What are the main causes of bloody diarrhea. How can you identify the symptoms of different conditions leading to bloody stools. What treatments are available for managing bloody diarrhea.

Understanding Bloody Diarrhea: A Comprehensive Overview

Bloody diarrhea is a concerning symptom that can indicate various underlying health conditions. This article delves into the nine primary causes of bloody diarrhea, their symptoms, and available treatments. By understanding these factors, you can better recognize when to seek medical attention and what to expect during diagnosis and treatment.

Inflammatory Bowel Disease (IBD): A Major Culprit of Bloody Diarrhea

Inflammatory Bowel Disease (IBD) is a chronic condition that can lead to persistent bloody diarrhea. There are two main types of IBD: ulcerative colitis and Crohn’s disease.

Ulcerative Colitis: Symptoms and Treatment Options

Ulcerative colitis affects the colon and rectum, often resulting in diarrhea with blood or pus. Common symptoms include:

• Abdominal pain and cramping
• Urgent bowel movements
• Weight loss
• Fatigue

Treatment options for ulcerative colitis may include:

• Anti-inflammatory drugs
• Immune system suppressors
• Antibiotics
• Dietary changes
• Surgery in severe cases

Crohn’s Disease: Recognizing the Signs

Crohn’s disease can affect any part of the digestive tract, from mouth to anus. Symptoms often include:

• Watery diarrhea (if only the small intestine is affected)
• Rectal bleeding
• Abdominal cramps and pain
• Weight loss
• Fever
• Mouth sores

Treatment approaches for Crohn’s disease may involve:

• Medication
• Dietary modifications
• Surgery in some cases

Ischemic Colitis: When Blood Flow to the Colon is Compromised

Ischemic colitis occurs when blood flow to the colon is reduced or blocked, leading to oxygen deprivation and potential damage to the intestine. This condition can result in bloody diarrhea accompanied by abdominal pain.

Additional symptoms of ischemic colitis may include:

• Bloating
• Fever
• Nausea or vomiting
• Urgent need to use the bathroom

Treatment options for ischemic colitis often focus on addressing the underlying cause and may include:

• Intravenous fluids
• Antibiotics
• Pain management
• Dietary changes
• Surgery in severe cases

Bacterial Infections: Common Culprits of Acute Bloody Diarrhea

Bacterial infections are a frequent cause of acute bloody diarrhea, typically lasting no more than two weeks. Several types of bacteria can lead to this condition:

E. coli: A Potentially Dangerous Foodborne Pathogen

Certain strains of E. coli, particularly STEC (Shiga toxin-producing E. coli), can cause bloody diarrhea. Symptoms of STEC infection may include:

• Severe stomach cramps
• Vomiting
• Fever (usually not very high)

Treatment for STEC infections primarily involves rest and hydration, as antibiotics may worsen the condition.

Salmonella: More Than Just Food Poisoning

Salmonella infections can lead to bloody diarrhea and other symptoms such as:

• Fever
• Stomach cramps
• Nausea or vomiting
• Headache

Severe cases of salmonella may require antibiotics and hospitalization for proper treatment and monitoring.

Shigella: A Common Cause of Traveler’s Diarrhea

Shigella infections can result in bloody diarrhea, often accompanied by:

• Fever
• Stomach pain
• Tenesmus (the urge to have a bowel movement even when the bowels are empty)

Treatment for shigella infections may include:

• Antacid medications like bismuth subsalicylate
• Antibiotics in severe cases
• Proper hydration

Campylobacter: A Lesser-Known but Significant Bacterial Infection

Campylobacter infections affect over a million people annually in the United States and can cause bloody diarrhea. Other symptoms may include:

• Fever
• Abdominal cramps
• Nausea or vomiting

Treatment for campylobacter infections often involves:

• Proper hydration
• Antibiotics in severe cases
• Probiotics to support gut health

Preventing Bacterial Infections: Essential Steps for Reducing Risk

To lower your risk of contracting bacterial infections that may cause bloody diarrhea, consider the following preventive measures:

• Practice good hand hygiene, especially after contact with people or animals
• Cook meat thoroughly and handle raw meat safely
• Avoid consuming raw milk or unpasteurized products
• Be cautious when swimming in lakes, ponds, or pools to avoid swallowing water
• Take precautions when traveling to areas with potentially unsafe water sources

Less Common Causes of Bloody Diarrhea: When to Consider Other Conditions

While less frequent, other conditions can also lead to bloody diarrhea. These include:

• Colon cancer
• Colon polyps
• Advanced stomach cancer (particularly when undergoing radiation therapy)

These conditions often require specialized diagnostic procedures and treatments, emphasizing the importance of consulting a healthcare professional when experiencing persistent or severe symptoms.

Seeking Medical Attention: When to Consult a Doctor

Bloody diarrhea is a symptom that should not be ignored. It’s crucial to seek medical attention if you experience:

• Persistent or severe bloody diarrhea
• Accompanying symptoms such as high fever, severe abdominal pain, or signs of dehydration
• Bloody diarrhea that lasts more than a few days
• Symptoms that worsen or fail to improve with home care

A healthcare professional can provide an accurate diagnosis and appropriate treatment plan, which may include diagnostic tests, medication, or referral to a specialist if necessary.

Diagnostic Approaches for Bloody Diarrhea

When evaluating the cause of bloody diarrhea, healthcare providers may employ various diagnostic techniques:

• Physical examination and medical history review
• Stool sample analysis to check for parasites, bacteria, or other pathogens
• Blood tests to assess inflammation markers and rule out other conditions
• Imaging studies such as CT scans or ultrasounds to examine the digestive tract
• Colonoscopy or sigmoidoscopy to visualize the colon and rectum

The specific diagnostic approach will depend on the suspected underlying cause and the severity of symptoms.

Treatment Strategies for Bloody Diarrhea

The treatment of bloody diarrhea varies based on the underlying cause. Common approaches include:

• Addressing dehydration through oral or intravenous fluid replacement
• Antibiotic therapy for bacterial infections, when appropriate
• Anti-inflammatory medications for conditions like IBD
• Dietary modifications to manage symptoms and support healing
• Probiotics to restore beneficial gut bacteria
• Surgical intervention in severe cases or for certain conditions

It’s important to note that over-the-counter anti-diarrheal medications should be avoided without medical advice, as they can sometimes worsen certain conditions causing bloody diarrhea.

Long-term Management and Prognosis

The long-term outlook for individuals experiencing bloody diarrhea depends on the underlying cause:

• Bacterial infections often resolve within a few weeks with proper treatment
• Chronic conditions like IBD may require ongoing management and lifestyle adjustments
• Ischemic colitis prognosis varies based on the severity and underlying cause
• Regular follow-ups with healthcare providers are essential for monitoring and adjusting treatment plans

By working closely with healthcare professionals and adhering to recommended treatments and lifestyle modifications, many individuals can effectively manage their condition and improve their quality of life.

Nutritional Considerations for Managing Bloody Diarrhea

Proper nutrition plays a crucial role in managing bloody diarrhea and supporting recovery. Consider the following dietary recommendations:

• Stay hydrated by consuming clear fluids, electrolyte solutions, and broths
• Opt for easily digestible foods such as bananas, rice, applesauce, and toast (BRAT diet)
• Avoid foods that may irritate the digestive system, such as spicy or fatty foods
• Incorporate probiotic-rich foods or supplements to support gut health
• Gradually reintroduce a balanced diet as symptoms improve

Always consult with a healthcare provider or registered dietitian for personalized nutritional advice, especially if you have a chronic condition like IBD.

The Impact of Bloody Diarrhea on Quality of Life

Experiencing bloody diarrhea can significantly affect an individual’s daily life and overall well-being. Some potential impacts include:

• Emotional distress and anxiety about the underlying condition
• Disruption to work, social activities, and personal relationships
• Nutritional deficiencies due to malabsorption or dietary restrictions
• Fatigue and weakness from fluid and electrolyte imbalances
• Increased healthcare costs and potential financial strain

Addressing these aspects through comprehensive care, including psychological support and lifestyle adjustments, is essential for improving overall quality of life for those affected by bloody diarrhea.

Emerging Research and Future Treatments

The field of gastroenterology continues to advance, offering hope for improved treatments and management strategies for conditions causing bloody diarrhea. Some areas of ongoing research include:

• Novel biologic therapies for inflammatory bowel diseases
• Microbiome-based treatments to restore gut health
• Targeted therapies for specific bacterial infections
• Improved diagnostic tools for faster and more accurate identification of underlying causes
• Gene therapy approaches for hereditary gastrointestinal disorders

While many of these developments are still in the research phase, they highlight the potential for more effective and personalized treatments in the future.

The Role of Stress Management in Gastrointestinal Health

Stress can exacerbate symptoms of many gastrointestinal conditions, including those that cause bloody diarrhea. Incorporating stress management techniques into your daily routine can be beneficial:

• Practice relaxation techniques such as deep breathing, meditation, or yoga
• Engage in regular physical activity, as approved by your healthcare provider
• Seek support from friends, family, or support groups
• Consider cognitive-behavioral therapy or other forms of counseling
• Prioritize adequate sleep and maintain a consistent sleep schedule

By managing stress effectively, you may be able to reduce the frequency and severity of gastrointestinal symptoms and improve your overall well-being.

The Importance of Patient Education and Self-advocacy

Being well-informed about your condition and actively participating in your healthcare can lead to better outcomes. Consider the following strategies:

• Educate yourself about your specific condition and treatment options
• Keep a symptom diary to track patterns and potential triggers
• Prepare questions for your healthcare provider before appointments
• Communicate openly with your healthcare team about your concerns and treatment preferences
• Join patient advocacy groups or online communities for support and information sharing

By taking an active role in your healthcare, you can work more effectively with your medical team to manage your condition and improve your quality of life.

Navigating Life with Chronic Gastrointestinal Conditions

For individuals living with chronic conditions that cause bloody diarrhea, such as IBD, developing coping strategies is essential. Consider the following approaches:

• Create a support network of family, friends, and healthcare professionals
• Develop a routine that accommodates your symptoms and treatment regimen
• Explore workplace accommodations if your condition affects your job performance
• Plan ahead for travel and social events to manage potential challenges
• Focus on overall wellness, including mental health and physical fitness

Remember that living with a chronic condition is a journey, and it’s okay to seek help and make adjustments as needed to maintain your quality of life.

The Global Impact of Gastrointestinal Diseases

Gastrointestinal diseases, including those causing bloody diarrhea, have a significant impact worldwide. Understanding this global perspective can provide context for individual experiences:

• Diarrheal diseases are a leading cause of death in children under five in developing countries
• Access to clean water and sanitation plays a crucial role in preventing many causes of bloody diarrhea
• The prevalence of inflammatory bowel diseases is increasing globally, particularly in newly industrialized countries
• Research and treatment advances often begin in developed countries but can have far-reaching impacts
• Global health initiatives aim to reduce the burden of gastrointestinal diseases worldwide

9 Causes of Bloody Diarrhea

It’s unpleasant to have diarrhea by itself, so it’s understandable to be concerned if you find blood in it. Loose, watery stool with bleeding can be a symptom of a serious condition like ulcerative colitis or a bacterial infection.

