Facts on File Encyclopedia of Health and Medicine

most common complications after surgery are
INFECTIONand difficulty swallowing.

Risk Factors and Preventive Measures

Doctors are uncertain what causes GERD to
develop, though various factors appear to con-
tribute. Among them are

• OBESITY


• cigarette smoking


• H. pylori


• ASTHMA


• eating within two hours of going to bed


• heavy ALCOHOLconsumption

Preventive measures include avoiding or mini-
mizing factors associated with GERD as well as
eating smaller meals and getting regular physical
exercise, which helps maintain effective PERISTALSIS
and gastrointestinal motility (movement of food
through the gastrointestinal tract).
See also ACHALASIA; BARRETT’S ESOPHAGUS;
ENDOSCOPY; ESOPHAGITIS.

gastrointestinal bleeding Gross (obvious) or
occult (microscopic) bleeding along any section of
the gastrointestinal tract. Gross bleeding generally
is obvious. Occult bleeding often occurs with
intestinal polyps. FECAL OCCULT BLOOD TEST(FOBT)is
one method used to detect microscopic BLOODin
the stool. Several kinds of FOBTs are available for
home use, though it is imperative to follow up
with the doctor when the results are questionable
or positive.
Gastrointestinal bleeding can result from
numerous conditions as well as excessive doses of
anticoagulant medications or irritation from med-

ications such as aspirin and NONSTEROIDAL ANTI-

INFLAMMATORY DRUGS(NSAIDS). The most common

sites are the STOMACH, DUODENUM, sigmoid COLON,

and RECTUM. There are three ways in which gas-

trointestinal bleeding presents:

• hematemesis is the VOMITING of bright red
  blood, signaling bleeding from the upper gas-
  trointestinal tract (usually theESOPHAGUS, stom-
  ach or duodenum)


• hematochezia is the passing of bright red blood
  rectally, indicating bleeding from the lower gas-
  trointestinal tract (usually the sigmoid colon or
  rectum) or from HEMORRHOIDS


• melena is the passing of dark, tarry stools that
  signal bleeding from the upper gastrointestinal
  tract

All gastrointestinal bleeding requires medical

evaluation to determine its cause. Persistent bleed-

ing, even when the amounts of blood appear small,

results in ANEMIA. The diagnostic path may include

ENDOSCOPYof the upper and lower gastrointestinal

tracts, esophagogastroduodenoscopy (EGD) and

COLONOSCOPYrespectively, as well as BARIUM SWAL-

LOW and BARIUM ENEMA. Treatment targets the

underlying condition, and may include BLOOD

TRANSFUSIONwhen the blood loss is significant.

CONDITIONS THAT CAN CAUSE

GASTROINTESTINAL BLEEDING

ANAL FISSURE BARRETT’S ESOPHAGUS

COLITIS DIVERTICULAR DISEASE

ESOPHAGEAL CANCER GASTRITIS

HEMORRHOIDS INFLAMMATORY BOWEL DISEASE(IBD)

INTESTINAL POLYP PEPTIC ULCER DISEASE

STOMACH CANCER

gastrointestinal bleeding 51

TREATMENTS FOR GERD

Medical Methods Surgical Methods Lifestyle Methods
H2 BLOCKERS fundoplication WEIGHT LOSS AND WEIGHT MANAGEMENT
PPIS endoscopic gastroplasty elevate head of bed
antibiotics for H.PYLORI SMOKING CESSATION
ANTACIDS avoid CAFFEINEand ALCOHOL
reduce carbonated beverages
stay upright for 2 hours after meals
sleep lying on the left side
avoid NSAIDSand aspirin