Gastrointestinal diseases refer to diseases involving the gastrointestinal tract, namely

the esophagus, stomach, small intestine, large intestine and rectum, and the accessory organs of digestion,
the liver, gallbladder, and pancreas.

Functional Disorders

Functional disorders are those in which the bowel looks normal but doesn't work properly. They are
the most common problems affecting the colon and rectum, and include constipation and irritable
bowel syndrome (IBS). The primary causes for functional disorders include:

 Eating a diet low in fiber

 Not getting enough exercise
 Traveling or other changes in routine
 Eating large amounts of dairy products
 Being stressed
 Resisting the urge to have a bowel movement
 Resisting the urge to have bowel movements due to pain from hemorrhoids
 Overusing laxatives (stool softeners) that, over time, weaken the bowel muscles
 Taking antacid medicines containing calcium or aluminum
 Taking certain medicines (especially antidepressants, iron pills, and strong pain medicines such as
narcotics)
 Being pregnant

Constipation

Constipation is the difficult passage of stools (bowel movements) or the infrequent (less than three
times a week) or incomplete passage of stools. Constipation is usually caused by inadequate
"roughage" or fiber in the diet, or a disruption of the regular routine or diet. Constipation causes a
person to strain during a bowel movement. It might include small, hard stools, and sometimes causes
anal problems such as fissures and hemorrhoids. Constipation is rarely the sign of a more serious
medical condition.

Treatment of constipation includes increasing the amount of fiber you eat, exercising regularly, and
moving your bowels when you have the urge (resisting the urge causes constipation). If these
treatment methods don't work, laxatives are a temporary solution. Note that the overuse of laxatives
can actually aggravate symptoms of constipation. Always follow the package instructions on the
laxative medicine, as well as the advice of your doctor.

Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome (also called spastic colon, irritable colon, or nervous stomach) is a condition
in which the colon muscle contracts more readily than in people without IBS. A number of factors can
trigger IBS including certain foods, medicines, and emotional stress. Symptoms of IBS
include abdominal pain and cramps, excess gas, bloating, and a change in bowel habits such as
harder, looser, or more urgent stools than normal. Often people with IBS have alternating constipation
and diarrhea.

Treatment includes avoiding caffeine, increasing fiber in the diet, monitoring which foods trigger IBS
(and avoiding these foods), minimizing stress or learning different ways to cope with stress, and
sometimes taking medicines as prescribed by your health care provider.
Structural Disorders

Structural disorders are those in which the bowel looks abnormal and doesn't work properly.
Sometimes, the structural abnormality needs to be removed surgically. The most common structural
disorders are those affecting the anus, as well as diverticular disease and cancer.

Anal Disorders

Hemorrhoids

Hemorrhoids are swollen blood vessels that line the anal opening caused by chronic excess pressure
from straining during a bowel movement, persistent diarrhea, or pregnancy. There are two types of
hemorrhoids: internal and external.

Internal Hemorrhoids

Internal hemorrhoids are normal structures cushioning the lower rectum and protecting it from
damage by stool. When they fall down into the anus as a result of straining, they become irritated and
start to bleed. Ultimately, internal hemorrhoids can fall down enough to prolapse (sink or protrude) out
of the anus.

Treatment includes improving bowel habits (such as avoiding constipation, not straining during bowel
movements, and moving your bowels when you have the urge), using elastic bands to pull the
internal hemorrhoids back into the rectum, or removing them surgically. Surgery is needed only for a
small number of patients with very large, painful, and persistent hemorrhoids.

External Hemorrhoids

External hemorrhoids are veins that lie just under the skin on the outside of the anus. Sometimes,
after straining, the external hemorrhoidal veins burst and a blood clot forms under the skin. This very
painful condition is called a pile.

Treatment includes removing the clot and vein under local anesthesia in the doctor's office.

Anal Fissures

Anal fissures are splits or cracks in the lining of the anal opening. The most common cause of an anal
fissure is the passage of very hard or watery stools. The crack in the anal lining exposes the
underlying muscles that control the passage of stool through the anus and out of the body. An anal
fissure is one of the most painful problems because the exposed muscles become irritated from
exposure to stool or air, and leads to intense burning pain, bleeding, or spasm after bowel
movements.

Initial treatment for anal fissures includes pain medicine, dietary fiber to reduce the occurrence of
large, bulky stools, and sitz baths (sitting in a few inches of warm water). If these treatments don't
relieve pain, surgery might be needed to decrease spasm in the sphincter muscle.