No matter what the cause is, your doctor has treatments that can help, so call them right away. Don’t try to treat it on your own with anti-diarrheal meds. In some cases, that could make things worse.

Your doctor will figure out what’s going on and prescribe the right medicine for you. They’ll also make sure that you don’t lose too many important fluids and minerals, which can be dangerous.

Here are some of the conditions that can bring on this symptom.

Inflammatory Bowel Disease (IBD)

If you have bloody diarrhea that goes on for weeks, IBD might be the reason why. This long-term condition inflames parts of your digestive tract. Experts aren’t sure exactly why that happens.

There are two main kinds of IBD: ulcerative colitis and Crohn’s disease.

Continued

Ulcerative colitis. This condition affects your colon and rectum. One of the most common symptoms is diarrhea with blood or pus.

Other signs are:

Treatments for ulcerative colitis include:

Crohn’s disease. This type of IBD can affect any section of your digestive tract, from your mouth to your anus. Diarrhea is a common symptom. If the disease affects only your small intestine, you’re more likely to have watery diarrhea. Sometimes it causes rectal bleeding.

You may also have:

• Belly cramps and pain
• Weight loss
• Fever
• Mouth sores

Treatments for Crohn’s include:

• Medication
• Changes to what you eat
• Surgery

Ischemic Colitis

This is when blood flow to your colon slows down or stops. The lack of oxygen causes damage to your intestine.

The blockage can happen slowly over time, such as when cholesterol builds up in your arteries. Or it can happen all of a sudden from a blood clot or from a serious drop in your blood pressure.

Continued

It can lead to bloody diarrhea. It usually also comes with abdominal pain that can be mild or serious.

You may also have symptoms like:

• Bloating
• Fever
• Nausea or vomiting
• Urgent need to go to the bathroom

Treatments for it can include:

Bacterial Infections

Bloody diarrhea from IBD can last for a while if you don’t treat it. If it’s from a bacterial infection, it doesn’t usually last more than 2 weeks. It doesn’t come back after it gets better, unless you catch the same infection again.

Bacterial infections that can cause bloody diarrhea include:

E. coli. It can taint food, water, and unwashed hands — and if you put any of those in your mouth, you could get sick. Some strains of E. coli in particular, called “STEC,” make a toxin that can trigger bloody diarrhea.

Other symptoms of a STEC infection:

Continued

There’s no specific treatment. Antibiotics might make it worse. Your doctor may tell you to drink plenty of fluids and get lots of rest.

Salmonella. It’s common for this bacteria to make you sick through food poisoning, yet the food may look and smell fine.

An infection can give you bloody diarrhea as well as other symptoms like:

• Fever
• Stomach cramps
• Nausea or vomiting
• Headache

Treatment for serious salmonella include antibiotics and hospital care.

Shigella. This tends to spread through fouled food or water and hand-to-mouth contact. You may be more likely to catch it if you travel to a developing country.

Sometimes it brings on bloody diarrhea. You may also have:

• Fever
• Stomach pain
• An urge to go to the bathroom even though you don’t need to

Continued

Treatment includes:

• An antacid medication like bismuth subsalicylate
• Antibiotics

Campylobacter. This bacteria makes about a million and a half people sick each year in the U.S., but you may be more likely to get infected by it if you travel abroad. In most cases, it’s the result of eating raw or undercooked poultry or another food that touched it.

Continued

The diarrhea that can come with it is usually bloody. It can also give you symptoms like:

• Fever
• Belly cramps
• Nausea or vomiting

Treatments include:

You can take steps to lower your odds of getting a bacterial infection that could give you bloody diarrhea:

• Wash your hands often, especially after you touch other people or animals.
• Cook meat all the way through. Keep it away from other foods.
• Wash any surfaces and utensils that raw meat touches.
• Don’t buy raw milk or unpasteurized foods or drinks.
• Try not to swallow water from lakes, ponds, or swimming pools.
• If you travel to places that don’t always have safe water, make sure to eat only cooked foods. Drink only bottled drinks from unopened bottles. Stay away from ice and unpeeled fruits and veggies.

Other Causes

A couple of conditions that are less likely to trigger diarrhea with rectal bleeding are colon cancer and polyps. Also, radiation therapy for advanced stomach cancer can cause diarrhea, while bleeding may be due to the disease itself.

Digestive Disorders Associates and MDTEC: Gastroenterology

If you have any digestive complaints, call our office in Annapolis at 410-224-4887 to schedule an appointment with one of our specialists, or use our online booking tool!

It’s perfectly normal to feel concerned if you spot blood in your stool or on the toilet paper after wiping. Bloody stool isn’t a normal occurrence and should be evaluated immediately. Whether you notice a faint red streak or dark blood in your stool, it can be a sign that something is amiss. If you ignore the symptom, whatever condition is causing it may get worse, so getting in to see a gastroenterologist can help get to the bottom of things.

At Digestive Disorders Associates, we see patients with a wide variety of digestive complaints and can provide a comprehensive evaluation for issues such as bloody stools. Sometimes there’s an innocent explanation for finding blood in your stool. The only way to know for sure is to have a thorough examination.

Here are some of the possible reasons behind bloody stools.

Inflammatory bowel disease

Inflammatory bowel disease (IBD) causes chronic inflammation and sores to develop along the digestive tract, and bloody stool is a common symptom. Ulcerative colitis and Crohn’s disease are the two most common forms of IBD. You may have IBD if your bloody stool is accompanied by:

• Bouts of diarrhea that come and go
• Abdominal pain and cramping
• Bloating after eating
• Constipation
• Difficult bowel movements

While there is no cure for IBD, treatments can reduce symptoms and help patients avoid complications. A combination of diet and lifestyle changes, and medication when necessary, can benefit IBD patients.

Peptic ulcers

Bleeding anywhere along the digestive tract can cause blood to appear in the stool. Peptic ulcers are sores that form on the lining of the stomach that commonly cause bloody stool. Long-term use of certain medications and H. pylori, a stomach bacteria, are two common causes of ulcers. Most patients who have ulcers experience some digestive complaints along with diarrhea. You may have an ulcer if you notice:

• Burning stomach pain
• Heartburn
• Nausea
• Gas
• Intolerance to fatty food

Having an empty stomach tends to make stomach ulcer pain worse.

Hemorrhoids  

On the least serious end of the spectrum, hemorrhoids could be responsible for blood in your stool. This common condition occurs when the anus or rectum becomes irritated and swollen. Hemorrhoids often occur from straining during bowel movements.

A low-fiber diet and dehydration can contribute to straining, which puts pressure on the veins in the rectum and anus. When you see one of our providers at Digestive Disorders Associates, a comprehensive evaluation will help rule out more serious causes.

Typical signs of hemorrhoids to look out for include:

• Anal itching and irritation
• Anal swelling
• Pain during bowel movements

Bleeding during bowel movements is the most common sign of hemorrhoids. However, it’s best not to assume that hemorrhoids are the cause of your bloody stool. Consult us for evaluation, especially if you’re over age 40, as blood in your stools could be a sign of a more serious issue.

Colon cancer or other serious condition

While most instances of blood-containing stool aren’t life-threatening, it’s necessary to have an evaluation. Bloody stool can be a sign of a more serious condition, such as colon cancer. Let us know if you experience bleeding along with a sudden change in bowel habits. This may signal a more extensive problem elsewhere in the digestive tract.

It’s important to find out the cause of blood in your stool and rule out serious digestive conditions. Left untreated, bloody stool could lead to dangerous complications. If you have any digestive complaints, call our office in Annapolis to schedule an appointment with one of our specialists.

6 causes of red diarrhea

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A healthy stool is usually solid, soft, and brown. While diarrhea is unpleasant, it is not usually a sign of something serious. Red or bloody diarrhea, however, may be a sign of an underlying health problem.

Diarrhea occurs when digested food material and water pass through the intestines too quickly. Instead of having time to form a solid mass, the material passes through in a liquid form.

Red diarrhea may be alarming, but stool color can help a person determine the cause of their symptoms. In this article, we look at the possible causes and treatment, as well as what other stool colors mean.

Six causes of red diarrhea:

1. Dysentery: Diarrhea with blood is called dysentery. The most common causes of dysentery are Shigella bacteria or Entamoeba histolytica, a type of parasite. These can cause severe infections that inflame the intestines enough to result in bleeding.
2. Red foods: Foods that are naturally red or contain red food coloring can turn the stool red. Red diarrhea might occur if the food that a person eats causes food poisoning or irritates the stomach. Foods that can turn stool red include beets, cranberries, red candy, red frosting, red licorice, tomatoes, and tomato sauce.
3. Gastrointestinal (GI) bleeding: A range of conditions can result in GI bleeding, including colon polyps, inflammatory bowel disease (IBD), or gastric cancer. These conditions can cause significant blood loss that may turn diarrhea red.
4. Hemorrhoids: Hemorrhoids are swollen blood vessels that occur inside the rectum and anus. They are a common cause of rectal bleeding and red diarrhea.
5. Medications: The side effects of some medications may cause red stool. They can also irritate the stomach and potentially lead to diarrhea. Medications that cause red stools include liquid antibiotics.
6. Anal fissure: Sometimes a scratch in the rectal area called an anal fissure can cause the stool to appear bloody. In this case, it may only be a small amount of bright red blood.

Looking at stool color can often help a person determine what is causing their gastrointestinal symptoms.

Stool can come in a range of colors and have a variety of causes:

• Black stools: Tarry, black stools or stools the consistency of coffee grounds can indicate potential gastrointestinal (GI) bleeding. Black diarrhea can sometimes point to an upper GI bleed because the blood has had more time to travel through the GI tract and darken. Certain foods, such as licorice or high quantities of grape juice, may also turn stool black.
• Green stools: Green stools may be due to the presence of bile in the stool. Taking iron supplements can also cause stool to become dark green.
• Pale stools: Pale or clay-colored stools may indicate stones in the bile duct that empty from the gallbladder. If a person observes dark urine as well, this is a further sign that the gallbladder or liver could be the underlying cause. Some antacids that contain aluminum hydroxide can also cause pale stools.
• Yellowish, greasy stool: Yellow stool may be a sign of an infection or a malabsorption disorder, such as celiac disease.

Share on PinterestFrequently sipping water may help prevent dehydration caused by diarrhea.

When a person has diarrhea, they can lose a significant amount of fluid via their stool. When this happens, a person can become dehydrated.

A person should drink small sips of water or an electrolyte-replacement beverage regularly to help replace the lost water. Electrolyte powders are available for purchase online.

Diarrhea is often a way in which the body gets rid of an unwanted virus. Instead of prescribing medications that would slow the intestines and cause the body to retain the bacteria for longer, doctors may encourage a person to allow the diarrhea to run its course.

