Endoscopy Conditions

Abdominal Pains

A stomach ache is a term often used to refer to cramps or a dull ache in the tummy (abdomen). It’s usually short-lived and is often not serious. Severe abdominal pain is a greater cause for concern. If it starts suddenly and unexpectedly, it should be regarded as a medical emergency, especially if the pain is concentrated in a particular area.

Stomach cramps with bloating:

Stomach cramps with bloating are often caused by trapped wind. This is a very common problem that can be embarrassing but is easily dealt with.

Sudden stomach cramps with diarrhoea

If your stomach cramps have started recently and you also have diarrhoea, the cause may be a tummy bug (gastroenteritis). This means you have a viral or bacterial infection of the stomach and bowel.  If you have repeated bouts of stomach cramps and diarrhoea, you may have a long-term condition, such as irritable bowel syndrome (IBS).

Sudden severe abdominal pain:

If you have sudden agonising pain in a particular area of your abdomen, phone your GP immediately. It may be a sign of a serious problem that could rapidly get worse without treatment.

Serious causes of sudden severe abdominal pain include:

• Appendicitis:– the swelling of the appendix which causes agonising pain in the lower right-hand side of your abdomen, and means your appendix will need to be removed
• A bleeding or perforated stomach ulcer: – a bleeding, open sore in the lining of your stomach or duodenum.
• Acute cholecystitis: – inflammation of the gallbladder, which is often caused by gallstones, in many cases, your gallbladder will need to be removed.
• Kidney stones: – small stones may be passed out in your urine, but larger stones may block the kidney tubes.
• Diverticulitis: – inflammation of the small pouches in the bowel that sometimes requires treatment with antibiotics in hospital.

If your GP suspects you have one of these conditions, they may refer you to hospital immediately. Sudden and severe pain in your abdomen can also sometimes be caused by an infection of the stomach and bowel (gastroenteritis).

Long-term or recurring abdominal pain:

See your GP if you or your child have persistent or repeated abdominal pain. The cause is often not serious and can be managed.

Possible causes in adults include:

• IBS – a common condition that causes bouts of stomach cramps, bloating, diarrhoea or constipation, the pain is often relieved when you go to the toilet.
• inflammatory bowel disease (IBD) – long-term conditions that involve inflammation of the gut, including Crohn’s disease and ulcerative colitis.
• a urinary tract infection: that keeps returning – in these cases, you’ll usually also experience a burning sensation when you urinate.
• constipation
• other stomach-related problems – such as a stomach ulcer, heartburn and acid reflux or gastritis.

Possible causes in children include:

• constipation
• a UTI that keeps returning.
• heartburn and acid reflux.

Anaemia:

Anaemia means that you have fewer red blood cells than normal or you have less haemoglobin than normal in each red blood cell. In either case, a reduced amount of oxygen is carried around in the bloodstream.

Anaemia symptoms:

Common symptoms are due to the reduced amount of oxygen in the body. These include tiredness, having little energy (lethargy), feeling faint and becoming easily breathless. Less common symptoms include headaches, a ‘thumping heart’ (palpitations), and ringing in the ears (tinnitus).

What are the causes of anaemia?

Iron-deficiency anaemia

Lack of iron is the most common cause of anaemia. This is called iron-deficiency anaemia. If you eat a normal balanced diet, it usually contains enough iron. The following are some reasons that may lead to a lack of iron and result in iron-deficiency anaemia:

Pregnancy or childhood growth spurts. These are times when you need more iron than usual. The amount of iron that you eat during these times may not be enough.

Heavy menstrual periods. The amount of iron that you eat may not be enough to replace the amount that you lose from heavy periods.

Poor absorption of iron. This may occur with some gut diseases – e.g Crohn’s disease.

Bleeding from the gut (intestines). Some conditions of the gut can bleed enough to cause anaemia. The bleeding may be slow or intermittent and you can pass blood out with your stools (faeces) without noticing.

If you eat a poor or restricted diet. Your diet may not contain enough iron.

Other causes:

There are many other causes of anaemia. These include the following:

Lack of certain vitamins such as folic acid and vitamin B12.

Red blood cell problems, such as thalassaemia, sickle cell anaemia and other causes of haemolytic anaemia. In these conditions the red cells are fragile and break easily in the bloodstream.

Bone marrow problems and leukaemia are uncommon; however, they can cause anaemia.

Other conditions such as rheumatoid arthritis and chronic kidney diseases can also cause anaemia.

Anaemia treatment:

A simple blood test can measure the amount of haemoglobin in your blood and count the number of red blood cells per millilitre (ml). Although this test can confirm that you are anaemic, it does not identify the cause of your anaemia. Sometimes the underlying cause is obvious. For example, anaemia is common in pregnancy and in women who have heavy menstrual periods. In these situations, no further tests may be needed and treatment with iron tablets may be advised. However, the cause of the anaemia may not be clear and so further tests may be advised. Some causes of anaemia are more serious than others and it is important to find the reason for anaemia. The treatment of anaemia depends on the underlying cause. For many people this may simply be iron tablets. For others it may be a course of vitamins or other more complex treatments.

Appendicitis:

Causes of Appendicitis:

Most cases of appendicitis are thought to be caused when something blocks the entrance of the appendix, a small, thin pouch measuring 5 to 10 cm. It is usually the result of infection, possibly of the stomach, or an obstruction, usually a hard piece of stool (faeces) that gets trapped in your appendix, and the bacteria in the stool then infects the appendix. Once bacteria enter your appendix, they rapidly multiply, causing the appendix to swell and become filled with pus. The causes are not fully understood so there is no guaranteed way of preventing appendicitis.

Symptoms of Appendicitis:

Patients can experience nausea, vomiting, loss of appetite, cramp like pain, constipation, high temperature and diarrhoea. The pain can worsen by coughing, sneezing or even walking. The pain can be severe enough to wake someone who is sleeping. It can start with similar mild nausea symptoms of a stomach bug but if it continues to get worse and the pain develops in the lower right abdominal area then you should seek medical attention.

Diagnosis of Appendicitis:

Only 50% of appendicitis conforms to typical symptoms so it can be a difficult condition to diagnose. Sometimes the pain is gastroenteritis or irritable bowel syndrome (IBS), constipation or a bladder infection. Some people’s appendixes are sited in slightly different positions. But GPs can usually diagnose by examining the abdomen and applying pressure to the site of the appendix. In more complex cases, a blood or urine test can check for infection and an ultrasound or CT scan will determine if they appendix is swollen.