Perianal Abscesses

Perianal abscesses can occur when the tiny anal glands that open on the inside of the anus become
blocked, and the bacteria always present in these glands cause an infection. When pus develops, an
abscess forms. Treatment includes draining the abscess, usually under local anesthesia in the
doctor's office.

Anal Fistula

An anal fistula often follows drainage of an abscess and is an abnormal tube-like passageway from
the anal canal to a hole in the skin near the opening of the anus. Body wastes traveling through the
anal canal are diverted through this tiny channel and out through the skin, causing itching and
irritation. Fistulas also cause drainage, pain, and bleeding. They rarely heal by themselves and
usually need surgery to drain the abscess and "close off" the fistula.

Other Perianal Infections

Sometimes the skin glands near the anus become infected and need to be drained. Just behind the
anus, abscesses can form that contain a small tuft of hair at the back of the pelvis (called a pilonidal
cyst).

Sexually transmitted diseases that can affect the anus include anal warts, herpes, AIDS, chlamydia,
and gonorrhea.

Diverticular Disease

Diverticulosis is the presence of small outpouchings (diverticula) in the muscular wall of the large
intestine that form in weakened areas of the bowel. They usually occur in the sigmoid colon, the high-
pressure area of the lower large intestine.

Diverticular disease is very common and occurs in 10 percent of people over age 40 and in 50
percent of people over age 60 in Western cultures. It is often caused by too little roughage (fiber) in
the diet. Diverticulosis rarely causes symptoms.

Complications of diverticular disease happen in about 10 percent of people with outpouchings. They
include infection or inflammation (diverticulitis), bleeding, and obstruction. Treatment of diverticulitis
includes antibiotics, increased fluids, and a special diet. Surgery is needed in about half the patients
who have complications to remove the involved segment of the colon.

Colon Polyps and Cancer

Each year 130,000 Americans are diagnosed with colorectal cancer, the second most common form
of cancer in the United States. Fortunately, with advances in early detection and treatment, colorectal
cancer is one of the most curable forms of the disease. By using a variety of screening tests, it is
possible to prevent, detect, and treat the disease long before symptoms appear.

The Importance of Screening

Almost all colorectal cancers begin as polyps, benign (non-cancerous) growths in the tissues lining
the colon and rectum. Cancer develops when these polyps grow and abnormal cells develop and
start to invade surrounding tissue. Removal of polyps can prevent the development of colorectal
cancer. Almost all precancerous polyps can be removed painlessly using a flexible lighted tube called
a colonoscope. If not caught in the early stages, colorectal cancer can spread throughout the body.
More advanced cancer requires more complicated surgical techniques.
Most early forms of colorectal cancer do not cause symptoms, which makes screening especially
important. When symptoms do occur, the cancer might already be quite advanced. Symptoms include
blood on or mixed in with the stool, a change in normal bowel habits, narrowing of the stool,
abdominal pain, weight loss, or constant tiredness.

Most cases of colorectal cancer are detected in one of four ways:

 By screening people at average risk for colorectal cancer beginning at age 50

 By screening people at higher risk for colorectal cancer (for example, those with a family history or a
personal history of colon polyps or cancer)
 By investigating the bowel in patients with symptoms
 A chance finding at a routine check-up

Early detection is the best chance for a cure.

Colitis

There are several types of colitis, conditions that cause an inflammation of the bowel. These include:

 Infectious Colitis
 Ulcerative colitis (cause not known)
 Crohn's disease (cause not known)
 Ischemic colitis (caused by not enough blood going to the colon)
 Radiation colitis (after radiotherapy)

Colitis Causes diarrhea, rectal bleeding, abdominal cramps, and urgency (frequent and immediate
need to empty the bowels). Treatment depends on the diagnosis, which is made
by colonoscopy and biopsy.

Summary

Many diseases of the colon and rectum can be prevented or minimized by maintaining a healthy
lifestyle, practicing good bowel habits, and submitting to cancer screening.

If you have a family history of colorectal cancer or polyps, you should have a colonoscopy beginning
at age 40, or 10 years younger than your youngest family member with cancer. (For example, if your
brother was diagnosed with colorectal cancer or polyps at age 45, you should begin screening at age
35).

If you have no family history of colorectal cancer and no personal history of other cancers, you should
have a colonoscopy at age 50.