However, prolonged diarrhea may require additional treatments, such as intravenous fluids and medications to reduce cramping in the bowels.

In more severe cases of dysentery, a person may be given antibiotics or amoebicidal medications, or both if the exact cause is unknown.

If a person’s red diarrhea is due to GI bleeding, they may require a blood transfusion until the body can produce more blood. This procedure takes place in the hospital, and the person will need to remain there until their blood count is within a normal range.

If a person thinks red diarrhea is due to their medication, they should speak to a doctor about possible alternatives.

If red diarrhea is the result of dysentery or infection, a person can take steps to prevent it in the future.

Ways to help prevent red diarrhea include:

• Thoroughly cleaning all food preparation areas.
• Cooking foods thoroughly, as raw foods are more likely to carry Shigella bacteria.
• Drinking bottled or boiled water when traveling to a foreign country.
• Avoiding sexual contact with a person with an active shigellosis infection or who has recently been ill with the Shigella virus.
• Not swallowing water used for recreational purposes, such as water from a lake or river.
• Washing hands frequently with soap and water, especially after touching contaminated surfaces or changing a diaper.
• Avoiding food dyes known to cause red diarrhea can also help to keep this symptom at bay.

Share on PinterestIf a person has chills and a fever alongside red diarrhea, they should consults a doctor.

Bloody diarrhea may be a sign of a medical emergency, so a person should see a doctor as soon as possible.

A person should also see a doctor if they have the following symptoms in addition to red diarrhea:

• chills
• diarrhea that lasts more than 2 weeks
• fainting
• a fever that is 101°F or higher
• severe diarrhea that lasts longer than 2 days
• vomiting
• pain or cramping that gets worse with time

While diarrhea is not always a cause for concern, severe or persistent bleeding may be a medical emergency. Anyone who is concerned about their red stool should speak to a doctor as soon as possible.

Abdominal Pain and Bloody Diarrhea in a 32-year-old Woman – Consult QD

Causes of Diarrhea and Skin Changes

1. What is the most likely diagnosis in our patient?

• Ulcerative colitis
• Crohn disease
• Behçet disease
• Intestinal tuberculosis
• Herpes simplex virus infection
• Cytomegalovirus infection

All of the above can cause diarrhea in combination with mucocutaneous lesions and other manifestations.

Ulcerative colitis and Crohn disease: Mucocutaneous findings

Extraintestinal manifestations of inflammatory bowel diseases (Crohn disease, ulcerative colitis, and Behçet disease) include arthritis, ocular involvement, mucocutaneous manifestations, and liver involvement in the form of primary sclerosing cholangitis. Less common extraintestinal manifestations include vascular, renal, pulmonary, cardiac, and neurologic involvement.

Mucocutaneous findings are observed in 5% to 10% of patients with ulcerative colitis and 20% to 75% of patients with Crohn disease.^1–3 The most common are erythema nodosum and pyoderma gangrenosum.⁴

Yüksel et al⁵ reported that of 352 patients with inflammatory bowel disease, 7.4% had erythema nodosum and 2.3% had pyoderma gangrenosum. Erythema nodosum was significantly more common in patients with Crohn disease than in those with ulcerative colitis, and its severity was linked with higher disease activity. Lesions frequently resolved when bowel disease subsided.

Lebwohl and Lebwohl⁶ reported that pyoderma gangrenosum occurred in up to 20% of patients with Crohn disease and up to 10% of those with ulcerative colitis. It is not known whether pyoderma gangrenosum correlates with intestinal disease severity.

Other mucocutaneous manifestations of inflammatory bowel disease include oral aphthous ulcers, acute febrile neutrophilic dermatosis (Sweet syndrome), and metastatic Crohn disease. Aphthous ulcers in the oral cavity, often observed in both Crohn disease and ulcerative colitis, cannot be differentiated on clinical examination from herpes simplex virus (HSV) type 1-induced or idiopathic mucous membrane ulcers. The most common ulcer locations are the lips and buccal mucosa. If biopsied (seldom required), noncaseating granulomas can be identified that are comparable with intestinal mucosal granulomas found in Crohn disease.⁷

Behçet disease has similar signs

Oral aphthous ulcers are also the most frequent symptom in Behçet disease, occurring in 97% to 100% of cases.⁸ They most commonly affect the tongue, lips, buccal mucosa, and gingiva.

Cutaneous manifestations include erythema nodosum-like lesions, which present as erythematous painful nodules over pretibial surfaces of the lower limbs but can also affect the arms and thighs; they can also present as papulopustular rosacea eruptions composed of papules, pustules, and noninflammatory comedones, most commonly on the chest, back, and shoulders.^8,9

Pathergy, ie, skin hyperresponse to minor trauma such as a bump or bruise, is a typical trait of Behçet disease. A positive pathergy test (ie, skin hyperreactivity to a needlestick or intracutaneous injection) has a specificity of 98.4% in patients with Behçet disease.¹⁰

Interestingly, there appears to be a regional difference in the susceptibility to pathergy. While a pathergy response in patients with Behçet disease is rare in the United States and the United Kingdom, it is very common in Japan, Turkey, and Israel.¹¹

Patient demographics also distinguish Beh­çet disease from Crohn disease. The prevalence of Behçet disease is highest along the Silk Road from the Mediterranean Basin to East Asia and lowest in North America and Northern Europe.¹² The mean age at onset is around the third and fourth decades. In males, the prevalence is highest in Mediterranean, Middle Eastern, and Asian countries. In females, the prevalence is highest in the United States, Northern Europe, and East Asia.¹⁰

Tuberculosis

Tubercular skin lesions can present in different forms.¹³ Lupus vulgaris, the most common, occurs after primary infection and presents as translucent brown nodules, mainly over the face and neck. So-called scrofuloderma is common at the site of a lymph node. It appears as a gradually enlarging subcutaneous nodule followed by skin breaks and ulcerations. Tuberculosis verrucosa cutis, also known as warty tuberculosis, is common in developing countries and presents as warty plaque over the hands, knees, and buttocks.¹⁴ Tuberculids are skin reactions to systemic tuberculosis infection.

Herpes simplex virus

Mucocutaneous manifestations of herpes simplex virus affect the oral cavity (gingivo­stomatitis, pharyngitis, and lip border lesions), the entire integumentary system, the eyes (HSV-1), and the genital region (HSV-2). The classic presentation is systemic symptoms (fever and malaise) associated with multiple vesicles on an erythematous base in a distinct region of skin. The virus can remain latent with reactivation occurring because of illness, immunosuppression, or stress. Pruritus and pain precede the appearance of these lesions.

Cytomegalovirus

Primary cytomegalovirus infection is subclinical in almost all cases unless the patient is immunocompromised, and it presents similarly to mononucleosis induced by Epstein-Barr virus. The skin manifestations are nonspecific and can include macular, maculopapular, morbilliform, and urticarial rashes, but usually not ulcerations.¹⁵

Our Patient: Behçet Disease or Crohn Disease?

In our patient, oral mucosal aphthous ulcers and the location of pustular skin lesions, in addition to pathergy, were highly suggestive of Behçet disease. However, Crohn disease with mucocutaneous manifestations remained in the differential diagnosis.

Because there is significant overlap between these diseases, it is important to know the key distinguishing features. Oral aphthous ulcers, pathergy, uveitis, skin and genital lesions, and neurologic involvement are much more common in Behçet disease than in Crohn disease.^16,17 Demographic information was not helpful in this case, given that the patient was adopted.

Further Workup

2. What should be the next step in the work-up?

• CT enterography
• Skin biopsy
• Colonoscopy with biopsy
• C-reactive protein, erythrocyte sedimentation rate, and fecal calprotecting testing

The endoscopic appearance and histopathology of the affected tissues are crucial for the diagnosis. Differentiating between Crohn disease and Behçet disease can be particularly challenging because of significant overlap between the intestinal and extraintestinal manifestations of the two diseases, especially the oral lesions and arthralgias. Thus, both colonoscopy with biopsy of the intestinal lesions and biopsy of a cutaneous ulceration should be pursued.

No single test or feature is pathognomonic for Behçet disease. Although many diagnostic criteria have been established, those of the International Study Group (Table 2) are the most widely used.¹⁸ Their sensitivity for Beh­çet disease has been found to be 92%, and their specificity 97%.¹⁹

Both CT enterography and inflammatory markers would depict inflammation, but since this is present in both Crohn disease and Beh­çet disease, these tests would not be helpful in this situation.

Endoscopic appearance of Crohn disease and Behçet disease

Intestinal Behçet disease, like Crohn disease, is an inflammatory bowel disease occurring throughout the gastrointestinal tract (small and large bowel). Both are chronic diseases with a waxing and waning course and have similar extraintestinal manifestations. Typical endoscopic lesions are deep, sharply demarcated (“punched-out”), round ulcers. The intestinal Behçet disease and Crohn disease ulcer phenotype and distribution can look the same, and in both entities, rectal sparing and “skip lesions” have been described.^20–22

Nevertheless, findings on endoscopy have been analyzed to try to differentiate between Crohn disease and Behçet disease.

In 2009, Lee et al²³ published a simple and accurate strategy for distinguishing the two diseases endoscopically. The authors reviewed 250 patients (115 with Behçet disease, 135 with Crohn disease) with ulcers on colonoscopy and identified 5 endoscopic findings indicative of intestinal Behçet disease:

• Round ulcers
• Focal single or focal multiple distribution of ulcers
• Fewer than 6 ulcers
• Absence of a “cobblestone” appearance
• Absence of aphthous lesions.

The two most accurate factors were absence of a cobblestone appearance (sensitivity 100%) and round ulcer shape (specificity 97.5 %). When more than one factor was present, specificity increased but sensitivity decreased.

Using a classification and regression tree analysis, the investigators created an algorithm that endoscopically differentiates between Crohn disease and Behçet disease (Figure 1) with an accuracy of 92 %.²³

Histopathologic analysis of both colonic and skin lesions can provide additional clues to the correct diagnosis. Vasculitis suggests Behçet disease, whereas granulomas suggest Crohn disease.

Case Continued: Skin Biopsy and Colonoscopy

Punch biopsy of the skin was performed on the right anterior thigh. Histopathologic analysis revealed acanthotic epidermis, a discrete full-thickness necrotic ulcer with a neutrophilic base, granulation tissue, and vasculitic changes. There were no vasculitic changes or granulomas outside the ulcer base. Cytomegalovirus staining was negative. An interferon-gamma release assay for tuberculosis was negative. Eye examination results were normal.

Colonoscopy showed multiple deep, round, and confluent ulcers with a punched-out appearance and fissures with normal intervening mucosa in the entire examined colon (Figure 2). The terminal ileal mucosa was normal. Colonic biopsies were consistent with cryptitis and rare crypt abscesses. Vasculitis was not identified.