Treatment of Appendicitis:

Mild cases can be treated with antibiotics but in the majority of cases the appendix will have to be surgically removed in a procedure known as an appendectomy, performed through open surgery or keyhole surgery. A prompt operation can result in most patients being allowed home within 24 hours with pain and bruising lasting just a few days and comfortably managed with painkillers. The appendix doesn’t perform any important functions so having it removed does not lead to any long-term problems.

Constipation:

Constipation can be an uncomfortable experience. The following information can help answer your questions about constipation and help you understand your doctor’s choice of treatment.

What is constipation?

Constipation may mean different things to different individuals. Most commonly, it refers to the passage of too few bowel movements per week.  It may also describe having hard, dry stools that are difficult to pass, a decrease in the size of the stool, or needing to strain to have a bowel movement.  Some individuals describe a sense of not emptying their bowel completely or the need for enemas, suppositories or laxatives in order to have a bowel movement. The definition of normal frequency of having a bowel movement ranges from 3 times a day to 3 times a week.

What causes constipation?

Common causes of occasional constipation include:

• Poor eating habits (for example, too much junk food, too much irregular eating times)
• Diet lacking in fiber and/or fluids
• Lack of exercise
• Some medications (including pain medications, tranquilizers, psychiatric medications) • Stress
• Pregnancy
• Travel

More serious causes of constipation include narrowing of the colon or growths in the colon. Sometimes constipation is caused by problems with the function of the pelvic floor muscles. The muscles may not relax appropriately when trying to pass stool, making it difficult and sometimes painful to have a bowel movement.

What can I do about constipation?

Help yourself maintain regularity by adding some of these simple steps to your daily routine:

• Gradually add high fiber foods to your diet, including dried fruits (apricots, prunes, raisins, and dates) raw vegetables, bran cereals whole-grain breads. • Drink 8 to 10 glasses of decaffeinated fluid each day
• Follow a regular exercise program.
• Respond to the urge to have a bowel movement.
• If one is recommended by your doctor, take a high-fiber supplement.
• Use laxatives only as your doctor recommends.

Should I take a laxative?

Your doctor may prescribe a laxative for you. There are many types of laxatives, each one having benefits and drawbacks for certain patients.

Bulk-forming agents are not digested but absorb liquid in the intestine and then swell to form a soft, bulky mass that stimulates a bowel movement.  

Stool softeners do not cause a bowel movement but ease the difficult passage often associated with hard dry stool.

Stimulant laxatives encourage bowel movements through action of the intestinal wall.  They increase the muscle contractions in the intestine that lead to having a bowel movement.

Hyperosmotic laxatives work by drawing water into the bowel from surrounding tissues.  This softens the stool and sends the bowel the message to empty.

Enemas fill the colon with fluid, which softens the stool and stimulates a bowel movement.

It is always a good idea to look for natural ways to meet your body’s needs and avoid long-term use of medication. Excessive use of stimulant laxatives can actually cause constipation and dependence upon laxatives because the colon loses its normal tone and the ability to contract.

Diarrhoea:

What is diarrhoea?

Diarrhoea is a common problem that we all suffer from occasionally. Fortunately, it is usually a limited episode that resolves quickly. When it doesn’t, there can be cause for concern. The word diarrhoea means different things to different people. Some patients who regularly experience bowel movements every three days think they have diarrhoea if they begin going everyday. Complaints of diarrhoea should be compared to what is normal for each individual patient. Typically, diarrhoea is thought to be loose, unformed or watery stools that come more often than normal. It is often accompanied by abdominal cramps, and less warning when it is time to go.

What causes diarrhoea?

As was already mentioned, most of us will get diarrhoea occasionally. Most of the time it is related to a viral illness, and will go away in a few days. Bacterial infections like food poisoning can also cause diarrhoea which can be accompanied by rectal bleeding. This is a more serious situation, and you should call your doctor. Other more serious causes of diarrhoea include inflammatory diseases like ulcerative colitis and Crohn’s disease, or diverticulitis. More common causes include irritable bowel syndrome, which is usually accompanied by constipation alternating with the diarrhoea. Another common cause is lactose intolerance, which makes a person unable to digest milk products.

What can I do?

During a minor episode of diarrhoea, simply forcing fluids and rest is enough. Fluids should be limited to water, fruit juices, non-caffeinated beverages and salt containing liquids such as broth and sport drinks like Gatorade or All Sport. Avoid all caffeinated beverages. Those people with a history of irritable bowel syndrome should make sure they are getting enough fiber and water in their diet. They should also make sure they are using any medicines their doctor has given them according to the prescription. If the diarrhoea persists, over the counter medicines like Immodium A-D should not be used without the advice of your doctor. If a serious condition exists, use of those medicines can actually make the problem worse.

Are there warning signs?

Things to watch for during an episode of diarrhoea include:

• bleeding with the stool
• high fever
• severe abdominal pain
• dehydration

If a person cannot drink enough to keep up with the fluid lost through bowel movements, they need to be in the hospital. If any of these warning signs occur, please call your doctor right away.

Colon cancer:

General Information About Colon Cancer

Colon cancer is a disease in which malignant (cancer) cells form in the tissues of the colon. The colon is part of the body’s digestive system. The digestive system is made up of the esophagus, stomach, and the small and large intestines. The first 6 feet of the large intestine are called the large bowel or colon. The last 6 inches are the rectum and the anal canal. The anal canal ends at the anus.

Why is it important?

The general population faces a lifetime risk for developing the disease of about 5 percent, while someone whose family has a history of colorectal cancer has a 10 to 15 percent chance of developing the disease. The risk rises to over 50 percent in people with ulcerative colitis and those whose family members harbour specific genetic mutations. Colorectal cancer strikes men and women with almost equal frequency.

Who is at risk?

The risk of developing colorectal cancer increases with age. All men and women aged 50 and older are at risk for developing colorectal cancer and should be screened. Some people are at a higher risk and should be screened at an age younger than 50, including those with a personal or family history of inflammatory bowel disease; colorectal cancer or polyps; or ovarian, endometrial or breast cancer. Other risk factors include:

• A family history of cancer of the colon or rectum.
• A personal history of cancer of the colon, rectum, ovary, or breast.
• A history of ulcerative colitis or Crohn disease.
• Hereditary conditions, such as familial adenomatous polyposis and hereditary nonpolyposis colon cancer (HNPCC; Lynch Syndrome).

Possible signs of colon cancer:

If you have any of the following symptoms for more than two weeks, see your doctor immediately.  While not everyone who has these symptoms will have colon cancer, persistence of these is not normal and requires additional investigation to determine the underlying cause.

• A change in bowel habits.
• Blood (either bright red or very dark) in the stool.
• diarrhoea, constipation, or feeling that the bowel does not empty completely.
• Stools that are narrower than usual.
• Frequent gas pains, bloating, fullness, or cramps.
• Weight loss for no known reason.
• Feeling very tired.

