Antibiotic and PPI Associated Diarrhea

Endoscopic Image of Pseudomembranous Colitis Our gut harbors a number of bacteria; many of them protect us from colonization and harmful effect of deadly bacteria. In recent times pathogenic bacteria like C. difficile are more often found causing diarrhea; what is called pseudomembranous colitis a suferinfection.
This is most commonly seen following use of prolonged antibiotic therapy and use of proton pump inhibitors (PPI).
Commonly used antibiotics damage the normal gut flora and tilt the balance towards invasion and overgrowth of pathogenic bacteria. Prolonged PPI use decreases the acidic environment and allows multiplication of organisms harmful to body.
Clostridium difficile,  a bacterium that takes this opportunity to overgrow and causes diarrhea. It is also difficult to eradicate as is not susceptible to conventional antibiotics. A tough antibiotic called vancomycin is being used to treat it along with metronidazole. Some cases of vancomycin resistance have also been reported.
It is wise at the first place to prevent this superinfection by restricted use of antibiotics and supplementing with good bacteria during its use. Peudomembranous colitis can be treated by vancomycin, toxin‐binding medications, active vaccination, intravenous immunoglobin, and fecal bacteriotherapy (FB). Fecal bacteriotherapy is putting feces from healthy donors to the intestine of patient through colonoscopy.
Further, indiscriminate use of PPIs needs to stop making it available strictly on prescription.
In several interesting researches of recent times it has been seen that curcumin an active agent found in turmeric helps to improve gut health. It's likely that daily use of turmeric in hospital settings, in food products like curry or soup, can potentially decrease the incidence of Clostridium difficile associated diarrhea.
More studies are needed to determine the mechanism of action of turmeric and the physiological effects of turmeric in animal models of pseudomembranous colitis.
If this is ignored communities is likely to face situations like development of superbugs like (New Delhi Metallo) NDM-betalactamase1 and much more resistance strains of bacteria.

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How to Manage Vomiting of Blood

Image by drppanda via Flickr

Blood vomiting is a very frightening scene; everybody will be watching not being able to do something concrete to stop it. There are many causes; commonest causes include; acid peptic disease, cancer stomach, esophageal varices and trauma to abdomen. There are also some rare but important diseases like bleeding disorders and blood cancers etc. Vomiting of blood is called haematemesis in medical language.
Acid peptic disease includes erosions and ulcerations in the esophagus, stomach and duodenum. Commonly this occurs due to analgesic abuse. The drugs belong to non-steroidal anti-inflammatory and analgesics (NSAID). These put defense of the mucosa, the inner layer of gastrointestinal tract in jeopardy. Ulcerations may follow erosions and sometimes may cause injury to the blood vessels. Once injured there occurs bleeding from it and is expelled out through mouth to be termed as haematemesis. Blood may pass down, get altered and subsequently evacuated in stool to be called as malena. This may be self-limiting, minimal to massive bleeding. Sometimes, it requires emergency surgery, but after the advent of acid inhibitor drugs, surgery for the bleeding episode has come down drastically. Another important cause of acid peptic disease is intake of excessive chilies and spices in the food. Those injure the mucosa by stimulating excessive acid output from the stomach. The cause of haematemesis can be diagnosed by an upper gastrointestinal endoscopically. Usually conservative treatment with proton pump inhibitor stops the bleeding. At times it is required to seal the bleeding blood vessel endoscopically by some chemical agent commonly with noradrenaline. Patients not responding to these measures may require surgery.
Cancer of stomach may give rise to bleeding from the ulcerated surface or as such due to the friability of the tumor mass. It can be diagnosed through endoscopy. Here a much planned approach is made, and conservative treatment started expecting cessation of bleeding.
Bleeding from esophageal varices occur due to its rapture. Here the bleeding is usually massive. Esophageal varices are dilated tortuous veins filled with blood. These are commonly seen as a result of portal hypertension arising out of cirrhosis of liver, where there is much fibrosis in the liver. Cirrhosis of liver is a common outcome of alcoholic and viral hepatitis. It may also be congenital in origin. The varicosity of the veins near the esophagus and stomach junction is due to opening up of alternative channel for blood flow from the lower region of body bypassing the liver. The varices can be ligated endoscopically, so that they do not rapture. Ruptured blood vessels can be compressed by equipments passed through mouth to stomach. Definitive treatment is treating the primary condition; the cirrhosis of liver. Portal hypertension may be treated surgically and various procedures have been described for it.

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All Those Diseases Presenting as Piles

Piles called hemorrhoid, in medical languages is a very common disease. It is seen more often in female than male. It is probably the reward to human race for adaption of erect posture, as quadrupeds do not suffer from this disease. Piles, as such occurs due to various local factors, mainly a cushion defect in the vascular bed of rectum and anal canal. But, there are some diseases which present as piles. Common amongst those are:

• Cancer rectum and Colon
• Portal hypertension

Cancer of rectum and colon: Many times the clinicians avoid digital rectal examination and presume that the bleeding from anus is from the simple piles. That is why, it is said that” If the clinician has not put his finger inside, he may put his foot in it”. This shows how much vexing the problem is, if  not properly examined. Many great surgeons have missed the diagnosis and operated as simple piles leaving the underlying disease intact. Rectal cancer may present as painless bleeding from anus. As the tumor grows there occurs some obstruction to the venous flow resulting in engorged anal veins, apart from it there may be direct bleeding from the tumor itself. Multiple polyposis is precursor of cancer rectum and colon. Non-vegetarian diet, especially meat consumption is associated with colon cancer. Vegetarian diet, fiber rich diet, aspirin, metformin and regular exercise may have some protective effect.
Portal Hypertension: This disease is rather a complication of cirrhosis of liver. Here, there is obstruction to free flow of blood from lower extremities through the liver; and alternative channels open up for the flow of blood to the heart. In that way an alternative channel opens up in the rectum and anal canal, in addition to other sites; the veins become engorged resulting in bleeding from the anus. Cirrhosis of liver may result from chronic hepatitis, commonly hepatitis B and C; besides this alcoholic cirrhosis, biliary cirrhosis and aflatoxin poisoning are some other causes.
So, for any bleeding from anus a simple examination like digital examination should not be skipped.

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