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Sample records for bowel preparation one-center

  1. Physiologic effects of bowel preparation

    DEFF Research Database (Denmark)

    Holte, Kathrine; Nielsen, Kristine Grubbe; Madsen, Jan Lysgård

    2004-01-01

    PURPOSE: Despite the universal use of bowel preparation before colonoscopy and colorectal surgery, the physiologic effects have not been described in a standardized setting. This study was designed to investigate the physiologic effects of bowel preparation. METHODS: In a prospective study, 12...... healthy volunteers (median age, 63 years) underwent bowel preparation with bisacodyl and sodium phosphate. Fluid and food intake were standardized according to weight, providing adequate calorie and oral fluid intake. Before and after bowel preparation, weight, exercise capacity, orthostatic tolerance...... preparation has significant adverse physiologic effects, which may be attributed to dehydration. The majority of these findings is small and may not be of clinical relevance in otherwise healthy patients undergoing bowel preparation and following recommendations for oral fluid intake....

  2. Physiologic effects of bowel preparation

    DEFF Research Database (Denmark)

    Holte, Kathrine; Nielsen, Kristine Grubbe; Madsen, Jan Lysgård

    2004-01-01

    PURPOSE: Despite the universal use of bowel preparation before colonoscopy and colorectal surgery, the physiologic effects have not been described in a standardized setting. This study was designed to investigate the physiologic effects of bowel preparation. METHODS: In a prospective study, 12...... healthy volunteers (median age, 63 years) underwent bowel preparation with bisacodyl and sodium phosphate. Fluid and food intake were standardized according to weight, providing adequate calorie and oral fluid intake. Before and after bowel preparation, weight, exercise capacity, orthostatic tolerance......, plasma and extracellular volume, balance function, and biochemical parameters were measured. RESULTS: Bowel preparation led to a significant decrease in exercise capacity (median, 9 percent) and weight (median, 1.2 kg). Plasma osmolality was significantly increased from 287 to 290 mmol kg(-1), as well...

  3. Mechanical bowel preparation for elective colorectal surgery

    DEFF Research Database (Denmark)

    Güenaga, Katia F; Matos, Delcio; Wille-Jørgensen, Peer

    2011-01-01

    The presence of bowel contents during colorectal surgery has been related to anastomotic leakage, but the belief that mechanical bowel preparation (MBP) is an efficient agent against leakage and infectious complications is based on observational data and expert opinions only.An enema before...... the rectal surgery to clean the rectum and facilitate the manipulation for the mechanical anastomosis is used for many surgeons. This is analysed separately...

  4. Achieving the best bowel preparation for colonoscopy.

    Science.gov (United States)

    Parra-Blanco, Adolfo; Ruiz, Alex; Alvarez-Lobos, Manuel; Amorós, Ana; Gana, Juan Cristóbal; Ibáñez, Patricio; Ono, Akiko; Fujii, Takahiro

    2014-12-21

    Bowel preparation is a core issue in colonoscopy, as it is closely related to the quality of the procedure. Patients often find that bowel preparation is the most unpleasant part of the examination. It is widely accepted that the quality of cleansing must be excellent to facilitate detecting neoplastic lesions. In spite of its importance and potential implications, until recently, bowel preparation has not been the subject of much study. The most commonly used agents are high-volume polyethylene glycol (PEG) electrolyte solution and sodium phosphate. There has been some confusion, even in published meta-analyses, regarding which of the two agents provides better cleansing. It is clear now that both PEG and sodium phosphate are effective when administered with proper timing. Consequently, the timing of administration is recognized as one of the central factors to the quality of cleansing. The bowel preparation agent should be administered, at least in part, a few hours in advance of the colonoscopy. Several low volume agents are available, and either new or modified schedules with PEG that usually improve tolerance. Certain adjuvants can also be used to reduce the volume of PEG, or to improve the efficacy of other agents. Other factors apart from the choice of agent can improve the quality of bowel cleansing. For instance, the effect of diet before colonoscopy has not been completely clarified, but an exclusively liquid diet is probably not required, and a low-fiber diet may be preferable because it improves patient satisfaction and the quality of the procedure. Some patients, such as diabetics and persons with heart or kidney disease, require modified procedures and certain precautions. Bowel preparation for pediatric patients is also reviewed here. In such cases, PEG remains the most commonly used agent. As detecting neoplasia is not the main objective with these patients, less intensive preparation may suffice. Special considerations must be made for patients

  5. Preoperative bowel preparation in children: Polyethylene glycol ...

    African Journals Online (AJOL)

    Background: Colorectal surgeries frequently require bowel preparation. In children, (is this standard of care?: this method is mostly followed) this is usually performed using normal saline, which is very cumbersome and causes unnecessary discomfort. This study compared polyethylene glycol (PEG) with normal saline for ...

  6. Mechanical bowel preparation for elective colorectal surgery.

    Science.gov (United States)

    Guenaga, K F; Matos, D; Castro, A A; Atallah, A N; Wille-Jørgensen, P

    2003-01-01

    For more than a century the presence of bowel content during surgery has been related to anastomotic leakage. Mechanical bowel preparation has been considered an efficient agent against leakage and infections complications. This dogma is not based on solid evidence, but more on observational data and expert's opinions. To determine the security and effectiveness of prophylactic mechanical bowel preparation for morbidity and mortality rates in colorectal surgery. The following hypothesis was tested: "The use of mechanical bowel preparation before elective colorectal surgery reduces the incidence of postoperative complications". All publications describing mechanical bowel preparation before elective colorectal surgery was sought through computerized searches of EMBASE, LILACS, MEDLINE, and Cochrane Library; by hand-searching in relevant medical journals, from major gastroenterological congresses, without limitation for date and language, using the search strategy described by the Colorectal Cancer Review Group. In addition, randomised clinical trials will be searched through personal communication with colleagues and from conference proceedings All randomised, clinical trials, that were performed in order to answer the hypothesis. Patients submitted elective colorectal surgery. Any strategy in mechanical bowel preparation compared with no mechanical bowel preparation. 1. Anastomosis leakage- stratified for rectum and colon 2. Overall anastomotic leakage 3. Mortality 4. Peritonitis 5. Re operation 6. Wound Infection 7 Infectious extra-abdominal complication 8. Non-infection extra-abdominal 9. Overall surgical site infections Data was independently extracted by two reviewers and cross-checked. The methodological quality of each trial was assessed by the same two reviewers. Details of the randomisation (generation and concealment), blinding, whether an intention-to-treat analysis was done, and the number of patients lost to follow-up was recorded. The results of each

  7. Quality of small bowel preparation for video-capsule endoscopy. Prospective comparison of two different preparations.

    Science.gov (United States)

    Triantafyllou, Konstantinos; Kalantzis, Chryssostomos; Papadopoulos, Aggelos A; Apostolopoulos, Pericles; Ladas, Dimitris; Kalli, Theodora; Kakavetsi, Vassiliki; Kalantzis, Nikolaos; Ladas, Spiros D

    2010-01-01

    The best preparation for successful small bowel video-capsule endoscopy (VCE) is still unknown. The primary aim of our study was to compare sodium phosphate (PS) and polyethylene glycol (PEG) purge on the quality of small bowel preparation. In this prospective, non-randomized, two centers study, we evaluated 47 and 48 consecutive outpatients who received PS and PEG preparations, respectively. Two independent investigators measured the proportion of small bowel transit time (SBTT) without clean mucosa. Two other investigators assessed bowel preparation independently, using a visual analogue scale (VAS). The proportion of SBTT without clean mucosa was similar for both preparations, in the proximal [3.8 (2.1-8.7) % vs. 4.85 (2.7-9.7) %, p = 0.24)] and in the distal half [31.9 (10.7-52.5) % vs. 22.9 (6.9-57.7) %, p = 0.48] of VCE recording. There was moderate - good correlation of VAS assessment of bowel preparation with the proportion of SBTT without clean mucosa in the proximal (r = 0.69, p preparations. PS and PEG preparations result in similar quality of small bowel preparation and similar outcome measures of VCE studies. VAS assessment could be an alternative measure of bowel preparation in clinical practice.

  8. MR Colonography with limited bowel preparation: Patient acceptance compared with that of full-preparation Colonoscopy

    NARCIS (Netherlands)

    Florie, Jasper; Birnie, Erwin; van Gelder, Rogier E.; Jensch, Sebastiaan; Haberkorn, Brigitte; Bartelsman, Joep F.; Veer, Annet van der Sluys; Snel, Pleun; van der Hulst, Victor P. M.; Bonsel, Gouke J.; Bossuyt, Patrick M. M.; Stoker, Jaap

    2007-01-01

    Purpose: To prospectively evaluate participants' experience and preference of magnetic resonance (MR) colonography with limited bowel preparation compared with full-preparation colonoscopy in participants at increased risk for colorectal cancer. Materials and Methods: This study had institutional

  9. Efficacy of prokinetic agents in improving bowel preparation for colonoscopy.

    Science.gov (United States)

    Mishima, Yuko; Amano, Yuji; Okita, Koichi; Takahashi, Yoshiko; Moriyama, Nobuyuki; Ishimura, Norihisa; Furuta, Kenji; Ishihara, Shunji; Adachi, Kyoichi; Kinoshita, Yoshikazu

    2008-01-01

    Colonoscopy plays an important role in the diagnosis and treatment of gastrointestinal illness in both Western countries and Japan. However, preparative bowel cleansing for colonoscopy is frequently troublesome for elderly and/or constipated patients, since they must drink larger volumes of lavage solution for adequate cleansing. We investigated the use of prokinetic agents for improving the efficacy and tolerability of bowel cleansing prior to colonoscopy. 613 patients were divided into two groups according to oral lavage solution used (polyethylene glycol or magnesium citrate), and were further randomized to receive either vehicle (100 ml water) alone, vehicle with 5 mg mosapride citrate, or vehicle with 50 mg itopride hydrochloride 30 min before administration of lavage solution. Experimental parameters included bowel cleansing quality, times to first defecation and completion of bowel cleansing, and incidence of uncomfortable abdominal symptoms during colonoscopy preparation. Administration of mosapride citrate or itopride hydrochloride prior to oral lavage solution did not significantly improve bowel cleansing quality. However, statistically significantly fewer uncomfortable abdominal symptoms were found in patients who received mosapride citrate or itopride hydrochloride versus vehicle alone. Prokinetic agents effectively decreased the incidence of uncomfortable abdominal symptoms experienced during colonoscopy preparation. Copyright 2008 S. Karger AG, Basel.

  10. Use of preoperative bowel preparation in elective colorectal surgery in Denmark remains high

    DEFF Research Database (Denmark)

    Andersen, Julie; Thorup, Jens; Wille-Jørgensen, Peer

    2011-01-01

    Previous studies have shown that preoperative bowel preparation does not influence the frequency of postoperative complications after elective open colonic resections. The Danish Colorectal Cancer Group (DCCG) recommends that mechanical bowel preparation (MBP) should be omitted prior to elective...

  11. One-day bowel preparation in children with colostomy using normal ...

    African Journals Online (AJOL)

    Background: Colonic and colorectal surgery frequently requires bowel preparation. This is an evaluation of the use of normal saline for one-day bowel preparation in children with colostomy. Patients and Methods: A prospective study of 55 children with colostomy who had one-day bowel preparation for colonic and ...

  12. Combination could be another tool for bowel preparation?

    Science.gov (United States)

    Soh, Jae Seung; Kim, Kyung-Jo

    2016-03-14

    Optimal bowel preparation increases the cecal intubation rate and detection of neoplastic lesions while decreasing the procedural time and procedural-related complications. Although high-volume polyethylene glycol (PEG) solution is the most frequently used preparation for bowel cleansing, patients are often unwilling to take PEG solution due to its large volume, poor palatability, and high incidence of adverse events, such as abdominal bloating and nausea. Other purgatives include osmotic agents (e.g., sodium phosphate, magnesium citrate, and sodium sulfate), stimulant agents (e.g., senna, bisacodyl, and sodium picosulfate), and prokinetic agents (e.g., cisapride, mosapride, and itopride). A combination of PEG with an osmotic, stimulant, or prokinetic agent could effectively reduce the PEG solution volume and increase patients' adherence. Some such solutions have been found in several published studies to not be inferior to PEG alone in terms of bowel cleansing quality. Although combination methods showed similar efficacy and safety, the value of these studies is limited by shortcomings in study design. New effective and well-tolerated combination preparations are required, in addition to rigorous new validated studies.

  13. Laparoscopic colorectal resections with and without routine mechanical bowel preparation: A comparative study

    Directory of Open Access Journals (Sweden)

    Miu Yee Chan

    2016-08-01

    Conclusion: The omission of mechanical bowel preparation does not increase surgical morbidities in patients undergoing laparoscopic bowel resections. It also has no effect on operating time and conversion rate.

  14. Predicting inadequate bowel preparation for colonoscopy in participants receiving split-dose bowel preparation: development and validation of a prediction score

    NARCIS (Netherlands)

    Dik, V.K.; Moons, L.M.; Huyuk, M.; Schaar, P. van der; Cappel, W.H. de Vos Tot Nede; Borg, P.C. ter; Meijssen, M.A.; Ouwendijk, R.J.; Fevre, D.M. Le; Stouten, M.; Galien, O. van der; Hiemstra, T.J.; Monkelbaan, J.F.; Oijen, M.G. van; Siersema, P.D.

    2015-01-01

    BACKGROUND: Adequate bowel preparation is important for optimal colonoscopy. It is important to identify patients at risk for inadequate bowel preparation because this allows taking precautions in this specific group. OBJECTIVE: To develop a prediction score to identify patients at risk for

  15. Predicting inadequate bowel preparation for colonoscopy in participants receiving split-dose bowel preparation : Development and validation of a prediction score

    NARCIS (Netherlands)

    Dik, Vincent K.; Moons, Leon M G; Hüyük, Melek; Van Der Schaar, Peter; De Vos Tot Nederveen Cappel, Wouter H.; Ter Borg, Pieter C J; Meijssen, Maarten A C; Ouwendijk, Rob J T H; Le Fèvre, Doris M.; Stouten, Merijn; Van Der Galiën, Onno; Hiemstra, Theo J.; Monkelbaan, Jan F.; van Oijen, Martijn G. H.; Siersema, Peter D.; Tang, Thjon J.; Ter Borg, Frank; Kuipers, Ernst J.

    2015-01-01

    Background: Adequate bowel preparation is important for optimal colonoscopy. It is important to identify patients at risk for inadequate bowel preparation because this allows taking precautions in this specific group. Objective: To develop a prediction score to identify patients at risk for

  16. Impact of patient education with cartoon visual aids on the quality of bowel preparation for colonoscopy.

    Science.gov (United States)

    Tae, Jae Woong; Lee, Jong Chan; Hong, Su Jin; Han, Jae Pil; Lee, Yun Hee; Chung, Jong Ho; Yoon, Hyung Geun; Ko, Bong Min; Cho, Joo Young; Lee, Joon Seong; Lee, Moon Sung

    2012-10-01

    High-quality bowel preparation is a prerequisite for colonoscopy. Few studies have evaluated visual aids as a means of improving the quality of bowel preparation. To assess the effect of patient education by using cartoon visual aids on the quality of bowel preparation. An endoscopist-blinded, randomized, controlled trial. Tertiary referral center. Patients scheduled for screening colonoscopy in a health examination center. Patients were assigned to receive the existing verbal and written instructions (group A) or a new cartoon visual educational instruction (group B) for colonoscopy. The primary endpoint was the quality of bowel preparation, assessed by using the Boston Bowel Preparation Scale (BBPS). Secondary endpoints were the quality of bowel preparation assessed by using the Universal Preparation Assessment Scale; insertion, withdrawal, and workup times; and polyp detection rates in the 2 groups. Logistic regression analysis was performed to determine the factors associated with poor bowel preparation according to a BBPS score less than 5. Group B exhibited better bowel preparation than group A according to BBPS scores (mean BBPS score, 6.12 ± 2.19 vs 7.44 ± 1.87, P ≤ .01; median BBPS score, 6.00 ± 0.00 vs 9.00 ± 0.00, P ≤ .01; good bowel preparation for colonoscopy, BBPS score ≥5, 81.6% vs 93.1%, P = .02). Multivariate analysis revealed that older age (odds ratio 1.07, P ≤ .01) and no use of visual aids (odds ratio 3.08, P = .02) were independent factors associated with poor bowel preparation. Single-center study. Patient education with cartoons effectively improved bowel preparation for colonoscopy. Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

  17. Impact of mechanical bowel preparation in elective colorectal surgery: A meta-analysis.

    Science.gov (United States)

    Rollins, Katie E; Javanmard-Emamghissi, Hannah; Lobo, Dileep N

    2018-01-28

    To analyse the effect of mechanical bowel preparation vs no mechanical bowel preparation on outcome in patients undergoing elective colorectal surgery. Meta-analysis of randomised controlled trials and observational studies comparing adult patients receiving mechanical bowel preparation with those receiving no mechanical bowel preparation, subdivided into those receiving a single rectal enema and those who received no preparation at all prior to elective colorectal surgery. A total of 36 studies (23 randomised controlled trials and 13 observational studies) including 21568 patients undergoing elective colorectal surgery were included. When all studies were considered, mechanical bowel preparation was not associated with any significant difference in anastomotic leak rates (OR = 0.90, 95%CI: 0.74 to 1.10, P = 0.32), surgical site infection (OR = 0.99, 95%CI: 0.80 to 1.24, P = 0.96), intra-abdominal collection (OR = 0.86, 95%CI: 0.63 to 1.17, P = 0.34), mortality (OR = 0.85, 95%CI: 0.57 to 1.27, P = 0.43), reoperation (OR = 0.91, 95%CI: 0.75 to 1.12, P = 0.38) or hospital length of stay (overall mean difference 0.11 d, 95%CI: -0.51 to 0.73, P = 0.72), when compared with no mechanical bowel preparation, nor when evidence from just randomized controlled trials was analysed. A sub-analysis of mechanical bowel preparation vs absolutely no preparation or a single rectal enema similarly revealed no differences in clinical outcome measures. In the most comprehensive meta-analysis of mechanical bowel preparation in elective colorectal surgery to date, this study has suggested that the use of mechanical bowel preparation does not affect the incidence of postoperative complications when compared with no preparation. Hence, mechanical bowel preparation should not be administered routinely prior to elective colorectal surgery.

  18. Predicting inadequate bowel preparation for colonoscopy in participants receiving split-dose bowel preparation: development and validation of a prediction score.

    Science.gov (United States)

    Dik, Vincent K; Moons, Leon M G; Hüyük, Melek; van der Schaar, Peter; de Vos Tot Nederveen Cappel, Wouter H; Ter Borg, Pieter C J; Meijssen, Maarten A C; Ouwendijk, Rob J T H; Le Fèvre, Doris M; Stouten, Merijn; van der Galiën, Onno; Hiemstra, Theo J; Monkelbaan, Jan F; van Oijen, Martijn G H; Siersema, Peter D

    2015-03-01

    Adequate bowel preparation is important for optimal colonoscopy. It is important to identify patients at risk for inadequate bowel preparation because this allows taking precautions in this specific group. To develop a prediction score to identify patients at risk for inadequate bowel preparation who may benefit from an intensified bowel cleansing regimen. Patient and colonoscopy data were prospectively collected, whereas clinical data were retrospectively collected for a total of 1996 colonoscopies in participants who received split-dose bowel preparation. Multivariate logistic regression analyses were conducted in a random two-thirds of the cohort to develop a prediction model. Validation and evaluation of the discriminative power of the prediction model were performed within the remaining one-third of the cohort. Four centers, including one academic and three medium-to-large size nonacademic centers. Consecutive colonoscopies in November and December 2012. Mean age was 57.3 ± 15.9 years, 45.8% were male and indications for colonoscopy were screening and/or surveillance (27%), abdominal symptoms and/or blood loss and/or anemia (60%), inflammatory bowel disease (9%), and others (4%). Colonoscopy. Inadequate bowel preparation defined as Boston Bowel Preparation Scale score development cohort, of which 172 (12.9%) had an inadequate bowel preparation. Independent factors included in the prediction model were American Society of Anesthesiologists Physical Status Classification System score ≥3, use of tricyclic antidepressants, use of opioids, diabetes, chronic constipation, history of abdominal and/or pelvic surgery, history of inadequate bowel preparation, and current hospitalization. The discriminative ability of the scale was good, with an area under the curve of 0.77 in the validation cohort. Study design partially retrospective, no data on patient compliance. We developed a validated, easy-to-use prediction scale that can be used to identify subjects with

  19. Validation of a New Bowel Preparation Scale for Measuring Colon Cleansing for Colonoscopy: The Chicago Bowel Preparation Scale

    Science.gov (United States)

    Gerard, David P; Foster, Diane B; Raiser, Manfred W; Holden, John L; Karrison, Theodore G

    2013-01-01

    Objectives: Current bowel preparation scales (BPSs) have significant limitations including an inability to distinguish among bowel preparations that adequately cleanse a high percentage of colons. We assessed the reliability and validity of the new Chicago BPS and compared it with existing BPSs. Methods: We performed a prospective evaluation of the cleanliness of 150 colons. Inter-rater agreement was assessed using kappa and Pearson correlation coefficients. Each colon was rated by a gastroenterologist and physician's assistant using the Ottawa BPS, the Boston BPS, a dichotomous (adequate/inadequate) BPS (where adequate was defined as being able to visualize at least 95% of the mucosa), and the Chicago BPS. Results: Pearson correlation coefficients between the gastroenterologists and physician's assistant for total BPS scores were 0.79 (95% confidence interval (CI): 0.73, 0.85), 0.79 (95% CI: 0.72, 0.84), and 0.84 (95% CI: 0.79, 0.88) for the Ottawa, Boston, and Chicago BPSs, respectively. Kappa coefficients for right, middle, and distal colon segment ratings were 0.66, 0.53, and 0.49, respectively, for the Ottawa BPS; 0.64, 0.66, and 0.54, respectively, for the Boston BPS; and 0.70, 0.62, and 0.63, respectively, for the Chicago BPS. Differences between the Chicago BPS and the other BPSs were not statistically significant. The Chicago BPS exhibited the best correspondence between BPS total score and the adequate/inadequate BPS. Conclusions: This study demonstrated the validity and reliability of the Chicago BPS. The better defined grading criteria, better designed numerical ratings scale, and better correspondence between Chicago BPS total score and the adequate/inadequate BPS make the Chicago BPS an attractive alternative to the Ottawa BPS and the Boston BPS. PMID:24304940

  20. Cost Effectiveness of Screening Colonoscopy Depends on Adequate Bowel Preparation Rates - A Modeling Study.

    Directory of Open Access Journals (Sweden)

    James Kingsley

    Full Text Available Inadequate bowel preparation during screening colonoscopy necessitates repeating colonoscopy. Studies suggest inadequate bowel preparation rates of 20-60%. This increases the cost of colonoscopy for our society.The aim of this study is to determine the impact of inadequate bowel preparation rate on the cost effectiveness of colonoscopy compared to other screening strategies for colorectal cancer (CRC.A microsimulation model of CRC screening strategies for the general population at average risk for CRC. The strategies include fecal immunochemistry test (FIT every year, colonoscopy every ten years, sigmoidoscopy every five years, or stool DNA test every 3 years. The screening could be performed at private practice offices, outpatient hospitals, and ambulatory surgical centers.At the current assumed inadequate bowel preparation rate of 25%, the cost of colonoscopy as a screening strategy is above society's willingness to pay (<$50,000/QALY. Threshold analysis demonstrated that an inadequate bowel preparation rate of 13% or less is necessary before colonoscopy is considered more cost effective than FIT. At inadequate bowel preparation rates of 25%, colonoscopy is still more cost effective compared to sigmoidoscopy and stool DNA test. Sensitivity analysis of all inputs adjusted by ±10% showed incremental cost effectiveness ratio values were influenced most by the specificity, adherence, and sensitivity of FIT and colonoscopy.Screening colonoscopy is not a cost effective strategy when compared with fecal immunochemical test, as long as the inadequate bowel preparation rate is greater than 13%.

  1. Is bowel preparation before excretory urography necessary? A prospective, randomized, controlled trial.

    Science.gov (United States)

    Guo, Hongfeng; Huang, Yong; Xi, Zhijun; Song, Yi; Guo, Yinglu; Na, Yanqun

    2006-02-01

    A prospective, randomized, single blind, controlled trial was performed to determine whether routine bowel preparations are necessary for satisfactory visualization of the urinary system during IVP and compare the side effects of several bowel preparation methods. A total of 200 patients between 17 and 70 years old at the outpatient department who were prescribed IVP were enrolled in this prospective study. Patients were divided into 4 groups and randomly received liquid supper, senna, magnesium sulfate solution and PEG-ELS as bowel preparation before IVP. Control and contrast images were assessed by a radiologist and a urologist blinded to the bowel preparation. IVP was given a visualization score, a fecal residue score, a bowel gas score and an overall quality score. Images were also divided into anatomical sections to assess visualization, and the effect of fecal residue and bowel gas. Questionnaires were prepared about the side effects of bowel preparation. For contrast images there was no significant difference in terms of visualization,, fecal residue, bowel gas and overall quality scores among the 4 groups. The same result was seen on the control image except for fecal residue scores, when the senna and PEG-ELS groups had a lower fecal residue score than the liquid supper group (p = 0.001). Interestingly when considering sectional images, the right renal region of the control image showed that the senna and PEG-ELS groups had better visualization scores with less bowel gas and fecal residue than the liquid supper only group. Patients in all 3 laxative bowel preparation groups except the liquid supper group reported side effects. There was no statistically significant difference among these 3 groups in the attitude toward ingesting laxatives again. Our results suggest that routine bowel preparation prior to IVP does not improve the visibility or overall quality of control or contrast images, while patients experience certain side effects due to the bowel

  2. Bowel preparation for pediatric colonoscopy: report of the NASPGHAN endoscopy and procedures committee.

    Science.gov (United States)

    Pall, Harpreet; Zacur, George M; Kramer, Robert E; Lirio, Richard A; Manfredi, Michael; Shah, Manoj; Stephen, Thomas C; Tucker, Neil; Gibbons, Troy E; Sahn, Benjamin; McOmber, Mark; Friedlander, Joel; Quiros, J A; Fishman, Douglas S; Mamula, Petar

    2014-09-01

    Pediatric bowel preparation protocols used before colonoscopy vary greatly, with no identified standard practice. The present clinical report reviews the evidence for several bowel preparations in children and reports on their use among North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition members. Publications in the pediatric literature for bowel preparation regimens are described, including mechanisms of action, efficacy and ease of use, and pediatric studies. A survey distributed to pediatric gastroenterology programs across the country reviews present national practice, and cleanout recommendations are provided. Finally, further areas for research are identified.

  3. Improving the Quality of Colonoscopy Bowel Preparation Using an Educational Video

    Directory of Open Access Journals (Sweden)

    Sateesh R Prakash

    2013-01-01

    Full Text Available Colonoscopy is the preferred modality for colon cancer screening. A successful colonoscopy requires proper bowel preparation. Adequate bowel preparation continues to remain a limiting factor. One hundred thirty-three patients scheduled for an outpatient colonoscopy were prospectively randomized in a single-blinded manner to video or nonvideo group. In addition to written bowel preparation instructions, patients in the video group viewed a brief instructional video. Quality of colon preparation was measured using the Ottawa Bowel Preparation Quality scale, while patient satisfaction with preparation was evaluated using a questionnaire. Statistical analyses were used to evaluate the impact of the instructional colonoscopy video. There were significant differences in the quality of colonoscopy preparation between the video and the nonvideo groups. Participants who watched the video had better preparation scores in the right colon (P = 0.0029, mid-colon (P = 0.0027, rectosigmoid (P = 0.0008, fluid content (P = 0.03 and aggregate score (median score 4 versus 5; P = 0.0002. There was no difference between the two groups with regard to patient satisfaction. Income, education level, sex, age and family history of colon cancer had no impact on quality of colonoscopy preparation or patient satisfaction. The addition of an instructional bowel preparation video significantly improved the quality of colon preparation.

  4. Impact of bowel preparation type on the quality of colonoscopy: a multicenter community-based study

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    Daniel Martin

    2016-04-01

    Full Text Available Background: High-quality bowel preparation is crucial for achieving the goals of colonoscopy. However, choosing a bowel preparation in clinical practice can be challenging because of the many formulations. This study aims to assess the impact the type of bowel preparation on the quality of colonoscopy in a community hospital setting. Methods: A retrospective, observational study was conducted utilizing a colonoscopy screening/surveillance database in central Illinois during the period of January 1, 2010, to March 31, 2014. Patients without bowel preparation assessment were excluded from this study. Controlling for the confounders, generalized linear models were used to estimate the adjusted impact [odds ratio (OR] of bowel preparation type on the quality of preparation (excellent, good, fair, and poor, and on the detection of advanced adenoma. The association between the time of withdrawal after insertion and the quality of preparation was also examined using a linear model. Results: A total of 28,368 colonoscopies; half the patients were male, and the average age was 61±9 years. Polyethylene glycol (PEG was used in the majority (70.2% of bowel preparations, followed by sodium sulfate (21.4%, sodium phosphate (2.5%, magnesium sulfate (0.4%, and others. Compared with PEG, magnesium sulfate had a poorer quality of bowel preparations (OR=0.6, 95% CI 0.4–0.9; p<0.05, whereas the quality of bowel preparation was significantly improved by using sodium sulfate (OR=5.7, 95% CI 5.4–6.1; p<0.001 and sodium phosphate (OR=2.1, 95% CI 1.8–2.5; p<0.001. For those who had adequate bowel preparation, the better quality of preparation significantly increased the detection rate of advanced adenoma (5.0, 3.6, and 2.9% for excellent, good, and fair, respectively. Conclusion: When possible, sodium sulfate–based preparations should be recommended in the community setting for colonoscopy because of their high quality of bowel preparation.

  5. Impact of Educational Cartoon on Pediatric Bowel Preparation Quality at Time of Colonoscopy

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    Elizabeth Maxwell MD

    2014-08-01

    Full Text Available Objective: To evaluate if addition of educational cartoon to pediatric bowel preparation instructions improves the quality of bowel preparation and patient experience. Methods: Patients were randomized to control group receiving standard bowel preparation instructions or intervention group receiving additional educational cartoon. To objectively rate bowel preparation, a blinded endoscopist completed numeric Ottawa score (0-14, with 0 being best. The family also completed a questionnaire rating the bowel preparation process. Results: Data from 23 patients were analyzed. Mean Ottawa score in the intervention group compared with controls was not significantly different (mean scores 3.73 and 3.33, respectively; P = .384. Level of education was significantly correlated with better Ottawa score in the overall population (ρ = −.462, P = .026 and within the control group (ρ = −.658, P = .02. Both groups of patients reported positive experience with bowel preparation. Conclusion: There may be benefit to further investigation of this educational cartoon in parents with less than college level education or non-English-speaking families in larger population of patients.

  6. An Automated Inpatient Split-dose Bowel Preparation System Improves Colonoscopy Quality and Reduces Repeat Procedures.

    Science.gov (United States)

    Yadlapati, Rena; Johnston, Elyse R; Gluskin, Adam B; Gregory, Dyanna L; Cyrus, Rachel; Werth, Lindsay; Ciolino, Jody D; Grande, David P; Keswani, Rajesh N

    2017-07-19

    Inpatient colonoscopy preparations are often inadequate, compromising patient safety and procedure quality, while resulting in greater hospital costs. The aims of this study were to: (1) design and implement an electronic inpatient split-dose bowel preparation order set; (2) assess the intervention's impact upon preparation adequacy, repeated colonoscopies, hospital days, and costs. We conducted a single center prospective pragmatic quasiexperimental study of hospitalized adults undergoing colonoscopy. The experimental intervention was designed using DMAIC (define, measure, analyze, improve, and control) methodology. Prospective data collected over 12 months were compared with data from a historical preintervention cohort. The primary outcome was bowel preparation quality and secondary outcomes included number of repeated procedures, hospital days, and costs. On the basis of a Delphi method and DMAIC process, we created an electronic inpatient bowel preparation order set inclusive of a split-dose bowel preparation algorithm, automated orders for rescue medications, and nursing bowel preparation checks. The analysis data set included 969 patients, 445 (46%) in the postintervention group. The adequacy of bowel preparation significantly increased following intervention (86% vs. 43%; P<0.01) and proportion of repeated procedures decreased (2.0% vs. 4.6%; P=0.03). Mean hospital days from bowel preparation initiation to discharge decreased from 8.0 to 6.9 days (P=0.02). The intervention resulted in an estimated 1-year cost-savings of $46,076 based on a reduction in excess hospital days associated with repeated and delayed procedures. Our interdisciplinary initiative targeting inpatient colonoscopy preparations significantly improved quality and reduced repeat procedures, and hospital days. Other institutions should consider utilizing this framework to improve inpatient colonoscopy value.

  7. Bowel preparation for excretory urography is not necessary: a randomized trial.

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    Jansson, M; Geijer, H; Andersson, T

    2007-08-01

    Despite the fact that computed tomography is becoming more commonly used to investigate the genitourinary tract, intravenous urography still plays an important role in uroradiology. The aim of this study was to compare bowel purgation and two other preparation methods - dietary restrictions and no preparations at all - in an attempt to find the optimal procedure for uniform practice. 210 consecutive patients were randomised to three preparation groups with 70 in each group. Group 1 received standard bowel purgation, Group 2 was instructed to fast, while Group 3 had no preparation at all. Irrespective of preparation, all patients underwent the same examination procedure. The examining radiographer and evaluating radiologists were unaware of the type of preparation given. Image quality was assessed according to European Commission criteria for excretory urography. The effectiveness of bowel purgation and the amount of residual gas were scored separately. There was no statistically significant difference in the proportions with fulfilled criteria between preparation Groups 1 and 2 and Groups 1 and 3. A criterion was regarded as fulfilled only when all three observers agreed. Assessment of the amount of residual faeces proved the effectiveness of our standard bowel purgation. The results of our study show equality of the evaluated preparation methods and cannot justify further use of bowel purgation before excretory urography.

  8. Retrospective analysis of large bowel obstruction or perforation caused by oral preparation for colonoscopy.

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    Yamauchi, Akihiro; Kudo, Shin-Ei; Mori, Yuichi; Miyachi, Hideyuki; Misawa, Masashi; Kamo, Hatsumi; Hisayuki, Tomokazu; Kudo, Toyoki; Hayashi, Takemasa; Wakamura, Kunihiko; Katagiri, Atsushi; Baba, Toshiyuki; Hidaka, Eiji; Ishida, Fumio

    2017-06-01

     Patients undergoing bowel preparation for colonoscopy are at risk of potentially severe adverse events such as large-bowel obstruction (LBO) and perforation. These patients usually need emergency surgery and the consequences may be fatal. Little is known about the risk factors for LBO and perforation in these circumstances. We sought to establish the natural history of LBO and perforation caused by oral preparation for colonoscopy.  We retrospectively analyzed data from 20 patients with LBO or perforation associated with oral preparation for colonoscopy. All patients were treated at the Showa University Northern Yokohama Hospital (SUNYH) between April 2001 and December 2015. Drugs used for bowel preparation, age, sex, indication for colonoscopy, pathogenesis and treatment were recorded.  Eighteen of the patients had LBO and 2 had perforation. Fourteen events occurred at SUNYH, which accounted for 0.016 % of patients who underwent bowel preparation during this period. Seventeen patients were symptomatic when the decision to undertake colonoscopy was made (including 7 who complained of constipation and 4 who complained of abdominal pain; 3e were asymptomatic). Nineteen patients ultimately required surgery, 13 within 3 days of presentation. Eleven patients ultimately required colostomy. There was no perioperative mortality in our cases.  Large bowel obstruction and perforation are rare events associated with oral preparation for colonoscopy, but frequently require surgery. Exacerbation of constipation might be a risk factor for LBO or perforation. Potentially catastrophic situations can be avoided by early detection and treatment.

  9. Importance of reporting segmental bowel preparation scores during colonoscopy in clinical practice.

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    Jain, Deepanshu; Momeni, Mojdeh; Krishnaiah, Mahesh; Anand, Sury; Singhal, Shashideep

    2015-04-07

    To evaluate the impact of reporting bowel preparation using Boston Bowel Preparation Scale (BBPS) in clinical practice. The study was a prospective observational cohort study which enrolled subjects reporting for screening colonoscopy. All subjects received a gallon of polyethylene glycol as bowel preparation regimen. After colonoscopy the endoscopists determined quality of bowel preparation using BBPS. Segmental scores were combined to calculate composite BBPS. Site and size of the polyps detected was recorded. Pathology reports were reviewed to determine advanced adenoma detection rates (AADR). Segmental AADR's were calculated and categorized based on the segmental BBPS to determine the differential impact of bowel prep on AADR. Three hundred and sixty subjects were enrolled in the study with a mean age of 59.2 years, 36.3% males and 63.8% females. Four subjects with incomplete colonoscopy due BBPS of 0 in any segment were excluded. Based on composite BBPS subjects were divided into 3 groups; Group-0 (poor bowel prep, BBPS 0-3) n = 26 (7.3%), Group-1 (Suboptimal bowel prep, BBPS 4-6) n = 121 (34%) and Group-2 (Adequate bowel prep, BBPS 7-9) n = 209 (58.7%). AADR showed a linear trend through Group-1 to 3; with an AADR of 3.8%, 14.8% and 16.7% respectively. Also seen was a linear increasing trend in segmental AADR with improvement in segmental BBPS. There was statistical significant difference between AADR among Group 0 and 2 (3.8% vs 16.7%, P Segmental AADRs correlate with segmental BBPS. It is thus valuable to report segmental BBPS in colonoscopy reports in clinical practice.

  10. Enhanced education for bowel preparation before colonoscopy: A state-of-the-art review.

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    Liu, Zhu; Zhang, Ming Ming; Li, Yue Yue; Li, Li Xiang; Li, Yan Qing

    2017-02-01

    Colonoscopy remains the mainstay in diagnosing and monitoring colorectal cancer and other colorectal lesions. The diagnostic efficiency of colonoscopy greatly depends on the quality of bowel preparation, which is closely associated with the patient's compliance with the preparation instructions. In addition, the procedural requirements of bowel preparation are often complex and difficult for patients to comprehend and memorize, especially those with lower health literacy and motivation. Therefore, in recent years, many educational methods have been developed, such as educational booklets, cartoon visual aids, educational videos, short message service, telephone, social media and smart phone applications. These educational methods have significantly improved compliance with the instructions for bowel preparation and ultimately promoted the visualization of the colon in patients undergoing colonoscopy. © 2017 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.

  11. Effect of Physician-Delivered Patient Education on the Quality of Bowel Preparation for Screening Colonoscopy

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    Tze-Yu Shieh

    2013-01-01

    Full Text Available Background. Inadequate bowel preparation is common in outpatients undergoing screening colonoscopy because of unawareness and poor adherence to instruction. Methods. Herein, 105 consecutive outpatients referred for screening colonoscopy were enrolled in this prospective, colonoscopist-blinded study. The patients were assigned to an intensive-education group, with 10 minutes of physician-delivered education, or to standard care. At the time of colonoscopy, the quality of bowel preparation was assessed using the Boston Bowel Preparation Scale (BBPS. The primary outcome was a BBPS score ≥5. The secondary outcomes were the mean BBPS score, insertion time, adenoma detection rate, and number of adenomas detected. Results. We analyzed 39 patients who received intensive education and 60 controls. The percentage of adequate bowel preparations with a BBPS score ≥5 was higher in the intensive-education group than in the control group (97.4% versus 80.0%; P=0.01. The adjusted odds ratio for having a BBPS score ≥5 in the intensive-education group was 10.2 (95% confidence interval = 1.23–84.3; P=0.03. Other secondary outcomes were similar in the 2 groups. Conclusions. Physician-delivered education consisting of a brief counseling session in addition to written instructions improves the quality of bowel preparation in outpatients undergoing screening colonoscopy.

  12. Delivery of Instructions via Mobile Social Media App Increases Quality of Bowel Preparation.

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    Kang, Xiaoyu; Zhao, Lina; Leung, Felix; Luo, Hui; Wang, Limei; Wu, Ji; Guo, Xiaoyang; Wang, Xiangping; Zhang, Linhui; Hui, Na; Tao, Qin; Jia, Hui; Liu, Zhiguo; Chen, Zhangqin; Liu, Junjun; Wu, Kaichun; Fan, Daiming; Pan, Yanglin; Guo, Xuegang

    2016-03-01

    Bowel preparation is closely linked to the quality of colonoscopy. We investigated whether delivery of instructions via a social media app increases the quality of colonoscopy by improving adequacy of bowel preparation. We performed a prospective study at 3 endoscopic centers in China of 770 colonoscopy outpatients (18-80 years old) with convenient access to Wechat (a widely used mobile social media app) from May through November 2014. Patients were randomly assigned to groups that received standard education along with delivery of interactive information via Wechat (n = 387) or standard education (controls, n = 383). The primary outcome was proportion of patients with adequate bowel preparation (Ottawa score higher proportion of patients in the group that received social media instruction had adequate bowel preparation than the control group (82.2% vs 69.5%, P social media instruction had lower mean total and segmental Ottawa scores (P higher proportion of patients receiving social media instruction also had cecal intubation (97.2% vs 93.2% in controls, P = .014) and were found to have adenomas (18.6% vs 12.0% in controls, P = .012). Instruction via a mobile social media app, in conjunction with regular instruction, increases subjective measures of adequacy of bowel preparation. Use of the app significantly increased the proportion of patients with successful cecal intubation and in whom adenomas were detected, indicating increased quality of colonoscopy. ClinicalTrials.gov number: NCT02140827. Copyright © 2016 AGA Institute. Published by Elsevier Inc. All rights reserved.

  13. Assessing bowel preparation quality using the mean number of adenomas per colonoscopy.

    Science.gov (United States)

    Hillyer, Grace Clarke; Lebwohl, Benjamin; Rosenberg, Richard M; Neugut, Alfred I; Wolf, Randi; Basch, Corey H; Mata, Jennie; Hernandez, Edwin; Corley, Douglas A; Shea, Steven; Basch, Charles E

    2014-11-01

    The quality of the bowel preparation directly influences colonoscopy effectiveness. Quality indicators are widely employed to monitor operator performance and to gauge colonoscopy effectiveness. Some have suggested that the enumeration of the mean number of adenomas per colonoscopy (MNA) may be a more useful measure of bowel preparation quality, but evidence of the utility of this metric is limited. The relationship between bowel preparation quality and MNA was assessed. Records of adult patients, aged 50-74 years, who had undergone a screening colonoscopy in a 6 month period at a hospital-based endoscopy suite in New York City were examined. Excluded were those who were symptomatic or having a colonoscopy for surveillance. Patient and procedural characteristics and clinical findings were abstracted from the endoscopy database. Bowel preparation quality was recorded as excellent, good, fair and poor. Histology and size of polyps removed were gathered from pathology reports. MNA was calculated and incident rate ratios assessing the relationship between bowel preparation quality, MNA, and covariates was calculated using Poisson regression. A total of 2422 colonoscopies were identified; 815 (33.6%) were screening colonoscopies among average risk individuals, 50-74 years; 203 (24.9%) had ≥1 adenomas; and 666 (81.7%) had excellent/good preparation quality. Overall MNA was 0.34 [standard deviation (SD) 0.68] and MNA was greater among those >60 years [incident rate ratio (IRR) 1.89, 95% confidence interval (CI) 1.48-2.42), males (IRR 1.60, 95%CI 1.26-2.04) and those with good bowel preparation (IRR 2.54, 95%CI 1.04-6.16). Among those with ≥1 adenomas, MNA was 1.48 (SD 1.05) for excellent and 1.00 (SD 0.00) for poor quality preparation (p = 0.55). We found that MNA is sensitive to changes in bowel preparation with higher MNA among those with good bowel preparation compared with those with poor preparation. Our evidence suggests MNA was particularly sensitive when

  14. Bowel cleansing for colonoscopy: prospective randomized assessment of efficacy and of induced mucosal abnormality with three preparation agents.

    Science.gov (United States)

    Lawrance, I C; Willert, R P; Murray, K

    2011-05-01

    Bowel-cleansing studies are frequently underpowered, poorly designed, and use subjective bowel cleansing assessments. Consensus on efficacy, tolerability, and preparation-induced mucosal abnormalities is lacking. This study aimed to clarify the differences in efficacy and preparation-induced mucosal inflammation of sodium phosphate (NaP), colonLYTLEY (PEG), and Picoprep (Pico). This was a prospective randomized single-blinded trial of ambulatory patients to assess the efficacy of bowel preparation and preparation-induced mucosal inflammation. Proceduralists who were blinded to the preparation taken, assessed both bowel cleansing by using the Ottawa bowel preparation assessment tool and preparation-induced mucosal inflammation. Of the 634 patients, 98 % ingested more than 75 % of the bowel preparation and data were complete for colonic preparation scoring in 99 %. The preparation used, time of procedure, and patient sex all independently impacted on bowel cleansing. NaP was less efficacious than PEG ( P morning procedures whereas all bowel preparations were equally efficacious for afternoon procedures. Preparation-induced mucosal inflammation was 10-fold greater with NaP ( P = 0.03) and Pico ( P = 0.03) compared with PEG. This is the largest published prospective randomized blinded study on this topic and the first to evaluate the three major classes of preparation with a validated tool. The bowel preparation used, time of procedure, and patient sex all independently impacted on bowel cleansing. NaP gave the worst preparation for morning procedures whereas all preparations were equally effective for afternoon procedures. NaP and Pico induced mucosal inflammation 10-fold more frequently than PEG, a finding that requires further investigation. © Georg Thieme Verlag KG Stuttgart · New York.

  15. One-day bowel preparation in children with colostomy using normal saline

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    Emmanuel A Ameh

    2011-01-01

    Full Text Available Background: Colonic and colorectal surgery frequently requires bowel preparation. This is an evaluation of the use of normal saline for one-day bowel preparation in children with colostomy. Patients and Methods:A prospective study of 55 children with colostomy who had one-day bowel preparation for colonic and colorectal surgical procedures in a 3-year period. The information, along with clinical data was recorded on a structured proforma. Data were analysed using SPSS version 11.0. Results:There were 33 boys and 22 girls. The median age was 4 years (range, one month - 13 years. The primary diagnosis were as follows: Anorectal malformation, 24 (44%; Hirschsprung`s disease, 24 (44%; Faecal incontinence- post-abdominoperineal pull-through, 2 (4%; Penetrating rectal injury, 1 (2%; others, 4(8%. Intraoperative bowel luminal fluid cleanliness was assessed as clear in 36 (62% and contaminated in 21 (38%. Overall, postoperatively, superficial surgical site infection occurred in 6 (10.9% patients (2 had clean intraoperative colonic fluid, 5.9%. Conclusion:One-day bowel preparation using normal saline is effective and safe in children with colostomy.

  16. Is Mechanical Bowel Preparation Necessary for Gynecologic Surgery? A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Zhang, Jing; Xu, Liangzhi; Shi, Gang

    2015-06-09

    To clarify the efficacy and side effects of mechanical bowel preparation (MBP) before gynecologic surgery. A systematic review was conducted. Embase, PubMed, the Cochrane Central Register of Controlled Trials in the Cochrane Library and China National Knowledge Infrastructure were searched. Randomized controlled trials on MBP prior to gynecologic surgery were included. The software package Revman 5.3 was used for statistical analysis. Odds ratio (OR) and standard mean deviation were calculated for dichotomous and continuous variable, respectively. The quality of the included studies was moderate to good. MBP prior to laparoscopic gynecologic benign surgery or vaginal prolapse surgery has not been proven to be valuable for surgical performance, mainly involving visualization of the surgical field (OR 1.52, 95% confidence interval [CI] 1 to 2.32; Z = 1.95, p = 0.05), bowel handling (OR 2.21, 95% CI 0.83 to 5.84; Z = 1.59, p = 0.11), surgical complications (OR 1.3, 95% CI 0.46 to 3.67; Z = 0.5, p = 0.62) and bowel preparation. The discomfort due to oral catharsis is severer than no bowel preparation and enema, however without any difference between enema and no bowel preparation. The routine practice of MBP before gynecologic surgery needs to be reconsidered. This traditional clinical behavior has to be abandoned before benign laparoscopic surgery. Studies on the role of MBP for gynecologic laparotomy and gynecologic cancer are urgent. © 2015 S. Karger AG, Basel.

  17. MRI enterography with divided dose oral preparation: Effect on bowel distension and diagnostic quality

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    Rakesh Sinha

    2013-01-01

    Full Text Available Aim: To assess the impact of an extended oral preparation magnetic resonance (MR enterography protocol on bowel distension, timing of imaging, and the quality of diagnostic images. Materials and Methods: An analysis of 52 patients who underwent divided oral preparation and 39 patients who underwent standard preparation for MR enterography examination was done. Distension was assessed by measuring the transverse diameters of the jejunum, ileum, and the ileocecal region. Diagnostic quality of the examination was assessed subjectively by two radiologists and graded as poor, diagnostic, and excellent (Grades 1-3. Correlation between bowel diameter and diagnostic quality was assessed using regression analysis. Results: The mean diameters of the jejunum, ileum, and colon in patients who underwent divided preparation were 1.90 ± 0.47, 2.14 ± 0.41, and 4.27 ± 0.96 cm, respectively, and the mean diameters in patients who underwent standard preparation were 1.46 ± 0.47, 2.02 ± 0.47, and 4.45 ± 0.90 cm, respectively. A total of 96.6% of patients on divided dose had diagnostic distension of the bowel (Grades 2 and 3. A total of 87.9% of the patients on standard dose had diagnostic distension of the bowel (Grades 2 and 3. A greater number of patients who underwent divided preparation had diagnostic quality examinations compared to those given standard preparation (96.6% vs. 87.9%. A greater number of patients who underwent divided preparation had Grade 3 quality examinations compared to those on standard preparation (75.5% vs. 68.5%. There was significant difference between diagnostic (Grades 2 and 3 and optimal grades (Grade 3 of the jejunal diameters in patients having divided or standard preparation (89.7% vs. 66.6%, P < 0.05; 40.8% vs. 25%, P < 0.05, respectively. Linear regression showed a positive correlation between increasing bowel diameter and diagnostic grade of the examination (ρ = 0.76. Conclusion: Using an extended oral preparation with

  18. Constipation, fiber intake and non-compliance contribute to inadequate colonoscopy bowel preparation: a prospective cohort study.

    Science.gov (United States)

    Fang, Jun; Fu, Hong Yu; Ma, Dan; Wang, Dong; Liu, Ya Ping; Wang, Yun Feng; Zhu, Chun Ping; Qian, Wei; Bai, Yu; Li, Zhao Shen

    2016-07-01

    Adequate bowel preparation is important for colonoscopy. Currently available evidence on the determinants of poor bowel preparation is largely derived from studies in Western countries. We aimed to identify the risk factors for inadequate bowel preparation for colonoscopy in the Chinese population. In this single-center study, patients admitted to the Outpatient Department between March 2013 and December 2015 and had indications for colonoscopy were prospectively enrolled. Questionnaires were administered to the patients. Their characteristics and procedure-related parameters such as procedure time were recorded. Bowel preparation was assessed using Boston bowel preparation scale score. A total of 409 patients with a mean age of 48.8 ± 12.9 years were enrolled in the study, 60.9% of whom were men. On univariate analysis, poor educational level (P = 0.020), chronic constipation (P = 0.001), taking no physical exercise after medication (P risk factors for inadequate bowel preparation. Chronic constipation, poor compliance with treatment and high-fiber diet were predictors of poor bowel preparation. Patients with these risk factors require more effective strategies for bowel preparation. © 2016 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.

  19. Low-Fiber Diet in Limited Bowel Preparation for CT Colonography: Influence on Image Quality and Patient Acceptance

    NARCIS (Netherlands)

    Liedenbaum, Marjolein H.; Denters, Maaike J.; de Vries, Ayso H.; van Ravesteijn, Vincent F.; Bipat, Shandra; Vos, Frans M.; Dekker, Evelien; Stoker, Jaap

    2010-01-01

    OBJECTIVE. The purpose of this study was to determine whether a low-fiber diet is necessary for optimal tagging-only bowel preparation for CT colonography. SUBJECTS AND METHODS. Fifty consecutively enrolled patients received an iodine bowel preparation: 25 patients used a low-fiber diet and 25 used

  20. Characteristics associated with suboptimal bowel preparation prior to colonoscopy: Results of a national survey

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    Corey H Basch

    2014-01-01

    Conclusions: This study indicates the potential value of a personalized approach to bowel preparation, which addresses the specific needs of an individual patient like chronic constipation and diabetes and those with poor literacy skills or poor fluency in English. Development and evaluation of educational interventions to address these factors warrants investment.

  1. Bowel Preparation of Outpatients for Intravenous Urography: Efficacy of Castor Oil Versus Bisacodyl

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    Huei-Chen Yang

    2005-04-01

    Full Text Available The purpose of this study was to compare the efficacy of two laxatives, castor oil and bisacodyl, in the routine bowel preparation of outpatients for intravenous urography (IVU. We used castor oil in patients undergoing IVU for 1 month, and then used bisacodyl in patients undergoing IVU for another month. Two uroradiologists, unaware of the method of bowel preparation, reviewed the standard radiographs and graded the residue in the large bowel and the clearness of the opacified urinary collecting system. In total, 71 consecutive outpatients received castor oil, and 84 received bisacodyl. For the castor oil group, grades from the two uroradiologists did not differ in terms of fecal residue on plain abdominal images (p = 0.54, and visualization of the urinary system on the left (p = 0.36 and right sides (p = 0.63. Findings were similar for bisacodyl recipients (p = 0.11, 0.59, and 0.32, respectively. When the laxative effect of the two agents was compared, we found no difference in the grading of fecal residue on plain abdominal images (p = 0.14, or in visualization of the urinary system on the left (p = 0.31 and right sides (p = 0.98. In conclusion, we observed no difference in laxative efficacy between castor oil and bisacodyl; thus, bisacodyl may be a useful alternative for bowel preparation before IVU.

  2. SAFETY OF MANNITOL USE IN BOWEL PREPARATION: a prospective assessment of intestinal methane (CH4) levels during colonoscopy after mannitol and sodium phosphate (NaP) bowel cleansing.

    Science.gov (United States)

    Paulo, Gustavo Andrade de; Martins, Fernanda Prata Borges; Macedo, Erika Pereira de; Gonçalves, Manoel Ernesto Peçanha; Ferrari, Angelo Paulo

    2016-01-01

    - Adequate bowel preparation is critical for the quality of colonoscopy. Despite reported occurrence of colonic explosion due to methane and hydrogen production by bacterial fermentation during colonoscopy, gas exchange during the procedure is believed to be effective in lowering existing methane concentration, allowing for safe utilization of mannitol for bowel preparation. Thus, mannitol is widely used for bowel cleansing prior to colonoscopy, considering its low cost and effectiveness for bowel preparation. - The aim of this study was to assess the safety of mannitol for bowel preparation, when compared to sodium phosphate (NaP). - We conducted a prospective observational study in which 250 patients undergoing colonoscopy at Universidade Federal de São Paulo and Hospital Albert Einstein (São Paulo, Brazil) were approached for inclusion in the study. Patients received either mannitol (n=50) or NaP (n=200) for bowel preparation, based on physician indication. Study was conducted from August 2009 to December 2009. The main outcome of interest was presence of detectable levels of methane (CH4) during colonoscopy and reduction in such levels after gas exchange during the procedure. Methane concentrations were measured in three intestinal segments during scope introduction and withdrawal. Safety was assessed as the absence of high levels of methane, defined as 5%. Measurements were made using a multi-gas monitor (X-am 7000, Dräger Safety AG & Co. KGaA, Lübeck, Germany) connected to a plastic catheter introduced into the working channel of the colonoscope. Additional outcomes of interest included levels of O2. Methane and O2 levels are reported as ppm. Mean, difference and standard deviation of levels of gas measured in both moments were calculated and compared in both groups. Proportions of patients with detectable or high levels of methane in both groups were compared. Continuous variables were analyzed using t test and categorical variables using qui

  3. Comparison of the Effect of the Routine Bowel Preparation and Use of Oral Sodium Phosphate on Acceptance and Bowel Cleansing in Patients Undergoing Colonoscopy: A Randomize Clinical Trial

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    Ghanbari A.

    2010-06-01

    Full Text Available Background and Objectives: Treatment team perform a variety of practices in the fields of treatment and caring. The main domain of nursing practice is to prepare patients for diagnostic tests. Colonoscopy is a method of endoscopy of lower gastrointestinal system which needs proper colon preparation that allows proper assessment, diagnosis and positive treatment. Currently, there are different methods of bowel preparation. Therefore more research by a clinical nurse on this can result in better care. This study was aimed at comparing the routine method (caster oil and bisacodyl tablet and oral sodium phosphate on the level of patients’ acceptance and bowel cleansing in patients undergoing colonoscopy.Methods: The study was a one-blind controlled randomized clinical trial done on 90 outpatient candidates for colonoscopy referring to Razi Training Center in Rasht city. Samples were randomly chosen on the visit day and divided to 2 groups of experiment and control. Data collection instrument included a demographic questionnaire and checklist to assess the level of patients’ acceptance and bowel preparation. Primarily demographic data form for each patient was filled, and then intervention was done for two groups with 45 samples. During the process the acceptance form was filled by the researcher by asking the patient and also the check list on the residual stool score and global preparation assessment left was marked by colonoscopist and the nurse.Results: The findings indicated that patients’ acceptance (p<0.000 and the level of bowel preparation (p<0.000 was better with oral sodium phosphate. Conclusion: According to the results result oral sodium phosphate has better acceptance and is more effective on colon cleansing prior to colonoscopy when compared with routine regime (caster oil and bisacodyl tablet.Keywords: Oral Sodium Phosphate; Colonoscopy; Bowel Preparation; Colonic Diseases; Intestines; A Randomize Clinical Trial.

  4. Magnetic resonance colonography with limited bowel preparation: a comparison of three strategies.

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    Florie, Jasper; van Gelder, Rogier E; Haberkorn, Brigitte; Birnie, Erwin; Lavini, Cristina; Reitsma, Johannes B; Stoker, Jaap

    2007-04-01

    To prospectively compare three strategies of magnetic resonance colonography (MRC) with fecal tagging. Three strategies were compared: (S1) gadolinium as oral tagging agent and a gadolinium-water mixture for rectal filling (bright lumen), (S2) oral barium and water rectally, and (S3) oral barium and air rectally. In S2 and S3 (both dark lumen) gadolinium was injected intravenously. Three-dimensional (3D) T1-weighted and two-dimensional (2D) T2-weighted sequences were used. Two observers scored diagnostic confidence and image quality (contrast, homogeneity, artifacts), analyzed by chi-squared and Fisher's exact test. Patient experience and preference were determined by questionnaire (Mann-Whitney test). A total of 45 patients were included, 15 were randomly assigned per strategy. Diagnostic confidence of S1 and S3 is significantly better than for S2. S1 has the additional advantage of showing significantly better contrast between bowel wall and lumen, and showing significantly better homogeneity on both T1- and T2-weighted sequences, but with significantly more artifacts on the T1-weighted sequences. S3 showed significantly better contrast and homogeneity than S2 on the T2-weighted sequences. Bowel preparation of S1 was rated significantly better. Patient preference was comparable. Image quality was best using the bright lumen strategy or the dark lumen strategy using air for rectal filling. Although bowel preparation was rated best using the bright lumen strategy, patient preference was comparable. Copyright (c) 2007 Wiley-Liss, Inc.

  5. Commonly used bowel preparations have significant and different effects upon cell proliferation in the colon: a pilot study

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    Riley Stuart A

    2008-11-01

    Full Text Available Abstract Background Markers of crypt cell proliferation are frequently employed in studies of the impact of genetic and exogenous factors on human colonic physiology. Human studies often rely on the assessment of tissue acquired at endoscopy. Modulation of cell proliferation by bowel preparation with oral laxatives may confound the findings of such studies, but there is little data on the impact of commonly used bowel preparations on markers of cell proliferation. Methods Crypt length, crypt cellularity and crypt cell proliferation were assessed in biopsies acquired after preparation with either Klean-Prep or Picolax. Crypt cell proliferation was assessed by whole-mount mitotic figure count, and by two different immunohistochemical (IHC labelling methods (Ki-67 and pHH3. Subsequent biopsies were obtained from the same patients without bowel preparation and similarly assessed. Parameters were compared between groups using analysis of variance and paired t-tests. Results There were significant differences in labelling indices (LI between biopsies taken after Klean-prep and those taken after Picolax preparation, for both Ki67 (p = 0.019 and pHH3 (p = 0.017. A similar trend was seen for whole-mount mitotic figure counts. Suppression or elevation of proliferation parameters by bowel preparation may mask any effect due to an intervention or disease. Conclusion Commonly used bowel preparations may have significant and different effects on crypt cell proliferation. This should be taken into account when designing studies and when considering the findings of existing studies.

  6. Analysis of YouTube™ videos related to bowel preparation for colonoscopy

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    Basch, Corey Hannah; Hillyer, Grace Clarke; Reeves, Rachel; Basch, Charles E

    2014-01-01

    AIM: To examine YouTube™ videos about bowel preparation procedure to better understand the quality of this information on the Internet. METHODS: YouTube™ videos related to colonoscopy preparation were identified during the winter of 2014; only those with ≥ 5000 views were selected for analysis (n = 280). Creator of the video, length, date posted, whether the video was based upon personal experience, and theme was recorded. Bivariate analysis was conducted to examine differences between consumers vs healthcare professionals-created videos. RESULTS: Most videos were based on personal experience. Half were created by consumers and 34% were ≥ 4.5 min long. Healthcare professional videos were viewed more often (> 19400, 59.4% vs 40.8%, P = 0.037, for healthcare professional and consumer, respectively) and more often focused on the purgative type and completing the preparation. Consumer videos received more comments (> 10 comments, 62.2% vs 42.7%, P = 0.001) and more often emphasized the palatability of the purgative, disgust, and hunger during the procedure. Content of colonoscopy bowel preparation YouTube™ videos is influenced by who creates the video and may affect views on colon cancer screening. CONCLUSION: The impact of perspectives on the quality of health-related information found on the Internet requires further examination. PMID:25228945

  7. Application of 5-Aminosalicylic Acid Preparations in the Treatment of Inflammatory Bowel Diseases

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    Yu.M. Stepanov

    2016-10-01

    Full Text Available The article is devoted to the comparative characterization of different derivatives of 5-aminosalicylic acid. Researches of the past decades have changed the presentation of the potential use of aminosalicylates in the therapy of various inflammatory bowel diseases. In connection with unknown etiology of Crohn’s disease and ulcerative colitis, there is no causal treatment of these diseases. The essence of treatment is reduced to inhibition of inflammatory activity during exacerbations and a course of preventive treatment. Numerous studies over the past 20 years have shown that the basis of basic treatment for nonspecific chronic inflammatory bowel diseases is 5-aminosalicylic acid drugs, or salicylates. When choosing the dosage form, you should take into account the differences between mesalazine preparations depending on the type of the coat. It is shown that in terms of pharmacokinetics, the most effective mesalazine dosage forms for the treatment of ulcerative colitis and Crohn’s disease with lesions of the colon are enteric coated tablets that provides a pH-dependent gradual release of 5-aminosalicylic acid throughout the entire colon. 5-aminosalicylic acid drugs available today on the pharmaceutical market are able to control the course of ulcerative colitis and Crohn’s disease with lesions of the colon in the majority of patients. The use of 5-aminosalicylic acid preparations is not limited to the treatment of ulcerative colitis and Crohn’s disease. The drug is widely used in other diseases of the bowel, such as diverticular disease of the colon, colitis banal, radiation damages of the colon, as well as to treat common diseases, such as irritable bowel syndrome. The study, which was conducted in the department bowel disease of the State Institution «Institute of Gastroenterology» for 2 years, showed a positive effect of 20-day treatment with Mesacol in uncomplicated diverticular disease. The use of Mesacol at a dose of 1,600 mg

  8. Improved bowel preparation increases polyp detection and unmasks significant polyp miss rate

    Science.gov (United States)

    Papanikolaou, Ioannis S; Sioulas, Athanasios D; Magdalinos, Nektarios; Beintaris, Iosif; Lazaridis, Lazaros-Dimitrios; Polymeros, Dimitrios; Malli, Chrysoula; Dimitriadis, George D; Triantafyllou, Konstantinos

    2015-01-01

    AIM: To retrospectively compare previous-day vs split-dose preparation in terms of bowel cleanliness and polyp detection in patients referred for polypectomy. METHODS: Fifty patients underwent two colonoscopies: one diagnostic in a private clinic and a second for polypectomy in a University Hospital. The latter procedures were performed within 12 wk of the index ones. Examinations were accomplished by two experienced endoscopists, different in each facility. Twenty-seven patients underwent screening/surveillance colonoscopy, while the rest were symptomatic. Previous day bowel preparation was utilized initially and split-dose for polypectomy. Colon cleansing was evaluated using the Aronchick scale. We measured the number of detected polyps, and the polyp miss rates per-polyp. RESULTS: Excellent/good preparation was reported in 38 cases with previous-day preparation (76%) vs 46 with split-dose (92%), respectively (P = 0.03). One hundred and twenty-six polyps were detected initially and 169 subsequently (P < 0.0001); 88 vs 126 polyps were diminutive (P < 0.0001), 25 vs 29 small (P = 0.048) and 13 vs 14 equal or larger than 10 mm. The miss rates for total, diminutive, small and large polyps were 25.4%, 30.1%, 13.7% and 6.6%, respectively. Multivariate analysis revealed that split-dose preparation was significantly associated (OR, P) with increased number of polyps detected overall (0.869, P < 0.001), in the right (0.418, P = 0.008) and in the left colon (0.452, P = 0.02). CONCLUSION: Split-dose preparation improved colon cleansing, enhanced polyp detection and unmasked significant polyp miss rates. PMID:26488024

  9. Scheduling rules for patients with diabetes mellitus that facilitate split-dosing improve the quality of bowel preparation for colonoscopy.

    Science.gov (United States)

    Hilsden, Robert J; Bridges, Ronald; Dube, Catherine; Heitman, Steven J; Rostom, Alaa

    2017-01-01

    An adequate bowel preparation for colonoscopy is best achieved by giving the cleansing regimen as a split-dose with the second dose given 4-6 hours before the procedure. This can be difficult to administer to diabetics who are preferentially scheduled for early morning procedures. We examined the impact on bowel preparation quality of scheduling diabetics for mid-morning (9:30 am or later) procedures rather than early morning procedures (7:30-9:00 AM) to facilitate a split-dose preparation. Historical cohort study of 34,415 patients (1,805 diabetics) age 18-74 years without significant comorbidities who underwent an outpatient colorectal cancer screening-related colonoscopy either before (2013) or after (2014) a unit wide change in scheduling practices for diabetics. The primary outcome was the rate of inadequate bowel preparation. Secondary outcomes include the rate of procedures complete to the cecum, procedure duration and detection rates of polyps, any colorectal cancer screening-relevant lesion (adenoma, sessile serrated adenoma, large proximal hyperplastic polyp) and advanced adenomas. From 2013 to 2014, the proportion of diabetics with an inadequate bowel preparation decreased from 7.7% to 3.2% (95% confidence interval for the difference 2.2%-6.8%, P<0.00005). There was no significant change in the proportion of non-diabetics with inadequate preparation (2% in both years). There was no change in secondary outcomes in diabetics from 2013 to 2014. Preferentially scheduling diabetic patients later in the morning that more conveniently allowed for a split dose bowel preparation resulted in decreased rates of inadequate bowel preparation without disadvantaging other patients.

  10. Scheduling rules for patients with diabetes mellitus that facilitate split-dosing improve the quality of bowel preparation for colonoscopy.

    Directory of Open Access Journals (Sweden)

    Robert J Hilsden

    Full Text Available An adequate bowel preparation for colonoscopy is best achieved by giving the cleansing regimen as a split-dose with the second dose given 4-6 hours before the procedure. This can be difficult to administer to diabetics who are preferentially scheduled for early morning procedures. We examined the impact on bowel preparation quality of scheduling diabetics for mid-morning (9:30 am or later procedures rather than early morning procedures (7:30-9:00 AM to facilitate a split-dose preparation.Historical cohort study of 34,415 patients (1,805 diabetics age 18-74 years without significant comorbidities who underwent an outpatient colorectal cancer screening-related colonoscopy either before (2013 or after (2014 a unit wide change in scheduling practices for diabetics. The primary outcome was the rate of inadequate bowel preparation. Secondary outcomes include the rate of procedures complete to the cecum, procedure duration and detection rates of polyps, any colorectal cancer screening-relevant lesion (adenoma, sessile serrated adenoma, large proximal hyperplastic polyp and advanced adenomas.From 2013 to 2014, the proportion of diabetics with an inadequate bowel preparation decreased from 7.7% to 3.2% (95% confidence interval for the difference 2.2%-6.8%, P<0.00005. There was no significant change in the proportion of non-diabetics with inadequate preparation (2% in both years. There was no change in secondary outcomes in diabetics from 2013 to 2014.Preferentially scheduling diabetic patients later in the morning that more conveniently allowed for a split dose bowel preparation resulted in decreased rates of inadequate bowel preparation without disadvantaging other patients.