How do I get screened for colon cancer?

Current screening methods include faecal occult blood testing (a simple chemical test that can detect hidden blood in the stool), flexible sigmoidoscopy (a visual examination of the rectum and lower portion of the colon, performed in a doctor’s office), double contrast barium enema (barium x-ray), colonoscopy (a visual examination of the entire colon) and digital rectal exam. Virtual colonoscopy, or CT colonography, is also being used in some specific situations, but is not recommended as a mainstream screening test as of this time.

Is it preventable?

YES! Polyp-related colorectal cancer can be prevented. The disease develops from benign polyps (mushroom-like growths on the lining of the colon and rectum). Removing these polyps before they become cancerous may prevent cancer from developing.  A low-fat diet, high in vegetable and fruit intake, and regular exercise can also lower your risk of developing colorectal cancer. Colorectal cancer can be cured in up to 90 percent of people when it is discovered in its early stages.   

Factors affecting survival of colon cancer:

The prognosis (chance of recovery) depends on the following:

• The stage of the cancer (whether the cancer is in the inner lining of the colon only, involves the whole colon, or has spread outside).
• Whether the cancer has blocked or created a hole in the colon.
• Whether there are any cancer cells left after surgery.
• The blood levels of carcinoembryonic antigen a substance in the blood that may be increased when cancer is present) before treatment begins.
• Whether the cancer has recurred.
• The patient’s general health.

Treatment options depend on the following:

• The stage of the cancer.
• Whether the cancer has recurred.
• The patient’s general health.

Polyps of the Colon and Rectum

Colorectal Polyps:

Colorectal polyps are commonly found during standard screening exams of the colon and rectum. They affect about 20% to 30% of adults. Polyps are abnormal growths that start in the inner lining of the colon or rectum. Some polyps are flat while others have a stalk. Colorectal polyps can grow in any part of the colon. Most often, they grow in the left side of the colon and in the rectum. While the majority of polyps will not become cancer, certain types may be precancerous. Having polyps removed reduces a person’s future risk for colorectal cancer.

Symptoms:

Most colorectal polyps do not cause any symptoms unless they are large. That is why screening for polyps and cancer is so important. While uncommon, polyps can cause these symptoms:

• Blood in the stool
• Excess mucus
• A change in bowel habits (such as frequency)
• Abdominal pain

Diagnosis:

The most common test used to detect colorectal polyps is a colonoscopy. During this outpatient test, your colon and rectal surgeon will examine your colon using a long, thin flexible tube with a camera and a light on the end. If polyps are found, they are removed at the same time. CT colonography (called virtual colonoscopy) may be used to examine the colon indirectly. However, if polyps or a tumour are found during this test, follow-up colonoscopy may be needed to remove or biopsy them. Other tests used to detect polyps include a digital rectal exam, faecal occult blood testing (these tests for microscopic or invisible blood in the stool), barium enema, and sigmoidoscopy, which uses a flexible tube to inspect the sigmoid colon.

Treatment:

Removal of colorectal polyps is advised because there is no test to determine if one will turn into cancer. Nearly all polyps can be removed or eliminated during a colonoscopy. Large polyps may require more than one treatment. Rarely, some patients may require surgery for complete removal.

Prognosis after treatment:

Once a colorectal polyp is completely removed, it rarely comes back. However, at least 30% of patients will develop new polyps after removal. For this reason, your surgeon will advise follow-up testing to look for new polyps. This is usually done 3 to 5 years after polyp removal. Taking a daily aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs) may reduce the risk of new polyps forming. If you had polyps removed, ask your physician if you should take this medication to help prevent them from coming back.

Crohn’s disease:

Crohn’s disease is an incurable inflammatory disorder that can affect any part of the gastrointestinal tract. Inflammation (red, swollen, and tender areas) always affects the innermost lining of the gastrointestinal tract, called the mucosa. However, the disease can affect the deeper layers of the gastrointestinal wall and even extend through the entire bowel wall.

Causes:

The exact cause of Crohn’s disease is unknown. Current research is exploring the possible connection of the disease to immune system problems and bacterial infections.

Symptoms:

Crohn’s disease can present as abdominal disease, anorectal (anus and rectum) disease, or both. Patients with Crohn’s are at greater risk of developing a fistula.  Symptoms vary widely among patients and often come and go over a long period of time. These include:

• Abdominal cramping, Abdominal pain, Ongoing diarrhoea, Chronic constipation,

Bleeding with bowel movements, Fever, Extreme tiredness, Weight loss, Drainage from the skin around the anus, Abscesses around the anus, Anal fissures.

Diagnosis:

During the first visit, your surgeon will perform a thorough medical history and physical exam. They will also examine the inside of the bowel using flexible instruments with lighted cameras. X-ray studies and lab tests such as stool samples and blood tests will also be done. This evaluation will provide information on the extent of disease and guide treatment.

Medical treatment:

Medication is always the first option unless emergency surgery is required. Several treatment approaches are used at the onset and for the long term to help patients control the disease. The most common initial therapy includes anti-inflammatory medication. Diet and lifestyle changes can also help.

Surgical treatment:

Surgery may be needed when patients develop disease-related abdominal and anorectal complications. Emergency surgery may be performed when a patient has either a perforation (a hole in their bowel) or a blockage of the bowel. Both of these conditions can be life-threatening. Immediate surgery may also be required for an abscess near the anus.

Abdominal surgery:

Surgery is typically performed when the patient’s symptoms are no longer being controlled with their medications.  This usually means there is a section of bowel that is either too scarred or narrow to function properly. The most common procedure is removal of the last portion of the small bowel and the start of the large bowel to relieve abnormal, narrowed sections. Following removal of part of the bowel, the remaining bowel is reconnected if possible. The end of the bowel can also be brought through a surgical opening in the skin of the abdominal wall.

This procedure (called an ostomy) redirects waste (faeces) from the bowels.

Anorectal surgery:

This is most commonly done to open and drain anorectal abscesses. Surgery is also used to treat anorectal fistulas.

Post-treatment prognosis:

It is important to follow up with your physicians so they can devise an ongoing management plan to control your symptoms. When you have Crohn’s disease, you must stay on medication throughout your entire life. Crohn’s that impacts the colon increases your risk of colon cancer. This risk goes up after 8 to 10 years of ongoing colon involvement. For those patients, it is key to undergo regular follow-up colonoscopies (examination of the colon using a flexible instrument with a lighted camera).

How can I reduce recurrence?

Recurrence is most common in patients who stop taking their medications, so it is vital to follow your physician’s orders. Smoking negatively impacts every organ in the body and presents health risks for everyone, so quitting is advised. For patients with Crohn’s disease, smoking has been linked to higher recurrence rates, so quitting can reduce this risk.