If you have symptoms of colorectal cancer you should consult your doctor right away. Common
symptoms include:

 A change in normal bowel habits

 Blood on or in the stool that is either bright or dark
 Unusual abdominal or gas pains
 Very narrow stool
 A feeling that the bowel has not emptied completely after passing stool
 Unexplained weight loss
 Fatigue
GASTROENTERITIS

Gastroenteritis, also known as infectious diarrhea, is inflammation of the gastrointestinal tract that involves
the stomach and small intestine. When you have diarrhea and vomiting, you may say you have the "stomach flu."
These symptoms often are due to a condition called gastroenteritis.

With gastroenteritis, your stomach and intestines are irritated and inflamed. The cause is typically a viral
or bacterial infection.

Symptoms of Gastroenteritis

With gastroenteritis, the main symptoms you probably have are watery diarrhea and vomiting. You might also
have stomach pain, cramping, fever, nausea, and a headache.

Because of diarrhea and vomiting, you also can become dehydrated. Watch for signs of dehydration, such as dry
skin and a dry mouth, feeling lightheaded, and being really thirsty. Call your doctor if you have any of these
symptoms.

Stomach Flu and Children

Children can get dehydrated quickly, so if your child has the stomach flu, it's important that you look for signs
that he is very thirsty or has dry skin or a dry mouth. If you have a baby, look for fewer, drier diapers.

Keep children with gastroenteritis out of day care or school until all symptoms are gone. Check with your doctor
before giving your child any medicine. Drugs used to control diarrhea and vomiting aren't usually given to children
younger than 5.

What Causes Gastroenteritis

There are many ways gastroenteritis can be spread:

 Contact with someone who has the virus

 Contaminated food or water
 Unwashed hands after going to the bathroom or changing a diaper

The most common cause of gastroenteritis is a virus. Gastroenteritis flu can be caused by many different kinds of
viruses. The main types are rotavirus and norovirus.

Rotavirus is the world's most common cause of diarrhea in infants and young children. Norovirus is the most common
cause of serious gastroenteritis and also foodborne disease outbreaks in the U.S.

Although not as common, bacteria such as E. coli and salmonella can also trigger the stomach flu. Salmonella and
campylobacter bacteria are the most common bacterial causes of gastroenteritis in the U.S. and are usually spread by
undercooked poultry, eggs, or poultry juices. Salmonella can also be spread through pet reptiles or live poultry.

Parasites can also cause gastroenteritis, but it's not common. You can pick up organisms such as giardia and
cryptosporidium in contaminated swimming pools or by drinking contaminated water.

There are also other unusual ways to get gastroenteritis:

 Heavy metals (arsenic, cadmium, lead, or mercury) in drinking water

 Eating a lot of acidic foods, like citrus fruit and tomatoes
 Toxins that might be found in certain seafood
 Medications such as antibiotics, antacids, laxatives, and chemotherapy drugs

Prevention includes hand washing with soap, drinking clean water, proper disposal of human waste,
and breastfeeding babies instead of using formula. The rotavirus vaccine is recommended in children. Treatment
involves getting enough fluids. For mild or moderate cases, this can typically be achieved by drinking oral
rehydration solution (a combination of water, salts, and sugar). In those who are breast fed, continued
breastfeeding is recommended. For more severe cases, intravenous fluids may be needed. Fluids may also be given
by a nasogastric tube. Zinc supplementation is recommended in children. Antibiotics are generally not needed.

 Lifestyle

A supply of easily accessible uncontaminated water and good sanitation practices are important for reducing rates
of infection and clinically significant gastroenteritis. [16] Personal measures (such as hand washing with soap) have
been found to decrease rates of gastroenteritis in both the developing and developed world by as much as
30%.[22] Alcohol-based gels may also be effective.[22]Breastfeeding is important, especially in places with poor
hygiene, as is improvement of hygiene generally.[14] Breast milk reduces both the frequency of infections and their
duration.[2] Avoiding contaminated food or drink should also be effective. [40]
  Vaccination

Due to both its effectiveness and safety, in 2009 the World Health Organization recommended that the rotavirus
vaccine be offered to all children globally.[23][41] Two commercial rotavirus vaccines exist and several more are in
development.[41] In Africa and Asia these vaccines reduced severe disease among infants [41] and countries that have
put in place national immunization programs have seen a decline in the rates and severity of disease. [42][43] This
vaccine may also prevent illness in non-vaccinated children by reducing the number of circulating
infections.[44] Since 2000, the implementation of a rotavirus vaccination program in the United States has
substantially decreased the number of cases of diarrhea by as much as 80 percent. [45][46][47] The first dose of
vaccine should be given to infants between 6 and 15 weeks of age. [23] The oral cholera vaccine has been found to be
50–60% effective over 2 years.