Although the histologic changes were nonspecific, at this point we considered Beh­çet disease to be more likely than Crohn disease, given the typical endoscopic appearance and skin changes.

6 Reasons Your Diarrhea is Bloody

Any blood in the stool may signal a more serious problem.

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Last updatedMarch 8, 2021

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What is bloody diarrhea?

Spotting blood in the toilet or on the toilet paper can be upsetting. And blood is always cause for concern. That said, a trace of blood in your stool (whether well-formed or diarrhea-like) can be caused by a relatively minor condition, such as mild constipation or hemorrhoids.

But if you’re noticing more than a trace, or if the blood is accompanied by other stomach issues, you may need to see a doctor. Possible culprits include a bacterial or parasite infection, inflammatory bowel diseases (such as Crohn’s disease or colitis), and colorectal cancer.

1. Bacterial infection

Symptoms

A stomach bug can be caused by bacteria. Common bacterial infections that can cause bloody diarrhea include E. coli, Campylobacter, Salmonella, Shigella, and Clostridium difficile infection (C. diff).

Bacterial infections may be contagious and can spread if an infected person does not wash their hands thoroughly.

E. coli, Campylobacter, Salmonella, and Shigella all come from contaminated foods or water, and are often due to improper handling or cooking. C. difficile often occurs in people taking antibiotics for other infections. It’s highly contagious and is often passed from patient to patient in the hospital. People who are hospitalized or recently discharged are at high risk.

Bacterial infections can sometimes be serious and spread through the body, so early diagnosis and treatment is important. You may be given antibiotics.

2. Hemorrhoids

Bloody diarrhea doesn’t necessarily indicate an emergency! —Dr. Shria Kumar

Symptoms

A hemorrhoid occurs when the small blood vessels around your anus become swollen and inflamed. They can be internal (inside the rectum) or external (outside). Hemorrhoids themselves may cause pain with bowel movements or blood on the toilet paper.

If you have diarrhea, this can irritate your hemorrhoids and cause some bleeding. Your doctor may recommend ointments or stool softeners (if you are constipated) to help reduce trauma to the hemorrhoids.

3. Inflammatory bowel disease

Symptoms

Inflammatory bowel disease (IBD) is inflammation of the bowel. There are two types: Crohn’s disease and ulcerative colitis. It is due to multiple factors, including genetics, the environment, and your body’s immune system. Symptoms may develop gradually or occur suddenly.

Untreated IBD causes inflammation throughout the digestive tract, which can lead to malnutrition, cancers, bleeding, and overall poor health.

Managing the condition involves eliminating the inflammation with medication and diet. Treatment includes taking anti-inflammatory medications, such as topical or oral steroids, and immunologic medications that tamp down your immune system. In some cases, surgery may be needed.

Once diagnosed with IBD, you will require regular check ups with your gastroenterologist (digestive disease doctor). You may be at increased risk of colorectal cancer, so you will need more regular cancer screenings, such as colonoscopies.

4. Intestinal ischemia

Symptoms

• Sudden nausea and vomiting
• Sudden bloody diarrhea
• Sudden, severe abdominal pain

Ischemia occurs when blood flow is low. This happens when there is a blockage in one of the arteries in the abdomen that supplies your intestines with blood. This blockage could be plaque or a blood clot. The loss of blood flow can damage your intestines. Ischemia is a life-threatening medical emergency.

People with very high or low blood pressure and heart disease may be at risk. Using certain illegal drugs like cocaine and methamphetamine may also cause ischemia.

If you have a clot, it is treated with “clot-busting” drugs. If there’s a blockage, you may need emergency surgery to remove the blockage as well as the damaged part of the intestine.

5. Colorectal cancer

Establishing a story around the bloody diarrhea helps me a lot. When did these symptoms start? Are they accompanied by other symptoms (even non-bowel related symptoms)? Did the patient travel anywhere or eat somewhere and now other people are sick, too? What’s their overall health profile? Are they in severe pain, are they bleeding profusely (things that would prompt me to admit them to a hospital, get bloodwork and imaging studies). —Dr. Kumar

Symptoms

• Weight loss
• Change in appetite
• Change in bowel habits, often including blood

Cancer of the colon (large intestine) or rectum is considered colorectal cancer. Colorectal cancer typically affects adults over age 50, but it can happen in younger adults.

The cancers usually begin as small polyps that become cancerous over time. This is why a colonoscopy screening test, which detects and removes these small polyps before they become cancerous, is important. If you are between age 50 and 75, the Centers for Disease Control and Prevention (CDC) recommends colorectal cancer screening. People at increased risk should begin screening in their 40s.

Colorectal cancer usually causes some changes to your bowel habits and eating patterns. Treatments include surgery, chemotherapy, and/or radiation.

6. Parasite infections

Symptoms

• Diarrhea that may be bloody
• Fever
• Vomiting
• Stomach cramps
• Fatigue or weakness
• Weight loss

You can pick up a parasite infection by consuming food or water containing parasites like hookworm or amoebiasis. Or if your hands come in contact with a parasite and you touch your face.

While parasite infections are more common in underdeveloped parts of the world where drinking water is contaminated, you can catch it in the U.S.

Blood and stool tests can determine the type of parasite, according to the CDC. Your doctor will prescribe an anti-parasitic medication.

Other possible causes of bloody diarrhea

Other less common causes of bloody diarrhea include:

• Viral infections
• Vascular inflammation (vasculitis), such as hemolytic uremic syndrome
• Bowel obstruction
• Intussusception
• Diverticulosis

When to call the doctor

Important questions to ask your doctor: What caused this? Do I need any treatment for this? —Dr. Kumar

Because bloody diarrhea is not normal, you should call your doctor if you see more than a few streaks of blood in your stool. Always seek medical care if you also feel lightheaded, can’t eat or drink, or have severe abdominal pain.

As bloody diarrhea can be caused by parasites or bacteria, be sure to let your doctor know about any recent trips. They will want to rule out parasites or bacteria that may be common in the places where you traveled.

In addition, the more information you share about your diet, recent medications, and lifestyle, the better your doctor can assess your symptoms. In some cases, medications could be causing your stool to appear bloody.

You should also call the doctor if you have more than one episode of bloody diarrhea, or the diarrhea is accompanied by:

• Abdominal pain
• Nausea or vomiting
• Fever
• Dizziness
• Confusion
• Shortness of breath
• Chest pain
• Headache
• Fatigue

Should I go to the emergency room for bloody diarrhea?

You should go to the ER if you have any of these signs, which can indicate a serious problem.

• Blood looks clumpy like coffee grounds or is dark and tarry.
• Blood seems to be filling the toilet or does not stop when you stand up.
• You’re experiencing intense abdominal pain.
• You’re experiencing uncontrollable nausea or vomiting.
• You feel dizzy.
• You cannot eat or drink.
• You are on blood thinners (anti-coagulants).

Treatment

At-home care

• Don’t take anti-diarrhea medications without a doctor’s approval. They can complicate some infections.
• Avoid over-the-counter pain medicines, including Aspirin and NSAIDs like ibuprofen, which can make the bleeding worse.
• Stay well-hydrated. Drinking fluids containing sodium and potassium, such as sports drinks, and bullion can help keep your electrolytes in balance.
• Stay well-nourished. Eating bland foods with good nutritional and caloric value is important.

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• Diarrhea is loose or watery stool, or having a stool at least 3 times in 24 hours. Common causes include viral gastroenteritis, bacterial infection, C. Diff colitis, medications, irritable bowel syndrome, and celiac disease.

• Try these tactics to get rid of diarrhea and keep from getting dehydrated. Drink water, take over-the-counter and natural remedies, and eat bland foods until you feel better.

• Abdominal pain is usually a sign of a common illness or infection. Other causes include indigestion, a stomach ulcer, IBS, or food poisoning.

• Common causes of stomach cramps include eating foods that can irritate your stomach, constipation, food poisoning, or a stomach bug.

• Nausea is that queasy feeling in your stomach that makes you feel like you’re going to throw up. Usually, nausea is from an infection, pregnancy, taking certain medication, or acid reflux.

IBD: Signs, Symptoms, and Complications

Rectal Bleeding

Bleeding from the rectum, or seeing blood in the stool, is never a normal occurrence, and it is a symptom of IBD.

Blood in the stool is a common symptom of UC and IC. (It’s less frequent in Crohn’s disease.) There are times, however, when it can be of serious concern.

Mucus in the Stool

Passing mucus in the stool is not always a cause for alarm. Mucus is actually a normal part of stool, but it usually isn’t visible to the naked eye. If there’s enough mucus in the stool that you’re aware of it, there could be several reasons why.

People with ulcerative colitis or Crohn’s disease do sometimes pass visible amounts of mucus in their stool, either as a result of ulcers in the colon or possibly from the formation of a fissure.

People who have had surgery for ulcerative colitis and have a j-pouch (ileal pouch-anal anastomosis, or IPAA) may also pass mucus, which could be a sign of a condition called pouchitis. 

Abdominal Pain

Abdominal pain (what most generally call stomach pain) can be a tricky problem to diagnose because it can be a symptom of many different diseases.

People with ulcerative colitis tend to have cramp-like pain that is located in the lower-left portion of the abdomen, and people with Crohn’s disease tend to have pain in the middle or lower-right abdomen (although pain could show up in other parts of the abdomen, too).

Not everyone with IBD has pain, and the pain may come and go, sometimes occurring after a meal or being relieved by having a bowel movement.

Persistent Diarrhea

Diarrhea has many causes, and most healthy adults have diarrhea a few times a year. Often, diarrhea resolves on its own, and the cause may go undiscovered. However, persistent diarrhea—lasting more than three days—can be the sign of a problem that might need treatment.

People with IBD often have episodes of what’s called “explosive” diarrhea several times a day. This could be anywhere from three up to 10 or even 20 watery bowel movements daily.

Unintended Weight Loss

Losing weight without restricting calories or exercising could be a sign that something is going wrong in the body.

Diarrhea and lack of appetite can result in unintended weight loss simply from not taking in enough calories during the day.

Gaining weight while in remission from IBD might become a priority, but it should be done in a healthful way.

Rare Symptoms

In rare cases, some people with IBD may also present with:

• Fevers
• Fatigue
• Joint pain
• Skin rashes
• Increased menstrual symptoms
• Flare-ups of IBD symptoms before or during a menstrual period

Your medical team should be able to help you manage these symptoms.

Complications

IBD is hard on your intestines and various systems in your body. Over time, and especially if treatment is delayed or inadequate, some people develop serious complications.

Potential complications of IBD include:

• Bowel obstruction
• Bowel perforation
• Intestinal abscesses
• Intestinal fistulas
• Intestinal fissures
• Toxic megacolon
• Colorectal cancer

Some complications that may strike outside of the digestive system include:

• Delayed growth (in children)
• Eye disease
• Arthritis (especially seronegative spondyloarthropathy)
• Osteoporosis
• Increased risk of gallstones
• Neurological symptoms, which can be severe
• Anemia
• Blood and circulatory problems
• Mouth ulcers
• Difficulty getting pregnant

When to See a Doctor

If you’re experiencing ongoing or severe digestive symptoms, you should see your primary care physician. Due to the difficulties involved in the diagnosis, you may be referred to a gastroenterologist.