Difficulty Swallowing/Dysphagia:

There are various causes of difficulty swallowing (dysphagia). Serious condition such as cancer of the gullet (oesophagus) can be the cause. This leaflet discusses the main causes of dysphagia.

What is dysphagia?

Dysphagia means difficulty in swallowing. This symptom is usually due to a problem of the gullet. There is a range of different causes of dysphagia. The severity of dysphagia can vary.

What are the causes of dysphagia?

There are many possible causes. Broadly they can be divided into problems starting at the top of the swallowing process (in the oropharynx) and those caused by problems lower down in the gullet (oesophagus). Below is a brief overview of the more common causes in each type of dysphagia.

Oropharyngeal causes of dysphagia

These are the causes which are problems high up in the swallowing process just below the mouth.

Neurological problems:

There are many muscle and nerve disorders (neurological diseases) that can affect the nerves and muscles in the gullet (oesophagus) to cause dysphagia.  Difficulty swallowing as a result of these conditions can be common in elderly people, in some disabled people and in people who have had strokes. Examples of these neurological conditions include: cerebral palsy, Severe learning disability, stroke, dementia, Parkinson’s disease.

Infections:

Severe infections can cause difficulty in swallowing. For example, bad tonsillitis, an abscess at the back of the throat or very swollen lymph nodes.

Tumours and swellings:

Tumours which press on the oropharynx can cause problems swallowing. This includes cancers of the mouth and throat, cancer of the thyroid gland.

Oesophageal causes of dysphagia:

Stricture due to severe oesophagitis:

Oesophagitis means inflammation of the lining of the gullet. Acid reflux occurs when some acid leaks up (refluxes) into the oesophagus from the stomach. The acid irritates the inside lining of the lower oesophagus to cause inflammation. A complication of severe long-standing oesophagitis is scarring and narrowing (a stricture) of the lower oesophagus.

Oesophageal

Most cases occur in people over the age of 55. Dysphagia is often the first symptom and is caused by the cancer growing and narrowing the passage in the oesophagus.

Strictures due to other causes:

Although oesophagitis and cancer are the most common causes of oesophageal narrowings (strictures) there are various other causes – for example, following surgery or radiotherapy to the oesophagus.

Achalasia:

This is a condition that affects both the muscles and the nerves that control the muscles of the oesophagus. The muscles do not contract properly to push food down. In addition, the sphincter does not relax properly so food cannot pass through into your stomach easily.

This makes it difficult for you to swallow food properly.

What tests might be advised?

It depends on the possible causes of the difficulty swallowing (dysphagia). Two of the most common tests done when someone has dysphagia are endoscopy and barium swallow.

Diverticular Disease

Diverticular disease is the general name for a common condition that causes small bulges (diverticula) or sacs to form in the wall of the large intestine (colon). Although these sacs can form anywhere in the colon, they are most common in the sigmoid colon (part of the large intestine closest to the rectum).

Diverticulosis: The presence of diverticula without associated complications or problems. The condition can lead to more serious issues including diverticulitis, perforation (the formation of holes), stricture (a narrowing of the colon that does not easily let stool pass), fistulas, and bleeding.                         

Diverticulitis: An inflammatory condition of the colon thought to be caused by perforation of one of the sacs. Several secondary complications can result from a diverticulitis attack. When this occurs, it is called complicated diverticulitis.

Diverticulitis Complications

Abscess formation

Abscess formation and perforation of the colon with peritonitis can occur. An abscess is a pocket of pus walled off by the body. Peritonitis is a potentially life-threatening infection that spreads freely within the abdomen, causing patients to become quite ill.

Rectal bleeding Colon stricture:

Formation of a narrowing of the colon that prevents easy passage of stool (called a stricture)

Fistula formation:

Formation of a tract or tunnel to another organ or the skin (called a fistula). When a fistula forms, it most commonly connects the colon to the bladder. It may also connect the colon to the skin, uterus, vagina, or another part of the bowel.

Causes:

The most commonly accepted theory ties diverticulosis to high pressure within the colon. This pressure causes weak areas of the colon wall to bulge out and form sacs. A diet low in fiber and high in red meat may also play a role. Currently, it is not well understood how these sacs become inflamed and cause diverticulitis.

Symptoms:

Most patients with diverticulosis have no symptoms or complications. Some patients with diverticulitis experience lower abdominal pain and a fever or they may have rectal bleeding.

Diagnosis:

Diverticulosis often causes no symptoms. It may be diagnosed during screening tests such as a colonoscopy. A CT scan of the abdomen and pelvis may be used to confirm the diagnosis of diverticulitis.

Treatment:

Most people with diverticulosis have no symptoms. However, as a preventative measure, it is advised to eat a diet high in fiber, fruits, and vegetables, and to limit red meat. Most cases of diverticulitis can be treated with antibiotics. Diverticulitis with an abscess may be treated with antibiotics with a drain placed under X-ray guidance. Surgery for diverticular disease is indicated for the following:

• A rupture in the colon that causes pus or stool to leak into the abdominal cavity, resulting in peritonitis, which often requires emergency surgery.
• An abscess than cannot be effectively drained.
• Severe cases that do not respond to maximum medical therapy including IV antibiotics and hospitalization.
• Patients with immune system problems.
• A colonic stricture or fistula.
• Multiple repeated attacks of diverticulitis.

Surgery for diverticular disease usually involves removal of the affected part of the colon. It may or may not involve a colostomy or ileostomy (intestine brought out through the abdominal wall to drain into a bag).

Gastritis:

Gastritis is an inflammation of the stomach lining. Weaknesses or injury to the mucus-lined barrier that protects your stomach wall allows your digestive juices to damage and inflame your stomach lining. A number of diseases and conditions can increase your risk of gastritis.

Risk factors for gastritis: Factors that increase your risk of gastritis include:

• Bacterial infection. Although infection with Helicobacter pylori is among the most 
common worldwide human infections, only some people with the infection develop gastritis or other upper gastrointestinal disorders.
• Regular use of pain relievers. Common pain relievers — such as aspirin, ibuprofen and naproxe — can cause both acute gastritis and chronic gastritis.
• Older age. Older adults have an increased risk of gastritis because the stomach lining tends to thin with age and because older adults are more likely to have H. pylori infection or autoimmune disorders than younger people are.
• Excessive alcohol use. Alcohol can irritate and erode your stomach lining, which makes your stomach more vulnerable to digestive juices.
• Severe stress due to major surgery, injury, burns or severe infections can cause acute gastritis.
• Other diseases and conditions. Gastritis may be associated with other medical conditions, including HIV/AIDS, Crohn’s disease and parasitic infections.