  11. Preoperative bowel preparation in gynecologic oncology: a review of practice patterns and an impetus to change.

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    Wells, Tiffany; Plante, Marie; McAlpine, Jessica N

    2011-08-01

    Preoperative mechanical bowel preparation (MBP) is commonly used in gynecologic oncology (GO). We wished to assess the practice patterns and beliefs within the Society of Gynecologic Oncologists of Canada (GOC), review the literature on MBP as applicable to GO surgeries, and construct recommendations specific to our subspecialty. A 23-question, 10-minute Internet survey was sent to 110 GOC members regarding their use, rationale, and understanding of the literature pertaining to MBP for GO surgeries. The historical justifications for using MBP before pelvic and abdominal surgery were identified through literature review. Half of respondents (48%) routinely order MBP despite acknowledgment in 77% that there was no good evidence to support its use. Use encompassed all cancer sites (53% ovary, 32% endometrial, 27% cervical, and 8% vulvar) and approaches (43% laparotomy and 29% laparoscopy/robotics). The most common reasons cited for ordering MBP were to decrease risk of anastomotic leak and improve visualization. In the last 5 years, use of MBP has decreased in most (77%) GOC respondents. Of all respondents, 71% felt that formal recommendations specific to the field of GO would be helpful. None of the arguments for using MBP could be justified in the literature. In contrast, common and often serious sequelae from MBP are frequently described. Admitted use of bowel preparation in other surgical specialties was even higher (53%-99%) than within the GOC. There is no literature to support the routine use of MBP in GO. Published recommendations (herein) should support and guide change in practice.

  12. Comorbid Illness, Bowel Preparation, and Logistical Constraints Are Key Reasons for Outpatient Colonoscopy Nonattendance

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    Deepti Chopra

    2016-01-01

    Full Text Available Background. Colonoscopy nonattendance is a challenge for outpatient clinics globally. Absenteeism results in a potential delay in disease diagnosis and loss of hospital resources. This study aims to determine reasons for colonoscopy nonattendance from a Canadian perspective. Design. Demographic data, reasons for nonattendance, and patient suggestions for improving compliance were elicited from 49 out of 144 eligible study participants via telephone questionnaire. The 49 nonattenders were compared to age and sex matched controls for several potential contributing factors. Results. Nonattendance rates were significantly higher in winter months; the OR of nonattendance was 5.2 (95% CI, 1.6 to 17.0, p<0.001 in winter versus other months. Being married was positively associated with attendance. There was no significant association between nonattendance and any of the other variables examined. The top 3 reasons for nonattendance were being too unwell to attend the procedure, being unable to complete bowel preparation, or experiencing logistical challenges. Conclusions. Colonoscopy attendance rates appear to vary significantly by season and it may be beneficial to book more colonoscopies in the summer or overbook in the winter. Targets for intervention include more tailored teaching sessions, reminders, taxi chits, and developing a hospital specific colonoscopy video regarding procedure and bowel preparation requirements.

  13. Anxiety is associated with impaired tolerance of colonoscopy preparation in inflammatory bowel disease and controls.

    Science.gov (United States)

    Bessissow, Talat; Van Keerberghen, Ciska-Anne; Van Oudenhove, Lukas; Ferrante, Marc; Vermeire, Séverine; Rutgeerts, Paul; Van Assche, Gert

    2013-12-01

    Pain and nausea are often reported during bowel cleansing (BC) for ileocolonoscopy (IC). We aimed to explore putative mechanisms associated with impaired tolerance to BC. A 1:1 (100 IBD and 100 controls) sex and age matched case-control study was performed. Patients completed the hospital anxiety and depression scale (HADS-A/HADS-D), visceral sensitivity index (VSI) and state-trait anxiety inventory, state scale (STAI-S), in addition to self-assessment of BC and abdominal pain and nausea ratings during BC. Endoscopists reported the Mayo score, Harvey Bradshaw index (HBI), simple endoscopic score for Crohn's disease, and Boston bowel preparation scale (BBPS). Higher VSI and depression scores were observed in IBD patients. VSI (Panxiety prior to IC (STAI-S). Significant correlations were found between VSI and STAI-S and disease activity. Higher gastrointestinal-specific anxiety and co-morbid anxiety are associated with increased pain and nausea during BC, respectively. Pain and nausea during BC were in turn associated with higher anxiety levels at the moment of IC, potentially creating a "vicious circle". Measures taken to reduce anxiety could improve BC and IC tolerance. Copyright © 2013 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

  14. The Impact of Patient Education with a Smartphone Application on the Quality of Bowel Preparation for Screening Colonoscopy.

    Science.gov (United States)

    Cho, JeongHyeon; Lee, SeungHee; Shin, Jung A; Kim, Jeong Ho; Lee, Hong Sub

    2017-09-01

    Few studies have evaluated the use of a smartphone application (app) for educating people undergoing colonoscopy and optimizing bowel preparation. Therefore, this study was designed to develop a smartphone app for people to use as a preparation guide and to evaluate the efficacy of this app when used prior to colonoscopy. In total, 142 patients (male:female=84:58, mean age=43.5±9.3 years), who were scheduled to undergo a colonoscopy at Myongji Hospital, were enrolled in this study. Seventy-one patients were asked to use a smartphone app that we had recently developed to prepare for the colonoscopy, while the 71 patients of the sex and age-matched control group were educated via written and verbal instructions. The quality of bowel cleansing, evaluated using the Boston Bowel Preparation Scale, was significantly higher in the smartphone app group than in the control group (7.70±1.1 vs. 7.24±0.8, respectively, p=0.007 by t-test). No significant differences were found between the two groups regarding work-up time and the number of patients with polyps. In this study, targeting young adults (≤50 years), the bowel preparation achieved by patients using the smartphone app showed significantly better quality than that of the control group.

  15. Randomized clinical trial comparing reduced-volume oral picosulfate and a prepackaged low-residue diet with 4-liter PEG solution for bowel preparation.

    Science.gov (United States)

    Kim, Yong Sok; Hong, Chang Won; Kim, Byung Chang; Han, Kyung Su; Park, Ji Won; Seong Choi, Hyo; Joo, Jungnam; Sohn, Dae Kyung

    2014-04-01

    Reduced-volume bowel preparation with a low-residue diet prior to colonoscopy would result in better patient compliance and sufficient bowel preparation. To compare the clinical efficacy of reduced-volume sodium picosulfate and a prepackaged low-residue diet with that of the standard bowel preparation using 4 L of PEG solution. Prospective, single center, single blind, active control, randomized study (NCCCTS-12-619, KCT0000470). Ambulatory outpatient clinic at the National Cancer Center, Republic of Korea. A total of 194 subjects were randomly assigned for this study, 97 in each group. After exclusions, 94 subjects in the Picolight group and 90 in the PEG group completed the study and were analyzed. Sodium picosulfate with a prepackaged low-residue, one-day diet or 4-L PEG for bowel preparation. Success rate of the bowel preparation, tolerability, adverse events, cecal intubation time, polyp detection rate and adenoma detection rate. The bowel preparation success rate was significantly higher (91.5% vs. 81.1%, p = 0.04) and the rates of adverse events, including abdominal distension, pain, nausea, vomiting and abdominal discomfort, were significantly lower in the picosulfate group than the PEG group. Cecal intubation times and the polyp and adenoma detection rates were similar in the 2 groups. Single center, limited population, all colonoscopies were performed in the morning. Bowel preparation with low-volume oral picosulfate and a prepackaged low-residue diet enhances colon cleansing and is better tolerated than the standard bowel preparation.

  16. Low-volume PEG plus ascorbic acid versus high-volume PEG as bowel preparation for colonoscopy

    NARCIS (Netherlands)

    Corporaal, Sietske; Kleibeuker, Jan H.; Koornstra, Jan J.

    2010-01-01

    Objective. High volumes of polyethylene glycol (PEG)-based solutions as bowel preparation for colonoscopy are effective, but often poorly tolerated. To compare a 2 l PEG-based solution combined with ascorbic acid (PEG + Asc) with 4 l PEG-based solution (PEG). Methods. In a single blind,

  17. Reducing the volume of polyethylene glycol electrolyte lavage solution to less than 2 liters for bowel preparation.

    Science.gov (United States)

    Mukai, M; Tajima, T; Suzuki, R; Yamamoto, S; Miyako, H; Hara, T; Morita, M; Makuuchi, H

    2000-04-01

    Smaller volumes of polyethylene glycol electrolyte lavage solution (PEG), an oral whole-bowel irrigation solution employed in colorectal preparation, were given to patients to decrease the discomfort associated with pretreatment. Comparison was made between groups receiving standard and modified preparations. A total of 68 patients (gastrointestinal surgery: 55; total colonoscopy: 13) were enrolled in the study. The mean volume of PEG used was significantly smaller in the modified than in the standard preparation (1,694 ml vs. 2,735 ml, p<0.01). In addition, the mean PEG administration period was significantly shorter for the modified preparation (183 min vs. 237 min, p<0.05). However, the mean PEG excretion time and the number of bowel movements were not significantly different between the two groups. There was also no significant difference between the two groups in terms of the efficacy, safety, usefulness, or tolerability of the preparations. These results suggest that it is possible to reduce the PEG volume by more than 1 L to alleviate patient discomfort without a significant loss of efficacy. The modified method is useful for preparing the large bowel for either gastrointestinal surgery or total colonoscopy.

  18. A prospective study of bowel preparation for colonoscopy with polyethylene glycol-electrolyte solution versus sodium phosphate in Lynch syndrome: a randomized trial

    NARCIS (Netherlands)

    Vugt-van Pinxteren, M.W.J. van; Kouwen, M.C.A. van; Oijen, M.G. van; Achterberg, T. van; Nagengast, F.M.

    2012-01-01

    Lynch gene carriers undergo regular surveillance colonoscopies. Polyethylene glycol-electrolyte solution (PEG) is routinely prescribed for bowel cleansing, but often poorly tolerated by patients. Sodium phosphate (NaP) may be an alternative. Prospective and random comparison of bowel preparation

  19. Validity of a Web-based educational program to disseminate a standardized bowel preparation rating scale.

    Science.gov (United States)

    Calderwood, Audrey H; Logan, Judith R; Zurfluh, Michael; Lieberman, David A; Jacobson, Brian C; Heeren, Timothy C; Schroy, Paul C

    2014-01-01

    Our goal was to assess the validity of a Web-based educational program on the Boston Bowel Preparation Scale (BBPS). Data on Web-based education for improving the practice and quality of colonoscopy are limited. Endoscopists worldwide participated in the BBPS Educational Program. We assessed program completion rates, satisfaction, short-term (0 to 90 d) and long-term (91 to 180 d) uptake of the BBPS, and the validity of the program by measuring the reliability of the BBPS among participants. A total of 207 endoscopists completed the program. Overall, 93% found the content relevant, 89% felt confident in using the BBPS, and 97% thought the quality was good or excellent. Uptake of the BBPS into clinical practice was robust with 91% and 98% of colonoscopy reports containing the BBPS at short-term and long-term follow-up, respectively. The interobserver and test-retest reliability of BBPS segment and total scores were both substantial. A BBPS Web-based educational program facilitates adoption into clinical practice and teaches the BBPS to be used reliably by a diverse group of endoscopists worldwide.

  20. Split-dose Bowel Preparation for Colonoscopy: 2 Liters Polyethylene Glycol with Ascorbic Acid versus Sodium Picosulfate versus Oral Sodium Phosphate Tablets.

    Science.gov (United States)

    Lee, Seok Won; Bang, Chang Seok; Park, Tae Young; Suk, Ki Tae; Baik, Gwang Ho; Kim, Dong Joon

    2017-08-25

    Adequate bowel preparation is an essential factor affecting the visibility of colonic mucosa and safety of related therapeutic interventions. The aim of this study was to assess the efficacy, tolerability, and safety of three bowel preparation agents -2 L polyethylene glycol with ascorbic acid (PEGA), sodium picosulfate magnesium citrate (SPMC), and oral sodium phosphate tablet (NaP)- for morning colonoscopy. Here, we analyzed the medical records of patients who had taken bowel preparation agents using the split-dose method and undergone colonoscopy in a single hospital. The efficacy of bowel preparation agents was evaluated using the Ottawa bowel preparation assessment tool. The safety and tolerability of the agents were assessed by measuring the renal function and electrolytes prior to and after the procedure as well as by assessing the self-reported questionnaire. Of the 365 patients (PEGA:163, SPMC: 93, NaP: 109), 98.6% ingested more than 90% of the agents. NaP showed an inferior cleansing efficacy, and serum phosphate elevation was significantly higher in the NaP group. However, the satisfaction score was lowest in the PEGA group. Age (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.92-0.99, p=0.04) and preparation agents (OR of PEGA versus NaP 5.0, 95% CI 2.28-10.97, p<0.001) (OR of SPMC versus NaP 2.73, 95% CI 1.22-6.08, p=0.01) were independently associated with bowel preparation success. According to our analysis, NaP showed an inferior cleansing efficacy compared with PEGA and SPMC, which may be attributed to the complex administration method and lower water intake. However, large-volume ingestion remains unsatisfactory for patients. Detailed bowel preparation instructions could enhance bowel cleansing efficacy.

  1. Efficacy of prokinetics with a split-dose of polyethylene glycol in bowel preparation for morning colonoscopy: a randomized controlled trial.

    Science.gov (United States)

    Kim, Hyoung Jun; Kim, Tae Oh; Shin, Bong Chul; Woo, Jae Gon; Seo, Eun Hee; Joo, Hee Rin; Heo, Nae-Yun; Park, Jongha; Park, Seung Ha; Yang, Sung Yeon; Moon, Young Soo; Shin, Jin-Yong; Lee, Nae Young

    2012-01-01

    Currently, a split-dose of polyethylene glycol (PEG) is the mainstay of bowel preparation due to its tolerability, bowel-cleansing action, and safety. However, bowel preparation with PEG is suboptimal because residual fluid reduces the polyp detection rate and requires a more thorough colon inspection. The aim of our study was to demonstrate the efficacy of a sufficient dose of prokinetics on bowel cleansing together with split-dose PEG. A prospective endoscopist-blinded study was conducted. Patients were randomly allocated to two groups: prokinetic with split-dose PEG or split-dose PEG alone. A prokinetic [100 mg itopride (Itomed)], was administered twice simultaneously with each split-dose of PEG. Bowel-cleansing efficacy was measured by endoscopists using the Ottawa scale and the segmental fluidity scale score. Each participant completed a bowel preparation survey. Mean scores from the Ottawa scale, segmental fluid scale, and rate of poor preparation were compared between both groups. Patients in the prokinetics with split-dose PEG group showed significantly lower total Ottawa and segmental fluid scores compared with patients in the split-dose of PEG alone group. A sufficient dose of prokinetics with a split-dose of PEG showed efficacy in bowel cleansing for morning colonoscopy, largely due to the reduction in colonic fluid. Copyright © 2012 S. Karger AG, Basel.

  2. Contrasting Perspectives of Anesthesiologists and Gastroenterologists on the Optimal Time Interval between Bowel Preparation and Endoscopic Sedation

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    Deepak Agrawal

    2015-01-01

    Full Text Available Background. The optimal time interval between the last ingestion of bowel prep and sedation for colonoscopy remains controversial, despite guidelines that sedation can be administered 2 hours after consumption of clear liquids. Objective. To determine current practice patterns among anesthesiologists and gastroenterologists regarding the optimal time interval for sedation after last ingestion of bowel prep and to understand the rationale underlying their beliefs. Design. Questionnaire survey of anesthesiologists and gastroenterologists in the USA. The questions were focused on the preferred time interval of endoscopy after a polyethylene glycol based preparation in routine cases and select conditions. Results. Responses were received from 109 anesthesiologists and 112 gastroenterologists. 96% of anesthesiologists recommended waiting longer than 2 hours until sedation, in contrast to only 26% of gastroenterologists. The main reason for waiting >2 hours was that PEG was not considered a clear liquid. Most anesthesiologists, but not gastroenterologists, waited longer in patients with history of diabetes or reflux. Conclusions. Anesthesiologists and gastroenterologists do not agree on the optimal interval for sedation after last drink of bowel prep. Most anesthesiologists prefer to wait longer than the recommended 2 hours for clear liquids. The data suggest a need for clearer guidelines on this issue.

  3. Prospective comparison of three bowel preparation regimens: fleet phosphosoda, two-liter and four-liter electrolyte lavage solutions.

    Science.gov (United States)

    Ker, Tim S

    2008-10-01

    In an attempt to improve patients' tolerance for colon cleaning, three bowel preparation regimens: 90-mL Fleet phosphosoda (FPS), 2-L electrolyte lavage solution plus 20 mg oral bisacodyl, and 4-L lavage, were compared for efficacy and safety. A total of 912 patients were prospectively nonrandomized into three study groups. In Group A, 304 patients were given 45-mL Fleet phosphosoda at 9 AM and 6 PM the day before colonoscopy. In Group B, 304 patients were given four tablets of 5 mg bisacodyl at 12 PM the day before colonoscopy followed by 2 L electrolyte lavage by mouth at 6:00 PM the evening before colonoscopy. In Group C, 304 patients were given 4 L electrolyte lavage at 6:00 PM the evening before colonoscopy. All patients were kept on a clear liquid diet the day before colonoscopy. The bowel cleanliness was accessed by one colonoscopist. One registered nurse accessed the ease of the patient. In Group A (FPS), every patient finished the 90-mL Fleet phosphosoda. Colon cleanliness was 95.1 per cent. In Group B (2 L), three patients (0.6%) could not finish the laxative. Colon cleanliness was 95.9 per cent. In Group C (4 L), 22 patients (7.3%) could not finish the laxative preparation. Colon cleanliness was 95.3 per cent. The study found these three regimens can achieve equally good results of bowel preparation; however, the small volume laxative (FPS) has been accepted favorably by patients.

  4. Comparison of claims data on hospitalization rates and repeat procedures in patients receiving a bowel preparation prior to colonoscopy.

    Science.gov (United States)

    Young, Lisa E; Sacks, Naomi C; Cyr, Philip L; Sharma, Abhishek; Dahdal, David N

    2017-01-01

    To evaluate outcomes of colorectal screening using sodium picosulfate and magnesium citrate compared with other prescription bowel-preparation agents. Primary endpoints were rates of procedure-associated hospitalizations, diagnosis at hospitalization, and rates of early repeat screenings. This retrospective cohort study identified patients using the Truven Health Analytics MarketScan databases, which contain fully adjudicated, de-identified, medical- and prescription-drug claims, as well as demographic and enrollment information for individuals with commercial, Medicaid, and Medicare supplemental insurance coverage. Patients who had a colonoscopy or sigmoidoscopy over a 3-year period were identified using International Classification of Diseases Clinical Modification procedure codes, recorded on claims from physicians and facilities. First, screening colonoscopy was identified for each patient, and the study was limited to those patients who could be observed for ≥6 months before and 3 months after the screening procedure. Total number of hospitalizations and rates of early repeat screenings were evaluated for all patients who received sodium picosulfate and magnesium citrate and compared with those who received other bowel-preparation agents. Individual prescription medications that could affect the outcome of the cleansing agent were identified; further evaluations were made to establish whether patients had comorbid conditions, such as chronic kidney disease, cardiovascular disease, or psychiatric illness. Statistical methods included descriptive statistics, two-tailed t-tests, and multivariate logistic regression. A total of 566,628 procedures were identified in the MarketScan databases and included in the study. Sodium picosulfate and magnesium citrate performed well in terms of safety outcomes, with no hospitalizations due to diagnosis of hyponatremia, dehydration, or other fluid disorders in the 10 days after procedure. Early repeat rates among

  5. 4-Liter split-dose polyethylene glycol is superior to other bowel preparations, based on systematic review and meta-analysis.

    Science.gov (United States)

    Enestvedt, Brintha K; Tofani, Christina; Laine, Loren A; Tierney, Ann; Fennerty, M Brian

    2012-11-01

    Adequate bowel cleansing is an important determinant of the efficacy of screening colonoscopy. Polyethylene glycol (PEG)-based solutions are used commonly in bowel preparation, but their poor palatability and large volumes (4 L) influence compliance. Adjunct therapies, such as bisacodyl, split-dose regimens, and lower-volume regimens have been tested. We performed a meta-analysis to determine whether a 4-L split dose of PEG is better than others for bowel cleansing before colonoscopy. We searched MEDLINE, the Cochrane Central Register of Controlled Trials and Database, recent abstracts from major conference proceedings, references from selected reviews and randomized trials (http://clinicaltrials.gov), and Google Scholar, through September 2011, for high-quality, randomized trials that compared 4-L split-dose PEG without adjunct therapy with other bowel preparation methods. Nine of 2477 trials considered were used in the analysis. We calculated pooled estimates of bowel preparation quality (primary outcome: excellent or good), preparation compliance, favorable overall experiences, willingness to repeat same preparation, and side effects. We calculated pooled estimates of odds ratios by fixed- and random-effects models. We also assessed heterogeneity among studies and publication bias. The overall pooled odds ratio for excellent or good bowel preparation quality for 4-L split-dose PEG was 3.46, compared with other methods (95% confidence interval, 2.45-4.89; P < .01). Although there was significant heterogeneity in results among studies, 7 of 9 reported a significant benefit from the 4-L split-dose PEG preparation. There were no significant differences between PEG and others in preparation compliance, favorable overall experience, willingness to repeat the same preparation, abdominal cramping, nausea, or sleep disturbance. There was no significant publication bias based on funnel plot. A meta-analysis showed that 4-L split-dose PEG is better than other bowel

  6. Optimal use of polyethylene glycol for preparation of small bowel video capsule endoscopy: a network meta-analysis.

    Science.gov (United States)

    Wu, Shan; Gao, Yun-Jie; Ge, Zhi-Zheng

    2017-06-01

    Standardized strategy of bowel preparation before video capsule endoscopy (VCE) remains controversial. This study aimed to assess the ideal dose of PEG, based on small bowel visualization quality (SBVQ), diagnostic yield (DY), and complete rate (CR) of VCE using a network meta-analysis (NMA) of randomized controlled trials (RCTs). This NMA included RCTs comparing any of the following bowel preparation interventions for VCE: fasting overnight ("Fast"), 1 liter PEG ("PEG 1L"), 2-liter PEG ("PEG 2L"), or 4-liter PEG ("PEG 4L"). The authors searched papers in PubMed, Cochrane Library, and Embase as of June 2016. The cumulative ranking (SUCRA) probabilities to rank different doses of PEG and Fast were used. The search engine provided 102 studies. Nine RCTs including 982 patients were incorporated into this analysis. All studies showed low risk of bias of blinding. SUCRA provided an initial ranking among these strategies, in which PEG 2 L showed the best score in SBVQ (PEG 2 L, 89.4%; PEG 1 L, 62.5%; PEG 4 L, 44.0%; Fast, 4.1%) and DY (PEG 2 L, 74.6%; PEG 1 L 28.1%; PEG 4 L 65.9%; Fast 31.4%) of VCE. No significant difference was shown in the analysis of CR. This study recommends PEG 2 L as the ideal dose, which may improve the SBVQ of VCE and, therefore, diagnostic accuracy. Multi-center randomized controlled trials are required to verify these findings.

  7. Can the localization of primary colonic tumors be improved by staging CT without specific bowel preparation compared to optical colonoscopy?

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    Feuerlein, Sebastian; Grimm, Lars J.; Davenport, Matthew S.; Haystead, Clare M.; Miller, Chad M.; Neville, Amy M. [Department of Radiology, Duke University Medical Center, DUMC 3808, Durham, NC 27710 (United States); Jaffe, Tracy A., E-mail: tracy.jaffe@duke.edu [Department of Radiology, Duke University Medical Center, DUMC 3808, Durham, NC 27710 (United States)

    2012-10-15

    Objectives: To investigate the ability of staging computed tomography (CT) without bowel preparation to accurately localize colonic tumors compared to optical colonoscopy. Methods: The local institutional review board approved this retrospective and HIPAA-compliant study. Forty-six patients with colonic adenocarcinoma, preoperative colonoscopy, and staging CT within 60 days of resection were included. Patients underwent contrast enhanced CT imaging without bowel preparation or oral contrast. The colon was divided into four segments with the operative reports used as the standard. Rectal and cecal cancers were excluded. CT scans were reviewed by 5 readers in a segmental binary fashion using a 5-point confidence scale in two sessions blinded and unblinded to the colonoscopy report. Results: At surgery 49 tumors were found in 46 patients. Readers detected 86.1%, 74.3%, and 66.9% of lesions with 92.0%, 94.1%, and 95.4% accuracy for confidence scores of ≥3, ≥4, and 5. CT interobserver agreement was good (κ = 0.82) for the unblinded and moderate (κ = 0.60) for the blinded read. Colonoscopic localization was only 78.7% accurate with 2 tumors undiscovered. Colonoscopic accuracy was low in the descending colon (57.1%) and the transverse colon (55.6%). Conclusions: Preoperative staging CT is more accurate than colonoscopy in the localization of colonic tumors.

  8. Effects of first-dose volume and exercise on the efficacy and tolerability of bowel preparations for colonoscopy in Chinese people

    Directory of Open Access Journals (Sweden)

    Qin Y

    2016-04-01

    Full Text Available Ying Qin, Wei Liu, Songbai Lin, Xiangfeng Li International Medical Services, Peking Union Medical College Hospital, Beijing, People’s Republic of China Aim: This study was designed to compare the efficacy and tolerability of bowel preparations with and without the higher first-dose volume of polyethylene glycol (PEG solution or exercise after drinking PEG solution in Chinese people. Methods: A total of 330 participants who had a colonoscopy done in Peking Union Medical College Hospital were randomly and evenly assigned to three groups. Participants in Group A ingested 1 L PEG solution and then ingested 2 L PEG solution at a rate of 250 mL every 15 minutes. Participants in Group B ingested 3 L PEG solution at a rate of 250 mL every 15 minutes and then exercised more than 10 minutes after ingesting each liter of PEG solution. Participants in Group C ingested 3 L PEG solution at a rate of 250 mL every 15 minutes. Experienced gastrointestinal endoscopists rated the efficacy of bowel preparations based on the Boston Bowel Preparation Scale score. A questionnaire regarding participants’ symptoms associated with bowel preparations was administered to evaluate participants’ tolerability. Results: The three groups had insignificant difference in the percentages of participants’ symptoms including dizziness, nausea, stomach ache, bloating, and asthenia. However, the percentages of participants having hunger sensation, sleep disturbance, and anal discomfort were significantly higher in groups with the higher first-dose volume of PEG solution or exercise after drinking PEG solution than without them. The three groups had insignificant difference in the Boston Bowel Preparation Scale score. Conclusion: Whether to add the higher first-dose volume of PEG solution and exercise after drinking PEG solution or not, all participants achieved a similar quality of bowel preparations. Bowel preparations without the additional first-dose volume of PEG

  9. Polyethylene Glycol Electrolyte Lavage Solution versus Colonic Hydrotherapy for Bowel Preparation before Colonoscopy: A Single Center, Randomized, and Controlled Study

    Science.gov (United States)

    Cao, Yan; Zhang, Kai-Yuan; Li, Jiao; Lu, Hao; Xie, Wan-Ling; Liao, Sheng-Tao; Chen, Dong-Feng; Zeng, Deng-Feng; Lan, Chun-Hui

    2014-01-01

    This single center, randomized, and controlled study aimed to compare the effectiveness and safety of polyethylene glycol electrolyte lavage (PEG-EL) solution and colonic hydrotherapy (CHT) for bowel preparation before colonoscopy. A total of 196 eligible outpatients scheduled for diagnostic colonoscopy were randomly assigned to the PEG-EL (n = 102) or CHT (n = 94) groups. Primary outcome measures included colonic cleanliness and adverse effects. Secondary outcome measures were patient satisfaction and preference, colonoscopic findings, ileocecal arrival rate, examiner satisfaction, and cecal intubation time. The results show that PEG-EL group was associated with significantly better colonic cleanliness than CHT group, fewer adverse effects, and increased examiner satisfaction. However, the CHT group had higher patient satisfaction and higher diverticulosis detection rates. Moreover, the results showed the same ileocecal arrival rate and patient preference between the two groups (P > 0.05). These findings indicate that PEG-EL is the preferred option in patients who followed the preparation instructions completely. PMID:24995014

  10. Polyethylene Glycol Electrolyte Lavage Solution versus Colonic Hydrotherapy for Bowel Preparation before Colonoscopy: A Single Center, Randomized, and Controlled Study

    Directory of Open Access Journals (Sweden)

    Yan Cao

    2014-01-01

    Full Text Available This single center, randomized, and controlled study aimed to compare the effectiveness and safety of polyethylene glycol electrolyte lavage (PEG-EL solution and colonic hydrotherapy (CHT for bowel preparation before colonoscopy. A total of 196 eligible outpatients scheduled for diagnostic colonoscopy were randomly assigned to the PEG-EL (n=102 or CHT (n=94 groups. Primary outcome measures included colonic cleanliness and adverse effects. Secondary outcome measures were patient satisfaction and preference, colonoscopic findings, ileocecal arrival rate, examiner satisfaction, and cecal intubation time. The results show that PEG-EL group was associated with significantly better colonic cleanliness than CHT group, fewer adverse effects, and increased examiner satisfaction. However, the CHT group had higher patient satisfaction and higher diverticulosis detection rates. Moreover, the results showed the same ileocecal arrival rate and patient preference between the two groups (P>0.05. These findings indicate that PEG-EL is the preferred option in patients who followed the preparation instructions completely.

  11. A Randomized Prospective Study of Bowel Preparation for Colonoscopy with Low-Dose Sodium Phosphate Tablets versus Polyethylene Glycol Electrolyte Solution

    Directory of Open Access Journals (Sweden)

    Erina Kumagai

    2014-01-01

    Full Text Available Optimal bowel preparation is essential for the safety and outcome of colonoscopy. A solution containing polyethylene glycol (PEG is often used as a bowel cleansing agent, but some patients are intolerant of PEG, and this may lead to discontinuation of colonoscopy. Sodium phosphates (NaP tablets are designed to improve patient acceptance and compliance. The objective of this study was to compare bowel preparation efficiency and patient acceptance of a 30 NaP tablet preparation (L-NaP and a 2 L PEG preparation. Patients were randomized into either the L-NaP or PEG group. The primary endpoint was the efficiency of colon cleansing as assessed by a validated four-point scale according to the Aronchick scale by endoscopists and was verified by blinded investigators. The secondary endpoints were patients’ tolerability and acceptance. Colon-cleansing efficiency was not significantly different between the two preparations. However, patients’ overall judgment was significantly in favor of L-NaP, reflecting better acceptance of L-NaP than PEG. Additionally, more patients favored L-NaP over PEG in a hypothetical future occasion requiring colonoscopy.

  12. A prospective randomized trial on the use of Coca-Cola Zero(®) vs water for polyethylene glycol bowel preparation before colonoscopy.

    Science.gov (United States)

    Seow-En, I; Seow-Choen, F

    2016-07-01

    The study aimed to determine whether Coca-Cola (Coke) Zero is a safe and effective solvent for polyethylene glycol (PEG). Between December 2013 and April 2014, 209 healthy adults (115 men, 95 women) scheduled for elective colonoscopy were randomized to use either Coke Zero (n = 100) or drinking water (n = 109) with PEG as bowel preparation. Each patient received two sachets of PEG to dissolve in 2 l of solvent, to be completed 6 h before colonoscopy. Serum electrolytes were measured before and after preparation. Bowel cleanliness and colonoscopy findings were recorded. Palatability of solution, adverse effects, time taken to complete and willingness to repeat the preparation were documented via questionnaire. Mean palatability scores in the Coke Zero group were significantly better compared with the control group (2.31 ± 0.61 vs 2.51 ± 0.63, P = 0.019), with a higher proportion willing to use the same preparation again (55% vs 43%). The mean time taken to complete the PEG + Coke Zero solution was significantly faster (74 ± 29 min vs 86 ± 31 min, P = 0.0035). The quality of bowel cleansing was also significantly better in the Coke Zero group (P = 0.0297). There was no difference in the frequency of adverse events (P = 0.759) or the polyp detection rate (32% vs 31.2%). Consumption of either preparation did not significantly affect electrolyte levels or hydration status. Coke Zero is a useful alternative solvent for PEG. It is well tolerated, more palatable, leads to quicker consumption of the bowel preparation and results in better quality cleansing. Colorectal Disease © 2015 The Association of Coloproctology of Great Britain and Ireland.

  13. Regime for Bowel Preparation in Patients Scheduled to Colonoscopy: Low-Residue Diet or Clear Liquid Diet? Evidence From Systematic Review With Power Analysis.

    Science.gov (United States)

    Song, Guo-Min; Tian, Xu; Ma, Li; Yi, Li-Juan; Shuai, Ting; Zeng, Zi; Zeng, Xian-Tao

    2016-01-01

    Clear liquid diet (CLD) is used to perform bowel preparation before colonoscopy traditionally, but several clinical studies indicated that low-residue diet (LRD) generates equal effects to CLD and a conclusive conclusion has not yet been yielded. The systematic review was performed to address this conflict and facilitate informed decision-making eventually. To capture randomized controlled trials (RCTs) comparing LRD with CLD in terms of bowel preparation, a search was performed in PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Science Direct, recent conference abstracts, Google Scholar, and Clinicaltrials.gov through May 2015. We performed all meta-analyses based on fixed- or random-effects model, which is generated from clinical characteristics and methodology. Moreover, the G*Power software was adopted to achieve statistical power for each outcome. In total, we captured 109 potential citations at initial search stage and 2 topic-related articles were included through other sources. After critical appraisal, 7 RCTs were eligible for our inclusion criteria. Meta-analyses generated similar effects in bowel preparation quality, efficacy of colon cleansing, and compliance with recommended dietary regime when LRD versus CLD regime, but patients who were prescribed to receive LRD have slightly better tolerance (RR, 1.06; 95% CI, 1.02-1.11) and tended to repeat the same preparation regime in future (RR, 1.17; 95% CI, 1.09-1.26) relative to patients in CLD. Importantly, both regimes resulted in similar adverse events (AEs). With the best available evidence, LRD could be recommended to be as standard regime for bowel preparation prior to colonoscopy.

  14. Effect of four-day psyllium supplementation on bowel preparation for colonoscopy:A prospective double blind randomized trial [ISRCTN76623768

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    Basson Marc D

    2004-02-01

    Full Text Available Abstract Background Patients with new onset constipation or presumed hemorrhoid bleeding frequently require the use of both fiber supplements and diagnostic colonoscopy. We sought to determine whether preliminary fiber supplementation would alter the tolerability or efficacy of a standard bowel preparation for colonoscopy Methods A prospective, double blind, randomized trial was designed to compare a short course of a psyllium-based supplement versus placebo prior to a colon lavage. Patients were given an unlabeled canister of powder, and instructed to take 1 tablespoon with 8 oz of water bid for 4 days before colonoscopy. A 4-liter polyethylene based glycol lavage was self-administered over 4 hours on the day prior to colonoscopy. A questionnaire on pre-study bowel habits and side effects was completed. Efficacy of the preparation was visually evaluated on a pre-determined scale. Results There were no significant differences between the two groups in gender, race, age, pre-study stool frequency or consistency. Tolerability was equivalent but efficacy of the bowel preparation was worse in the psyllium group compared to placebo (P Conclusions In non-constipated patients psyllium based fiber supplementation should not be initiated in the few days prior to endoscopy using a polyethylene glycol preparation.

  15. Effect of four-day psyllium supplementation on bowel preparation for colonoscopy:A prospective double blind randomized trial [ISRCTN76623768

    Science.gov (United States)

    Salwen, Walter A; Basson, Marc D

    2004-01-01

    Background Patients with new onset constipation or presumed hemorrhoid bleeding frequently require the use of both fiber supplements and diagnostic colonoscopy. We sought to determine whether preliminary fiber supplementation would alter the tolerability or efficacy of a standard bowel preparation for colonoscopy Methods A prospective, double blind, randomized trial was designed to compare a short course of a psyllium-based supplement versus placebo prior to a colon lavage. Patients were given an unlabeled canister of powder, and instructed to take 1 tablespoon with 8 oz of water bid for 4 days before colonoscopy. A 4-liter polyethylene based glycol lavage was self-administered over 4 hours on the day prior to colonoscopy. A questionnaire on pre-study bowel habits and side effects was completed. Efficacy of the preparation was visually evaluated on a pre-determined scale. Results There were no significant differences between the two groups in gender, race, age, pre-study stool frequency or consistency. Tolerability was equivalent but efficacy of the bowel preparation was worse in the psyllium group compared to placebo (P psyllium based fiber supplementation should not be initiated in the few days prior to endoscopy using a polyethylene glycol preparation. PMID:15005812

  16. Preoperative mechanical bowel preparation in elective colorectal surgery: an update of systematic review of the literature and meta-analysis

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    Katia Ferreira Güenaga

    2012-03-01

    Full Text Available The belief that mechanical bowel preparation is related to the reduction of complications in elective colorectal surgery is based on observational studies and expert opinion. This question led the authors to a systematic literature review, with the completion of meta-analysis, followed by three updates. METHOD: The sources of information were EMBASE, LILACS, MEDLINE, IBECS, the Cochrane Controlled Trials Register and letters to the authors. The studies were included according to the randomization criteria. The studied variables were: anastomotic dehiscence, mortality and operatory wound infection. The analysis was divided into two comparisons: one group with mechanical preparation (Group A compared with a group without preparation (Group B (Comparison I and a group submitted to rectal enema (Comparison II. RESULTS: We analyzed 5,805 patients in 20 clinical trials. In comparison I, anastomotic leak occurred in 4.4% (101/2,275 patients in Group A and 4.5% (103/2,258 patients in Group B. In comparison II, anastomotic leak occurred in 4.4% (27/601 patients in Group A and 3.4% (21/609 patients in Group B. CONCLUSION: Despite the inclusion of more studies, evidences found in studies did not show any benefit obtained from the use of preoperative mechanical bowel preparation or rectal cleansing enemas in elective colorectal surgery.A crença de que o preparo mecânico do cólon está relacionado à diminuição de complicações na cirurgia colorretal eletiva é baseada em estudos observacionais e opinião de especialistas. Seu questionamento motivou os autores na busca sistemática da literatura, com a realização de meta-análise, seguida de três atualizações. MÉTODO: Fontes de informação foram EMBASE, LILACS, MEDLINE, IBECS, Registros de Ensaios Clínicos Casualizados da Colaboração Cochrane e cartas para os autores. Os estudos foram incluídos de acordo com os critérios de casualização. Os desfechos clínicos estudados foram: deisc

  17. Impact of Bowel Preparation with Low-Volume (2-Liter) and Intermediate-Volume (3-Liter) Polyethylene Glycol on Colonoscopy Quality: A Prospective Observational Study.

    Science.gov (United States)

    Cheng, Chi-Liang; Kuo, Yen-Lin; Liu, Nai-Jen; Lin, Cheng-Hui; Tang, Jui-Hsiang; Tsui, Yi-Ning; Lee, Bai-Ping; Su, Ming-Yao; Chiu, Cheng-Tang

    2015-01-01

    Two-liter polyethylene glycol (PEG) is the most commonly used bowel-cleansing regimen in Taiwan, but its efficacy is unsatisfactory. The aim of this study was to compare 2-liter and 3-liter PEG in terms of their impact on colonoscopy quality among an average-risk population. Two-liter PEG was provided between August 2012 and May 2013, while 3-liter PEG was provided between June 2013 and March 2014. A split-dose regimen was provided for morning colonoscopy and a same-day regimen was provided for afternoon colonoscopy. The level of bowel cleansing was prospectively scored. A total of 407 consecutive subjects completed the 2-liter regimen, and another 407 consecutive subjects completed the 3-liter regimen. The 3-liter group had a significantly higher rate of excellent or good preparations, equivalent to a Boston bowel preparation scale of ≥7, than the 2-liter group (90 vs. 73%, p liter preparation group compared with the 2-liter group had overall adenoma (70 vs. 54%, p liter PEG provided better cleansing quality and higher adenoma detection rate than 2-liter PEG. © 2015 S. Karger AG, Basel.

  18. Bowel Movement

    Science.gov (United States)

    ... passes through the large intestine too slowly. Bowel incontinence is a problem controlling your bowel movements. Other abnormalities with bowel movements may be a sign of a digestive problem. NIH: National Institute of Diabetes and Digestive and Kidney Diseases

  19. Virtual Colonoscopy Screening With Ultra Low-Dose CT and Less-Stressful Bowel Preparation: A Computer Simulation Study

    Science.gov (United States)

    Wang, Jing; Wang, Su; Li, Lihong; Fan, Yi; Lu, Hongbing; Liang, Zhengrong

    2008-10-01

    Computed tomography colonography (CTC) or CT-based virtual colonoscopy (VC) is an emerging tool for detection of colonic polyps. Compared to the conventional fiber-optic colonoscopy, VC has demonstrated the potential to become a mass screening modality in terms of safety, cost, and patient compliance. However, current CTC delivers excessive X-ray radiation to the patient during data acquisition. The radiation is a major concern for screening application of CTC. In this work, we performed a simulation study to demonstrate a possible ultra low-dose CT technique for VC. The ultra low-dose abdominal CT images were simulated by adding noise to the sinograms of the patient CTC images acquired with normal dose scans at 100 mA s levels. The simulated noisy sinogram or projection data were first processed by a Karhunen-Loeve domain penalized weighted least-squares (KL-PWLS) restoration method and then reconstructed by a filtered backprojection algorithm for the ultra low-dose CT images. The patient-specific virtual colon lumen was constructed and navigated by a VC system after electronic colon cleansing of the orally-tagged residue stool and fluid. By the KL-PWLS noise reduction, the colon lumen can successfully be constructed and the colonic polyp can be detected in an ultra low-dose level below 50 mA s. Polyp detection can be found more easily by the KL-PWLS noise reduction compared to the results using the conventional noise filters, such as Hanning filter. These promising results indicate the feasibility of an ultra low-dose CTC pipeline for colon screening with less-stressful bowel preparation by fecal tagging with oral contrast.

  20. The use of low-volume polyethylene glycol containing ascorbic acid versus 2 L of polyethylene glycol plus bisacodyl as bowel preparation for colonoscopy.

    Science.gov (United States)

    Tae, Chung Hyun; Jung, Sung-Ae; Na, Sun-Kyung; Song, Hye-Kyung; Moon, Chang Mo; Kim, Seong-Eun; Shim, Ki-Nam; Jung, Hye-Kyung; Moon, Il Hwan

    2015-08-01

    Low-volume polyethylene glycol (PEG) bowel preparations have been developed to improve compliance for colonoscopy. Our study aimed to compare the efficacy and tolerability of low-volume PEG containing ascorbic acid for colonoscopy against 2 L of PEG plus bisacodyl. We prospectively enrolled consecutive inpatients who had not undergone polypectomy at the index colonoscopy and were subsequently referred for polypectomy at our hospital. A total of 62 patients were randomized to receive either low-volume PEG containing ascorbic acid (n = 31) or 2 L of PEG plus bisacodyl (n = 31) as a split-dose regimen in inpatients. The efficacy of preparation was determined using the Ottawa Bowel Preparation Score (OBPS) and a 4-point scale. Adverse events, tolerability, and willingness were evaluated using a questionnaire. Based on the OBPS and 4-point scale, we determined that the efficacy of low-volume PEG containing ascorbic acid was comparable to that of the 2 L of PEG plus bisacodyl (p = 0.071 for OBPS, p = 0.056 for the 4-point scale). Adverse events were comparable between the two groups (p = 1.000). A greater proportion of patients in the low-volume PEG containing ascorbic acid (90.6%) and the 2L of PEG plus bisacodyl (96.9%) were willing to repeat the same preparation for subsequent colonoscopy. Low-volume PEG containing ascorbic acid had comparable efficacy and tolerability to 2 L of PEG plus bisacodyl, when given as a split dose, for colonoscopy in inpatients. Split-dose low-volume PEG containing ascorbic acid is a good alternative for bowel preparation for colonoscopy in inpatients.

  1. Comparative Evaluation of the Efficacy of Polyethylene Glycol With Ascorbic Acid and an Oral Sulfate Solution in a Split Method for Bowel Preparation: A Randomized, Multicenter Phase III Clinical Trial.

    Science.gov (United States)

    Kim, Bun; Lee, Seong Dae; Han, Kyung Su; Kim, Byung Chang; Youk, Eui-Gon; Nam, Myung Jin; Lee, Doo Han; Sohn, Dae Kyung

    2017-04-01

    An adequate level of bowel preparation before colonoscopy is important. The ideal agent for bowel preparation should be effective and tolerable. The purpose of this study was to compare the clinical efficacy and tolerability of polyethylene glycol with ascorbic acid and oral sulfate solution in a split method for bowel preparation. This was a prospective, multicenter, randomized controlled clinical trial. Outpatients at the specialized clinics were included. A total of 186 subjects were randomly assigned. After exclusions, 84 subjects in the polyethylene glycol with ascorbic acid group and 83 subjects in the oral sulfate solution group completed the study and were analyzed. Polyethylene glycol with ascorbic acid or oral sulfate solution in a split method was the included intervention. The primary end point was the rate of successful bowel preparation, which was defined as being excellent or good on the Aronchick scale. Tolerability and adverse events were also measured. Success of bowel preparation was not different between 2 groups (91.7% vs 96.4%; p = 0.20), and the rate of adverse GI events (abdominal distension, pain, nausea, vomiting, or abdominal discomfort) was not significantly different between the 2 groups. In contrast, the mean intensity of vomiting was higher in the oral sulfate solution group than in the polyethylene glycol with ascorbic acid group (1.6 ± 0.9 vs 1.9 ± 1.1; p = 0.02). All of the colonoscopies were performed in the morning, and the subjects were offered enhanced instructions for bowel preparation. In addition, the results of tolerability and adverse effect may have a type II error, because the number of cases was calculated for confirming the efficacy of bowel preparation. Oral sulfate solution is effective at colonoscopy cleansing and has acceptable tolerability when it is compared with polyethylene glycol with ascorbic acid. The taste and flavor of oral sulfate solution still need to be improved to enhance tolerability.

  2. Comparison of a split-dose bowel preparation with 2 liters of polyethylene glycol plus ascorbic acid and 1 liter of polyethylene glycol plus ascorbic acid and bisacodyl before colonoscopy.

    Science.gov (United States)

    Kang, Seung Hun; Jeen, Yoon Tae; Lee, Jae Hyung; Yoo, In Kyung; Lee, Jae Min; Kim, Seung Han; Choi, Hyuk Soon; Kim, Eun Sun; Keum, Bora; Lee, Hong Sik; Chun, Hoon Jai; Kim, Chang Duck

    2017-08-01

    Recently, a low-volume polyethylene glycol formulation containing ascorbic acid (PEG-Asc) has proven as safe and effective as traditional 4-L PEG solutions for colonoscopy preparation. However, currently available aqueous purgative formulations are poorly tolerated. The aim of this study was to compare a split-dose 2-L PEG-Asc formulation and a 1-L PEG-Asc formulation with bisacodyl (10 mg) to determine the quality of bowel cleansing and patient tolerability. A single-center, randomized, observer-blinded study was performed between May 2015 and September 2015. Two hundred outpatients referred for colonoscopy were prospectively enrolled and assigned to either the split-dose 2-L PEG-Asc group or the 1-L PEG-Asc with bisacodyl 10-mg group. The Boston Bowel Preparation Scale (BBPS) and Aronchick Bowel Preparation Scale (ABPS) were used to evaluate bowel cleansing. The tolerability of the regimens and satisfaction of patients was determined based on a questionnaire. Two hundred patients received either 2-L PEG-Asc or 1-L PEG-Asc with bisacodyl. Regarding colon cleansing outcome (BBPS and ABPS), the 1-L PEG-Asc with bisacodyl group showed similar but non-inferior results compared with the 2-L PEG-Asc group on both BBPS (6.92 ± 1.63 vs 6.57 ± 1.37; P = .103) and ABPS (96% vs 95%; P = 1.000) scales. Tolerability was similar for both 1-L PEG-Asc with bisacodyl and 2-L PEG-Asc. 1-L PEG-Asc is a suitable alternative to low-volume bowel preparation for colonoscopy. Our study showed that the 1-L PEG-Asc plus bisacodyl preparation has comparable tolerability and results in adequate colon cleansing. Bowel preparation with bisacodyl and 1-L PEG-Asc is a suitable alternative to low-volume bowel preparation for colonoscopy. (Clinical trial registration number: NCT02980562.). Copyright © 2017 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

  3. Preparo intestinal para colonoscopia com picossulfato sódico e citrato de magnésio em crianças e adolescentes Bowel preparation for colonoscopy with sodium picosulphate and magnesium citrate in children and adolescents

    Directory of Open Access Journals (Sweden)

    Elisabete Kawakami

    2004-03-01

    Full Text Available RACIONAL: A eficácia do exame colonoscópico depende diretamente da limpeza colônica. Ao contrário do paciente adulto, há poucos relatos na literatura sobre preparo colônico em crianças. OBJETIVO: Avaliar a eficácia do preparo colônico à base de picossulfato sódico e citrato de magnésio em crianças e adolescentes. PACIENTES E MÉTODOS: Realizou-se estudo aberto, prospectivo e consecutivo em crianças maiores de 1 ano, de ambos os sexos, que realizaram colonoscopia por diferentes indicações. Os pacientes receberam a medicação associada à dieta líquida e pastosa sem resíduos no dia anterior ao exame. A eficácia do preparo foi classificada em: Grau I: ótimo; Grau II: bom; Grau III: regular; Grau IV: ruim. RESULTADOS: A idade variou de 12 meses a 16 anos e 1 mês (mediana: 6 anos e 6 meses, sendo 54,3% do sexo masculino. O preparo foi feito conforme a orientação em 37/46 (80,4% dos pacientes, sendo que 9 não fizeram a dieta adequadamente e 22/46 (47,8% referiram efeitos colaterais. A eficácia do preparo foi: GI em 41,3%, GII em 52,2%, GIII em 6,5% e GIV em 0%. CONCLUSÃO: Preparo intestinal com picossulfato sódico e citrato de magnésio é eficiente e prático, podendo ser recomendado de rotina nos exames de colonoscopia em crianças e adolescentes.BACKGROUND: The efficacy of colonoscopic examination depends directly on bowel cleasing preparation. There are few studies in the medical literature about bowel preparation in children. AIM: To determinate the efficacy of picosulphate sodium with magnesium citrate as a bowel preparation in children and adolescents. PATIENTS AND METHODS: In an open prospective and consecutive trial, we included all children above 1 year of age submitted to colonoscopy for different indications. All patients received the drug the day before the procedure and was allowed no solid food but a liberal intake of clear fluids. The adequacy of the preparation was graded as follows: gI - excellent, g

  4. A low-volume polyethylene glycol solution was associated with an increased suboptimal bowel preparation rate but had similar recommendations for an early repeat colonoscopy, procedure times, and adenoma detection rates.

    Directory of Open Access Journals (Sweden)

    Sam C Hankins

    Full Text Available Low-volume polyethylene glycol (PEG bowel preparations are better tolerated by patients than high-volume preparations and may achieve similar preparation quality. However, there is little data comparing their effects on a recommendation for an early repeat colonoscopy (because of a suboptimal preparation, procedure times, adenoma detection rate (ADR, and advanced adenoma detection rate (AADR.This is a retrospective cohort study of outpatient colonoscopies performed during a one-year period at a single academic medical center in which low-volume MoviPrep® (n = 1841 or high-volume Colyte® (n = 1337 was used. All preparations were split-dosed. Appropriate covariates were included in regression models assessing suboptimal preparation quality (fair, poor, or inadequate, procedure times, recommendation for an early repeat colonoscopy, ADR, and AADR.MoviPrep® was associated with an increase in having a suboptimal bowel preparation (OR 1.36; 95% CI: 1.06-1.76, but it was not associated with differences in insertion (p = 0.43, withdrawal (p = 0.22, or total procedure times (p = 0.10. The adjusted percentage with a suboptimal preparation was 11.7% for patients using MoviPrep® and 8.8% for patients using Colyte®. MoviPrep® was not associated with a significant difference in overall ADR (OR 0.93; 95% CI: 0.78-1.11, AADR (OR 1.18; 95% CI: 0.87-1.62, or recommendation for early repeat colonoscopy (OR 1.16; 95% CI: 0.72-1.88.MoviPrep® was associated with a small absolute increase in having a suboptimal preparation, but did not affect recommendations for an early repeat colonoscopy, procedure times, or adenoma detection rates. Mechanisms to reduce financial barriers limiting low-volume preparations should be considered because of their favorable tolerability profile.

  5. Avaliação do preparo intestinal para videocolonoscopia em crianças Evaluation of bowel preparation in children for videocolonoscopy

    Directory of Open Access Journals (Sweden)

    Juvenal da Rocha Torres Neto

    2008-06-01

    Full Text Available Para a realização adequada da colonoscopia, é necessária uma limpeza colônica satisfatória. Existem vários métodos de preparo intestinal, mas para crianças ainda não existe um ideal. Portanto, buscamos, com este trabalho, um preparo intestinal padrão para esta faixa etária, que proporcione uma limpeza colônica excelente, tenha menos efeitos colaterais, grande aceitabilidade e custo reduzido, garantindo o apoio e a segurança dos familiares sobre o método. Foram avaliadas 46 crianças que se submeteram a videocolonoscopia, no período de 2002 a 2006, no serviço de videocolonoscopia do Hospital Universitário de Sergipe e na UPEP. As crianças foram divididas nos seguintes grupos etários: até um ano (grupo A, crianças de 1 a 5 anos(grupo B e crianças maiores que 5 anos (grupo C. Nos lactentes e menores que 5 anos, foi usado fosfato de sódio via retal e as crianças maiores que 5 anos receberam solução de manitol via oral. Das 25 crianças que usaram o fosfato de sódio por via retal, o preparo foi excelente em 21 (88% pacientes e bom em 1 (4% paciente, embora todas as mães tenham relatado uma aplicação difícil. As outras 21 crianças usaram manitol, com resultado excelente em 17 (80,9% pacientes e bom em um (4,8% paciente; entretanto, todas as crianças apresentaram náuseas e vômitos após sua ingestão, com recusa pelas crianças devido ao grande volume. Alcançou-se o ceco em 41 (89% casos, dos quais, o íleo terminal foi alcançado em 19 (41,3% casos. Um preparo intestinal individualizado permitiu alto índice de bom preparo e baixa morbidade.To an accurate colonoscopy procedure it is necessary a satisfactory colonic cleansing. There are many bowel preparation methods for adults, but there is not any ideal method for children. Therefore, this study tried to find a standard method for this age that can associate excellent colonic cleansing, less side effects, higher acceptability and affordability, relatives' support

  6. Small Bowel Review: Part II

    Directory of Open Access Journals (Sweden)

    ABR Thomson

    1999-01-01

    Full Text Available In the past year there have been many advances in the area of small bowel physiology and pathology. In preparation for this review, over 500 papers were assessed; some have been selected and reviewed, with a particular focus on presenting clinically useful information for the practising gastroenterologist.

  7. Safety, patient's tolerance, and efficacy of a 2-liter vitamin C-enriched macrogol bowel preparation: a randomized, endoscopist-blinded prospective comparison with a 4-liter macrogol solution.

    Science.gov (United States)

    Mathus-Vliegen, E M H; van der Vliet, K

    2013-08-01

    Optimal bowel preparation is associated with lower polyp miss rates, but patients have difficulties in complying with the usual 4-L bowel preparation. This study aimed to compare the safety, acceptance, and efficacy of 2-L polyethylene glycol electrolyte solution enriched in vitamin C with 4-L polyethylene glycol electrolyte solution. This study is an endoscopist-blinded randomized controlled trial. The study was conducted at a tertiary referral hospital. Consecutive outpatients were randomly assigned to receive 4-L polyethylene glycol electrolyte solution or 2-L polyethylene glycol electrolyte solution enriched in vitamin C with 2 L of clear fluids in a single-dose or a split-dose regime. Safety was assessed by blood sampling before and after the preparation and by a 30-day postcolonoscopy chart and complication database review. Acceptance was investigated by questionnaires, and the adequacy of bowel preparation was assessed by the Aronchick and Ottawa scales. One hundred eighty-eight patients, 98 in the polyethylene glycol electrolyte solution enriched in vitamin C group and 90 in the polyethylene glycol electrolyte solution group, participated. Although changes in bicarbonate blood concentrations with polyethylene glycol electrolyte solution enriched in vitamin C were seen to such an extent that the blinded investigator correctly guessed the preparation in 75.6%, no unsafe values were observed. A 30-day chart and complication database review revealed 1 severe adverse event of a myocardial infarction in the polyethylene glycol electrolyte solution enriched in vitamin C group. Patient acceptance and compliance were significantly higher with the polyethylene glycol electrolyte solution enriched in vitamin C group. The impact on sleep, daily activities, and physical complaints were similar in both groups. Polyethylene glycol electrolyte solution enriched in vitamin C was noninferior to polyethylene glycol electrolyte solution in cleansing efficacy, but the segmental

  8. Efficacy and tolerability of split-dose magnesium citrate: low-volume (2 liters) polyethylene glycol vs. single- or split-dose polyethylene glycol bowel preparation for morning colonoscopy.

    Science.gov (United States)

    Park, Sin Sil; Sinn, Dong Hyun; Kim, Young-Ho; Lim, Yeun Jung; Sun, Yang; Lee, Jun Haeng; Kim, Jin Yong; Chang, Dong Kyung; Son, Hee Jung; Rhee, Poong-Lyul; Rhee, Jong Chul; Kim, Jae J

    2010-06-01

    Preparation regimens for morning colonoscopy are suboptimal. The aim of this study was to test the efficacy and tolerance of a split-dose magnesium citrate-low-volume (2 liters) polyethylene glycol (PEG) regimen for morning colonoscopy. A total of 232 patients were randomly assigned to receive 4 liters PEG (day before procedure; group 1, n=79), 2 liters PEG (day before procedure) followed by another 2 liters PEG (day of procedure; group 2, n=80), or magnesium citrate (250 ml, day before procedure) followed by 2 liters PEG (day of procedure; group 3, n=73). The quality of bowel cleansing, tolerability, and adverse effects in group 3 were compared with those in groups 1 and 2. Satisfactory bowel preparation was more frequently reported for group 3 than for group 1 (75% vs. 51%, P=0.001) and was similar to that for group 2 (75% vs. 76%, P=0.896). A significantly greater proportion of patients in group 3 graded their overall satisfaction as satisfactory compared with group 1 (43% vs. 23%, P=0.010), and the proportion was similar to that in group 2 (43% vs. 35%, P=0.133). Patients in group 3 were more willing to repeat the same preparation regimen, if necessary, than those in group 1 (93% vs. 48%, Pliters) PEG regimen was more efficient than and preferred to the conventional regimen of 4 liters of PEG, and it was equally efficient as, but, again, preferred to the split-dose (2+2 liters) regimen for morning colonoscopy.

  9. Preparo do intestino grosso para a coloscopia: usos, abusos e idéias controversas Bowel preparation for colonoscopy: myths and misconceptions

    Directory of Open Access Journals (Sweden)

    Julio César M Santos Jr

    2010-09-01

    determinar seus usos indiscriminados para propiciar as melhores condições para os mais adequados exames. Estamos diante de um impasse: o manitol, mundialmente proscrito, continua sendo indicado entre nós, sem causar problemas, num esquema posológico diferente do que foi usado no passado e que influenciou os acidentes. Por outro lado, a industria farmacêutica não conseguiu popularizar o PEG; o NaP, fabricado para uso retal, substituiu os antecessores com limpeza eficiente, mas com ações lesivas significativas, principalmente renais. Assim, o que nos resta é resgatar o manitol - demonstrar por meio de um estudo prospectivo, casualizado, que o manitol a 10% ingerido pelo menos até 4 horas antes da coloscopia é totalmente inócuo para o procedimento de diagnóstico e de terapêutica.The routine of the colonoscopic examination for therapeutic evaluation, for diagnosis, and management of the diseases of the colon and of the rectum, as well as for screening and prevention of the colorectal cancer in young patients bearing premalignant diseases or in those above 50 years of age, as well as for screening and prevention of the colorectal cancer in young patients bearing premalignant diseases or in those above 50 years of age, "has been one of the most successful public health projects worldwide71". The easy acceptance is due to three principal factors: first, to the technical adaptation and evolution of the instruments, and the safety of the examination; second one, to the practical development of the examiner skills, and, thirdly, to the magnificence of the image revealing broad access to the fine structures of the mucous membrane, with a large criteria for the diagnosis. In this context, the necessary preparation became the worst part or less tolerable of the colonoscopy. For this reason, it is necessary to look for a method of preparation, quick, efficient, cheap, pleasant, and safe. In the last 40 years, between the commentaries on mechanical and pharmacological methods

  10. Daily bowel care program

    Science.gov (United States)

    ... gov/ency/patientinstructions/000133.htm Daily bowel care program To use the sharing features on this page, ... Work with your health care provider. Basic Bowel Program Keeping active helps prevent constipation. Try to walk, ...

  11. Accidental Bowel Leakage

    Science.gov (United States)

    ... I do to help treat accidental bowel leakage? Kegel exercises strengthen the muscles that surround the openings ... bowels that may cause cramping, diarrhea, or constipation. Kegel Exercises: Pelvic muscle exercises that assist in bladder ...

  12. Preparation

    Directory of Open Access Journals (Sweden)

    M.M. Dardir

    2014-03-01

    Full Text Available Some hexanamide-mono and di-linoleniate esters were prepared by the reaction of linolenic acid and hexanamide (derived from the reaction of hexanoic acid and diethanolamine. The chemical structure for the newly prepared hexanamide-mono and di-linoleniate esters were elucidated using elemental analysis, (FTIR, H 1NMR and chemical ionization mass spectra (CI/Ms spectroscopic techniques. The results of the spectroscopic analysis indicated that they were prepared through the right method and they have high purity. The new prepared esters have high biodegradability and lower toxicity (environmentally friendly so they were evaluated as a synthetic-based mud (ester-based mud for oil-well drilling fluids. The evaluation included study of the rheological properties, filtration and thermal properties of the ester based-muds formulated with the newly prepared esters compared to the reference commercial synthetic-based mud.

  13. Frequent Bowel Movements

    Science.gov (United States)

    ... 2017. Irritable bowel syndrome (IBS). National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome. Accessed Nov. 15, 2017. Nov. 18, 2017 Original article: http://www.mayoclinic.org/symptoms/frequent-bowel- ...

  14. Efficacy and Safety of Sodium Picosulfate/Magnesium Citrate for Bowel Preparation in a Physically Disabled Outpatient Population: A Randomized, Endoscopist-Blinded Comparison With Ascorbic Acid-Enriched Polyethylene Glycol Solution Plus Bisacodyl (The PICO-MOVI Study).

    Science.gov (United States)

    Mathus-Vliegen, Elisabeth M H; van der Vliet, Karin; Wignand-van der Storm, Inge J; Stadwijk, John S

    2018-02-01

    Because of its volume, adequate bowel preparation remains problematic in physically unfit patients. This study aimed to compare a small-volume sodium picosulfate/magnesium citrate preparation with a 2-L ascorbic acid-enriched polyethylene glycol solution plus bisacodyl. This study has a noninferiority design, assuming that ascorbic acid-enriched polyethylene glycol solution plus bisacodyl is 70% efficacious in achieving an Ottawa score ≤7 and accepting a difference in success rate of ascorbic acid-enriched polyethylene glycol solution plus bisacodyl according to a split-dose regimen. Patients in the sodium picosulfate/magnesium citrate group received advice on the recommended 4-L fluid intake. Patients in the ascorbic acid-enriched polyethylene glycol solution plus bisacodyl group received 2 bisacodyl tablets 2 days before and advice on the additionally recommended 2-L fluid intake. To assess bowel-cleansing adequacy, the Ottawa, Aronchick, and Boston scores were used. Colonoscopy quality measures were obtained. Safety was assessed for a 30-day follow-up period. Overall, 341 patients (169 men, mean age 57.0 years; BMI 26.2 kg/m) were included. Comorbidities were present in 76.2% of patients, and 75.4% of patients used medication. An adequate Ottawa score was obtained in 81.4% and 75.8% of patients receiving ascorbic acid-enriched polyethylene glycol solution plus bisacodyl and sodium picosulfate/magnesium citrate (difference of 5.6% (95% CI, -3.5 to -14.6; p = 0.023)), showing noninferiority of the sodium picosulfate/magnesium citrate therapy. Ottawa segmental scores were lower for sodium picosulfate/magnesium citrate in the right and transverse colon. In both groups, successful ileocecal intubation was achieved in 95%. No medication-related adverse events were reported. These results in a physically disabled ambulant population cannot be extrapolated to immobile, hospitalized patients. Sodium picosulfate/magnesium citrate proved to be noninferior to ascorbic

  15. Functional bowel disease

    DEFF Research Database (Denmark)

    Rumessen, J J; Gudmand-Høyer, E

    1988-01-01

    Twenty-five patients with functional bowel disease were given fructose, sorbitol, fructose-sorbitol mixtures, and sucrose. The occurrence of malabsorption was evaluated by means of hydrogen breath tests and the gastrointestinal symptoms, if any, were recorded. One patient could not be evaluated...... with functional bowel disease. The findings may have direct influence on the dietary guidance given to a major group of patients with functional bowel disease and may make it possible to define separate entities in this disease complex....

  16. Identification of a Functional TPH1 Polymorphism Associated with Irritable Bowel Syndrome Bowel Habit Subtypes

    Science.gov (United States)

    Grasberger, Helmut; Chang, Lin; Shih, Wendy; Presson, Angela P.; Sayuk, Gregory S.; Newberry, Rodney D.; Karagiannides, Iordanis; Pothoulakis, Charalabos; Mayer, Emeran; Merchant, Juanita L.

    2014-01-01

    Background & Aims Alterations in 5-hydroxytryptamine (5-HT) signaling have been implicated as a factor contributing to the altered bowel habit of irritable bowel syndrome (IBS) patients. Tryptophan hydroxylase 1 (TPH1) is the rate–limiting enzyme in enterochromaffin cell 5-HT biosynthesis. We hypothesized that genetic variants affecting TPH1 gene expression might alter intestinal 5-HT bioavailability and subsequently the propensity for distinct bowel habit subtypes in IBS. In this study, we assessed the only common TPH1 proximal promoter variant (-347C/A; rs7130929) and its association with bowel habit predominance in IBS. Methods Electrophoretic mobility shift assays were performed to assess whether the -347C/A allele variant affects the DNA-binding of nuclear factors. Genotype distribution was determined for 422 IBS patients subtyped using Rome III criteria and for 495 healthy controls recruited from two university medical centers. Association with bowel habit was tested using a multinomial logistic regression model controlling for race, anxiety, depression, and study site. Results Early growth response factor 1 (EGR-1) bound with higher affinity to a site comprising the minor A-allele of SNP -347C/A. TPH1 genotype frequencies did not differ between IBS patients and controls overall. The CC genotype was more prevalent in the IBS-D subtype (47%) than in the IBS-C (25%) and IBS-M (37%) subtypes (P=0.039) after adjusting for race and other covariates. Colonic biopsies from a small cohort of IBS patients from one center were tested for higher TPH1 mRNA expression in samples with CC compared to CA genotype, but the results did not reach statistical significance. Conclusions The TPH1 promoter SNP -347C/A differentially binds EGR1, correlates with IBS bowel habit subtypes and possibly colonic TPH1 expression consistent with its role in modulating intestinal 5-HT signaling. PMID:24060757

  17. Small Bowel Review: Part I

    Directory of Open Access Journals (Sweden)

    ABR Thomson

    2000-01-01

    Full Text Available In the past year, there have been many advances in the area of small bowel physiology and pathology. More than 1500 papers were assessed in preparation for this review. Some were selected and reviewed, with a particular focus on presenting clinically useful information for the practising gastroenterologist. Relevant review articles have been highlighted, and important clinical learning points have been stressed. The topics are varied in scope, and wherever possible show a logical progression from basic physiology to pathophysiology to clinical disorders and management.