• Significant abdominal pain could mean many things and should be checked out by a physician as soon as possible. Don’t assume this is due to IBD if it’s accompanied by vomiting, nausea, and fever. These are potential symptoms of a bowel obstruction, which requires immediate medical care.
• Any blood in the stool should always be checked out by a doctor right away. The blood loss of UC and IC can be significant. If it continues or is accompanied by diarrhea, pain, or vomiting, see a doctor immediately.
• If the mucus in stool is accompanied by abdominal pain, vomiting, or diarrhea, see a doctor right away to get it checked out.
• Suddenly losing weight unexpectedly is a reason to talk to a doctor, especially if there is also ongoing diarrhea, vomiting, or a lack of appetite.
• If diarrhea doesn’t resolve on its own and is also accompanied by abdominal pain, blood in the stool, weight loss, fever, or other symptoms, see a physician as soon as possible.

If abdominal pain is severe or rectal bleeding is substantial, you may have a serious condition that needs emergency medical treatment.

When to Call 911

If you experience any sudden or dramatic changes in your condition or the following symptoms, go to the emergency room or call 911: 

• Severe abdominal pain that lasts for more than one hour 
• Significant or new rectal bleeding 
• Persistent vomiting, accompanied by a stoppage of bowel movements 
• Drastic changes in bowel movements without any passing of gas 
• High temperature, especially if taking corticosteroids or other medications that might be affecting your immune system

A Word From Verywell

IBD symptoms can be scary and a proper diagnosis can take some time. That may be frustrating, but each IBD requires different treatments, so it’s important to work with your doctor to figure out exactly what’s going on in your digestive system and get started with the right course for you. Doing so can help minimize the effect of the disease on your daily life.

11 Common Causes Of Rectal Bleeding

03-17-20 – Colonoscopy, GI Articles

Why is there blood in my stool?

It’s a question we never want to ask, but it’s one in vital need of an answer. Even a slight presence of blood in your stool or on the toilet tissue hints that bleeding is occurring in the digestive tract. The darker the appearance of the blood, the higher up on the digestive tract the blood entered the stool. Bright red blood can be the result of anal bleeding or problems in the lower intestinal tract. But this is not an absolute rule by which you can make decisions.

Although bright red blood may suggest that it is from hemorrhoids, sometimes there may be another serious underlying problem. If the physician performs the necessary evaluation and decides that the bleeding is from hemorrhoids, that is acceptable. Assuming that the bleeding is from hemorrhoids because is it a small amount or because it is bright red in color, or based on someone else’s experience is somewhat risky. There are some patients who may have colon cancer and have minimal or NO  bleeding. The most common symptom of colon cancer is …no symptom!

So please don’t ignore, postpone or assume something when a serious symptom like blood in the stool occurs. Appropriate evaluation gives you peace of mind and relief from your symptoms. Most of these underlying causes have effective management and there is no need to suffer.

The 11 most common causes of rectal bleeding are

1. Anal fissures, which are small cuts or tears in the lining of the anus, can appear after passing a particularly hard stool.
2. Hemorrhoids are swollen veins in the lower rectum, which can cause pain, itching, and difficulty sitting, as well as the appearance of bright red blood. The good news is that there is no need for painful surgery in most cases due to recent developments in non-surgical techniques which are easy, pain-free, in-office and very effective.
3. An anal fistula is a small channel that forms between the anal canal and the skin surrounding the anus. Along with minor bleeding, it can cause swelling, tenderness, and persistent discharge/drainage. Currently, the only remedy for an anal fistula is surgery.
4. Gastroenteritis is a sudden-onset intestinal infection, which can be viral, bacterial, or parasitic. In addition to blood in the stool, gastroenteritis is characterized by diarrhea, abdominal cramps, nausea, vomiting, fever, and body aches. If gastroenteritis recurs or lasts longer than 2 days, we recommend further evaluation by a trained digestive specialist.
5. Peptic ulcers are sores in the esophagus, stomach, or the lining of the upper part of the small intestine. Depending on the location of the sores, the blood in the stool may appear darker, possibly even black. In addition, you may experience burning pain in the stomach, which worsens as the stomach empties, heartburn, nausea and vomiting, bloating, appetite changes, and weight loss. If left untreated peptic ulcers can cause severe damage to the lining of your digestive system, so please seek help immediately if symptoms of peptic ulcers persist.
6. Diverticular disease is defined by the development of small bulges—or diverticula—in the lining of the colon. Along with rectal bleeding, diverticular disease—and diverticulitis—include severe abdominal pain, bloating, high fever, and frequent diarrheal bowel movements.
7. Angiodysplasia occurs more often in older adults and is defined by swollen, fragile blood vessels in the colon. If the swelling worsens, small passages ways can form between the artery and vein, resulting in bleeding from the colon wall, which can manifest as bright red or black blood in the stool. Angiodysplasia is also characterized by weakness, fatigue, shortness of breath, and anemia.
8. Inflammatory Bowel Diseases, such as Crohn’s disease or ulcerative colitis, can cause ulcers, abscesses, and scarring in the intestinal lining over time. Blood in the stool is often accompanied by diarrhea, fever, weight loss, and abdominal pain.
9. Bleeding varices: When dilated blood vessels (varices) in the esophagus and stomach rupture and bleed, they can be life-threatening. If your black, tarry or bloody stool is accompanied by vomiting blood, low blood pressure, lightheadedness, or rapid heart rate, seek medical attention immediately. If not addressed, the sufferer can go into shock.
10. Colon polyps are noncancerous growths in the colon or rectal lining. Though colon polyps are normally asymptomatic, they can cause rectal bleeding, sudden changes in bowel habits, and constipation or diarrhea that lasts for more than a week. Though colon polyps are not necessarily cancerous, they can develop into colon or colorectal cancer, so it’s vital to get screened by a skilled gastroenterologist immediately.
11. Colon cancer may cause blood in the stool, anywhere from minimal bleeding to a significant amount. Sometimes it may not cause any bleeding at all and be completely asymptomatic. Everyone 50 years and above needs SCREENING COLONOSCOPY (done in the absence of symptoms as a prevention/ wellness check) to identify precancerous polyps and remove them before they could become cancer. Sometimes cancer may cause abdominal pain, weight loss or anemia.

While rectal bleeding can be the result of many intestinal or anal issues that are not life-threatening and can resolve themselves, it can also be an early indication of a more severe digestive tract issue. If you are experiencing rectal bleeding, you may want to take the next step in protecting your future with preventative screenings, like a colonoscopy.  The gastroenterologists with GI Alliance are specialized and highly experienced in screening for, detecting, and treating colorectal cancer and the precursors to colorectal cancer (ie polyps).  Contact a GI Alliance gastroenterologist today.

City Clinical Hospital # 31 – IBD: Ulcerative colitis. What does the patient need to know? (page 4)

Page 4 of 10

Symptoms of ulcerative colitis

In most patients (75%), the disease begins gradually. Sometimes patients for a long time do not seek qualified help from a specialist doctor, regarding the presence of blood in the stool as a manifestation of chronic hemorrhoids. It can take from 10 months to 5 years between the onset of the first symptoms of UC and the moment of diagnosis.Much less often, the YAK makes a sharp debut.

The severity of the clinical manifestations of UC depends on the length of the inflammatory lesion and the severity of the disease. Symptoms characteristic of UC can be divided into three groups:

• intestinal
• general (system)
• extraintestinal.

The most frequent intestinal symptoms are stool disorders in the form of diarrhea ( in 60-65% of UC patients, stool frequency is from 3-5 to 10 or more times a day in small portions) or constipation (at 16-20 % of cases, mainly with lesions of the lower colon).In more than 90% of patients, an impurity of blood is found in the feces. Its amount is different (from veins to a glass and more). With inflammation of the lower colon, the blood is usually scarlet and sits on top of the stool. If the disease has affected most of the colon, then the blood appears in the form of dark cherry-colored clots mixed with feces. Often in the stool, patients also notice pathological impurities of pus and mucus. Typical clinical signs of UC are fecal incontinence, urgent urge to empty the bowel, false urge with the release of blood, mucus and pus from the anus, practically without feces (“rectal spitting”).Unlike patients with functional intestinal disorders (irritable bowel syndrome), UC patients also have stool at night. In addition, about 50% of patients complain of abdominal pain, usually of moderate intensity. More often pains occur in the left half of the abdomen, after the passage of the stool, they weaken, less often intensify.

General or systemic symptoms of UC reflect the effect of the disease not only on the large intestine, but on the entire patient’s body as a whole.Their appearance indicates a severe and widespread inflammatory process in the intestine. Due to intoxication and loss of useful substances along with loose stools and blood, the patient develops an increase in body temperature, loss of appetite, nausea and vomiting, increased heart rate, weight loss, dehydration, anemia (anemia), hypovitaminosis, etc. Often, patients have various disorders from the psycho-emotional sphere.

Extraintestinal manifestations of UC occurring in 30% of patients are the result of immune disorders.The severity of most of them is associated with UC activity. It should be noted that patients often do not associate these symptoms with intestinal pathology and seek help from various specialist doctors (rheumatologists, neuropathologists, ophthalmologists, dermatologists, hematologists, etc.). Sometimes their appearance precedes intestinal symptoms. A variety of organs can be involved in the disease process.

With damage of the musculoskeletal system patients complain of pain, swelling, decreased mobility of various joints (knee, ankle, hip, elbow, wrist, interphalangeal, etc.). As a rule, pains migrate from one joint to another without leaving significant deformities. The defeat of large joints is usually associated with the severity of the inflammatory process in the intestine, and arthropathy of small joints occurs independently of the activity of the UC. The duration of the described articular syndrome sometimes reaches up to several years. Inflammatory changes in the spine with limited mobility (spondylitis) and sacroiliac joints (sacroiliitis) may also appear.

Lesions of the skin and of the oral mucosa in patients with UC are manifested in the form of various rashes.Typical are painful red or purple subcutaneous nodules on the arms or legs (erythema nodosum), vesicles in areas with a small thickness of subcutaneous tissue – the legs, in the sternum region, self-opening with the formation of ulcers (pyoderma gangrenosum), ulcers on the mucous membrane of the cheeks, gums, soft and hard palate.

When eyes are involved patients with UC develop pain, itching, burning in the eyes, redness of the eyes, photophobia, a feeling of “sand in the eyes”, blurred vision, headaches.Such complaints accompany the appearance of inflammation of the mucous membrane of the eye (conjunctivitis), the iris (iritis), the white membrane of the eye (episcleritis), the middle layer of the eye (uveitis), the cornea (keratitis) and the optic nerve. For a correct diagnosis, patients need an ophthalmologist’s consultation and a study using a slit lamp.

