### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
My dr told me a few yrs ago that I have GIRD. I haven t had any of my 40mg Nexium in almost a yr. Within the last few weeks intermittently I ve been feeling like I ve been kicked in the stomache. I don t have rebound tenderness . The pain is in the upper middle abdomen . Also, I pass gas frequently which is normal but lately it smells so much worse than before. Also, I do have a very small amount of blood in my stool , almost not noticeable, which i have had for at least a yr and was diagnosed as hemorroids. I am a 33 Y/O male healthy otherwise. Any ideas what could be wrong.

### output:

Hello! Thank you for the query. Upper middle abdominal pain is most likely caused by peptic ulcer. The pain usually appears 1-2 hours after a meal, nausea can be present. If the pain radiates to the back, gallstones are also possible. Bad smelling gases can appear due to bad diet or intestinal bacteria overgrow. Blood in stool, if it is fresh, on the surface of the stool (not mixed with it) is most likely caused by hemorrhoids. I suggest you to have upper GI endoscopy performed with Helicobacter Pylori test. This is also very important in cancer ruling out (as your symptoms can appear due to stomach cancer as well). Avoid fatty foods, spicy foods, alcohol, coffee, chocolate, fruit juices. Increase fiber rich products and mineral water intake. Probiotics should be also used. If such treatment won't give any help, you should visit gastroenterologist for further examination. Hope this will help. Regards.