  18. Bowel Diseases and Kidneys

    Directory of Open Access Journals (Sweden)

    A.E. Dorofeiev

    2015-09-01

    Full Text Available This review of contemporary publications analyzes the prevalence of combinations of bowel and renal diseases. Special attention is paid to the problem of correlation between bowel diseases and urolithiasis. We consider the possible pathogenic mechanisms of lesions, such as genetically determined violations of intestinal absorption and secretion, changes in the intestinal microbiota, systemic inflammatory response, water and electrolyte disturbances.

  19. Inflammatory Bowel Disease (For Teens)

    Science.gov (United States)

    ... Protecting Your Online Identity and Reputation ADHD Medicines Inflammatory Bowel Disease KidsHealth > For Teens > Inflammatory Bowel Disease Print A ... en español Enfermedad inflamatoria del intestino What Is Inflammatory Bowel Disease? Inflammatory bowel disease (IBD) is a condition that ...

  20. Bowel transit time

    Science.gov (United States)

    You will be asked to swallow 2 gelatin capsules filled with a colored food dye. You take these capsules with a meal. Afterwards, you observe your bowel movements and write down how long it takes for the ...

  1. The Relationship between Irritable Bowel Syndrome, Depression, Anxiety, and Stress among Sample of Irritable Bowel Patients - Predictive Study

    OpenAIRE

    Osama Hasan Gaber

    2016-01-01

    This study aimed to examine the relationship of irritable bowel syndrome, anxiety, depression and stress among a sample of78 IBS patients (Rome III Diagnostic Criteria for Irritable Bowel Syndrome), anxiety symptoms scale, Depression symptoms scale, and stress scale (prepared by the researcher) were used Pearson Correlation Coefficient showed that there are statistically significant relationship between IBS and Anxiety, Depression and Stress (P?=0.01). The Regression and Prediction Coefficien...

  2. Mechanical bowel preparation for elective colorectal surgery

    DEFF Research Database (Denmark)

    Guenaga, Katia K F G; Matos, Delcio; Wille-Jørgensen, Peer

    2009-01-01

    with no MBP. Primary outcomes included anastomosis leakage - both rectal and colonic - and combined figures. Secondary outcomes included mortality, peritonitis, reoperation, wound infection, extra-abdominal complications, and overall surgical site infections. DATA COLLECTION AND ANALYSIS: Data were...... independently extracted and checked. The methodological quality of each trial was assessed. Details of randomisation, blinding, type of analysis, and number lost to follow up were recorded. For analysis, the Peto-Odds Ratio (OR) was used as the default (no statistical heterogeneity was observed). MAIN RESULTS....../2378) of Group B; Peto OR 1.26 (95% CI: 0.941 to 1.69). Wound infection occurred in 9.6% (232/2417) of Group A, compared with 8.3% (200/2404) of Group B; Peto OR 1.19 (95% CI: 0.98 to 1.45). Sensitivity analyses did not produce any differences in overall results. AUTHORS' CONCLUSIONS: There is no statistically...

  3. Inflammatory Bowel Disease (For Children)

    Science.gov (United States)

    ... Bowel Disease Print A A A en español Enfermedad inflamatoria del intestino What Is Inflammatory Bowel Disease? ... of IBD? There are two kinds of IBD: Crohn's disease and ulcerative colitis (say: UL-sur-uh- ...

  4. Small bowel imaging - still a radiologic approach?

    Science.gov (United States)

    Markova, Ingrid; Kluchova, Katerina; Zboril, Radek; Mashlan, Miroslav; Herman, Miroslav

    2010-06-01

    In recent years, there has been renewed interest in small bowel imaging using a variety of radiologic or endoscopic techniques. This article gives an overview and comparison of old and new techniques used in small bowel imaging. New imaging methods as computed tomography (CT), CT enteroclysis (CTEc), CT enterography (CTEg), ultrasound (US), contrast-enhanced ultrasound (CEUS), US enteroclysis, US enterography, magnetic resonance imaging (MRI), MR enteroclysis (MREc) and MR enterography (MREg) are compared with the older techniques such as small- bowel follow- through (SBFT), conventional enteroclysis (CE) and endoscopic techniques including push enteroscopy, ezofagogastroduodenoscopy (EGD), sonde enteroscopy, ileocolonoscopy, double-balloon enteroscopy, intraoperative enteroscopy and wireless capsule enteroscopy (WCE). Systematic scan of Pubmed, Medline, Ovid, Elsevier search engines was used.. Additional information was found through the bibliographical review of relevant articles. SBFT has only secondary role in small bowel imaging. US is still the method of choice in imaging for pediatric populations. US and CEUS are also accepted as a method of choice especially in inflammatory cases. CE has been replaced by new cross - sectional imaging techniques (CTEc/CTEg or MREc/MREg). CTEc combines the advantages of CT and CE. MREc combines the advantages of MRI and CE. Some authors prefer CTEg or MREg with peroral bowel preparation and they strictly avoid nasojejunal intubation under fluoroscopic control. MREc has better soft tissue contrast, showing it to be more sensitive in detecting mucosal lesions than CTEc in inflammatory diseases. CTEg/MREg are techniques preferred for patients in follow-up of the inflammatory diseases. The radiologic community is not unanimous however about their role in the imaging process. CTEc/MREc as well as CTEg/MREg are superior to endoscopic methods in the investigation of small-bowel tumors. WCE gives unparalleled imaging of the mucosal

  5. Postoperative bowel function, symptoms, and habits in women after vaginal reconstructive surgery.

    Science.gov (United States)

    Ballard, Alicia; Parker-Autry, Candace; Lin, Chee Paul; Markland, Alayne D; Ellington, David R; Richter, Holly E

    2015-06-01

    The objective was to characterize postoperative bowel symptoms in women undergoing vaginal prolapse reconstructive surgery randomized to preoperative bowel preparation vs a regular diet. Subjects (N = 121) completed two bowel diaries: a 7-day bowel diary immediately before surgery and a 14-day diary postoperatively. Self-reported bowel diary data and symptoms included the time to first bowel movement (BM), daily number of BMs, Bristol Stool Form Scale score, pain, and urgency associated with BM, episodes of fecal incontinence, and use of laxatives. Antiemetic use was abstracted from medical records. Outcomes of groups were compared using Chi-squared/Fisher's exact test or Student's t test as appropriate. Mean time to first postoperative BM was similar in the bowel preparation (n = 60) and control groups (n = 61), 81.2 ± 28.9 vs 78.6 ± 28.2 h, p = 0.85. With the first BM, there were no significant differences between bowel preparation and control groups regarding pain (17.2 vs 27.9 %, p = 0.17), fecal urgency with defecation (56.9 vs 52.5 %, p = 0.63), fecal incontinence (14.0 vs 15.0 %, p = 0.88) and >1 use of laxatives (93.3 vs 96.7 % p = 0.44) respectively. Antiemetic use was similar in both groups (48.3 vs 55.7 % respectively, p = 0.42). There were no differences in the return of bowel function and other bowel symptoms postoperatively between the randomized groups. Lack of bowel preparation does not have an impact on the risk of painful defecation postoperatively. This information may be used to inform patients regarding expectations for bowel function after vaginal reconstructive surgery.

  6. Inflammatory bowel disease epidemiology

    DEFF Research Database (Denmark)

    Burisch, Johan; Munkholm, Pia

    2013-01-01

    The occurrence of inflammatory bowel disease (IBD) is increasing worldwide, yet the reasons remain unknown. New therapeutic approaches have been introduced in medical IBD therapy, but their impact on the natural history of IBD remains uncertain. This review will summarize the recent findings...

  7. Bowel Endometriosis Syndrome

    DEFF Research Database (Denmark)

    Riiskjær, M; Egekvist, A G; Hartwell, D

    2017-01-01

    STUDY QUESTION: Is it possible to develop a validated score that can identify women with Bowel Endometriosis Syndrome (BENS) and be used to monitor the effect of medical and surgical treatment? SUMMARY ANSWER: The BENS score can be used to identify women with BENS and to monitor the effect...

  8. Effect of Bowel Cleansing on Colonic Transit Time Measurement in Children with Chronic Constipation.

    Science.gov (United States)

    Quitadamo, Paolo; Thapar, Nikhil; Staiano, Annamaria; Tambucci, Renato; Saliakellis, Efstratios; Pescarin, Matilde; Coluccio, Chiara; Lindley, Keith J; Borrelli, Osvaldo

    2015-12-01

    We evaluated the effect of bowel preparation on colonic transit time (CTT) measured by the radio-opaque marker test in children with constipation. All children underwent 2 radio-opaque marker-CTT tests, both in cleansed and uncleansed bowel state. Our findings confirm that the state of colonic fecal filling may significantly influence CTT. Copyright © 2015. Published by Elsevier Inc.

  9. Short bowel syndrome.

    LENUS (Irish Health Repository)

    Donohoe, Claire L

    2012-02-01

    The short bowel syndrome (SBS) is a state of malabsorption following intestinal resection where there is less than 200 cm of intestinal length. The management of short bowel syndrome can be challenging and is best managed by a specialised multidisciplinary team. A good understanding of the pathophysiological consequences of resection of different portions of the small intestine is necessary to anticipate and prevent, where possible, consequences of SBS. Nutrient absorption and fluid and electrolyte management in the initial stages are critical to stabilisation of the patient and to facilitate the process of adaptation. Pharmacological adjuncts to promote adaptation are in the early stages of development. Primary restoration of bowel continuity, if possible, is the principle mode of surgical treatment. Surgical procedures to increase the surface area of the small intestine or improve its function may be of benefit in experienced hands, particularly in the paediatric population. Intestinal transplant is indicated at present for patients who have failed to tolerate long-term parenteral nutrition but with increasing experience, there may be a potentially expanded role for its use in the future.

  10. Advances in small bowel transplantation

    OpenAIRE

    Gürkan, Alp

    2017-01-01

    Small bowel transplantation is a life-saving surgery for patients with intestinal failure. The biggest problem in intestinal transplantation is graft rejection. Graft rejection is the main reason for morbidity and mortality. Rejection has a negative effect on the survival of the graft. While 50%–75% of small bowel transplantation patients experience acute rejection, chronic rejection occurs in approximately 15% of patients. Immune monitoring is crucial after small bowel transplantation. Unlik...

  11. Preoperative mechanical preparation of the colon: the patient's experience

    Directory of Open Access Journals (Sweden)

    Arodell Malin

    2007-05-01

    Full Text Available Abstract Background Preoperative mechanical bowel preparation can be questioned as standard procedure in colon surgery, based on the result from several randomised trials. Methods As part of a large multicenter trial, 105 patients planned for elective colon surgery for cancer, adenoma, or diverticulitis in three hospitals were asked to complete a questionnaire regarding perceived health including experience with bowel preparation. There were 39 questions, each having 3 – 10 answer alternatives, dealing with food intake, pain, discomfort, nausea/vomiting, gas distension, anxiety, tiredness, need of assistance with bowel preparation, and willingness to undergo the procedure again if necessary. Results 60 patients received mechanical bowel preparation (MBP and 45 patients did not (No-MBP. In the MBP group 52% needed assistance with bowel preparation and 30% would consider undergoing the same preoperative procedure again. In the No-MBP group 65 % of the patients were positive to no bowel preparation. There was no significant difference between the two groups with respect to postoperative pain and nausea. On Day 4 (but not on Days 1 and 7 postoperatively patients in the No-MBP group perceived more discomfort than patients in the MBP group, p = 0.02. Time to intake of fluid and solid food did not differ between the two groups. Bowel emptying occurred significantly earlier in the No-MBP group than in the MBP group, p = 0.03. Conclusion Mechanical bowel preparation is distressing for the patient and associated with a prolonged time to first bowel emptying.

  12. Leven met Inflammatory Bowel Disease

    NARCIS (Netherlands)

    Duijvendijk J. van, [No Value

    2004-01-01

    Leven met Inflammatory Bowel Disease Inflammatory bowel disease (IBD) is de verzamelnaam voor Colitis ulcerosa en de ziekte van Crohn. Het zijn chronische darmontstekingen, waarvan de ziekteactiviteit wisselt en zich niet laat voorspellen. Door de lichamelijke klachten en het onvoorspelbare karakter

  13. Accuracy of abdominal auscultation for bowel obstruction

    DEFF Research Database (Denmark)

    Breum, Birger Michael; Rud, Bo; Kirkegaard, Thomas

    2015-01-01

    AIM: To investigate the accuracy and inter-observer variation of bowel sound assessment in patients with clinically suspected bowel obstruction. METHODS: Bowel sounds were recorded in patients with suspected bowel obstruction using a Littmann(®) Electronic Stethoscope. The recordings were processed...

  14. Ageing with neurogenic bowel dysfunction

    DEFF Research Database (Denmark)

    Nielsen, S D; Faaborg, Pia Møller; Finnerup, Nanna Brix

    2017-01-01

    at 18% in 1996 and 19% in 2015. During the 19-year period, there had been no significant change in the methods for bowel care, but 22 (20%) had undergone surgery for bowel dysfunction, including 11 (10%) who had some form of stoma. Conclusion: Self-assessed severity of constipation increased but quality...... of life remained stable in a cohort of people with SCI followed prospectively for 19 years. Methods for bowel care remained surprisingly stable but a large proportion had undergone stoma surgery....

  15. Short bowel syndrome in adults

    DEFF Research Database (Denmark)

    Matarese, Laura E; Jeppesen, Palle B; O'Keefe, Stephen J D

    2014-01-01

    Short bowel syndrome (SBS) is a heterogeneous disorder with broad variation in disease severity arising from different types of intestinal resection. The spectrum of malabsorption ranges from intestinal insufficiency to intestinal failure. Individualized patient strategies involving modifications...

  16. Bowel Control Problems (Fecal Incontinence)

    Science.gov (United States)

    ... System & How it Works Zollinger-Ellison Syndrome Bowel Control Problems (Fecal Incontinence) View or Print All Sections ... NIDDK would like to thank: William E. Whitehead, Ph.D., University of North Carolina School of Medicine ...

  17. IRRITATED BOWEL SYNDROME IN CHILDREN

    Directory of Open Access Journals (Sweden)

    V. F. Privorotskiy

    2012-01-01

    Full Text Available Irritated bowel syndrome is a significant and underestimated problem in childhood. This condition is not so good studied in pediatrics in comparison with adult practice. Pediatricians often diagnosed this disease in infants and young children without proper reasons. The authors analyze current opinions about etiology and pathogenesis, clinical presentation, diagnosticsand treatment of irritated bowel syndrome in children. An emphasis is made on diagnostic criteria, which allow suggesting and confirming the diagnosis.

  18. Mebeverine alters small bowel motility in irritable bowel syndrome.

    Science.gov (United States)

    Evans, P R; Bak, Y T; Kellow, J E

    1996-10-01

    Despite its widespread use in irritable bowel syndrome (IBS), limited clinical data exist on the effects of mebeverine hydrochloride on gastrointestinal motility. Human motor activity in the small bowel is more reproducible than that in the large bowel; therefore the aim of this study was to determine in the small bowel the effects of oral mebeverine in both IBS patients and in healthy controls. Twelve IBS patients (11 females/1 male, 46 +/- 13 years old)-predominant constipation (IBS-C, n = 6) and predominant diarrhoea (IBS-D, n = 6)-and six healthy controls, underwent continuous 48 h ambulant recording of small bowel motor activity. One low energy (400 kcal) and one high energy (800 kcal) standard meal were administered in each consecutive 24-h period. Subjects received, in blinded fashion, placebo tablets in the first 24 h then mebeverine 135 mg q.d.s. in the second 24 h. Mebeverine had no effect on parameters of small bowel motility in controls. In contrast, in both IBS-C (P = 0.01) and IBS-D (P mebeverine administration. Also, after mebeverine the proportion of the migrating motor complex cycle occupied by phase 2 was reduced in IBS-D (P = 0.01), while phase 2 burst frequency was reduced in IBS-C (P mebeverine, in the initial dosing period, has a normalizing effect in the small bowel in IBS, enhancing contractile activity in a similar fashion to 'prokinetic' agents, as well as producing alterations in motor activity consistent with an 'antispasmodic' effect.

  19. Irritable bowel syndrome: Is it "irritable brain" or "irritable bowel"?

    Directory of Open Access Journals (Sweden)

    Susanta Kumar Padhy

    2015-01-01

    Full Text Available Irritable bowel syndrome (IBS has been recognized as one of the most common and best studied disorders among the group of functional gastrointestinal disorders. It is a functional bowel disorder in which abdominal pain or discomfort is associated with defecation or a change in bowel habit. In the Western world, IBS appears to affect up to 20% of the population at any given time but in Asian countries, the median value of IBS prevalence defined by various criteria ranges between 6.5% and 10.1%, and community prevalence of 4% is found in North India. Those attending gastroenterology clinics represent only the tip of the iceberg. The disorder substantially impairs the quality of life, and the overall health-care costs are high. IBS has therefore gained increased attention from clinicians, researchers, and pharmaceutical industries. It is often frustrating to both patients and physicians as the disease is usually chronic in nature and difficult to treat. However, the understanding of IBS has been changing from time to time and still most of its concepts are unknown. In this review we have discussed, debated, and synthesized the evidence base, focusing on underlying mechanisms in the brain and bowel. We conclude that it is both brain and bowel mechanisms that are responsible. The clinical implication of such mechanisms is discussed.

  20. Inflammatory bowel disease: pathogenesis.

    Science.gov (United States)

    Zhang, Yi-Zhen; Li, Yong-Yu

    2014-01-07

    Inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, is characterized by chronic relapsing intestinal inflammation. It has been a worldwide health-care problem with a continually increasing incidence. It is thought that IBD results from an aberrant and continuing immune response to the microbes in the gut, catalyzed by the genetic susceptibility of the individual. Although the etiology of IBD remains largely unknown, it involves a complex interaction between the genetic, environmental or microbial factors and the immune responses. Of the four components of IBD pathogenesis, most rapid progress has been made in the genetic study of gut inflammation. The latest internationally collaborative studies have ascertained 163 susceptibility gene loci for IBD. The genes implicated in childhood-onset and adult-onset IBD overlap, suggesting similar genetic predispositions. However, the fact that genetic factors account for only a portion of overall disease variance indicates that microbial and environmental factors may interact with genetic elements in the pathogenesis of IBD. Meanwhile, the adaptive immune response has been classically considered to play a major role in the pathogenesis of IBD, as new studies in immunology and genetics have clarified that the innate immune response maintains the same importance in inducing gut inflammation. Recent progress in understanding IBD pathogenesis sheds lights on relevant disease mechanisms, including the innate and adaptive immunity, and the interactions between genetic factors and microbial and environmental cues. In this review, we provide an update on the major advances that have occurred in above areas.

  1. Transition of adolescents with inflammatory bowel disease from pediatric to adult care: a survey of adult gastroenterologists

    NARCIS (Netherlands)

    Hait, Elizabeth J.; Barendse, Renée M.; Arnold, Janis H.; Valim, Clarissa; Sands, Bruce E.; Korzenik, Joshua R.; Fishman, Laurie N.

    2009-01-01

    Transition of patients with inflammatory bowel disease (IBD) from pediatric to adult providers requires preparation. Gastroenterologists for adult patients ("adult gastroenterologists") may have expectations of patients that are different from those of pediatric patients. We sought to explore the

  2. Capsule endoscopy of the small bowel

    Science.gov (United States)

    Ching, Hey-Long; Yung, Diana; Sidhu, Reena; Koulaouzidis, Anastasios

    2016-01-01

    Capsule endoscopy (CE) is a first line small bowel investigative modality which provides more sensitive mucosal imaging than comparators. It is a non-invasive, non-irradiating tool well tolerated by patients. The risk of retention of the capsule can be minimised by ensuring luminal patency using the Agile patency device. Research continues into how to minimise missed pathology and variability in the identification of pathology or interpretation of images. The consensus is that bowel preparation using laxatives improves visibility and diagnostic yield. Research includes the development of image recognition software, both to eliminate sequentially identical images to improve viewing speed and to select or enhance images likely to represent pathology. However, careful reading by experienced capsule endoscopists remains the benchmark. This should be performed at a speed comfortable to the viewer, probably at a maximum of 15 frames per second. Some prior experience of endoscopy appears to be helpful for novice capsule endoscopists and formal training on a hands-on training course seems to improve pathology recognition, for novices and for those with CE experience. PMID:27826572

  3. Lubiprostone neither decreases gastric and small-bowel transit time nor improves visualization of small bowel for capsule endoscopy: a double-blind, placebo-controlled study.

    Science.gov (United States)

    Hooks, S Bennett; Rutland, Travis J; Di Palma, Jack A

    2009-11-01

    Lubiprostone, a selective activator of type 2 chloride channels, is approved for treatment of chronic idiopathic constipation and recently constipation-predominant irritable bowel syndrome. It has been suggested that lubiprostone has a prokinetic effect. This investigation was designed to evaluate lubiprostone as a preparation and propulsive agent for small-bowel capsule endoscopy. The PillCam Small Bowel capsule endoscopy system with the PillCam SB1 capsule and Rapid 5 software platform were used. The study was designed as a double-blind, placebo-controlled trial. Forty healthy adults. Gastric transit time (GTT), small-bowel transit time (SBTT), and adequacy of small-bowel cleansing preparation. The study subjects received 24 mug lubiprostone or placebo 30 minutes before PillCam capsule ingestion. Capsule endoscopy studies were read by 2 independent investigators unaware of the study medication received, and differences in interpretation were resolved by consensus. Anatomical landmarks were identified, and GTT and SBTT were calculated. Overall preparation quality assessment of the proximal, mid, and distal small bowel was determined by using a 4-step scale. The percentage of visualized bowel was determined by review of 10-minute video segments at 1-hour intervals after the capsule passed through the pylorus. In the lubiprostone group (n = 20), 2 subjects did not pass the capsule through the pylorus in the 8-hour battery life of the capsule. An additional 3 capsules did not pass into the colon. In the placebo group (n = 20), all capsules passed into the small bowel, but 1 did not pass into the colon. The subjects in whom the capsule did not pass into the small bowel were excluded from the small-bowel analysis. In the subjects in whom the capsule did reach the colon, the SBTT could not be calculated and they were excluded from SBTT analysis. The mean GTT in the lubiprostone group was 126 minutes and 43 minutes in the placebo group (P = .0095). The mean SBTT in the

  4. Tumours in the Small Bowel

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    N. Kurniawan

    2014-01-01

    Full Text Available Small bowel tumours are rare and originate from a wide variety of benign and malignant entities. Adenocarcinomas are the most frequent primary malignant small bowel tumours. Submucosal tumours like gastrointestinal stromal tumours (GIST or neuroendocrine tumours (NET may show a central umbilication, pathologic vessels, bridging folds or an ulceration of the overlying mucosa. These signs help to differentiate them from harmless bulges caused by impression from outside, e.g. from other intestinal loops. Sarcomas of the small bowel are rare neoplasias with mesenchymal origin, sometimes presenting as protruding masses. Benign tumours like lipoma, fibrolipoma, fibroma, myoma, and heterotopias typically present as submucosal masses. They cannot be differentiated endoscopically from those with malignant potential as GIST or NET. Neuroendocrine carcinomas may present with diffuse infiltration, which may resemble other malignant tumours. The endoscopic appearance of small bowel lymphomas has a great variation from mass lesions to diffuse infiltrative changes. Melanoma metastases are the most frequent metastases to the small bowel. They may be hard to distinguish from other tumours when originating from an amelanotic melanoma.

  5. Development and validation of the Bowel Cleansing Impact Review (BOCLIR).

    Science.gov (United States)

    Doward, Lynda; Wilburn, Jeanette; McKenna, Stephen P; Leicester, Roger; Epstein, Owen; Hedley, Vicki; Korala, Sanjeeva; Twiss, James; Jones, Deborah; Geraint, Mike

    2013-04-01

    Acceptability and tolerability of bowel cleansers influence whether patients are able to complete the prescribed dose and, consequently, the quality of the cleansing achieved. No standardised means of assessing patients' experience of using bowel cleansing is currently available. The aim of the study was to develop the Bowel Cleansing Impact Review (BOCLIR) to assess patient response to bowel cleansing products. Content was derived from qualitative interviews. Face and content validity were assessed via cognitive-debriefing interviews. Finally, patients completed the BOCLIR and a demographic questionnaire. Item response theory (Rasch analysis) was employed for item reduction and assessment of unidimensionality. Internal consistency and construct validity were also assessed. Analysis of 40 interviews resulted in the production of three scales; patient satisfaction, symptomatic impact and activity limitations. Scales were designed to be used alone or together. 19 debriefing interviews demonstrated BOCLIR acceptability, relevance and ease of completion. The validation survey involved 166 patients (52% male, mean (SD) age 54.3 (15.2) years). After misfitting and redundant items were removed all scales fit the Rasch model confirming their unidimensionality. Cronbach's α-coefficients were high (0.77-0.94) indicating good internal consistency. Scores on the BOCLIR were related to patients' willingness to use the product in future and ease of drinking the full preparation (p<0.01 for each scale). The BOCLIR is a new measure consisting of three unidimensional scales (satisfaction, symptoms and activity limitations) with good psychometric and scaling properties. The BOCLIR will allow accurate assessment of patients' response to bowel cleansing preparations.

  6. Primary small bowel anastomosis in generalised peritonitis

    NARCIS (Netherlands)

    deGraaf, JS; van Goor, Harry; Bleichrodt, RP

    Objective: To find out if primary small bowel anastomosis of the bowel is safe in patients with generalised peritonitis who are treated by planned relaparotomies. Design: Retrospective study. Setting: University hospital, The Netherlands. Subjects. 10 Patients with generalised purulent peritonitis

  7. Inflammatory Bowel Disease (IBD) and Pregnancy

    Science.gov (United States)

    Inflammatory Bowel Disease In every pregnancy, a woman starts out with a 3-5% chance of having a baby ... risk. This sheet talks about whether exposure to inflammatory bowel disease may increase the risk for birth defects over ...

  8. Laparoscopic Bowel Injuries Among Gynecologic Patients

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    Francisco A. R. Garcia

    1997-01-01

    Full Text Available Bowel injury is an uncommon but recognized risk of operative laparoscopy. Because of the significant morbidity that can occur with this complication, it is important that clinicians be aware of its incidence, presentation, and management. This manuscript outlines the common causes of bowel injury, including herniation and traumatic bowel perforation. Management of laparoscopic bowel injuries is discussed and recommendations are made for avoidance of such complications.

  9. Inflammatory bowel disease and pregnancy.

    Science.gov (United States)

    Maliszewska, Anna Małgorzata; Warska, Aleksandra; Cendrowski, Krzysztof; Sawicki, Włodzimierz

    2017-01-01

    Inflammatory bowel disease (IBD) comprising Crohn's disease (CD), ulcerative colitis (UC), and IBD-unclassified (IBD-U) may appear at any age. As such, IBD commonly affects young patients in their reproductive age. Rate of voluntary childlessness among women with IBD far exceed that of the general population, as patients with IBD fear not only the effect of pregnancy on the course of inflammatory bowel disease, but also the increased risk of the offspring developing the disease, adverse pregnancy outcomes, the effect IBD treatment may have on the health and development of the infant or the risk of relapse during pregnancy and the influence of lactation on child development and disease course. This article aims at improving pre-conception counseling of patients with inflammatory bowel disease.

  10. Irritable bowel syndrome in primary care

    NARCIS (Netherlands)

    Bijkerk, C.J.

    2008-01-01

    Irritable bowel syndrome (IBS) is a functional bowel disorder in which abdominal pain or discomfort is associated with a change in bowel habit, or with features of disordered defecation. Patients and doctors in primary care generally agree on IBS symptomatology and consider pain and bloating as its

  11. Perforated small bowel in omphalocele at birth

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    Kale R

    2006-01-01

    Full Text Available The rupture of an omphalocele sac during birth is a well recognized entity. The associated lesions due to vascular compromise can result in necrosis of the bowel with perforation. Spontaneous bowel perforation in an omphalocele at birth is not reported in the literature. We describe a case with bowel perforation at the fundus of an omphalocele in a newborn.

  12. Cutaneous Manifestations in Inflammatory Bowel Diseases

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    Simona Roxana Georgescu

    2015-10-01

    Full Text Available Inflammatory bowel diseases have a high frequency in Europe. They are chronic disorders that evolve with relapses and remissions. Clinical features include the signs of underlying inflammatory bowel disease and also signs of extraintestinal manifestations. Cutaneous disorders are the most common extraintestinal manifestations associated with inflammatory bowel diseases, which can be dependent on or independent of gastrointestinal disease activity. The main cutaneous disorders are erythema nodosum and pyodermagangrenosum. The pathogenic mechanisms are not fully understood but it seems that related mechanisms are involved in the development of inflammatory bowel diseases and extraintestinal manifestations. Treatment should be aimed at both the cutaneous manifestations and the bowel inflammation

  13. Whole bowel irrigation: experience in pediatric patients.

    Science.gov (United States)

    Vila, J J; Gutierrez, C; Garcia-Sala, C; Ruiz, S

    1987-05-01

    Whole bowel irrigation (WBI) was used in 50 children aged 16 months to 14 years in preparation for surgery (n = 30) and colonoscopy (n = 20). The patients were divided into three groups according to age: group A, 12 to 36 months; group B, 3 to 6 years; and group C, 6 to 14 years. A hydroelectrolytic solution (Na 150 mEq/L, K 30 mEq/L, Cl 130 mEq/L, HCO3 50 mEq/L) was administered to all the groups at a variable rate established according to tolerance, weight, and age. Neomycin (1 g) and erythromycin (50 mg/kg) were administered in the last liter of the solution of the patients being prepared for colorectal surgery. Vital signs (heartbeat, arterial tension, and central venous pressure) and blood parameters (Na, K, HCO3, pH, and Hct) were assessed before and after irrigation and remained stable in all the groups. The rate of administration of the solution was best tolerated in each group as follows: group A, 75 mL/kg/h; group B, 60 mL/kg/h; and group C, 45 mL/kg/h. Colonic preparation was satisfactory in 49 of the 50 cases. Postoperative infectious complications were reduced to 3.3%. WBI in pediatric patients is a fast, simple, and well-tolerated method that gets a colon in excellent condition for surgery and colonoscopy exploration and considerably decreases the number of postoperative complications.

  14. Capsule endoscopy: Beyond small bowel

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    Samuel N Adler

    2012-01-01

    Full Text Available In this article the brief and dramatic history of capsule endoscopy of the digestive tract is reviewed. Capsule endoscopy offers a non invasive method to diagnose diseases that affect the esophagus, small bowel and colon. Technological improvements relating to optics, software, data recorders with two way communication have revolutionized this field. These advancements have produced better diagnostic performance.

  15. Radiological Evaluation of Bowel Ischemia

    Science.gov (United States)

    Dhatt, Harpreet S.; Behr, Spencer C; Miracle, Aaron; Wang, Zhen Jane; Yeh, Benjamin M.

    2015-01-01

    Intestinal ischemia, which refers to insufficient blood flow to the bowel, is a potentially catastrophic entity that may require emergent intervention or surgery in the acute setting. Although the clinical signs and symptoms of intestinal ischemia are nonspecific, CT findings can be highly suggestive in the correct clinical setting. In this chapter we review the CT diagnosis of arterial, venous, and non-occlusive intestinal ischemia. We discuss the vascular anatomy, pathophysiology of intestinal ischemia, CT techniques for optimal imaging, key and ancillary radiological findings, and differential diagnosis. In the setting of an acute abdomen, rapid evaluation is necessary to identify intraabdominal processes that require emergent surgical intervention (1). While a wide-range of intraabdominal diseases may be present from trauma to inflammation, one of the most feared disorders is mesenteric ischemia, also known as intestinal ischemia, which refers to insufficient blood flow to the bowel (2). Initial imaging evaluation for intestinal ischemia is typically obtained with CT. Close attention to technique and search for key radiologic features with relation to the CT technique is required. Accurate diagnosis depends on understanding the vascular anatomy, epidemiology, and pathophysiology of various forms of mesenteric ischemia and their corresponding radiological findings on MDCT. At imaging, not only is inspection of the bowel itself important, but evaluation of the mesenteric fat, vasculature, and surrounding peritoneal cavity also helps improves accuracy in the diagnosis of bowel ischemia. PMID:26526436

  16. Evaluation of bowel distension and bowel wall visualization according to patient positions during administration of oral contrast media for CT enterography.

    Science.gov (United States)

    Lee, Seul Bi; Kim, Seung Ho; Son, Jung Hee; Baik, Ji Yeon

    2017-12-01

    To compare small bowel distension and bowel wall visualization among three different patients' positions (supine, sitting and right decubitus) during administration of oral contrast media in preparation for CT enterography (CTE). A total of 150 consecutive patients (104 males and 46 females; mean age 34.6 years, range 15-78 years) who were scheduled to undergo CTE were recruited. Patients were randomly allocated into the three position groups during oral contrast media administration, and there were 50 patients in each group. Two blinded radiologists independently scored the luminal distension and visualization of the bowel wall using a continuous 5-point scale (1: worst and 5: best) at the jejunum and ileum. The Mann-Whitney U test was used to evaluate differences between any two groups among the three positions for bowel distension and wall visualization. For ileal distension, the supine and sitting positions performed better than the right decubitus position [for reader 1, mean: 3.4/3.2/2.9 (hereafter, supine/sitting/right decubitus in order), p = 0.002/0.033; for reader 2, 3.3/3.0/2.6, p 0.05, respectively). For bowel wall visualization, the supine and sitting positions were superior to the right decubitus position for the ileum when scored by one reader (4.0/3.8/3.4, p = 0.001/0.015). Supine and sitting positions during the administration of oral contrast media provided better ileal distension than the right decubitus position in obtaining CTE. Advances in knowledge: The performance of CTE largely depends on adequate luminal distension and wall visualization. As the terminal ileum is the predominant site of small bowel pathology for inflammatory bowel disease, the supine or sitting position would be preferable for patients who are suspected of having small bowel pathology.

  17. Bowel resection in Nigerian children

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    Abdur-Rahman L

    2009-01-01

    Full Text Available Background : Although bowel resections are commonly done for congenital malformations in children in developed countries, they usually follow neglected and preventable acquired diseases of the intestine in developing countries. Objectives : To determine the indications and outcome of bowel resections in children of a developing country in a university teaching hospital. Materials and Methods: Data of the patients operated (from birth to 15 years was retrospectively collected over eight years (January 1999 to December 2006. The biodata of children included the following: Indications for operation, type of operations, duration of admission, and outcome of treatment including complications. Patients with Hirschsprung′s disease were excluded from the study because bowel resection forms part of their definitive surgical management. Results : There were 70 patients (38 boys and 32 girls. The age ranged between four hours to 15 years (median, five months. There were 16 (22.9% neonates, 26 (37.1% infants, and 28 (40% grown children. The indications were congenital anomalies in the 16 neonates. Also, 23 (88.5% infants had intussusception, 2 (7.7% had midgut vovulusm and 1 (3.8% had congenital small intestine band. Among the grown children, typhoid ileal perforation (TIP was seen in 14 (50.0%, intussusception in 5 (17.9%, and other causes in nine patients. Overall, intussusception was the most common indication for bowel resection, followed by TIP. A total of 24 patients developed 33 complications. Complications included wound infection in 47.8% and anastomotic leak in 42.8%. The duration of admission ranged between 4-35 days (median, 15 days. The overall mortality was 17.1% -; which was highest among neonates (56.3%, followed by the infants (26.9% -. Conclusion : Bowel resections are mainly done for intussusception and complications of TIP at our centre. Late presentation, preexisting malnutrition, and nonavailability of parenteral nutrition

  18. Review article: complementary and alternative therapies for inflammatory bowel disease.

    Science.gov (United States)

    Langmead, L; Rampton, D S

    2006-02-01

    Complementary and alternative medicine includes a wide range of practices and therapies outside the realms of conventional western medicine. Despite a lack of scientific data in the form of controlled trials for either efficacy or safety of complementary and alternative medicine, use by patients with inflammatory bowel disease, particularly of herbal therapies, is widespread and increasing. There is limited controlled evidence indicating efficacy of traditional Chinese medicines, aloe vera gel, wheat grass juice, Boswellia serrata and bovine colostrum enemas in ulcerative colitis. Encouraging results have also been reported in small studies of acupuncture for Crohn's disease and ulcerative colitis. Contrary to popular belief, natural therapies are not necessarily safe: fatal hepatic and irreversible renal failure have occurred with some preparations and interactions with conventional drugs are potentially dangerous. There is a need for further controlled clinical trials of the potential efficacy of complementary and alternative approaches in inflammatory bowel disease, together with enhanced legislation to maximize their quality and safety.

  19. Interdigestive migrating contraction in short bowel dogs.

    Science.gov (United States)

    Takeuchi, S; Aizawa, I; Takayanagi, R; Itoh, Z

    1980-01-01

    Extraluminal force transducers were chronically implanted onto the serosal surface of the gastrointestinal tract in dogs and the interdigestive migrating contractions (IMC) were studied in conscious dogs. When the IMC occurring periodically in the stomach reaches the distal ileum, the next IMC develops in the stomach. We therefore studied the effect of isolation or resection of the lower third of the small bowel on the periodic occurrence of IMC in the stomach. Transducers were sutured onto the antrum, the upper jejunum, the mid intestine and the terminal ileum. After control records on gastrointestinal motility were made for these dogs, the abdominal cavity was again opened to prepare a Thiry loop in the lower third of the small bowel. (isolation group) Next, the loop was removed (resection group) and gastrointestinal motility was recorded. In these groups, we 1) measured the time from the feeding to the initiation of the first IMC. 2) measured the time from the termination of one IMC to the termination of the next IMC. 3) measured the migrating time of the IMC. 4) and measured the duration of the IMC in the stomach. As a result, it was found that the time interval between the termination of one IMC in the stomach and the termination of the next was almost constant throughout all experiments. The migrating time of the IMC from the stomach to the terminal ileum in isolation and resection groups was slightly shortened. These findings indicate that the existence of the lower gut has no significant influence upon the regular periodic occurrence of the IMC in the stomach and the migrating time.

  20. What do patients with irritable bowel syndrome dream about? A comparison with inflammatory bowel disease.

    Science.gov (United States)

    Lal, S; Whorwell, P J

    2002-07-01

    It is a common experience for people to dream of events about which they are either anxious or concerned. We therefore hypothesised that the dreams of patients with irritable bowel syndrome may reflect their worries about their problem especially as hospital out-patients with this disorder tend to exhibit some anxiety. In addition, dreaming about, for instance bowels, in patients with irritable bowel syndrome in excess of that observed in other gastrointestinal disorders may be of importance. To establish whether patients with irritable bowel syndrome dream about bowel-related issues more than controls or patients with inflammatory bowel disease. A total of 57 patients with irritable bowel syndrome and 57 patients with inflammatory bowel disease were compared with 60 healthy controls. All subjects completed a structured questionnaire concerning sleeping habits and dream characteristics as well as an assessment of anxiety and depression. There were no differences in the sleeping habits between any of the groups. However, significantly more patients with irritable bowel syndrome and inflammatory bowel disease dreamt about their bowels (22% inflammatory bowel disease patients, 18% irritable bowel syndrome patients vs 3% of controls, p disorders, of both a functional and organic nature, may influence the nature of dreams. In those patients who dream about their symptoms, it would be interesting to know whether this affects the course of their disease, either positively or negatively, in any way.

  1. Whole-bowel transit in patients with the irritable bowel syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Hardy, J.G.; Clark, A.G.; Wood, E.; Reynolds, J.R.

    1986-02-01

    The transit of radiolabelled preparations through the stomach, small intestine and colon was monitored in ten patients with the irritable bowel syndrome. Five patients complained of diarrhoea, and five complained of constipation. The preparations comprised a non-disintegrating capsule and a multiparticulate system. Both preparations emptied from the stomach together and at the same rates in both groups of patients. In the patients complaining of constipation, the transit times through the small intestine were the same for both preparations. In the patients complaining of diarrhoea, the capsule passed through the small intestine slightly faster than the particles, but there were no significant differences in the small-intestinal transit rates of the two patient groups. Within the colon, the transit of the capsule was faster than that of the small particles. Although movement through the colon was, on average, faster in the group of patients complaining of diarrhoea, there was considerable intersubject variability, and the differences in transit rates between the two patient groups were not statistically significant. (orig.).

  2. Nutrition in inflammatory bowel disease.

    Science.gov (United States)

    Stein, R B; Lichtenstein, G R; Rombeau, J L

    1999-09-01

    Clinical and basic research continues to expand our understanding of the complex pathogenesis of inflammatory bowel diseases. The potential roles played by fatty acid intake, serum leptin, and nitric oxide in the promotion of intestinal inflammation in Crohn's disease and ulcerative colitis will be reviewed. In addition, important advances in the areas of bone disease, vitamin deficiency, growth failure, and home parenteral nutrition will be discussed.

  3. Mesalazine in inflammatory bowel disease: A trendy topic once again?

    Science.gov (United States)

    Iacucci, Marietta; de Silva, Shanika; Ghosh, Subrata

    2010-01-01

    5-aminosalicylic acid (5-ASA) preparations (eg, mesalazine, mesalamine) are well-established preparations used in the management of inflammatory bowel disease. These drugs are most useful for the treatment of mild to moderate flares of ulcerative colitis and, especially, for maintenance of remission. Although most gastroenterologists are very familiar with these drugs, the interest in these drugs has undergone a resurgence, with new preparations offering convenience and high dosage, while preserving their customary safety. New dosage regimens are likely to become standard practice in the near future. There is also considerable interest in chemoprevention of colorectal cancer in the context of inflammatory bowel disease, and the role of long-term maintenance therapy with 5-ASAs in achieving such chemoprevention. A mechanism of action for such chemoprevention has been provided by the agonism of the peroxisome proliferator-activated receptor-gamma by 5-ASA, which unifies its efficacy as an anti-inflammatory and chemopreventive agent. In the future, even more effective agents based on 5-ASA are expected, based on more powerful agonism of peroxisome proliferator-activated receptor-gamma; 5-ASA preparations have become ‘trendy’ again. PMID:20151072

  4. Inflammatory Bowel Disease in Primary Immunodeficiencies.

    Science.gov (United States)

    Kelsen, Judith R; Sullivan, Kathleen E

    2017-08-01

    Inflammatory bowel disease is most often a polygenic disorder with contributions from the intestinal microbiome, defects in barrier function, and dysregulated host responses to microbial stimulation. There is, however, increasing recognition of single gene defects that underlie a subset of patients with inflammatory bowel disease, particularly those with early-onset disease, and this review focuses on the primary immunodeficiencies associated with early-onset inflammatory bowel disease. The advent of next-generation sequencing has led to an improved recognition of single gene defects underlying some cases of inflammatory bowel disease. Among single gene defects, immune response genes are the most frequent category identified. This is also true of common genetic variants associated with inflammatory bowel disease, supporting a pivotal role for host responses in the pathogenesis. This review focuses on practical aspects related to diagnosis and management of children with inflammatory bowel disease who have underlying primary immunodeficiencies.

  5. Neurostimulation for Neurogenic Bowel Dysfunction

    Directory of Open Access Journals (Sweden)

    J. Worsøe

    2013-01-01

    Full Text Available Background. Loss of normal bowel function caused by nerve injury, neurological disease or congenital defects of the nervous system is termed neurogenic bowel dysfunction (NBD. It usually includes combinations of fecal incontinence, constipation, abdominal pain and bloating. When standard treatment of NBD fails surgical procedures are often needed. Neurostimulation has also been investigated, but no consensus exists about efficacy or clinical use. Methods. A systematic literature search of NBD treated by sacral anterior root stimulation (SARS, sacral nerve stimulation (SNS, peripheral nerve stimulation, magnetic stimulation, and nerve re-routing was made in Pubmed, Embase, Scopus, and the Cochrane Library. Results. SARS improves bowel function in some patients with complete spinal cord injury (SCI. Nerve re-routing is claimed to facilitate defecation through mechanical stimulation of dermatomes in patients with complete or incomplete SCI or myelomeningocele. SNS can reduce NBD in selected patients with a variety of incomplete neurological lesions. Peripheral stimulation using electrical stimulation or magnetic stimulation may represent non-invasive alternatives. Conclusion. Numerous methods of neurostimulation to treat NBD have been investigated in pilot studies or retrospective studies. Therefore, larger controlled trials with well-defined inclusion criteria and endpoints are recommended before widespread clinical use of neurostimulation against NBD.

  6. Transabdominal Ultrasonography of the Small Bowel

    OpenAIRE

    Rudolf Kralik; Peter Trnovsky; Marcela Kopáčová

    2013-01-01

    In the era of double balloon enteroscopy, capsule endoscopy, CT, and MRI enterography is transabdominal ultrasonography (TUS) underestimated method for evaluation of small bowel pathology. As often initial imagine method in abdominal complaints, nowadays has TUS much better diagnostic potential than two decades ago. High-resolution ultrasound probes with harmonic imaging significantly improve resolution of bowel wall in real time, with possibility to asses bowel peristalsis. Color flow dop...

  7. Non-small-bowel abnormalities identified during small bowel capsule endoscopy

    NARCIS (Netherlands)

    Hoedemakers, Reinier; Westerhof, Jessie; Weersma, Rinse K.; Koornstra, Jan J.

    2014-01-01

    AIM: To investigate the incidence of non-small-bowel abnormalities in patients referred for small bowel capsule endoscopy, this single center study was performed. METHODS: Small bowel capsule endoscopy is an accepted technique to investigate obscure gastrointestinal bleeding. This is defined as

  8. Definition and Facts for Irritable Bowel Syndrome

    Science.gov (United States)

    ... For Health Professionals Diabetes Discoveries & Practice Blog Health Communication Programs FAQs ... Syndrome (IBS) Definition & Facts Related Topics Section Navigation Irritable Bowel Syndrome ( ...

  9. Lubiprostone improves visualization of small bowel for capsule endoscopy: a double-blind, placebo-controlled 2-way crossover study.

    Science.gov (United States)

    Matsuura, Mizue; Inamori, Masahiko; Inou, Yumi; Kanoshima, Kenji; Higurashi, Takuma; Ohkubo, Hidenori; Iida, Hiroshi; Endo, Hiroki; Nonaka, Takashi; Kusakabe, Akihiko; Maeda, Shin; Nakajima, Atsushi

    2017-06-01

     Lubiprostone has been reported to be an anti-constipation drug. The aim of the study was to investigate the usefulness of lubiprostone both for bowel preparation and as a propulsive agent in small bowel endoscopy.  This was a double-blind, placebo-controlled, 2-way crossover study of subjects who volunteered to undergo capsule endoscopy (CE). A total of 20 subjects (16 male and 4 female volunteers) were randomly assigned to receive a 24-μg tablet of lubiprostone 120 minutes prior to capsule ingestion for CE (L regimen), or a placebo tablet 120 minutes prior to capsule ingestion for CE (P regimen). Main outcome was gastric transit time (GTT) and small-bowel transit time (SBTT). Secondary outcome was adequacy of small-bowel cleansing and the fluid score in the small bowel. The quality of the capsule endoscopic images and fluid in the small bowel were assessed on 5-point scale.  The capsule passed into the small bowel in all cases. Median GTT was 57.3 (3 - 221) minutes for the P regimen and 61.3 (10 - 218) minutes for the L regimen ( P  = 0.836). Median SBTT was 245.0 (164 - 353) minutes for the P regimen and 228.05 (116 - 502) minutes for the L regimen ( P  = 0.501). The image quality score in the small bowel was 3.05 ± 1.08 for the P regimen and 3.80 ± 0.49 for the L regimen ( P  lubiprostone prior to CE significantly improved visualization of the small bowel during CE as a result of inducing fluid secretion into the small bowel.

  10. Hypertrophic osteoarthropathy of chronic inflammatory bowel disease

    Energy Technology Data Exchange (ETDEWEB)

    Oppenheimer, D.A.; Jones, H.H.

    1982-12-01

    The case of a 14-year old girl with painful periostitis and ulcerative colitis is reported. The association of chronic inflammatory bowel disease with osteoarthropathy is rare and has previously been reported in eight patients. The periosteal reaction found in association with inflammatory bowel disease is apparently related to a chronic disease course and may cause extreme localized pain.

  11. Irritable Bowel Syndrome and Complementary Health Practices

    Science.gov (United States)

    ... approaches for the treatment of irritable bowel syndrome. Nutrition in Clinical Practice. 2008;23(3):284–292. Wu JC. Complementary and alternative medicine modalities for the treatment of irritable bowel syndrome: facts or myths? Gastroenterology & Hepatology. 2010;6(11):705–711. Yoon ...

  12. Pregnancy outcome in inflammatory bowel disease

    DEFF Research Database (Denmark)

    Bortoli, A; Pedersen, N; Duricova, D

    2011-01-01

    Inflammatory bowel disease (IBD) frequently affects women during their reproductive years. Pregnancy outcome in women with IBD is well described, particularly in retrospective studies.......Inflammatory bowel disease (IBD) frequently affects women during their reproductive years. Pregnancy outcome in women with IBD is well described, particularly in retrospective studies....

  13. Surgical perspectives on inflammatory bowel disease

    African Journals Online (AJOL)

    VikasC

    J. Inflammatory bowel disease in Towsend: Sabiston. Textbook of Surgery. ... 1998; 44:28991. 19. Xie J, Itzkowitz SH. Cancer in inflammatory bowel disease. World J Gastroenterol 2008;14:37889. 20. Roses RE, Rombeau JL. Recent trends in the surgical ... dyselectrolytemia, anemia, and malnutrition are commonly present.

  14. Childhood Inflammatory Bowel Disease in Libya: Epidemiological ...

    African Journals Online (AJOL)

    Background & Aims: Inflammatory bowel disease is thought to be rare in Libya. The aim is to determine the prevalence of juvenile onset inflammatory bowel disease in Libya. Setting: Al-Fateh childrens' hospital, Benghazi, Libya. Methods: This is a retrospective study of all cases diagnosed over 10 years (1997-2006) with ...

  15. Bowel injury as a complication of laparoscopy

    NARCIS (Netherlands)

    van der Voort, M.; Heijnsdijk, E. A. M.; Gouma, D. J.

    2004-01-01

    Background: Bowel injury is a rare but serious complication of laparoscopic surgery. This review examines the incidence, location, time of diagnosis, causative instruments, management and mortality of laparoscopy-induced bowel injury. Methods: The review was carried out using the MeSH browser within

  16. Heritability in inflammatory bowel disease

    DEFF Research Database (Denmark)

    Gordon, Hannah; Trier Moller, Frederik; Andersen, Vibeke

    2015-01-01

    estimation regard genetic and environmental variance as separate entities, although it is now understood that there is a complex multidirectional interplay between genetic are environmental factors mediated by the microbiota, the epigenome, and the innate and acquired immune systems. Due to the limitations...... of heritability estimates, it is unlikely that a true value for heritability will be reached. Further work aimed at quantifying the variance explained across GWAS, epigenome-wide, and microbiota-wide association studies will help to define factors leading to inflammatory bowel disease....

  17. [Pregnancy and inflammatory bowel disease].

    Science.gov (United States)

    Walldorf, J; Zwirnmann, K; Seufferlein, T

    2011-01-01

    Medical advice regarding the desire to have children and pregnancy in patients with inflammatory bowel disease (IBD) is often requested. The influence of IBD on pregnancy and--vice versa--of pregnancy on the activity of IBD is discussed. Based on three clinical cases the chances and limitations of medical treatment of CED during pregnancy are reviewed. Generally it is important to balance the therapy between the patients desire to be treated most effectively and to deliver a healthy child after an uncomplicated pregnancy. An interdisciplinary treatment is always advisable in patients with IBD and a desire to have children.

  18. [Inflammatory bowel disease and pregnancy].

    Science.gov (United States)

    Parfenov, A I

    2012-01-01

    Inflammatory bowel disease (IBD) in pregnant women in their characteristics do not differ from general population, unless they had operations on the pelvic organs. Women with a first pregnancy, regardless of the activity of IBD have an increased risk of adverse pregnancy and high risk births. Most treatment methods are compatible with pregnancy and breastfeeding. Women affected by IBD should discuss their plans for pregnancy with the doctor first in order to know the possible dangers. Every patient in the IBD during pregnancy must be observed by a gastroenterologist, accoucheur and pediatrician to ensure peace of mother and child.

  19. Rifaximin - Chitosan Nanoparticles for Inflammatory Bowel Disease (IBD).

    Science.gov (United States)

    Kumar, Jatinder; Newton, Amaldoss M J

    2017-01-01

    Inflammatory Bowel Disease (IBD) cannot be controlled easily and the recurrence is the most challenging issue for the physicians. There are various controlled and colon targeted drug delivery systems available for the treatment with limited success rate. Nanoparticles prepared by using the colon targeted polymers such as chitosan may improve the IBD due to their smaller size, unique physico chemical properties and targeting potential. The aim of this investigation was designed to formulate and develop a colon targeted polysaccharide nanoparticles of rifaximin (RFX) by using linear polysaccharide chitosan, for the improvement of rifaximin solubility, overall therapeutic efficacy and colon targeting. The research was focused on developing RFX nanoparticles for the treatment of Inflammatory Bowel Disease (IBD) by ionic gelation method. Nanoparticles were subjected to various characterization techniques such as XRD, FTIR and mean particle size (MPS) by Master Sizer and Zeta Sizer. Transmission Electron Microscopy (TEM), drug entrapment efficiency and zeta potential are also determined for the developed formulations. The efficiency of drug release from prepared formulation was studied in vitro by using a dialysis bag diffusion technique in the buffer condition mimicking stomach, intestine and colonic pH conditions. The prepared nanoparticles demonstrated the size in the nano range. The drug release profile was controlled in the upper GI tract and the maximum amount of drug was released in the colonic conditions. The prepared nanoparticles significantly improved the solubility of rifaximin. The zeta potential of the best chitosan preparation was found to be 37.79, which confirms the stability of prepared nanosuspension. Nanoparticles with small particle size found to have high encapsulation efficiency and relatively high loading capacity and predetermined in vitro release profile. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  20. Implications of probiotics in the treatment on functional bowel diseases in infants

    Directory of Open Access Journals (Sweden)

    Marushko RV

    2014-03-01

    Full Text Available Nowadayes in the treatment of most diseases of the gastrointestinal tract correction of microbiota is one of the important part of pathogenetic therapy. Studies of relationship between intestinal microbiota disorders and functional bowel diseases in infants are actually insufficient. Promising is the use of spores generating probiotics in functional bowel disease in infants Aim of this study was to evaluate the efficacy and safety of the preparation called «BiosporinBiopharma» in the treatment of functional bowel disorders in infants. Materials and methods. The study involved 86 children aged from 3 to 18 months of which 45 were children with functional constipation and 41 children with functional diarrhea. Underwent clinical and laboratory investigations, including bacteriological, biochemical (structural components of mucosal bar rier mucins. We studied the clinical efficacy of the drug «BiosporinBiopharma» — shores generating probiotic, which is composed of bacteria of the Bacillus genus (B. Subtilis, B. Licheniformis in young children. Results. Revealed characteristic clinical manifestations of functional constipation and functional diarrhea accompanied by severe disorders of intestinal microbial flora, reduction of the level main representatives of the indigenous microflora (Bifidobacterium, Lactobacillus and E. Coli and increasing the concentration of saprophytic microflora, opportunistic bacteria and fungal flora as well as changes in the status of mucin glycoproteins in intestinal mucosa. Using the preparation «BiosporinBiopharma» in a complex treatment of functional bowel disease had pronounced positive effect on the clinical course of functional bowel disorders, with improvement and normalization of the sntestinal microbial flora and the status protective mucosal barrier of the intestine. Conclusions. The results of studies on the effectiveness of the preparation «BiosporinBiopharma» allow us to recommend it for widespread

  1. Toxic megacolon presenting in the leukocyte scan as distended transverse bowel

    Energy Technology Data Exchange (ETDEWEB)

    Becker, W.; Pabst, C.; Boerner, W.

    1988-02-01

    We recommend the /sup 111/In-granulocyte scan as a possible non-invasive procedure without necessary preparations of the bowel in the follow-up. For primary diagnosis the scan is recommended in all situations where endoscopy or double-contrast studies are impossible or even contraindicated, as in acute pancolitis with the risk of bowel perforation, in rectum or sigma stenosis where colonoscopy cannot be performed, an in suspected abscesses. The diagnosis of an abscess demands sudden therapeutic intervention. Another emergency is the diagnosis of a toxic megacolon where scintigraphic images have not yet been published.

  2. Nutrigenomics and inflammatory bowel diseases.

    Science.gov (United States)

    Ferguson, Lynnette R

    2010-07-01

    The field of nutrigenomics recognizes gene-diet interactions, with regard to both the impact of genetic variation on nutrient requirements, and conversely nutrient regulation of the expression of genes. Crohn's disease and ulcerative colitis are inflammatory bowel diseases for which twin studies reveal genetic susceptibility that is impacted by diet and environment. Apparently contradictory data on the role of diet in inflammatory bowel disease would be entirely explainable if genetic variability determined dietary requirements and intolerances. Considering Crohn's disease, we recognize three major classes of genes. The first of these involves bacterial recognition through pattern recognition receptors and autophagy genes, while the second act through secondary immune response, and the third concern epithelial barrier integrity. Despite genetic overlap with CD, the first two groups of genes appear to be less important in ulcerative colitis, while other genes, particularly those involved in barrier function, gain prominence. Case-control studies suggest that these different genetic groups reflect distinct dietary requirements. Such studies suggest nutrigenomic approaches to maintaining disease remission at present, and preventing disease development in the future.

  3. Small Bowel Dissemination of Coccidioidomycosis

    Directory of Open Access Journals (Sweden)

    Shengmei Zhou

    2015-01-01

    Full Text Available Gastrointestinal coccidioidomycosis is extremely rare, with less than 10 cases reported in the literature. We report a case of small bowel dissemination of coccidioidomycosis in a 21-year-old African American male with a history of living in San Joaquin Valley. The patient presented with one week of abdominal pain, nausea, shortness of breath, intermittent fever, and sweat, and one month of abdominal distention. A chest radiograph revealed complete effusion of left lung. A computed tomography scan of the abdomen showed diffuse small bowel thickening and enhancement, as well as omental and peritoneal nodules, and ascites. The coccidioidal complement fixation titer was 1 : 256. The duodenal biopsy revealed many spherules filled with round fungal endospores. Later, blood fungal culture showed positivity for Coccidioides immitis. The final diagnosis is disseminated coccidioidomycosis involving lungs, blood, and duodenum. Despite aggressive antifungal therapy, the patient’s clinical situation deteriorated and he succumbed to multisystem organ failure one and half months later. A high index of suspicion for gastrointestinal coccidioidomycosis should be maintained in patients from an endemic area presenting as abdominal distention and pain.

  4. Combination could be another tool for bowel preparation?

    National Research Council Canada - National Science Library

    Jae Seung Soh Kyung-Jo Kim

    2016-01-01

    ...), and prokinetic agents(e.g., cisapride, mosapride, and itopride). A combination of PEG with an osmotic, stimulant, or prokinetic agent could effectively reduce the PEG solution volume and increase patients’ adherence...

  5. Understanding Microbial Sensing in Inflammatory Bowel Disease Using Click Chemistry

    Science.gov (United States)

    2016-10-01

    AWARD NUMBER: W81XWH-15-1-0368 TITLE: Understanding Microbial Sensing in Inflammatory Bowel Disease Using Click Chemistry PRINCIPAL...AND SUBTITLE with Click Chemistry : : Understanding Microbial Sensing in Inflammatory Bowel Disease with Click Chemistry Understanding Microbial...Sensing in Inflammatory Bowel Disease with Click Chemistry 5a. CONTRACT NUMBER Understanding Microbial Sensing in Inflammatory Bowel Disease Using Click

  6. Towards an integrated psychoneurophysiological approach of irritable bowel syndrome

    NARCIS (Netherlands)

    Veek, Patrick Petrus Johannes van der

    2009-01-01

    Irritable bowel syndrome (IBS) is a functional bowel disorder characterized by recurrent abdominal pain or discomfort accompanied by disturbed bowel habits. It is among the most frequently occurring functional bowel syndromes, but the pathophysiology is poorly understood. A variety of mechanisms

  7. Medicinal potions used against infectious bowel diseases in Mayan traditional medicine.

    Science.gov (United States)

    Vera-Ku, Marina; Méndez-González, Martha; Moo-Puc, Rosa; Rosado-Vallado, Miguel; Simá-Polanco, Paulino; Cedillo-Rivera, Roberto; Peraza-Sánchez, Sergio R

    2010-10-28

    Since one of the main health problems of the indigenous population are infectious bowel diseases, we decided to test Mayan medicinal potions used to treat these conditions against some of the causal agents. Thirty-one herbal formulations used for the treatment of infectious bowel diseases were prepared according to the collected ethnobotanical data. Their activities were tested against some of the causal agents of diarrheic symptoms, such as Entamoeba histolytica, Giardia lamblia, Escherichia coli, Klebsiella pneumoniae, Salmonella typhi and Shigella flexneri. Nine formulations were active against bacteria (MIC=0.5 mg/ml), four on Entamoeba histolytica, and seven on Giardia lamblia (IC(50)≤20 μg/ml). This work supports the use of the traditional Mayan formulations against some infectious bowel diseases, and it is the first step towards their study. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  8. Transabdominal Ultrasonography of the Small Bowel

    Directory of Open Access Journals (Sweden)

    Rudolf Kralik

    2013-01-01

    Full Text Available In the era of double balloon enteroscopy, capsule endoscopy, CT, and MRI enterography is transabdominal ultrasonography (TUS underestimated method for evaluation of small bowel pathology. As often initial imagine method in abdominal complaints, nowadays has TUS much better diagnostic potential than two decades ago. High-resolution ultrasound probes with harmonic imaging significantly improve resolution of bowel wall in real time, with possibility to asses bowel peristalsis. Color flow doppler enables evaluation of intramural bowel vascularisation, pulse wave doppler helps to quantificate flow in coeliac and superior mesenteric arteries. Small intestine contrast ultrasonography with oral contrast fluid, as well as contrast enhanced ultrasonography with intravenous microbubble contrast also improves small bowel imaging. We present a review of small intestine pathology that should be detected during ultrasound examinations, discuss technical requirements, advantages and limitations of TUS, typical ultrasound signs of Crohn's disease, ileus, celiac disease, intussusception, infectious enteritis, tumours, ischemic and haemorrhagic conditions of small bowel. In the hands of experienced investigator, despite some significant limitations(obesity, meteorism, is transabdominal ultrasonography reliable, noninvasive and inexpensive alternative method to computerised tomography (CT and magnetic resonance imaging (MRI in small bowel examination.

  9. Transabdominal ultrasonography of the small bowel.

    Science.gov (United States)

    Kralik, Rudolf; Trnovsky, Peter; Kopáčová, Marcela

    2013-01-01

    In the era of double balloon enteroscopy, capsule endoscopy, CT, and MRI enterography is transabdominal ultrasonography (TUS) underestimated method for evaluation of small bowel pathology. As often initial imagine method in abdominal complaints, nowadays has TUS much better diagnostic potential than two decades ago. High-resolution ultrasound probes with harmonic imaging significantly improve resolution of bowel wall in real time, with possibility to asses bowel peristalsis. Color flow doppler enables evaluation of intramural bowel vascularisation, pulse wave doppler helps to quantificate flow in coeliac and superior mesenteric arteries. Small intestine contrast ultrasonography with oral contrast fluid, as well as contrast enhanced ultrasonography with intravenous microbubble contrast also improves small bowel imaging. We present a review of small intestine pathology that should be detected during ultrasound examinations, discuss technical requirements, advantages and limitations of TUS, typical ultrasound signs of Crohn's disease, ileus, celiac disease, intussusception, infectious enteritis, tumours, ischemic and haemorrhagic conditions of small bowel. In the hands of experienced investigator, despite some significant limitations(obesity, meteorism), is transabdominal ultrasonography reliable, noninvasive and inexpensive alternative method to computerised tomography (CT) and magnetic resonance imaging (MRI) in small bowel examination.

  10. Musculoskeletal Manifestations in Inflammatory Bowel Disease

    Directory of Open Access Journals (Sweden)

    Giovanni Fornaciari

    2001-01-01

    Full Text Available Muscoloskeletal manifestations are the most common extraintestinal complications of inflammatory bowel disease. Wide ranges in prevalence have been reported, depending on the criteria used to define spondylarthropathy. In 1991, the European Spondylarthropathy Study Group developed classification criteria that included previously neglected cases of undifferentiated spondylarthropathies, which had been ignored in most of the oldest epidemiological studies on inflammatory bowel disease. The spectrum of muscoloskeletal manifestations in inflammatory bowel disease patients includes all of the clinical features of spondylarthropathies: peripheral arthritis, inflammatory spinal pain, dactylitis, enthesitis (Achilles tendinitis and plantar fasciitis, buttock pain and anterior chest wall pain. Radiological evidence of sacroiliitis is common but not obligatory. The articular manifestations begin either concomitantly or subsequent to the bowel disease; however, the onset of spinal disease often precedes the diagnosis of inflammatory bowel disease. The prevalence of the different muscoloskeletal manifestations is similar in ulcerative colitis and Crohn's disease. Symptoms usually disappear after proctocolectomy. The pathogenetic mechanisms that produce the muscoloskeletal manifestations in inflammatory bowel disease are unclear. Several arguments favour an important role of the intestinal mucosa in the development of spondylarthropathy. The natural history is characterized by periods of flares and remission; therefore, the efficacy of treatment is difficult to establish. Most patients respond to rest, physical therapy and nonsteroidal anti-inflammatory drugs, but these drugs may activate bowel disease. Sulphasalazine may be recommended in some patients. There is no indication for the systemic use of steroids.

  11. Intestino Corto Short bowel syndrome

    Directory of Open Access Journals (Sweden)

    María Matilde Socarrás Suárez

    2004-06-01

    Full Text Available El intestino corto está asociado a pérdida o disfunción del intestino delgado por resección del mismo, que causa diarreas, tránsito intestinal acelerado, malabsorción intestinal, y eventualmente la pérdida de peso y el desgaste muscular. El objetivo de este trabajo fue actualizar el conocimiento acerca de este síndrome. Se realiza una revisión del tema de intestino corto donde se refiere a su definición, causas fundamentales frecuentes e infrecuentes en el niño y en el adulto, cómo se adapta el intestino a la resección de diferentes extensiones, las funciones del íleon terminal. Se hacen una valoración clínica inicial, con el interrogatorio médico, revisión minuciosa de la historia clínica para cuantificar la capacidad de absorción. Se habla de los síntomas y signos de deficiencia nutricional. Se explican las estrategias del tratamiento, que tienen 3 etapas de evolución clínica. Se concluye que se indica la dietoterapia adecuada según el estado nutricional del paciente y la resección intestinal realizada, evitando las complicaciones para lograr una calidad máxima de vidaShort bowel is associated with loss or dysfunction of the small bowel due to its resection, which causes diarrheas, accelerated intestinal transit, intestinal malabsorption and, eventually, weight loss ansd muscular waste. The objective of this paper was to update knowledge about this syndrome. A review of the short intestine topic is made, making reference to its definition, common and uncommon main cuases in the child and adult, how the bowel adapts itslef to resection of different extensions, and the functions of the terminal ileum. An initial clinical assessment is made with the medical questionnaire and a detailed review of the medical history to quantify the absorption capacity. The symptoms and signs of nutritional deficiency are dealt with. The strategies of the treatment consisting of 3 stages of clinical evolution are explained. It is concluded

  12. Small-bowel permeability in collagenous colitis

    DEFF Research Database (Denmark)

    Wildt, Signe; Madsen, Jan L; Rumessen, Jüri J

    2006-01-01

    Collagenous colitis (CC) is a chronic inflammatory bowel disease that affects the colon. However, some patients with CC present with accompanying pathologic small-bowel manifestations such as coeliac disease, defects in bile acid absorption and histopathologic changes in small-intestinal biopsies......, indicating that CC is a pan-intestinal disease. In small-intestinal disease, the intestinal barrier function may be impaired, and the permeability of the small intestine altered. The purpose of this research was to study small-bowel function in patients with CC as expressed by intestinal permeability....

  13. Disturbances in small bowel motility.

    LENUS (Irish Health Repository)

    Quigley, E M

    2012-02-03

    Recently, the small intestine has become the focus of investigation as a potential site of dysmotility in the irritable bowel syndrome (IBS). A number of motor abnormalities have been defined in some studies, and include \\'clustered\\' contractions, exaggerated post-prandial motor response and disturbances in intestinal transit. The significance of these findings remains unclear. The interpretation of available studies is complicated by differences in subject selection, the direct influence of certain symptoms, such as diarrhoea and constipation, and the interference of compounding factors, such as stress and psychopathology. Dysmotility could also reflect autonomic dysfunction, disturbed CNS control and the response to heightened visceral sensation or central perception. While motor abnormalities may not explain all symptoms in IBS, sensorimotor interactions may be important in symptom pathogenesis and deserve further study.