Often, the extraintestinal symptoms of UC include signs of damage to other digestive organs (liver and biliary tract (incl.including poorly amenable to drug treatment primary sclerosing cholangitis), pancreas), disorders in the blood system (phlebitis, thrombosis, autoimmune hemolytic anemia).

Feeling of a coma in the stomach

IMPORTANT!

The information in this section cannot be used for self-diagnosis and self-medication. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests.For a diagnosis and correct treatment, you should contact your doctor.

Feeling of a coma in the stomach: the reasons for the appearance, in what diseases it occurs, the diagnosis and methods of treatment.

The feeling of a coma in the stomach is spoken of when they experience a feeling of heaviness, discomfort and fullness of the stomach even with its insignificant filling. Sometimes patients find it difficult to determine the exact location of the coma and indicate the lower third of the sternum or solar plexus.In some cases, a coma and stomach cramps may occur on an empty stomach.

Varieties of feeling of coma in the stomach

Feeling of heaviness or coma in the stomach can be an independent symptom, but it can be accompanied by other unpleasant sensations. Sometimes it is heartburn, sour belching, bloating, constipation.

In some cases, the sensation of a coma appears 90,075 when swallowing , making it difficult for the chewed food to pass.

In addition, patients may complain that food did not enter the stomach, but stopped in the esophagus.In such patients, vomiting of unchanged food is possible.

When describing symptoms, you should pay attention to the time of onset of discomfort – to or after eating .

The patient may feel heaviness in the stomach with cramps or heartburn, on an empty stomach or after eating, and night pains also occur.

Sometimes a feeling of a coma in the stomach occurs regardless of food intake . In such cases, they complain of stomach cramps , sometimes accompanied by a sensation of a lump in the throat.

For what diseases there is a feeling of coma in the stomach

Eating food in excess of the usual portion is accompanied by a feeling of fullness and heaviness in the stomach. This condition is not a manifestation of the disease and goes away on its own after a while.

It should be noted that stomach capacity varies with eating habits.

People who are small or who have undergone a resection of the stomach can eat a small portion in terms of volume, otherwise they will not only have a feeling of heaviness or fullness of the stomach, but also vomit.

A feeling of coma can 9075 appear when eating foods that cause excessive gas formation , as well as heavy for digesting food (salads with mayonnaise, fatty, fried and smoked foods) and carbonated drinks . At dry food and hastily , an unpleasant sensation in the epigastric region is caused by poor processing of the food lump with saliva and insufficient secretion of gastric juice.

However, a feeling of coma or discomfort in the stomach or, more precisely, in the epigastric region, can appear 90,075 after eating even a small amount of food .

This condition can be caused by both diseases of the gastrointestinal tract, and other reasons.

First of all, they suggest a digestive disorder, or functional dyspepsia. Symptoms most often include pain and discomfort right after a meal, a feeling of heaviness and fullness in the stomach, heartburn, belching, nausea, sometimes vomiting, backlash of stomach contents into the esophagus, bloating, and stool disturbance.

Dyspepsia can be a symptom of both functional disorders of the gastrointestinal tract and organic diseases.

Functional causes of dyspepsia are often due to inaccuracies in diet and medication.

Iron ions have an irritating effect on the gastric mucosa, which is most pronounced when taking medications based on ferrous iron. Non-steroidal anti-inflammatory drugs, which are systematically taken for rheumatic and non-rheumatic diseases of the musculoskeletal system, also cause undesirable effects: heaviness and discomfort in the stomach, nausea, vomiting, dyspeptic disorders.

Neurological disorders (neuroses, depression), psychological trauma almost always affect the state of the gastrointestinal tract, leading to impaired motility.

Functional dyspepsia is not accompanied by erosive or ulcerative lesions of the stomach, its symptoms disappear with the normalization of the general state of health.

One of the common causes of stomach discomfort immediately after eating is gastritis .It is accompanied by functional and inflammatory processes that have a negative effect on the gastric mucosa. Symptoms of gastritis include heaviness and pain in the stomach, indigestion, nausea, heartburn, sour belching, and bloating from any food. The inflammatory process leads to atrophy of the mucous membrane and disruption of the glands that secrete gastric juice.

An insufficient amount of gastric juice and poor peristalsis of the stomach and intestines make it difficult to digest food.

Gastritis is often accompanied by dyspepsia. In addition to the feeling of heaviness and aching pain in the epigastric region after eating, poor appetite, weakness, fatigue, irritability are noted. When pressing on the abdomen, a dull pain appears in the projection of the stomach.

Violation of motor-evacuation functions of the upper digestive tract is always accompanied by a feeling of coma or a feeling of heaviness in the stomach. Violation of esophageal motility is caused, as a rule, by discoordination of the work of the esophageal sphincters.Inconsistent work of the muscles of the esophagus can lead to a delay in the food lump on the way to the stomach, the throwing of food particles into the respiratory tract, reflux (the return of the contents of the stomach into the esophagus). Impaired gastric motility leads to delayed gastric emptying, which is accompanied by a feeling of heaviness and fullness even with a small amount of food consumed, pain in the epigastric region, heartburn, nausea and vomiting.

Motility disorders of the esophagus and stomach can be associated with gastroesophageal reflux disease, gastritis, tumors and stenoses (narrowings), metabolic disorders (hyperkalemia, hypercalcemia), postoperative complications of gastric resection, taking certain medications (opiates, antidepressants, alcohol, hormones) …

Peristalsis worsens with a sedentary lifestyle and with age.

Stomach cancer can also cause symptoms such as a feeling of heaviness or a coma in the stomach. Moreover, depending on the localization of the tumor, its manifestations differ. If the tumor is located closer to the esophagus, there is a problem with swallowing food. This is accompanied by increased salivation, nausea, vomiting, pain in the epigastric region. When the tumor is localized in the lower parts of the stomach, closer to the duodenum, a prolonged feeling of heaviness after eating, bloating is characteristic.When belching, a putrid smell may be felt.

Which doctor should you contact if you feel a coma in the stomach

If you have a constant feeling of a coma in your stomach or a feeling of heaviness, you should contact
therapist or
a gastroenterologist for a preliminary diagnosis. A gastroenterologist may also refer a patient to an oncologist. Consultation may also be required
neurologist.

Diagnostics and examination with a feeling of coma in the stomach

First of all, clinical tests of blood and feces are required for differential diagnosis.

Vomiting blood after alcohol: why vomits blood

Excessive alcohol consumption disrupts the functioning of various organs and systems in the body. A severe hangover is accompanied by severe nausea and vomiting. If blood particles appear in the waste products, you should seriously think about it. This indicates severe liver damage , as well as problems with the stomach and esophagus.

If a person vomits blood after alcohol, it is necessary to cleanse the body and provide him with complete rest.When you feel better, you should definitely visit a doctor. A comprehensive examination will help identify the underlying causes of the ailment. The situation is too serious to be allowed to take its course. The appearance of blood in vomiting can be regarded as an SOS signal from the body. In order not to aggravate the problem, will have to completely abandon alcohol .

Causes of vomiting with blood

Nausea is a normal reaction to alcohol poisoning. The body tries to “throw away” toxic substances as quickly as possible.However, blood impurities usually appear at internal bleeding . In this situation, immediate hospitalization is required.

The reasons why vomits blood after alcohol include:

1. Injury to the walls of the stomach . This condition is also called Malory-Weiss syndrome. The stomach is in a tense state. With emetic spasms, tears and cracks appear on the walls of the stomach. This is how the blood enters the esophagus and mouth. Another reason is a strong blow to the stomach.A drunken person may not even understand what is happening to him. This condition is treated with conservative methods, but in some cases, surgical intervention is required.
2. Varicose veins of internal organs . The symptom is scarlet blood clots in vomit. On the mucous membranes, the vessels dilate and rupture. As a rule, the bleeding is short-lived. If the clots are dark, you should immediately consult a doctor.
3. Acute gastritis . Observed with improper nutrition.In combination with alcohol, slight bleeding may occur. Not only addicts can face such a problem, but also people who decide to violate the recommendations of doctors and drank a little alcohol.
4. Peptic ulcer . Sometimes accompanied by gnawing pains. Minor bleeding is eliminated by therapeutic methods; in difficult cases, surgery is required.
5. Hepatitis . It is not always viral in nature. Systematic alcohol abuse provokes the development of the disease.If you do not monitor your health, the disease will quickly turn into cirrhosis. Women are at risk. In their body, much fewer enzymes are produced that can neutralize the breakdown products of alcohol.
6. Cirrhosis of the liver and stomach ulcer . With such diagnoses, alcohol is prohibited even in small doses. In people with cirrhosis, the vessels of the esophagus dilate strongly and rupture under strong stress. Bleeding often leads to the death of the patient.

Attention! Chocolate, as well as red-brown vegetables and fruits, color the contents of the stomach in a specific color, which is often confused with blood.

In addition to bloody vomiting, there are other symptoms . So, the skin becomes pale with a bluish tint, dizziness appears and darkens in the eyes. The person feels intense thirst and dry mouth, and loose stools become black. This lowers blood pressure. Visual impairment is also possible.

Emergency

Continuous nausea and vomiting with blood after alcohol exhaust and dehydrate the body. This condition is sometimes accompanied by painful sensations.If there is a dark shade of blood in the masses, doctors should be called immediately. It is not recommended to give medicines to the patient . Only a specialist can correctly establish the causes of bloody vomiting.

Before the ambulance arrives, you can take the following measures:

1. Put the patient on his side . Vomit will not accumulate in the airways and will not cause an attack of suffocation. On the back, a person can easily choke.
2. Above the patient should be covered with a rug or blanket.Constantly be near him, measure pulse and blood pressure.
3. If a person is thirsty, they give him clean water. No food or medicine.
4. It is permissible to give only activated carbon , according to the dosages in the instructions.
5. Doctors will perform a lavage, put on a dropper with a glucose solution and give the necessary recommendations.

Vomiting with bloody matter is a dangerous condition. If you do not provide assistance on time, you can face various complications.Among them, one can especially single out general dehydration and weakening of the body, shock, anemia, convulsions and suffocation. By artificially inducing vomiting, can only exacerbate bleeding .

Professional help

If vomiting with blood after alcohol, the patient is carefully examined to determine the exact cause. In most cases, this is a stomach ulcer. Alcohol destroys the barrier functions of mucus and blood vessels. Hydrochloric acid enters the stomach, eroding its walls. X-rays of the abdominal cavity , pH-metry, as well as analysis for the presence of Helicobacter pylori bacteria will help to establish the diagnosis.

Uncontrolled use of alcohol provokes the development of Malory-Weiss syndrome. For treatment, blood transfusions (crystalloid and colloidal) are used. Additionally, drugs are prescribed to stop vomiting. To cope with severe bleeding, they resort to using the Blackmore probe . With its help, bleeding vessels are squeezed.