The signs and symptoms of gastritis include:  

• Burning ache or pain (indigestion) in your upper abdomen that may become either worse or better with eating, Nausea, Vomiting, A feeling of fullness in your upper abdomen after eating Gastritis doesn’t always cause signs and symptoms.

When to see a doctor: See your doctor if you have signs and symptoms of gastritis for a week or longer. If you are vomiting blood, have blood in your stools or have stools that appear black, see your doctor right away to determine the cause.

Complications

Left untreated, gastritis may lead to stomach ulcers and stomach bleeding. Rarely, some forms of chronic gastritis may increase your risk of stomach cancer.

Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a common disorder, affecting an estimated 15% of the population. It is one of the several conditions known as functional gastrointestinal disorders. This means the bowel may function abnormally, but tests are normal and there are no detectable structural defects.

Symptoms:

Symptoms vary from person to person and can range from mild to severe. IBS is a long-term condition, so symptoms may come and go and change over time. Symptoms include:

• Abdominal pain, Fullness, Gas and bloating, Change in bowel habits, Alternating diarrhea or constipation or both

Causes:

No clear answer exists as to what causes IBS. It is believed that the symptoms occur due to abnormal functioning or communication between the nervous system and bowel muscles. The muscles in the bowel wall may lose their coordination, contracting too much or too little at certain times. While there is no physical obstruction, a patient may feel like cramps are a functional blockage.

Risk factors:

All of the following have been identified as possible IBS risk factors:

• Gender: IBS is nearly twice as common in women as men, Environmental factors, Genetic factors, Bacterial activity in the gut, Bacterial overgrowth, Food intolerance, altered ability of the bowel to move freely, Oversensitive intestines, altered nervous system processing, Altered hormonal regulation

The role of stress:

IBS is not caused by stress or anxiety and is not a mental health disorder. However, emotional stress may be a factor in the onset of IBS episodes. Many people experience worse IBS symptoms when they are nervous or anxious.

Diagnosis:

No single test can confirm the diagnosis or IBS. A careful history and physical examination is essential. This is done to rule out more serious conditions. The two following criteria are helpful in making a diagnosis:

• Symptoms (described above) occur at least three days a month for three months
• IBS discomfort improves after a bowel movement or passage of gas

Treatment:

Stress and anxiety do not cause IBS but may trigger episodes or makes symptoms worse. Knowing that IBS is not serious condition may ease a patient’s anxiety or stress. The goal of treatment is to relieve symptoms. There may be some trial and error before an effective approach is found.

Non-medical treatment:

• Regular exercise, Improved sleep habits, Stress reduction, Behavioural therapy, Physical therapy, Biofeedback, Relaxation or pain management techniques, Probiotics, Dietary changes

The role of diet:

Dietary fiber can play a positive or negative role in IBS. For some people, too much fiber can increase bloating and cause abdominal pain. For others, eating foods high in fiber can help ease chronic constipation. Using a diary for two or three weeks can help identify foods and activities that seem to trigger or worsen symptoms.

Medical treatment:

No single medication works for everyone. People with moderate to severe IBS may benefit from prescribed medication. Anti-spasmodic medication may help control symptoms. Other patients improve when prescribed antidepressants in low doses.

Post-treatment prognosis:

Having IBS does not put you at risk for more serious problems. The condition does not cause cancer, bleeding, or inflammatory bowel diseases such as ulcerative colitis. However, if you experience rectal bleeding or unexplained weight loss, you should consult a colon and rectal surgeon as soon as possible. Patience is the key when dealing with this condition. Achieving relief from IBS symptoms can be a slow process. It may take six months or longer for symptoms to improve. If nothing is done, symptoms may come and go. The condition may improve or get worse over time and continue to impact the quality of your life.

Obesity and Overweight:

If you are obese or overweight, you have an increased risk of developing various health problems, including cancer, diabetes and heart disease. Even a modest amount of weight loss can help to reduce your increased health risks. The best chance of losing weight and keeping the weight off, is to be committed to a change in lifestyle. This includes eating a healthy diet and doing some regular physical activity.

What is obesity?

Obesity is the medical term for being very overweight. Over time, it means that you have an increased risk of developing various health problems. As an adult, you can find out whether you are overweight or obese and whether your health may be at risk, by calculating your body mass index (BMI) and measuring your waist circumference.

Body mass index (BMI)

To calculate your BMI, you divide your weight (in kilograms) by the square of your height (in metres). The more overweight you are, the more the risk to your health.

Health risks of obesity:

If you are obese or overweight, from day to day you may: Feel tired, Experience breathing problems, Feel that you sweat a lot, Have difficulty sleeping, Experience back and joint pains which can affect your mobility.

You may also have an increased risk of developing: diabetes, high cholesterol, high blood pressure, heart diseases, stroke, sleep apnoea, fertility problems, gallstones, fatty liver, asthma.

Causes of obesity:

Your weight depends on how much energy you take in and how much energy your body uses up: If you eat more calories than you burn up, you put on weight. The excess energy is converted into fat and stored in your body.

Genetics:

You are more likely to be obese if one of your parents is obese, or both of your parents are obese. This may partly be due to learning bad eating habits from your parents. But, some people inherit a tendency in their genes that makes them prone to overeat. So, for some people, part of the problem is genetic.

Medical problems:

Very few obese people have a ‘medical’ cause for their obesity. For example, conditions such as Cushing’s syndrome and an underactive thyroid gland are rare causes of weight gain, until they are treated. Women with polycystic ovary syndrome may also be overweight.

What are the benefits of losing weight?

It is difficult to measure how much quality of life is improved if you lose some weight. Many people feel better and have more energy. Some people notice an improvement in their self-esteem. But there are also definite health benefits from losing some weight.

Surgery to help with weight loss

This may be an option if you are obese and your health is at risk. It may be particularly considered if you have type 2 diabetes. This is because it will have even more health benefits, as the surgery may cure your diabetes as well. Surgery usually has very good results and most people do lose a lot of weight. However, this is specialist surgery and it is a major undertaking. Surgeons work in specialist weight management teams. The team helps with all the aspects of weight loss, and all the possible ways of helping you. Surgery to help weight loss is called bariatric surgery.

Oesophageal Cancer:

Symptoms of Oesophageal Cancer:

The prime symptoms of oesophageal cancer are difficulty swallowing, persistent indigestion or heartburn, loss of appetite and weight loss. You may also feel pain or discomfort in your upper tummy, chest or back and bring up food soon after eating. Difficulty swallowing, from the cancer narrowing the oesophagus, is the most common of these symptoms. It may feel as though food is getting stuck and swallowing can be uncomfortable or painful.