  14. Infections in inflammatory bowel disease.

    Science.gov (United States)

    Rodríguez de Santiago, Enrique; Albillos Martínez, Agustín; López-Sanromán, Antonio

    2017-05-10

    Patients with inflammatory bowel disease constitute a population with a special predisposition to develop bacterial, viral and fungal infections. Iatrogenic immunosuppression, frequent contact with healthcare facilities and surgical interventions are some of the risk factors that explain why these infections are one of the main causes of morbi-mortality in this disease. Some of these infections follow a subtle and paucisymptomatic evolution; their diagnosis and management may become a real challenge for the attending physician if their screening is not systematized or they are not considered in the differential diagnosis. The objective of this review is to provide an update from a practical and concise perspective on the knowledge regarding the epidemiology, prevention, diagnosis and treatment of the most common infections. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  15. Probiotics and irritable bowel syndrome.

    Science.gov (United States)

    Dai, Cong; Zheng, Chang-Qing; Jiang, Min; Ma, Xiao-Yu; Jiang, Li-Juan

    2013-09-28

    Irritable bowel syndrome (IBS) is common gastrointestinal problems. It is characterized by abdominal pain or discomfort, and is associated with changes in stool frequency and/or consistency. The etiopathogenesis of IBS may be multifactorial, as is the pathophysiology, which is attributed to alterations in gastrointestinal motility, visceral hypersensitivity, intestinal microbiota, gut epithelium and immune function, dysfunction of the brain-gut axis or certain psychosocial factors. Current therapeutic strategies are often unsatisfactory. There is now increasing evidence linking alterations in the gastrointestinal microbiota and IBS. Probiotics are living organisms which, when ingested in certain numbers, exert health benefits beyond inherent basic nutrition. Probiotics have numerous positive effects in the gastrointestinal tract. Recently, many studies have suggested that probiotics are effective in the treatment of IBS. The mechanisms of probiotics in IBS are very complex. The purpose of this review is to summarize the evidence and mechanisms for the use of probiotics in the treatment of IBS.

  16. Biomarkers in inflammatory bowel diseases

    DEFF Research Database (Denmark)

    Bennike, Tue; Birkelund, Svend; Stensballe, Allan

    2014-01-01

    Unambiguous diagnosis of the two main forms of inflammatory bowel diseases (IBD): Ulcerative colitis (UC) and Crohn's disease (CD), represents a challenge in the early stages of the diseases. The diagnosis may be established several years after the debut of symptoms. Hence, protein biomarkers...... for early and accurate diagnostic could help clinicians improve treatment of the individual patients. Moreover, the biomarkers could aid physicians to predict disease courses and in this way, identify patients in need of intensive treatment. Patients with low risk of disease flares may avoid treatment...... with medications with the concomitant risk of adverse events. In addition, identification of disease and course specific biomarker profiles can be used to identify biological pathways involved in the disease development and treatment. Knowledge of disease mechanisms in general can lead to improved future...

  17. Thalidomide for inflammatory bowel disease

    Science.gov (United States)

    Bramuzzo, Matteo; Ventura, Alessandro; Martelossi, Stefano; Lazzerini, Marzia

    2016-01-01

    Abstract Background: Thalidomide is an immunomodulatory drug used in the experimental treatment of refractory Crohn disease and ulcerative colitis. We aimed to review the existing evidence on the efficacy and safety of thalidomide in the treatment of inflammatory bowel diseases. Methods: CENTRAL, MEDLINE, LILACS, POPLINE, CINHAL, and Web of Science were searched in March 2016. Manual search included conference and reference lists. All types of studies, except single case reports, were included. Outcomes evaluated were: induction of remission; maintenance of remission; steroid reduction; effect on penetrating Crohn disease; endoscopic remission; adverse events. Results: The research strategies retrieved 722 papers. Two randomized controlled trials and 29 uncontrolled studies for a total of 489 patients matched the inclusion criteria. Thalidomide induced a clinical response in 296/427 (69.3%) patients. Clinical remission was achieved in 220/427 (51.5%) cases. Maintenance of remission was reported in 128/160 (80.0%) patients at 6 months and in 96/133 (72.2%) at 12 months. Reduction in steroid dosage was reported in 109/152 (71.7%) patients. Fistulas improved in 49/81 (60.5%) cases and closed in 28/81 (34.6%). Endoscopic improvement was observed in 46/66 (69.7%) and complete mucosal healing in 35/66 (53.0%) patients. Cumulative incidence of total adverse events and of those leading to drug suspension was 75.6 and 19.7/1000 patient-months, respectively. Neurological disturbances accounted for 341/530 (64.3%) adverse events and were the most frequent cause of drug withdrawal. Conclusion: Existing evidence suggests that thalidomide may be a valid treatment option for patients with inflammatory bowel diseases refractory to other first- and second-line treatments. PMID:27472695

  18. Endoscopic evaluation of surgically altered bowel in patients with inflammatory bowel diseases.

    Science.gov (United States)

    Sinh, Preetika; Shen, Bo

    2015-06-01

    Patients with inflammatory bowel diseases often undergo surgical procedures for medically refractory disease or colitis associated dysplasia. Endoscopic evaluation of the surgically altered bowel is often needed to assess for disease recurrence, its severity, and for therapy. It is important to obtain and review the operative report and abdominal imaging before performing the endoscopy. Diagnostic and therapeutic endoscopy can be safely performed in most patients with inflammatory bowel disease with altered bowel anatomy under conscious sedation without fluoroscopy. Carefully planned stricture therapy with balloon dilation or needle knife stricturotomy can be performed for simple, short, and fibrotic strictures. A multidisciplinary approach involving a team of endoscopist, endoscopy nurse, colorectal surgeon, gastrointestinal pathologist, and gastrointestinal radiologist is important for a safe and effective endoscopy. We attempt to review the aspects that need consideration before the endoscopy, the technique of endoscopy, and briefly the therapies that can be performed during endoscopy of the bowel through an ileostomy, a colostomy, in the diverted large bowel or ileal pouch, and small bowel after stricturoplasty and bowel bypass surgery in patients with inflammatory bowel diseases.

  19. Multidetector row computed tomography in bowel obstruction. Part 2. Large bowel obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Sinha, R. [Department of Radiology, Glenfield Hospital, Leicester (United Kingdom)]. E-mail: rakesh.sinha@uhl-tr.nhs.uk; Verma, R. [Department of Radiology, Glenfield Hospital, Leicester (United Kingdom)

    2005-10-01

    Large bowel obstruction may present as an emergency as high-grade colonic obstruction and can result in perforation. Perforated large bowel obstruction causes faecal peritonitis, which can result in high morbidity and mortality. Multidetector row computed tomography (MDCT) has the potential of providing an accurate diagnosis of large bowel obstruction. The rapid acquisition of images within one breath-hold reduces misregistration artefacts than can occur in critically ill or uncooperative patients. The following is a review of the various causes of large bowel obstruction with emphasis on important pathogenic factors, CT appearances and the use of multiplanar reformatted images in the diagnostic workup.

  20. Small-bowel permeability in collagenous colitis

    DEFF Research Database (Denmark)

    Wildt, Signe; Madsen, Jan L; Rumessen, Jüri J

    2006-01-01

    OBJECTIVE: Collagenous colitis (CC) is a chronic inflammatory bowel disease that affects the colon. However, some patients with CC present with accompanying pathologic small-bowel manifestations such as coeliac disease, defects in bile acid absorption and histopathologic changes in small...... permeability. MATERIAL AND METHODS: Ten patients with CC and chronic diarrhoea participated in the study. Coeliac disease was excluded by small-bowel biopsy and/or serology. Intestinal permeability was assessed as urinary excretion (ratios) 2, 4 and 6 h after ingestion of 14C-labelled mannitol (14C......-intestinal biopsies, indicating that CC is a pan-intestinal disease. In small-intestinal disease, the intestinal barrier function may be impaired, and the permeability of the small intestine altered. The purpose of this research was to study small-bowel function in patients with CC as expressed by intestinal...

  1. Recent advances in inflammatory bowel disease

    African Journals Online (AJOL)

    2009-05-12

    analysis comparing capsule endoscopy with small- bowel barium radiology, colonoscopy with ileoscopy, computer tomography ..... Each tablet contains Aspirin 81mg. Reg.No.: 29/2.7/0767. Pharmafrica (Pty) Ltd, 33 Hulbert Road, ...

  2. Stem cell therapy for inflammatory bowel disease

    NARCIS (Netherlands)

    Duijvestein, Marjolijn

    2012-01-01

    Hematopoietic stem cell transplantation (HSCT) and mesenchymal stromal (MSC) cell therapy are currently under investigation as novel therapies for inflammatory bowel diseases (IBD). Hematopoietic stem cells are thought to repopulate the immune system and reset the immunological response to luminal

  3. Use of thiopurines in inflammatory bowel disease

    DEFF Research Database (Denmark)

    Frei, Pascal; Biedermann, Luc; Nielsen, Ole Haagen

    2013-01-01

    The use of thiopurines as immunosuppression for the treatment of refractory or chronic active inflammatory bowel disease is established for both Crohn's disease and ulcerative colitis. Nevertheless, many questions remain concerning the optimal treatment regimens of azathioprine, 6-mercaptopurine...

  4. Symptoms and Causes of Irritable Bowel Syndrome

    Science.gov (United States)

    ... you haven’t finished a bowel movement whitish mucus in your stool Women with IBS often have ... as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of ...

  5. Diverticulosis of the small bowel with Diverticulitis

    Energy Technology Data Exchange (ETDEWEB)

    Barner, L.; Doldt, H.; Strecker, E.P.

    1980-11-01

    Case report of diverticulosis of the small bowel complicated by diverticulitis. Radiography is the method of choice to demonstrate this finding preoperatively. This entity should be included in the differential diagnosis of right lower quadrant abdominal pecin.

  6. Hirschsprung disease-Bowel function beyond childhood.

    Science.gov (United States)

    Wester, Tomas; Granström, Anna Löf

    2017-10-01

    Hirschsprung disease is a developmental defect of the enteric nervous system characterized by lack of enteric neurons in the distal hindgut. There are numerous reports on short-term outcomes indicating that impaired bowel function is common. Recently, several controlled studies show that bowel function outcomes are affected beyond childhood, in adolescents and adults, compared with healthy control subjects. Constipation and fecal incontinence are common. The impaired bowel function appears to have a negative impact on quality of life, although, a majority of patients have adapted to their symptoms. On the other hand, Hirschsprung disease seems to have limited impact on education and occupation in adult life. The aim of this review was to summarize current knowledge of bowel function outcome beyond childhood in patients with Hirschsprung disease. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Building a second brain in the bowel

    National Research Council Canada - National Science Library

    Avetisyan, Marina; Schill, Ellen Merrick; Heuckeroth, Robert O

    2015-01-01

    The enteric nervous system (ENS) is sometimes called the "second brain" because of the diversity of neuronal cell types and complex, integrated circuits that permit the ENS to autonomously regulate many processes in the bowel...

  8. Implementation of the victoria bowel performance scale.

    Science.gov (United States)

    Hawley, Philippa; Barwich, Doris; Kirk, Lisa

    2011-12-01

    There is a lack of evidence to guide constipation management in patients receiving palliative care. Data collection requires the systematic use of validated assessment tools. The objective of this study was to assess the usefulness of the Victoria Bowel Performance Scale (BPS) as an audit tool. Charts were reviewed before and after the implementation of a program to monitor constipation through repeated use of the Victoria Bowel Scale. The program was initiated at three oncology pain and symptom management clinics, four palliative care units, and four residential hospices. An additional "control" palliative care unit introduced new nursing assessment tools without the new scale. The Victoria BPS was recorded at 86% of 192 postimplementation outpatient clinic visits and was easy to use in this setting. Documentation of bowel performance at comparable visits improved from 44% to 66% (Passessment tool, uniquely incorporating the patient's usual bowel function. Modifications to the scale have been made to improve clarity and allow for the expected drop in bowel activity seen in end-of-life care. Considerable educational effort and appropriate organization of the charts are required for optimal implementation. The proportion of revised BPS scores ranging from -1 to +1 is proposed as an indicator of satisfactory bowel management for clinical, audit, and research purposes. Copyright © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

  9. Prenatal magnetic resonance and ultrasonographic findings in small-bowel obstruction: imaging clues and postnatal outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Rubio, Eva I.; Blask, Anna R.; Bulas, Dorothy I. [Children' s National Medical System, Division of Diagnostic Imaging and Radiology, Washington, DC (United States); Badillo, Andrea T. [Children' s National Medical System, Division of General and Thoracic Surgery, Washington, DC (United States)

    2017-04-15

    gastrointestinal complications. The presence of multiple atresias was not predicted by prenatal US or MRI. MR provides useful additional information regarding meconium distribution in the small bowel, which helps to clarify the level of obstruction. MR was additionally useful in the assessment of colon and rectal contents, serving as a fetal enema. Abnormally diminished meconium in the rectum suggests cystic fibrosis or combined small-bowel and colonic obstruction, information that is useful in counseling and preparing for postnatal care. (orig.)

  10. Intravenous iron in inflammatory bowel disease

    Science.gov (United States)

    Muñoz, Manuel; Gómez-Ramírez, Susana; García-Erce, José Antonio

    2009-01-01

    The prevalence of anemia across studies on patients with inflammatory bowel disease (IBD) is high (30%). Both iron deficiency (ID) and anemia of chronic disease contribute most to the development of anemia in IBD. The prevalence of ID is even higher (45%). Anemia and ID negatively impact the patient’s quality of life. Therefore, together with an adequate control of disease activity, iron replacement therapy should start as soon as anemia or ID is detected to attain a normal hemoglobin (Hb) and iron status. Many patients will respond to oral iron, but compliance may be poor, whereas intravenous (IV) compounds are safe, provide a faster Hb increase and iron store repletion, and presents a lower rate of treatment discontinuation. Absolute indications for IV iron treatment should include severe anemia, intolerance or inappropriate response to oral iron, severe intestinal disease activity, or use of an erythropoietic stimulating agent. Four different products are principally used in clinical practice, which differ in their pharmacokinetic properties and safety profiles: iron gluconate and iron sucrose (lower single doses), and iron dextran and ferric carboxymaltose (higher single doses). After the initial resolution of anemia and the repletion of iron stores, the patient’s hematological and iron parameters should be carefully and periodically monitored, and maintenance iron treatment should be provided as required. New IV preparations that allow for giving 1000-1500 mg in a single session, thus facilitating patient management, provide an excellent tool to prevent or treat anemia and ID in this patient population, which in turn avoids allogeneic blood transfusion and improves their quality of life. PMID:19787830

  11. The first joint ESGAR/ ESPR consensus statement on the technical performance of cross-sectional small bowel and colonic imaging

    Energy Technology Data Exchange (ETDEWEB)

    Taylor, S.A.; Torkzad, M.R.; Bhatnagar, G. [University College London, Centre for Medical Imaging, London (United Kingdom); Avni, F. [Lille University Hospitals, Department of Paediatric Imaging, Jeanne de Flandre Hospital, Lille (France); Cronin, C.G. [Mater Misericordiae University Hospital, Department of Radiology, Dublin (Ireland); Hoeffel, C. [Hopital Robert Debre, Department of Radiology, Reims (France); Kim, S.H. [Inje University College of Medicine, Haeundae Paik Hospital, Department of Radiology, Busan (Korea, Republic of); Laghi, A. [Sapienza University of Rome, I.C.O.T. Hospital, Department of Radiological Sciences, Oncology and Pathology, Latina (Italy); Napolitano, M. [V. Buzzi Children' s Hospital, Department of Radiology and Neuroradiology, Milan (Italy); Petit, P. [Timone Enfant Hospital, Department of Paediatric Radiology, Marseille (France); Rimola, J. [University of Barcelona, Radiology Department, Hospital Clinic Barcelona, Catalonia (Spain); Tolan, D.J. [St James' s University Hospital, Leeds Teaching Hospitals NHS Trust (United Kingdom); Zappa, M. [Hopital Beaujon, AP-HP, Universite Paris 7, INSERM CRI U1149, Department of Radiology, Clichy (France); Puylaert, C.A.J.; Stoker, J. [University of Amsterdam, Department of Radiology, Academic Medical Centre, Amsterdam (Netherlands)

    2017-06-15

    To develop guidelines describing a standardised approach to patient preparation and acquisition protocols for magnetic resonance imaging (MRI), computed tomography (CT) and ultrasound (US) of the small bowel and colon, with an emphasis on imaging inflammatory bowel disease. An expert consensus committee of 13 members from the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) and European Society of Paediatric Radiology (ESPR) undertook a six-stage modified Delphi process, including a detailed literature review, to create a series of consensus statements concerning patient preparation, imaging hardware and image acquisition protocols. One hundred and fifty-seven statements were scored for agreement by the panel of which 129 statements (82 %) achieved immediate consensus with a further 19 (12 %) achieving consensus after appropriate modification. Nine (6 %) statements were rejected as consensus could not be reached. These expert consensus recommendations can be used to help guide cross-sectional radiological practice for imaging the small bowel and colon. (orig.)

  12. Low-FODMAP diet reduces irritable bowel symptoms in patients with inflammatory bowel disease

    DEFF Research Database (Denmark)

    Pedersen, Natalia; Ankersen, Dorit Vedel; Felding, Maria

    2017-01-01

    AIM: To investigate the effect of a low-FODMAP diet on irritable bowel syndrome (IBS)-like symptoms in patients with inflammatory bowel disease (IBD). METHODS: This was a randomised controlled open-label trial of patients with IBD in remission or with mild-to-moderate disease and coexisting IBS...

  13. Contrast enema depiction of small-bowel volvulus in complicated neonatal bowel obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Navarro, Oscar M.; Daneman, Alan; Miller, Stephen F. [Hospital for Sick Children, Department of Diagnostic Imaging, Toronto, ON (Canada)

    2004-12-01

    About one-half of patients with meconium ileus (MI) present with a complication such as volvulus, atresia, meconium peritonitis or giant cystic meconium peritonitis. The treatment of these complications requires surgery. However, the preoperative diagnosis of complicated MI is difficult. We describe two neonates with complicated small-bowel obstruction, one with MI related to cystic fibrosis and the other not related to cystic fibrosis. In both, contrast enema depicted a spiral appearance of the distal small bowel, which at surgery proved to be the result of volvulus associated with antenatal bowel perforation. This appearance of the small bowel on contrast enema in this clinical setting has not been previously described. The recognition of this spiral appearance of the distal small bowel suggests the need for surgery. (orig.)

  14. Treatment of Irritable Bowel Syndrome.

    Science.gov (United States)

    Spiller, Robin C.

    2003-08-01

    Irritable bowel syndrome (IBS) is an extremely common cause of consultation, and at present is diagnosed on the basis of symptoms and a few simple exclusion tests. Exclusion diets can be successful, but many patients have already attempted and failed such treatments before consulting. Anxiety and somatization may be an important driver of consultation. Patients' concerns should be understood and addressed. Those with prominent psychiatric disease may benefit from psychotherapy. Hypnotherapy benefits symptoms in those without psychologic disturbance, but its availability is limited. Antidepressants are effective in improving both mood and IBS symptoms globally, and the evidence is particularly good for tricyclic antidepressants. Although antispasmodics are currently the most commonly prescribed drugs, most responses (75%) are due to the placebo effect and not specific to the drug. Bulk laxatives such as ispaghula can increase stool frequency and help pain, but bloating may be aggravated. Loperamide is effective treatment for urgency and loose stools, but less effective for bloating and pain. 5-HT(3) antagonists such as alosetron improve urgency, stool consistency, and pain in diarrhea-predominant-IBS. The 5-HT(4) agonist tegaserod shows modest benefit in constipation-predominant IBS, improving stool frequency, consistency, and bloating as well as global improvement. There are many new drugs, such as cholecystokinin, neurokinin, and corticotropin receptor antagonists, in development.

  15. Nutrition in inflammatory bowel disease

    Science.gov (United States)

    Martínez Gómez, María Josefa; Melián Fernández, Cristóbal; Romeo Donlo, María

    2016-07-12

    Inflammatory bowel disease (IBD) is a chronic pathology that has an outbreaks course that in recent years have seen an increase in incidence, especially at younger ages. Malnutrition is frequently associated with this condition, therefore, it is very important to ensure a right nutritional intervention, especially in pediatric patients, to ensure an optimal growth and also an improvement in the clinic. Our goal will be updated the role of nutrition in this disease and in its treatment based on the published evidence. Malnutrition in these patients is frequent and is influenced by various factors such as, decreased food intake, increased nutrient requirements, increased protein loss and malabsorption of nutrients. Therefore there should be a nutritional monitoring of all of them, in which anthropometric measurements, laboratory tests and densitometry were made to establish the needs and sufficient caloric intake tailored to each patient. The use of enteral nutrition as a treatment in Crohn’s disease with mild to moderate outbreak in child population, is amply demonstrated, has even shown to be superior to the use of corticosteroids. Therefore we can conclude by stressing that nutritional intervention is a mainstay in the management of patients with IBD, which aims to prevent and / or control disease-related malnutrition to decrease morbidity and mortality and improve quality of life.

  16. Immunopathology of inflammatory bowel disease.

    Science.gov (United States)

    Wallace, Kori L; Zheng, Li-Bo; Kanazawa, Yoshitake; Shih, David Q

    2014-01-07

    Inflammatory bowel disease (IBD) results from a complex series of interactions between susceptibility genes, the environment, and the immune system. The host microbiome, as well as viruses and fungi, play important roles in the development of IBD either by causing inflammation directly or indirectly through an altered immune system. New technologies have allowed researchers to be able to quantify the various components of the microbiome, which will allow for future developments in the etiology of IBD. Various components of the mucosal immune system are implicated in the pathogenesis of IBD and include intestinal epithelial cells, innate lymphoid cells, cells of the innate (macrophages/monocytes, neutrophils, and dendritic cells) and adaptive (T-cells and B-cells) immune system, and their secreted mediators (cytokines and chemokines). Either a mucosal susceptibility or defect in sampling of gut luminal antigen, possibly through the process of autophagy, leads to activation of innate immune response that may be mediated by enhanced toll-like receptor activity. The antigen presenting cells then mediate the differentiation of naïve T-cells into effector T helper (Th) cells, including Th1, Th2, and Th17, which alter gut homeostasis and lead to IBD. In this review, the effects of these components in the immunopathogenesis of IBD will be discussed.

  17. Selenium and inflammatory bowel disease.

    Science.gov (United States)

    Kudva, Avinash K; Shay, Ashley E; Prabhu, K Sandeep

    2015-07-15

    Dietary intake of the micronutrient selenium is essential for normal immune functions. Selenium is cotranslationally incorporated as the 21st amino acid, selenocysteine, into selenoproteins that function to modulate pathways involved in inflammation. Epidemiological studies have suggested an inverse association between selenium levels and inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis that can potentially progress to colon cancer. However, the underlying mechanisms are not well understood. Here we summarize the current literature on the pathophysiology of IBD, which is multifactorial in origin with unknown etiology. We have focused on a few selenoproteins that mediate gastrointestinal inflammation and activate the host immune response, wherein macrophages play a pivotal role. Changes in cellular oxidative state coupled with altered expression of selenoproteins in macrophages drive the switch from a proinflammatory phenotype to an anti-inflammatory phenotype to efficiently resolve inflammation in the gut and restore epithelial barrier integrity. Such a phenotypic plasticity is accompanied by changes in cytokines, chemokines, and bioactive metabolites, including eicosanoids that not only mitigate inflammation but also partake in restoring gut homeostasis through diverse pathways involving differential regulation of transcription factors such as nuclear factor-κB and peroxisome proliferator-activated receptor-γ. The role of the intestinal microbiome in modulating inflammation and aiding in selenium-dependent resolution of gut injury is highlighted to provide novel insights into the beneficial effects of selenium in IBD. Copyright © 2015 the American Physiological Society.

  18. Pregnancy and Inflammatory Bowel Disease.

    Science.gov (United States)

    Hashash, Jana G; Kane, Sunanda

    2015-02-01

    Many patients with inflammatory bowel disease (IBD), whether Crohn's disease or ulcerative colitis, are of reproductive age. Young women with IBD are usually very worried about their fertility, the activity of their disease during pregnancy, the heritability of the disease to their unborn child, and the effect of their underlying IBD on the pregnancy itself. Additionally, patients express concerns about using IBD medications during pregnancy, fearing that the medications may negatively affect the fetus. For this reason, it is of the utmost importance that gastroenterologists and patients with IBD be aware of the effect of IBD on pregnancy, the effect of pregnancy on IBD, and the effect of IBD medications on the fetus and on pregnancy outcomes. Increasing the awareness of patients with IBD about the importance of maintaining disease remission at the time of conception and throughout pregnancy is key to improving the outcomes of both mothers and fetuses. This article addresses the fertility of patients with IBD, the effect of pregnancy on disease activity, and the effect of IBD on pregnancy. Also discussed are which IBD medications can be used during conception and pregnancy and which medications must be avoided.

  19. Inflammatory bowel disease in pregnancy.

    Science.gov (United States)

    Beaulieu, Dawn B; Kane, Sunanda

    2011-06-14

    Crohn's disease and ulcerative colitis affect women in their child-bearing years. Family planning has come to be a common discussion between the gastroenterologist and the inflammatory bowel disease (IBD) patient. Disease control prior to desired conception and throughout pregnancy is the most important thing to keep in mind when caring for the IBD patient. Continued medical management during pregnancy is crucial in optimizing outcomes. Studies indicate that quiescent disease prior to conception infer the best pregnancy outcomes, similar to those in the general population. Active disease prior to and during pregnancy, can lead to complications such as pre-term labor, low birth weight, and small for gestational age infants. Although there are no definitive long term effects of pregnancy on IBD, there are some limited studies that suggest that it may alter the disease course. Understanding the literature and its limitations is important in the modern era of IBD care. Educating the patient and taking a team approach with the obstetrician will help achieve successful outcomes for mother and baby.

  20. [Treatment of inflammatory bowel diseases].

    Science.gov (United States)

    Gomollón, Fernando

    2015-09-01

    In addition to immunosuppressive drugs and anti-TNF, there are a number of new options in the treatment of inflammatory bowel diseases. Vedolizumab has been approved by the FDA and EMA and has demonstrated utility both in the treatment of ulcerative colitis (UC) and Crohn's disease (CD), even in anti-TNF refractory patients. Other monoclonal antibodies with different targets such as PF-005447659 (antiMAd-CAM1), ustekinumab (anti-IL23/IL12) or MEDI2070 (anti-IL23) have shown promising results in distinct clinical scenarios. Mongersen (antisense oligonucleotide anti-Smad7) and oznimod (an SP-1 modulator) are new alternatives with proven efficacy in clinical trials in CD and UC, respectively. Some data suggest that faecal microbiota transplantation could be efficacious in individual patients, although controlled data do not show clear differences with placebo. Autologous stem-cell transplantation has shown long-term efficacy in "ultra-refractory" CD. The number of possible treatments is constantly increasing, and future research should focus both on the selection of the most appropriate treatment for any given patient and on comparative trials between options. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  1. [Irritable bowel syndrome in children].

    Science.gov (United States)

    Ansaldi, N; Villata, L; Santini, B; Fantino, N; Robazza, V; Ciervo, T; Barbera, C; Elia, G; Oderda, G

    1987-01-01

    The irritable bowel syndrome (IBS) is the most common chronic functional gastroenterological disorder both in adults and in children. In this study we evaluate the different aspects of this syndrome, comparing our observations on 332 children with other studies. Epidemiological data (frequency, sex, age) are examined so as the family histories of gastroenterological disorders. We take in account several pathogenic hypotheses, especially with reference to the alterations of gastrointestinal motility, which could be caused by several factors (psychological, prostaglandins, bile acids, etc.). The clinical picture is very variable, variations depending on the age of children and on the time of onset of IBS. The colic of neonate, caused by retention of air, is the main symptom in the first months of life, followed by chronic diarrhoea, also defined as toddler's diarrhoea, sometime alternating with constipation. In later childhood, recurrent abdominal pain represents a common complaint, in association with diarrhoea or constipation. The principal steps for a proper diagnosis so as the main differential diagnosis are defined. We explain the most important features of management (reassuring parents, free diet), excluding prescription of drugs, that produce only a transitory and symptomatic relief, so as elimination diets, that cause only a failure to thrive without any improvement of symptoms.

  2. Feasibility of laparoscopy for small bowel obstruction

    Directory of Open Access Journals (Sweden)

    De Sol Angelo A

    2009-01-01

    Full Text Available Abstract Background Adherential pathology is the most common cause of small bowel obstruction. Laparoscopy in small bowel obstruction does not have a clear role yet; surely it doesn't always represent only a therapeutic act, but it is always a diagnostic act, which doesn't interfere with abdominal wall integrity. Methods We performed a review without any language restrictions considering international literature indexed from 1980 to 2007 in Medline, Embase and Cochrane Library. We analyzed the reference lists of the key manuscripts. We also added a review based on international non-indexed sources. Results The feasibility of diagnostic laparoscopy is high (60–100%, while that of therapeutic laparoscopy is low (40–88%. The frequency of laparotomic conversions is variable ranging from 0 to 52%, depending on patient selection and surgical skill. The first cause of laparotomic conversion is a difficult exposition and treatment of band adhesions. The incidence of laparotomic conversions is major in patients with anterior peritoneal band adhesions. Other main causes for laparotomic conversion are the presence of bowel necrosis and accidental enterotomies. The predictive factors for successful laparoscopic adhesiolysis are: number of previous laparotomies ≤ 2, non-median previous laparotomy, appendectomy as previous surgical treatment causing adherences, unique band adhesion as phatogenetic mechanism of small bowel obstruction, early laparoscopic management within 24 hours from the onset of symptoms, no signs of peritonitis on physical examination, experience of the surgeon. Conclusion Laparoscopic adhesiolysis in small bowel obstruction is feasible but can be convenient only if performed by skilled surgeons in selected patients. The laparoscopic adhesiolysis for small bowel obstruction is satisfactorily carried out when early indicated in patients with a low number of laparotomies resulting in a short hospital stay and a lower postoperative

  3. Heterotaxy syndromes and abnormal bowel rotation

    Energy Technology Data Exchange (ETDEWEB)

    Newman, Beverley [Stanford University, Lucile Packard Children' s Hospital, Department of Radiology, Stanford, CA (United States); Koppolu, Raji; Sylvester, Karl [Lucile Packard Children' s Hospital at Stanford, Department of Surgery, Stanford, CA (United States); Murphy, Daniel [Lucile Packard Children' s Hospital at Stanford, Department of Cardiology, Stanford, CA (United States)

    2014-05-15

    Bowel rotation abnormalities in heterotaxy are common. As more children survive cardiac surgery, the management of gastrointestinal abnormalities has become controversial. To evaluate imaging of malrotation in heterotaxy with surgical correlation and provide an algorithm for management. Imaging reports of heterotaxic children with upper gastrointestinal (UGI) and/or small bowel follow-through (SBFT) were reviewed. Subsequently, fluoroscopic images were re-reviewed in conjunction with CT/MR studies. The original reports and re-reviewed images were compared and correlated with surgical findings. Nineteen of 34 children with heterotaxy underwent UGI, 13/19 also had SBFT. In 15/19 reports, bowel rotation was called abnormal: 11 malrotation, 4 non-rotation, no cases of volvulus. Re-review, including CT (10/19) and MR (2/19), designated 17/19 (90%) as abnormal, 10 malrotation (abnormal bowel arrangement, narrow or uncertain length of mesentery) and 7 non-rotation (small bowel and colon on opposite sides plus low cecum with probable broad mesentery). The most useful CT/MR findings were absence of retroperitoneal duodenum in most abnormal cases and location of bowel, especially cecum. Abnormal orientation of mesenteric vessels suggested malrotation but was not universal. Nine children had elective bowel surgery; non-rotation was found in 4/9 and malrotation was found in 5/9, with discrepancies (non-rotation at surgery, malrotation on imaging) with 4 original interpretations and 1 re-review. We recommend routine, early UGI and SBFT studies once other, urgent clinical concerns have been stabilized, with elective laparoscopic surgery in abnormal or equivocal cases. Cross-sectional imaging, usually obtained for other reasons, can contribute diagnostically. Attempting to assess mesenteric width is important in differentiating non-rotation from malrotation and more accurately identifies appropriate surgical candidates. (orig.)

  4. The Role of Diet in Inflammatory Bowel Disease.

    Science.gov (United States)

    Shivashankar, Raina; Lewis, James D

    2017-05-01

    Diet may play both a causal and therapeutic role for inflammatory bowel disease (IBD). Physicians caring for patients with IBD are often asked to make dietary recommendations. However, there are no well-established guidelines on the use of diet as a treatment of IBD. In this review, we describe the evidence supporting diet as a potential cause for IBD, patient-perceived symptoms based on diet, current research on various diets as a treatment for IBD, and areas of future research. New studies in murine models suggest that dietary emulsifiers may trigger the gut inflammatory cascade. New studies of restriction diets in patients have shown a relationship between dietary intake, symptoms, and bowel inflammation. Until several ongoing clinical trials are completed, a reasonable approach to dietary recommendations for patients with IBD is to propose a well-balanced, healthy (low-fat, low-sugar) diet prepared from fresh ingredients, such as the Mediterranean diet, with exclusions of self-identified foods that worsen or trigger IBD-related symptoms.

  5. How patients view probiotics: findings from a multicenter study of patients with inflammatory bowel disease and irritable bowel syndrome.

    Science.gov (United States)

    Mercer, MaryBeth; Brinich, Margaret A; Geller, Gail; Harrison, Krista; Highland, Janelle; James, Katherine; Marshall, Patricia; McCormick, Jennifer B; Tilburt, Jon; Achkar, Jean-Paul; Farrell, Ruth M; Sharp, Richard R

    2012-02-01

    Patients with inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) have access to a growing number of probiotic products marketed to improve digestive health. It is unclear how patients make decisions about probiotics and what role they expect their gastroenterologists to play as they consider using probiotics. Understanding patients' knowledge, attitudes and expectations of probiotics may help gastroenterologists engage patients in collaborative discussions about probiotics. Focus groups were conducted with patients with IBD and IBS at the Cleveland Clinic, Mayo Clinic, and Johns Hopkins University. Inductive analytic methods were used to identify common themes and draw interpretations from focus group narratives. One hundred thirty-six patients participated in 22 focus groups between March and August 2009. Patients viewed probiotics as an appealing alternative to pharmaceutical drugs and understood probiotics as a more "natural," low-risk therapeutic option. Many patients were hesitant to use them without consulting their gastroenterologists. Patients would weigh the risks and benefits of probiotics, their disease severity and satisfaction with current treatments when considering probiotic use. Patients are interested in probiotics but have many unanswered questions about their use. Our findings suggest that patients with IBD and IBS will look to gastroenterologists and other clinicians as trustworthy advisors regarding the utility of probiotics as an alternative or supplement to pharmaceutical drugs. Gastroenterologists and other clinicians who care for patients with these diseases should be prepared to discuss the potential benefits and risks of probiotics and assist patients in making informed decisions about their use.

  6. Identifying decreased peristalsis of abnormal small bowel segments in Crohn's disease using cine MR enterography: the frozen bowel sign.

    Science.gov (United States)

    Guglielmo, Flavius F; Mitchell, Donald G; O'Kane, Patrick L; Deshmukh, Sandeep P; Roth, Christopher G; Burach, Ilene; Burns, Aaron; Dulka, Susan; Parker, Laurence

    2015-06-01

    The purpose of this study was to evaluate whether affected bowel in Crohn's disease patients can be identified by observing decreased peristalsis (frozen bowel sign) using cine balanced steady-state free precession (cine BSSFP) images. 5 radiologists independently reviewed cine BSSFP sequences from randomized MR Enterography (MRE) exams for 30 normal and 30 Crohn's disease patients, graded overall small bowel peristalsis from slowest to fastest, and graded peristalsis for the most abnormal small bowel segment. Sensitivity and specificity of the frozen bowel sign for diagnosing Crohn's disease were calculated. T tests of the peristalsis difference between abnormal segments and overall small bowel were conducted. For 5 readers, the sensitivity and specificity of cine BSSFP of the frozen bowel sign for diagnosing Crohn's disease ranged from 70% to 100% and 87% to 100%, respectively. There were significant differences in peristalsis between abnormal small bowel segments and the overall small bowel for Crohn's patients, but not in the overall small bowel between normal-MRE patients and Crohn's disease patients. Abnormal Crohn's small bowel segments have significantly decreased peristalsis compared to normal small bowel, which can be identified using cine BSSFP sequences as the frozen bowel sign.

  7. Fibromyalgia in inflammatory bowel disease.

    Science.gov (United States)

    Buskila, D; Odes, L R; Neumann, L; Odes, H S

    1999-05-01

    Studies of the rheumatological complications of inflammatory bowel disease (IBD; Crohn's disease and ulcerative colitis) have focused on peripheral arthritis and spondylitis, and less is known about soft tissue rheumatism, specifically the fibromyalgia syndrome (FM). Our aim was to estimate the prevalence of FM and assess pain thresholds in patients with Crohn's disease (CD) and ulcerative colitis (UC). Seventy-two patients with UC and 41 with CD attending consecutively at the Gastroenterology Outpatient Clinic were assessed for the presence of FM and tenderness thresholds. FM was diagnosed according to the American College of Rheumatology 1990 criteria. Tenderness was measured by manual palpation and with a dolorimeter. One hundred twenty healthy subjects served as controls. FM was documented in 30 of 113 patients with IBD (30%), specifically in 49% of patients with CD and 19% with UC (p = 0.001); in controls the rate was 0%. Subjects with CD exhibited more tenderness and reported more frequent and more severe FM associated symptoms than subjects with UC. Patients with CD had a higher tender point count, 11.3 (+/- 6.5), than those with UC, 6.4 (+/- 5.7) (p = 0.001); in healthy controls, the count was 0.1 (+/- 0.5). Tenderness thresholds (kg) were lower in CD 2.9 (+/- 1.7) than UC 3.9 (+/- 2.0) (p = 0.005) and controls 5.8 (+/- 0.9). FM is common in IBD, particularly Crohn's disease. The lower pain threshold in Crohn's disease may suggest a disease-specific effect. Recognizing FM in patients with IBD will prevent misdiagnosis and ensure correct treatment.

  8. Low volume polyethylene glycol with ascorbic acid, sodium picosulfate-magnesium citrate, and clear liquid diet alone prior to small bowel capsule endoscopy.

    Science.gov (United States)

    Rayner-Hartley, Erin; Alsahafi, Majid; Cramer, Paula; Chatur, Nazira; Donnellan, Fergal

    2016-06-10

    To compare low volume polyethylene glycol with ascorbic acid, sodium picosulfate-magnesium citrate and clear liquid diet alone as bowel preparation prior to small bowel capsule endoscopy (CE). We retrospectively collected all CE studies done from December 2011 to July 2013 at a single institution. CE studies were reviewed only if low volume polyethylene glycol with ascorbic acid, sodium picosulfate-magnesium citrate or clear liquid diet alone used as the bowel preparation. The studies were then reviewed by the CE readers who were blinded to the preparation type. Cleanliness and bubble burden were graded independently within the proximal, middle and distal small bowel using a four-point scale according to the percentage of small bowel mucosa free of debris/bubbles: grade 1 = over 90%, grade 2 = between 90%-75%, grade 3 = between 50%-75%, grade 4 = less than 50%. Data are expressed as mean ± SEM. ANOVA and Fishers exact test were used where appropriate. P values < 0.05 were considered statistically significant. A of total of 123 CE studies were reviewed. Twenty-six studies were excluded from analysis because of incomplete small bowel examination. In the remaining studies, 39 patients took low volume polyethylene glycol with ascorbic acid, 31 took sodium picosulfate-magnesium citrate and 27 took a clear liquid diet alone after lunch on the day before CE, followed by overnight fasting in all groups. There was no significant difference in small bowel cleanliness (1.98 ± 0.09 vs 1.84 ± 0.08 vs 1.76 ± 0.08) or small bowel transit time (213 ± 13 vs 248 ± 14 ± 225 ± 19 min) for clear liquid diet alone, MoviPrep and Pico-Salax respectively. The bubble burden in the mid small bowel was significantly higher in the MoviPrep group (1.6 ± 0.1 vs 1.9 ± 0.1 vs 1.6 ± 0.1, P < 0.05). However this did not result in a significant difference in diagnosis of pathology. There was no significant difference in small bowel cleanliness or diagnostic yield of small bowel CE between

  9. Small Bowel Obstruction due to Intestinal Xanthomatosis

    Directory of Open Access Journals (Sweden)

    L. E. Barrera-Herrera

    2015-01-01

    Full Text Available Vast majority of bowel obstruction is due to postoperative adhesions, malignancy, intestinal inflammatory disease, and hernias; however, knowledge of other uncommon causes is critical to establish a prompt treatment and decrease mortality. Xanthomatosis is produced by accumulation of cholesterol-rich foamy macrophages. Intestinal xanthomatosis is an uncommon nonneoplastic lesion that may cause small bowel obstruction and several cases have been reported in the English literature as obstruction in the jejunum. We report a case of small intestinal xanthomatosis occurring in a 51-year-old female who presented with one day of copious vomiting and intermittent abdominal pain. Radiologic images revealed jejunal loop thickening and inflammatory changes suggestive of foreign body obstruction, diagnostic laparoscopy found two strictures at the jejunum, and a pathologic examination confirmed a segmental small bowel xanthomatosis. This case illustrates that obstruction even without predisposing factors such as hyperlipidemia or lymphoproliferative disorders.

  10. International bowel function basic spinal cord injury data set

    DEFF Research Database (Denmark)

    Krogh, K; Perkash, I; Stiens, S A

    2008-01-01

    . SETTING: Working group consisting of members appointed by the American Spinal Injury Association (ASIA) and the International Spinal Cord Society (ISCoS). METHODS: A draft prepared by the working group was reviewed by Executive Committee of the International SCI Standards and Data Sets, and later by ISCo......S Scientific Committee and the ASIA Board. Relevant and interested scientific and professional (international) organizations and societies (approximately 40) were also invited to review the data set and it was posted on the ISCoS and ASIA websites for 3 months to allow comments and suggestions. The ISCo......S Scientific Committee, Council and ASIA Board received the data set for final review and approval. RESULTS: The International Bowel Function Basic SCI Data Set includes the following 12 items: date of data collection, gastrointestinal or anal sphincter dysfunction unrelated to SCI, surgical procedures...

  11. Small Bowel Obstruction caused by a Carcinoid Tumour | Shallaly ...

    African Journals Online (AJOL)

    We present a rare case of carcinoid tumour presenting as a small bowel obstruction in a young male patient. Pitfalls of diagnosis, including confusion with irritable bowel syndrome are high-lighted. The current management strategies of this tumour are reviewed. Keywords: irritable bowel, appendicitis, choleystitis.

  12. Outcomes of Bowel Resection in Patients with Crohn's Disease.

    Science.gov (United States)

    Moghadamyeghaneh, Zhobin; Carmichael, Joseph C; Mills, Steven D; Pigazzi, Alessio; Stamos, Michael J

    2015-10-01

    There is limited data regarding outcomes of bowel resection in patients with Crohn's disease. We sought to investigate complications of such patients after bowel resection. The Nationwide Inpatient Sample databases were used to examine the clinical data of Crohn's patients who underwent bowel resection during 2002 to 2012. Multivariate regression analysis was performed to investigate outcomes of such patients. We sampled a total of 443,950 patients admitted with the diagnosis of Crohn's disease. Of these, 20.5 per cent had bowel resection. Among patients who had bowel resection, 51 per cent had small bowel Crohn's disease, 19.4 per cent had large bowel Crohn's disease, and 29.6 per cent had both large and small bowel Crohn's disease. Patients with large bowel disease had higher mortality risk compared with small bowel disease [1.8% vs 1%, adjusted odds ratio (AOR): 2.42, P Crohn's disease (AOR: 1.90, P Crohn's disease, 20.5 per cent underwent bowel resection during 2002 to 2012. Although colonic disease has a higher mortality risk, small bowel disease has a higher risk of postoperative fistula.

  13. Multidetector CT findings of bowel Transection in blunt abdominal trauma

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Hyun Suk; Woo, Ji Young; Hong, Hye Suk; Park, Mee Hyun; Yang, Ik; Lee, Yul; Jung, Ah Young; Hwang, Ji Young [Dept. of Radiology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul (Korea, Republic of); Ha, Hong Il [Dept. of Radiology, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang (Korea, Republic of)

    2013-08-15

    Though a number of CT findings of bowel and mesenteric injuries in blunt abdominal trauma are described in literature, no studies on the specific CT signs of a transected bowel have been published. In the present study we describe the incidence and new CT signs of bowel transection in blunt abdominal trauma. We investigated the incidence of bowel transection in 513 patients admitted for blunt abdominal trauma who underwent multidetector CT (MDCT). The MDCT findings of 8 patients with a surgically proven complete bowel transection were assessed retrospectively. We report novel CT signs that are unique for transection, such as complete cutoff sign (transection of bowel loop), Janus sign (abnormal dual bowel wall enhancement, both increased and decreased), and fecal spillage. The incidence of bowel transection in blunt abdominal trauma was 1.56%. In eight cases of bowel transection, percentage of CT signs unique for bowel transection were as follows: complete cutoff in 8 (100%), Janus sign in 6 (100%, excluding duodenal injury), and fecal spillage in 2 (25%). The combination of complete cutoff and Janus sign were highly specific findings in patients with bowel transection. Complete cut off and Janus sign are the unique CT findings to help detect bowel transection in blunt abdominal trauma and recognition of these findings enables an accurate and prompt diagnosis for emergency laparotomy leading to reduced mortality and morbidity.

  14. Multidetector CT Findings of Bowel Transection in Blunt Abdominal Trauma

    NARCIS (Netherlands)

    Cho, H.S.; Woo, J.Y.; Hong, H.S.; Park, M.H.; Ha, H.I.; Yang, I.; Lee, Y.; Jung, A.Y.; Hwang, J.Y.

    2013-01-01

    OBJECTIVE: Though a number of CT findings of bowel and mesenteric injuries in blunt abdominal trauma are described in literature, no studies on the specific CT signs of a transected bowel have been published. In the present study we describe the incidence and new CT signs of bowel transection in

  15. Antibiotics during childhood and inflammatory bowel disease?

    Science.gov (United States)

    2014-10-01

    Four epidemiological studies, including two large cohort studies in children aged 17 years or under, have studied the link between antibiotic therapy and inflammatory bowel disease. The risk of inflammatory bowel disease appeared to be twice as high in children exposed to an antibiotic as in unexposed children. The risk appeared higher following exposure during the first year of life, with beta-lactam antibiotics, and with repeated antibiotic courses. One postulated mechanism is through destruction of the anaerobic intestinal flora by antibiotics. In practice, these data provide yet another reason to avoid unnecessarily exposing children to antibiotics.

  16. Caring for Women with Inflammatory Bowel Disease.

    Science.gov (United States)

    Feagins, Linda A; Kane, Sunanda V

    2016-06-01

    Ulcerative colitis and Crohn disease are chronic inflammatory diseases with typical onset in early adulthood. These diseases, therefore, can affect a woman throughout the many stages of her life, including menstruation, sexuality, pregnancy, and menopause. Unique health issues face women during these stages and can affect the course of their inflammatory bowel disease as well as treatment strategies and health maintenance. This article covers the non-pregnancy-related issues that are important in caring for women with inflammatory bowel disease. The topics of pregnancy and fertility are covered in a separate review. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Gender differences in inflammatory bowel disease: Explaining body image dissatisfaction.

    Science.gov (United States)

    Trindade, Inês A; Ferreira, Cláudia; Duarte, Cristiana; Pinto-Gouveia, José

    2017-12-01

    The aim of this study was to examine the role of body image problems in the context of inflammatory bowel disease and to explore gender differences in these associations. A sample of inflammatory bowel disease patients (60 males and 140 females) was collected. Findings from a multi-group analysis show that inflammatory bowel disease symptomatology may impact on body image in both male and female patients through the effect of body-image-related cognitive fusion. Body image difficulties in the context of inflammatory bowel disease should not be a neglected dimension in research aiming at understanding the psychosocial effects of inflammatory bowel disease and by health professionals working with these patients.

  18. CT enteroclysis in small bowel Crohn's disease

    Energy Technology Data Exchange (ETDEWEB)

    Kohli, Marc D. [Department of Radiology, Indiana University School of Medicine, Indianapolis, IN (United States); Maglinte, Dean D.T. [Department of Radiology, Indiana University School of Medicine, Indianapolis, IN (United States)], E-mail: dmaglint@iupui.edu

    2009-03-15

    The diagnostic evaluation of small bowel Crohn's disease has changed dramatically over the last decade. The introduction of wireless capsule endoscopy, double balloon endoscopy and the introduction of newer therapeutic agents have changed the role of imaging in the small bowel. Additionally, advances in multidetector CT technology have further changed how radiologic investigations are utilized in the diagnosis and management of small bowel Crohn's disease. This article describes how we perform CT enteroclysis in the investigation of small bowel Crohn's disease and discusses the role of CT enteroclysis in the current management of small bowel Crohn's disease.

  19. Methods for diagnosing irritable bowel syndrome

    NARCIS (Netherlands)

    Tuk, L.; Vos, de W.M.; Rajilic-Stojanovic, M.

    2015-01-01

    The present invention discloses a method for diagnosing Irritable Bowel Syndrome (IBS) in a test sample by determining the level of several bacterial taxa in the test sample, comparing this level with the levels of those bacterial taxa in a control sample, and relating the level to a diagnosis of

  20. Methods for diagnosing irritable bowel syndrome

    NARCIS (Netherlands)

    Tuk, L.; Vos, de W.M.; Rajilic-Stojanovic, M.

    2012-01-01

    The present invention discloses a method for diagnosing Irritable Bowel Syndrome (IBS) in a test sample by determining the level of several bacterial taxa in the test sample, comparing this level with the levels of those bacterial taxa in a control sample, and relating the level to a diagnosis of

  1. Isotretinoin-induced inflammatory bowel disease

    NARCIS (Netherlands)

    Passier, J L M; Srivastava, N; van Puijenbroek, E P

    Three case reports on inflammatory bowel disease associated with use of isotretinoin are described. All three patients were male adolescents, in good health when starting isotretinoin (for acne treatment for about six months). Several weeks after discontinuation of isotretinoin the patients

  2. Adult Bochdalek hernia with bowel incarceration.

    Science.gov (United States)

    Hung, Yeh-Huang; Chien, Yu-Hon; Yan, Sheng-Lei; Chen, Ming-Feng

    2008-10-01

    Bochdalek hernias are rare in adults. We report 2 cases of Bochdalek hernia with bowel obstruction. The first case was a 74-year-old male patient who suffered from abdominal pain and chest tightness for 1 day. Chest radiography indicated a mass-like lesion above the left diaphragm. The pain could not be relieved by nasogastric tube decompression for 12 hours. We arranged computed tomography, which revealed a dilated bowel above the diaphragm and intestinal obstruction with gangrenous change. The patient received emergency laparotomy, and a Bochdalek hernia was detected during the operation. The second case was a 75-year-old female patient who suffered from chest tightness and dyspnea for about 1 week. Chest X-ray and magnetic resonance imaging revealed herniation of small and large bowels at the right posterior aspect of the thoracic cavity. She received transthoracic repair of diaphragmatic hernia, recovered, and was discharged 15 days later. We recommend that adult Bochdalek hernia should be considered in the differential diagnosis of bowel obstruction.

  3. Adult Bochdalek Hernia with Bowel Incarceration

    Directory of Open Access Journals (Sweden)

    Yeh-Huang Hung

    2008-10-01

    Full Text Available Bochdalek hernias are rare in adults. We report 2 cases of Bochdalek hernia with bowel obstruction. The first case was a 74-year-old male patient who suffered from abdominal pain and chest tightness for 1 day. Chest radiography indicated a mass-like lesion above the left diaphragm. The pain could not be relieved by nasogastric tube decompression for 12 hours. We arranged computed tomography, which revealed a dilated bowel above the diaphragm and intestinal obstruction with gangrenous change. The patient received emergency laparotomy, and a Bochdalek hernia was detected during the operation. The second case was a 75-year-old female patient who suffered from chest tightness and dyspnea for about 1 week. Chest X-ray and magnetic resonance imaging revealed herniation of small and large bowels at the right posterior aspect of the thoracic cavity. She received transthoracic repair of diaphragmatic hernia, recovered, and was discharged 15 days later. We recommend that adult Bochdalek hernia should be considered in the differential diagnosis of bowel obstruction.

  4. Neuropeptide receptor expression in inflammatory bowel disease

    NARCIS (Netherlands)

    Beek, Willy Pascale ter

    2008-01-01

    Inflammatory bowel disease (IBD), i.e. Crohn’s disease and ulcerative colitis are characterized by a chronic inflammation of the gastrointestinal tract. Neuropeptides are involved in the regulation of intestinal motility, chloride secretion and inflammatory response, three processes that are

  5. Bowel injury following gynecological laparoscopic surgery.

    African Journals Online (AJOL)

    When bowel injury is recognized during the first laparoscopic procedure then laparoscopic primary suturing could be tried although laparotomy may be needed. When diagnosis is delayed, then laparotomy is the treatment of choice. The role of robotic surgery and three-dimensional laparoscopic gynecological surgery on ...

  6. Future directions in inflammatory bowel disease management

    NARCIS (Netherlands)

    D'Haens, Geert R.; Sartor, R. Balfour; Silverberg, Mark S.; Petersson, Joel; Rutgeerts, Paul

    2014-01-01

    Clinical management of inflammatory bowel diseases (IBD), new treatment modalities and the potential impact of personalised medicine remain topics of intense interest as our understanding of the pathophysiology of IBD expands. Potential future strategies for IBD management are discussed, based on

  7. Anatomy and Physiology of the Small Bowel.

    Science.gov (United States)

    Volk, Neil; Lacy, Brian

    2017-01-01

    Comprehension of small intestine physiology and function provides a framework for the understanding of several important disease pathways of the gastrointestinal system. This article reviews the development, anatomy and histology of the small bowel in addition to physiology and digestion of key nutrients. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Inflammatory bowel disease with primary sclerosing cholangitis

    DEFF Research Database (Denmark)

    Sørensen, Jakob Ørskov; Nielsen, Ole Haagen; Andersson, Mikael

    2017-01-01

    BACKGROUND AND AIMS: Inflammatory bowel disease (IBD) may be complicated by primary sclerosing cholangitis (PSC). We aimed to assess the characteristics of Danish PSC-IBD patients and to compare their prognosis with IBD patients without PSC. METHODS: A retrospective nationwide population...

  9. Innate lymphoid cells in inflammatory bowel diseases

    NARCIS (Netherlands)

    Peters, C. P.; Mjösberg, J. M.; Bernink, J. H.; Spits, H.

    2016-01-01

    It is generally believed that inflammatory bowel diseases (IBD) are caused by an aberrant immune response to environmental triggers in genetically susceptible individuals. The exact contribution of the adaptive and innate immune system has not been elucidated. However, recent advances in treatments

  10. The epidemiology of irritable bowel syndrome

    DEFF Research Database (Denmark)

    Krogsgaard, L. R.; Engsbro, A. L.; Jones, M. P.

    2017-01-01

    Background: We aimed to explore the natural history of irritable bowel syndrome (IBS) in Denmark over 3 years by studying development of IBS symptoms and associated factors. Methods: A cohort study was carried out using a web panel representative of the Danish general population 18-50 years...

  11. Inflammatory Bowel Disease: School Nurse Management

    Science.gov (United States)

    Kitto, Lisa

    2010-01-01

    Initial symptoms and diagnosis of inflammatory bowel disease (IBD) usually occur between 10 and 20 years of age, although younger cases are reported. The complicated nature of IBD diagnosis and treatment can interfere with physical and emotional development that normally occurs in school-age children and adolescents. The school nurse should be…

  12. Familial risk of inflammatory bowel disease

    DEFF Research Database (Denmark)

    Moller, Frederik Trier; Andersen, Vibeke; Wohlfahrt, Jan

    2015-01-01

    OBJECTIVES: Estimates of familial risk of inflammatory bowel diseases (IBDs), Crohn's disease (CD), and ulcerative colitis (UC) are needed for counseling of patients and could be used to target future prevention. We aimed to provide comprehensive population-based estimates of familial risk of IBD...

  13. Management of inflammatory bowel disease in pregnancy

    NARCIS (Netherlands)

    S. Vermeire (Silvio); F. Carbonnel (Franck); P.G. Coulie (Pierre); V. Geenen (Vincent); J.M.W. Hazes (Mieke); P.L. Masson (Pierre); F. de Keyser (Filip); E. Louis (Edouard)

    2012-01-01

    textabstractBackground and Aims: Inflammatory bowel disease (IBD) is a chronic disease affecting mainly young people in their reproductive years. IBD therefore has a major impact on patients' family planning decisions. Management of IBD in pregnancy requires a challenging balance between optimal

  14. Inflammatory bowel disease: potential therapeutic strategies

    DEFF Research Database (Denmark)

    Nielsen, O H; Vainer, B; Bregenholt, S

    1997-01-01

    This review deals with potential and possibly primary therapeutics that, through insight into the inflammatory cascade, result in more rational treatment principles replacing the classical therapy of inflammatory bowel disease (IBD), i.e. Crohn's disease (CD) and ulcerative colitis (UC). These ne...

  15. Bowel injury following gynecological laparoscopic surgery.

    African Journals Online (AJOL)

    High clinical suspicion is crucial for early diagnosis. Diagnostic workup of suspected cases includes serial ab- dominal examination, measuring inflammatory markers, and performing imaging studies including abdominal ultrasound and. CT scan. When bowel injury is recognized during the first laparoscopic procedure then ...

  16. Dynamic bowel obstruction: aetiology, clinical presentation ...

    African Journals Online (AJOL)

    Data were analyzed using SPSS software system. A total of .... This was a descriptive prospective study of patients operated for dynamic bowel obstruction at Bugando ... The modal age group was 31-40 years accounting for 32.2% of cases (Table 1). Two hundred and six (60.2%) patients were aged 40 years and below.

  17. Environmental factors in inflammatory bowel disease

    DEFF Research Database (Denmark)

    Hansen, Tanja Stenbaek; Jess, Tine; Vind, Ida

    2011-01-01

    The role of environmental factors in development of inflammatory bowel disease (IBD) remains uncertain. The aim of the present study was to assess a number of formerly suggested environmental factors in a case-control study of an unselected and recently diagnosed group of patients with IBD...

  18. INFLAMMATORY BOWEL DISEASE: OUTPATIENT TREATMENT PROFILE

    Directory of Open Access Journals (Sweden)

    Rachael Miranda dos SANTOS

    2017-03-01

    Full Text Available ABSTRACT BACKGROUND Crohn’s disease and ulcerative colitis are the two major forms of inflammatory bowel disease. The incidence and prevalence of both conditions have increased and are progressively increasing. These diseases are frequently recurrent and clinically highly severe. In Brazil, the lack of epidemiological data related to such diseases has left these patients in a vulnerable state and contributed to increased morbidity. OBJECTIVE To describe the profiles of patients with inflammatory bowel disease treated in an outpatient service in Brazil. METHODS This descriptive, exploratory, and retrospective documentary study with a quantitative approach was performed in an outpatient treatment service for inflammatory bowel disease, at a university polyclinic located in Rio de Janeiro, Brazil, from May to July 2016. The study included 556 patients and was approved by the research ethics committee of the institution (CAAE no. 55179316.6.0000.5259/2016. RESULTS The data showed a high prevalence of inflammatory bowel disease in white female patients. Crohn’s disease was diagnosed in more patients than was ulcerative colitis; the ileocolon was the most commonly affected location in patients with Crohn’s disease. The stenotic phenotype was prevalent in patients with Crohn’s disease. CONCLUSION The prevalence of the stenotic phenotype in Crohn’s disease in relation to others demonstrates the need for further investigations in this field of study in Brazil. In conclusion, the data showed that the epidemiologic profile of the study population is similar to that published in the national and international literature.

  19. Helping Patients Cope with Inflammatory Bowel Disease.

    Science.gov (United States)

    1984-01-01

    Recovery (mastectomy patients) and the Ostomy Association. They consist of people with Inflammatory Bowel Disease. Members support one another by sharing...problems 10 unique to single people. Subjects such as dating, social relationships, sexuality , and career planning are discussed. The couples group

  20. Opioid-Induced Constipation and Bowel Dysfunction

    DEFF Research Database (Denmark)

    Müller-Lissner, Stefan; Bassotti, Gabrio; Coffin, Benoit

    2017-01-01

    of Recommendation Taxonomy (SORT) system. RESULTS:  From a list of 10,832 potentially relevant studies, 33 citations were identified for review. Screening the reference lists of the pertinent papers identified additional publications. Current definitions, prevalence, and mechanism of opioid-induced bowel...

  1. Role of alimentation in irritable bowel syndrome

    NARCIS (Netherlands)

    Dapoigny, M.; Stockbrügger, R. W.; Azpiroz, F.; Collins, S.; Coremans, G.; Müller-Lissner, S.; Oberndorff, A.; Pace, F.; Smout, A.; Vatn, M.; Whorwell, P.

    2003-01-01

    BACKGROUND: Different food items are made responsible for irritable bowel syndrome (IBS) symptoms, but the physiopathology of IBS remains unclear. AIMS: During a meeting in Nice, France, experts of the European Working Team of the IBiS Club discussed selected data regarding the relationships between

  2. Dynamic bowel obstruction: aetiology, clinical presentation ...

    African Journals Online (AJOL)

    This study was conducted to describe in our region, the aetiology, clinical presentation, management and outcome of dynamic bowel obstruction. Data were analyzed using SPSS software system. A total of 342 patients were studied. Males outnumbered females by a ratio of 2.1: 1. The median age of patients at presentation ...

  3. Review of Irritable Bowel Syndrome Treatment

    Directory of Open Access Journals (Sweden)

    Ghadir M.R.

    2010-06-01

    Full Text Available Background and Objectives: Irritable bowel syndrome is one of the most common functional gastrointestinal disorders striking 10-20% of the world population. Although most patients do not take medical assistance, this disease enforces significant cost on the patient and health systems and has negative effects on quality of life of the individual. After diagnosis ,treatment of this disease is the next step. Many pathways of treatment has been introduced and the efficacy of each other has been established in one way or another. The first step in the path of treatment is education and confidence of patients that might also be the most important step. Fiber diet, probiotic, anti-cholinergic and anti antispasmodics, laxatives, anti-diarrhea, the drugs affecting serotonin receptors, antidepressants and anti-anxiety, the chloride channel activator and non-drug methods such as cognitive-behavior therapy, hypnotherapy, acupuncture and herbal medicine each of which has been tested on irritable bowel syndrome and efficacy of each one has been indicated in one way or another. This paper tried to outline new treatments available in addition to categorization and discussion of various treatments for irritable bowel syndrome.Keywords: Irritable Bowel Syndrome; Probiotics; Parasmpatholytics; Laxatives.

  4. Inflammatory Bowel Disease. Medical and psychological aspects

    NARCIS (Netherlands)

    Albersnagel, Frans; Dijkstra, Gerard

    A review is presented in which the state of the art of behavioural-scientific research on inflammatory bowel disease (BID) is sorted out. After a short introduction on medical aspects of the two diseases that constitute IBD, i.e. Crohn's disease and ulcerative colitis, the factors that may have an

  5. Managing neonatal bowel obstruction: clinical perspectives

    Directory of Open Access Journals (Sweden)

    Desoky SM

    2018-02-01

    Full Text Available Sarah M Desoky,1 Ranjit I Kylat,2 Unni Udayasankar,1 Dorothy Gilbertson-Dahdal1 1Department of Medical Imaging, University of Arizona College of Medicine, Tucson, AZ, USA; 2Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Arizona College of Medicine, Tucson, AZ, USA Abstract: Neonatal intestinal obstruction is a common surgical emergency and occurs in approximately 1 in 2,000 live births. The causes of obstruction are diverse with varied embryological origins, and some underlying etiologies are not yet well described. Some findings of neonatal bowel obstruction can be detected prenatally on ultrasound imaging. The obstruction is classified as “high” when the level of obstruction is proximal to the ileum, and “low” when the level of obstruction is at the ileum or colon. Early diagnosis of the type of intestinal obstruction and localization of the obstructive bowel segment guides timely and appropriate management of the underlying pathologic entity. Neonatal bowel obstructions are ideally managed at specialized centers with a large volume of neonatal surgery and dedicated pediatric surgical and anesthesia expertise. Although surgical intervention is necessary in most cases, initial management strategies often target underlying metabolic, cardiac, or respiratory abnormalities. Imaging plays a key role in early and accurate diagnosis of the abnormalities. When bowel obstruction is suspected clinically, initial imaging workup usually involves abdominal radiography, which may direct further evaluation with fluoroscopic examination such as upper gastrointestinal (UGI contrast study or contrast enema. This article provides a comprehensive review of clinical and radiological features of common and less common causes of intestinal obstruction in the neonatal age group, including esophageal atresia, enteric duplication cysts, gastric volvulus, congenital microgastria, hypertrophic pyloric stenosis, duodenal atresia

  6. THE POTENTIAL OF RADIOLOGIC PROCEDURES IN THE DIAGNOSIS OF INFLAMMATORY BOWEL DISEASE

    Directory of Open Access Journals (Sweden)

    S. E. Dubrova

    2016-01-01

    Full Text Available At present, there is no "golden standard" of diagnosis of inflammatory bowel disease. Each and every individual case requires a thorough analysis of clinical symptoms in their association with endoscopic, histological, radiological and laboratory data. This review paper analyzes both conventional and novel methods of radiological investigations. Some of them have changed their significance from the "golden standard" to rare and limited application and from promising, then frequent and currently sporadic use of small bowel enema. Traditional ileocolonoscopy maintains its diagnostic potential, especially as a tool for follow up of patients with colonic and ileac disorders. The state-of-the-art non-invasive (ultrasound examination and limitedly non-invasive (computerized tomography and magnetic resonance imaging procedures are considered to be the most accurate methods for assessment of inflammatory bowel disorders in patient with already confirmed diagnosis and those with suspected cases of Crohn's disease and ulcerative colitis. The paper describes preparation of patient for each method, assessment technique, advantages and limitations for use, diagnostic criteria for intestinal wall thickness, accuracy of methods and discusses the perspectives of their use. The main sign of inflammatory bowel disease is thickening of intestinal wall. Usually its mean thickness in Crohn's disease (11 to 13 mm is higher than that in ulcerative colitis (7 to 8 mm. This may provide a diagnostic key during differential diagnosis of an isolated colon disease. The amount of the contrast cumulated by the intestinal wall directly correlates with inflammation activity. Intensive contract cumulation in the intestinal wall after intravenous contrast enhancement is a symptom of active inflammatory process. However, despite progression in the technologies, initial signs of inflammatory bowel diseases are quite superficial and remain hardly visible, being below the resolution

  7. Care of the Pregnant Patient With Inflammatory Bowel Disease.

    Science.gov (United States)

    Mahadevan, Uma; Matro, Rebecca

    2015-08-01

    Inflammatory bowel disease affects women in their peak reproductive years. Patients and physicians often have questions regarding the effect of inflammatory bowel disease on a woman's ability to conceive and to carry a pregnancy safely to term as well as the effect of inflammatory bowel disease and the medications used to treat it on pregnancy outcomes. Women with inflammatory bowel disease have the same rates of fertility as women without inflammatory bowel disease unless they have had prior surgery in the pelvis or active disease. However, women with inflammatory bowel disease do have higher rates of adverse pregnancy outcomes. A multidisciplinary approach involving gastroenterologists, obstetricians, and maternal-fetal medicine physicians should focus on preconception planning and disease optimization before pregnancy. Women with inflammatory bowel disease should be followed as high-risk obstetric patients. Most medications used to treat inflammatory bowel disease can be continued safely during pregnancy and lactation. The greatest risk to the pregnancy is active disease, which can be precipitated by discontinuation of effective maintenance medications. Preconception counseling should include education regarding the low risk of most inflammatory bowel disease medications during pregnancy and lactation and the high risk of a significant disease flare during pregnancy. This review outlines important considerations for obstetricians caring for women with inflammatory bowel disease before and during pregnancy and in the postpartum period.

