Brief Answer: Problems can be due to hypovolemia Detailed Answer: Hi XXXXXXX Thanks for your query. Your symptoms are not due to esophageal Varices, since this condition occurs only in cirrhosis of Liver. Hypovolemia may be the reason, provided that there was significant amount of blood in stools. Also, the fact that there was only a SINGLE EPISODE of blood in the stools, rules out bleeding in the stomach/duodenum, in which case, the stools are tarry black following the bleeding. Hence, the source of bleeding appears to be the terminal part of colon or, bleeding from piles (if you have piles). Further, Gastro-esophageal reflux disease (GERD) is commonly associated with H.pylori infection of the stomach and small intestine, apart from stomach ulcers. Only in case of massive bleeding from the ulcers, does fresh blood passes in the stools. So, the possibility of a massive bleed from the ulcers cannot be overlooked, in view of momentary giddiness with blurred vision. Then, in the presence of H.pylori infection, absorption of food's nutrients and, essential vitamins, particularly, Vitamin B12 and Folic Acid is grossly impaired. Vitamin B12 and Folic Acid deficiency (due to mal-absorption) cause numbness in legs/tightness near arms and, giddiness. In view of the above-mentioned possibilities, I would strongly recommend that you undergo COLONOSCOPY (to directly visualize the inside of colon for the cause of bleeding, such as, erosions, polyps or growths); ENDOSCOPY for evidence of stomach/duodenal ulcers, as well as, biopsy of stomach lining for detecting H.pylori infection; and, Hemoglobin levels to assess anemia, following bleeding. In the meanwhile, pending the above-mentioned tests, you may start taking Folic Acid 5mg; 1.5mg of Methylcobalamin (Vitamin B12) once daily; a Probiotic, such as, lactobacilli thrice a day; and, a Proton Pump Inhibitor (anti-acid drug), such as, Rabeprazole or Esmoprazole. A 2 weeks' course of anti-H.pylori therapy would be required, if the stomach biopsy is found to be positive for the said infection. Consult your doctor and apprise him of my opinion. I am certain that he will agree with me; order required tests, and- based on the reports- will arrive at a certain diagnosis and prescribe suitable treatment as advised. Hope I have addressed your concerns to your complete satisfaction and you find my response helpful and informative. I will be happy to answer further queries, if any. Take care, Col (Dr.) Rakesh Karanwal

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Brief Answer: Take advised preventive measures and tests Detailed Answer: Hi Mr. XXXXXXX Giddiness and visual changes after a meal, usually occurs due to fall in blood pressure as the extra blood is shunted to the stomach and intestine for efficient digestion. This results in reduced blood supply to the brain and thereby, consequent giddiness, visual changes, generalized weakness and other symptoms. In normal individuals, this does not occur. However, there is a significant fall in blood pressure in certain underlying conditions (at your age), such as, low blood pressure, dieting, dehydration (after massive bleeding), underlying heart or neurological disease, thyroid disorder or under-active adrenal glands. Therefore, get your standing and lying BP checked up (for detecting low blood pressure), test for anemia (following massive bleeding in stools), TMT and echo (in view of post-meal tightness in left arm which might represent atypical angina) and serum electrolytes (to detect low sodium in the blood). H.pylori infection of the intestine does NOT directly cause the symptoms. Post-infection-induced malabsorption causes defective absorption of fluids, nutrients, salts, minerals and vitamins into the blood with consequent weight loss and malnutrition, which cause low blood pressure. The preventive measures to reduce the possibility of post-meal giddiness are :- 1. Drink 1 liter of water 15 minutes before eating which can blunt a fall in blood pressure. 2. Take smaller and more frequent meals. Larger meals are more likely to trigger postprandial hypotension than smaller ones. Try switching from three square meals a day to six or seven smaller meals. 3. Take less of refined sugar-containing foods such as, white bread and other foods made with highly refined flour, white rice, potatoes, and sugary beverages. Instead, take slowly digested whole grains, beans, protein, and healthy oils which may keep your blood pressure up after a meal. 4. Take rest (Sitting or lying down) for an hour or so after eating. H.pylori infection is cured with 2-3 weeks' course of anti-H.pylori therapy. Proton Pump Inhibitors (PPIs), such as, Pantoprazole or rabeprazole have lesser side effects, but much more effective, than antacids. 2-3 months' course of PPIs will cure the stomach ulcers without any appreciable side effects.

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