Diagnosis of Oesophageal Cancer:

Diagnosis is best done with an endoscopy, when a thin, flexible tube with a light and camera is passed into your mouth and down towards the stomach so that a doctor can check for cancer. Small tissue samples – a biopsy –  may be removed for testing. If oesophageal cancer is determined, then further tests such as a CT or ultrasound scan can judge how far the cancer has progressed – measured in stages –  and the appropriate treatment.

Treatment of Oesophageal Cancer:

A multi-disciplinary team will recommend a treatment plan which will feature surgery, chemotherapy or radiotherapy. Stage 1-3 is usually treated with surgery but may also require chemotherapy and radiotherapy; Stage 4 is not curable and requires chemotherapy, radiotherapy and other treatments to slow the spread of the cancer. A surgeon can perform an oesophagectomy to remove a section of the oesophagus and then reconnect the remaining section to your stomach. An Endoscopic Mucosal Resection (EMR) which cuts out the tumour with a loop of wire could be recommended. Stents can also be used to hold the oesophagus open to ease swallowing difficulties in advanced cases.

What Is Pancreatitis?

The two forms of pancreatitis are distinct but the most common cause of the illness are drinking too much alcohol and gallstones, which are responsible for 50% of all acute pancreatitis cases.

Acute Pancreatitis:

This is usually a one-off illness, usually lasting a few days before the pancreas returns to normal.

Chronic Pancreatitis:

This is repeat inflammations which can lead to scarring and reduced function. It is a long-term condition in which the pancreas does not recover. It is believed that acute pancreatitis is caused by misfiring enzymes which try to digest the organ. Admission to hospital is always required, though, because the functions of the body need to be supported until the pancreas recovers.

Symptoms of Pancreatitis:

These can range from mild to severe and can worsen over a few days. The main symptom of acute pancreatitis is a severe, dull abdominal pain around the top of the stomach and radiating to the back. Patients have also experienced a loss of appetite, high temperatures, feeling sick and vomiting, tenderness or swelling of the tummy and a fast heartbeat. Chronic pancreatitis can often start with a series of acute attacks. Chronic sufferers experience a dull abdominal pain which can get worse after eating but often there is no obvious trigger. They can also lose weight and experience the symptoms of diabetes, including feeling thirsty and needing to urinate more frequently.

Diagnosis of Pancreatitis:

Hospital admission may be required in severe cases but GPs can ask for blood tests, stools test – particularly for chronic pancreatitis –  and an abdominal ultrasound that detect if the pancreas is inflamed. An ERCP (Endoscopic retrograde cholangiopancreatography) produces a high definition X-Ray of the pancreas and bile ducts to detect and remove gallstones. An endoscope is passed through the mouth and stomach to the opening of the pancreas in the bowel. During the procedure, narrowing of the bile or pancreatic tubes can be widened and stones in the bile tubes can be removed. Damage caused by gallstones can also be picked up by a type of MRI scan called a magnetic resonance cholangiopancreatogram (MRCP).

Treatment of Pancreatitis:

Acute pancreatitis usually improve on its own so treatment is supportive but if you have severe acute pancreatitis, you’re likely to need treatment in hospital. Most patients are well enough to leave hospital after five to ten days but if complications develop you’ll need to be treated in intensive care or on a high dependency unit. Treatment for acute pancreatitis can involve intravenous fluids given by a drip, through a vein in your arm, painkillers such as opiates and medicines to treat sickness. Doctors will want to ‘rest’ your pancreas so you won’t be able to eat or drink for a few days, so you may be given liquid food through a tube instead.  A special liquid food can then be put straight into your stomach or bowel until your pancreas heals and you can eat and drink again. Your pancreas produces a hormone which controls the level of glucose (sugar) in your blood. When your pancreas is inflamed it stops working properly and doesn’t produce enough of this hormone. In some cases, pancreatic enzyme preparations may be prescribed. For chronic pancreatitis, treatments vary depending on the individual symptoms but lifestyle changes such as cutting alcohol intake and stopping smoking are strongly advised. Diet changes and food supplements can also be prescribed and, in severe cases, surgery to remove or drain any cysts or remove part of the pancreas can be an option.

Rectal Bleeding

Causes of Rectal Bleeding:

Rectal Bleeding may be caused by haemorrhoids or something more serious. Find out what is causing your bleeding and get the right help. The most common cause of rectal bleeding is from internal haemorrhoids. The blood is typically bright red and associated with bowel movements. It may be noticed on the tissue paper, on the surface of the stool, or drip into the bowel. The bleeding is typically mild and intermittent but occasionally is massive and causes anaemia. Internal haemorrhoids are present in everyone. If they become dilated the blood vessels become friable and bleed. There may be associated rectal pain, swelling, itching, incomplete evacuation of stool, or leakage of stool. Black Tarry stools are usually due to digested blood from the stomach or oesophagus. There may be an ulcer, inflammation-gastritis, or varices-dilated blood vessels from cirrhosis of the liver. Black liquorice, lead, iron, or Pepto Bismol can also cause black stools. Red or maroon-coloured stools, which may be foul smelling, is referred to as haematochezia or lower GI bleeding. Causes include diverticulosis, angiodysplasia, inflammatory bowel disease, polyps, cancer, colitis or radiation damage.  Not all rectal complaints are due to haemorrhoids. Fissures, thrombosed external haemorrhoids, Colon or Rectal Cancer, Proctitis, STDs, Pruritus Ani from fungal or bacterial infections, Ulcerative Colitis, Diverticulosis, Arterio-venous malformations, Crohn’s disease, haemangiomas, and rectal varices are other causes.

Diagnosis of Rectal Bleeding:

Do not assume the rectal bleeding is from haemorrhoids. A physical exam, rectal exam, sigmoidoscopy, and in some cases colonoscopy is mandatory to identify the cause of the bleeding and help rule out other conditions such as colon or rectal cancer. Associated change in bowel habits, weight loss, and abdominal pain mandate additional testing. New onset rectal bleeding in someone over the age of 40 that is not typical of haemorrhoids or does not respond to banding requires further testing with colonoscopy. Selected patients under the age of 40 may also need colonoscopy as colon cancer does occasionally occur in younger individuals. Sexually transmitted diseases of the rectum such as HPV, syphilis, gonorrhoea, or herpes may also cause rectal bleeding.

Colonoscopy:

Colonoscopy is an important procedure for screening for colon polyps and cancer. Rectal bleeding, abdominal pain, change in bowel habits, and weight loss require consultation and frequently colonoscopy. Colonoscopy has helped reduce the incidence of colon cancer.  Your doctor will outline bowel preparation for the procedure. You will likely be put under sedation during the colonoscopy. A flexible tube is used to look at the lining of the colon.  Biopsies or removal of any polyps will be done.