  8. Treatment of Irritable Bowel Syndrome Using Complementary and Alternative Medicine

    Directory of Open Access Journals (Sweden)

    Full-Young Chang

    2009-06-01

    Full Text Available The therapeutic objectives for irritable bowel syndrome (IBS patients are to improve their functioning in society. Accordingly, recommended management is to develop a logical strategy including a positive diagnosis, consideration of the patient's agenda and emotional state, critical appraisal of the efficacies of various drugs and a graded therapeutic response. Unfortunately, none of the currently available drugs (e.g. antispasmodics, antidiarrheals, osmotics, cathartics, bulking agents, tranquilizers, sedatives are globally effective in treating all IBS symptoms, and the advanced receptor-targeted drugs are not always successfully and safely marketed. Consequently, more than half of patients may seek complementary and alternative medicine (CAM to treat the annoying bowel symptoms. Physicians have considered these CAM measures to have an ‘enhanced placebo effect’. For example, many herbal medicine and plant products are globally used to treat IBS, whereas their efficacies are often inconclusive because of small sample sizes, inadequate data analyses and lack of standardized preparations. Meta-analyses do not establish their true efficacy. Acupuncture has long been employed by patients themselves to treat functional gastrointestinal disorders with satisfactory response, but its effect on IBS does not seem to be promising. Peppermint oil, melatonin and clay-like materials are effective in treating some IBS symptoms, while their true pharmacology remains enigmatic. In conclusion, IBS treatment is usually tailored to the individual's manifestations, ranging from reassurance to psychotherapy. Apart from conventional medications, CAM may be considered individually as a supplement or alternative to treat IBS patients that is at least equal in effect to placebo if patients do not exhibit any intolerable or serious side effects.

  9. Enhanced diagnostic yield with prolonged small bowel transit time during capsule endoscopy.

    Science.gov (United States)

    Buscaglia, Jonathan M; Kapoor, Sumit; Clarke, John O; Bucobo, Juan Carlos; Giday, Samuel A; Magno, Priscilla; Yong, Elaine; Mullin, Gerard E

    2008-01-01

    The effect of small bowel transit time (SBTT) on diagnostic yield during capsule endoscopy (CE) has not been previously evaluated. Our study aim was to assess the effect of SBTT on the likelihood of detecting intestinal pathology during CE. We reviewed collected data on CE studies performed at Johns Hopkins Hospital from January 2006 to June 2007. In patients investigated for anemia or obscure bleeding, the following lesions were considered relevant: ulcers, erosions, AVMs, red spots, varices, vascular ectasias, and presence of blood. In patients with diarrhea or abdominal pain, ulcers, erosions, and blood were considered relevant. Age, gender, study indication, hospital status, and quality of bowel preparation were identified as candidate risk factors affecting SBTT. Univariate logistic and linear regression analyses were performed to study the effect of SBTT on diagnostic yield. Total of 212 CE studies were analyzed; most were in outpatients (n=175, 82.9%) and with excellent bowel preparation (n=177, 83.5%). Mean SBTT was 237.0 min (3.9 hrs). Age, gender, bowel prep, hospital status, and study indication did not significantly affect SBTT. However, increased SBTT was independently associated with increased diagnostic yield; OR=1.7 in SBTT=2-4 hr (p=0.41), OR=1.8 in SBTT=4-6 hrs (p=0.30), OR=9.6 in SBTT=6-8 hrs (p=0.05). Prolonged SBTT during CE (>6 hr) is associated with an increased diagnostic yield. This may be due to a positive effect on image quality during a "slower" study. The use of promotility agents may adversely affect the ability of CE to detect significant intestinal pathology.

  10. Clinical peculiarities of antibiotic associated bowels impairment and its significance in irritable bowel syndrome appearance

    Directory of Open Access Journals (Sweden)

    І. O. Pasichna

    2016-06-01

    Full Text Available Aim: the main objective of this study was to investigate bowels impairment due to treatment with antibiotics, its incidence and clinical peculiarities; to evaluate its role in appearance of in irritable bowel syndrome. Material and Methods. We studied 110 patients (33 males and 77 females, age range 16-83 years, who received treatment with antibiotic. We evaluated the function of the intestine before treatment with antibiotic, then in 1 week, 3 months after treatment finish (1, 2, 3, 4 visits respectively. Control group included 20 healthy persons, who haven't had antibiotics administered during recent two years. Results. We revealed that the signs of bowel function impairment took place at the first visit in 18.2% of patients, at the second visit – in 60.0% of patients, at the third visit – in 45.5% of patients and at the fourth visit – in 41.1% of patients. At the second, third and fourth visits the signs of bowels function impairment were observed reliably more often then at the first visit (before antibiotic administration, p<0.001. At the second visit the signs bowels function disorders were the most prominent: abdominal pain – in 44.5%, distention – in 46.4%, diarrhea – in 29.1%, constipation – in 18.2%, presence of both (diarrhea and periodically constipation manifestations – in 2.7%; and extraintestinal manifestations (depression. depressed mood, sorrow, apathy, decreased stamina, sleep disturbances – in 29.1% of patients. Clinical manifestations of irritable bowel syndrome occured in 6 months of observation in 32.2% of patients. Conclusions. The signs of bowel function impairment were observed in 60.0% of patients after finishing treatment with antibiotic. This incidence is much higher than in control group (р<0.001. Bowel disorders mostly manifested as the changes in quantity and consistency of feaces, pain, abdominal distention and extraintestinal manifestations. In 32.2% of patients clinical manifestations of

  11. The epidemiology of inflammatory bowel disease

    DEFF Research Database (Denmark)

    Burisch, Johan; Munkholm, Pia

    2015-01-01

    BACKGROUND AND AIMS: The inflammatory bowel diseases (IBD), Crohn's disease (CD) and ulcerative colitis (UC), are chronic relapsing disorders of unknown aetiology. The aim of this review is to present the latest epidemiology data on occurrence, disease course, risk for surgery, as well as mortality...... and cancer risks. MATERIAL AND METHODS: Gold standard epidemiology data on the disease course and prognosis of patients with inflammatory bowel disease (IBD) are based on unselected population-based cohort studies. RESULTS: The incidence of ulcerative colitis (UC) and Crohn's disease (CD) has increased...... IBD patients. CONCLUSION: In recent years, self-management and patient empowerment, combined with evolving eHealth solutions, has utilized epidemiological knowledge on disease patterns and has been improving compliance and the timing of adjusting therapies, thus optimizing efficacy by individualizing...

  12. Diet and risk of inflammatory bowel disease

    DEFF Research Database (Denmark)

    Andersen, Vibeke; Olsen, Anja; Carbonnel, Franck

    2012-01-01

    dioxide and aluminium silicate). Conclusions: A diet high in protein, particular animal protein, may be associated with increased risk of inflammatory bowel disease and relapses. N-6 polyunsaturated fatty acids may predispose to ulcerative colitis whilst n-3 polyunsaturated fatty acid may protect...... on European cohorts, mainly including middle-aged adults, suggest that a diet high in protein from meat and fish is associated with a higher risk of inflammatory bowel disease. Intake of the n-6 polyunsaturated fatty acid linoleic acid may confer risk of ulcerative colitis, whereas n-3 polyunsaturated fatty...... acids may be protective. No effect was found of intake of dietary fibres, sugar, macronutrients, total energy, vitamin C, D, E, Carotene, or Retinol (vitamin A) on risk of ulcerative colitis. No prospective data was found on risk related to intake of fruits, vegetables or food microparticles (titanium...

  13. Liver Disorders in Inflammatory Bowel Disease

    Directory of Open Access Journals (Sweden)

    Victor Uko

    2012-01-01

    Full Text Available Disorders of the hepatobiliary system are relatively common extraintestinal manifestations of inflammatory bowel disease (IBD. These disorders are sometimes due to a shared pathogenesis with IBD as seen in primary sclerosing cholangitis (PSC and small-duct primary sclerosing cholangitis (small-duct PSC. There are also hepatobiliary manifestations such as cholelithiasis and portal vein thrombosis that occur due to the effects of chronic inflammation and the severity of bowel disease. Lastly, medications used in IBD such as sulfasalazine, thiopurines, and methotrexate can adversely affect the liver. It is important to be cognizant of these disorders as some do have serious long-term consequences. The management of these disorders often requires the expertise of multidisciplinary teams to achieve the best outcomes.

  14. Intestinal barrier integrity and inflammatory bowel disease

    DEFF Research Database (Denmark)

    Holmberg, Fredrik Eric Olof; Pedersen, Jannie; Jørgensen, Peter

    2017-01-01

    Disruption of normal barrier function is a fundamental factor in the pathogenesis of inflammatory bowel disease, which includes increased epithelial cell death, modified mucus configuration, altered expression and distribution of tight junction-proteins, along with a decreased expression......, novel treatment strategies to accomplish mucosal healing and to re-establish normal barrier integrity in inflammatory bowel disease are warranted, and luminal stem cell-based approaches might have an intriguing potential. Transplantation of in vitro expanded intestinal epithelial stem cells derived...... either directly from mucosal biopsies or from directed differentiation of human pluripotent stem cells may constitute complementary treatment options for patients with mucosal damage, as intestinal epithelial stem cells are multipotent and may give rise to all epithelial cell types of the intestine...

  15. Familial occurrence of inflammatory bowel disease

    DEFF Research Database (Denmark)

    Orholm, M; Munkholm, P; Langholz, E

    1991-01-01

    BACKGROUND AND METHODS: We assessed the familial occurrence of inflammatory bowel disease in Copenhagen County, where there has been a long-term interest in the epidemiology of such disorders. In 1987 we interviewed 662 patients in whom inflammatory bowel disease had been diagnosed before 1979......, asking whether their first- and second-degree relatives had this disorder. Ninety-six percent of the patients (504 with ulcerative colitis and 133 with Crohn's disease) provided adequate information. RESULTS: As compared with the general population, the first-degree relatives of the 637 patients...... with ulcerative colitis or Crohn's disease had a 10-fold increase in the risk of having the same disease as the patients, after standardization for age and sex. The risk of having the other of the two diseases was also increased, but less so, and the increase in the risk of having Crohn's disease...

  16. Vedolizumab in pediatric inflammatory bowel disease

    DEFF Research Database (Denmark)

    Ledder, Oren; Assa, Amit; Levine, Arie

    2017-01-01

    Background: Vedolizumab, an anti-integrin antibody, has proven to be effective in adults with Inflammatory Bowel Disease (IBD), but the data in pediatrics are limited. We describe the short-term effectiveness and safety of vedolizumab in a European multi-center pediatric IBD cohort. Method: Retro...... was safe and effective in this cohort of pediatric refractory IBD. These data support previous findings of slow induction rate of vedolizumab in CD and a trend to be less effective compared to patients with UC.......Background: Vedolizumab, an anti-integrin antibody, has proven to be effective in adults with Inflammatory Bowel Disease (IBD), but the data in pediatrics are limited. We describe the short-term effectiveness and safety of vedolizumab in a European multi-center pediatric IBD cohort. Method...

  17. Leukocyte migration in experimental inflammatory bowel disease

    Directory of Open Access Journals (Sweden)

    E. P. Van Rees

    1997-01-01

    Full Text Available Emigration of leukocytes from the circulation into tissue by transendothelial migration, is mediated subsequently by adhesion molecules such as selectins, chemokines and integrins. This multistep paradigm, with multiple molecular choices at each step, provides a diversity in signals. The influx of neutrophils, monocytes and lymphocytes into inflamed tissue is important in the pathogenesis of chronic inflammatory bowel disease. The importance of each of these groups of adhesion molecules in chronic inflammatory bowel disease, either in human disease or in animal models, will be discussed below. Furthermore, the possibilities of blocking these different steps in the process of leukocyte extravasation in an attempt to prevent further tissue damage, will be taken into account.

  18. Nutrigenetics, nutrigenomics and inflammatory bowel diseases.

    Science.gov (United States)

    Ferguson, Lynnette R

    2013-08-01

    Inflammatory bowel disease includes ulcerative colitis and Crohn's disease, which are both inflammatory disorders of the gastrointestinal tract. Both types of inflammatory bowel disease have a complex etiology, resulting from a genetically determined susceptibility interacting with environmental factors, including the diet and gut microbiota. Genome Wide Association Studies have implicated more than 160 single-nucleotide polymorphisms in disease susceptibility. Consideration of the different pathways suggested to be involved implies that specific dietary interventions are likely to be appropriate, dependent upon the nature of the genes involved. Epigenetics and the gut microbiota are also responsive to dietary interventions. Nutrigenetics may lead to personalized nutrition for disease prevention and treatment, while nutrigenomics may help to understand the nature of the disease and individual response to nutrients.

  19. [SHORT BOWEL SYNDROME AND NUTRITIONAL ENTERAL].

    Science.gov (United States)

    Ariadel Cobo, Diana; Pereira Cunill, José Luis; Socas Macías, María; Serrano Aguayo, Pilar; Gómez Liébana, Eulalia; Morales Conde, Salvador; García Luna, Pedro Pablo

    2015-12-01

    The particularity of this case is the nutritional management that has managed to avoid the use of prolonged parenteral nutrition and possible complications by placing jejunal tube at the distal end in patients with short bowel. It is a 34-year-old colecistectomizado complicated with postoperative peritonitis and dehiscence; two years he studied with small bowel obstruction, he was made de-volvulus and was complicated with two leak at different times after the second escape took place jejunostomy side double barreled shotgun level dehiscence, presented high debits by afferent loop of the terminal jejunostomy; during admission, polyurethane probe enteral feeding was inserted by the efferent loop jejunostomy. He received jejunal tube feeding laundry in the efferent loop terminal with decreased weight gain and subsequent reconstruction of intestinal transit debit proximal jejunostomy. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

  20. How Patients View Probiotics: Findings from a Multicenter Study of Patients with Inflammatory Bowel Disease and Irritable Bowel Syndrome

    Science.gov (United States)

    Mercer, MaryBeth; Brinich, Margaret A.; Geller, Gail; Harrison, Krista; Highland, Janelle; James, Katherine; Marshall, Patricia; McCormick, Jennifer B.; Tilburt, Jon; Achkar, Jean-Paul; Farrell, Ruth M.; Sharp, Richard R.

    2011-01-01

    Background Patients with inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) have access to a growing number of probiotic products marketed to improve digestive health. It is unclear how patients make decisions about probiotics and what role they expect their gastroenterologists to play as they consider using probiotics. Understanding patients’ knowledge, attitudes and expectations of probiotics may help gastroenterologists engage patients in collaborative discussions about probiotics. Study Focus groups were conducted with patients with IBD and IBS at the Cleveland Clinic, Mayo Clinic and Johns Hopkins University. Inductive analytic methods were utilized to identify common themes and draw interpretations from focus group narratives. Results One hundred thirty-six patients participated in 22 focus groups between March and August 2009. Patients viewed probiotics as an appealing alternative to pharmaceutical drugs and understood probiotics as a more “natural,” low-risk therapeutic option. Many patients were hesitant to use them without consulting their gastroenterologists. Patients would weigh the risks and benefits of probiotics, their disease severity and satisfaction with current treatments when considering probiotic use. Conclusions Patients are interested in probiotics but have many unanswered questions about their use. Our findings suggest that patients with IBD and IBS will look to gastroenterologists and other clinicians as trustworthy advisors regarding the utility of probiotics as an alternative or supplement to pharmaceutical drugs. Gastroenterologists and other clinicians who care for patients with these diseases should be prepared to discuss the potential benefits and risks of probiotics and assist patients in making informed decisions about their use. PMID:21716123

  1. Association between psoriasis and inflammatory bowel disease

    DEFF Research Database (Denmark)

    Egeberg, Alexander; Mallbris, L; Warren, R B

    2016-01-01

    BACKGROUND: Psoriasis, Crohn disease (CD) and ulcerative colitis (UC) are chronic inflammatory disorders with overlapping genetic architecture. However, data on the frequency and risk of CD and UC in psoriasis are scarce and poorly understood. OBJECTIVES: To investigate the association between CD......-associated increased risk of CD and UC, which was higher in severe psoriasis, and an increased risk of psoriasis in patients with inflammatory bowel disease. Increased focus on gastrointestinal symptoms in patients with psoriasis may be warranted....

  2. Innovative therapeutics for inflammatory bowel disease

    OpenAIRE

    Yamamoto-Furusho, Jesus K

    2007-01-01

    Inflammatory bowel diseases (IBD) are chronic inflammatory conditions of the gastrointestinal tract, which clinically present as one of two disorders, Crohn’s disease or ulcerative colitis. Mainstays of drug treatments for IBD include aminosalicylates, corticosteroids and immunosuppressants such as azathioprine, methotrexate and cyclosporin. Advances in basic research of the pathophysiological process in IBD have been applied to generate a variety of new therapeutics targeting at different le...

  3. Irritable bowel syndrome and its psychological management

    Directory of Open Access Journals (Sweden)

    Ravikesh Tripathi

    2015-01-01

    Full Text Available Irritable Bowel Syndrome (IBS is a chronic and disabling gastrointestinal problem that affects psychosocial functioning as well as the quality of life. This case study reports the utility of cognitive behavior therapy as a psychological intervention procedure in a chronic case of IBS. The use of psychological intervention was found to result in a reduction of anxiety; amelioration of the symptoms associated with IBS and improved functioning.

  4. The evolving epidemiology of inflammatory bowel disease.

    LENUS (Irish Health Repository)

    Shanahan, Fergus

    2009-07-01

    Epidemiologic studies in inflammatory bowel disease (IBD) include assessments of disease burden and evolving patterns of disease presentation. Although it is hoped that sound epidemiologic studies provide aetiological clues, traditional risk factor-based epidemiology has provided limited insights into either Crohn\\'s disease or ulcerative colitis etiopathogenesis. In this update, we will summarize how the changing epidemiology of IBD associated with modernization can be reconciled with current concepts of disease mechanisms and will discuss studies of clinically significant comorbidity in IBD.

  5. CT assessment of anastomotic bowel leak

    Energy Technology Data Exchange (ETDEWEB)

    Power, N. [Department of Radiology, Sunnybrook Hospital, Toronto, Ontario M4N 3M5 (Canada); Atri, M. [Department of Radiology, Sunnybrook Hospital, Toronto, Ontario M4N 3M5 (Canada)]. E-mail: mostafa.atri@sw.ca; Ryan, S. [Department of Radiology, Sunnybrook Hospital, Toronto, Ontario M4N 3M5 (Canada); Haddad, R. [Department of Surgery, Sunnybrook Hospital, Toronto, Ontario M4N 3M5 (Canada); Smith, A. [Department of Surgery, Sunnybrook Hospital, Toronto, Ontario M4N 3M5 (Canada)

    2007-01-15

    Aim: To evaluate the predictors of clinically important gastrointestinal anastomotic leaks using multidetector computed tomography (CT). Subjects and methods: Ninety-nine patients, 73 with clinical suspicion of anastomotic bowel leak and 26 non-bowel surgery controls underwent CT to investigate postoperative sepsis. Fifty patients had undergone large bowel and 23 small bowel anastomoses. The time interval from surgery was 3-30 days (mean 10 {+-} 5.9 SD) for the anastomotic group and 3-40 days (mean 14 {+-} 11 SD) for the control group (p = 0.3). Two radiologists blinded to the final results reviewed the CT examinations in consensus and recorded the presence of peri-anastomotic air, fluid or combination of the two; distant loculated fluid or combination of fluid and air; free air or fluid; and intestinal contrast leak. Final diagnosis of clinically important anastomotic leak (CIAL) was confirmed at surgery or by chart review of predetermined clinical and laboratory criteria. Results: The prevalence of CIAL in the group undergoing CT was 31.5% (23/73). The CT examinations with documented leak were performed 5-28 (mean; 11.4 {+-} 6 SD) days after surgery. Nine patients required repeat operation, 10 percutaneous abscess drainage, two percutaneous drainage followed by surgery, and two prolonged antibiotic treatment and total parenteral nutrition (TPN). Of the CT features examined, only peri-anastomotic loculated fluid containing air was more frequently seen in the CIAL group as opposed to the no leak group (p = 0.04). There was no intestinal contrast leakage in this cohort. Free air was present up to 9 days and loculated air up to 26 days without CIAL. Conclusion: Most postoperative CT features overlap between patients with and without CIAL. The only feature seen statistically more frequently with CIAL is peri-anastomotic loculated fluid containing air.

  6. CT assessment of anastomotic bowel leak.

    Science.gov (United States)

    Power, N; Atri, M; Ryan, S; Haddad, R; Smith, A

    2007-01-01

    To evaluate the predictors of clinically important gastrointestinal anastomotic leaks using multidetector computed tomography (CT). Ninety-nine patients, 73 with clinical suspicion of anastomotic bowel leak and 26 non-bowel surgery controls underwent CT to investigate postoperative sepsis. Fifty patients had undergone large bowel and 23 small bowel anastomoses. The time interval from surgery was 3-30 days (mean 10+/-5.9 SD) for the anastomotic group and 3-40 days (mean 14+/-11 SD) for the control group (p=0.3). Two radiologists blinded to the final results reviewed the CT examinations in consensus and recorded the presence of peri-anastomotic air, fluid or combination of the two; distant loculated fluid or combination of fluid and air; free air or fluid; and intestinal contrast leak. Final diagnosis of clinically important anastomotic leak (CIAL) was confirmed at surgery or by chart review of predetermined clinical and laboratory criteria. The prevalence of CIAL in the group undergoing CT was 31.5% (23/73). The CT examinations with documented leak were performed 5-28 (mean; 11.4+/-6 SD) days after surgery. Nine patients required repeat operation, 10 percutaneous abscess drainage, two percutaneous drainage followed by surgery, and two prolonged antibiotic treatment and total parenteral nutrition (TPN). Of the CT features examined, only peri-anastomotic loculated fluid containing air was more frequently seen in the CIAL group as opposed to the no leak group (p=0.04). There was no intestinal contrast leakage in this cohort. Free air was present up to 9 days and loculated air up to 26 days without CIAL. Most postoperative CT features overlap between patients with and without CIAL. The only feature seen statistically more frequently with CIAL is peri-anastomotic loculated fluid containing air.

  7. Novel targeted therapies for inflammatory bowel disease

    DEFF Research Database (Denmark)

    Coskun, Mehmet; Vermeire, Severine; Nielsen, Ole Haagen

    2017-01-01

    Our growing understanding of the immunopathogenesis of inflammatory bowel disease (IBD) has opened new avenues for developing targeted therapies. These advances in treatment options targeting different mechanisms of action offer new hope for personalized management. In this review we highlight...... to intestinal sites of inflammation (e.g., sphingosine 1-phosphate receptor modulators). We also provide an update on the current status in clinical development of these new classes of therapeutics....

  8. Irritable bowel syndrome: a comparison of subtypes.

    Science.gov (United States)

    Rey de Castro, Nicolas G; Miller, Vivien; Carruthers, Helen R; Whorwell, Peter J

    2015-02-01

    Irritable bowel syndrome (IBS) is traditionally divided into subtypes depending on the bowel habit abnormality, but there is little clarity in the literature about whether these subtypes differ symptomatically or psychologically. Furthermore, there are conflicting reports on the relationship between symptom severity and psychological status. The aim of this study was to address these issues in a large cohort of patients defined by bowel habit. One thousand IBS patients were divided into diarrhea (IBS-D), constipation (IBS-C), and mixed (IBS-M) bowel habit subtypes and completed a series of validated questionnaires capturing symptom severity, non-colonic symptomatology (somatization), quality of life, and anxiety or depression levels. Comparisons were made using SPSS version 20. There were no significant differences between the three subtypes with respect to symptom severity, abdominal pain intensity, non-colonic symptomatology, quality of life, and anxiety or depression scores (all Ps > 0.05). In addition, there was only a small but statistically significant correlation between IBS symptom severity and both anxiety or depression, as well as quality of life (highest r = 0.34), while the relationship between somatization and disease severity was moderate (r = 0.42). This study suggests that there are no differences in the symptom profiles and anxiety or depression scores between different subtypes of IBS. In addition, anxiety and depression do not appear to be strongly associated with symptom severity, although this does not exclude the possible interplay between these and other psychological drivers of severity, such as poor coping skills. © 2014 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

  9. Inflammatory bowel disease and colorectal cancer

    Directory of Open Access Journals (Sweden)

    Andreja Ocepek

    2006-12-01

    Full Text Available Background: Colorectal cancer is one of the most frequent cancers in developed countries and Slovenia, and the incidence is still rising. Groups of people with higher risk for colorectal cancer are well defined. Among them are patients with inflammatory bowel disease. The risk is highest in patients in whom whole large bowel is affected by inflammation, it rises after 8 to 10 years and increases with the duration of the disease. Precancerous lesion is a displastic, chronically inflammed mucosa and not an adenoma as in cases of sporadic colorectal carcinoma.Conclusions: Many studies suggest that the influence of genetic factors differs between sporadic and inflammatory bowel disease related colorectal cancer. Symptomatic patients at the time of diagnosis have a much worse prognosis. The goal of prevention programes is therefore discovering early precancerous lesions. Established screening protocols are based on relatively frequent colonoscopies which are inconvinient for the patient as well as the endoscopist. Use of specific genetic markers, mutations of candidate genes, as a screening method and a prognostic predictor could greatly lighten therapeutic decisions.

  10. Neurological Manifestations In Inflammatory Bowel Disease

    Directory of Open Access Journals (Sweden)

    youssef HNACH

    2015-06-01

    Full Text Available IntroductionThe purpose of this retrospective study was to report neurological manifestations noted in patients who were monitored for inflammatory bowel disease, in order to document the pathophysiological, clinical, progressive, and therapeutic characteristics of this entity.Material and methodsWe conducted a retrospective study on patients monitored -in the gastroenterology service in Ibn Sina Hospital in Rabat, Morocco- for inflammatory bowel disease from 1992 till 2013 and who developed neurological manifestations during its course. Patients with iatrogenic complications were excluded, as well as patients with cerebrovascular risk factors.ResultsThere were 6 patients, 4 of whom have developed peripheral manifestations. Electromyography enabled the diagnosis to be made and the outcome was favorable with disappearance of clinical manifestations and normalization of the electromyography.The other 2 patients, monitored for Crohn’s disease, developed ischemic stroke. Cerebral computed tomography angiography provided positive and topographic diagnosis. Two patients were admitted to specialized facilities.ConclusionNeurological manifestations in inflammatory bowel disease are rarely reported.  Peripheral neuropathies and stroke remain the most common manifestations. The mechanisms of these manifestations are not clearly defined yet. Currently, we hypothesize the interaction of immune mediators.

  11. The epidemiology of irritable bowel syndrome

    Directory of Open Access Journals (Sweden)

    Canavan C

    2014-02-01

    Full Text Available Caroline Canavan, Joe West, Timothy Card Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK Abstract: Irritable bowel syndrome (IBS is a functional condition of the bowel that is diagnosed using clinical criteria. This paper discusses the nature of the diagnostic process for IBS and how this impacts epidemiological measurements. Depending on the diagnostic criteria employed, IBS affects around 11% of the population globally. Around 30% of people who experience the symptoms of IBS will consult physicians for their IBS symptoms. These people do not have significantly different abdominal symptoms to those who do not consult, but they do have greater levels of anxiety and lower quality of life. Internationally, there is a female predominance in the prevalence of IBS. There is 25% less IBS diagnosed in those over 50 years and there is no association with socioeconomic status. IBS aggregates within families and the genetic and sociological factors potentially underlying this are reviewed. Patients diagnosed with IBS are highly likely to have other functional disease and have more surgery than the general population. There is no evidence that IBS is associated with an increased mortality risk. The epidemiological evidence surrounding these aspects of the natural history is discussed. Keywords: irritable bowel syndrome, epidemiology, prevalence, mortality, natural history

  12. Monitoring of small bowel Crohn's disease.

    Science.gov (United States)

    Kopylov, Uri; Koulaouzidis, Anastasios; Klang, Eyal; Carter, Dan; Ben-Horin, Shomron; Eliakim, Rami

    2017-11-01

    In recent years, the therapeutic paradigm in Crohn's disease has shifted from a mere symptom-oriented approach, to aiming to healing of the underlying inflammation and prevention of long-term structural complications. Such 'treat-to-target' approach may allow for a more stable disease course with less hospitalizations, lower requirement for surgery and improved quality of life. In Crohn's disease, the small bowel is affected in the majority of patients; frequently, Crohn's involves only the small bowel, which remains inaccessible to conventional ileocolonoscopic techniques. Thus, non-invasive monitoring techniques are crucial for accurate disease assessment. Areas covered: This review addresses the indications and clinical implications of non-invasive small bowel monitoring modalities (magnetic resonance enterography, intestinal ultrasound, capsule endoscopy) in the assessment and management of Crohn's disease. Expert commentary: This review addresses the limitations of the current knowledge and future areas of research, including the possible utilization of transmural healing as an imaging target and the need to establish clear quantitative target values to guide treatment by imaging findings in Crohn's disease.

  13. Review of Irritable Bowel Syndrome Treatment

    Directory of Open Access Journals (Sweden)

    M.R Ghadir

    2012-05-01

    Full Text Available

    Background and Objectives: Irritable bowel syndrome is one of the most common functional gastrointestinal disorders striking 10-20% of the world population. Although most patients do not take medical assistance, this disease enforces significant cost on the patient and health systems and has negative effects on quality of life of the individual. After diagnosis ,treatment of this disease is the next step. Many pathways of treatment has been introduced and the efficacy of each other has been established in one way or another. The first step in the path of treatment is education and confidence of patients that might also be the most important step. Fiber diet, probiotic, anti-cholinergic and anti antispasmodics, laxatives, anti-diarrhea, the drugs affecting serotonin receptors, antidepressants and anti-anxiety, the chloride channel activator and non-drug methods such as cognitive-behavior therapy, hypnotherapy, acupuncture and herbal medicine each of which has been tested on irritable bowel syndrome and efficacy of each one has been indicated in one way or another. This paper tried to outline new treatments available in addition to categorization and discussion of various treatments for irritable bowel syndrome.

  14. Changes of smooth muscle contractile filaments in small bowel atresia

    OpenAIRE

    Gfrörer, Stefan; Fiegel, Henning; Ramachandran, Priya; Rolle, Udo; Metzger, Roman

    2012-01-01

    AIM: To investigate morphological changes of intestinal smooth muscle contractile fibres in small bowel atresia patients. METHODS: Resected small bowel specimens from small bowel atresia patients (n = 12) were divided into three sections (proximal, atretic and distal). Standard histology hematoxylin-eosin staining and enzyme immunohistochemistry was performed to visualize smooth muscle contractile markers α-smooth muscle actin (SMA) and desmin using conventional paraffin sections of the proxi...

  15. THE ROLE OF A COLONOSCOPY IN INFLAMMATORY BOWEL DISEASE (IBD)

    OpenAIRE

    Davorin Dajčman

    2008-01-01

    BACKGROUND Gastrointestinal endoscopy provides details of the surface of the gastrointestinal tract, whichhas made it possible to examine it. Despite significant advances in our understanding andtreatment of inflammatory bowel disease, the role of gastrointestinal endoscopy in diagnosis, surveillance and therapy of inflammatory bowel disease patients is still controversal.Of course, endoscopy plays a key role in the management of inflammatory bowel disease.Indication for endoscopy in patie...

  16. Pathophysiology of acute small bowel disease with CT correlation

    Energy Technology Data Exchange (ETDEWEB)

    Sarwani, N., E-mail: nsarwani@hmc.psu.ed [Department of Radiology, Section of Abdominal Imaging, Penn State Milton Hershey Medical Center, Hershey, PA (United States); Tappouni, R.; Tice, J. [Department of Radiology, Section of Abdominal Imaging, Penn State Milton Hershey Medical Center, Hershey, PA (United States)

    2011-01-15

    The objective of this article is to review the pathophysiology of acute small bowel diseases, and to correlate the mechanisms of disease with computed tomography (CT) findings. Disease entities will be classified into the following: immune mediated and infectious causes, vascular causes, mechanical causes, trauma, and others. Having an understanding of acute small bowel pathophysiology is a useful teaching tool, and can lead to imaging clues to the most likely diagnosis of acute small bowel disorders.

  17. Magnetic resonance enterography/enteroclysis in acquired small bowel diverticulitis and small bowel diverticulosis.

    Science.gov (United States)

    Mansoori, Bahar; Delaney, Conor P; Willis, Joseph E; Paspulati, Raj M; Ros, Pablo R; Schmid-Tannwald, Christine; Herrmann, Karin A

    2016-09-01

    Small bowel (SB) diverticulosis is a rare disorder that may entail serious complications, including SB diverticulitis. Both are often missed in imaging. Magnetic resonance enterography/enteroclysis (MRE) is increasingly used to assess SB disease; awareness of the appearance of SB diverticulitis is essential to ensure appropriate management. Our aim was to systematically describe imaging characteristics of SB diverticulosis and diverticulitis in MRE. This retrospective, HIPAA-compliant study identified 186 patients with suspected SB diverticulosis/diverticulitis in medical databases of two tertiary medical centres between 2005 and 2011. Patients with surgically confirmed diagnoses of SB diverticulosis/diverticulitis were included. Two observers analyzed MR images for the presence, location, number, and size of diverticula, wall thickness, and mural and extramural patterns of inflammation. Seven patients were recruited. MRI analysis showed multiple diverticula in all (100 %). Diverticular size ranged from 0.5 to 6 cm. Prevalence of diverticula was higher in the proximal than the distal SB (jejunum 86 %, ileum 57 %, distal ileum43%). Diverticulitis occurred in 3/7 patients (43 %) showing asymmetric bowel wall thickening and focal mesenteric inflammation. SB diverticulitis demonstrates characteristic MRE imaging features to distinguish this rare disorder from more common diseases. Asymmetric, focal mesenteric and mural inflammation and presence of multiple diverticula are keys to diagnosis. • Small bowel diverticulosis and diverticulitis is rare and often missed in imaging • Acquired small bowel diverticula are variable in size and number • Small bowel diverticulitis demonstrates characteristic features on MR enterography/enteroclysis • A focal or segmental asymmetric small bowel inflammation should prompt the search for diverticula.

  18. ARMA-based spectral bandwidth for evaluation of bowel motility by the analysis of bowel sounds.

    Science.gov (United States)

    Emoto, Takahiro; Shono, Koichi; Abeyratne, Udantha R; Okahisa, Toshiya; Yano, Hiromi; Akutagawa, Masatake; Konaka, Shinsuke; Kinouchi, Yohsuke

    2013-08-01

    Approximately 10%-20% of adults and adolescents suffer from irritable bowel syndrome (IBS) worldwide. IBS is characterized by chronic gastrointestinal dysfunction which may reflect in altered motility. Currently, the diagnosis of IBS is made through expensive invasive radiographic and endoscopic examinations. However these are inconvenient and unsuited for community screening. Bowel sounds (BSs) can be easily recorded with non-invasive and low-cost equipment. Recently, several researchers have pointed out changes in features obtained from BS according to the pathological condition of bowel motility. However a widely accepted, simple automatic BS detection algorithm still has to be found, and the appropriate recording period needs to be investigated for further evaluation of bowel motility. In this study we propose a novel simple automatic method to detect the BSs based on the 3 dB bandwidth of the frequency peaks in the autoregressive moving average spectrum. We use the measure, sound-to-sound interval (SSI) obtained by the proposed method, to capture bowel motility. In this paper, we show that the proposed method for automatic detection could achieve a sensitivity of 87.8±5.88%, specificity of 91.7±4.33% and area under the curve of 0.923 when working on 16 healthy volunteers during mosapride administrations. Furthermore, we show that the measured SSI averaged over a period of 30 min can clearly capture bowel motility. Our findings should have the potential to contribute toward developing automated BS-based diagnosis of IBS.

  19. Hypnotherapy for treatment of irritable bowel syndrome.

    Science.gov (United States)

    Webb, A N; Kukuruzovic, R H; Catto-Smith, A G; Sawyer, S M

    2007-10-17

    Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder of unknown aetiology. Current pharmacological treatments have limited value. Hypnotherapy has been reported to have beneficial effects for IBS symptoms. To evaluate the efficacy of hypnotherapy for the treatment of irritable bowel syndrome. Published and unpublished randomised clinical trials and quasi-randomised clinical trials were identified through structured searches of MEDLINE (1966 to March 2006), EMBASE (1980 to March 2006), PsycINFO (1806 to March 2006), CINAHL (Cumulative Index to Nursing and Allied Health Literature, 1982 to March 2006), AMED (Allied and Complementary Medicine Database, 1985 to March 2006) and The Cochrane Central Register of Controlled trials. Conference proceedings from Digestive Disease Week (1980 to 2005) were also searched. Eligible studies included all randomised and quasi-randomised clinical studies comparing hypnotherapy for the treatment of irritable bowel syndrome with no treatment or another therapeutic intervention. All studies were evaluated for eligibility for inclusion. Included studies were assessed for quality and data were extracted independently by four authors. The primary outcome measure of interest was the overall bowel symptom severity score which combines abdominal pain, diarrhoea or constipation and bloating. Secondary outcomes included abdominal pain, diarrhoea, constipation, bloating, quality of life, patient's overall assessment of well-being, psychological measures as per validated questionnaires, and adverse events. Four studies including a total of 147 patients met the inclusion criteria. Only one study compared hypnotherapy to an alternative therapy (psychotherapy and placebo pill), two studies compared hypnotherapy with waiting-list controls and the final study compared hypnotherapy to usual medical management. Data were not pooled for meta-analysis due to differences in outcome measures and study design. The therapeutic

  20. Primary Amyloidosis Presenting as Small Bowel Encapsulation

    Directory of Open Access Journals (Sweden)

    Jennifer Jones

    2004-01-01

    Full Text Available Amyloidosis is a pathological process which encompasses a spectrum of diseases that result from extracellular deposition of pathological fibrillar proteins. Clinical presentations vary depending on the organs involved. There is no documented case of amyloidosis presenting as small bowel encapsulation. A previously healthy 62-year-old man developed a small bowel obstruction in 1997. At surgery, a peculiar membrane encasing his entire small bowel was discovered. This appeared to have no vascularity and was removed without difficulty, exposing a grossly normal bowel. Histopathology revealed thick bands of collagen overlying the peritoneal surface, which was congo red positive and showed apple green birefringence. The findings were consistent with encapsulating peritonitis due to amyloidosis. There was no history or symptoms of any chronic inflammatory condition and he became symptom-free postoperatively. An abdominal fat pad biopsy failed to demonstrate amyloidosis. Endoscopic duodenal biopsies revealed classical primary amyloidosis. Quantitative immunoglobulins, lactate dehydrogenase, C3, C4 and beta-2 microglobulin were normal. Protein electrophoresis identified monoclonal paraprotein, immunoglobulin G lambda 3.7 g/L. Bone marrow biopsy and aspirate revealed only a mild plasmacytosis (5% to 10%. Echocardiogram and skeletal survey were normal. He had mild proteinuria. Complete blood count, C-reactive protein, calcium, albumin and total protein were normal. No specific therapy was instituted. In January of 1998 the patient remained asymptomatic with no gastrointestinal, cardiovascular or constitutional symptoms. He had developed nephrotic range proteinuria (3.95 g/24 h, microalbuminuria, hypoalbuminemia and a renal biopsy consistent with renal amyloidosis. In 1999 there was an increase in the monoclonal paraprotein (6.2 g/L. The remaining investigations were normal except for an echocardiogram which showed left ventricular hypertrophy but a normal

  1. AN ANALYTICAL STUDY IN ADHESIVE BOWEL OBSTRUCTION

    Directory of Open Access Journals (Sweden)

    Gerald Anand Raja

    2017-04-01

    Full Text Available BACKGROUND Peritoneal adhesions can be defined as abnormal fibrous bands between organs or tissues or both in the abdominal cavity that are normally separated. Adhesions may be acquired or congenital; however, most are acquired as a result of peritoneal injury, the most common cause of which is abdominopelvic surgery. Less commonly, adhesions may form as the result of inflammatory conditions, intraperitoneal infection or abdominal trauma. The extent of adhesion formation varies from one patient to another and is most dependent on the type and magnitude of surgery performed as well as whether any postoperative complications develop. Fortunately, most patients with adhesions do not experience any overt clinical symptoms. For others, adhesions may lead to any one of a host of problems and can be the cause of significant morbidity and mortality. MATERIALS AND METHODS This is a retrospective study of 50 patients admitted in Government Royapettah Hospital with adhesive bowel obstruction between September 2008 to September 2010. All patients were admitted and managed either conservatively or surgically. RESULTS 1. Adhesive bowel disease is the most common cause for bowel obstruction followed by hernias. 2. Increased incidence is noted in females. 3. Increased incidence of adhesions was documented in gynaecological and colorectal surgeries. 4. Below umbilical incisions have higher propensity for adhesion formation. 5. Laparotomies done for infective aetiology have higher adhesion risks. 6. Most of adhesive obstructions can be managed conservatively. 7. Adhesiolysis preferably laparoscopic can be done. For gangrenous bowel resection and anastomosis or ostomy done. 8. Given the above risk factors, adhesive bowel disease can be prevented to a certain extent. CONCLUSION The formation of peritoneal adhesions continues to plague patients, surgeons and society. Although, research in this area is ongoing, there is currently no method that is 100% effective in

  2. Small bowel diverticulitis: an imaging review of an uncommon entity.

    Science.gov (United States)

    Transue, Darren L; Hanna, Tarek N; Shekhani, Haris; Rohatgi, Saurabh; Khosa, Faisal; Johnson, Jamlik-Omari

    2017-04-01

    In this review, we discuss the clinical and radiologic findings of small bowel diverticulosis, which is infrequently encountered during practice and far less common than colonic diverticulosis. Small bowel diverticulosis can present with a range of emergent symptomatic complications including diverticulitis, perforation, or hemorrhage. Here, we focus on the clinical features, pathogenesis, radiologic findings, and treatment of small bowel diverticulitis. Although not routinely considered in the differential diagnosis of an acute abdomen, prospective radiologic diagnosis of small bowel diverticulitis is important and can lead to conservative treatment thus preventing unnecessary exploratory laparotomy.

  3. Multislice CT enteroclysis in the diagnosis of bowel endometriosis

    Energy Technology Data Exchange (ETDEWEB)

    Biscaldi, Ennio; Rollandi, Gian A. [' ' Duchesse of Galliera' ' -Hospital, Genoa (Italy). Dept. of Radiology; Ferrero, Simone; Ragni, Nicola; Remorgida, Valentino [San Martino Hospital and Genoa Univ. (Italy). Dept. of Obstretics and Gynaecology; Fulcheri, Ezio [San Martino Hospital and Genoa Univ. (Italy). Unit of Anatomy and Histopathology

    2007-01-15

    This prospective study aims to evaluate the efficacy of multislice computed tomography combined with colon distension by water enteroclysis (MSCTe) in determining the presence and depth of bowel endometriotic lesions. Ninety-eight women with symptoms suggestive of colorectal endometriosis underwent MSCTe; locations, number of nodule/s, size of the nodule/s and depth of bowel wall infiltration were determined. Independently from the findings of MSCTe, all women underwent laparoscopy. MSCTe findings were compared with surgical and histological results. Abnormal findings suggestive of bowel endometriotic nodules were detected by MSCTe in 75 of the 76 patients with bowel endometriosis. MSCTe identified 110 (94.8%) of the 116 bowel endometriotic nodules removed at surgery; 6 nodules missed at MSCTe were located on the rectum. MSCTe correctly determined the degree of infiltration of the bowel wall in all of the 34 serosal bowel nodules identified at MSCTe. In six nodules reaching the submucosa, the depth of infiltration was underestimated by MSCTe. MSCTe had a sensitivity of 98.7%, a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 95.7% in identifying women with bowel endometriosis. MSCTe is effective in determining the presence and depth of bowel endometriotic lesions. (orig.)

  4. Nonocclusive ischaemic bowel disease in patients on chronic haemodialysis

    Energy Technology Data Exchange (ETDEWEB)

    Engel, A.; Adler, O.B.; Loberant, N.; Rosenberger, A.; Weissman, I.

    1989-06-01

    Six patients with chronic renal failure on longstanding haemodialysis are presented, in whom nonocclusive bowel ischaemia occurred as a rare complication of their underlying disorder. Factors implicated in the development of bowel ischaemia in these patients are chronic constipation resulting in increased intraluminal pressure on the bowel wall, premature and progressive arterial disease and bouts of hypotension accompanying the haemodialysis procedure. Contrast studies of the bowel and computed tomography examination can suggest the diagnosis, but angiography alone provides the exact answer in demonstrating nonocclusive mesenteric ischaemia. In patients with chronic renal failure and longstanding dialysis presenting with abdominal symptoms this diagnosis should be considered. (orig.).

  5. Small bowel cancer diagnosis: role of nuclear magnetic resonance

    Directory of Open Access Journals (Sweden)

    Alessandro Morotti

    2015-10-01

    Full Text Available The diagnosis of small intestine tumors is challenging. Even in the era of modern medicine, standard approaches including echography, computed tomography-scan and conventional endoscopy are unable to reveal small bowel lesions. Video-capsule has substantially improved the evaluation of small bowel; however this procedure cannot be proposed to all patients and in particular to those experiencing intestine sub-occlusion. Nuclear magnetic resonance (NMR of the abdomen is an additional diagnostic approach that offers high sensitivity in the identification of small bowel lesions. Here, we describe a case of small bowel neoplasia identified with NMR of the abdomen.

  6. Multi-detector CT (MDCT in bowel and mesenteric injury

    Directory of Open Access Journals (Sweden)

    Vajjalla Ravikumar

    2013-04-01

    Full Text Available Objectives: To evaluate multi-detector CT (MDCT findings in bowel and mesenteric injury due to blunt abdominal trauma.Method: Retrospective evaluation of MDCT scan reports of patients admitted in Hamad Medical Corporation, Doha, Qatar with bowel and mesenteric injury during the period of January 2005 to April 2008.Results: MDCT, without using oral contrast, clearly demonstrated various specific and less specific findings of bowel and mesenteric injury.Conclusion: Multi-detector CT is an excellent diagnostic modality in bowel and mesenteric injury. Routine administration of oral contrast agent is not mandatory for initial evaluation of these patients.

  7. Colonic inflammation in pediatric inflammatory bowel disease: detection with magnetic resonance enterography

    Energy Technology Data Exchange (ETDEWEB)

    Campari, Alessandro [E. Bassini Hospital - ASST Nord Milano, Radiology Department, Milan (Italy); V. Buzzi Children' s Hospital - ASST Fatebenefratelli-Sacco, Pediatric Radiology Department, Milan (Italy); Napolitano, Marcello [V. Buzzi Children' s Hospital - ASST Fatebenefratelli-Sacco, Pediatric Radiology Department, Milan (Italy); Zuin, Giovanna [V. Buzzi Children' s Hospital - ASST Fatebenefratelli-Sacco, Pediatric Department, Milan (Italy); Maestri, Luciano [V. Buzzi Children' s Hospital - ASST Fatebenefratelli-Sacco, Pediatric Surgery Department, Milan (Italy); Di Leo, Giovanni [IRCCS Policlinico San Donato, Radiology Unit, Milan (Italy); Sardanelli, Francesco [IRCCS Policlinico San Donato, Radiology Unit, Milan (Italy); Universita degli Studi di Milano, Department of Biomedical Sciences for Health, Milan (Italy)

    2017-06-15

    Colonic involvement in pediatric inflammatory bowel disease is common. Magnetic resonance (MR) enterography is considered the best imaging modality for pediatric inflammatory bowel disease evaluation. It is unclear whether the lack of a dedicated large bowel preparation prevents a reliable colonic assessment. To determine the diagnostic performance of standard MR enterography in detecting and grading colonic inflammatory activity. We retrospectively evaluated children who underwent both MR enterography and ileocolonoscopy with biopsies <4 weeks apart. Two radiologists independently reviewed MR examinations and quantified inflammation in each of the five colonic segments using a standardized MR score system. Findings were compared with histological examination of the corresponding segment. Mann-Whitney, Kruskal-Wallis, Jonckheere-Terpstra and Bland-Altman statistics were used. One hundred seventy-five segments from 37 examinations were included. MR enterography diagnostic performance for inflammation was as follows: sensitivity 94% (95% confidence interval [CI]: 90-97%), specificity: 64% (95% CI: 57-71%). A significant positive correlation was found between MR score and inflammatory activity histologically graded (P<0.001, Jonckheere-Terpstra test). The interobserver agreement was good (mean difference between MR enterography scores was -0.03; limits of agreement -2.8 to 2.7). Standard MR enterography is sensitive for the detection of actively inflamed colonic segments. MR enterography might provide useful information for guiding biopsies and its role as an alternative to ileocolonoscopy in monitoring colonic disease activity in children should be further investigated. (orig.)

  8. Software-assisted small bowel motility analysis using free-breathing MRI: feasibility study.

    Science.gov (United States)

    Bickelhaupt, Sebastian; Froehlich, Johannes M; Cattin, Roger; Raible, Stephan; Bouquet, Hanspeter; Bill, Urs; Patak, Michael A

    2014-01-01

    To validate a software prototype allowing for small bowel motility analysis in free breathing by comparing it to manual measurements. In all, 25 patients (15 male, 10 female; mean age 39 years) were included in this Institutional Review Board-approved, retrospective study. Magnetic resonance imaging (MRI) was performed on a 1.5T system after standardized preparation acquiring motility sequences in free breathing over 69-84 seconds. Small bowel motility was analyzed manually and with the software. Functional parameters, measurement time, and reproducibility were compared using the coefficient of variance and paired Student's t-test. Correlation was analyzed using Pearson's correlation coefficient and linear regression. The 25 segments were analyzed twice both by hand and using the software with automatic breathing correction. All assessed parameters significantly correlated between the methods (P software (3.90%, standard deviation [SD] ± 5.69) than manual examinations (9.77%, SD ± 11.08). The time needed was significantly less (P software (4.52 minutes, SD ± 1.58) compared to manual measurement, lasting 17.48 minutes for manual (SD ± 1.75 minutes). The use of the software proves reliable and faster small bowel motility measurements in free-breathing MRI compared to manual analyses. The new technique allows for analyses of prolonged sequences acquired in free breathing, improving the informative value of the examinations by amplifying the evaluable data. Copyright © 2013 Wiley Periodicals, Inc.

  9. Crohn enteritis-associated small bowel adenocarcinomas exhibit gastric differentiation.

    Science.gov (United States)

    Whitcomb, Emma; Liu, Xiuli; Xiao, Shu-Yuan

    2014-02-01

    Primary small bowel adenocarcinoma is rare. Although generally similar to colonic adenocarcinoma, some small bowel adenocarcinomas exhibit unique morphologic features, particularly those arising in association with Crohn disease. In this study, 15 sporadic small bowel adenocarcinomas and 11 Crohn enteritis-associated small bowel adenocarcinomas were examined for histology and immunohistochemical profile including cytokeratins (CK) 7 and 20, intestinal markers CDX2 and MUC2, and gastric epithelial markers MUC5AC and MUC6. We found that Crohn enteritis-associated small bowel adenocarcinomas frequently resemble gastric tubular adenocarcinoma histologically. In addition, when compared to sporadic small bowel adenocarcinoma, the former expressed MUC5AC and MUC6 with much higher frequency (82% vs. 7% and 73% vs. 0%, respectively). Ten of 11 Crohn enteritis-associated small bowel adenocarcinomas (91%) were positive for at least one gastric-type marker (MUC5AC or MUC6). Expression of CK7 was also more frequent in Crohn enteritis-associated small bowel adenocarcinoma (73% versus 27%) while expression of CK20 was less frequent (64% vs. 100%). There was no difference between sporadic and Crohn enteritis-associated small bowel adenocarcinoma in expression of CDX2 (100% vs. 91%) and MUC2 (93% vs. 73%). These observations suggest that there is a difference in the morphologic and immunohistochemical characteristics of sporadic versus Crohn enteritis-associated small bowel adenocarcinoma, particularly in their expression of gastric-type mucin. The findings also suggest that gastric differentiation in Crohn enteritis-associated small bowel adenocarcinoma is related to gastric metaplasia, a common phenomenon in Crohn disease. © 2014 Elsevier Inc. All rights reserved.

  10. Bowel Dysfunction Related to Spina Bifida: Keep It Simple.

    Science.gov (United States)

    Brochard, Charlène; Peyronnet, Benoît; Dariel, Anne; Ménard, Hélène; Manunta, Andréa; Ropert, Alain; Neunlist, Michel; Bouguen, Guillaume; Siproudhis, Laurent

    2017-11-01

    Although care of urological disorders in spina bifida is well established, there is yet no agreement on a standardized approach to bowel dysfunction in this population. The purpose of this study was to assess bowel dysfunction using validated instruments and the risk factors in adults with spina bifida. A multidisciplinary team prospectively collected patient data, focusing on anorectal and urological symptoms. The study was conducted with data from a French referral center for spina bifida. A total of 228 adults with spina bifida (sex ratio men:women, 92 (40%):136 (60%)) with a median age of 34.7 years (range, 26.8-44.7 y) were assessed. Factors associated with severe fecal incontinence (Cleveland Clinic Incontinence Score ≥9) and severe bowel dysfunction (Neurogenic Bowel Dysfunction score ≥14) were assessed in a multivariate analysis model. The prevalence rates of severe fecal incontinence and severe bowel dysfunction were 60% (130/217) and 42% (71/168). Bowel dysfunction was the second most common major concern of patients after lower urinary tract dysfunction. Male sex, obesity, urinary incontinence, and a Knowles-Eccersley-Scott symptom constipation score ≥10 were independently associated with severe fecal incontinence. Patients with soft stools had significantly less severe bowel dysfunction. Neither neurologic level nor other neurologic features of spina bifida were associated with severe fecal incontinence or severe bowel dysfunction. The recruitment of patients with spina bifida through a national referral center might have resulted in selection bias, and some data were missing especially regarding BMI and Neurogenic Bowel Dysfunction score (21% and 26% of missing data). The prevalence rates of severe fecal incontinence and severe bowel dysfunction in adults with spina bifida were high and were adequately perceived by the patients. The present study emphasized the association of bowel dysfunction and fecal incontinence with obesity, urologic

  11. Two liters of polyethylene glycol-electrolyte lavage solution versus sodium phosphate as bowel cleansing regimen for colonoscopy: a prospective randomized controlled trial.

    Science.gov (United States)

    Poon, C M; Lee, D W H; Mak, S K; Ko, C W; Chan, K C; Chan, K W; Sin, K S; Chan, A C W

    2002-07-01

    As a bowel cleansing agent for colonoscopy, sodium phosphate (NaP) has been reported to have equal effectiveness and better patient tolerance in comparison with 4 l polyethylene glycol-electrolyte lavage (PEG-EL) solution. Poor patient tolerance is frequently associated with a large amount of fluid consumed, and better patient tolerance might therefore be expected if the volume of PEG-EL solution could be reduced. This study aimed to compare 2 l PEG-EL solution with NaP in relation to patients' tolerance and its effectiveness as a bowel cleansing agent. Two hundred consecutive patients admitted to the day-procedure ward for elective colonoscopy were prospectively randomized to receive either a 2-l PEG-EL solution or a 90-ml oral NaP regimen. Patients with a history of congestive heart failure, impaired renal function (creatinine > 1.5 mg/dl), or previous colectomy were excluded from the study. The patients completed a questionnaire to assess their tolerance of bowel preparation before the colonoscopy. Endoscopists, who were blinded to the type of regimen that had been used, scored the adequacy of bowel preparation from the rectum to cecum using a defined endoscopic score. Two hundred patients were included in this randomized trial. Nine patients were excluded, due to either an incomplete questionnaire (two in the PEG-EL group, one in the NaP group) or inability to complete the bowel preparation regimen (four in the PEG-EL group and two in the NaP group). The demographic data were comparable in the two groups. There were no differences between the two groups with regard to willingness to repeat the regimen, ease of consumption, acceptability of the bowel preparation regimen, or the endoscopists' satisfaction with the quality of bowel preparation. The NaP group had a better mean endoscopic score at the cecum compared with the PEG-EL group (1.47 +/- 1.15 vs. 1.05 +/- 0.76; P = 0.007). The effectiveness and patient tolerance of the 2-l PEG-EL solution is comparable

  12. Colonic stenting as a bridge to surgery in malignant large-bowel obstruction: a report from two large multinational registries

    DEFF Research Database (Denmark)

    Jiménez-Pérez, J; Casellas, J; García-Cano, J

    2011-01-01

    To date, this is the largest prospective series in patients with malignant colorectal obstruction to evaluate the effectiveness and safety of colonic self-expanding metal stents (SEMSs) as an alternative to emergency surgery. SEMSs allow restoration of bowel transit and careful tumor staging in p...... in preparation for elective surgery, hence avoiding the high morbidity and mortality associated with emergency surgery and stoma creation....

  13. Matrix metalloproteases role in bowel inflammation and inflammatory bowel disease: an up to date review.

    Science.gov (United States)

    OʼShea, Nuala R; Smith, Andrew M

    2014-12-01

    There has been an explosion of literature in recent years highlighting the pivotal role of matrix metalloproteases (MMPs) in the immune response. This review will focus on our current understanding of MMPs in the gastrointestinal tract and in particular the field of inflammatory bowel disease. MMPs are structurally similar proteins that classically degrade extracellular components. In the gastrointestinal tract, they are involved in the physical maintenance and turnover of the intestinal barrier, aid in leukocyte recruitment, regulate the activity of cytokines, chemokines, and growth factors. During inflammation, numerous MMPs are upregulated in the bowel and play a key role in the resolution of inflammation and wound healing during the normal immune response. In humans, an aberrant expression has been extensively documented in inflammatory bowel disease implicating them in tissue degradation, persistence of the inflammatory state and fibrosis. Animal studies in particular knockout mouse models have provided insight into the importance of individual MMPs in bowel homeostasis and inflammation. Endogenous inhibitors of MMPs such as tissue inhibitors of MMPs (TIMPs) and alpha-2 macroglobulin maintain the balance between extracellular matrix deposition and degradation. An imbalance between MMPs and their inhibitors through genetic variation, gene expression abnormalities, or environmental effects can directly impact on tissue homeostasis resulting in tissue damage and prolonged inflammation. In the future, targeting MMPs or their inhibitors could be a possible therapeutic option. The challenge will be achieving selectivity.

  14. Small bowel intussusception in 2 adults caused by inflammatory polyps

    Directory of Open Access Journals (Sweden)

    André Carvalho, MD

    2017-12-01

    Full Text Available Inflammatory fibroid polyps are rare, benign pseudotumors of the gastrointestinal tract of unknown etiology, which may rarely present as bowel intussusception and obstruction. The authors describe the clinical, radiologic, and pathologic features of 2 patients with ileal inflammatory fibroid polyps presenting as small bowel intussusception.

  15. Childhood Sexual Abuse and Psychosomatic Symptoms in Irritable Bowel Syndrome

    Science.gov (United States)

    Ross, Colin A.

    2005-01-01

    Irritable bowel syndrome is characterized by chronic gastrointestinal symptoms without a demonstrable physical cause. In a subgroup of patients, irritable bowel syndrome may be part of a cluster of psychosomatic symptoms related to childhood sexual abuse. To investigate this possibility, the Dissociative Disorders Interview Schedule (DDIS), the…

  16. Large Bowel Obstruction Caused by Adhesions without Previous ...

    African Journals Online (AJOL)

    Background: Large bowel obstruction is rarely caused by adhesions. To our knowledge, the few cases reported in literature are secondary to previous abdomino-pelvic surgery, and are in female patients. Case Reports: We report two cases of large bowel obstruction due to adhesions in males with no previous abdominal ...

  17. The research progress of acute small bowel perforation

    Directory of Open Access Journals (Sweden)

    Rudolf Schiessel

    2015-08-01

    Full Text Available This article reviews the various aetiologies of small bowel perforations and their management. In addition to the well-known aetiologies such as trauma, inflammation and circulatory disorders, several new causes of small bowel perforation have been described in recent years. The spectrum reaches from iatrogenic perforations during laparoscopic surgery or enteroscopies to drug-induced perforations with new anticancer agents. The management of small bowel perforations requires a concept consisting of the safe revision of the leaking bowel and the treatment of the peritonitis. Depending on the local situation and the condition of the patient, several treatment options are available. The surgical management of the bowel leak can range from a simple primary closure to a delayed restoration of bowel continuity. When the condition of the bowel or patient is frail, the risk of a failure of a closure or anastomosis is too high, and the exteriorization of the bowel defect as a primary measure is a safe option. The treatment of the peritonitis is also dependent on the condition of the patient and the local situation. Early stages of peritonitis can be treated by a simple peritoneal lavage, either performed by laparoscopy or laparotomy. Severe forms of peritonitis with multi-organ failure and an abdominal compartment syndrome need repeated peritoneal revisions. In such cases, the abdomen can only be closed temporarily. Different technical options are available in order to overcome the difficult care of these patients.

  18. Solar radiation is inversely associated with inflammatory bowel disease admissions.

    Science.gov (United States)

    Jaime, Francisca; Riutort, Maria C; Alvarez-Lobos, Manuel; Hoyos-Bachiloglu, Rodrigo; Camargo, Carlos A; Borzutzky, Arturo

    To explore the associations between latitude and solar radiation with inflammatory bowel disease admission rates in Chile, the country with the largest variation in solar radiation in the world. This is an ecological study, which included data on all hospital-admitted population for inflammatory bowel disease between 2001 and 2012, according to different latitudes and solar radiation exposures in Chile. The data were acquired from the national hospital discharge database from the Department of Health Statistics and Information of the Chilean Ministry of Health. Between 2001 and 2012 there were 12,869 admissions due to inflammatory bowel disease (69% ulcerative colitis, 31% Crohn's disease). Median age was 36 years (IQR: 25-51); 57% were female. The national inflammatory bowel disease admission rate was 6.52 (95% CI: 6.40-6.63) per 100,000 inhabitants with increasing rates over the 12-year period. In terms of latitude, the highest admission rates for pediatric ulcerative colitis and Crohn's disease, as well as adult ulcerative colitis, were observed in the southernmost region with lowest annual solar radiation. Linear regression analysis showed that regional solar radiation was inversely associated with inflammatory bowel disease admissions in Chile (β: -.44, p = .03). Regional solar radiation was inversely associated with inflammatory bowel disease admission rates in Chile; inflammatory bowel disease admissions were highest in the southernmost region with lowest solar radiation. Our results support the potential role of vitamin D deficiency on inflammatory bowel disease flares.

  19. Bowel prolapse following spontaneous rupture of a femoral hernia.

    Science.gov (United States)

    Sein, Tin Aung; Damodaran, Ashok

    2012-09-01

    This case presents a rare complication of the spontaneous rupture of a femoral hernia in an elderly woman without causing much systemic effect despite the herniated bowel being necrosed and perforated, giving rise to an enterocutaneous fistula. The small bowel had also prolapsed through the fistula opening, making it a very rare and alarming presentation.

  20. Irritable bowel syndrome in black Kenyans | Lule | East African ...

    African Journals Online (AJOL)

    Irritable bowel syndrome in black Kenyans. ... The mean age was 40 years with range of 11 to 75 years with a peak prevalence in the 3rd decade. The male ... Conclusion: The Black African patient is equally as exposed to Irritable Bowel Syndrome as is his counterpart in the western world and has similar morbidity patterns.

  1. Small bowel angiodysplasia and novel disease associations: a cohort study.

    LENUS (Irish Health Repository)

    Holleran, Grainne

    2013-04-01

    Gastrointestinal angiodysplasias recurrently bleed, accounting for 3-5% of obscure gastrointestinal bleeding. The advent of small bowel capsule endoscopy (SBCE) has led to an increased recognition of small bowel angiodysplasias (SBAs) but little is known about their etiology. Previous small cohorts and case reports suggest an equal gender incidence and associations with cardiovascular disease, renal impairment, and coagulopathies.

  2. Retro-ureteral Small Bowel Herniation After Radical Cystectomy

    Directory of Open Access Journals (Sweden)

    Abbey L. Cole-Clark

    2017-11-01

    Full Text Available Small bowel obstruction caused by internal herniation under ureteric bands is a rare occurrence. Only 6 previous cases have been documented. This case report reviews the case of a 79-year-old male who presented to emergency with abdominal pain requiring subsequent laparotomy and release of internal herniation of bowel under ureter.

  3. Transmesenteric hernia with bowel ischemia in unusual site

    Directory of Open Access Journals (Sweden)

    Praveen S

    2007-01-01

    Full Text Available An 8-year-old girl presented with distal ileal obstruction secondary to transmesenteric hernia. The ileum just proximal to the herniated loop was ischemic, while the herniated bowel did not show ischemia. The ischemia was due to stretching and torsion of the vessels around the mesenteric defect by the herniated bowel. Such a mechanism has not been reported before.

  4. Rapunzel Syndrome: a rare cause of acute small bowel obstruction ...

    African Journals Online (AJOL)

    The Rapunzel syndrome is a very rare condition where trichobezoar has extended up to the small bowel. Here we are reporting a rare case of Rapunzel syndrome in an adolescent girl with history of trichophagia who presented with small bowel obstruction. Patient underwent exploratory laparotomy and bezoar was ...

  5. Prevalence of irritable bowel syndrome among psychiatric patients ...

    African Journals Online (AJOL)

    Background: Irritable Bowel Syndrome (IBS) is a chronic gastrointestinal illness characterized by abdominal pain, bloating and bowel disturbance, which may either be constipation or diarrhea with no detectable organic pathologic process. About 70-90% of patients with IBS have psychiatric comorbidity, such as depression, ...

  6. Surgical treatment of complex small bowel Crohn disease.

    Science.gov (United States)

    Michelassi, Fabrizio; Sultan, Samuel

    2014-08-01

    The clinical presentations of Crohn disease of the small bowel vary from low to high complexity. Understanding the complexity of Crohn disease of the small bowel is important for the surgeon and the gastroenterologist caring for the patient and may be relevant for clinical research as a way to compare outcomes. Here, we present a categorization of complex small bowel Crohn disease and review its surgical treatment as a potential initial step toward the establishment of a definition of complex disease. The complexity of small bowel Crohn disease can be sorted into several categories: technical challenges, namely, fistulae, abscesses, bowel or ureteral obstruction, hemorrhage, cancer and thickened mesentery; extensive disease; the presence of short gut; a history of prolonged use of medications, particularly steroids, immunomodulators, and biological agents; and a high risk of recurrence. Although the principles of modern surgical treatment of Crohn disease have evolved to bowel conservation such as strictureplasty techniques and limited resection margins, such practices by themselves are often not sufficient for the management of complex small bowel Crohn disease. This manuscript reviews each category of complex small bowel Crohn disease, with special emphasis on appropriate surgical strategy.

  7. Small bowel volvulus with intussusception: an unusual revelation of ...

    African Journals Online (AJOL)

    The biological test showed no hydro electrolytic disorders with normal hemoglobin and normal renal function. The abdominal CT-Scan showed signs of bowel obstruction due to a volvulus with intussusception without ischemia. The patient was operated urgently; the exploration has revealed a small bowel obstruction in the ...

  8. Utilisation and diagnostic yield of large bowel endoscopy at Korle ...

    African Journals Online (AJOL)

    Utilisation and diagnostic yield of large bowel endoscopy at Korle-Bu Teaching Hospital. JCB Dakubo, B Seshie, LNA Ankrah. Abstract. Large bowel endoscopy, the most accurate diagnostic investigation of the colon and rectum has been available at the Korle-Bu Teaching for close to two decades and has been used ...

  9. The Changing Phenotype of Inflammatory Bowel Disease

    Directory of Open Access Journals (Sweden)

    Carthage Moran

    2016-01-01

    Full Text Available It is widely known that there have been improvements in patient care and an increased incidence of Inflammatory Bowel Disease (IBD worldwide in recent decades. However, less well known are the phenotypic changes that have occurred; these are discussed in this review. Namely, we discuss the emergence of obesity in patients with IBD, elderly onset disease, mortality rates, colorectal cancer risk, the burden of medications and comorbidities, and the improvement in surgical treatment with a decrease in surgical rates in recent decades.

  10. The Changing Phenotype of Inflammatory Bowel Disease

    Science.gov (United States)

    Sheehan, Donal; Shanahan, Fergus

    2016-01-01

    It is widely known that there have been improvements in patient care and an increased incidence of Inflammatory Bowel Disease (IBD) worldwide in recent decades. However, less well known are the phenotypic changes that have occurred; these are discussed in this review. Namely, we discuss the emergence of obesity in patients with IBD, elderly onset disease, mortality rates, colorectal cancer risk, the burden of medications and comorbidities, and the improvement in surgical treatment with a decrease in surgical rates in recent decades. PMID:28050166

  11. Innate lymphoid cells in inflammatory bowel diseases.

    Science.gov (United States)

    Peters, C P; Mjösberg, J M; Bernink, J H; Spits, H

    2016-04-01

    It is generally believed that inflammatory bowel diseases (IBD) are caused by an aberrant immune response to environmental triggers in genetically susceptible individuals. The exact contribution of the adaptive and innate immune system has not been elucidated. However, recent advances in treatments targeting key inflammatory mediators such as tumour necrosis factor highlight the crucial role of the innate immune system in IBD. Innate lymphoid cells (ILCs) have recently been identified to play an important role in immune mediated inflammatory diseases. In this review we recapitulate the current knowledge on ILCs in IBD. Copyright © 2015 European Federation of Immunological Societies. Published by Elsevier B.V. All rights reserved.