Also do local adrenaline blockade, which helps to constrict blood vessels. Bleeding caused by varicose veins of the stomach is fraught with cirrhosis. In such cases, the veins are checked regularly. At the slightest suspicion of bleeding, it is necessary to reduce the portal pressure .

Special drugs (vasodilators and vasoconstrictors), balloon tamponade with two types of probes are used as therapy. Endoscopic and surgical methods are also used.

Folk remedies against vomiting

To eliminate vomiting, use the following means:

1. Potato starch (1 tsp raw material / 1 tbsp warm water). This gruel will help to cope with unpleasant cramps.
2. Blackberry branches. A decoction is prepared from them. You will need 0.5 liters of water. The branches are boiled for 5 minutes, and after another 40 minutes they are insisted.
3. Dry chicory. The herb is ground into powder (1 tbsp. L / 300 ml of boiling water). The resulting mixture is covered with a warm blanket and left overnight.Drink several times a day for 1 tbsp. l. 30 minutes before meals.
4. Egg whites. It will take only 3 eggs, and in an hour the nausea will bother you less.

In case of severe vomiting of blood, such remedies will not help. However, can quickly remove residual effects from .

Dieting

You will not only have to forget about alcohol, but also completely revise your diet. At first, the patient is better off not eating.The most important thing right now is to drink plenty of fluids to stay hydrated. It is useful to drink teas based on calendula, rose hips or chamomile. They have a calming effect, relieve inflammation and help to recover faster from illness.

Usually on days 2-3 there is a significant relief of the condition. This is only if the patient adhered to bed rest and followed all the prescriptions of doctors. Correctly selected food will help replenish the supply of nutrients, will not irritate the esophagus and stomach.During this period, it is important not to overload the liver and pancreas. All fried and fatty foods are completely excluded. Also, you can not eat marinades, canned food, raw vegetables and fruits, as well as red meat. Food should be soft, mashed, at a comfortable temperature.

It is best to start with weak tea and jelly, gradually moving on to liquid porridge, diluted chicken broth. Next, they move on to chopped chicken pulp and soft-boiled eggs. It is recommended to drink vitamin C to strengthen the body.After complete recovery, it will be necessary to strictly observe the diet and to visit a gastroenterologist regularly. A specialist will help you choose the right diet for the future.

Preventive measures

It is always better to prevent a critical condition than to deal with it.

In this case, the following tips will help:

1. Try to get more rest and eat right.
2. Get rid of bad habits.
3. Avoid injury to the abdominal cavity.
4. Regularly visit a gastroenterologist and take all the necessary tests.

Vomiting blood cannot be ignored. Even if this condition has passed quickly, you need to visit a doctor. In the case when a person vomits blood after alcohol, only comprehensive examination of digestive organs can establish the reasons. With repeated use of alcohol, the situation can worsen even more and lead to tragic consequences.

A person who drinks will need help from relatives.Getting rid of an addiction can be difficult. Therefore, you need to find a good drug therapist who will help solve alcohol problems. The task of relatives is to convince a person of the need to give up alcohol. Only in this way will the treatment be effective. A healthy lifestyle, measured balanced nutrition , regular examinations will prevent the risk of recurrent bleeding.

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90,000 Blood from the anus.Diagnostics and treatment in Rostov-on-Don

The detection of blood from the anus can signal the onset of proctological problems that should be solved quickly, without delaying a visit to a proctologist.

Often in humans, the discussion of problems related to the anus and intestines is prohibited. Therefore, there are often cases when a visit to a doctor occurs when time is lost and the disease has caused significant damage to the body.

Should you be afraid of bleeding?

Don’t panic. But it is not recommended to relax either. Blood after defecation means the presence of injury to the mucous membrane, vessels of the anus, anal canal, rectum. It is necessary to identify the cause in a short time in order to prevent the developing disease.

The leading disease with this symptomatology is hemorrhoids. Men and women are at risk. Bleeding is not accompanied by pain and, depending on the stage of the disease, it can manifest itself as a drip, stream or splash.If the bleeding is not one-time, but is observed repeatedly, then we are not talking about trauma to the anus with a hard fecal lump. Oncology is characterized by latent red blood in the stool.

To identify the cause, it is important to promptly consult a proctologist, undergo an examination, and, if necessary, an examination in order to receive adequate treatment.

Causes of the appearance of blood

In addition to hemorrhoids and direct trauma to the anus, the anus can bleed for a variety of reasons.Moreover, both a man and a woman can be a potential patient of a proctologist equally.

• The large intestine may be affected by colitis.
• The anal fissure will bleed, accompanied by a burning sensation and itching. Little blood is observed immediately after a bowel movement.
• If a person has a tendency to constipation, then during the passage of solid feces, the mucous membrane and even the sphincter can be injured.
• Polyps can bleed – depending on the size and location of the discharge, it can be either scanty or profuse.
• Proctitis – the mucous membrane of the rectum is covered with ulcerations that become inflamed. Bloody discharge will be present in the feces, characterized by a noticeable amount of mucus.
• In a malignant tumor of the rectum, the symptoms will be similar to bleeding with polyps.
• Diverticulosis – if protrusions and pockets – diverticula have formed on the mucous membrane, then fecal lumps can injure them when passing. The blood will mix with the feces.
• Bleeding in people with HIV – the nature of the complication will play a decisive role.With reduced immunity, problems can arise in any possible manifestation, which will affect the nature of bleeding.

Blood from the anus may be a reaction to drugs containing potassium – these may be antibiotics or other drugs. If you are taking medication and find an unpleasant side effect, tell your doctor.

What can be the blood from the anus

Blood shade may indicate the location of the problem and its specifics.It is worth paying attention to such details in order to inform the doctor when visiting.

• Scarlet blood is a sign of anal fissure and hemorrhoids.
• The tint of cherry suggests looking for a problem in the colon.
• Dark blood clots are characteristic of tumor processes and diverticulosis.
• Red – indicates a polyp or cancer.
• Black discharge – requires the intervention of a gastroenterologist. The source of bleeding is located in the small intestine and above.

A person who finds traces of blood on underwear, toilet paper, should see a doctor as soon as possible to determine the cause of the problem. It is important to carry out a complete diagnosis to make sure there are no malignant growths and to take steps for a successful treatment.

Diagnostics

Many patients are confused by the prospect of probe insertion and are afraid of discomfort or pain. At the same time, colonoscopy is rightfully considered the “gold standard” of proctological diagnostics, which allows detecting any changes in the large intestine.

• The proctologist performs a digital examination, uses an anoscope or rectoscope, which will allow you to see the picture at a depth of 25 cm and, if necessary, take tissue samples for histology.
• Irrigoscopy – X-ray examination with the introduction of a contrast agent.

Before diagnosis, it will be necessary to cleanse the intestines and adhere to a diet that reduces gas production for several days. In addition to enemas, special preparations are used to empty the contents naturally.

If the patient is sensitive or is in such a condition that endoscopic techniques may cause discomfort, local anesthetics may be used, and if necessary, spinal anesthesia and even general anesthesia.

Single case

If you have a predisposition to constipation, then there are times when the blood appears once and after the symptom does not recur. This indicates a trauma to the sphincter or a closely located area of ​​the anal canal with a hard fecal lump.In the absence of repetitions, such a symptom does not require medical intervention.

But lovers of erotic experiments should be wary and watch: perhaps, during intercourse, damage was caused to the anus or the external sphincter, mucous membrane. If soreness is felt, there are problems with defecation, then it is necessary to contact a proctologist to avoid complications.

Treatment

Once the cause of the bleeding has been established, conservative, surgical methods may be used.Modern proctology, even if surgical intervention is necessary, offers low-traumatic methods of treatment, with a short rehabilitation period.

The traditional scalpel has been replaced by radio wave and laser methods, which allow removing neoplasms and excising damaged tissues with minimal blood loss and practically without complications.

Hardware surgery allows you to shorten the hospitalization period, and in some cases the patient is allowed to go home within a day or on the day of treatment.Rehabilitation takes from 14 days to a month, except in difficult cases.

Early treatment increases the chance of a conservative solution to the problem. Suppositories and ointments are most preferred by patients, since even a small intervention by the surgeon imposes restrictions on the usual way of life. However, drugs are not always effective, therefore they are used in an integrated approach.

Predictions for bleeding from the anus

If the cause of the bleeding was not a malignant formation in the last stages, then the proctologist will successfully help solve the rest of the problems.There are highly qualified specialists in Rostov-on-Don, whose experience guarantees the patient a speedy recovery and a high level of well-being.

Proctological problems with bleeding from the anus may be of concern to patients regardless of gender and age. Doctors note that hemorrhoidal disease has become younger and now, even in adolescence, you can face a similar nuisance.

A proctologist should be contacted without waiting for an exacerbation of the disease.In case of emergency treatment, the doctor will do everything to stop bleeding and pain, and after that he will carry out all the necessary research. There is no need to be afraid and ashamed, specialists are delicate in all procedures, trying to carry out manipulations as carefully as possible in relation to the patient.

Blood from the anus is just one symptom. It is important for the patient to find out the cause of the ailment as soon as possible and to enlist the support of a specialist. It is important to eliminate the problem in time in order to prevent it from becoming chronic.

You may also be interested in hemorrhoid treatment

The author of the article is a doctor proctologist

Edelgeriev Magomed Omarovich

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90,000 🧬 Analysis for “dysbiosis”: please, enough

Somehow aliens flew to Earth. We looked: glaciers are melting, ozone holes are growing, pandas do not breed. They began to think why this is all. We went down to the Moscow district of Biryulevo. They took a hundred people, undressed, felt, interrogated. They concluded: the ozone holes are because of the brunettes (many of them were caught), the pandas do not reproduce because of the men – there were more than half of them on the flying saucer.Well, global warming is due to the ruble: all residents of Biryulyovo had this currency in their pockets. The aliens flew to their home and, according to the results of the study, printed ten Ph.D. theses with their green tentacles.

This is how the “analysis for dysbiosis” is carried out. Let’s talk about this diagnosis with GMS Clinic gastroenterologist Aleksey Golovenko.

What’s wrong with this study? He is so often prescribed by doctors!