Treatment of Rectal Bleeding from Haemorrhoids:

If the haemorrhoid bleeding does not stop with adding fiber to your diet and limiting your time on the commode to two minutes, it is time to have the blood vessels shrunk with rubber banding. Preparation H, steroid creams, cold compresses, and haemorrhoid suppositories may provide temporary relief. In addition to haemorrhoid banding custom compound medications containing Nitro-glycerine, Diltiazem, or Nifedipine plus analgesics may be prescribed reduce anal pressure and pain.  Over half of us will suffer from haemorrhoids at some point in our life. At our Haemorrhoid Centre, it is our goal to provide you with a non-painful treatment for your haemorrhoid (piles) and/or anal fissures. We understand the fear and embarrassment you may be feeling. Our staff will help you feel comfortable. If you are having trouble with rectal bleeding, our Haemorrhoid Centre.

RECTAL CANCER

The rectum is the last 6 inches of the large intestine (colon). Rectal cancer arises from the lining of the rectum. Colorectal cancer is highly curable if detected in the early stages.

Who is at risk of rectal cancer:

No one knows the exact causes of rectal cancer. Rectal cancer is more likely to occur as people get older, and more than 90% of people with this disease are diagnosed after age 50. Other risk factors include a family history of colorectal cancer (especially in close relatives), and a personal history of inflammatory bowel disease such as ulcerative colitis, colorectal polyps or cancers of other organs.

Is rectal cancer preventable?

Rectal cancer is preventable. Nearly all rectal cancer develops from rectal polyps, which are benign growths on the rectal wall. Detection and removal of these polyps by colonoscopy reduces the risk of getting rectal cancer. Screening typically starts at age 50 in patients with average risk, or at younger ages in patients at higher risk for rectal cancer. Though not definitely proven, there is some evidence that diet may play a significant role in preventing colorectal cancer. As far as we know, a diet high in fiber (whole grains, fruits, vegetables, nuts) and low in fat is the only dietary measure that might help prevent colorectal cancer

Symptoms of rectal cancer:

Many rectal cancers cause no symptoms at all and are detected during routine screening examinations. The most common symptoms of rectal cancer are a change in bowel habits, such as constipation or diarrhoea, narrow shaped stools, or blood in your stool. You may also have pelvic or lower abdominal pain, unexplained weight loss, or feel tired all the time.  Abdominal pain and weight loss are typically late symptoms, indicating possible extensive disease.

Diagnosis of rectal cancer:

• Physical exam and medical history
• Digital rectal exam (DRE)
• Proctoscopy: An examination of the rectum using a proctoscope, inserted into the rectum.
• Colonoscopy: A procedure to look inside the rectum and colon for polyps (small pieces of bulging tissue), abnormal areas, or cancer.
• Biopsy: The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer.

What determines the outcome of rectal cancer?

• The stage of the cancer (how far advanced the cancer is).
• Where the cancer is found in the rectum.
• Whether the bowel is blocked or has a hole in it.
• Whether all of the tumour can be removed by surgery.
• The patient’s general health and ability to tolerate different treatment regimens.
• Whether the cancer has just been diagnosed or has recurred (come back).

How is rectal cancer treated?

For complete cure, surgery to remove the rectal cancer is almost always required.  Depending on the location and stage, this may be performed through the anus (opening of the rectum) or through the abdomen. Rectal cancer surgery removes the cancer and lymph nodes, along with a small portion of normal rectum on either side of the tumour. Creation of a colostomy (opening the intestine to a bag on the skin) is typically needed only in a very small number of patients. Additional treatment with chemotherapy or radiation therapy may be offered either before or after the surgery, depending on the stage of the cancer.

What factors determine the outcome?

The outcome of patients with rectal cancer is most clearly related to the stage at the time of diagnosis, with cancer that is confined to the lining of colon having the best chance of success. This is one reason why early detection through screening methods like colonoscopy is crucial.

Any need for follow up treatment?

After treatment for rectal cancer, a blood test to measure amounts of CEA (a substance in the blood that may be increased when cancer is present) may be done to see if the cancer has come back. Routine CT scans, clinical examinations, and colonoscopy are also performed at intervals determined by the stage.

Stomach Cancers:

Symptoms:

Many symptoms of stomach cancers are similar to less serious conditions with early stage signs being persistent indigestion, heartburn, trapped wind, difficulty swallowing and vomiting. The more advanced signs include blood in your stools, a swelling or lump in the stomach, loss of appetite, weight loss, fatigue, anaemia and jaundice.

Around 90% of stomach cancers appear in people aged over 55.

Diagnosis:

It is easier to treat if diagnosed early and GPs are instructed to check symptoms and examine your stomach for any lumpiness or tenderness and to refer to a specialist for further investigation. A GP should also refer you to a specialist if you have indigestion and weight loss. You may need a blood test or a gastroscopy and biopsy, using a narrow flexible tube to examine the inside of the stomach, and possibly take a small tissue sample for testing

Treatment:

Treatment will vary depending on your general health and how far advanced the cancer has become. The three main treatment options are surgery, chemotherapy and radiotherapy. An operation is usually recommended if the cancer has been detected early and the damaged tissue can be removed. Chemotherapy and radiotherapy are normally prescribed at a later stage to kill cancer cells and arrest tumour growth. Biological treatments, which stimulate the body’s immune system to fight back, are also available It is estimated that a cure is possible in 20-30% of cases.

Gastric/Stomach ulcers

Peptic ulcers occur when acid in the digestive tract eats away at the inner surface of the stomach. The acid can create a painful open sore that may bleed.Your digestive tract is coated with a mucous layer that normally protects against acid. But if the amount of acid is increased or the amount of mucus is decreased, you could develop an ulcer. 

Common causes include: 

 Helicobacter pylori bacteria commonly live in the mucous layer that covers and protects tissues that line the stomach. Often, the H. pylori bacterium causes no problems, but it can cause inflammation of the stomach’s inner layer, producing an ulcer.

Regular use of certain pain relievers. Taking aspirin, as well as certain over-the-counter and prescription pain medications called nonsteroidal anti-inflammatory drugs (NSAIDs) can irritate or inflame the lining of your stomach. These medications include ibuprofen and naproxen. Peptic ulcers are more common in older adults who take these pain medications frequently.

Other medications. Taking certain other medications along with NSAIDs, such as steroids, anticoagulants, low-dose aspirin can greatly increase the chance of developing ulcers.

Risk factors:

You may have an increased risk of peptic ulcers if you: Smoke, Drink alcohol, Have untreated stress, Eat spicy foods.

