’s risk of getting colon cancer.

Collagenous colitis and lymphocytic colitis do not increase a person’s risk of getting colon cancer.

Volvulus

Volvulus refers to the twisting of a portion of the intestine around itself or a stalk of mesentery tissue to cause an obstruction. Volvulus occurs most frequently in the colon, although the stomach and small bowel can also twist. The part of the digestive system above the volvulus continues to function and may swell as it fills with digested food, fluid, and gas. A condition called strangulation develops if the mesentery of the bowel is twisted so tightly that blood flow is cut off and the tissue dies. This condition is called gangrene. Volvulus is a surgical emergency because gangrene can develop quickly, cause a hole in the wall of the bowel (perforation), and become life-threatening.

In the colon, volvulus most often involves the caecum and sigmoid segment. Sigmoid volvulus is more common than cecal volvulus.

Sigmoid Volvulus
The sigmoid is the last section of the colon. Two anatomic differences can increase the risk of sigmoid volvulus. One is an elongated or movable sigmoid colon that is unattached to the left sidewall of the abdomen. Another is a narrow mesentery that allows twisting at its base. Sigmoid volvulus, however, can occur even without an anatomic abnormality.

Risk factors that can make a person more likely to have sigmoid volvulus are Hirschsprung's disease, intestinal pseudo-obstructions, and megacolon (an enlarged colon). Adults, children, and infants can all have sigmoid volvulus. It is more common in men than in women, possibly because men have longer sigmoid colons. It is also more common in people over age 60, in African Americans, and in institutionalized individuals who are on medications for psychiatric disorders. In addition, children with malrotation are more likely to get sigmoid volvulus.

The symptoms can be acute (occur suddenly) and severe. They include a bowel obstruction (commonly seen in infants), nausea, vomiting, bloody stools, abdominal pain, constipation, and shock. Other symptoms can develop more slowly but increase over time, such as severe constipation, lack of passing gas, crampy abdominal pain, and abdominal distention. A doctor may also hear increased or decreased bowel sounds.

Several tests are used to diagnose sigmoid volvulus. X rays show a dilated colon above the volvulus. Upper and lower GI series help locate the point of obstruction and show whether malrotation of the rest of the colon is present. A CT scan may be used to show the degree of twisting and malrotation, and whether perforation has occurred.

In most instances, a sigmoidoscope, a tube used to look into the sigmoid colon and rectum, can be used to reach the site, untwist the colon, and release the obstruction. However, if the colon is found to be twisted very tightly or is twisted so tightly that blood flow is cut off and the tissue is dead, immediate surgery will be needed to correct the problem and, if possible, restore the blood supply. Dead tissue will be removed during surgery, and a portion of the colon may be removed as well—a procedure called a resection. Sigmoid volvulus can recur after untwisting with the sigmoidoscope, but resection eliminates the chance of recurrence. Prompt diagnosis of sigmoid volvulus and appropriate treatment generally lead to a good outcome.

Cecal Volvulus

Cecal volvulus is the twisting of the caecum and ascending segment of the colon. Normally, the caecum and ascending colon are fixed to the internal abdominal wall. If not, they can move and become twisted. The main symptoms of cecal volvulus are crampy abdominal pain and swelling that are sometimes associated with nausea and vomiting.

In testing, x rays will show the caecum out of its normal place and inflated with trapped air. The appendix may be filled with gas, but little or no gas is seen in other parts of the colon. Upper and lower GI series will locate the volvulus and the position of the colon. A CT scan may show how tightly the volvulus is twisted. A colonoscopy, which uses a small, flexible tube with a light and a lens on the end to see the inside of the colon, can sometimes be used to untwist the volvulus. If the caecum becomes gangrenous or holes develop in it, surgery will be needed.

Gastritis

Gastritis is not a single disease, but several different conditions that all have inflammation of the stomach lining. Gastritis can be caused by drinking too much alcohol, prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen, or infection with bacteria such as Helicobacter pylori (H. pylori). Sometimes gastritis develops after major surgery, traumatic injury, burns, or severe infections. Certain diseases, such as pernicious anemia, autoimmune disorders, and chronic bile reflux, can cause gastritis as well.

The most common symptoms are abdominal upset or pain. Other symptoms are belching, abdominal bloating, nausea, and vomiting or a feeling of fullness or of burning in the upper abdomen. Blood in your vomit or black stools may be a sign of bleeding in the stomach, which may indicate a serious problem requiring immediate medical attention.

Gastritis is diagnosed through one or more medical tests:

• Upper gastrointestinal endoscopy. The doctor eases an endoscope, a thin tube containing a tiny camera, through your mouth (or occasionally nose) and down into your stomach to look at the stomach lining. The doctor will check for inflammation and may remove a tiny sample of tissue for tests. This procedure to remove a tissue sample is called a biopsy.
  
  
• Blood test. The doctor may check your red blood cell count to see whether you have anemia, which means that you do not have enough red blood cells. Anemia can be caused by bleeding from the stomach.
  
  
• Stool test. This test checks for the presence of blood in your stool, a sign of bleeding. Stool test may also be used to detect the presence of H. pylori in the digestive tract.
  

Treatment usually involves taking drugs to reduce stomach acid and thereby help relieve symptoms and promote healing. (Stomach acid irritates the inflamed tissue in the stomach.) Avoidance of certain foods, beverages, or medicines may also be recommended.

If your gastritis is caused by an infection, that problem may be treated as well. For example, the doctor might prescribe antibiotics to clear up H. pylori infection. Once the underlying problem disappears, the gastritis usually does too. Talk to your doctor before stopping any medicine or starting any gastritis treatment on your own.