1. Let’s make a reservation: it is prescribed by doctors only in the countries of the former USSR.Outside these states, simple stool culture to detect microflora imbalances is not performed. You will not find guidance on the need for this study in the WGO Irritable Bowel Syndrome Syndrome Guidelines, the ACG (American College of Gastroenterology) guidelines for acute diarrhea, or the AAFP (American Association of Family Physicians) standard for monitoring newborns with colic. And, of course, there is no diagnosis of “dysbiosis” either in the International Classification of Diseases, or in at least one (!) Non-Russian-language textbook.
2. Our gastrointestinal tract is inhabited by at least 1000 (thousand!) Species of bacteria, and the number of all identified species is 2172. Performing the “analysis of feces for dysbiosis” we place stools in the nutrient medium and wait for the growth (appearance of colonies) of about 20 species of bacteria which we have chosen only because they are able to grow in this nutrient medium. Most of the intestinal inhabitants are not cultivated, that is, we cannot see their colonies in a Petri dish with our own eyes.8 per gram of stool. The standard is full of references to literature, but, suspiciously, there is not a single foreign publication among them. Well, the articles and textbooks themselves do not describe how exactly the microflora of healthy and sick people was compared, that is, how exactly the conclusion was made about the normal content of a particular bacterium.
3. The bacteria found in stool (which forms in the colon) are not the same bacteria found in the mouth or small intestine. In addition, bacteria in stool (that is, in the lumen of the intestine) are not bacteria at all, living in the mucus that protects the intestinal wall.In general, an insane amount of foreign bacteria, fungi and viruses “flies” through our digestive tract. Fortunately, most of them cannot get close to the intestinal wall: the parietal microflora living there competes with the “aliens”. We call this phenomenon colonization resistance, and it is to him that we owe the fact that the very first opportunistic bacteria swallowed with a glass of Moscow water does not cause diarrhea in us.
4. The composition and ratio of intestinal bacteria is different for each person.Having studied (not by seeding feces, of course, but by the most complex genetic methods) the composition of bacteria in the stool, you can, for example, guess whether the sample belongs to a resident of New York or the Amazon coast. Well, or in which region of a particular country (for example, Denmark). there is a person who sent his feces for analysis. In general, the true composition of the intestinal microflora is our “fingerprints”, and it is ridiculous to assume a certain general norm, and even more so to judge the “normalcy” of the flora by only 20 species out of 1000.
5. Whether bacteria will multiply on a nutrient medium depends not only on what bacteria live in the stool, but also on how the stool was collected (from the toilet, from sterile paper), how it was stored (in the refrigerator, by the battery, windows), as quickly delivered to the laboratory.How many people who were recommended to be tested for dysbiosis have read this instruction, according to which feces must be collected in sterile dishes, placed in the refrigerator and carried to the laboratory not in their hands, but in a thermos with an ice cube? However, even when performing these actions, the result of the analysis for dysbiosis cannot be interpreted by a normal doctor. So, he shouldn’t even try to do it.

Colonies of bacteria appeared in the nutrient medium. Luckily for us, the really dangerous Salmonella grows in a nutrient medium.Most of the gut bacteria, alas, are not.

So, there is no such thing – “dysbiosis”?

Of course have. For example, pseudomembranous colitis – a severe inflammation of the colon after an antibiotic – is a real dysbiosis: competitors have died, and therefore Clostridium difficile multiplies. Just in order to treat it, there is absolutely no need to state the obvious – the composition of bacteria in the intestine has changed. It is enough to confirm the infection (to identify C.difficile) and prescribe treatment.

The intestinal microflora undoubtedly affects all processes in our body. By transplanting a chair from an obese mouse to a mouse with a normal weight, we cause obesity in the latter. The composition of gut bacteria is fundamentally different in people with anxiety and depression. Well, adding the probiotic Bacteroides fragilis to mice artificially induced with autism improves their social skills. Read the popular book “Look What You Have Inside” by the famous microbiologist Rob Knight: our knowledge of microflora is colossal, but we are just beginning to put it into practice (that is, to treat diseases).

The composition of bacteria can and should be studied. The ambitious international research Human Microbiome Project with a budget of $ 115 million is dedicated to this. Naturally, no “stool crops” are used in this case. Metagenomics methods are used to analyze the microbial “jungle” of the intestine. They allow you to describe how many unique DNA sequences are present in a particular person, which groups of bacteria are predominant and which are absent. By the way, when such technologies (for example, sequencing of 16S-rRNA appeared, it turned out that 75% of the species found in the genetic analysis of the same feces were not known to science at all.

Stop. That is, it makes no sense to do stool seeding at all?

I did not say that. We will definitely perform a stool culture if we want to detect the growth of truly harmful bacteria. For example, in a person with bloody diarrhea, we are trying to find Salmonella or Shigella, Campylobacter or a special type of E. coli. Here, feces culture is vital, because this way we can prescribe antibiotic treatment – to kill a specific pathogen.

A competent doctor only performs a diagnostic test when the result can change the treatment.If the same medicine or diet is prescribed for both the “deficiency” of lactobacilli and the “excess” of E. coli, the analysis is a waste of money.

A full-fledged study of one’s own microflora can already be done on a commercial basis in the United States and Europe. A “pleasure” costs about 100 euros, and as a result of a genetic analysis of microflora, you will receive a conclusion (for example, this one) about the bacteria prevailing in your digestive tract. The problem is that even these results cannot be applied in practice.Because:

until we have a way to selectively change the composition of intestinal bacteria.

Suppose we have unequivocally established that a person has a deficiency of a specific microorganism (for example, lactobacilli). We can:

• Give a probiotic (that is, a specific live bacterium) and hope that it stays alive in the intestines.
• Give a prebiotic (that is, “food” for the bacteria) and hope that this will enhance the growth of exactly the bacteria we need.
• Give an antibiotic (poison for bacteria) and hope that it is the overgrowing bacteria that will die.
• To transplant someone else’s microflora into a person – to make a fecal microbiota transplant (to introduce diluted stool from a healthy person to a sick person).

Obviously, only the administration of a probiotic can be considered a selective action. The maximum dose of the best commercial probiotic is 10 billion viable bacteria per dose.There are about 100 trillion bacteria in the gut. That is, for every bacterium “from the pharmacy” there are 10 thousand bacteria already “living” in the intestine. It is unlikely that this tiny amount of bacteria will be able to overcome colonization resistance and “populate” the gut. In addition, the mechanism of action of probiotics (when they work) may generally not be associated with the bacteria themselves: in transgenic mice predisposed to intestinal inflammation, this very inflammation was stopped by using not a “live” probiotic, but in general DNA and some proteins isolated from the drug “killed” by the temperature.

Well, and most importantly: theory and laboratory research is one thing, and clinical trials (that is, studying the effect of drugs in humans) is another thing. Let us analyze three typical situations for Russia when a person is offered to pass a “fecal analysis for dysbiosis”:

Colic in newborn

Mom complains that the baby cries a lot. By the way, any child in the first three months of life screams for 117 to 133 minutes a day (meta-analysis). The presence or absence of colic (an unreasonable cry for more than 3 hours a day at least 3 days a week), in general, does not affect the risk of delayed development of the child.In one study, simply talking to parents about the “safety” of colic reduced the duration of crying from 2.6 to 0.8 hours per day. Children are empaths.

More often than not, this is not the case. The analysis of feces for dysbiosis is performed, there, naturally (the norm is taken from the “ceiling”), “deviations” are found. A probiotic is prescribed. And it often helps: still, because the frequency of colic decreases inexorably with the age of the child. At the same time, we do not have confidence that probiotics are generally effective for colic.Numerous meta-analyzes devoted to the treatment and prevention of this condition have not been able to unequivocally confirm the effectiveness of probiotics. The probiotic Lactobacillus reuteri may have some beneficial effect. But in order to prescribe this drug, we absolutely do not need an analysis of feces for “dysbiosis”.

Atopic dermatitis in a child

Everyone is sure that skin problems are caused by the “belly”. If this were the case, perhaps atopic dermatitis would be perfectly treated with probiotics.But this approach is not very effective. The latest meta-analysis shows that the use of probiotics (mainly Lactobacillus rhamnosus GG) somewhat reduces the severity of eczema, but this effect is very symbolic, and additional probiotic therapy does not reduce the frequency of use of topical steroids, which (together with skin hydration) remain the mainstay of treatment for atopic dermatitis. And again: we can prescribe this probiotic regardless of the “results” of the “dysbiosis test”.

Bloating and cramps in the abdomen in an adult

Bloating is most often a manifestation of bacterial overgrowth in the small intestine (SIBO), which is not helped by a probiotic but an antibiotic such as rifaximin. This condition is diagnosed with a special breath test. Often, constant bloating is a consequence of exocrine pancreatic insufficiency: enzyme deficiency in the stool can be detected using a fecal elastase test, by prescribing constant enzyme therapy with a decrease.But most often, the feeling of “bloating” is associated with increased sensitivity of the intestine (visceral hypersensitivity), which develops in people with irritable bowel syndrome. As you may have guessed, in order to estimate the number of bacteria in the small intestine, the function of the pancreas or the sensitivity of the intestine to distension, it is pointless to study 20 bacteria in the stool. And the effectiveness of probiotics in irritable bowel syndrome is questionable.

So it is necessary at least in some situation to take “feces for dysbiosis”?

Not.Never. Under no circumstances. We do not treat bloating by examining the lines in the palm of your hand. We do not treat a rash by looking into a crystal ball. We do not do a pointless analysis for dysbiosis in order to prescribe a treatment.

We are waiting for evidence-based medicine to offer us effective drugs and practical ways to understand what is wrong with our bacteria.

I am waiting with you!

Source: deti.mail.ru

7 danger signals (Signs of cancer.What are they?)

What cancer symptoms should alert you?

Abnormal stool or bladder function: Chronic constipation, diarrhea, or change in stool count may indicate colon cancer. Pain when urinating, blood in the urine, or changes in bladder function (more frequent or less frequent urination) may be associated with bladder or prostate cancer. These changes must be urgently reported to the doctor.

Non-healing wound or ulcer:

Skin cancers may bleed and resemble a wound or ulcer. A long-standing mouth ulcer can be oral cancer, especially in those who smoke, chew tobacco, or frequently drink alcohol. Ulcers on the penis or vagina can be signs of infection or early cancer and should therefore be examined.

Unusual bleeding or discharge:

Unusual bleeding may occur with early or advanced cancer.Blood in sputum can be a sign of lung cancer. Blood in your stool (or the presence of dark or black stool) can be a sign of colon or rectal cancer. Cancer of the cervix or the uterus itself can lead to bleeding from the vagina. Blood in the urine is a sign of possible bladder or kidney cancer. Discharge of blood from the nipple can be a sign of breast cancer.

A lump or tumor in the mammary gland or other parts of the body:
Many tumors can be felt through the skin, especially in the mammary gland, testes, lymph nodes and soft tissues of the body.A lump or tumor formation may be the first signs of early or advanced cancer. Any such finding should be reported to the doctor, especially if you have just discovered it or the tumor (induration) has begun to increase in size.

Indigestion or difficulty swallowing:

Although these symptoms can occur in a variety of conditions, they can also indicate the presence of cancer of the esophagus, stomach or pharynx.

Change of wart or mole:

Any changes in color, shape, borders or size of these formations should be immediately reported to the doctor.The skin lesion may turn out to be melanoma, which, if diagnosed early, responds well to treatment.

Irritant cough or hoarseness:

A prolonged, persistent cough may be a sign of lung cancer. Hoarseness of the voice is a possible sign of cancer of the larynx or thyroid gland.

.