Symptoms:

Burning stomach pain, Feeling of fullness, bloating or belching, Fatty food intolerance, Heartburn and nausea. The most common peptic ulcer symptom is burning stomach pain. Stomach acid makes the pain worse, as does having an empty stomach. The pain may be worse between meals and at night. Nearly three-quarters of people with peptic ulcers don’t have symptoms. 

Less often, ulcers may cause severe signs or symptoms such as: Vomiting or vomiting blood — which may appear red or black, Dark blood in stools, or stools that are black or tarry, Trouble breathing, Feeling faint, Nausea or vomiting, unexplained weight loss and appetite change  

Complications

Left untreated, peptic ulcers can result in: 

• Internal bleeding. Bleeding can occur as slow blood loss that leads to anaemia or as severe blood loss that may require hospitalization or a blood transfusion. Severe blood loss may cause black or bloody vomit or black or bloody stools.
• Infection. Peptic ulcers can eat a hole through (perforate) the wall of your stomach or small intestine, putting you at risk of serious infection of your abdominal cavity.
• Obstruction. Peptic ulcers can lead to swelling, inflammation or scarring that may block passage of food through the digestive tract. A blockage may make you become full easily, vomit and lose weight.

ULCERATIVE COLITIS:

What is ulcerative proctitis?

Ulcerative proctitis is characterized by inflammation, redness, and ulcerations of the lining of the rectum. The word “ulcerative” is used because the disease actually causes the formation of sores/ulcers on the inner lining of the rectum. The cause of ulcerative proctitis is unknown.

What are the symptoms of ulcerative proctitis?

The symptoms associated with ulcerative proctitis include:

• Diarrhoea, Bleeding, Tenesmus (a persistent urge to empty the bowel whether or not stool is present), Mucus discharge, Rectal pain and accidental Bowel Leakage Patients may notice the passage of blood or mucus with or without stool. The amount of bleeding from ulcerative proctitis is usually small, but it can appear to be a lot and can be frightening.

What causes ulcerative proctitis?

Researchers are actively trying to find its cause. Many scientists now believe that it is due to a reaction of the body’s immune system which results in an inflammation of the lining of the rectum. Although the cause of ulcerative proctitis has not been identified, it is known that dietary habits or stress do not cause it. However, people with the disease may find that busier, more stressful times aggravate their symptoms.

How is ulcerative proctitis detected?

Your doctor can detect this disease by a visual exam of the lining of your rectum using an instrument called a flexible sigmoidoscope. This examination is important because the symptoms of proctitis may be the same as the symptoms of many other diseases, some of which are quite serious.

How is ulcerative proctitis treated?

The treatment of ulcerative proctitis depends on the extent of the inflammation and the number of flareups you have had. For mild inflammation medicated enemas, suppositories, or foam are usually prescribed.  Patients with repeated episodes are often prescribed oral medication to reduce the chance of further episodes. Regular examinations are important for monitoring your disease and staying current with the best approaches for ongoing care of your ulcerative proctitis. In addition to medication, changes in diet may be helpful. A high-fiber diet and plenty of water is helpful. Patients with diarrhoea often find that avoiding milk and milk products, spicy foods, and raw fruits and vegetables will improve the diarrhoea. Regular visits with the doctor are important to adjust your medication as your symptoms change. Patients who participate actively in learning how to manage their disease find the quality of their life improves.

What can I expect?

You can expect to lead a normal, active life. Symptoms will vary from person to person. Some people have symptoms constantly. In others, ulcerative proctitis may be inactive for months or even years and then flare up without warning. Regardless of your symptoms pattern, you will need regular follow-ups with your physician to monitor changes in the disease and adjust your medications. Ulcerative proctitis does not significantly increase your risk of developing cancer.

What can I do to improve my condition?

You can do certain things which may make your disease easier to live with.

• Increase the amount of fiber in your diet either through high fiber foods or commercial fiber supplements.
• Avoid dairy products. A lactose-free diet can help to control symptoms of cramping, gas, diarrhoea or abdominal bloating.
• Decrease stress. Stress and tension can make your symptoms worse. Relaxation techniques and changes in lifestyle may help.
• Talk to someone who is experiencing the same symptoms.

Vomiting Blood/haematemesis:

You should call an ambulance or go directly to the nearest emergency department if you bring up (vomit) blood. Often the bleeding will stop quite quickly but in some cases it can become severe and life-threatening. Many causes can be treated but the first priority is to make sure the bleeding stops.

What is vomiting blood (haematemesis)?

The medical word for vomiting blood (or throwing up blood) is haematemesis. This symptom is usually due to a problem within the upper gut. That is, the gullet (oesophagus), stomach or the first part of the gut (small intestine) known as the duodenum.

Understanding the upper gut:

Your gut (gastrointestinal tract) is the tube that starts at your mouth and ends at your bottom (anus). The upper gut includes the gullet (oesophagus), stomach and first part of the gut (small intestine) known as the duodenum.

What are the causes of vomiting blood?

Common causes of throwing up blood include: A stomach ulcer, Alcoholic liver disease, A tear in your gullet caused by prolonged retching, Swallowing blood from a nosebleed.

Bleeding from the oesophagus:

Oesophageal varices: Varices are enlarged, swollen blood vessels in the lining of the gullet or stomach and are a complication of liver cirrhosis.

Inflammation of the oesophagus: Oesophagitis is often a result of acid reflux in the oesophagus. The inflamed oesophagus sometimes bleeds.

Oesophageal cancer: this sometimes cause bleeding in the oesophagus.

Bleeding from the stomach

Stomach ulcers: An ulcer is a small breakdown in the lining of the stomach. An ulcer may bleed, sometimes heavily. There are several causes of stomach ulcers, including:

Stomach cancer: sometimes causes bleeding in the stomach.

Gastritis: Inflammation of the stomach can also bleed.

Bleeding from the duodenum:

Duodenal ulcers: An ulcer may bleed, sometimes heavily. Like stomach ulcers, a duodenal ulcer is usually caused by an infection with the germ (bacterium) called H. pylori. Inflammation of the duodenum lining: (duodenitis) has similar causes to duodenal ulcers.

Bleeding which has not come from the gut:

Sometimes when blood is vomited, it has not come from the gut. For example, if you have had a nosebleed and then swallowed the blood, you may vomit blood.

What tests may be needed?

Your doctor is likely to ask various questions about the nature of the bleeding and ask if you have any other symptoms.

Blood tests:

Blood tests will usually be done to assess your general situation as to how much blood you have lost. 

Gastroscopy:

A thin, flexible telescope is passed down the gullet (oesophagus) into the stomach and to the upper duodenum. The cause of the bleeding can often be identified by endoscopy.