It is estimated that three to five billion cases of gastroenteritis resulting in 1.4 million deaths occur globally each
year. Children and those in the developing world are most commonly affected. As of 2011, in those below age five,
there were about 1.7 billion cases resulting in 0.7 million deaths. In the developing world children less than two
years of age frequently get six or more infections a year. It is less common in adults, partly due to the
development of immunity.

DIAGNOSIS

Gastroenteritis is typically diagnosed clinically, based on a person's signs and symptoms. Determining the exact
cause is usually not needed as it does not alter management of the condition. However, stool cultures should be
performed in those with blood in the stool, those who might have been exposed to food poisoning, and those who
have recently traveled to the developing world. Diagnostic testing may also be done for
surveillance. As hypoglycemia occurs in approximately 10% of infants and young children, measuring
serum glucose in this population is recommended. Electrolytes and kidney function should also be checked when
there is a concern about severe dehydration.

MANAGEMENT

Rehydration

The primary treatment of gastroenteritis in both children and adults is rehydration. This is preferably achieved by
drinking rehydration solution, although intravenous delivery may be required if there is a decreased level of
consciousness or if dehydration is severe.[51][52] Drinking replacement therapy products made with complex
carbohydrates (i.e. those made from wheat or rice) may be superior to those based on simple sugars. [53] Drinks
especially high in simple sugars, such as soft drinks and fruit juices, are not recommended in children under 5 years
of age as they may increase diarrhea.[21] Plain water may be used if more specific ORT preparations are unavailable
or the person is not willing to drink them.[21] A nasogastric tube can be used in young children to administer fluids if
warranted.[10] In those who require intravenous fluids, one to four hours' worth is often sufficient. [54]

Dietary

It is recommended that breast-fed infants continue to be nursed in the usual fashion, and that formula-fed infants
continue their formula immediately after rehydration with ORT. [55] Lactose-free or lactose-reduced formulas
usually are not necessary.[55] Children should continue their usual diet during episodes of diarrhea with the
exception that foods high in simple sugars should be avoided.[55] The BRAT diet (bananas, rice, applesauce, toast
and tea) is no longer recommended, as it contains insufficient nutrients and has no benefit over normal feeding. [55]
Some probiotics have been shown to be beneficial in reducing both the duration of illness and the frequency of
stools.[56][57]They may also be useful in preventing and treating antibiotic associated diarrhea.[58] Fermented milk
products (such as yogurt) are similarly beneficial.[59] Zinc supplementation appears to be effective in both treating
and preventing diarrhea among children in the developing world. [60]

Antiemetics

Antiemetic medications may be helpful for treating vomiting in children. Ondansetron has some utility, with a single
dose being associated with less need for intravenous fluids, fewer hospitalizations, and decreased
vomiting.[49][61][62][63]Metoclopramide might also be helpful.[63] However, the use of ondansetron might possibly be
linked to an increased rate of return to hospital in children.[64] The intravenous preparation of ondansetron may be
given orally if clinical judgment warrants.[65] Dimenhydrinate, while reducing vomiting, does not appear to have a
significant clinical benefit.[2]

Antibiotics

Antibiotics are not usually used for gastroenteritis, although they are sometimes recommended if symptoms are
particularly severe[66] or if a susceptible bacterial cause is isolated or suspected. [67] If antibiotics are to be
employed, a macrolide (such as azithromycin) is preferred over a fluoroquinolone due to higher rates of resistance
to the latter.[18] Pseudomembranous colitis, usually caused by antibiotic use, is managed by discontinuing the
causative agent and treating it with either metronidazole or vancomycin.[68] Bacteria and protozoans that are
amenable to treatment include Shigella[69] Salmonella typhi,[70] and Giardia species.[33] In those with Giardia species
or Entamoeba histolytica, tinidazole treatment is recommended and superior to metronidazole. [33][71] The World
Health Organization (WHO) recommends the use of antibiotics in young children who have both bloody diarrhea
and fever.[2]

Antimotility agents

Antimotility medication has a theoretical risk of causing complications, and although clinical experience has shown
this to be unlikely,[39] these drugs are discouraged in people with bloody diarrhea or diarrhea that is complicated by
fever.[72]Loperamide, an opioid analogue, is commonly used for the symptomatic treatment of
diarrhea.[73] Loperamide is not recommended in children, however, as it may cross the immature blood–brain barrier
and cause toxicity. Bismuth subsalicylate, an insoluble complex of trivalent bismuth and salicylate, can be used in
mild to moderate cases,[39] but salicylate toxicity is theoretically possible.