  12. Inflammatory Bowel Disease and Cervical Neoplasia

    DEFF Research Database (Denmark)

    Rungoe, Christine; Simonsen, Jacob; Riis, Lene

    2015-01-01

    BACKGROUND & AIMS: We examined the risk of cervical neoplasia (dysplasia or cancer) in women with ulcerative colitis (UC) or Crohn's disease (CD). We also calculated the reverse, the risk for diagnosis with cervical neoplasia before development of inflammatory bowel disease (IBD). METHODS: We...... with IBD were assessed by Cox proportional hazards regression analysis. Odds ratios (ORs) of cervical neoplasia before diagnosis of IBD were calculated by using conditional logistic regression. RESULTS: Women with CD underwent cervical cancer screening as often as women in the general population (IRR, 0...

  13. EXPERIENCE IN MANAGEMENT OF ADHESIVE BOWEL OBSTRUCTION

    Directory of Open Access Journals (Sweden)

    E. Yu. D'yakonova

    2015-01-01

    Full Text Available The article discusses the most common causes and strategies for treatment of adhesive bowel obstruction and its timely diagnostics (which consists in the need for X-ray, ultrasound and endoscopy. It is shown that laparoscopic adhesiolysis in conjunction with anti-adhesion therapy not only minimizes complications in the postoperative period, reduces the time of hospital stay and ensures a good cosmetic result, but also helps verify the nature and extent of adhesions, as well as exclude the presence of other abdominal cavity diseases. 

  14. Time for individualized colonoscopy bowel-prep regimens? A randomized controlled trial comparing sodium picosulphate and magnesium citrate versus 4-liter split-dose polyethylene glycol.

    Science.gov (United States)

    Voiosu, Theodor; Ratiu, Iulia; Voiosu, Andrei; Iordache, Tiberiu; Schipor, Adrian; Baicus, Cristian; Sporea, Ioan; Voiosu, Radu

    2013-06-01

    Good bowel cleansing is essential to achieving optimal endoscopic evaluation of the colon. There are many different regimens available, but none have shown consistently superior results in achieving a clean colon. We compared the efficiency of two regimens with regard to bowel cleansing and patient satisfaction. The study also aimed to identify patient-related factors that influenced the quality of the bowel cleansing. We conducted a single-blind, multicenter, randomized controlled trial comparing sodium picosulphate and magnesium citrate versus 4-liter split-dose polyethylene glycol (PEG). Consecutive patients presenting for colonoscopy at two tertiary referral centers were invited to participate. The main outcomes were colon cleanliness and patient satisfaction with the preparation regimen. The quality of bowel cleansing was assessed by the endoscopist with the use of a 4-grade scale. Patients completed questionnaires evaluating their experience during the preparation process. Multivariate analysis was conducted in order to compare the two regimens and identify patient-related factors that influenced the main outcomes. One hundred eighty-one patients were randomized and 165 completed the trial (91.1%). PEG was slightly superior to sodium picosulphate with regard to bowel cleansing (p=0.01), while patient satisfaction was higher with sodium picosulphate (p=0.008). Patients with higher education and patients reporting high adherence to instructions achieved better colon cleansing using PEG. There seems to be no clear advantage for one bowel preparation solution over the other. However, by taking into account individual patient characteristics, opting for a particular regimen could increase the likelihood of achieving a cleaner colon.

  15. Vitamin D, immune regulation, the microbiota, and inflammatory bowel disease.

    Science.gov (United States)

    Cantorna, Margherita T; McDaniel, Kaitlin; Bora, Stephanie; Chen, Jing; James, Jamaal

    2014-11-01

    The inflammatory bowel diseases are complex diseases caused by environmental, immunological, and genetic factors. Vitamin D status is low in patients with inflammatory bowel diseases, and experimental inflammatory bowel diseases are more severe in vitamin D-deficient or vitamin D receptor knockout animals. Vitamin D is beneficial in inflammatory bowel diseases because it regulates multiple checkpoints and processes essential for homeostasis in the gut. Vitamin D inhibits IFN-γ and IL-17 production while inducing regulatory T cells. In addition, vitamin D regulates epithelial cell integrity, innate immune responses, and the composition of the gut microbiota. Overall, vitamin D regulates multiple pathways that maintain gastrointestinal homeostasis. The data support improving vitamin D status in patients with inflammatory bowel diseases. © 2014 by the Society for Experimental Biology and Medicine.

  16. Small bowel volvulus with jejunal diverticulum: Primary or secondary?

    Science.gov (United States)

    Shen, Xiao-Fei; Guan, Wen-Xian; Cao, Ke; Wang, Hao; Du, Jun-Feng

    2015-09-28

    Small bowel volvulus, which is torsion of the small bowel and its mesentery, is a medical emergency, and is categorized as primary or secondary type. Primary type often occurs without any apparent intrinsic anatomical anomalies, while the secondary type is common clinically and could be caused by numerous factors including postoperative adhesions, intestinal diverticulum, and/or tumors. Here, we report a rare case of a 60-year-old man diagnosed with small bowel volvulus using multidetector computed tomography (MDCT) angiography. Further discovery by laparotomy showed one jejunal diverticulum, longer corresponding mesentery with a narrower insertion, and a lack of mesenteric fat. This case report includes several etiological factors of small bowel volvulus, and we discuss the possible cause of small bowel volvulus in this patient. We also highlight the importance of MDCT angiography in the diagnosis of volvulus and share our experience in treating this disease.

  17. Small bowel villous atrophy: celiac disease and beyond.

    Science.gov (United States)

    Elli, Luca; Branchi, Federica; Sidhu, Reena; Guandalini, Stefano; Assiri, Asaad; Rinawi, Firas; Shamir, Raanan; Das, Prasenjit; Makharia, Govind K

    2017-02-01

    Small bowel villous atrophy can represent a diagnostic challenge for gastroenterologists and pathologists. In Western countries small bowel atrophy and mild non-atrophic alterations are frequently caused by celiac disease. However, other pathology can mimic celiac disease microscopically, widening the differential diagnosis. The several novelties on this topic and the introduction of the device-assisted enteroscopy in the diagnostic flowchart make an update of the literature necessary. Areas covered: In this review, a description of the different clinical scenarios when facing with small bowel mucosal damage, particularly small bowel atrophy, is described. The published literature on this subject has been summarized and reviewed. Expert commentary: When an intestinal mucosal alteration is histologically demonstrated, the pathology report forms part of a more complex workup including serological data, clinical presentation and clinical history. A multidisciplinary team, including pathologists and enteroscopy-devoted endoscopists, is frequently required to manage patients with small bowel alterations, especially in cases of severe malabsorption syndrome.

  18. Advantages of handsewn over stapled bowel anastomosis.

    Science.gov (United States)

    Dziki, A J; Duncan, M D; Harmon, J W; Saini, N; Malthaner, R A; Trad, K S; Fernicola, M T; Hakki, F; Ugarte, R M

    1991-06-01

    Bowel anastomoses are conventionally performed using a handsewn technique or a stapling device. Each has potential benefits and disadvantages. The most clinically significant complications of the bowel anastomosis are anastomotic leakage and stricture formation. The indices of healing and tissue cohesion were compared dynamically over time in 24 dogs randomized to undergo either a standard two-layer handsewn anastomosis or a stapled anastomosis with the Premium CEEA (United States Surgical Corporation, Norwalk, CT). Animals were sacrificed at 1, 4, 7, and 28 days postoperatively. Each anastomosis was evaluated for anastomotic index, burst pressure, collagen content, and histologic appearance. The anastomotic index was similar on postoperative day (POD) 1, 4, and 7; but on day 28 all handsewn anastomoses had larger diameters than the widest CEEA anastomosis. Burst pressure was higher in handsewn anastomoses at all intervals. Collagen content tended to be higher on POD 7 in the CEEA anastomoses. Histological evaluation showed more complete epithelialization and less inflammation in handsewn anastomoses on POD 28. The higher level of collagen in the CEEA anastomoses on POD 7 may be implicated in the tendency toward stricture formation found with this type of anastomosis. This study demonstrates that the greater speed and ease of the stapled anastomosis is offset by the greater strength, reduced tendency to stricture, and more complete healing of the handsewn anastomosis.

  19. Bacteria, genetics and irritable bowel syndrome.

    LENUS (Irish Health Repository)

    Craig, Orla F

    2010-06-01

    EVALUATION OF: Villani AC, Lemire M, Thabane M et al. Genetic risk factors for post-infectious irritable bowel syndrome following a waterborne outbreak of gastroenteritis. Gastroenterology 138, 1502-1513 (2010). While the pathogenesis of irritable bowel syndrome (IBS) remains to be fully defined, two clinical observations - the occurrence, de novo, of IBS following bacterial gastroenteritis and the history, commonly obtained from IBS patients, of other instances of the syndrome within their families - have instigated investigations, in IBS, of the potential roles, on the one hand, of the gut microbiota and the host response and, on the other hand, of genetic factors. The study reviewed here relates to both of these factors by studying genetic predisposition to postinfective IBS in a large population of individuals who were exposed to a multimicrobial enteric infection, which resulted in a severe outbreak of gastroenteritis and was followed by the development of IBS in over a third. In this detailed study, the investigators identified a number of genes that were linked significantly to the development of postinfectious-IBS in the Toll-like receptor 9, IL-6 and cadherin 1 regions. These genes play important roles in bacterial recognition, the inflammatory response and epithelial integrity, respectively, and provide considerable support for the hypothesis that links IBS onset to disturbances in the microbiota and the host response.

  20. Sensory dysfunction and the irritable bowel syndrome.

    Science.gov (United States)

    Houghton, L A

    1999-10-01

    Dysfunction of the sensory system of the gut is now generally believed to be important in the pathophysiology of irritable bowel syndrome (IBS). This disturbance may well account for some of the symptoms of the disorder, such as abdominal pain, by virtue of the fact that intra-lumenal events (e.g. contractions) may be 'sensed' more easily. It can be assessed in the laboratory by a variety of techniques, but usually involves measuring the patient's response to distension of any site of the gut, most commonly the rectum. Hypersensitivity is the most frequent finding, but hyposensitivity can also occur--hypersensitivity does not appear to be specific to any particular pattern of bowel habit, but hyposensitivity does tend to be generally only seen in patients with constipation, especially those with the 'no urge' type. Although there is some evidence to support hypersensitivity being related to enhanced vigilance in some patients, other data suggest that there may be a true alteration in sensory processing. The mechanisms underlying this sensory dysfunction remain to be elucidated, but could involve changes in either the enteric, spinal and/or central nervous systems. Finally, factors such as gender, stress, emotion and infection can all influence the sensitivity of the gut and may therefore play a role in IBS.

  1. Management of patients with a short bowel

    Science.gov (United States)

    Nightingale, Jeremy M D

    2001-01-01

    There are two common types of adult patient with a short bowel, those with jejunum in continuity with a functioning colon and those with a jejunostomy. Both groups have potential problems of undernutrition, but this is a greater problem in those without a colon, as they do not derive energy from anaerobic bacterial fermentation of carbohydrate to short chain fatty acids in the colon. Patients with a jejunostomy have major problems of dehydration, sodium and magnesium depletion all due to a large volume of stomal output. Both types of patient have lost at least 60 cm of terminal ileum and so will become deficient of vitamin B12. Both groups have a high prevalence of gallstones (45%) resulting from periods of biliary stasis. Patients with a retained colon have a 25% chance of developing calcium oxalate renal stones and they may have problems with D (-) lactic acidosis. The survival of patients with a short bowel, even if they need long-term parenteral nutrition, is good. PMID:11819867

  2. Probiotics use to treat irritable bowel syndrome.

    Science.gov (United States)

    Hosseini, Asieh; Nikfar, Shekoufeh; Abdollahi, Mohammad

    2012-10-01

    Irritable bowel syndrome (IBS) is a common chronic gastrointestinal (GI) tract disorder with significant disability and a considerable financial burden to health service due to the consumption of resources including investigations, physician time, and cost of treatment. Despite availability of multiple treatment options, there is still poor functional recovery. Probiotics has been investigated as a promising treatment for IBS, and have demonstrated beneficial effects in some patients. There are many clinical trials investigating the therapeutic benefits of probiotics in IBS but most of them are heterogenic in terms of dose or species used and clinical endpoints. However, recent major meta-analyses revealed benefits of probiotics in patients with IBS. Inhibition of binding of pathogenic bacteria to intestinal epithelial cells, enhancing barrier function of intestinal epithelial, acidification of the colon, suppression of the growth of pathogens, modulation of immunity, inhibition of visceral hypersensitivity, alteration in mucosal response to stress, and improvement of bowel dysmotility are among mechanisms that probiotics may act. Most commonly used probiotics come from the genera Bifidobacterium and Lactobacillus but other species are in trial. Although further studies are still needed, current evidences are almost enough to convince experts that probiotics are efficient in the treatment of IBS.

  3. Inflammatory bowel disease and colon cancer.

    Science.gov (United States)

    Jawad, Noor; Direkze, Natalie; Leedham, Simon J

    2011-01-01

    The inflammatory bowel diseases (IBD); Crohn's and Ulcerative colitis, result from an altered host response to intestinal flora. Recurrent inflammation with ulceration and tissue restitution confers an increased risk of cancer in both UC and Crohns, and genome wide searches have identified a number of disease susceptibility alleles. The carcinogenesis pathway in colitis-associated colorectal cancer (CACRC) is less clearly understood than it's sporadic counterpart. Clonal ordering experiments have indicated the order and timing of chromosomal instability and common genetic mutations. Epigenetic changes such as DNA methylation and histone modification are thought to play an increasingly important role in inflammation induced carcinogenesis. Clonal expansion of procarcinogenic mutations can lead to large fields of mutant tissue from which colitis associated cancers can arise (field cancerisation). Endoscopic screening is the mainstay of surveillance in high-risk patients although the development of appropriate, clinically applicable biomarkers remains a research priority. Despite the expanding field of biological therapy in inflammatory bowel disease the ASA compounds remain the best-studied and most efficacious chemopreventive agents. Colitis associated CRC appears to have a different aetiology, carcinogenesis pathway and clinical course to its sporadic counterpart. Further research including long-term follow up of patient cohorts taking biological therapies will improve the detection and treatment of these important, inflammation-induced malignancies.

  4. Correlations between Psoriasis and Inflammatory Bowel Diseases

    Directory of Open Access Journals (Sweden)

    Nevena Skroza

    2013-01-01

    Full Text Available For a long time the relationship between inflammatory bowel diseases (IBDs and psoriasis has been investigated by epidemiological studies. It is only starting from the 1990s that genetic and immunological aspects have been focused on. Psoriasis and IBD are strictly related inflammatory diseases. Skin and bowel represent, at the same time, barrier and connection between the inner and the outer sides of the body. The most important genetic correlations involve the chromosomal loci 6p22, 16q, 1p31, and 5q33 which map several genes involved in innate and adaptive immunity. The genetic background represents the substrate to the common immune processes involved in psoriasis and IBD. In the past, psoriasis and IBD were considered Th1-related disorders. Nowadays the role of new T cells populations has been highlighted. A key role is played by Th17 and T-regs cells as by the balance between these two cells types. New cytokines and T cells populations, as IL-17A, IL-22, and Th22 cells, could play an important pathogenetic role in psoriasis and IBD. The therapeutic overlaps further support the hypothesis of a common pathogenesis.

  5. Inflammatory bowel disease and novel endoscopic technologies.

    Science.gov (United States)

    Naganuma, Makoto; Hosoe, Naoki; Ogata, Haruhiko

    2014-01-01

    Conventional ileocolonoscopy and barium small bowel follow-through are useful techniques for assessing the extension and severity of disease in patients with inflammatory bowel disease (IBD). More recently, novel techniques to enable IBD diagnosis have been developed, such as capsule endoscopy (CE), balloon enteroscopy (BE), computed tomography enterography (CTE) and magnetic resonance enterography (MRE). The advantages of CE and BE are that they enable mucosal assessment directly whereas the usefulness of CTE/MRE is in its ability to enable detection of transmural inflammation, stenosis, and extraintestinal lesions including abscesses and fistulas. In ulcerative colitis (UC), colitis-associated dysplasia/cancer is one of the critical complications in patients with chronic disease. Detection of colitis-associated cancer is difficult in cases with inflammation. Magnification colonoscopy has been used to detect dysplasia in patients with chronic UC. Furthermore, colon CE and endocytoscopy have also developed and these might be used for selected patients in the near future. © 2013 The Authors. Digestive Endoscopy © 2013 Japan Gastroenterological Endoscopy Society.

  6. Biopsychosocial Model of Irritable Bowel Syndrome

    Science.gov (United States)

    Kanazawa, Motoyori; Fukudo, Shin; Drossman, Douglas A

    2011-01-01

    Irritable bowel syndrome (IBS) is a common chronic disorder seen in gastroenterology and primary care practice. It is characterized by recurrent abdominal pain or discomfort associated with disturbed bowel function. It is a heterogeneous disorder with varying treatments, and in this regard physicians sometimes struggle with finding the optimal approach to management of patients with IBS. This disorder induces high health care costs and variably reduces health-related quality of life. IBS is in the class of functional gastrointestinal disorders, and results from dysregulation of central and enteric nervous system interactions. Psychosocial factors are closely related to their gut physiology, associated cognitions, symptom manifestations and illness behavior. Therefore, it is important for the physician to recognize the psychosocial issues of patients with IBS and in addition to build a good patient-physician relationship in order to optimize treatment. This review focuses on the interaction between psychological and physiological factors associated with IBS by using a biopsychosocial model. In this article, we describe (1) the predisposing psychological features seen in early life; (2) the psychological factors associated with life stress, the symptom presentation, and their associated coping patterns; (3) gut pathophysiology with emphasis on disturbances in motility, visceral hypersensitivity and brain-gut interactions; and finally (4) the clinical outcomes and effective treatments including psychotherapeutic methods. PMID:21602989

  7. Single-dose lubiprostone along with split-dose PEG solution without dietary restrictions for bowel cleansing prior to colonoscopy: a randomized, double-blind, placebo-controlled trial.

    Science.gov (United States)

    Stengel, Joel Z; Jones, David P

    2008-09-01

    Proper colonic cleansing prior to colonoscopy is paramount to ensuring complete mucosal visualization and polyp identification. In a double-blind fashion, we compared single-dose lubiprostone (24 microg) versus placebo pretreatment prior to a split-dose polyethylene glycol electrolyte (PEG-E) bowel preparation without dietary restriction to determine the efficacy, safety, and patient tolerability. Two hundred patients referred for outpatient colorectal cancer screening were randomized to receive a single-dose of unlabeled lubiprostone (24 microg) or placebo prior to a split-dose PEG-E bowel preparation without dietary restriction. The patients were surveyed prior to the colonoscopy on the tolerability of the bowel preparation, and any adverse events were recorded. The cleanliness of the colon was graded by the endoscopist during the procedure utilizing the Ottawa bowel preparation scale. One hundred ninety-one patients completed the study (95%). Split-dose PEG-E with lubiprostone pretreatment was found to be more effective at bowel cleansing in each segment of the colon when compared with split-dose PEG-E with placebo (P lubiprostone treatment arm rated the overall experience as more tolerable (P 0.003) and complained of less abdominal bloating (P 0.049). No differences were observed between the groups for treatment-emergent side effects or adverse events (P > 0.05). Single-dose lubiprostone prior to split-dose PEG-E without dietary restriction significantly improves colonic mucosa visualization during colonoscopy and is well tolerated by patients.

  8. Irritable Bowel Syndrome: Role of Intestinal Microbiota Disorders and Ways of Their Correction

    Directory of Open Access Journals (Sweden)

    I.Ya. Budzak

    2013-05-01

    Full Text Available The article presents the correlation between intestinal microbiota disorders and irritable bowel syndrome. The mechanisms of pathogenic role of bowel dysbiosis in the development of irritable bowel syndrome were shown. There were analyzed the results of investigations concerning the evaluation of probiotics efficiency in patients with irritable bowel syndrome. The approaches to correction of these disorders were determined.

  9. Improved CNDO/S calculation of electronic spectra of organic compounds. I. New CNDO/S calculation by using an improved method of one-center electron repulsion integral.

    Science.gov (United States)

    Hata, Toshiyuki; Murakami, Takahiro; Shibuya, Hirotaka; Ono, Yukio

    2006-05-01

    The NM-gamma CNDO/S program previously developed by our group was modified by the introduction of a new one-center electron repulsion integral gamma(AA)(new) approximation, namely, the gamma(AA)(new)-CNDO/S method. The value of this gamma(AA)(new) was evaluated according to the product values of the coefficient C with the gamma(AA) value proposed in our previous paper. This method using a new gamma(AA) was also found to improve the two-center electron repulsion integral gamma(AB) value with respect to the chemical softness proposed by Nishimoto and co-workers, together with the difference between HOMO and LUMO orbital energies. The results calculated by the present improved gamma(AA)(new)-CNDO/S method demonstrated that not only the calculated absorption maxima wavelengths and ionization potentials, but also the order and the assignment of orbitals coincided very well with those based on the results of experiments investigating a variety of polyenes, cyanynes, and polycyclic aromatic hydrocarbons.

  10. Intussusception of the bowel in adults: A review

    Science.gov (United States)

    Marinis, Athanasios; Yiallourou, Anneza; Samanides, Lazaros; Dafnios, Nikolaos; Anastasopoulos, Georgios; Vassiliou, Ioannis; Theodosopoulos, Theodosios

    2009-01-01

    Intussusception of the bowel is defined as the telescoping of a proximal segment of the gastrointestinal tract within the lumen of the adjacent segment. This condition is frequent in children and presents with the classic triad of cramping abdominal pain, bloody diarrhea and a palpable tender mass. However, bowel intussusception in adults is considered a rare condition, accounting for 5% of all cases of intussusceptions and almost 1%-5% of bowel obstruction. Eight to twenty percent of cases are idiopathic, without a lead point lesion. Secondary intussusception is caused by organic lesions, such as inflammatory bowel disease, postoperative adhesions, Meckel’s diverticulum, benign and malignant lesions, metastatic neoplasms or even iatrogenically, due to the presence of intestinal tubes, jejunostomy feeding tubes or after gastric surgery. Computed tomography is the most sensitive diagnostic modality and can distinguish between intussusceptions with and without a lead point. Surgery is the definitive treatment of adult intussusceptions. Formal bowel resection with oncological principles is followed for every case where a malignancy is suspected. Reduction of the intussuscepted bowel is considered safe for benign lesions in order to limit the extent of resection or to avoid the short bowel syndrome in certain circumstances. PMID:19152443

  11. Role of capsule endoscopy in inflammatory bowel disease.

    Science.gov (United States)

    Kopylov, Uri; Seidman, Ernest G

    2014-02-07

    Videocapsule endoscopy (VCE) has revolutionized our ability to visualize the small bowel mucosa. This modality is a valuable tool for the diagnosis of obscure small bowel Crohn's disease (CD), and can also be used for monitoring of disease activity in patients with established small-bowel CD, detection of complications such as obscure bleeding and neoplasms, evaluation of response to anti-inflammatory treatment and postoperative recurrence following small bowel resection. VCE could also be an important tool in the management of patients with unclassified inflammatory bowel disease, potentially resulting in reclassification of these patients as having CD. Reports on postoperative monitoring and evaluation of patients with ileal pouch-anal anastomosis who have developed pouchitis have recenty been published. Monitoring of colonic inflammatory activity in patients with ulcerative colitis using the recently developed colonic capsule has also been reported. Capsule endoscopy is associated with an excellent safety profile. Although retention risk is increased in patients with small bowel CD, this risk can be significanty decreased by a routine utilization of a dissolvable patency capsule preceding the ingestion of the diagnostic capsule. This paper contains an overview of the current and future clinical applications of capsule endoscopy in inflammatory bowel disease.

  12. Large Bowel Obstruction, a Delayed Complication of Severe Gallstone Pancreatitis

    Directory of Open Access Journals (Sweden)

    Neeraj Lal

    2016-01-01

    Full Text Available Colonic complications are rare after acute pancreatitis but are associated with a high mortality. Possible complications include mechanical obstruction, ischaemic necrosis, haemorrhage, and fistula. We report a case of large bowel obstruction in a 31-year-old postpartum female, secondary to severe gallstone pancreatitis. The patient required emergency laparotomy and segmental bowel resection, as well as cholecystectomy. Presentation of obstruction occurs during the acute episode or can be delayed for several weeks. The most common site is the splenic flexure owing to its proximity to the pancreas. Initial management may be conservative, stenting, or surgical. CT is an acceptable baseline investigation in all cases of new onset bowel obstruction. Although bowel obstruction is a rare complication of pancreatitis, clinicians should be aware of it due to its high mortality. Obstruction can occur after a significant delay following the resolution of pancreatitis. Those patients with evidence of colonic involvement on pancreatic imaging warrant further large bowel evaluation. Bowel resection may be required electively or acutely. Colonic stenting has an increasing role in the management of large bowel obstruction but is a modality of treatment that needs further evaluation in this setting.

  13. How many meals should you skip before undergoing a colonoscopy? A randomized controlled trial: association between duration of abstinence from solid food to cleanliness of the bowel in patients undergoing elective colonoscopy

    Directory of Open Access Journals (Sweden)

    Aziz DA

    2015-01-01

    Full Text Available Dayang A Abdul Aziz,1 Loh H Peow,2 Jasiah Zakaria,2 Mahmud M Nor,3 Zarina A Latiff41Pediatric Surgery Unit, Department of Surgery, UKM Medical Center, Kuala Lumpur, Malaysia; 2Department of Surgery, Hospital Tuanku Jaafar, Seremban, Malaysia; 3Department of Surgery, Universiti Sains Islam, 4Department of Pediatrics, UKM Medical Center, Kuala Lumpur, Malaysia Purpose: An ideal cleansing regime to prepare a clean colon is important for yielding best results during colonoscopy. Many centers practice strict dietary modifications – ie, skipping more than one solid meal 1 or 2 days before the procedure with the consumption of a bowel cleansing agent. No formal studies have been performed to determine how long a patient should withhold solid meals during bowel preparation prior to an outpatient colonoscopy. Materials and methods: A randomized prospective controlled trial was carried out with patients who underwent elective colonoscopy at a tertiary general hospital in Malaysia for 7 months’ duration. Patients were randomized into one of two groups. Group A patients abstained from a solid diet for 24 hours (the last solid meal was breakfast the day before the colonoscopy. Group B patients abstained from a solid diet 14 hours prior to the colonoscopy (the last solid meal was dinner the day before the colonoscopy. We standardized the time for the oral intake of sodium phosphosoda in both groups. The Boston Bowel Preparation Scale was used to grade the cleanliness between the two groups and a score ≥2 was taken as clean bowel preparation. Results: A total of 178 patients (each arm had 89 patients were recruited for this study. Group A showed a mean bowel cleanliness score of 3. Group B showed a mean bowel cleanliness score of 2.5. However, there was a significant difference in bowel cleanliness between the groups (P≤0.05. Conclusion: Abstinence of solid food for either 24 hours or 14 hours prior to the colonoscopy both produced clean bowel

  14. New and emerging therapies for the treatment of irritable bowel syndrome: an update for gastroenterologists

    OpenAIRE

    Foxx-Orenstein, Amy E.

    2016-01-01

    Irritable bowel syndrome is a functional bowel disorder with gastrointestinal symptoms (e.g. abdominal pain, straining, urgency, incomplete evacuation, nausea, and bloating) that occur alongside bowel function alterations (i.e. constipation, diarrhea, or both). Patients with irritable bowel syndrome may also experience comorbid anxiety and depression. Irritable bowel syndrome is common, with a prevalence estimated between 3% and 28%, affecting patient health and quality of life. Patients with...

  15. Flavonoids in Inflammatory Bowel Disease: A Review

    Science.gov (United States)

    Vezza, Teresa; Rodríguez-Nogales, Alba; Algieri, Francesca; Utrilla, Maria Pilar; Rodriguez-Cabezas, Maria Elena; Galvez, Julio

    2016-01-01

    Inflammatory bowel disease (IBD) is characterized by chronic inflammation of the intestine that compromises the patients’ life quality and requires sustained pharmacological and surgical treatments. Since their etiology is not completely understood, non-fully-efficient drugs have been developed and those that have shown effectiveness are not devoid of quite important adverse effects that impair their long-term use. In this regard, a growing body of evidence confirms the health benefits of flavonoids. Flavonoids are compounds with low molecular weight that are widely distributed throughout the vegetable kingdom, including in edible plants. They may be of great utility in conditions of acute or chronic intestinal inflammation through different mechanisms including protection against oxidative stress, and preservation of epithelial barrier function and immunomodulatory properties in the gut. In this review we have revised the main flavonoid classes that have been assessed in different experimental models of colitis as well as the proposed mechanisms that support their beneficial effects. PMID:27070642

  16. Clostridium difficile and pediatric inflammatory bowel disease

    DEFF Research Database (Denmark)

    Martinelli, Massimo; Strisciuglio, Caterina; Veres, Gabor

    2014-01-01

    BACKGROUND: Clostridium difficile infection is associated with pediatric inflammatory bowel disease (IBD) in several ways. We sought to investigate C. difficile infection in pediatric patients with IBD in comparison with a group of children with celiac disease and to evaluate IBD disease course...... period, stool specimens for C. difficile toxins analysis were collected from 112 children with celiac disease as controls. RESULTS: Clostridium difficile occurrence was significantly higher in patients with IBD compared with patients with celiac disease (7.5% versus 0.8%; P = 0.008). Clostridium...... difficile was associated with active disease in 71.4% of patients with IBD (P = 0.01). Colonic involvement was found in 85.7% of patients with C. difficile. Antibiotics, proton pump inhibitors, hospitalization, and IBD therapies were not associated with increased C. difficile detection. At 12 months...

  17. Intestinal epithelium in inflammatory bowel disease

    Directory of Open Access Journals (Sweden)

    Mehmet eCoskun

    2014-08-01

    Full Text Available The intestinal epithelium has a strategic position as a protective physical barrier to luminal microbiota and actively contributes to the mucosal immune system. This barrier is mainly formed by a monolayer of specialized intestinal epithelial cells (IECs that are crucial in maintaining intestinal homeostasis. Therefore, dysregulation within the epithelial layer can increase intestinal permeability, lead to abnormalities in interactions between IECs and immune cells in underlying lamina propria, and disturb the intestinal immune homeostasis, all of which are linked to the clinical disease course of inflammatory bowel disease (IBD. Understanding the role of the intestinal epithelium in IBD pathogenesis might contribute to an improved knowledge of the inflammatory processes and the identification of potential therapeutic targets.

  18. Intestinal barrier in inflammatory bowel disease.

    Science.gov (United States)

    Antoni, Lena; Nuding, Sabine; Wehkamp, Jan; Stange, Eduard F

    2014-02-07

    A complex mucosal barrier protects as the first line of defense the surface of the healthy intestinal tract from adhesion and invasion by luminal microorganisms. In this review, we provide an overview about the major components of this protective system as for example an intact epithelium, the synthesis of various antimicrobial peptides (AMPs) and the formation of the mucus layer. We highlight the crucial importance of their correct functioning for the maintenance of a proper intestinal function and the prevention of dysbiosis and disease. Barrier disturbances including a defective production of AMPs, alterations in thickness or composition of the intestinal mucus layer, alterations of pattern-recognition receptors, defects in the process of autophagy as well as unresolved endoplasmic reticulum stress result in an inadequate host protection and are thought to play a crucial role in the pathogenesis of the inflammatory bowel diseases Crohn's disease and ulcerative colitis.

  19. Inflammatory bowel diseases, celiac disease, and bone.

    Science.gov (United States)

    Bianchi, Maria Luisa

    2010-11-01

    The article summarizes the current knowledge on the pathogenesis, clinical aspects and treatment of bone problems in the major inflammatory bowel diseases (Crohn's disease and ulcerative colitis) and celiac disease. It presents the physiological relationship between intestine and bone as well as the alterations determined by disease-disrupted intestinal integrity. Two hypotheses about the pathogenetic mechanisms of bone metabolism derangements and bone loss are discussed: the classical one, that indicates calcium malabsorption as the main culprit, and the new one, that emphasizes the role of inflammation. The article summarizes the available epidemiological data about osteopenia/osteoporosis and fragility fractures in these chronic intestinal diseases and presents the state-of-the-art treatment options. Copyright © 2010 Elsevier Inc. All rights reserved.

  20. Irritable Bowel Syndrome: Yoga as Remedial Therapy

    Science.gov (United States)

    Kavuri, Vijaya; Raghuram, Nagarathna; Malamud, Ariel; Selvan, Senthamil R.

    2015-01-01

    Irritable bowel syndrome (IBS) is a group of symptoms manifesting as a functional gastrointestinal (GI) disorder in which patients experience abdominal pain, discomfort, and bloating that is often relieved with defecation. IBS is often associated with a host of secondary comorbidities such as anxiety, depression, headaches, and fatigue. In this review, we examined the basic principles of Pancha Kosha (five sheaths of human existence) concept from an Indian scripture Taittiriya Upanishad and the pathophysiology of a disease from the Yoga approach, Yoga Vasistha's Adhi (originated from mind) and Vyadhi (ailment/disease) concept. An analogy between the age old, the most profound concept of Adhi-Vyadhi, and modern scientific stress-induced dysregulation of brain-gut axis, as it relates to IBS that could pave way for impacting IBS, is emphasized. Based on these perspectives, a plausible Yoga module as a remedial therapy is provided to better manage the primary and secondary symptoms of IBS. PMID:26064164

  1. [Importance of diet in irritable bowel syndrome].

    Science.gov (United States)

    Mearin, Fermín; Peña, Enrique; Balboa, Agustín

    2014-05-01

    About two-thirds of irritable bowel syndrome (IBS) patients associate their symptoms with certain foods. We reviewed food-related factors putatively associated with manifestations of IBS. Soluble fiber may improve constipation but frequently increases bloating and abdominal pain. Carbohydrate malabsorption seems to be more frequent in IBS. A low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diet significantly reduces IBS symptoms and has been suggested as a therapeutic option. Serological screening for celiac disease should be done in patients without constipation. Moreover, non-celiac disease gluten sensitivity, defined as gluten intolerance once celiac disease and wheat allergy have been ruled out, should be considered in these patients. There is no specific diet for IBS patients but small and frequent meals, avoiding greasy foods, dairy products, many carbohydrates, caffeine and alcohol, is recommended. Copyright © 2013 Elsevier España, S.L. and AEEH y AEG. All rights reserved.

  2. Inflammatory bowel disease pathogenesis: where are we?

    Science.gov (United States)

    Fiocchi, Claudio

    2015-03-01

    Inflammatory bowel disease (IBD) is presently one of the most investigated human disorders. Expansion of knowledge of its pathophysiology has helped in developing novel medications to combat gut inflammation with a considerably degree of success. Despite this progress, much more remains to be done in regard to gaining a more profound understanding of IBD pathogenesis, detecting inflammation before it clinically manifests, implementing lifestyle modifications, and developing agents that can modify the natural course of the disease. One of the limitations to achieve these goals is the lack of integration of the major components of IBD pathogenesis, that is the exposome, the genome, the gut microbiome, and the immunome. An "IBD integrome" approach that takes advantage of all functional information derived from the detailed investigation of each single pathogenic component through the use of systems biology may offer the solution to understand IBD and cure it. © 2015 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

  3. Environment and the inflammatory bowel diseases

    Science.gov (United States)

    Frolkis, Alexandra; Dieleman, Levinus A; Barkema, Herman W; Panaccione, Remo; Ghosh, Subrata; Fedorak, Richard N; Madsen, Karen; Kaplan, Gilaad G

    2013-01-01

    Inflammatory bowel diseases (IBD), which consists of Crohn disease and ulcerative colitis, are chronic inflammatory conditions of the gas-trointestinal tract. In genetically susceptible individuals, the interaction between environmental factors and normal intestinal commensal flora is believed to lead to an inappropriate immune response that results in chronic inflammation. The incidence of IBD have increased in the past century in developed and developing countries. The purpose of the present review is to summarize the current knowledge of the association between environmental risk factors and IBD. A number of environmental risk factors were investigated including smoking, hygiene, microorganisms, oral contraceptives, antibiotics, diet, breast-feeding, geographical factors, pollution and stress. Inconsistent findings among the studies highlight the complex pathogenesis of IBD. Additional studies are necessary to identify and elucidate the role of environmental factors in IBD etiology. PMID:23516681

  4. Environmental Risk Factors for Inflammatory Bowel Disease

    Science.gov (United States)

    Molodecky, Natalie A.

    2010-01-01

    Inflammatory bowel disease (IBD) is characterized by chronic inflammation of the gastrointestinal tract and is associated with significant morbidity. The etiology of IBD has been extensively studied during the last several decades; however, causative factors in disease pathology are not yet fully understood. IBD is thought to result from the interaction between genetic and environmental factors that influence the normal intestinal commensal flora to trigger an inappropriate mucosal immune response. Although many IBD susceptibility genes have been discovered, similar advances in defining environmental risk factors have lagged. A number of environmental risk factors have been explored, including smoking, appendectomy, oral contraceptives, diet, breastfeeding, infections/ vaccinations, antibiotics, and childhood hygiene. However, most of these factors have demonstrated inconsistent findings, thus making additional studies necessary to better understand the etiology of IBD. PMID:20567592

  5. Pregnancy and breastfeeding in inflammatory bowel disease.

    Science.gov (United States)

    Biedermann, Luc; Rogler, Gerhard; Vavricka, Stephan R; Seibold, Frank; Seirafi, Mariam

    2012-01-01

    Inflammatory bowel disease (IBD) is frequent in women during their peak reproductive years. Accordingly, a significant number of questions and uncertainties arise from this population regarding the risk of transmission of IBD to the offspring, the impact of the disease and therapies on the fertility, the role of the disease on the course of the pregnancy and the mode of delivery, the impact of the therapy on the pregnancy and fetal development as well as breastfeeding. The safety of medical therapy during pregnancy and lactation is a major concern for both pregnant women and their partners as well as for physicians. As a general rule, it can be stated that the benefit of continuing medical therapy in IBD during pregnancy outweighs the potential risks in the vast majority of instances. This article will review recent developments on this topic consistent with the European Crohn's and Colitis Organization guidelines. Copyright © 2012 S. Karger AG, Basel.

  6. Inflammatory bowel disease and pregnancy: overlapping pathways.

    Science.gov (United States)

    Nasef, Noha Ahmed; Ferguson, Lynnette R

    2012-07-01

    Several studies have reported on the association between inflammatory bowel disease (IBD) and adverse pregnancy outcomes, such as preterm birth. The exact mechanisms of action are unclear; however, several pathways and processes are involved in both IBD and pregnancy that may help explain this. In this review, we discuss the immune system's T helper cells and human leukocyte antigens, inflammation, its function, and the role of Toll-like receptors (TLRs), NOD-like receptors (NLRs), and prostaglandins in the inflammatory response. For each of these topics, we consider their involvement in IBD and pregnancy, and we speculate as to how they can lead to preterm birth. Finally, we review briefly corticosteroids, biologic therapies, and immunosuppressants for the treatment of IBD, as well as their safety in use during pregnancy, with special focus on preterm birth. Copyright © 2012 Mosby, Inc. All rights reserved.

  7. Bowel Perforation complicating an incarcerated inguinal hernia

    Directory of Open Access Journals (Sweden)

    Adam Sigal

    2017-04-01

    Full Text Available History of present illness: A 51-year-old male presents complaining of increasing right groin pain and an enlarging bulge. Symptoms started as a “bubble” 6 weeks prior to presentation. One week prior to presentation, thinking the bulge was an abscess, the patient attempted to “pop” the bulge with a sewing needle, the needle became lodged in the site and he attempted retrieval with a second sewing needle, which also became lodged. No purulent material was obtained. The patient denied any nausea, vomiting or constipation as well as any fevers or urinary symptoms. His abdomen was soft, non-tender, non-distended with active bowel sounds. The groin exam demonstrated an incarcerated right inguinal hernia and cellulitis of the right hemiscrotum with associated induration and tenderness. Significant findings: The AP and lateral pelvis x-rays revealed two sewing needles, 60 mm in length, within the soft tissue over the anterior right lower hemipelvis. In addition, the AP view showed emphysema involving the right hemiscrotum (arrow, concerning for perforated bowel. Discussion: Groin hernias have a lifetime risk of 27% for men and 3% for women and the incidence increases with age.1 Groin hernias can be either direct or indirect, and inguinal or femoral. The distinction is made during surgery. Femoral hernias make up only 5% of groin hernias but are more common in women.1 Concerning complications include incarceration, in which a hernia cannot be reduced, and strangulation in which vascular compromise occurs.1 Incarcerated hernias often present with a painful, tender mass and are difficult to distinguish from strangulation. Patients with strangulation may present with fevers and peritonitis. The overlying skin may also be red.2 The percentage of patients presenting with strangulation varies by region. Western developed countries report only 1%-3% of patients presenting as surgical emergencies whereas in Africa the percentage can be as high as 26

  8. Microbiome, Metabolome and Inflammatory Bowel Disease

    Directory of Open Access Journals (Sweden)

    Ishfaq Ahmed

    2016-06-01

    Full Text Available Inflammatory Bowel Disease (IBD is a multifactorial disorder that conceptually occurs as a result of altered immune responses to commensal and/or pathogenic gut microbes in individuals most susceptible to the disease. During Crohn’s Disease (CD or Ulcerative Colitis (UC, two components of the human IBD, distinct stages define the disease onset, severity, progression and remission. Epigenetic, environmental (microbiome, metabolome and nutritional factors are important in IBD pathogenesis. While the dysbiotic microbiota has been proposed to play a role in disease pathogenesis, the data on IBD and diet are still less convincing. Nonetheless, studies are ongoing to examine the effect of pre/probiotics and/or FODMAP reduced diets on both the gut microbiome and its metabolome in an effort to define the healthy diet in patients with IBD. Knowledge of a unique metabolomic fingerprint in IBD could be useful for diagnosis, treatment and detection of disease pathogenesis.

  9. The Immunological Basis of Inflammatory Bowel Disease

    Directory of Open Access Journals (Sweden)

    Francesca A. R. Silva

    2016-01-01

    Full Text Available Inflammatory bowel diseases (IBDs are chronic ailments, Crohn’s disease and ulcerative colitis being the most important. These diseases present an inflammatory profile and they differ according to pathophysiology, the affected area in the gastrointestinal tract, and the depth of the inflammation in the intestinal wall. The immune characteristics of IBD arise from abnormal responses of the innate and adaptive immune system. The number of Th17 cells increases in the peripheral blood of IBD patients, while Treg cells decrease, suggesting that the Th17/Treg proportion plays an important role in the development and maintenance of inflammation. The purpose of this review was to determine the current state of knowledge on the immunological basis of IBD. Many studies have shown the need for further explanation of the development and maintenance of the inflammatory process.

  10. Irritable Bowel Syndrome: Yoga as Remedial Therapy

    Directory of Open Access Journals (Sweden)

    Vijaya Kavuri

    2015-01-01

    Full Text Available Irritable bowel syndrome (IBS is a group of symptoms manifesting as a functional gastrointestinal (GI disorder in which patients experience abdominal pain, discomfort, and bloating that is often relieved with defecation. IBS is often associated with a host of secondary comorbidities such as anxiety, depression, headaches, and fatigue. In this review, we examined the basic principles of Pancha Kosha (five sheaths of human existence concept from an Indian scripture Taittiriya Upanishad and the pathophysiology of a disease from the Yoga approach, Yoga Vasistha’s Adhi (originated from mind and Vyadhi (ailment/disease concept. An analogy between the age old, the most profound concept of Adhi-Vyadhi, and modern scientific stress-induced dysregulation of brain-gut axis, as it relates to IBS that could pave way for impacting IBS, is emphasized. Based on these perspectives, a plausible Yoga module as a remedial therapy is provided to better manage the primary and secondary symptoms of IBS.

  11. Environment and the inflammatory bowel diseases.

    Science.gov (United States)

    Frolkis, Alexandra; Dieleman, Levinus A; Barkema, Herman W; Panaccione, Remo; Ghosh, Subrata; Fedorak, Richard N; Madsen, Karen; Kaplan, Gilaad G

    2013-03-01

    Inflammatory bowel diseases (IBD), which consists of Crohn disease and ulcerative colitis, are chronic inflammatory conditions of the gastrointestinal tract. In genetically susceptible individuals, the interaction between environmental factors and normal intestinal commensal flora is believed to lead to an inappropriate immune response that results in chronic inflammation. The incidence of IBD have increased in the past century in developed and developing countries. The purpose of the present review is to summarize the current knowledge of the association between environmental risk factors and IBD. A number of environmental risk factors were investigated including smoking, hygiene, microorganisms, oral contraceptives, antibiotics, diet, breastfeeding, geographical factors, pollution and stress. Inconsistent findings among the studies highlight the complex pathogenesis of IBD. Additional studies are necessary to identify and elucidate the role of environmental factors in IBD etiology.

  12. Cytokines and inflammatory bowel disease: a review.

    Science.gov (United States)

    McClane, S J; Rombeau, J L

    1999-01-01

    The etiology and pathogenesis of inflammatory bowel disease (IBD) remains an area under intense investigation. Cytokine secretion, which is important in the regulation of normal gastrointestinal immune responses, appears to be dysregulated in IBD. In Crohn's disease, there appears to be an excessive T(H)1 T-cell response to an antigenic stimulus, leading to increased levels of proinflammatory cytokines, such as interferon-gamma (IFN-gamma), interleukin (IL)-12, IL-1, IL-6, and tumor necrosis factor-alpha (TNF-alpha). In ulcerative colitis, a T(H)2 T-cell response appears to be the pathological process responsible for the inflammatory disease. New and innovative therapeutic strategies targeting cytokines, such as TNF-alpha, are producing some promising results in animal and human studies. As more is learned about the complex cytokine interactions in IBD, more effective treatments will undoubtedly ensue.

  13. Indicators for surgery in adhesive bowel obstruction.

    Science.gov (United States)

    Rajanikmanth, P V; Kate, V; Ananthakrishnan, N

    2001-01-01

    There is lack of data on risk factors, which, if present, would indicate the need for surgery in patients with adhesive bowel obstruction. A Cohort of 100 consecutive patients with adhesive obstruction was studied prospectively to compare clinical and investigative parameters between the operative and conservative group. It was found that female gender, previous obstetric or gynaecological procedures, pulse and BP on admission, nature of nasogastric aspirate, single distended loop on abdominal x-ray as also predominant ileal distension were independent factors indicating a high probability of surgical intervention. Patients with 2 or more risk factors had 12 times higher probability of surgery and in those with 3 or more the relative risk was 30 times. Patients with such risk factors should be monitored closely after admission and should be taken for surgery after an initial short trial of conservative measures.

  14. Flavonoids in Inflammatory Bowel Disease: A Review

    Directory of Open Access Journals (Sweden)

    Teresa Vezza

    2016-04-01

    Full Text Available Inflammatory bowel disease (IBD is characterized by chronic inflammation of the intestine that compromises the patients’ life quality and requires sustained pharmacological and surgical treatments. Since their etiology is not completely understood, non-fully-efficient drugs have been developed and those that have shown effectiveness are not devoid of quite important adverse effects that impair their long-term use. In this regard, a growing body of evidence confirms the health benefits of flavonoids. Flavonoids are compounds with low molecular weight that are widely distributed throughout the vegetable kingdom, including in edible plants. They may be of great utility in conditions of acute or chronic intestinal inflammation through different mechanisms including protection against oxidative stress, and preservation of epithelial barrier function and immunomodulatory properties in the gut. In this review we have revised the main flavonoid classes that have been assessed in different experimental models of colitis as well as the proposed mechanisms that support their beneficial effects.

  15. Psychoemotional Features in Irritable Bowel Syndrome

    Science.gov (United States)

    Dragoş, D; Ionescu, O; Ojog, DG; Tănăsescu, MD

    2012-01-01

    Objective. To delineate the psychological profile of individuals with irritable bowel syndrome (IBS). Method. A triple questionnaire of 614 items (including psychological and medical ones) was given to 10192 respondents and the results were analyzed by means of Cronbach alpha and Chi square test, together with an ad-hoc designed method that implied ranking and outliers detecting. Results and conclusions. Anxiety and depression are general psychological tendencies unspecifcally linked with IBS. Among the features with a relatively more specific correlation with IBS, tension has the strongest association, followed by the inclination to endure unacceptable situations, preoccupation for health, and susceptibility, and then by fear of failure and sense of demanding profession. IBS individuals readily accept a subordinate position, which may be connected to their history of tyrannical parents, and also to their preoccupation for authority factors. The sense of being treated unfairly by the authority persons during the school years nuances this last feature. Some features that bring some nuances to this psychological portrait are: contemplative nature and analyzing tendency, preoccupation with health issues, a reserved, unsociable, and precautious nature, clinging to known circumstances. Abbreviations: ChiSq = chi-square; OdRa = odds ratio; OdRaCL = OdRa confidence limits; ErrProb = probability of error; SS = statistically significant; CrA = Cronbach alpha; a / m = the calculations were done by taking into account the average/ maximal score; P / M = psychological / medical category; PaMm / PmMa / PmMm / PaMa = the calculations were done by taking into account the average score for the PsyCt and the maximal score for the MedCt / the maximal score for PsyCt and the average score for the MedCt / and the maximal score for both / and the average score for both; FD = functional dyspepsia; IBS = irritable bowel syndrome; IBSCt = IBS category; MedCt = medical category; Psy

  16. [Inflammatory bowel disease during pregnancy and childbirth].

    Science.gov (United States)

    Závorová, K

    2017-01-01

    The aim is to give basic information about inflammatory bowel disease (IBD) during pregnancy, to highlight the importance of treatment in pregnancy and also show our own experience with the issue. Original work - a retrospective study. Department of Obstetrics and Gynecology, Hospital Hořovice. We provide basic overview information about inheritance, fertility, mutual influence of IBD and pregnancy therapy in pregnancy and childbirth options for patients with IBD. We present also the results of the group of 17 patients with varying degrees of disability IBD (including patients after previous surgeries - bowel resection, hemicolectomy, ileostomy or with a pouch) that gave birth to our workplace. A crucial factor for good results is the degree of inflammation at the time of conception and during pregnancy. If the disease is inactive and nutrition of the diseased sufficient, there is no decrease in fertility, course of pregnancy is seamless, there is no greater risk of deterioration of disease in pregnancy and pregnancy do not differ from the normal population. The opposite situation occurs if there is a pregnancy at the time of disease activity. Then up to 75% pregnancy courses with big problems, fertility is declining, inflammation is also worsening and the risk of exacerbations increases during pregnancy, which aggravates the course of pregnancy and childbirth and has a negative effect on the fetus. Pregnancy is therefore necessary to plan for a longer period of disease stabilization and continue chronic medication and not discontinue drugs for fear of negative impact of medications on fetal development. On the contrary, active inflammation of the mother during pregnancy poses a greater risk to the fetus than adequate treatment. Commonly used drugs-aminosalicylates, corticosteroids, immunosuppressants and biological therapy appears to be safe and well tolerated during pregnancy. Method of delivery is individual and depends on the form and location of the

  17. A Comparison of Self-Perceived Health Status in Inflammatory Bowel Disease and Irritable Bowel Syndrome Patients from a Canadian National Population Survey

    Directory of Open Access Journals (Sweden)

    Linda YL Tang

    2008-01-01

    Full Text Available OBJECTIVE: To determine whether differences exist in perceptions of physical health, mental health and stress levels between patients with inflammatory bowel disease (IBD and patients with irritable bowel syndrome (IBS.

  18. Emergency one-stage resection without mechanical bowel ...

    African Journals Online (AJOL)

    stage resection. Similarly, the conventional requirement for bowel cleansing is being increasingly questioned. In this report, we reviewed the outcome of our management over a ten-year period. There were 24 patients aged 23-100 years.

  19. Eating, Diet, and Nutrition for Irritable Bowel Syndrome

    Science.gov (United States)

    ... Causes Diagnosis Treatment Eating, Diet, & Nutrition Clinical Trials Eating, Diet, & Nutrition for Irritable Bowel Syndrome How can ... Some people with IBS have more symptoms after eating gluten, even though they do not have celiac ...

  20. Metastatic choriocarcinoma in the small bowel: a case report

    Directory of Open Access Journals (Sweden)

    Zohreh Yousefi

    2014-08-01

    Conclusion: In abnormal postpartum hemorrhage, we should consider the possibility of choriocarcinoma. Although, it is important to note rare manifestations of metastatic choriocarcinoma of small bowel in massive gastrointestinal hemorrhage.

  1. Intestinal microbiota in inflammatory bowel disease: Friend of foe

    National Research Council Canada - National Science Library

    Francesca Fava Silvio Danese

    2011-01-01

    Inflammatory bowel disease (IBD) arises from disruption of immune tolerance to the gut commensal microbiota, leading to chronic intestinal inflammation and mucosal damage in genetically predisposed hosts...

  2. Managing inflammatory bowel disease in pregnancy: current perspectives

    National Research Council Canada - National Science Library

    Pinder, Matthew; Lummis, Katie; Selinger, Christian P

    2016-01-01

    ...: Inflammatory bowel disease (IBD) affects many women of childbearing age. The course of IBD is closely related to pregnancy outcomes with poorly controlled IBD increasing the risk of prematurity, low weight for gestation, and fetal loss...

  3. Effects and treatment of inflammatory bowel disease during pregnancy

    OpenAIRE

    Brar, Harvinder; Einarson, Adrienne

    2008-01-01

    QUESTION I have several patients with inflammatory bowel disease (IBD) who are pregnant or planning pregnancies. What information can I give them regarding the possible effects of IBD on pregnancy and the medications used to treat IBD during pregnancy?

  4. Campylobacter jejuni enterocolitis presenting as inflammatory bowel disease.

    Science.gov (United States)

    Quondamcarlo, C; Valentini, G; Ruggeri, M; Forlini, G; Fenderico, P; Rossi, Z

    2003-10-01

    We report a case of Campylobacter jejuni enterocolitis presenting as inflammatory bowel disease in a 19-year old woman. After a useless course of corticosteroids, ceftazidime and metronidazole, she was successfully treated with erythromicin. Campylobacter species represent an important cause of gastroenteritis in children and adults. The rate of Campylobacter isolation is 5-6 per 100,000 persons. This rate, however, grossly understimates the actual number of Campylobacter infections. In most cases, Campylobacter enteritis is a self-limiting disease, rarely associated with severe complications. Our case demonstrates the difficulty in distinguishing inflammatory bowel disease (Crohn's disease or ulcerative colitis) at onset from atypical infectious colitis. Unfortunately, corticosteroids (necessary for the treatment of inflammatory bowel disease) may exacerbate infectious etiologies. Campylobacter jejuni should be ruled out when assessing inflammatory bowel diseases at onset (as during flare-ups), especially if corticosteroids or immunosuppressive therapies are required.

  5. Food avoidance in irritable bowel syndrome leads to a nutrition ...

    African Journals Online (AJOL)

    2013-03-26

    Mar 26, 2013 ... Keywords: irritable bowel syndrome, dietary intake, fibre, fructose. Food avoidance in .... energy intake for protein, fat and carbohydrates was compared to ..... groups. A potential relationship exists between overweight/obesity.

  6. Preoperative Diagnosis of Adult Intussusception Caused by Small Bowel Lipoma

    Directory of Open Access Journals (Sweden)

    Hiroaki Shiba

    2009-11-01

    Full Text Available Adult intussusception is rare, accounting for only 5% of all intussusceptions, for which preoperative diagnosis is difficult. We herein report a preoperatively diagnosed case of adult intussusception caused by a small bowel lipoma. A 33-year-old man was admitted to our hospital with three weeks history of colicky epigastric pain. Computed tomography revealed thickening of the ileal wall suggestive of intussusception. Colonoscopy revealed an ileocolic intussusception. Barium enema for reduction of ileocolic intussusception demonstrated a small bowel tumor in the ileum 15 cm proximal to the ileocecal valve. The intussusception was reduced, and the patient underwent partial resection of the ileum encompassing the small bowel tumor. Histological findings confirmed the diagnosis of lipoma of the small bowel. The patient made a satisfactory recovery and remains well.

  7. Noninvasive Tests for Inflammatory Bowel Disease : A Meta-analysis

    NARCIS (Netherlands)

    Holtman, Gea A; Lisman-van Leeuwen, Yvonne; Reitsma, Johannes B.|info:eu-repo/dai/nl/189853107; Berger, Marjolein Y

    2016-01-01

    BACKGROUND: The clinical presentation of pediatric inflammatory bowel disease (IBD) is often nonspecific and overlaps with functional gastrointestinal disorders. OBJECTIVE: To determine the diagnostic accuracy of symptoms, signs, noninvasive tests, and test combinations that can assist the clinician

  8. Noninvasive Tests for Inflammatory Bowel Disease : A Meta-analysis

    NARCIS (Netherlands)

    Holtman, Gea A; Lisman-van Leeuwen, Yvonne; Reitsma, Johannes B; Berger, Marjolein Y

    BACKGROUND: The clinical presentation of pediatric inflammatory bowel disease (IBD) is often nonspecific and overlaps with functional gastrointestinal disorders. OBJECTIVE: To determine the diagnostic accuracy of symptoms, signs, noninvasive tests, and test combinations that can assist the clinician

  9. Steroid allergy in patients with inflammatory bowel disease.

    LENUS (Irish Health Repository)

    Malik, M

    2007-11-01

    Background: Contact allergy to a steroid enema leading to worsening of inflammatory bowel disease (IBD) has recently been reported. This study was designed to look for evidence of steroid allergy in patients with IBD.

  10. Capsule endoscopy in the small bowel Crohn's disease.

    Science.gov (United States)

    Argüelles-Arias, Federico; Rodríguez-Oballe, Juan; Duarte-Chang, Calixto; Castro-Laria, Luisa; García-Montes, Josefa María; Caunedo-Álvarez, Angel; Herrerías-Gutiérrez, Juan Manuel

    2014-01-01

    CD is a chronic inflammatory disorder associated to mucosal and transmural inflammation of the bowel wall. It is well known that CD can affect the entire gastrointestinal. Therefore, ileocolonoscopy and biopsies of the terminal ileum as well as of each colonic segment to look for microscopic evidence of CD are the first-line procedures to establish the diagnosis. However, it has been observed that up to 30% of the patients have only small bowel involvement. Evaluation of the small bowel has been made with radiological procedures, barium radiography, and abdominal computed tomography or by ileocolonoscopy or enteroscopy, but they have many recognized limitations. CE is undoubtedly a very useful diagnostic tool proposed to observe small-bowel lesions undetectable by conventional endoscopy or radiologic studies. We review different studies that have been published reporting the use of CE in suspected and evaluation of the extension or the recurrence in CD and also its use in pediatric population and its complications.

  11. New pharmacological treatment options for irritable bowel syndrome with constipation.

    Science.gov (United States)

    Nusrat, Salman; Miner, Philip B

    2015-01-01

    Constipation predominant irritable bowel syndrome (IBS-C) is a common disorder and accounts for a large number of ambulatory visits. Sensory abnormalities, that is, presence of abdominal pain and discomfort, distinguish IBS-C from chronic idiopathic constipation. This review focuses on the pharmacology, efficacy, safety, and future of prucalopride, YKP-10811, DSP-6952, dexloxiglumide, linaclotide, plecanatide, tenapanor, and elobixibat. It is now well established that treatment focusing only on bowel transit provides incomplete relief to patients with IBS-C. Improved understanding of pathophysiology of IBS-C has led to use of sensory end points like complete spontaneous bowel movements and the FDA combined end point (abdominal pain and complete spontaneous bowel movements) in clinical trials. A number of drugs are in development and provide hope for this challenging group of patients. However, because of recent failures secondary to ineffectiveness and/or adverse events, we cautiously await how clinical data play out in larger studies and in clinical practice.

  12. Childhood inflammatory bowel disease: Parental concerns and expectations

    OpenAIRE

    Day, AS; Whitten, KE; Bohane, TD

    2005-01-01

    AIM: To document the concerns and expectations of parents of children with inflammatory bowel disease (IBD) within the context of a multidisciplinary IBD clinic, and to highlight the importance of a holistic approach to the care of these children.

  13. Ileal angiodysplasia presentation as a bowel obstruction: A case report

    Directory of Open Access Journals (Sweden)

    Ons Ghdes

    2017-01-01

    Conclusion: Angiodysplasia should be kept in the back of one’s mind as one of the causes of acute abdomen and bowel obstruction, especially in elderly people suffering from occult gastrointestinal bleeding.

  14. CT findings of small bowel metastases from primary lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jae Wook; Ha, Hyun Kwon; Kim, Ah Young; Kim, Gab Choul; Kim, Tae Kyoung; Kim, Pyo Nyun; Lee, Moon Gyu [Ulsan University College of Medicine, Seoul (Korea, Republic of)

    2002-11-01

    To evaluate the CT findings of small bowel metastases from primary lung cancer. Of the 1468 patients with primary lung cancer between 1990 and 2000, 13 patients who had metastasis to the small intestine were collected. Of these 13 patients, nine who underwent CT scan were included for analysis. The pathologic diagnoses of primary lung cancer in these nine patients were squamous cell carcinoma in six, adenocarcinoma in two, and large cell carcinoma in one. CT scans were analyzed with regard to the site and patterns (intraluminal mass/bowel wall thickening/bowel implants) of metastatic masses, and the presence or absence of complication such as intussusception, obstruction, or perforation of the small bowel. The medical records of the patients were also reviewed retrospectively for evaluation of presenting abdominal symptom and time interval of metastases from initial diagnosis of lung cancer. Metastatic lesions were distributed throughout the small intestine: the duodenum in five, the jejunum in four, the ileum in six, and both jejunum and ileum in one patient. The size of metastatic masses of small bowel ranged from 1.3 cm to 5.0 cm (mean size, 2.6 cm) On CT, the small bowel was involved with intraluminal masses (mean size, 3.4 cm) in eight patients, diffuse wall thickening (mean thickness, 1.6 cm) in five, and bowel implants (mean size, 2.2 cm) in two. Complications occurred in seven patients, including intussusceptions without obstruction in two patients and with obstruction in two, obstruction without intussusceptions in two, and bowel perforation in one. Of 9 patients, 6 had at least one symptom referable to the small bowel including abdominal pain in 4, anemia in 3, vomiting in 1, and jaundice in 1. Lung cancer and small bowel lesions were detected simultaneously in four patients and the time interval of metastases from initial diagnosis of lung cancer ranged from 10 days to 30 months (median interval, 54 days) in patients. CT helps in defining the extent and

  15. Early bowel complications following radiotherapy of uterine cervix carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Won Dong [College of Medicine, Chungbuk National Univ., Cheongju (Korea, Republic of)

    1999-06-01

    This study evaluated early bowel complications in cervix cancer patients, following external radiotherapy (ERT) and high dose rate intracavitary radiation (HDR ICR). Factors affecting the risk of developing early bowel complications and its incidence are analyzed and discussed. The study is the retrospective review of 66 patients who received radiotherapy at Chungbuk National University Hospital from April 1994 to December 1998. The patients underwent 41.4 or 50.4 Gy ERT according to FIGO stage and tumor size, then A point dose was boosted to 71.4 or 74.4 Gy using a remotely controlled after loading Buchler HDR ICR. The EORTC/RTOG morbidity criteria were used to grade early bowel complications, which are valid from day 1, the commencement of therapy, through day 90. The actuarial incidence, severity of complications were investigated and clinical pretreatment factors relevant to complications were found through univariate (Wilcoxon) and multivariate (Cox proportional hazard model) analysis. Of the 66 patients, 30 patients (46%) developed early bowel complications; 25 patients (38%) with grade 1 or 2, 4 patients (6%) with grade 3 and 1 patient (2%) with grade 4. The complications usually began to occur 3 weeks after the commencement of radiotherapy. The actuarial incidence of early bowel complications was 41% at 10 weeks. The early bowel complications were associated significantly with an old age and a history of previous abdomino-pelvic surgery. All three patients who had a protracted overall treatment time (about 2 weeks) due to severe bowel complication, suffered from pelvic recurrences. Forty six percent of patients experienced early bowel complications, most of which were grade 1 or 2 and relieved spontaneously or by medication. The patients with an old age or a previous surgery have a high probability of early complications and they may be less compliant with planned radiotherapy. So more careful precaution is necessary for these patients.

  16. Bizarre behaviour, bizarre intruder and bizarre bowel obstruction

    OpenAIRE

    Di Saverio, Salomone; Catena, Fausto; Coccolini, Federico; Gazzotti, Filippo; Filicori, Filippo; Ansaloni, Luca

    2010-01-01

    An 82-year-old woman, with previous history of hiatal hernia, cholecystectomy and depression, has been admitted for worsening diffuse abdominal pain with constipation and vomiting for 4 days. She lived alone, without signs of dementia or cognitive impairment. The abdomen was distended and tender in middle quadrants. Abdominal x-ray revealed concentric distension of bowel loops. CT scan confirmed mechanical small bowel obstruction with a transition point in the right iliac fossa. At laparotomy...

  17. Maternal inflammatory bowel disease and offspring body size

    DEFF Research Database (Denmark)

    Ajslev, Teresa Adeltoft; Sorensen, Thorkild I A; Jess, Tine

    2012-01-01

    Maternal inflammatory bowel disease (IBD) may influence intrauterine growth and hence size at birth, but the consequences for offspring in later life remain uncertain. This study investigated the growth of children of mothers with Crohn's disease (CD) or ulcerative colitis (UC).......Maternal inflammatory bowel disease (IBD) may influence intrauterine growth and hence size at birth, but the consequences for offspring in later life remain uncertain. This study investigated the growth of children of mothers with Crohn's disease (CD) or ulcerative colitis (UC)....

  18. Transcutaneous bowel sonography for inflammatory bowel disease is sensitive and specific when performed in a nonexpert low-volume North American center.

    Science.gov (United States)

    Sey, Michael Sai Lai; Gregor, Jamie; Chande, Nilesh; Ponich, Terry; Bhaduri, Mousumi; Lum, Andrea; Zaleski, Witek; Yan, Brian

    2013-08-01

    Transcutaneous bowel sonography is a nonionizing imaging modality used in inflammatory bowel disease. Although available in Europe, its uptake in North America has been limited. Since the accuracy of bowel sonography is highly operator dependent, low-volume centers in North America may not achieve the same diagnostic accuracy reported in the European literature. Our objective was to determine the diagnostic accuracy of bowel sonography in a nonexpert low-volume center. All cases of bowel sonography at a single tertiary care center during an 18-month period were reviewed. Bowel sonography was compared with reference standards, including small-bowel follow-through, computed tomography, magnetic resonance imaging, colonoscopy, and surgical findings. A total of 103 cases were included for analysis during the study period. The final diagnoses included Crohn disease (72), ulcerative colitis (8), hemolytic uremic syndrome (1), and normal (22). The sensitivity and specificity of bowel sonography for intestinal wall inflammation were 87.8% and 92.6%, respectively. In the subset of patients who had complications of Crohn disease, the sensitivity and specificity were 50% and 100% for fistulas and 14% and 100% for strictures. One patient had an abscess, which was detected by bowel sonography. Abnormal bowel sonographic findings contributed to the escalation of treatment in 55% of cases. Bowel sonography for inflammatory bowel disease can be performed in low-volume centers and provides diagnostic accuracy for luminal disease comparable with published data, although it is less sensitive for complications of Crohn disease.

  19. Solution preparation

    Energy Technology Data Exchange (ETDEWEB)

    Seitz, M.G.

    1982-01-01

    Reviewed in this statement are methods of preparing solutions to be used in laboratory experiments to examine technical issues related to the safe disposal of nuclear waste from power generation. Each approach currently used to prepare solutions has advantages and any one approach may be preferred over the others in particular situations, depending upon the goals of the experimental program. These advantages are highlighted herein for three approaches to solution preparation that are currently used most in studies of nuclear waste disposal. Discussion of the disadvantages of each approach is presented to help a user select a preparation method for his particular studies. Also presented in this statement are general observations regarding solution preparation. These observations are used as examples of the types of concerns that need to be addressed regarding solution preparation. As shown by these examples, prior to experimentation or chemical analyses, laboratory techniques based on scientific knowledge of solutions can be applied to solutions, often resulting in great improvement in the usefulness of results.

  20. [Nutritional impact of inflammatory bowel diseases on children and adolescents].

    Science.gov (United States)

    dos Santos, Gilton Marques; Silva, Luciana Rodrigues; Santana, Genoile Oliveira

    2014-12-01

    To perform a systematic review of the literature about the nutritional impact of inflammatory bowel diseases in children and adolescents. A systematic review was performed using PubMed/MEDLINE, LILACS and SciELo databases, with inclusion of articles in Portuguese and in English with original data, that analyzed nutritional aspects of inflammatory bowel diseases in children and adolescents. The initial search used the terms "inflammatory bowel diseases" and "children" or "adolescents" and "nutritional evaluation" or "nutrition deficiency". The selection of studies was initially performed by reading the titles and abstracts. Review studies and those without data for pediatric patients were excluded. Subsequently, the full reading of the articles considered relevant was performed. 237 studies were identified, and 12 of them were selected according to the inclusion criteria. None of them was performed in South America. During the analysis of the studies, it was observed that nutritional characteristics of patients with inflammatory bowel disease may be altered; the main reports were related to malnutrition, growth stunting, delayed puberty and vitamin D deficiency. There are nutritional consequences of inflammatory bowel diseases in children and adolescents, mainly growth stunting, slower pubertal development, underweight and vitamin deficiencies. Nutritional impairments were more significant in patients with Crohn's disease; overweight and obesity were more common in patients with ulcerative rectocolitis. A detailed nutritional assessment should be performed periodically in children and adolescents with inflammatory bowel disease. Copyright © 2014 Associação de Pediatria de São Paulo. Publicado por Elsevier Editora Ltda. All rights reserved.

  1. Mesenteric Air Embolism Following Enteroscopic Small Bowel Tattooing Procedure

    Directory of Open Access Journals (Sweden)

    Natalie Chen

    2012-01-01

    Full Text Available Double balloon enteroscopy (DBE is a revolutionary procedure in which the entire small bowel can be visualized endoscopically. DBE has the advantage of both diagnostic and therapeutic capabilities in the setting of small bowel neoplasms and vascular malformations. We present a unique case of a 76-year-old female who underwent small bowel DBE tattoo marking of a distal small bowel tumor complicated by development of severe abdominal pain postprocedure secondary to bowel air embolism into the mesenteric veins. Mesenteric air can be seen after other endoscopic procedures such as biopsy, mucosal clip placement and polypectomy, or following a colonoscopy. Mesenteric air embolism following small bowel tattooing procedure has not been previously reported in the literature. Mesenteric air when present may be attributed to mesenteric ischemia and can subject the patient to unnecessary surgical intervention if misdiagnosed. Thus, this report holds significance for the radiologist as computed tomography (CT findings of mesenteric air embolism must be evaluated in the context of appropriate clinical history before treatment decisions are made.

  2. Pharmacological treatment of bowel obstruction in cancer patients.

    LENUS (Irish Health Repository)

    O'Connor, Brenda

    2012-02-01

    INTRODUCTION: Malignant bowel obstruction (MBO) is a common complication of advanced cancer, occurring most frequently in gynaecological and colorectal cancer. Its management remains complex and variable. This is in part due to the lack of evidence-based guidelines for the clinicians involved. Although surgery should be considered the primary treatment, this may not be feasible in patients with a poor performance status or advanced disease. Advances have been made in the medical management of MBO which can lead to a considerable improvement in symptom management and overall quality of life. AREAS COVERED: This review emphasizes the importance of a prompt diagnosis of MBO with early introduction of pharmacological agents to optimize symptom control. The authors summarize the treatment options available for bowel obstruction in those patients for whom surgical intervention is not a feasible option. The authors also explore the complexities involved in the introduction of parenteral hydration and total parenteral nutrition in this group of patients. EXPERT OPINION: It is not always easy to distinguish reversible from irreversible bowel obstruction. Early and aggressive management with the introduction of pharmacological agents including corticosteroids, octreotide and anti-cholinergic agents have the potential to maintain bowel patency, and allow for more rapid recovery of bowel transit. A combination of analgesics, anti-emetics and anti-cholinergics with or without anti-secretory agents can successfully improve symptom control in patients with irreversible bowel obstruction.

  3. Altered gastric emptying in patients with irritable bowel syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Caballero-Plasencia, A.M.; Valenzuela-Barranco, M. [Department of Medicine, School of Medicine, University of Granada (Spain); Herrerias-Gutierrez, J.M. [Division of Gastroenterology, University Hospital ``Virgen de la Macarena``, Sevilla (Spain); Esteban-Carretero, J.M. [Central Service of Investigation in Health Sciences, University of Cadiz, Cadiz (Spain)

    1999-04-29

    Irritable bowel syndrome is the most frequent functional disorder of the digestive system. Patients with irritable bowel syndrome have motor disorders not only in the colon, but also in other parts of the digestive tract such as the oesophagus and small intestine; however, it is not known whether the stomach is also involved. We used a radiolabelled mixed solid-liquid meal (technetium-99m for the solid component, indium-111 for the liquid component) to study gastric emptying of solids (GES), liquids (GEL) and indigestible solids (GER) in 50 patients diagnosed as having irritable bowel syndrome (30 with predominant constipation and 20 with predominant diarrhoea). GER was measured by counting the number of indigestible solids remaining in the stomach 4 h after they were swallowed. In patients with irritable bowel syndrome, GES and GEL were slower than in control subjects (P<0.05). GER was normal in all patients except for two women. Thirty-two patients (64%) showed delayed GES, 29 (58%) delayed GEL, and 2 (4%) delayed GER. Among patients with irritable bowel syndrome, GES was slower in those with predominant constipation than in those with predominant diarrhoea (P<0.05); GEL and GER were similar in both groups. Gastroparesis was found in a large proportion of patients with irritable bowel syndrome, suggesting the presence of a more generalised motor disorder of the gut. (orig.) With 1 fig., 3 tabs., 48 refs.

  4. Nutritional impact of inflammatory bowel diseases on children and adolescents

    Directory of Open Access Journals (Sweden)

    Gilton Marques dos Santos

    2014-12-01

    Full Text Available OBJECTIVE: To perform a sistematiy review of the literature about the nutritional impact of inflammatory bowel diseases in children and adolescents.DATA SOURCES: A systematic review was performed using PubMed/MEDLINE, LILACS and SciELO databases, with inclusion of articles in Portuguese and in English with original data, that analyzed nutritional aspects of inflammatory bowel diseases in children and adolescents. The initial search used the terms "inflammatory bowel diseases" and "children" or "adolescents" and "nutritional evaluation" or "nutrition deficiency". The selection of studies was initially performed by reading the titles and abstracts. Review studies and those withouth data for pediatric patients were excluded. Subsequently, the full reading of the articles considered relevant was performed.RESULTS: 237 studies were identified, and 12 of them were selected according to the inclusion criteria. None of them was performed in South America. During the analysis of the studies, it was observed that nutritional characteristics of patients with inflammatory bowel disease may be altered; the main reports were related to malnutrition, growth stunting, delayed puberty and vitamin D deficiency.CONCLUSION: There are nutritional consequences of inflammatory bowel diseases in children and adolescents, mainly growth stunting, slower pubertal development, underweight and vitamin deficiencies. Nutritional impairments were more significant in patients with Crohn's disease; overweight and obesity were more common in patients with ulcerative rectocolitis. A detailed nutritional assessment should be performed periodically in children and adolescents with inflammatory bowel disease.

  5. A family study of asymptomatic small bowel Crohn's disease.

    Science.gov (United States)

    Biancone, Livia; Calabrese, Emma; Petruzziello, Carmelina; Capanna, Alessandra; Zorzi, Francesca; Onali, Sara; Condino, Giovanna; Lolli, Elisabetta; Ciccacci, Cinzia; Borgiani, Paola; Pallone, Francesco

    2014-03-01

    Discrepancies between severity of lesions and symptoms may be observed in Crohn's disease. We prospectively assessed whether Crohn's disease may be diagnosed among asymptomatic relatives of patients, using Small Bowel Contrast Ultrasonography. Diagnosis of asymptomatic Crohn's disease relatives was defined ultrasonographically as: bowel wall thickness >3mm, bowel dilation/stricture, lumen diameter >2.5 cm. Diagnosis was confirmed by ileocolonoscopy. Subjects were also screened for the Leu3020insC mutation. Consent was given by 35 asymptomatic first-degree relatives of 18 Crohn's disease patients. Ultrasonography indicated increased bowel wall thickness (5mm) compatible with ileal Crohn's disease in 1 relative (2.8%), a 42 year-old male. Ileocolonoscopy, histology, and radiology confirmed the diagnosis of stricturing ileal Crohn's disease. Gallbladder stones were detected in 7/35 (20%) relatives and Leu3020insC mutation in 3/35 (8.5%). Small Bowel Contrast Ultrasonography may be a useful tool to diagnose asymptomatic small bowel Crohn's disease among first-degree relatives of patients. Copyright © 2013 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  6. Mesenteric air embolism following enteroscopic small bowel tattooing procedure.

    Science.gov (United States)

    Chen, Natalie; Lamba, Ramit; Lee, John; Lall, Chandana

    2012-01-01

    Double balloon enteroscopy (DBE) is a revolutionary procedure in which the entire small bowel can be visualized endoscopically. DBE has the advantage of both diagnostic and therapeutic capabilities in the setting of small bowel neoplasms and vascular malformations. We present a unique case of a 76-year-old female who underwent small bowel DBE tattoo marking of a distal small bowel tumor complicated by development of severe abdominal pain postprocedure secondary to bowel air embolism into the mesenteric veins. Mesenteric air can be seen after other endoscopic procedures such as biopsy, mucosal clip placement and polypectomy, or following a colonoscopy. Mesenteric air embolism following small bowel tattooing procedure has not been previously reported in the literature. Mesenteric air when present may be attributed to mesenteric ischemia and can subject the patient to unnecessary surgical intervention if misdiagnosed. Thus, this report holds significance for the radiologist as computed tomography (CT) findings of mesenteric air embolism must be evaluated in the context of appropriate clinical history before treatment decisions are made.

  7. Pectin improves colonic function in rat short bowel syndrome.

    Science.gov (United States)

    Roth, J A; Frankel, W L; Zhang, W; Klurfeld, D M; Rombeau, J L

    1995-02-01

    Short bowel syndrome is characterized by weight loss, diarrhea, and malabsorption. Pectin, a highly fermentable fiber, improves small and large bowel mucosal structure, prolongs intestinal transit, and decreases diarrhea. This study determined if the addition of citrus pectin to an enteral liquid diet (LD) improved structure and absorptive function in the rat jejunum and colon following massive intestinal resection. Twenty-one male Sprague-Dawley rats underwent placement of gastrostomy tube for isocaloric, isonitrogenous feeding and either 60% small bowel and cecal resection or small bowel transection with anastomosis. Animals in each group were then randomly and equally assigned to receive either LD (Enercal Plus, Wyeth) or LD supplemented with 2% citrus pectin for 7 days. Study variables included body weight change, percentage of stool solidity, jejunal villous height (JVH) and crypt depth, colonic crypt depth (CCD), and colonic short-chain fatty acid content (SCFA). Jejunal [14C]glucose absorption and colonic [3H]H2O absorption were measured by a dual in vivo perfusion assay. Resection significantly (P < 0.05) decreased body weight, stool solidity, and colonic SCFA content; enlarged structure (JVH, CCD); and increased absorptive function in the remaining bowel. Pectin significantly decreased (P < 0.05) body weight loss, increased (P < 0.05) stool solidity, and improved (P = 0.05) colonic water absorption following resection without significantly altering mucosal structure. It is concluded that pectin improves colonic absorptive function following massive bowel resection in the rat.

  8. Integrated real time bowel sound detector for artificial pancreas systems

    Directory of Open Access Journals (Sweden)

    Khandaker A. Al Mamun

    2016-03-01

    Full Text Available This paper reports an ultra-low power real time bowel sound detector with integrated feature extractor for physiologic measure of meal instances in artificial pancreas devices. The system can aid in improving long term diabetic patient care and consists of a front end detector and signal processing unit. The front end detector transduces the initial bowel sound recorded from a piezoelectric sensor into a voltage signal. The signal processor uses a feature extractor to determine whether a bowel sound is detected. The feature extractor consists of a low noise, low power signal front-end, peak and trough locator, signal slope and width detector, digitizer, and bowel pulse locator. The system was fabricated in a standard 0.18 μm CMOS process, and the bowel sound detection system was characterized and verified with experimentally recorded bowel sounds. The integrated instrument consumes 53 μW of power from a 1 V supply in a 0.96 mm2 area, and is suitable for integration with portable devices.

  9. The role of fecal calprotectin in investigating inflammatory bowel diseases

    Directory of Open Access Journals (Sweden)

    Mustafa Erbayrak

    2009-05-01

    Full Text Available INTRODUCTION: Invasive and non-invasive tests can be used to evaluate the activity of inflammatory bowel diseases. OBJECTIVE: The aim of the present study was to investigate the role of fecal calprotectin in evaluating inflammatory bowel disease activity and the correlation of fecal calprotectin with the erythrocyte sedimentation rate and C reactive protein values in inflammatory bowel disease. METHOD: Sixty-five patients affected with inflammatory bowel disease were enrolled. Twenty outpatients diagnosed with inflammatory bowel disease comprised the control group. RESULTS: In the present study, all patients in the control group had an fecal calprotectin value lower than the cut-off point (50 mg/kg. CONCLUSION: In conclusion, fecal calprotectin was found to be strongly associated with colorectal inflammation indicating organic disease. Fecal calprotectin is a simple and non-invasive method for assessing excretion of macrophages into the gut lumen. Fecal calprotectin values can be used to evaluate the response to treatment, to screen asymptomatic patients, and to predict inflammatory bowel disease relapses.

  10. Inflammatory bowel disease nurses in Canada: An examination of Canadian gastroenterology nurses and their role in inflammatory bowel disease care

    Science.gov (United States)

    Stretton, Jennifer G; Currie, Barbara K; Chauhan, Usha K

    2014-01-01

    BACKGROUND/OBJECTIVE: Inflammatory bowel disease (IBD) is a chronic relapsing illness primarily including Crohn disease and ulcerative colitis. The disease course often fluctuates over time, and requires maintenance therapy and acute interventions to target disease flares. IBD management requires a multidisciplinary approach, with care from physicians, nurses, dieticians, social workers and psychologists. Because nurses play a pivotal role in managing chronic disease, the aim of the present study was to assess and determine how many nurses work primarily with IBD patients in Canada. METHODS: A 29-question survey was developed using an Internet-based survey tool (www.surveymonkey.com) to investigate nursing demographics, IBD nursing roles and nursing services provided across Canada. Distribution included the Canadian Society of Gastroenterology Nurses and Associates, the Canadian Association of Gastroenterology, Progress (AbbVie Corporation, USA) and BioAdvance (Janssen Inc, USA) coordinators (via e-mail), and online availability for 15 weeks. RESULTS: Of 275 survey respondents, 98.2% were female nurses, with 68.7% employed in full-time positions. Among them, 42.5% were between 51 and 60 years of age, and 32.4% were between 41 and 50 years of age. In addition, 53.8% were diploma-prepared registered nurses, 35.3% were Baccalaureate-prepared nurses and 4.4% were Masters-prepared nurses. Almost one-half (44% [n=121]) were employed in Ontario, followed by 19.6% (n=54) in Alberta and 9.1% (n=25) in British Columbia. All provinces were represented with the exception of Nunavut and the Northwest Territories. Forty-three per cent (n=119) of nurses identified as working in endoscopy units. Of the 90% who responded as working with IBD patients, only 30% (n=79) had a primary role in IBD care. Among these 79 nurses with a primary role in IBD care, 79.7% worked with the adult population, 10.1% with the pediatric population, and 10.1% worked with both adult and pediatric patients

  11. Diagnostic performance of CT colonography with limited cathartic preparation in colorectal cancer screening; comparison with conventional colonoscopy

    Directory of Open Access Journals (Sweden)

    Mohammed Farghally Amin

    2015-09-01

    Conclusion: This study proved that CTC with limited cathartic bowel preparation and iodinated agents for fecal tagging can obtain high sensitivity and PPV values results for <5 mm polyps comparable to those obtained with conventional preparation with laxatives. Furthermore, this method could really improve the acceptance of CTC for colorectal cancer screening.

  12. Investigation of the blastocystis hominis frequency in patients with irritable bowel syndrome

    Directory of Open Access Journals (Sweden)

    Bayram Pektaş

    2014-06-01

    Full Text Available AimIn this study, it was aimed to investigate the relationship between Blastocystis hominis infection and inflammatory bowel syndrome (IBS. Methods: In this study, the frequency of B. hominis in the stool samples of 52 patients applied to Microbiology laboratory and pre-diagnosed with irritable bowel syndrome in January 2013-June 2013 was investigated, retrospectively. Microscopic investigations were evaluated after macroscopic examination. For this purpose, the stool samples of the diarrheal cases were investigated by trichrome staining after they were prepared by native-lugol and formol ethyl acetate concentration method. The results were compared with the examination of 2160 stool samples sent to our laboratory during the same period. Results: Stool samples of 52 patients pre-diagnosed with IBS were accepted to our laboratory in January 2013-June 2013. 13 of the patients were found as B. hominis positive. Weight loss and anorexia was identified only in one patient while abdominal pain, diarrhea and gas complaints were identified in all of the IBH and B. hominis positive patients. During the same period, parasites were detected in 96 (4.4% of 2160 stool samples sent to our laboratory and the most common was B. hominis 48 (2.2%. 452 of these patients applied with diarrhea symptoms and B. hominis was detected in 36 samples (7.96%. Conclusion: The limited studies investigating the presence of B. hominis in patients with irritable bowel syndrome are far from illuminating the role of this agent in disease pathogenesis. We believe that further investigations should be performed. In this study, 25% of the patients were found as positive. J Clin Exp Invest 2014; 5 (2: 242-245

  13. Prevalence of irritable bowel syndrome, influence of lifestyle factors and bowel habits in Korean college students.

    Science.gov (United States)

    Kim, You Joung; Ban, D J

    2005-03-01

    Irritable bowel syndrome (IBS) is considered to be prevalent in the general population, but there are little data on bowel habits and IBS in Korea. Because nurses are frequently called on to help this patient population with IBS and help manage their symptoms, it is very necessary to get some practical information about patients' experiences and to outline a multifaceted approach to the practical management of patient with IBS. So this study aims to describe the bowel habits and the prevalence of IBS in young university students in Korea and to investigate the influence of lifestyle factors, including dietary habits, on IBS prevalence. Finally, we discuss the nursing needs for an holistic approach. A cross-sectional study, using the self-reported questionnaire based on previous studies done abroad and the Rome alpha criteria was applied with 1717 young university students. The answers of 747 men and 970 women were included in the study. The prevalence of IBS, as defined by the Rome alpha criteria, was 5.7% of the subjects. The proportion of women (70.7%) was significantly higher than the proportion of men in the IBS group as compared to that in the non-IBS group (odds ratio 2.07, 95% CI 1.2-3.7). Residential type (odds ratio 1.27, 95% 1.06-1.5) and frequency of meals (odds ratio 1.69, 95% CI 1.2-2.5) significantly differed between the IBS group and non-IBS group. There was a trend towards the higher prevalence of IBS with fewer hours of exercise (odds ratio 0.99, 95% CI 0.95-1.04). 90.6% of respondents reported stool frequencies between three times per day and three times per week. Characteristics of defecation differed significantly between men and women (pstress.

  14. Globalisation of inflammatory bowel disease: perspectives from the evolution of inflammatory bowel disease in the UK and China.

    Science.gov (United States)

    Kaplan, Gilaad G; Ng, Siew C

    2016-12-01

    The UK and China provide unique historical perspectives on the evolution of the incidence of inflammatory bowel disease, which might provide insight into its pathogenesis. Historical records from the UK document the emergence of ulcerative colitis during the mid-1800s, which was later followed by the recognition of Crohn's disease in 1932. During the second half of the 20th century, the incidence of inflammatory bowel disease rose dramatically in high-income countries. Globalisation at the turn of the 21st century led to rapid economic development of newly industrialised countries such as China. In China, the modernisation of society was accompanied by the recognition of a sharp rise in the incidence of inflammatory bowel disease. The prevalence of inflammatory bowel disease is expected to continue to rise in high-income countries and is also likely to accelerate in the developing world. An understanding of the shared and different environmental determinants underpinning the pathogenesis of inflammatory bowel disease in western and eastern countries is essential to implement interventions that will blunt the rising global burden of inflammatory bowel disease. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. Small Bowel Carcinoid: The "Dancing Bowel Sign" on 18F-FDOPA PET/CT.

    Science.gov (United States)

    Helali, Mehdi; Heimburger, Céline; Rohr, Serge; Goichot, Bernard; Imperiale, Alessio

    2016-12-01

    The localization of small bowel (SB) neuroendocrine tumors (NETs) remains a diagnostic challenge in clinical practice. In about a third of cases, SB-NETs are multiple at diagnosis. However, the sensitivity of conventional presurgical diagnostic investigations is not exhaustive. F-FDOPA (6-L-F-fluorodihydroxyphenylalanine) PET seems to be a valuable diagnostic technique for the detection of midgut NETs. According to our experience, a delayed PET/CT acquisition centered on abdominopelvic region and performed after oral hydration may improve the detection of primary tumor and the identification of patients with multifocal SB-NETs who could benefit from a more accurate intraoperative palpation of the entire SB.

  16. MR enterography for assessment and management of small bowel Crohn disease.

    Science.gov (United States)

    Allen, Brian C; Leyendecker, John R

    2014-07-01

    Magnetic resonance enterography (MRE) utilization has increased for the evaluation of small bowel diseases over the last several years. In addition to performing similarly to computed tomography enterography (CTE) in the evaluation of inflammatory bowel disease, MRE lacks ionizing radiation, can image the small bowel dynamically, and provides excellent soft tissue contrast resolution. This article reviews imaging protocols for MRE, normal MR imaging appearance of small bowel, and the imaging findings of small bowel Crohn disease. The importance of imaging findings for directing management in patients with small bowel Crohn disease is emphasized throughout. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. Experimental single-session imagery rescripting of distressing memories in bowel/bladder-control anxiety: a case series

    National Research Council Canada - National Science Library

    Pajak, Rosanna; Kamboj, Sunjeev K

    2014-01-01

    Bowel and bladder obsession [bowel/bladder-control anxiety (BBCA)] is a viscerally centered phobic syndrome involving a specific concern about losing control of bowel or bladder functioning in a public place...

  18. Dietary fiber in irritable bowel syndrome (Review)

    Science.gov (United States)

    El-Salhy, Magdy; Ystad, Synne Otterasen; Mazzawi, Tarek; Gundersen, Doris

    2017-01-01

    Irritable bowel syndrome (IBS) is a common chronic gastrointestinal disorder. It is widely believed that IBS is caused by a deficient intake of dietary fiber, and most physicians recommend that patients with IBS increase their intake of dietary fiber in order to relieve their symptoms. However, different types of dietary fiber exhibit marked differences in physical and chemical properties, and the associated health benefits are specific for each fiber type. Short-chain soluble and highly fermentable dietary fiber, such as oligosaccharides results in rapid gas production that can cause abdominal pain/discomfort, abdominal bloating/distension and flatulence in patients with IBS. By contrast, long-chain, intermediate viscous, soluble and moderately fermentable dietary fiber, such as psyllium results in a low gas production and the absence of the symptoms related to excessive gas production. The effects of type of fiber have been documented in the management of IBS, and it is known to improve the overall symptoms in patients with IBS. Dietary fiber acts on the gastrointestinal tract through several mechanisms, including increased fecal mass with mechanical stimulation/irritation of the colonic mucosa with increasing secretion and peristalsis, and the actions of fermentation byproducts, particularly short-chain fatty acids, on the intestinal microbiota, immune system and the neuroendocrine system of the gastrointestinal tract. Fiber supplementation, particularly psyllium, is both safe and effective in improving IBS symptoms globally. Dietary fiber also has other health benefits, such as lowering blood cholesterol levels, improving glycemic control and body weight management. PMID:28731144

  19. Intestinal Endometriosis: Mimicker of Inflammatory Bowel Disease?

    Science.gov (United States)

    Guadagno, Antonio; Grillo, Federica; Vellone, Valerio Gaetano; Ferrero, Simone; Fasoli, Alberto; Fiocca, Roberto; Mastracci, Luca

    2015-01-01

    Endometriosis of the intestinal tract (IE) is thought to mimic inflammatory bowel disease (IBD) both clinically and pathologically but robust data on a large unselected series are missing. Diagnostic problems arise both at colonoscopy as well as on resection specimens for IE when IBD-like features are encountered. The aim was to establish the frequency of IBD-like histology in IE and which type of histological lesions are shared by these two entities. One hundred consecutive, unselected cases of surgically resected IE were collected and clinical features and histopathology reviewed and reevaluated. Seventy-five surgical specimens showed no histological alterations except for endometriosis foci. Twenty-two cases showed focal architectural alterations in the absence of significant inflammation. Three cases showed marked inflammatory and architectural mucosal changes making a differential diagnosis with IBD particularly challenging. On follow-up, however, these patients remained symptom-free and with no need for anti-inflammatory therapy after surgical resection of IE. Diagnostic problems may arise in women who have IBD-like symptoms and histology at colonoscopy but who lack a known diagnosis of endometriosis. Clinicians must be aware that the diagnosis of IBD in patients with IE should be reevaluated over time. © 2015 S. Karger AG, Basel.

  20. Immunological pathogenesis of inflammatory bowel disease

    Directory of Open Access Journals (Sweden)

    Seung Hoon Lee

    2018-01-01

    Full Text Available Inflammatory bowel disease (IBD is a chronic inflammatory state of the gastrointestinal tract and can be classified into 2 main clinical phenomena: Crohn's disease (CD and ulcerative colitis (UC. The pathogenesis of IBD, including CD and UC, involves the presence of pathogenic factors such as abnormal gut microbiota, immune response dysregulation, environmental changes, and gene variants. Although many investigations have tried to identify novel pathogenic factors associated with IBD that are related to environmental, genetic, microbial, and immune response factors, a full understanding of IBD pathogenesis is unclear. Thus, IBD treatment is far from optimal, and patient outcomes can be unsatisfactory. As result of massive studying on IBD, T helper 17 (Th17 cells and innate lymphoid cells (ILCs are investigated on their effects on IBD. A recent study of the plasticity of Th17 cells focused primarily on colitis. ILCs also emerging as novel cell family, which play a role in the pathogenesis of IBD. IBD immunopathogenesis is key to understanding the causes of IBD and can lead to the development of IBD therapies. The aim of this review is to explain the pathogenesis of IBD, with a focus on immunological factors and therapies.

  1. Irritable bowel syndrome and psychological stress

    Directory of Open Access Journals (Sweden)

    Anita D Stuart

    1999-01-01

    Full Text Available The purpose of this study was twofold. The first aim was to clarify the relationship between psychological stress and lrritable Bowel Syndrome (IBS by establishing whether individuals suffering from IBS experience minor stress differently from healthy individuals in terms of its frequency or intensity. The second aim was more general and concerns theory building in a field filled with ambiguity and confusion. Two groups, one comprising IBS sufferers and the other healthy controls, completed the Daily Stress lnventory and the Occupational Stress lnventory - questionnaires designed to measure minor daily and occupational stress respectively. The findings indicate that IBS sufferers do not experience more stress than healthy individuals, but they experience the stressors with greater intensity.

    Opsomming
    Die doel van die studie was tweeledig. Eerstens is daar gepoog om duidelikheid te kry oor die verband tussen sielkundige stres en Prikkelbare Dermsindroom (PDS, deur te bepaal of individue wat aan PDS ly geringe stres anders ervaar as gesonde individue in terme van gereeldheid of intensiteit. Die tweede doelwit was meer algemeen en spreek die kwessie van teorie ontwikkeling aan in 'n veld gevul met dubbelsinningheid en verwarring. Twee groepe, een bestaande uit PDS lyers en die ander 'n gesonde kontrolegroep, het die "Daily Stress Inventory'' en die "Occupational Stress Inventory" voltooi. Die vraelyste is ontwerp om onderskeidelik daaglikse stres en werkstres te meet. Die resultate dui daarop dat PDS lyers nie meer stres ervaar as die gesonde individue nie, maar dat hulle wel die stressors ervaar met groter intensiteit.

  2. Familial risk of inflammatory bowel disease

    DEFF Research Database (Denmark)

    Trier Møller, Frederik; Andersen, Vibeke; Jess, Tine

    2014-01-01

    Background The inflammatory bowel diseases (IBD) – ulcerative colitis (UC) and Crohn’s disease (CD) - are caused by complex gene-environment interactions. This study provides updated familial aggregation patterns in a large population-based Danish IBD cohort. Methods: Our cohort study was based.......92(5.28-9.06) 2.62(1.63-4.23) 1.15(0.29-4.62) One CD relative 2.57(2.28-2.90) 1.51(1.22-1.86) 1.47(1.00-2.17) One UC relative 4.09(3.81-4.38) 1.85(1.60-2.13) 1.51(1.07-2.13) Conclusion: This large-scale population-based study provides updated numbers of familial aggregation of IBD. Familial exposure to CD...... in the entire population. Individuals receiving at least 2 diagnoses of IBD during the time period (n=45,780) were identified using the Danish National Registry of Patients. Risk of IBD in family members to individuals with IBD was assessed by Poisson regression analysis. Results: The overall proportion...

  3. Inflammatory bowel disease: immunodiagnostics, immunotherapeutics, and ecotherapeutics.

    LENUS (Irish Health Repository)

    Shanahan, F

    2012-02-03

    Treatment options for inflammatory bowel disease (IBD) reflect a continuing shift from empiricism to strategies based on improved understanding of the pathophysiology of disease. In susceptible individuals, IBD appears to be the result of defective regulation of mucosal immune interactions with the enteric microflora. This has prompted research directed at the interface of the traditional disciplines of immunology, microbiology, and epithelial cell biology. Whereas immunodiagnostics have been of limited clinical value in IBD, assessments of mucosal rather than systemic immune function are promising. Therapeutically, there is an increasing trend toward more aggressive and earlier use of immunomodulatory agents, particularly for prevention of relapse, with cytokine manipulation as a bridge therapy to achieve remission in patients with acute severe disease. Although most drug treatments are directed toward altering the host response, the rationale for manipulating the enteric flora appears sound and will be the basis of additional future therapeutic strategies. Notwithstanding the widening range of options for drug therapy in IBD, other outcome modifiers and well-established principles of managing chronic disease are as important as ever.

  4. Microbiota Small RNAs in Inflammatory Bowel Disease.

    Science.gov (United States)

    Filip, Anca T; Balacescu, Ovidiu; Marian, Catalin; Anghel, Andrei

    2016-12-01

    MiRNAs are a class of potential gene regulators of critical importance in Inflammatory Bowel Disease (IBD). This review aims to present the connection between gut microbiota, probiotics administration and microRNA (miRNA) expression in IBD. It also brings into question cross-kingdom RNAi (RNA interference). Not only that gut host cells garden the intestinal microbiome via miRNA, but also strong evidence supports the idea that different species of bacteria have an impact on the intestinal immune response by modulating miRNA expression. Cross-kingdom RNAi refers to RNA silencing signals that travel between two unrelated, interacting organisms. RNAs communication between prokaryotes and eukaryotes (bacteria and nematodes) via RNAs transfer has been proved. Some authors also support the idea that non-coding RNAs are being transferred by bacterial pathogens to the host cells as part of the intracellular infection process. Further studies are required in order to clarify whether the mechanism by which bacteria modulate miRNA expression concerns RNAs transfer. These findings may lead to a different approach to IBD therapy in the future.

  5. Management of inflammatory bowel disease in pregnancy.

    Science.gov (United States)

    Vermeire, Séverine; Carbonnel, Franck; Coulie, Pierre G; Geenen, Vincent; Hazes, Johanna M W; Masson, Pierre L; De Keyser, Filip; Louis, Edouard

    2012-09-01

    Inflammatory bowel disease (IBD) is a chronic disease affecting mainly young people in their reproductive years. IBD therefore has a major impact on patients' family planning decisions. Management of IBD in pregnancy requires a challenging balance between optimal disease control and drug safety considerations. This article aims to provide a framework for clinical decision making in IBD based on review of the literature on pregnancy-related topics. Medline searches with search terms 'IBD', 'Crohn's disease' or 'ulcerative colitis' in combination with keywords for the topics fertility, pregnancy, congenital abnormalities and drugs names of drugs used for treatment of IBD. IBD patients have normal fertility, except for women after ileal pouch-anal anastomosis (IPAA) and men under sulfasalazine treatment. Achieving and maintaining disease remission is a key factor for successful pregnancy outcomes in this population, as active disease at conception carries an increased risk of preterm delivery and low birth weight. Clinicians should discuss the need for drug therapy to maintain remission with their patients in order to ensure therapy compliance. Most IBD drugs are compatible with pregnancy, except for methotrexate and thalidomide. If possible, anti-TNF therapy should be stopped by the end of the second trimester and the choice of delivery route should be discussed with the patient. Disease control prior to conception and throughout pregnancy is the cornerstone of successful pregnancy management in IBD patients. Copyright © 2012 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

  6. Management of Inflammatory Bowel Disease During Pregnancy.

    Science.gov (United States)

    Bar-Gil Shitrit, Ariella; Grisaru-Granovsky, Sorina; Ben Ya'acov, Ami; Goldin, Eran

    2016-08-01

    Inflammatory bowel disease (IBD) usually affects women during their reproductive years and many concerns arise among these young patients. Pre-pregnancy consultation with a multi-disciplinary team is very important. The team should make patients aware of the critical importance of ensuring that conception occurs during a period of disease remission. Conception during an IBD flare-up results in disease activity or even exacerbates disease in two-thirds of women. Exacerbation of the disease is associated with increased frequency of maternal and fetal complications. Drug therapy constitutes a considerable source of patient anxiety but most drugs used for treating IBD are considered safe. Therefore, continuing pharmacological therapy during pregnancy is necessary to maintain disease control. Optimization of pre-conception nutritional status and smoking cessation are also emphasized. The general guideline for most patients, except for active perianal disease patients, is to aim for vaginal delivery in the absence of obstetric contraindications. Consistent, ongoing follow-up, as detailed in this review, should allay the anxieties and fears surrounding continuing immunosuppressive drugs during pregnancy, allowing each patient to attain the optimal conditions for achieving her goal of holding a healthy baby.

  7. Diagnosis and therapy of irritable bowel syndrome.

    Science.gov (United States)

    De Giorgio, R; Barbara, G; Stanghellini, V; Cremon, C; Salvioli, B; De Ponti, F; Corinaldesi, R

    2004-07-01

    Irritable bowel syndrome (IBS) is one of the most common gut functional diseases, affecting 10-20% of people worldwide. Although most patients do not seek medical help, the disease accounts for huge costs for both patients and health-care systems and worsens significantly patients' quality of life. Diagnosis is based on the identification of symptoms according to Manning, Rome I and Rome II criteria and exclusion of alarm indicators. IBS symptoms overlap with those of coeliac disease, lactose intolerance, food allergies and bile salt malabsorption. The treatment of IBS is centred on an excellent doctor-patient relationship along with drugs targeting the predominant symptom, especially during exacerbations. Current pharmacological remedies are unsatisfactory due to the high number of patients complaining of lack of response and/or symptom recurrence. Although useful in some IBS patients, the validity of psychotherapy deserves further investigation. A wide array of potentially useful drugs are currently under consideration in pre-clinical trials. A better understanding of the pathogenetic mechanisms underlying IBS may help to develop more effective drugs for this disease.

  8. Smell and taste in inflammatory bowel disease.

    Science.gov (United States)

    Steinbach, Silke; Reindl, Wolfgang; Dempfle, Astrid; Schuster, Anna; Wolf, Petra; Hundt, Walter; Huber, Wolfgang

    2013-01-01

    To investigate the olfactory/gustatory functions of patients with inflammatory bowel disease (IBD) by smell/taste tests, and to determine if disease activity or medication might influence the olfactory/gustatory functions of patients. In total, 59 IBD patients (37 Crohn's disease (CD) and 22 ulcerative colitis (UC) patients) were studied using "Sniffin' sticks" and "taste strips" for olfactory and gustatory tests, respectively, and compared to healthy controls and published normative data. Among IBD (CD and UC) patients, the values for odor threshold, but not for odor identification or discrimination, were significantly lower than that of the normative data. Further, these patients showed lower values than the normative taste values and the control group for all tastes, except sour; 57.6% of the IBD patients were hyposmic, while 30.5% were hypogeusic. Subjective self-assessments showed that the patients were not aware of their reduced olfactory/gustatory functions. There were no relevant differences in taste and smell abilities between the CD and UC patients. Disease activity and treatment did not influence the olfactory/gustatory functions. IBD (CD and UC) patients exhibited significant reductions in the olfactory and gustatory functions. Therefore, patients should be tested by smell/taste tests, in order to be adequately informed of their olfactory/gustatory functions and provided an understanding of how to overcome their limitations, and thus improve their quality of life.

  9. Skin Manifestations of Inflammatory Bowel Disease

    Directory of Open Access Journals (Sweden)

    Brian L Huang

    2012-02-01

    Full Text Available Inflammatory bowel disease (IBD is a disease that affects the intestinal tract via an inflammatory process. Patients who suffer from IBD often have diseases that affect multiple other organ systems as well. These are called extraintestinal manifestations (EIMs and can be just as, if not more, debilitating than the intestinal inflammation itself. The skin is one of the most commonly affected organ system in patients who suffer from IBD. The scientific literature suggests that a disturbance of the equilibrium between host defense and tolerance, and subsequent over-activity of certain immune pathways, are responsible for the cutaneous disorders seen so frequently in IBD patients. The purpose of this review article is to give an overview of the types of skin diseases that are typically seen with IBD and their respective pathogenesis, proposed mechanisms, and treatments. These cutaneous disorders can manifest as a metastatic lesion, reactive process to the intestinal inflammation, association by genetic linkage and autoimmune processes, complication of IBD itself, as side effects from IBD treatments, and from other mechanisms that will be discussed in this article. Ultimately, it is important for healthcare providers to understand that skin manifestations should always be checked and evaluated for in patients with IBD.

  10. Potential Human Models of Infammatory Bowel Disease

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    Stephen B Hanauer

    1995-01-01

    Full Text Available Similar to animal models of inflammatory bowel disease (IBD, there is no single human model representative of ulcerative colitis or Crohn's disease. An optimal human model awaits etiopathogenetic definitions and further reclassification or depiction of clinicopathological scenarios. Current human models can be classified into models depicting risk of disease; preclinical disease; acute inflammation; and miscellaneous IBD. Family studies are the best means of pursuing patients at risk. Evolving genetic and serological markers may further identify subgroups to assess with permeability probes, leukocyte scans or endoscopy for preclinical disease. Provocation with nonsteroidal anti-inflammatory drugs (NSAIDs may be useful in selected patients because NSAID mucosal damage may induce or mimic IBD. Alternative natural history or interventional studies in patients with human leukocyte antigen (HLA-B27 spondylarthropathy may be useful. The disease margin and pouchitis are models within the disease state of ulcerative colitis as are the aphthous ulcer, anastomotic margin and diverted fecal stream for Crohn's disease. Newly defined colitides, such as microscopic and collagenous colitis and diversion colitis, also provide potential comparative models to evaluate mucosal immune, inflammatory, reparative, secretory and absorptive regulation.

  11. Inflammatory Bowel Disease: Progress Towards a Gene

    Directory of Open Access Journals (Sweden)

    David A van Heel

    2000-01-01

    Full Text Available The pathogenesis of ulcerative colitis (UC and Crohn’s disease (CD is still unknown, but the importance of genetic susceptibility has been clearly shown by epidemiological data from family and twin studies. Linkage studies have identified two susceptibility loci for inflammatory bowel disease (IBD on chromosomes 12 and 16. Importantly, these linkages have been replicated by independent investigators, and studies of positional candidates within these regions continue, together with fine mapping strategies. Regions of ’suggestive’ linkage on chromosomes 1, 3, 4, 6, 7, 10, 22 and X have also been reported in individual studies. Other important candidate genes investigated include the interleukin-1 receptor antagonist, MUC3 and genes of the human leukocyte antigen (HLA system. The apparently conflicting data in different studies from around the world may be explained by ethnic differences, case mix and genetic heterogeneity. Replicated class II HLA associations include HLA DRB1*0103 and DR2 (DRB1*1502, involved in UC susceptibility, and HLA DRB1*03 and DR4 as resistance alleles for CD and UC respectively. Animal studies have provided insights from targeted mutations and quantitative trait locus analysis. The goals of continuing research include narrowing the regions of linkages and analysis of candidate genes, and possibly the application of newly developed methods using single nucleotide polymorphisms. Advances in IBD genetics hold the potential to provide knowledge about the disease pathogenesis at the molecular level, with ensuing benefits for clinical practice.

  12. [Irritable bowel syndrome, celiac disease and gluten].

    Science.gov (United States)

    Mearin, Fermín; Montoro, Miguel

    2014-08-04

    For many years irritable bowel syndrome (IBS) and celiac disease (CD) have been considered 2 completely separate entities, with CD being clearly related to a permanent gluten intolerance and IBS having no relation with gluten ingestion. However IBS and CD symptoms may be indistinguishable, especially when diarrhea, bloating or abdominal pain predominate. In the last decade several studies have shown that the separation between CD and IBS is not so clear. Thus, some patients who have been diagnosed of IBS suffer in fact from CD. In addition, it seems that there is a group of patients who, without having CD, suffer gluten intolerance that cause them digestive symptoms similar to those of IBS. Gluten sensitivity is defined as the spectrum of morphological, immunological and functional abnormalities that respond to a gluten-free diet. This concept includes histological, immunological and clinical manifestations in the absence of evident morphological abnormalities. Therefore, it is mandatory to establish in a scientific way in which patients a gluten-free diet will be beneficial as well as when this is not justified. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  13. Preventing disability in inflammatory bowel disease.

    Science.gov (United States)

    Allen, Patrick B; Gower-Rousseau, Corinne; Danese, Silvio; Peyrin-Biroulet, Laurent

    2017-11-01

    Disability is a common worldwide health challenge and it has been increasing over the past 3 decades. The treatment paradigm has changed dramatically in inflammatory bowel diseases (IBDs) from control of symptoms towards full control of disease (clinical and endoscopic remission) with the goal of preventing organ damage and disability. These aims are broadly similar to rheumatoid arthritis and multiple sclerosis. Since the 1990s, our attention has focused on quality of life in IBD, which is a subjective measure. However, as an objective end-point in clinical trials and population studies, measures of disability in IBD have been proposed. Disability is defined as '…any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being.' Recently, after 10 years of an international collaborative effort with the World Health Organization (WHO), a disability index was developed and validated. This index ideally would assist with the assessment of disease progression in IBD. In this review, we will provide the evidence to support the use of disability in IBD patients, including experience from rheumatoid arthritis and multiple sclerosis. New treatment strategies, and validation studies that have underpinned the interest and quantification of disability in IBD, will be discussed.

  14. RECTAL ENDOSCOPIC ULTRASOUND FOR THE DIAGNOSTICS OF BOWEL ENDOMETRIOSIS

    Directory of Open Access Journals (Sweden)

    David Drobne

    2015-01-01

    Full Text Available Background: Deep infiltrating endometriosis (DIE affects rectosigmoid in up to one third of patients. In these cases bowel resection with end-to-end anastomosis is indicated. Our aim was to determine sensitivity, specificity, positive and negative predictive value and accuracy of rectal endoscopic ultrasound (REUS for preoperative assessment of bowel in patients with DIE. Methods: In this retrospective study we included 72 patients who underwent surgery for DIE between 2004 and 2010 in University Medical Centre Ljubljana, Slovenia and had REUS preoperatively. REUS findings were compared with intraoperative findings and in case of bowel resection also with patohistological findings.  Results: Bowel infiltration was found in 29/72 (40% of patients during surgery. Bowel resection was performed in 23 patients - in all cases patohistological examination confirmed endometriosis. REUS correctly confirmed or excluded endometriosis in 60/72 (83% of patients, in one patient (1,4% it was false positive and in 11 patients (15% it was false negative. Sensitivity and specificity of REUS were 62% and 98%, respectively. Coefficient Kappa between REUS and surgery was 0,63. Conclusions: REUS should be used during preoperative workup of patients with DIE as it can accurately diagnose bowel lesions in approximately 80% of patients. The positive result of REUS is very reliable (specificity 98%, however, negative result should be interpreted with caution due to limited sensitivity (62% of the examination. Indeed, REUS is false negative in approximately one third of patients. Therefore, additional preoperative examinations  should be performed in case of negative result of REUS when bowel endometriosis is suspected.

  15. Increased risk for irritable bowel syndrome after acute diverticulitis.

    Science.gov (United States)

    Cohen, Erica; Fuller, Garth; Bolus, Roger; Modi, Rusha; Vu, Michelle; Shahedi, Kamyar; Shah, Rena; Atia, Mary; Kurzbard, Nicole; Sheen, Victoria; Agarwal, Nikhil; Kaneshiro, Marc; Yen, Linnette; Hodgkins, Paul; Erder, M Haim; Spiegel, Brennan

    2013-12-01

    Individuals with diverticulosis frequently also have irritable bowel syndrome (IBS), but there are no longitudinal data to associate acute diverticulitis with subsequent IBS, functional bowel disorders, or related emotional distress. In patients with postinfectious IBS, gastrointestinal disorders cause long-term symptoms, so we investigated whether diverticulitis might lead to IBS. We compared the incidence of IBS and functional bowel and related affective disorders among patients with diverticulitis. We performed a retrospective study of patients followed up for an average of 6.3 years at a Veteran's Administration medical center. Patients with diverticulitis were identified based on International Classification of Diseases, 9th revision codes, selected for the analysis based on chart review (cases, n = 1102), and matched with patients without diverticulosis (controls, n = 1102). We excluded patients with prior IBS, functional bowel, or mood disorders. We then identified patients who were diagnosed with IBS or functional bowel disorders after the diverticulitis attack, and controls who developed these disorders during the study period. We also collected information on mood disorders, analyzed survival times, and calculated adjusted hazard ratios. Cases were 4.7-fold more likely to be diagnosed later with IBS (95% confidence interval [CI], 1.6-14.0; P = .006), 2.4-fold more likely to be diagnosed later with a functional bowel disorder (95% CI, 1.6-3.6; P diverticulitis could be at risk for later development of IBS and functional bowel disorders. We propose calling this disorder postdiverticulitis IBS. Diverticulitis appears to predispose patients to long-term gastrointestinal and emotional symptoms after resolution of inflammation; in this way, postdiverticulitis IBS is similar to postinfectious IBS. Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.

  16. [Articular and extraarticular involvement in inflammatory bowel diseases].

    Science.gov (United States)

    Nitsche, A; Tejeda, A; Gallo, J E; Chianello, M

    1993-01-01

    Idiopathic inflammatory bowel disease include basically two disorders: ulcerative colitis and Crohn's disease. Both diseases are chronic and of unknown etiology and extraintestinal manifestations are seen in a high number of these patients. We studied 18 patients (7 female, 11 male) with previous diagnosis of inflammatory bowel disease (14 ulcerative colitis, 2 Crohn's disease, 1 pancolitis, 1 ulcerative proctitis) in order to search for extraintestinal manifestations with emphasis on osteoarticular and ocular involvement. The mean age at the time of diagnosis of the inflammatory bowel disease was 44 years (range 20 to 71 years). Mean time duration of the inflammatory bowel disease was 7 years (range 1 to 24 years) and of the articular manifestations 3.2 years (range 1 to 8 years). The osteoarticular manifestations developed after the diagnosis of the bowel disease in all but one patient (simultaneously) 17/18 patients had artralgias, 7/18 lumbalgia, 3/18 talalgia, 1/18 knee arthritis. (table I) Only six of the 17 patients with orteoarticular involvement has simultaneous activity of the underlying bowel disease. All the 18 patients were taking 2 g/day of sulfasalazine. Radiographic screening in all patients revealed sacroiliitis in 10. (table II) Of the 10 radiographic sacroiliitis 4 were grade I (confirmed by technetium phosphate scans, 2 were grade II and 4 grade III-IV. Three of the ten patients with radiographic sacroiliitis were asymptomatic (table II). Axial computed tomography was performed done in two patients: a) in one case to exclude osteitis condensens ilii, and b) in the other case to exclude septic arthritis. The severity of the sacroiliac damage was related with a longer duration of the inflammatory bowel disease.(ABSTRACT TRUNCATED AT 250 WORDS)

  17. Predictive factors of small bowel patency in Crohn's disease patients

    Directory of Open Access Journals (Sweden)

    Andreia Albuquerque

    2016-02-01

    Full Text Available Background: Patency capsule was developed to avoid small bowel video capsule endoscopy retention, namely in patients with Crohn's disease. Aims: To evaluate the predictive factors of small bowel patency in Crohn's disease patients. Patients and methods: Retrospective analysis including 151 Crohn's disease patients submitted to patency capsule (Agile® Patency Capsule from 2011 to 2012. Patients that excreted the intact patency capsule were classified as having a patent small bowel (without patency capsule retention, other patients were considered to have negative patency of the small bowel (patency capsule retention. Results: Patients had a mean age of 41±14 years, 54% were female and 25% had been previously submitted to surgery. Stricturing disease was seen in 20% of cases and penetrating disease in 16% of cases. Left-sided colonic lesions and ileal strictures were observed at colonoscopy in 13% and 9% of patients, respectively. In our sample, 28% of patients had negative patency of the small bowel (patency capsule retention. In multivariate analysis, independent factors that were associated with negative patency of the small bowel in Crohn's disease patients were stricturing (OR 10.16, p < 0.001 and penetrating phenotypes (OR 11.73, p = 0.001, left-sided colonic lesions (OR 3.77, p = 0.038, ileal stricture (OR 9.76, p = 0.003; previous intestinal surgery was found to be protective (OR 0.16, p = 0.006. Conclusions: Stricturing or penetrating disease, ileal strictures, no previous surgery and left-sided colonic lesions were the factors associated with negative small bowel patency in Crohn's disease patients.

  18. Metabolic inflammation in inflammatory bowel disease: crosstalk between adipose tissue and bowel.

    Science.gov (United States)

    Gonçalves, Pedro; Magro, Fernando; Martel, Fátima

    2015-02-01

    Epidemiological studies show that both the incidence of inflammatory bowel disease (IBD) and the proportion of people with obesity and/or obesity-associated metabolic syndrome increased markedly in developed countries during the past half century. Obesity is also associated with the development of more active IBD and requirement for hospitalization and with a decrease in the time span between diagnosis and surgery. Patients with IBD, especially Crohn's disease, present fat-wrapping or "creeping fat," which corresponds to ectopic adipose tissue extending from the mesenteric attachment and covering the majority of the small and large intestinal surface. Mesenteric adipose tissue in patients with IBD presents several morphological and functional alterations, e.g., it is more infiltrated with immune cells such as macrophages and T cells. All these lines of evidence clearly show an association between obesity, adipose tissue, and functional bowel disorders. In this review, we will show that the mesenteric adipose tissue and creeping fat are not innocent by standers but actively contribute to the intestinal and systemic inflammatory responses in patients with IBD. More specifically, we will review evidence showing that adipose tissue in IBD is associated with major alterations in the secretion of cytokines and adipokines involved in inflammatory process, in adipose tissue mesenchymal stem cells and adipogenesis, and in the interaction between adipose tissue and other intestinal components (immune, lymphatic, neuroendocrine, and intestinal epithelial systems). Collectively, these studies underline the importance of adipose tissue for the identification of novel therapeutic approaches for IBD.

  19. Small Bowel Ultrasound beyond Inflammatory Bowel Disease: An Updated Review of the Recent Literature.

    Science.gov (United States)

    Cavalcoli, Federica; Zilli, Alessandra; Fraquelli, Mirella; Conte, Dario; Massironi, Sara

    2017-09-01

    The use of bowel ultrasonography (US) for the evaluation of gut diseases has increased in recent years and has been proven to provide a widely available, non-invasive and inexpensive method for the initial work-up and follow-up of different intestinal diseases, limited mostly by technical challenges posed by the patient's anatomy. The present review aims to provide an extensive overview of the main pathologic features at US examination of intestinal diseases other than inflammatory bowel disease, both acute (e.g., acute appendicitis, colonic diverticulitis, infectious diseases and ischemic conditions) and chronic (e.g., celiac disease, cystic fibrosis and other enterocolites). The identification of typical US features may help in the diagnostic process and guide the treatment approach. Therefore, the application of knowledge of the US appearance of gastrointestinal diseases is of relevance in enabling greater diagnostic performance and better patient management. Copyright © 2017 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  20. Low-FODMAP diet reduces irritable bowel symptoms in patients with inflammatory bowel disease.

    Science.gov (United States)

    Pedersen, Natalia; Ankersen, Dorit Vedel; Felding, Maria; Wachmann, Henrik; Végh, Zsuzsanna; Molzen, Line; Burisch, Johan; Andersen, Jens Rikardt; Munkholm, Pia

    2017-05-14

    To investigate the effect of a low-FODMAP diet on irritable bowel syndrome (IBS)-like symptoms in patients with inflammatory bowel disease (IBD). This was a randomised controlled open-label trial of patients with IBD in remission or with mild-to-moderate disease and coexisting IBS-like symptoms (Rome III) randomly assigned to a Low-FODMAP diet (LFD) or a normal diet (ND) for 6 wk between June 2012 and December 2013. Patients completed the IBS symptom severity system (IBS-SSS) and short IBD quality of life questionnaire (SIBDQ) at weeks 0 and 6. The primary end-point was response rates (at least 50-point reduction) in IBS-SSS at week 6 between groups; secondary end-point was the impact on quality of life. Eighty-nine patients, 67 (75%) women, median age 40, range 20-70 years were randomised: 44 to LFD group and 45 to ND, from which 78 patients completed the study period and were included in the final analysis (37 LFD and 41 ND). There was a significantly larger proportion of responders in the LFD group (n = 30, 81%) than in the ND group (n = 19, 46%); (OR = 5.30; 95%CI: 1.81-15.55, P FODMAP diet reduced IBS-like symptoms and increased quality of life in patients with IBD in remission.

  1. Visceral hypersensitivity in inflammatory bowel diseases and irritable bowel syndrome: The role of proteases.

    Science.gov (United States)

    Ceuleers, Hannah; Van Spaendonk, Hanne; Hanning, Nikita; Heirbaut, Jelena; Lambeir, Anne-Marie; Joossens, Jurgen; Augustyns, Koen; De Man, Joris G; De Meester, Ingrid; De Winter, Benedicte Y

    2016-12-21

    Proteases, enzymes catalyzing the hydrolysis of peptide bonds, are present at high concentrations in the gastrointestinal tract. Besides their well-known role in the digestive process, they also function as signaling molecules through the activation of protease-activated receptors (PARs). Based on their chemical mechanism for catalysis, proteases can be classified into several classes: serine, cysteine, aspartic, metallo- and threonine proteases represent the mammalian protease families. In particular, the class of serine proteases will play a significant role in this review. In the last decades, proteases have been suggested to play a key role in the pathogenesis of visceral hypersensitivity, which is a major factor contributing to abdominal pain in patients with inflammatory bowel diseases and/or irritable bowel syndrome. So far, only a few preclinical animal studies have investigated the effect of protease inhibitors specifically on visceral sensitivity while their effect on inflammation is described in more detail. In our accompanying review we describe their effect on gastrointestinal permeability. On account of their promising results in the field of visceral hypersensitivity, further research is warranted. The aim of this review is to give an overview on the concept of visceral hypersensitivity as well as on the physiological and pathophysiological functions of proteases herein.

  2. Risk of inflammatory bowel disease following a diagnosis of irritable bowel syndrome

    Directory of Open Access Journals (Sweden)

    Porter Chad K

    2012-05-01

    Full Text Available Abstract Background Irritable bowel syndrome (IBS and inflammatory bowel disease (IBD symptoms often overlap. In some IBS cases there are subtle inflammatory changes similar to the immune-mediated pathophysiology of IBD, and the risk of both increases after infectious gastroenteritis (IGE. Methods To evaluate the effect of IBS and IGE on IBD risk utilizing US Department of Defense medical encounter data, active duty personnel with IBS were matched to subjects without IBS. Medical encounter history was analyzed to assess for incident IBD. IGE was identified from documented medical encounters and by self-report. Relative risks were calculated using Poisson regression models. Results We identified 9,341 incident IBS cases and 18,678 matched non-IBS subjects and found an 8.6-fold higher incidence (p p  Conclusions These data reflect a complex interaction between illness presentation and diagnosis of IBS and IBD and suggest intercurrent IGE may increase IBD risk in IBS patients. Additional studies are needed to determine whether IBS lies on the causal pathway for IBD or whether the two are on a pathophysiological spectrum of the same clinical illness. These data suggest consideration of risk reduction interventions for IGE among IBS patients at high disease risk.

  3. Probiotics in the management of irritable bowel syndrome and inflammatory bowel disease.

    Science.gov (United States)

    Whelan, Kevin; Quigley, Eamonn M M

    2013-03-01

    There is direct evidence that the pathogenesis of inflammatory bowel disease (IBD) involves the gastrointestinal microbiota and some evidence that the microbiota might also play a similar role in irritable bowel syndrome (IBS). The aim of this article is to review the emerging evidence for the mechanisms and effectiveness of probiotics in the management of these disorders. The composition of the gastrointestinal microbiota is strongly influenced by factors including age, diet and disease. Probiotics may be effective through their impact on the host gastrointestinal microbiota and promotion of mucosal immunoregulation. Probiotics are considered to be well tolerated, although the quality of studies and health claims has been variable. There are many short-term studies demonstrating the effectiveness of probiotics in IBS, although recommendations should be made for specific strains and for specific symptoms. Within IBD, a number of trials have shown the benefits of a range of probiotics in pouchitis and in ulcerative colitis, although current evidence in Crohn's disease is less promising. Clearly, some probiotics have considerable potential in the management of IBS and IBD; however, the benefits are strain specific. High-quality trials of probiotics in gastrointestinal disorders as well as laboratory investigations of their mechanism of action are required in order to understand who responds and why.

  4. Diagnostic approach to small bowel involvement in inflammatory bowel disease: view of the endoscopist.

    Science.gov (United States)

    Papadakis, Konstantinos A

    2009-01-01

    Recent advances in endoscopic small bowel (SB) techniques have revolutionalized the diagnostic approach of patients with suspected or known inflammatory bowel disease (IBD). Wireless capsule endoscopy (WCE) has become an important diagnostic tool for the evaluation of suspected CD of the SB or in patients with known IBD to rule out SB involvement. The greatest utility of WCE has been observed in cases of suspected CD, where the initial evaluation with traditional radiographic and endoscopic studies has failed to establish the diagnosis. WCE can detect early SB lesions that can be overlooked by traditional radiological studies. The sensitivity of diagnosing SB CD by WCE is superior to other endoscopic or radiological methods such as push enteroscopy, computed tomography or magnetic resonance enteroclysis. The utility of WCE in patients with known CD, IBD unclassified (IBDU) and a select group of patients with ulcerative colitis (UC) can better define the diagnosis and extent of the disease and may lead to reclassification of IBD from UC/IBDU to definitive CD. In addition, previously diagnosed patients with CD may be found to have more significant disease burden in the SB. This information may facilitate more targeted and effective therapies and potentially lead to better patient outcomes. A disadvantage of WCE is its low specificity and the risk of being retained in a strictured area of the SB. Balloon-assisted enteroscopy has essentially replaced push enteroscopy, and has been used to treat CD strictures, obtain biopsies from areas of SB involvement and even retrieving a retained capsule.

  5. Review article: intestinal serotonin signalling in irritable bowel syndrome.

    Science.gov (United States)

    Mawe, G M; Coates, M D; Moses, P L

    2006-04-15

    Alterations in motility, secretion and visceral sensation are hallmarks of irritable bowel syndrome. As all of these aspects of gastrointestinal function involve serotonin signalling between enterochromaffin cells and sensory nerve fibres in the mucosal layer of the gut, potential alterations in mucosal serotonin signalling have been explored as a possible mechanism of altered function and sensation in irritable bowel syndrome. Literature related to intestinal serotonin signalling in normal and pathophysiological conditions has been searched and summarized. Elements of serotonin signalling that are altered in irritable bowel syndrome include: enterochromaffin cell numbers, serotonin content, tryptophan hydroxylase message levels, 5-hydroxyindoleacedic acid levels, serum serotonin levels and expression of the serotonin-selective reuptake transporter. Both genetic and epigenetic factors could contribute to decreased serotonin-selective reuptake transporter in irritable bowel syndrome. A serotonin-selective reuptake transporter gene promoter polymorphism may cause a genetic predisposition, and inflammatory mediators can induce serotonin-selective reuptake transporter downregulation. While a psychiatric co-morbidity exists with IBS, changes in mucosal serotonin handling support the concept that there is a gastrointestinal component to the aetiology of irritable bowel syndrome. Additional studies will be required to gain a more complete understanding of changes in serotonin signalling that are occurring, their cause and effect relationship, and which of these changes have pathophysiological consequences.

  6. Irritable bowel syndrome: the burden and unmet needs in Europe.

    LENUS (Irish Health Repository)

    Quigley, E M M

    2012-02-03

    Irritable bowel syndrome affects approximately 10-15% of the European population, although prevalence rates vary depending on the classification used and the country surveyed. This may be due to differences in patterns of medical care and diagnosis of the condition. Up to 70% of individuals with irritable bowel syndrome may not have been formally diagnosed. The disorder affects 1.5-3 times as many women as men and poses a significant economic burden in Europe, estimated at euro 700-euro 1600 per person per year. It also reduces quality of life and is associated with psychological distress, disturbed work and sleep, and sexual dysfunction. It is a chronic disorder, which affects many individuals for more than 10 years. Most patients are managed in primary care, although some are referred to gastroenterologists and other specialists. Patients with irritable bowel syndrome undergo more abdomino-pelvic surgery than the general population. We propose that a positive diagnosis of the condition may avoid the delay in diagnosis many patients experience. We conclude that, in Europe, there are significant unmet needs including lack of familiarity with irritable bowel syndrome, difficulties in diagnosis and lack of effective treatments for the multiple symptoms of the disorder. The development of pan-European guidelines for irritable bowel syndrome will benefit patients with this condition in Europe.

  7. [Obstetrical and gynecological relevance of inflammatory bowel disease].

    Science.gov (United States)

    Kálmán, Judit; Bajor, Judit; Gáll, János; Harsányi, László; Horváth, Henrik Csaba; Kerékgyártó, Olga; László, Adám; Novák, János; Salamon, Agnes; Wacha, Judit

    2012-11-18

    Inflammatory bowel disease may show a life long persistence, while female fertility is time-limited. The aim of the authors was to obtain more knowledge about the obstetrical-gynecological aspects of this disorder. The authors evaluated 100 patients with inflammatory bowel disease and 100 healthy women with a self-composed questionnaire. Menarche occurred significantly earlier in patients than in controls (p = 0,03). Either the activity of the disease, or the therapy itself may initiate irregularities in the menstrual cycle. Patients used contraceptives less frequently than controls (p = 0,002), and the time from family-planning to conception was longer in patients. Symptoms of bowel disease during pregnancy were not as severe as before and after pregnancy (ppregnancy (p = 0,042) and on the frequency of complications. Preterm birth and low birth weight were more frequent in newborns of patients (p = 0,019). Pregnancy has positive effect on the symptoms of inflammatory bowel disease in case gestation occurs in a stable period of the inflammatory bowel disease.

  8. Relationship between symptoms and hypersensitivity to rectal distension in patients with irritable bowel syndrome

    NARCIS (Netherlands)

    Kuiken, S. D.; Lindeboom, R.; Tytgat, G. N.; Boeckxstaens, G. E.

    2005-01-01

    Visceral hypersensitivity is considered an important pathophysiological mechanism in irritable bowel syndrome, yet its relationship to symptoms is unclear. Aim: To detect possible associations between symptoms and the presence of hypersensitivity to rectal distension in patients with irritable bowel

  9. What People with Inflammatory Bowel Disease Need to Know about Osteoporosis

    Science.gov (United States)

    ... With Inflammatory Bowel Disease Need to Know About Osteoporosis What Is Inflammatory Bowel Disease? Crohn’s disease and ... Management Strategies Resources For Your Information What Is Osteoporosis? Osteoporosis is a condition in which the bones ...

  10. Diagnosis of strangulated small bowel obstruction; Efficacy of enhanced CT scanning

    Energy Technology Data Exchange (ETDEWEB)

    Mukai, Masaya; Noto, Takashi; Iwata, Yoshio (Tokai Univ., Isehara, Kanagawa (Japan). School of Medicine) (and others)

    1992-01-01

    We have experienced 25 cases of strangulated small bowel obstruction with bowel resection in the past 10 years. According to the histological findings in the resected bowel, these cases were divided into a necrotic group and a non-necrotic group. Preoperative findings on the clinical course and hematobiochemical examination in these two groups were compared, but no significant examination in these two groups were compared, but no significant differences were found. The results of enhanced CT scanning in these two groups were analyzed and some characteristic findings were seen in the necrotic group. Gasless small bowel, disappearance of the Kerckring's folds and increased mesenteric density were special features in the necrotic cases. Blurred enhancement of the small bowel wall and increased density of the bowel contents indicating bleeding were observed in the more severe cases. Enhanced CT scanning is very useful for diagnosing strangulated small bowel obstruction and should be used in cases of suspected necrotic bowel. (author).

  11. Bowel cancer screening: how to take the test (English and 10 translations)

    OpenAIRE

    Public Health Agency

    2010-01-01

    Format: 6 page A5 leaflet Target group: Prospective participants in the Northern Ireland Bowel cancer screening programme Description: This leaflet provides step by step instructions on using the Faecal Occult Blood test (FOBt) for bowel cancer screening.

  12. Biologic therapies for chronic inflammatory bowel disease

    Directory of Open Access Journals (Sweden)

    M. P. Martínez-Montiel

    Full Text Available Crohn's disease (CD and ulcerative colitis (UC make up the so-called chronic inflammatory bowel disease (IBD. Advances in the understanding of IBD pathophysiologic mechanisms in the last few years have allowed the development of novel therapies such as biologic therapies, which at least theoretically represent a more specific management of this disease with fewer side effects. Currently, the only effective and widely accepted biologic therapy for the treatment of intraluminal, fistulizing CD, both for remission induction and maintenance, is infliximab. The role of other monoclonal antibodies such as adalimumab is not clearly established. It could be deemed an alternative for patients with allergic reactions to infliximab, and for those with lost response because of anti-infliximab antibody development. However, relevant issues such as dosage and administration regimen remain to be established. Anti-integrin α4 therapies, despite encouraging results in phase-3 studies, are still unavailable, as their marketing authorization was held back in view of a number of reports regarding progressive multifocal leukoencephalopathy cases. Immunostimulating therapy may be highly relevant in the near future, as it represents a novel strategy against disease with the inclusion of granulocyte-monocyte colony-stimulating factors. Regarding ulcerative colitis, results from the ACT-1 and ACT-2 studies showed that infliximab is also useful for the management of serious UC flare-ups not responding to standard treatment, which will lead to a revision of therapeutic algorithms, where this drug should be given preference before intravenous cyclosporine. In the next few years, the role of anti-CD3 drugs (vilisilizumab, T-cell inhibiting therapies, and epithelial repair and healing stimulating factors will be established.

  13. The Mexican consensus on irritable bowel syndrome.

    Science.gov (United States)

    Carmona-Sánchez, R; Icaza-Chávez, M E; Bielsa-Fernández, M V; Gómez-Escudero, O; Bosques-Padilla, F; Coss-Adame, E; Esquivel-Ayanegui, F; Flores-Rendón, Á R; González-Martínez, M A; Huerta-Iga, F; López-Colombo, A; Méndez-Gutiérrez, T H; Noble-Lugo, A; Nogueira-de Rojas, J R; Raña-Garibay, R H; Remes-Troche, J M; Roesch-Dietlen, F; Schmulson, M J; Soto-Pérez, J C; Tamayo, J L; Uscanga, L F; Valdovinos, M Á; Valerio-Ureña, J; Zavala-Solares, M R

    2016-01-01

    Since the publication in 2009 of the Guidelines on the Diagnosis and Treatment of Irritable Bowel Syndrome of the Asociación Mexicana de Gastroenterología (2009 Guidelines), there have been significant advances in our knowledge of the epidemiology, pathophysiology, diagnosis, and treatment of this disease. To present a consensus review of the most current knowledge of IBS, updating the 2009 Guidelines by incorporating new internationally published scientific evidence, with a special interest in Mexican studies. The PubMed literature from January 2009 to March 2015 was reviewed and complemented through a manual search. Articles in English and Spanish were included and preference was given to consensuses, guidelines, systematic reviews, and meta-analyses. Statements referring to the different aspects of the disease were formulated and voted upon by 24 gastroenterologists employing the Delphi method. Once a consensus on each statement was reached, the quality of evidence and strength of recommendation were determined through the GRADE system. Forty-eight statements were formulated, updating the information on IBS and adding the complementary data that did not appear in the 2009 Guidelines regarding the importance of exercise and diet, diagnostic strategies, and current therapy alternatives that were analyzed with more stringent scientific vigor or that emerged within the last 5 years. We present herein a consensus review of the most relevant advances in the study of IBS, updating and complementing the 2009 Guidelines. Several studies conducted in Mexico were included. Copyright © 2016 Asociación Mexicana de Gastroenterología. Publicado por Masson Doyma México S.A. All rights reserved.

  14. Fecal Microbiota Transplantation in Inflammatory Bowel Disease.

    Science.gov (United States)

    Reinisch, Walter

    2017-01-01

    The etiology of inflammatory bowel disease (IBD) is unknown, but it is thought to arise from an aberrant immune response to a change in colonic environment in a genetically susceptible individual. The intestinal microbiota are located at the complex interface of the epithelial barrier and are sensitive to changes in environmental factors, such as diets, drugs or smoking and signals derived from the intestinal immune system and the gut-brain axis. In patients with IBD, an imbalance in the structural and/or functional configuration of the intestinal microbiota leading to the disruption of the host-microorganism homeostasis (dysbiosis) has been reproducibly reported. As animal models of IBD require gut bacteria to induce inflammation, it is hypothesized that the dysbiosis observed in patients is not only a surrogate of changes at the intestinal barrier but also a potential cause or at least enhancer of the mucosal inflammatory process. That burgeoning notion has stimulated thoughts to modify the intestinal microbiota and rekindled interest in previous work on the efficacy of antibiotics in patients with IBD. The feasibility and tremendous success of fecal microbiota transplantation (FMT) to treat antibiotic resistant Clostridium difficile has finally paved the way to embark into the unchartered territory of IBD using FMT. Different routes and number of administrations, choices of donors, disease status and permitted therapies might have contributed to mixed results, particularly from the so far published randomized controlled trials. However, microbiome analysis suggests that a durable transplantation of donor bacteria to the host appears feasible and might be associated with a higher likelihood of response. On the other hand, this raises the concern of transplanting not only anti-inflammatory active bacteria and their products, but also not-yet-known dispositions for other diseases including cancer. Attempts are being made to better characterize those components of

  15. Nutrigenomics and nutrigenetics in inflammatory bowel diseases.

    Science.gov (United States)

    Gruber, Lisa; Lichti, Pia; Rath, Eva; Haller, Dirk

    2012-10-01

    Inflammatory bowel diseases (IBD) including ulcerative colitis and Crohn's disease are chronically relapsing, immune-mediated disorders of the gastrointestinal tract. A major challenge in the treatment of IBD is the heterogenous nature of these pathologies. Both, ulcerative colitis and Crohn's disease are of multifactorial etiology and feature a complex interaction of host genetic susceptibility and environmental factors such as diet and gut microbiota. Genome-wide association studies identified disease-relevant single-nucleotide polymorphisms in approximately 100 genes, but at the same time twin studies also clearly indicated a strong environmental impact in disease development. However, attempts to link dietary factors to the risk of developing IBD, based on epidemiological observations showed controversial outcomes. Yet, emerging high-throughput technologies implying complete biological systems might allow taking nutrient-gene interactions into account for a better classification of patient subsets in the future. In this context, 2 new scientific fields, "nutrigenetics" and "nutrigenomics" have been established. "Nutrigenetics," studying the effect of genetic variations on nutrient-gene interactions and "Nutrigenomics," describing the impact of nutrition on physiology and health status on the level of gene transcription, protein expression, and metabolism. It is hoped that the integration of both research areas will promote the understanding of the complex gene-environment interaction in IBD etiology and in the long-term will lead to personalized nutrition for disease prevention and treatment. This review briefly summarizes data on the impact of nutrients on intestinal inflammation, highlights nutrient-gene interactions, and addresses the potential of applying "omic" technologies in the context of IBD.

  16. Evolution of osteopenia in inflammatory bowel disease.

    Science.gov (United States)

    Dinca, M; Fries, W; Luisetto, G; Peccolo, F; Bottega, F; Leone, L; Naccarato, R; Martin, A

    1999-05-01

    Our aim was the assessment of frequency and evolution of osteopenia in patients with inflammatory bowel disease and identification of related factors. Bone mineral density (BMD) of the lumbar spine was measured in 54 patients with Crohn's disease (CD) and in 49 patients with ulcerative colitis (UC) and was repeated after a mean observation period of 21 (range, 8-50) months in 30 CD and 14 UC patients. Eighteen age-matched healthy subjects served as controls. Serum biochemistry (parathyroid hormone, osteocalcin, alkaline phosphatase, insulin-like growth factor 1, minerals, and markers of inflammation) was assessed at the time of the second BMD measurement. Reduced BMD values were found in 48% of CD, and in 38% of UC patients. Compared with control subjects, the mean BMD was significantly lower in CD (p < 0.003) and UC (p < 0.0001) patients. BMD was positively correlated with the body mass index (p < 0.05) and inversely correlated with the lifetime steroid dose (p < 0.03). After 21 months the BMD of CD patients was virtually unchanged, with an annual variation (%deltaBMD/yr) of -0.31 +/- 0.49, whether treated with steroids or not, whereas in UC patients the BMD decreased significantly (p < 0.02) with a %deltaBMD/yr of -2.47 +/- 0.82 (p < 0.02 vis CD). This decrease can be attributed to steroid treatment. No biochemical alterations were detected in patients with rapid bone loss, compared with those with stable BMD. Low bone density is frequent in both CD and UC, but apparently stable in CD. The evolution of BMD suggests that low bone density is associated with the pathogenesis of CD, whereas in UC it seems to be correlated with the side effects of corticosteroid treatment.

  17. Inflammatory Bowel Disease: Genetics, Epigenetics and Pathogenesis

    Directory of Open Access Journals (Sweden)

    Italia eLoddo

    2015-11-01

    Full Text Available Inflammatory Bowel Diseases (IBDs are complex, multifactorial disorders characterized by chronic relapsing intestinal inflammation. Although aetiology remains largely unknown, recent research has suggested that genetic factors, environment, microbiota and immune response are involved in the pathogenesis.Epidemiological evidence for a genetic contribution is defined: 15% of patients with Crohn’s Disease (CD have an affected family member with IBD, and twin studies for CD have shown 50% concordance in monozygotic twins compared to less than 10% in dizygotics. The most recent and largest genetic association studies, which employed genome-wide association data for over 75,000 patients and controls, identified 163 susceptibility loci for IBD. More recently, a trans-ethnic analysis, including over 20,000 individuals, identified an additional 38 new IBD loci.Although most cases are correlated with polygenic contribution toward genetic susceptibility, there is a spectrum of rare genetic disorders that can contribute to early onset IBD (before 5 years or very early IBD (before 2 years. Genetic variants that cause these disorders have a wide effect on gene function. These variants are so rare in allele frequency that the genetic signals are not detected in genome-wide association studies of patients with IBD. With recent advances in sequencing techniques, approximately 50 genetic disorders have been identified and associated with IBD-like immunopathology. Monogenic defects have been found to alter intestinal immune homeostasis through many mechanisms. Candidate gene resequencing should be carried out in early-onset patients in clinical practice.The evidence that genetic factors contribute in small part to disease pathogenesis confirms the important role of microbial and environmental factors. Epigenetic factors can mediate interactions between environment and genome. Epigenetic mechanisms could affect development and progression of IBD. Epigenomics is

  18. Role of alimentation in irritable bowel syndrome.

    Science.gov (United States)

    Dapoigny, M; Stockbrügger, R W; Azpiroz, F; Collins, S; Coremans, G; Müller-Lissner, S; Oberndorff, A; Pace, F; Smout, A; Vatn, M; Whorwell, P

    2003-01-01

    Different food items are made responsible for irritable bowel syndrome (IBS) symptoms, but the physiopathology of IBS remains unclear. During a meeting in Nice, France, experts of the European Working Team of the IBiS Club discussed selected data regarding the relationships between alimentation, food items (including fibers) and IBS symptoms. Food allergy remains a difficult diagnosis, but medical and general history, presence of general symptoms such as skin rash, and hypersensitivity tests may help in achieving a positive diagnosis. On the other hand, food intolerance is more confusing because of the subjectivity of the relationship between ingestion of certain foods and the appearance of clinical symptoms. Different food items which are commonly implicated in adverse reactions mimicking IBS were found to be stimulants for the gut, suggesting that patients with predominant diarrhea IBS have to be carefully questioned about consumption of different kinds of food (i.e., coffee, alcohol, chewing gum, soft drinks) and not only on lactose ingestion. Gas production is discussed on the basis of retention of intestinal gas as well as on malabsorption of fermentable substrates. The role of a large amount of this kind of substrate reaching the colon is suggested as a potential mechanism of IBS-type symptoms in overeating patients. Regarding the role of fiber in IBS, the expert group concluded that fibers are not inert substances and that they could trigger pain or bloating in some IBS patients. Despite numerous reviews on this subject, it is very difficult to give general dietary advice to IBS patients, but dieteticians may have a positive role in managing such patients. Copyright 2003 S. Karger AG, Basel

  19. Laparoscopic Surgery is Useful for Preventing Recurrence of Small Bowel Obstruction After Surgery for Postoperative Small Bowel Obstruction.

    Science.gov (United States)

    Nakamura, Takatoshi; Sato, Takeo; Naito, Masanori; Ogura, Naoto; Yamanashi, Takahiro; Miura, Hirohisa; Tsutsui, Atsuko; Yamashita, Keishi; Watanabe, Masahiko

    2016-02-01

    Risk factors for recurrence postoperative small bowel obstruction in patients who have postoperative abdominal surgery remain unclear. The study group comprised 123 patients who underwent surgery for ileus that developed after abdominal surgery from 1999 through 2013. There were 58 men (47%) and 65 women (53%), with a mean age of 63 years (range, 17 to 92 y). The following surgical procedures were performed: lower gastrointestinal surgery in 47 patients (39%), gynecologic surgery in 39 (32%), upper gastrointestinal surgery in 15 (12%), appendectomy in 9 (7%), cholecystectomy in 5 (4%), urologic surgery in 5 (4%), and repair of injuries caused by traffic accidents in 3 (2%). Laparoscopic surgery was performed in 75 patients (61%), and open surgery was done in 48 (39%). We examined the following 11 potential risk factors for recurrence of small bowel obstruction after surgery for ileus: sex, age, body mass index, the number of episodes of ileus, the number of previously performed operations, the presence or absence of radiotherapy, the previously used surgical technique, the current surgical technique (laparoscopic surgery, open surgery), operation time, bleeding volume, and the presence or absence of enterectomy. The median follow-up was 57 months (range, 7 to 185 mo). Laparoscopic surgery was switched to open surgery in 11 patients (18%). The reason for surgery for postoperative small bowel obstruction was adhesion to the midline incision in 36 patients (29%), band formation in 30 (24%), intrapelvic adhesion in 23 (19%), internal hernia in 13 (11%), small bowel adhesion in 20 (16%), and others in 1 (1%). Postoperative complications developed in 35 patients (28%): wound infection in 12 (10%), recurrence of postoperative small bowel obstruction in 12 (10%), paralytic ileus in 4 (3%), intra-abdominal abscess in 3 (2%), suture failure in 1 (1%), anastomotic bleeding in 1 (1%), enteritis in 1 (1%), and dysuria in 1 (1%). Enterectomy was performed in 42 patients (38

  20. Alosetron relieves pain and improves bowel function compared with mebeverine in female nonconstipated irritable bowel syndrome patients.

    Science.gov (United States)

    Jones, R H; Holtmann, G; Rodrigo, L; Ehsanullah, R S; Crompton, P M; Jacques, L A; Mills, J G

    1999-11-01

    Irritable bowel syndrome is one of the most common gastrointestinal disorders, yet no therapy convincingly controls the multiple symptoms of this syndrome. To compare the efficacy and tolerability of the new 5-HT3-receptor antagonist alosetron and the smooth muscle relaxant mebeverine in a double-blind, multicentre, randomized trial. Six hundred and twenty-three nonconstipated females with irritable bowel syndrome were randomized to receive alosetron 1 mg twice daily (n=319) or mebeverine 135 mg three times daily (n=304) for 12 weeks, followed by a 4-week post-treatment period. The primary efficacy end-point was monthly responders for adequate relief of irritable bowel syndrome related abdominal pain and discomfort (defined as patients reporting adequate relief on at least 2 out of 4 weeks). Secondary end-points included assessments of bowel function, including urgency, stool frequency and stool consistency. There were significantly more responders in the alosetron group compared with mebeverine at months 2 and 3 (P mebeverine, the alosetron group experienced significant decreases in proportion of days with urgency and mean stool frequency, and had firmer stools within 1 week of starting treatment. A similar proportion of patients reported adverse events in the two treatment groups. In nonconstipated female irritable bowel syndrome patients, alosetron is significantly more effective than mebeverine in improving symptoms.

  1. Palliative management of malignant bowel obstruction in terminally Ill patient

    Directory of Open Access Journals (Sweden)

    Darshit A Thaker

    2010-01-01

    Full Text Available Mr. P was a 57-year-old man who presented with symptoms of bowel obstruction in the setting of a known metastatic pancreatic cancer. Diagnosis of malignant bowel obstruction was made clinically and radiologically and he was treated conservatively (non-operativelywith octreotide, metoclopromide and dexamethasone, which provided good control over symptoms and allowed him to have quality time with family until he died few weeks later with liver failure. Bowel obstruction in patients with abdominal malignancy requires careful assessment. The patient and family should always be involved in decision making. The ultimate goals of palliative care (symptom management, quality of life and dignity of death should never be forgotten during decision making for any patient.

  2. MR enterography in the evaluation of small bowel dilation

    Energy Technology Data Exchange (ETDEWEB)

    Cronin, C.G. [Department of Radiology, University College Hospital, Galway (Ireland)], E-mail: carmelcronin2000@hotmail.com; Lohan, D.G.; Browne, A.M.; Alhajeri, A.N.; Roche, C.; Murphy, J.M. [Department of Radiology, University College Hospital, Galway (Ireland)

    2009-10-15

    Magnetic reasonance (MR) enterography enables high contrast resolution depiction of the location and cause of bowel obstruction through a combination of predictable luminal distension and multiplanar imaging capabilities. Furthermore, because the patient is not exposed to ionizing radiation, sequential 'dynamic' MR imaging can be performed repeatedly over time further facilitating depiction of the site and/or the cause of obstruction. With increasing availability of MR imaging and standardization of the oral contrast medium regimens, it is likely that this technique will assume an ever-increasing role in the evaluation of small bowel dilation in the coming years. We illustrate the utility of MR enterography in the evaluation of small bowel dilation, whether it be mechanical, functional (e.g., ileus), or related to infiltrative mural disease.

  3. Reproductive Planning and Contraception for Women with Inflammatory Bowel Diseases.

    Science.gov (United States)

    Gawron, Lori M; Sanders, Jessica; Steele, Katelyn P; Flynn, Ann D

    2016-02-01

    Women with chronic medical conditions, such as inflammatory bowel diseases, are at increased risk for adverse pregnancy outcomes. Pregnancy outcomes for these conditions are best during stable disease remission. Unfortunately, women with inflammatory bowel disease are equally as likely as the general population to have unintended pregnancies. Patients look to their gastroenterologist for contraceptive counseling; however, the current standards for disease management do not prioritize this topic. Guidelines based on available evidence and expert opinion, such as the Centers for Disease Control U.S. Medical Eligibility Criteria for Contraceptive Use, exist to help practitioners provide safe and effective contraception to women with chronic medical conditions. If health care providers were to educate themselves and screen women with inflammatory bowel disease for risk of unintended pregnancy, there would be a reduction in the number of unintended pregnancies and subsequent adverse neonatal and maternal outcomes.

  4. Giant mesenteric lymphatic malformation presenting as small bowel volvulus.

    Science.gov (United States)

    Cauley, Christy E; Spencer, Philip J; Sagar, Pallavi; Goldstein, Allan M

    2013-09-20

    Abdominal pain with bilious emesis is an ominous clinical presentation with many possible causes. We describe a previously healthy 4-year-old boy who presented with these symptoms and ultrasound findings of fluid throughout most of the abdominal cavity. Computed tomography imaging revealed a large cystic mass (21-by-13 cm) associated with a small bowel obstruction due to volvulus. A laparoscopic exploration was undertaken, revealing a large mass arising from the small intestinal mesentery and causing a segmental volvulus of the small bowel. Conversion to mini-laparotomy allowed reduction of the volvulus and segmental resection of the small bowel associated with a giant mesenteric lymphatic malformation. This case describes a rare cause of intestinal volvulus due to a mesenteric lymphatic malformation. Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author 2013.

  5. Merkel cell carcinoma metastatic to the small bowel mesentery

    Directory of Open Access Journals (Sweden)

    Guang-Yu Yang

    2011-03-01

    Full Text Available Merkel cell carcinoma (MCC is an uncommon cutaneous malignant tumor that presents as a rapidly growing skin nodule on sun-exposed areas of the body. MCC is aggressive with regional nodal and distant metastases to the skin, lung, and bones. There have been no reports of metastatic MCC to the mesentery and 6 reports describing metastasis to the small intestine. We present a case of metastatic MCC to the mesentery with infiltration to the small bowel, 8 years after original tumor resection. This is the 5th metastasis and it encased the small bowel resulting in a hair-pin loop contributing to the unusual clinical presentation. Although MCC metastatic to the bowel is uncommon, it is not rare. It is important to recognize the unusual manifestations of this disease as they are becoming more common in the future. Routine radiologic surveillance and thorough review of systems are important to patient follow-up.

  6. Diagnosis of Irritable Bowel Syndrome: Role of Potential Biomarkers

    Directory of Open Access Journals (Sweden)

    Ivana Plavšić

    2015-01-01

    Full Text Available Irritable bowel syndrome is a disorder diagnosed on symptom-based criteria without inclusion of any objective parameter measurable by known diagnostic methods. Heterogeneity of the disorder and overlapping with more serious organic diseases increase uncertainty for the physician’s work and increase the cost of confirming the diagnosis. This paper is an attempt to summarize the efforts to find adequate biomarkers for irritable bowel syndrome, which should shorten the time to diagnosis and reduce the cost. Most of the reviewed papers were observational studies from secondary care institutions. Since publication of the Rome III criteria in 2006, most recent studies use these for the recruitment of IBS patients. This is a positive step forward as future studies should use the same criteria, facilitating comparison of their results. Among the studied biomarkers, most evidence is provided for fecal calprotectin. Cutoff values for fecal calprotectin have still to be investigated prior to inclusion in the irritable bowel syndrome diagnostic algorithm.

  7. Psychological characteristics of patients with functional and inflammatory bowel disorders

    Directory of Open Access Journals (Sweden)

    Kozlova I.V.

    2014-03-01

    Full Text Available Objective: to study the psychological characteristics of patients with irritable bowel syndrome (IBS, ulcerative colitis (UC, Crohn's disease (CD. Material and methods. The study group included 98 patients with IBD (inflammatory bowel disease and IBS, the control group included 30 healthy individuals. Set of psychological tests included questionnaire (multifactorial systemic examination of the person, the Luscher color test, Beck Depression Inventory, a test on health, activity, mood. Results. Premorbid personality traits, communication disorders with stress have been revieled. According to the nosology different types of emotional response to the disease, changes in health and activity have been marked. There is a high level of frustration needs, increased frequency of anxiety and depression in all patients. Conclusion. Psychological mechanisms of pathology are similar in functional and organic bowel diseases with the greatest influence on the course of functional disorders.

  8. Transanal irrigation for the treatment of neuropathic bowel dysfunction.

    Science.gov (United States)

    López Pereira, Pedro; Salvador, Obdulia Perez; Arcas, Julia Alonso; Martínez Urrutia, M A Jose; Romera, Roberto Lobato; Monereo, Enrique Jaureguízar

    2010-04-01

    Children with spinal cord lesions very often experience bowel dysfunction, with a significant impact on their social activities and quality of life. Our aim was to evaluate the efficacy of the Peristeen transanal irrigation (TI) system in patients with neuropathic bowel dysfunction (NBD). We prospectively reviewed 40 children with spina bifida and NBD who did not respond satisfactorily to conventional bowel management and were treated with the Peristeen TI system. Dysfunctional bowel symptoms, patient opinion and level of satisfaction were analysed before and during TI treatment using a specific questionnaire. Thirty-five children completed the study. Mean patient age and follow up were 12.5 years (6-25) and 12 months (4-18), respectively. Average irrigation frequency and instillation volume were once every 3 days and 616ml (200-1000), respectively. Bowel dysfunction symptoms including faecal incontinence improved significantly in all children. Patient opinion of intestinal functionality improved from 2.3±1.4 to 8.2±1.5 (P<0.0001) and mean grade of satisfaction with the Peristeen system was 7.3. Patient independence also improved from 28 to 46% and no adverse events were recorded. TI should be used as a first therapeutic approach in those children with NBD who do not respond to conservative or medical bowel management before other more invasive treatment modalities are considered. The Peristeen system is as effective as other TI methods, but it is easy to learn, safe and increases the patient's independence. Copyright © 2009 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  9. Outcomes after laparoscopic surgery in children with inflammatory bowel disease.

    Science.gov (United States)

    Diamond, Ivan R; Gerstle, J Ted; Kim, Peter C W; Langer, Jacob C

    2010-11-01

    The utility and efficacy of the laparoscopic approach to the management of inflammatory bowel disease (IBD) in children are not clearly known. We conducted a retrospective descriptive cohort study of children with a diagnosis of IBD who underwent a laparoscopic or laparoscopy-assisted procedure at a quaternary pediatric referral center between 1999 and 2007. One-hundred thirty-six children underwent 154 operations (85 small bowel/ileocolic and 69 colorectal) over the 8 years of the study. Median age was 14.8 years (range = 1.8-18.8). The diagnosis was Crohn's disease in 83, ulcerative colitis in 50, and indeterminate colitis in 3. Median time to regular diet was 5 days (range = 1-19), and median postoperative stay was 7 days (range = 1-70). Seven patients undergoing a small bowel/ileocolic resection (8.2%) were converted to an open procedure. Overall morbidity for the small bowel/ileocolic procedures was 27.1%. The conversion rate during subtotal colectomy (STC) was 7.1% (3/42), and it was 0% for the 22 patients who underwent ileal pouch-anal anastomosis (IPAA) procedures. Overall morbidity associated with STC was 62.8%, and following IPAA it was 63.6%. Sixteen percent (7/69) of those who underwent a colorectal procedure developed a late postoperative bowel obstruction with three patients requiring operative intervention. A laparoscopic approach is feasible with a low conversion rate in most children with IBD. Despite superior cosmesis, perioperative morbidity is similar to that seen with open procedures. Laparoscopic colorectal IBD procedures are associated with an unexpectedly high incidence of postoperative bowel obstruction, although the rates are comparable to those seen with open surgery.

  10. The role of abuse in the development of irritable bowel syndrome: a ...

    African Journals Online (AJOL)

    Irritable Bowel Syndrome (IBS) is defined as a chronic relapsing functional bowel disorder of unknown causes which is characterised by attacks of abdominal pain and change of bowel habit resulting in diarrhoea or constipation or both. The prevalence of IBS in the general population of Western countries is 14-24% of ...

  11. Lubiprostone Decreases the Small Bowel Transit Time by Capsule Endoscopy: An Exploratory, Randomised, Double-Blind, Placebo-Controlled 3-Way Crossover Study

    Directory of Open Access Journals (Sweden)

    Mizue Matsuura

    2014-01-01

    Full Text Available The aim of this study was to investigate the usefulness of lubiprostone for bowel preparation and as a propulsive agent in small bowel endoscopy. Six healthy male volunteers participated in this randomized, 3-way crossover study. The subjects received a 24 μg tablet of lubiprostone 60 minutes prior to the capsule ingestion for capsule endoscopy (CE and a placebo tablet 30 minutes before the capsule ingestion (L-P regimen, a placebo tablet 60 minutes prior to CE and a 24 μg tablet of lubiprostone 30 minutes prior to CE (P-L regimen, or a placebo tablet 60 minutes prior to r CE and a placebo tablet again 30 minutes prior to CE (P-P regimen. The quality of the capsule endoscopic images and the amount of water in the small bowel were assessed on 5-point scale. The median SBTT was 178.5 (117–407 minutes in the P-P regimen, 122.5 (27–282 minutes in the L-P regimen, and 110.5 (11–331 minutes in the P-L regimen (P=0.042. This study showed that the use of lubiprostone significantly decreased the SBTT. We also confirmed that lubiprostone was effective for inducing water secretion into the small bowel during CE.

  12. Lubiprostone decreases the small bowel transit time by capsule endoscopy: an exploratory, randomised, double-blind, placebo-controlled 3-way crossover study.

    Science.gov (United States)

    Matsuura, Mizue; Inamori, Masahiko; Endo, Hiroki; Matsuura, Tetsuya; Kanoshima, Kenji; Inoh, Yumi; Fujita, Yuji; Umezawa, Shotaro; Fuyuki, Akiko; Uchiyama, Shiori; Higurashi, Takuma; Ohkubo, Hidenori; Sakai, Eiji; Iida, Hiroshi; Nonaka, Takashi; Futagami, Seiji; Kusakabe, Akihiko; Maeda, Shin; Nakajima, Atsushi

    2014-01-01

    The aim of this study was to investigate the usefulness of lubiprostone for bowel preparation and as a propulsive agent in small bowel endoscopy. Six healthy male volunteers participated in this randomized, 3-way crossover study. The subjects received a 24 μg tablet of lubiprostone 60 minutes prior to the capsule ingestion for capsule endoscopy (CE) and a placebo tablet 30 minutes before the capsule ingestion (L-P regimen), a placebo tablet 60 minutes prior to CE and a 24 μg tablet of lubiprostone 30 minutes prior to CE (P-L regimen), or a placebo tablet 60 minutes prior to r CE and a placebo tablet again 30 minutes prior to CE (P-P regimen). The quality of the capsule endoscopic images and the amount of water in the small bowel were assessed on 5-point scale. The median SBTT was 178.5 (117-407) minutes in the P-P regimen, 122.5 (27-282) minutes in the L-P regimen, and 110.5 (11-331) minutes in the P-L regimen (P = 0.042). This study showed that the use of lubiprostone significantly decreased the SBTT. We also confirmed that lubiprostone was effective for inducing water secretion into the small bowel during CE.

  13. Incarcerated small bowel within a spontaneous lumbar hernia.

    Science.gov (United States)

    Teo, K A T; Burns, E; Garcea, G; Abela, J E; McKay, C J

    2010-10-01

    Lumbar hernias are rare, resulting from protrusion through the posterior abdominal wall that may be congenital, acquired or spontaneous. They very rarely present with acute bowel obstruction. We present a case of incarcerated small bowel within a spontaneous inferior (Petit's) lumbar hernia, treated by early open repair with mesh insertion. This case highlights the importance of thorough clinical examination and a high index of suspicion, even in the absence of previous surgery around the anatomical site of the suspected hernia, in order to effect an early repair before the onset of ischaemia in incarcerated contents.

  14. MRI for chronic inflammatory bowel disease; MRT chronisch entzuendlicher Darmerkrankungen

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    Hansmann, H.J.; Hess, T.; Hahmann, M.; Erb, G.; Richter, G.M.; Duex, M. [Heidelberg Univ. (Germany). Abt. Roentgendiagnostik; Elsing, C. [Heidelberg Univ. (Germany). Abt. IV - Gastroenterologie

    2001-01-01

    Chronic inflammatory bowel disease is diagnosed and monitored by the combination of colonoscopy and small bowel enteroklysis. Magnetic resonance imaging has become the gold standard for the imaging of perirectal and pelvic fistulas. With the advent of ultrafast MRI small and large bowel imaging has become highly attractive and is being advocated more and more in the diagnostic work up of inflammatory bowel disease. Imaging protocols include fast T{sub 1}-weighted gradient echo and T{sub 2}-weighted TSE sequences and oral or rectal bowel distension. Furthermore, dedicated imaging protocols are based on breath-hold imaging under pharmacological bowel paralysis and gastrointestinal MR contrast agents (Hydro-MRI). High diagnostic accuracy can be achieved in Crohn's disease with special reference to the pattern of disease, depth of inflammation, mesenteric reaction, sinus tract depiction and formation of abscess. In ulcerative colitis, the mucosa-related inflammation causes significantly less bowel wall thickening compared to Crohn's disease. Therefore with MRI, the extent of inflammatory changes is always underestimated compared to colonoscopy. According to our experience in more than 200 patients as well as the results in other centers, Hydro-MRI possesses the potential to replace enteroklysis in the diagnosis of chronic inflammatory bowel disease and most of the follow-up colonoscopies in Crohn's disease. Further technical improvements in 3D imaging will allow interactive postprocessing of the MR data. (orig.) [German] Zusammenfassung: Die Standardverfahren in der Diagnostik und der Verlaufskontrolle chronisch entzuendlicher Darmerkrankungen, speziell des Morbus Crohn und der Colitis ulcerosa, sind die Koloskopie und das Enteroklysma. Die MRT hat sich dazu ihren festen Platz in der Diagnostik perirektaler Fisteln erobert. Mit schnellen, T{sub 1}-gewichteten Gradienten-Echo-Sequenzen und T{sub 2}-gewichteten Turbo-Spin-Echo-Sequenzen koennen auch Duenn

  15. Small-bowel neoplasms in patients undergoing video capsule endoscopy

    DEFF Research Database (Denmark)

    Rondonotti, E; Pennazio, M; Toth, E

    2008-01-01

    BACKGROUND AND STUDY AIM: Small-bowel tumors account for 1% - 3% of all gastrointestinal neoplasms. Recent studies with video capsule endoscopy (VCE) suggest that the frequency of these tumors may be substantially higher than previously reported. The aim of the study was to evaluate the frequency...... findings. 55 patients underwent VCE as the third procedure after negative bidirectional endoscopy. The lesions were single in 89.5% of cases, and multiple in 10.5%. Retention of the capsule occurred in 9.8% of patients with small-bowel tumors. After VCE, 54/124 patients underwent 57 other examinations...

  16. Challenges in management of irritable bowel syndrome in children.

    Science.gov (United States)

    Paul, Siba Prosad; Barnard, Penny; Bigwood, Charlotte; Candy, David C A

    2013-12-01

    Irritable bowel syndrome (IBS) is a common cause of recurrent abdominal pain (RAP) in children and can be a debilitating experience for both child and family. Organic causes of RAP symptoms such as celiac and inflammatory bowel diseases should be excluded before a diagnosis of IBS is made. Treatment consists of dietary manipulation, drugs, and stress management. Newer therapies may offer better control of symptoms with minimal side-effects. This article discusses the challenges faced by pediatricians in managing IBS and reviews management in the context of children from the Indian subcontinent.

  17. Intestinal homeostasis and its breakdown in inflammatory bowel disease.

    Science.gov (United States)

    Maloy, Kevin J; Powrie, Fiona

    2011-06-15

    Intestinal homeostasis depends on complex interactions between the microbiota, the intestinal epithelium and the host immune system. Diverse regulatory mechanisms cooperate to maintain intestinal homeostasis, and a breakdown in these pathways may precipitate the chronic inflammatory pathology found in inflammatory bowel disease. It is now evident that immune effector modules that drive intestinal inflammation are conserved across innate and adaptive leukocytes and can be controlled by host regulatory cells. Recent evidence suggests that several factors may tip the balance between homeostasis and intestinal inflammation, presenting future challenges for the development of new therapies for inflammatory bowel disease.

  18. Obturator hernia: An uncommon cause of small bowel obstruction

    Directory of Open Access Journals (Sweden)

    S Shreshtha

    2016-01-01

    Full Text Available A 70 year old lady presented to surgery emergency with small bowel obstruction without any obvious etiology. On exploration she was found to have an obstructed obturator hernia, which is a rare pelvic hernia with an incidence of 0.07-1.4% of all intra-abdominal hernias. Diagnosis is often delayed until laparotomy for bowel obstruction. Strangulation is frequent and mortality remains high (25%. Early diagnosis and surgical treatment contributes greatly to reduce the mortality and morbidity rates. A variety of techniques have been described, however surgical repair has not been standardized. It is an important diagnosis to be considered in elderly patients with intestinal obstruction.

  19. Psychological adjustment and autonomic disturbances in inflammatory bowel diseases and irritable bowel syndrome.

    Science.gov (United States)

    Pellissier, Sonia; Dantzer, Cécile; Canini, Fréderic; Mathieu, Nicolas; Bonaz, Bruno

    2010-06-01

    Psychological factors and the autonomic nervous system (ANS) are implicated in the pathogenesis of inflammatory bowel diseases (IBD) and irritable bowel syndrome (IBS). This study aimed to assess, firstly the way IBS and IBD patients cope with their pathology according to their affective adjustment and secondly the possible links between these affective adjustments and ANS reactivity. Patients with Crohn's disease (CD; n=26), ulcerative colitis (UC; n=22), or IBS (n=27) were recruited and compared to 21 healthy subjects based on psychological variables (trait- and state anxiety, depressive symptomatology, negative mood, perceived stress, coping, health locus of control) and sympatho-vagal balance through heart-rate variability monitored at rest. A principal component analysis, performed on all affective variables, isolated a leading factor labelled as "affective adjustment". In each disease, patients were distributed into positive and negative affective adjustment. In all the diseases, a positive affect was associated with problem-focused coping, and a negative affect with emotion-focused coping and external health locus of control. Results show that the sympatho-vagal balance varied according to the disease. In CD presenting positive affectivity, an adapted high sympathetic activity was observed. In UC, a parasympathetic blunt was observed in the presence of negative affectivity and an equilibrated sympatho-vagal balance in the presence of positive affectivity. In contrast, in IBS, an important dysautonomia (with high sympathetic and low parasympathetic tone) was constantly observed whatever the affective adjustment. In conclusion, this study suggests that the equilibrium of the ANS is differentially adapted according to the disease. This equilibrium is conjugated with positive affective and cognitive adjustment in IBD (CD and UC) but not in IBS. Copyright 2009 Elsevier Ltd. All rights reserved.

  20. Characterization of Symptoms in Irritable Bowel Syndrome with Mixed Bowel Habit Pattern

    Science.gov (United States)

    Su, Andrew; Shih, Wendy; Presson, Angela P.; Chang, Lin

    2013-01-01

    Background Irritable bowel syndrome (IBS) with mixed bowel habits (IBS-M) is a heterogeneous subtype with varying symptoms of constipation and diarrhea, and has not been well characterized. We aimed to characterize gastrointestinal (GI) and non-GI symptoms in IBS-M patients from a U.S. community, and to compare them with IBS with constipation (IBS-C) and diarrhea (IBS-D). Methods Subjects answering community advertisements and meeting Rome III criteria for IBS completed symptom questionnaires. Key Results Of the initial 289 IBS patients identified, one-third (n=51, 32.5%) who met Rome III criteria for IBS-M endorsed having either loose stools or hard stools due to medication. These patients had more severe symptoms and longer duration of flares compared to the rest of the IBS-M group (p = 0.014, p = 0.005). Excluding IBS-M patients with medication-related extremes in stool form who could not be reclassified by medical history, 247 IBS patients were assessed. IBS-M was the most common (44.1%), followed by IBS-C (27.9%), IBS-D (26.3%), and IBS-U (unsubtyped, 1.6%). IBS-M shared symptoms with both IBS-C and IBS-D (p-value range: habits (27.5%), bloating (26.6%), and abdominal pain (20.2%). There were no differences in non-GI symptoms between subtypes. Conclusions & Inferences IBS-M is a heterogeneous symptom group and thus requires that subclassification criteria be better defined. Use of laxative/anti-diarrheal medications adds to the diagnostic complexity in a potentially more severe subset of IBS-M and should be assessed for accurate subclassification. PMID:23991913

  1. T Cell Repertoire and Inflammatory Bowel Disease

    Directory of Open Access Journals (Sweden)

    Kenneth Croitoru

    1996-01-01

    Full Text Available The diversity of the T cell receptor repertoire is generated through rearrangement of the variable, junctional and constant region genes. Selection processes in the thymus and periphery serve to eliminate self-reacting T cells, thereby preventing autoimmune disease. The possibility that inflammatory bowel disease (IBD is an autoimmune disease has led to the search for an auto-antigen. In addition, studies are exploring the T cell receptor repertoire in IBD patients for changes that may provide clues regarding etiopathogenesis. Using monoclonal antibodies to T cell receptor variable-gene products or polymerase chain reaction analysis of variable-gene mRNA expression, the mucosal T cell repertoire has been examined in humans. The intestinal intraepithelial lymphocytes show a significant degree of oligoclonal expansion that may represent local antigen exposure or unique selection processes. This is in keeping with studies that show that murine intestinal intraepithelial lymphocytes undergo positive and possibly negative selection independent of the thymus. In the inflamed human gut, shifts in the T cell receptor repertoire may also reflect recruitment of peripheral T cells to the gut. In one study, a subset of Crohn’s disease patients was shown to have an increase in the proportion of variable β8 peripheral blood lymphocyte and mesenteric lymph node cells, suggesting a superantigen effect. The authors hypothesized that changes in the functional T cell receptor repertoire can also occur which might be independent of changes in the distribution of T cells expressing variable β T cell receptors. In fact, the authors have shown there is a selective decrease in the cytotoxic function of peripheral variable β8 T cells in Crohn’s disease. Furthermore, stimulation with the variable β8 selective bacterial enterotoxin staphylococcal enterotoxin E failed to increase the cytotoxic function in this subset of Crohn’s disease patients compared with

  2. Transrectal Mesh Erosion Requiring Bowel Resection.

    Science.gov (United States)

    Kemp, Marta Maria; Slim, Karem; Rabischong, Benoît; Bourdel, Nicolas; Canis, Michel; Botchorishvili, Revaz

    To report a case of a transrectal mesh erosion as complication of laparoscopic promontofixation with mesh repair, necessitating bowel resection and subsequent surgical interventions. Sacrocolpopexy has become a standard procedure for vaginal vault prolapse [1], and the laparoscopic approach has gained popularity owing to more rapid recovery and less morbidity [2,3]. Mesh erosion is a well-known complication of surgical treatment for prolapse as reported in several negative evaluations, including a report from the US Food and Drug Administration in 2011 [4]. Mesh complications are more common after surgeries via the vaginal approach [5]; nonetheless, the incidence of vaginal mesh erosion after laparoscopic procedures is as high as 9% [6]. The incidence of transrectal mesh exposure after laparoscopic ventral rectopexy is roughly 1% [7]. The diagnosis may be delayed because of its rarity and variable presentation. In addition, polyester meshes, such as the mesh used in this case, carry a higher risk of exposure [8]. A 57-year-old woman experiencing genital prolapse, with the cervix classified as +3 according to the Pelvic Organ Prolapse Quantification system, underwent laparoscopic standard sacrocolpopexy using polyester mesh. Subtotal hysterectomy and bilateral adnexectomy were performed concomitantly. A 3-year follow-up consultation demonstrated no signs or symptoms of erosion of any type. At 7 years after the surgery, however, the patient presented with rectal discharge, diagnosed as infectious rectocolitis with the isolation of Clostridium difficile. She underwent a total of 5 repair surgeries in a period of 4 months, including transrectal resection of exposed mesh, laparoscopic ablation of mesh with digestive resection, exploratory laparoscopy with abscess drainage, and exploratory laparoscopy with ablation of residual mesh and transverse colostomy. She recovered well after the last intervention, exhibiting no signs of vaginal or rectal fistula and no recurrence

  3. Joint involvement associated with inflammatory bowel disease.

    Science.gov (United States)

    De Vos, M

    2009-01-01

    Joint involvement associated with inflammatory bowel disease (IBD) belongs to the concept of spondyloarthritis (SpA) and includes two types of arthritis: a peripheral arthritis characterized by the presence of pauciarticular asymmetrical arthritis affecting preferentially joints of lower extremities and an axial arthropathy including inflammatory back pain, sacroiliitis and ankylosing spondylitis (AS). Treatment of arthritis includes a short-term use of NSAIDs associated with optimized treatment of gut inflammation. Safety concerns mean that long-term treatment with NSAIDs is best avoided if possible. Salazopyrine can be recommended for treatment of peripheral arthritis. Methotrexate and azathioprine are generally ineffective. Finally, efficacy of anti-TNF therapy (infliximab and adalimumab) is well established. However, use of etanercept is not recommended because of the increased risk for intestinal disease relapse. Pathogenesis of gut-joint iteropathy is not elucidated. Both inflammations are tightly related as suggested by human evidence of gut inflammation in patients with other forms of SpA and animal evidence of gut and joint inflammation in HLA-B27/human beta(2)-microglobulin transgenic rat model and TNF(DeltaARE) mice. Several clues for the linkage between gut and joint inflammation have been put forward including an altered recognition and handling of bacterial antigens, an aberrant trafficking of CD8+ T cells with an impaired T-helper type 1 cytokine profile and expression of aEb7 integrin, an altered trafficking of macrophages expressing CD163 and evidence of an increased angiogenesis. A transcriptome analysis of mucosal biopsies identified a set of 95 genes that are differentially expressed in both CD and SpA as compared with healthy controls suggesting common pathways. TNF plays a key role in the pathogenesis of various arthritic diseases and IBD. Mesenchymal/myofibroblast-like cells may represent the local primary targets of TNF in the induction of

  4. Specimen Preparation

    Science.gov (United States)

    Williams, David B.; Carter, C. Barry

    Specimen preparation is a very broad subject; there are books devoted to this topic alone. The intention here is to summarize the techniques, suggest routes that you might follow, and above all to emphasize that there are many ways to produce a TEM specimen; the one you choose will depend on the information you need, time constraints, availability of equipment, your skill, and the material. So we’ll concentrate on the ‘principles of cooking,’ but won’t try to list all the possible ‘recipes.’ One important point to bear in mind is that your technique must not affect what you see or measure, or if it does, then you must know how. Specimen preparation artifacts may be interesting but they are not usually what you want to study. Incidentally, we’ll make ‘specimens’ from the ‘sample’ we’re investigating so we’ll look at ‘TEM specimens,’ but sometimes we, and everyone else, will interchange the two words.

  5. Inter-observer agreement for detection of small bowel Crohn's disease with capsule endoscopy

    DEFF Research Database (Denmark)

    Jensen, Michael Dam; Nathan, Torben; Kjeldsen, Jens

    2010-01-01

    OBJECTIVE: Compared to other modalities, capsule endoscopy (CE) has a high diagnostic yield for diagnosing small bowel Crohn's disease (CD). The aim of this study was to determine the inter-observer agreement for detection of small bowel CD with predefined diagnostic criteria. MATERIAL AND METHODS...... was diagnostic of small bowel CD. Three observers with experience in gastrointestinal endoscopy and CE participated in the study. RESULTS: The presence or absence of small bowel CD was determined with complete agreement in 23 patients, nine patients with and 14 without small bowel CD. The inter...

  6. Follow-up of patients with functional bowel symptoms treated with a low FODMAP diet

    DEFF Research Database (Denmark)

    Maagaard, Louise; Ankersen, Dorit Vedel; Callaerts-Vegh, Zsuzsanna

    2016-01-01

    AIM: To investigate patient-reported outcomes from, and adherence to, a low FODMAP diet among patients suffering from irritable bowel syndrome and inflammatory bowel disease. METHODS: Consecutive patients with irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD) and co-existing IBS...... deviations. Wheat, dairy products, and onions were the foods most often not reintroduced by patients. CONCLUSION: These data suggest that a diet low in FODMAPs is an efficacious treatment solution in the management of functional bowel symptoms for IBS and IBD patients....

  7. Rational Management of Iron-Deficiency Anaemia in Inflammatory Bowel Disease.

    Science.gov (United States)

    Nielsen, Ole Haagen; Soendergaard, Christoffer; Vikner, Malene Elbaek; Weiss, Günter

    2018-01-13

    Anaemia is the most frequent, though often neglected, comorbidity of inflammatory bowel disease (IBD). Here we want to briefly present (1) the burden of anaemia in IBD, (2) its pathophysiology, which mostly arises from bleeding-associated iron deficiency, followed by (3) diagnostic evaluation of anaemia, (4) a balanced overview of the different modes of iron replacement therapy, (5) evidence for their therapeutic efficacy and subsequently, (6) an updated recommendation for the practical management of anaemia in IBD. Following the introduction of various intravenous iron preparations over the last decade, questions persist about when to use these preparations as opposed to traditional and other novel oral iron therapeutic agents. At present, oral iron therapy is generally preferred for patients with quiescent IBD and mild iron-deficiency anaemia. However, in patients with flaring IBD that hampers intestinal iron absorption and in those with inadequate responses to or side effects with oral preparations, intravenous iron supplementation is the therapy of choice, although information on the efficacy of intravenous iron in patients with active IBD and anaemia is scare. Importantly, anaemia in IBD is often multifactorial and a careful diagnostic workup is mandatory for optimized treatment. Nevertheless, limited information is available on optimal therapeutic start and end points for treatment of anaemia. Of note, neither oral nor intravenous therapies seem to exacerbate the clinical course of IBD. However, additional prospective studies are still warranted to determine the optimal therapy in complex conditions such as IBD.

  8. Small bowel endoscopy in familial adenomatous polyposis and Lynch syndrome

    NARCIS (Netherlands)

    Koornstra, Jan Jacob

    Patients with familial adenomatous polyposis (FAP) and patients with Lynch syndrome have an increased risk of developing small intestinal neoplasia. In both conditions, the lifetime risk to develop small bowel cancer is estimated to be around 5%. In FAP, this risk is associated with the degree of

  9. Intestinal microbiota in functional bowel disorders: a Rome foundation report

    NARCIS (Netherlands)

    Simrén, M.; Barbara, G.; Flint, H.J.; Spiegel, B.M.; Spiller, R.C.; Vanner, S.; Verdu, E.F.; Whorwell, P.J.; Zoetendal, E.G.

    2013-01-01

    It is increasingly perceived that gut host-microbial interactions are important elements in the pathogenesis of functional gastrointestinal disorders (FGID). The most convincing evidence to date is the finding that functional dyspepsia and irritable bowel syndrome (IBS) may develop in predisposed

  10. Faecal Calprotectin in Suspected Paediatric Inflammatory Bowel Disease

    NARCIS (Netherlands)

    Degraeuwe, Pieter L. J.; Beld, Monique P. A.; Ashorn, Merja; Canani, Roberto Berni; Day, Andrew S.; Diamanti, Antonella; Fagerberg, Ulrika L.; Henderson, Paul; Kolho, Kaija-Leena; Van de Vijver, Els; van Rheenen, Patrick F.; Wilson, David C.; Kessels, Alfons G. H.

    Objectives: The diagnostic accuracy of faecal calprotectin (FC) concentration for paediatric inflammatory bowel disease (IBD) is well described at the population level, but not at the individual level. We reassessed the diagnostic accuracy of FC in children with suspected IBD and developed an

  11. Treatment of abdominal pain in irritable bowel syndrome

    NARCIS (Netherlands)

    Vanuytsel, Tim; Tack, Jan F.; Boeckxstaens, Guy E.

    2014-01-01

    Functional abdominal pain in the context of irritable bowel syndrome (IBS) is a challenging problem for primary care physicians, gastroenterologists and pain specialists. We review the evidence for the current and future non-pharmacological and pharmacological treatment options targeting the central

  12. Case Study: The nutritional management of short bowel syndrome in ...

    African Journals Online (AJOL)

    SASPEN Case Study: The nutritional management of short bowel syndrome in a very low-birthweight neonate. Lize Rossouw, Chief Dietician, Groote Schuur Hospital, Cape Town. Correspondence to: Elizabeth van der Merwe, e-mail: elizabeth.vandermerwe@westerncape.gov.za. Keywords: NEC, necrotising enterocolitis, ...

  13. Guidelines on the irritable bowel syndrome: mechanisms and practical management.

    Science.gov (United States)

    Spiller, R; Aziz, Q; Creed, F; Emmanuel, A; Houghton, L; Hungin, P; Jones, R; Kumar, D; Rubin, G; Trudgill, N; Whorwell, P

    2007-12-01

    IBS affects 5-11% of the population of most countries. Prevalence peaks in the third and fourth decades, with a female predominance. To provide a guide for the assessment and management of adult patients with irritable bowel syndrome. Members of the Clinical Services Committee of The British Society of Gastroenterology were allocated particular areas to produce review documents. Literature searching included systematic searches using electronic databases such as Pubmed, EMBASE, MEDLINE, Web of Science, and Cochrane databases and extensive personal reference databases. Patients can usefully be classified by predominant bowel habit. Few investigations are needed except when diarrhoea is a prominent feature. Alarm features may warrant further investigation. Adverse psychological features and somatisation are often present. Ascertaining the patients' concerns and explaining symptoms in simple terms improves outcome. IBS is a heterogeneous condition with a range of treatments, each of which benefits a small proportion of patients. Treatment of associated anxiety and depression often improves bowel and other symptoms. Randomised placebo controlled trials show benefit as follows: cognitive behavioural therapy and psychodynamic interpersonal therapy improve coping; hypnotherapy benefits global symptoms in otherwise refractory patients; antispasmodics and tricyclic antidepressants improve pain; ispaghula improves pain and bowel habit; 5-HT(3) antagonists improve global symptoms, diarrhoea, and pain but may rarely cause unexplained colitis; 5-HT(4) agonists improve global symptoms, constipation, and bloating; selective serotonin reuptake inhibitors improve global symptoms. Better ways of identifying which patients will respond to specific treatments are urgently needed.

  14. Bowel Habits of Preterm Infants in Ilorin | Adegboye | Nigerian ...

    African Journals Online (AJOL)

    Objective: To determine the pattern of bowel habits of preterm infants in the first 10 days of postnatal life. Methods: One hundred and forty preterm infants delivered at the University of Ilorin Teaching Hospital (UITH) or referred to it within twelve hours of delivery, were studied. The babies were divided into two equal groups ...

  15. Resection of peritoneal metastases causing malignant small bowel obstruction

    Directory of Open Access Journals (Sweden)

    Merrie Arend EH

    2007-10-01

    Full Text Available Abstract Background Resection of peritoneal metastases has been shown to improve survival in patients with abdominal metastatic disease from abdominal or extra abdominal malignancy. This study evaluates the benefit of peritoneal metastatic resection in patients with malignant small bowel obstruction and a past history of treated cancer. Patients and methods Patients undergoing laparotomy for resection of peritoneal metastases from recurrence of previous cancer between 1992–2003 were reviewed retrospectively. Data were collected about type of primary cancer, interval to recurrence, extent of the disease and completeness of resection, morbidity and mortality and long-term survival. Results Between 1992 and 2003 there were 79 patients (median age 62, range 19–91 who had laparotomy for small bowel obstruction due to recurrent cancer. The primary cancer was colorectal (31, gynaecologic cancer (19, melanoma (16 and others (13. Overall, the rate of complications was 35% and mortality was 10%. Median survival was 5 months; patients with history of colorectal cancer had better survival than other cancer (median survival 7 months vs. 4 months; p = 0.02. Multivariate analysis showed that the extent of recurrent disease was the only factor that affected overall survival. Conclusion Laparotomy for small bowel obstruction is a worthwhile option for patients with malignant small bowel obstruction. Although it is associated with significant morbidity and mortality it offers a reasonable survival benefit in particular for patients with completely resectable disease.

  16. Lumbar hernia: a rare cause of large bowel obstruction

    OpenAIRE

    Hide, I; Pike, E.; Uberoi, R.

    1999-01-01

    We describe a 70-year-old woman presenting with large bowel obstruction secondary to incarceration of the mid descending colon within a lumbar hernia. This was diagnosed on barium enema and successfully treated surgically.


Keywords: hernia; intestinal obstruction; colon

  17. Lumbar hernia: a rare cause of large bowel obstruction

    Science.gov (United States)

    Hide, I; Pike, E; Uberoi, R

    1999-01-01

    We describe a 70-year-old woman presenting with large bowel obstruction secondary to incarceration of the mid descending colon within a lumbar hernia. This was diagnosed on barium enema and successfully treated surgically.


Keywords: hernia; intestinal obstruction; colon PMID:10715766

  18. Inflammatory bowel disease Cape Town, 1975-1980

    African Journals Online (AJOL)

    1983-02-12

    Feb 12, 1983 ... SA MEDIESE TYDSKRIF DEEL 63 12 FEBRUARIE 1983. 3. Tobias R, Wright JP, Konler RE et al. Primary sclerosing cholangitis asso- ciated with inflammatory bowel disease in Cape Town, 197;"'1981. S. Afr Med] 1983; 63: 229-235. 4. Edwards Fe, Truelove Se. The course and prognosis ofulcerative colitis ...

  19. The microbiome and its therapeutic potential in inflammatory bowel diseases

    NARCIS (Netherlands)

    Rossen, N.G.M.

    2016-01-01

    While the etiology of inflammatory bowel diseases (IBD) remains unclear, there is substantial evidence for the link between the microbiota and the pathogenesis of IBD. Interest for the application of Fecal Microbiota Transplantation (FMT) increases, especially now the insight in the intestinal

  20. Gastric pentadecapeptide BPC 157 and short bowel syndrome in rats.

    Science.gov (United States)

    Sever, Marko; Klicek, Robert; Radic, Bozo; Brcic, Luka; Zoricic, Ivan; Drmic, Domagoj; Ivica, Mihovil; Barisic, Ivan; Ilic, Spomenko; Berkopic, Lidija; Blagaic, Alenka Boban; Coric, Marijana; Kolenc, Danijela; Vrcic, Hrvoje; Anic, Tomislav; Seiwerth, Sven; Sikiric, Predrag

    2009-10-01

    The gastric pentadecapeptide BPC 157, which was shown to be safe as an antiulcer peptide in trials for inflammatory bowel disease (PL14736, Pliva), successfully healed intestinal anastomosis and fistula in rat. Therefore, we studied for 4 weeks rats with escalating short bowel syndrome and progressive weight loss after small bowel resection from fourth ileal artery cranially of ileocecal valve to 5 cm beneath pylorus. BPC 157 (10 microg/kg or 10 ng/kg) was given perorally, in drinking water (12 ml/rat/day) or intraperitoneally (once daily, first application 30 min following surgery, last 24 h before sacrifice). Postoperatively, features of increasingly exhausted presentation were: weight loss appearing immediately regardless of villus height, twofold increase in crypt depth and fourfold increase in muscle thickness within the first week, jejunal and ileal overdilation, and disturbed jejunum/ileum relation. In contrast, constant weight gain above preoperative values was observed immediately with BPC 157 therapy, both perorally and parenterally, and villus height, crypt depth, and muscle thickness [inner (circular) muscular layer] also increased, at 7, 14, 21, and 28 days. Moreover, rats treated with pentadecapeptide BPC 157 showed not different jejunal and ileal diameters, constant jejunum-to-ileum ratio, and increased anastomosis breaking strength. In conclusion, pentadecapeptide BPC 157 could be helpful to cure short bowel syndrome.

  1. Technologies in the evaluation of irritable bowel syndrome

    NARCIS (Netherlands)

    Smout, AJPM; Azpiroz, F; Brummer, RJ; Coremans, G; Dapoigny, M; Muller-Lissner, SA; Pace, F; Stockbrugger, RM; Vatn, M; Whorwell, PJ

    2004-01-01

    During a meeting in The Hague, The Netherlands, the IBiS Club evaluated the most important techniques that can be used in the investigation of irritable bowel syndrome, either in the context of scientific research or as a clinical diagnostic tool. In each of these, the relevance of findings made in

  2. Small bowel ultrasound in patients with celiac disease

    Energy Technology Data Exchange (ETDEWEB)

    Bartusek, D. [Department of Radiology, Masaryk University hospital Brno (Czech Republic)], E-mail: dbartusek@fnbrno.cz; Valek, V. [Department of Radiology, Masaryk University hospital Brno (Czech Republic)], E-mail: v.valek@fnbrno.cz; Husty, J. [Department of Radiology, Masaryk University hospital Brno (Czech Republic)], E-mail: jhusty@fnbrno.cz; Uteseny, J. [Department of Pediatric Internal Medicine, Masaryk University hospital Brno (Czech Republic)], E-mail: juteseny@fnbrno.cz

    2007-08-15

    Objective: Celiac disease (CD) is a common, lifelong disease with small bowel malabsorption based on genetically conditioned gluten intolerance. The clinical manifestation could be very heterogeneous. The proof of celiac disease is now based mainly on clinical and laboratory (antibodies and enterobiopsy) signs, which are in some cases problematic and inconvenient. Materials and methods: In our study we have examined 250 patients with suspection or with proven celiac disease and we evaluated specific ultrasound small bowel changes in this group. In the next step, we chose 59 patients with laboratory proved celiac disease and we statistically compared ultrasound, other laboratory and clinical findings in different forms and stages of the disease. Results: Specific small bowel pathologies in patients with celiac disease (like changes of intestinal villi in different parts of small bowel, abnormal peristalsis and mesenterial lymphadenopathy) can be well visualized by ultrasound and in combination with clinical and laboratory signs ultrasound examination could have an important role in screening, determination of diagnosis and monitoring of patients with different forms of celiac disease.

  3. Small bowel obstruction following perforation of the uterus at ...

    African Journals Online (AJOL)

    BACKGROUND: Unsafe abortion is an important contributor to maternal morbidity and mortality. OBJECTIVE: To present a case of small bowel obstruction following perforation of the uterus at induced abortion. METHODS: A 36-year-old woman, presented at a private hospital, with abdominal pain and weight loss. She had ...

  4. Etiology of Small Bowel Thickening on Computed Tomography

    Directory of Open Access Journals (Sweden)

    Lee Finkelstone

    2012-01-01

    Full Text Available BACKGROUND: Abdominal pain is often evaluated using imaging, most often with computed tomography (CT. While CT is sensitive and specific for certain diagnoses, small bowel thickening is a nonspecific finding on CT with a broad differential diagnosis including infection, inflammation, ischemia and neoplasm.

  5. Adult large bowel obstruction: A review of clinical experience

    African Journals Online (AJOL)

    Background: Adult large bowel obstruction is an infrequent cause of acute obstruction in Africa and India. The cause of obstruction varies between regions of the world. Current controversy concerns the surgical management of the acutely obstructed left colon. Materials and Methods: This is a prospective study of adult ...

  6. Gastrografin in the management of adhesive small bowel ...

    African Journals Online (AJOL)

    contrast, gastrografin, in the conservative management of ASBO. Patients and methods During the period January ... improve after 48 h of conservative management in the absence of signs of strangulation were subjected .... a liquid diet and then solid food. If the contrast failed to reach the large bowel within 24h, the patient ...

  7. Implementation of a bowel management program in the treatment of ...

    African Journals Online (AJOL)

    Objectives: Our surgical team has devised a bowel management program (BMP) as a basic approach for primary healthcare providers with the least use of resources. Background: Soiling in children is a major problem that has a serious impact on the child's social and psychological life. Causes vary from idiopathic ...

  8. Bovine colostrum to children with short bowel syndrome

    DEFF Research Database (Denmark)

    Aunsholt, Lise; Jeppesen, Palle Bekker; Lund, Pernille

    2014-01-01

    Background: Management of short bowel syndrome (SBS) aims to achieve intestinal autonomy to prevent fluid, electrolyte, and nutrient deficiencies and maintain adequate development. Remnant intestinal adaptation is required to obtain autonomy. In the newborn pig, colostrum has been shown to support...

  9. Complex host genetics influence the microbiome in inflammatory bowel disease

    NARCIS (Netherlands)

    Knights, Dan; Silverberg, Mark S.; Weersma, Rinse K.; Gevers, Dirk; Dijkstra, Gerard; Huang, Hailiang; Tyler, Andrea D.; van Sommeren, Suzanne; Imhann, Floris; Stempak, Joanne M.; Huang, Hu; Vangay, Pajau; Al-Ghalith, Gabriel A.; Russell, Caitlin; Sauk, Jenny; Knight, Jo; Daly, Mark J.; Huttenhower, Curtis; Xavier, Ramnik J.

    2014-01-01

    Background: Human genetics and host-associated microbial communities have been associated independently with a wide range of chronic diseases. One of the strongest associations in each case is inflammatory bowel disease (IBD), but disease risk cannot be explained fully by either factor individually.

  10. Treatment of inflammatory bowel disease in childhood: Best available evidence

    NARCIS (Netherlands)

    Escher, Johanna C.; Taminiau, Jan A. J. M.; Nieuwenhuis, Edward E. S.; Büller, Hans A.; Grand, Richard J.

    2003-01-01

    The physician treating children with inflammatory bowel disease is confronted with a number of specific problems, one of them being the lack of randomized, controlled drug trials in children. In this review, the role of nutritional therapy is discussed with a focus on primary treatment, especially

  11. Fetal Bowel Dilatation due to Intestinal Neuronal Dysplasia: A Rarity.

    Science.gov (United States)

    Akdag, Arzu; Anadut, Karar Orkun; Yalcin, Omer; Kaya, Mete

    2016-01-01

    Intestinal neuronal dysplasia (IND) type B is characterized by malformation of parasympathetic plexus and manifests at more than 6 month of age with progressive severe constipation. We report a case of IND type B presented with bowel dilatation on antenatal scan and neonatal intestinal obstruction which is unusual with this type of IND.

  12. Lubiprostone for constipation and irritable bowel syndrome with constipation.

    Science.gov (United States)

    Tuteja, Ashok K; Rao, Satish S C

    2008-12-01

    Chronic constipation and irritable bowel syndrome are heterogeneous disorders characterized by altered bowel habits, abdominal discomfort and/or difficult defecation. These conditions have a significant impact on patients' quality of life, as well as on the US economy, both in terms of healthcare costs and lost productivity. Treatment typically begins with lifestyle changes, increased fiber intake and osmotic and stimulant laxative intake. However, treatments for constipation vary in terms of their efficacy and safety. Furthermore, surveys of physicians and patients have revealed a strong desire for improved therapeutic options. Lubiprostone is a synthetic bicyclic fatty acid that is gut selective and stimulates type 2 chloride channels, resulting in increased chloride, sodium and water secretion into the lumen. The increased fluid secretion causes luminal distension, secondary peristalsis and laxation. Randomized Phase III trials have shown that lubiprostone is efficacious in the treatment of chronic idiopathic constipation and irritable bowel syndrome with constipation. The US FDA has approved lubiprostone at a dose of 24 microg twice daily for the treatment of chronic idiopathic constipation in adults, and at a dose of 8 microg twice daily for irritable bowel syndrome with constipation in adult women. Nausea, diarrhea and headaches are the most commonly reported side effects. In long-term studies, lubiprostone appears to be safe.

  13. Clinical Predictors of Future Nonadherence in Inflammatory Bowel Disease

    NARCIS (Netherlands)

    Severs, M.; Mangen, M.J.; Fidder, H.H.; Valk, M.E. van der; Have, M. van der; Bodegraven, A.A. van; Clemens, C.H.; Dijkstra, G.; Jansen, J.M.; Jong, D.J. de; Mahmmod, N.; Meeberg, P.C. van de; Jong, A E F de; Pierik, M.; Ponsioen, C.Y.; Romberg-Camps, M.J.; Siersema, P.D.; Jharap, B.; Woude, J.C. van der; Zuithoff, N.P.; Oldenburg, B.

    2017-01-01

    BACKGROUND: Nonadherence to medical therapy is frequently encountered in patients with inflammatory bowel disease (IBD). We aimed to identify predictors for future (non)adherence in IBD. METHODS: We conducted a multicenter prospective cohort study with adult patients with Crohn's disease (CD) and

  14. Testing a biobehavioral model of irritable bowel syndrome

    NARCIS (Netherlands)

    Veek, P.P.J. van der; Dusseldorp, E.; Rood, Y.R. van; Masclee, A.A.M.

    2010-01-01

    Objective: The pathogenesis of irritable bowel syndrome (IBS) is probably multifactorial with dysfunction at different levels of the brain-gut axis. The aim of this study was to evaluate an existing biobehavioral model of IBS symptom generation in a large group of patients. Material and Methods: In

  15. An Uncommon Cause of Acute Bowel Obstruction: The Left Para ...

    African Journals Online (AJOL)

    X-ray showed an air-fluid small bowel levels. The computed tomography (CT) showed the presence ... Although PH is congenital, most cases are discovered between the 4th and 6th decades of life with mean age about ... guided, its discovery sometimes occurs during surgery. After diagnosis of PH is made, the treatment is ...

  16. Interleukin-10-based therapy for inflammatory bowel disease

    NARCIS (Netherlands)

    Braat, Henri; Peppelenbosch, Maikel P.; Hommes, Daan W.

    2003-01-01

    In recent years it has become clear that chronic inflammatory bowel disease (IBD), especially Crohn's disease (CD), is caused by a loss of tolerance against the autologous bacterial flora of the intestine. Tolerance against the indigenous flora requires optimal recognition of antigens by pattern

  17. Obstructive Small Bowel Metastasis from Uterine Leiomyosarcoma: A Case Report

    Directory of Open Access Journals (Sweden)

    Mutahir A. Tunio

    2014-01-01

    Full Text Available Background. Uterine leiomyosarcoma is a rare and aggressive gynecologic malignancy with an overall poor prognosis. Lungs, bones, and brain are common sites of metastases of uterine leiomyosarcoma. Metastases of uterine leiomyosarcoma to the small bowel are extremely rare, and only four case reports have been published to date. Case presentation. A 55-year-old Saudi woman diagnosed with a case of uterine leiomyosarcoma treated with total abdominal hysterectomy (TAH and bilateral salpingooophorectomy (BSO presented in emergency room after sixteen months with acute abdomen. Subsequent work-up showed a jejunal mass for which resection and end-to-end anastomosis were performed. Biopsy confirmed the diagnosis of small bowel metastasis from uterine leiomyosarcoma. Further staging work-up showed wide spread metastasis in lungs and brain. After palliative cranial irradiation, systemic chemotherapy based on single agent doxorubicin was started. Conclusion. Metastatic leiomyosarcoma of small bowel from uterine leiomyosarcoma is a rare entity and is sign of advanced disease. It should be differentiated from primary leiomyosarcoma of small bowel as both are treated with different systemic chemotherapeutic agents.

  18. Irritable Bowel Syndrome in a Population of African Patients

    Directory of Open Access Journals (Sweden)

    Sylvester Chuks Nwokediuko

    2012-01-01

    Full Text Available Background. Functional dyspepsia is the prototype functional gastrointestinal disorder. This study was designed to determine its prevalence, subtypes, and risk factors associated with the subtypes. Method. Patients with upper gastrointestinal symptoms who presented for endoscopy were administered a questionnaire containing the functional dyspepsia and irritable bowel syndrome modules of the Rome III diagnostic criteria. Results. Of 192 patients who had functional dyspepsia, epigastric pain syndrome, postprandial distress syndrome, and combination of the two subtypes accounted for 79.2%, 62.5%, and 50%, respectively. Multivariate analysis of the risk factors showed that independent predictors of postprandial distress syndrome were alcohol and irritable bowel syndrome while irritable bowel syndrome was independent predictor of epigastric pain syndrome. Alcohol, smoking, and use of nonsteroidal anti-inflammatory drugs were independent predictors of cooccurrence of postprandial distress syndrome and epigastric pain syndrome. Conclusion. Functional dyspepsia accounts for 62.5% of dyspepsia in a population of black African patients. Regarding symptomatology, epigastric pain syndrome, postprandial distress syndrome, and combination of the two subtypes account for 79.2%, 62.5%, and 50%, respectively. Risk factors for functional dyspepsia are irritable bowel syndrome, alcohol, smoking, and use of nonsteroidal anti-inflammatory drugs.

  19. A holistic approach to the treatment of irritable bowel syndrome ...

    African Journals Online (AJOL)

    The purpose of this study is to investigate the effects of a holistic intervention approach to the management of Irritable Bowel Syndrome (IBS). The sample consisted of 70 South African women who were diagnosed with IBS. The sample was divided into four groups. Group 1 (n = 13) received IBS medication and holistic ...

  20. Prevalence and predictors of irritable bowel syndrome among ...

    African Journals Online (AJOL)

    Background: Irritable bowel syndrome (IBS) is a frequent, costly, and potentially disabling gastrointestinal disorder. Medical education is among the most challenging and the most stressful education, and this may predispose to high rates of IBS. Objective: To determine the prevalence and predictors of IBS among medical ...