Irritable bowel syndrom

IBS是胃肠病门诊最常见的疾病,目前的诊断主要依靠罗马标准,根据这一标准,病人须有腹部不适或疼痛,以及肠道功能异常.在美国IBS的发病率为10-20%,其中75%为女性.多数IBS病人为轻度,对本病能够耐受,对安慰和生活改变等治疗反应良好;约25%为中度,可明显影响日常生活,经一般胃肠病对症治疗效果欠佳,用心理治疗常可得到缓解;另外,5%为重症病人,各种治疗效果均差.IBS的发生涉及肠道的运动和感觉异常,疼痛阈值降低;30%的IBS病人有急性结肠感染史,机理尚不清楚,可能通过心理-神经-免疫因素而导致IBS的发生;脑肠轴也参与IBS的发生.作者主要用胃肠道和脑相互作用这一循环模式来认识IBS的身心异常,焦虑和抑郁在IBS病人中很常见.IBS的治疗应考虑其身心异常这一特点,轻度病人通过饮食调整、肠道扩容或动力药治疗,也可用抗胆碱和抗抑郁药,但应注意它们的副作用;认知治疗也是有效的方法之一.作者采用心理和胃肠道结合疗法,强调家庭的作用,因为IBS和家庭成员间的关系可相互影响.同时心理和消化专家一起对病人咨询,这样有利于对病人进行IBS的心理和躯体两方面的特点的解释.     

Patients’ perspective on bowel resection for inflammatory bowel disease

Purpose

The study aimed to determine whether patients are receiving adequate counselling about elective bowel resection and timely surgery for inflammatory bowel disease (IBD).

Methods

Patients with IBD who underwent an elective bowel resection in a tertiary referral centre between April 2012 and Dec 2014 were identified from a prospective database. Patients under the age of 16 years were excluded from the study. Patients were contacted over the phone to complete a questionnaire regarding their perspective on their surgery, including the consultations that took place, preparedness and timing of surgery, as well as patient attitude towards bowel resection and satisfaction with post-operative outcomes. Demographic details were recorded.

Results

Thirty-one patients participated in the study. Twenty-one (68%) patients were diagnosed with Crohn’s disease, nine (29%) were diagnosed with ulcerative colitis, and one (3%) had indeterminate colitis. Twenty-seven (87%) patients reported that the timing of the initial consultation regarding the option of bowel resection was appropriate. Twenty-five (81%) patients felt prepared after a consultation with the surgical team with regard to perioperative issues and potential complications. Fourteen (45%) patients reported that the timing of bowel resection was appropriate, while 15 (48%) reported that it should have been earlier. A significant improvement in patient’s pre- and post-operative attitudes towards bowel resection was demonstrated (p?=?0.004). Thirty (97%) patients were either happy or very happy with their results and symptom improvement post-bowel resection.

Conclusion

Most patients are receiving adequate counselling about elective bowel resection for IBD, although there is room for improvement for preoperative education and optimising timing of surgery.

     

Irritable bowel syndrome: a little understood organic bowel disease?

Irritable bowel syndrome affects 10% of adults with an unexplained female predominance. Although only a few people see their family doctor, the disease causes reduced quality of life and represents a multi-billion pound health-care problem. The disorder clusters in families, which is possibly because of intra-familial learning and a genetic predisposition. Visceral hypersensitivity is a key feature in most patients. Results of imaging studies of regional cerebral blood flow during rectal distension suggest underlying disturbances of central processing of afferent signals, though this is not unique to the disorder, since it is seen in other chronic pain syndromes. Environmental factors that are strongly implicated in at least some patients include gastrointestinal infection and inflammation and chronic stress. Diagnosis is based on positive symptoms and absence of any alarm indicators. Treatment remains unsatisfactory and hinges on an excellent doctor-patient relationship, with drugs for symptom exacerbations. Cognitive behavioural treatment, psychotherapy, and hypnosis could provide long-lasting benefit in some patients. Tricyclic antidepressants in low doses seem to be the most effective class of drugs for the disorder on the basis of limited data.     

Kirsner''''s inflammatory bowel disease

Very few medical textbooks have so thoroughly dominated, and even defined a field, as has Inflammatory Bowel Diseases by Joe Kirsner. Originally co-edited with Roy Shorter of Mayo Clinic, this book, beginning with its first edition in     

Irritable bowel syndrome and inflammatory bowel disease: infectious gastroenteritis-related disorders?

Infectious gastroenteritis may be one of the important factors in the development of irritable bowel syndrome (IBS), with affected individuals often categorized as having post-infectious IBS (PI-IBS), and is linked to the onset of symptoms in approximately 10–20% of patients diagnosed with IBS. Intestinal mucosal infiltration of T cells and mast cells, and enterochromaffin cell hyperplasia are significant immunological and pathological findings that reveal the pathogenesis of PI-IBS, and results of laboratory studies using animal models of PI-IBS clearly support clinical evidence. Recently, infectious gastroenteritis has also been suggested to be associated with the development of inflammatory bowel disease (IBD), and various studies have suggested that individuals with IBS or IBS-like symptoms may be susceptible to initiation of IBD. However, it is still unclear whether infectious gastroenteritis is directly or indirectly (through PI-IBS) linked to the initiation of IBD. Additional studies are necessary to understand the clinical overlap among infectious gastroenteritis, IBS, and IBD.     

MR imaging of distal ileal and colorectal chronic inflammatory bowel disease—diagnostic accuracy of 1.5 T and 3 T MRI compared to colonoscopy

Purpose

The aim of this study was to investigate the diagnostic accuracy of MR enterography (MRE) for detection of distal ileal and colorectal inflammatory bowel disease (IBD) and to evaluate whether 3 T MRI can provide a higher diagnostic performance compared to 1.5 T.

Methods

A retrospective review of patients with known or suspected IBD who underwent MRE and colonoscopy within 3 months was performed. For analysis, the bowel was divided into six segments. Compared with colonoscopy, the accuracy values for MRI diagnosis of overall and each magnetic field strength were calculated, and the differences between 1.5 T and 3.0 T were compared. The image quality was scored separately for both field strengths and compared.

Results

Eighty-eight patients were included in the study. On a patient basis, MRE had an overall sensitivity of 92.1 % and specificity of 72.0 %. On a segment basis, the sensitivity and specificity were 79.1 % and 93.6 %, respectively. Concerning severely inflamed segments, per-segment sensitivity increased from 79.1 to 94.7 %. The comparison of accuracy values between the two field strengths showed no statistically significant difference. B1 homogeneity and overall artifacts were not significantly different between 3.0 T and 1.5 T imaging. Compared to colonoscopy, MRI found four more fistulas confirmed at subsequent surgery.

Conclusions

MRI has a high diagnostic accuracy for detection of distal ileal and colorectal IBD. 3 T MRI can be considered equivalent but not superior compared to 1.5 T imaging in this context. In addition, our findings suggest MRE to be a valuable tool in detecting surgically relevant pathologies (fistulas) with higher accuracy than colonoscopy.     

The gut–brain axis in irritable bowel syndrome and inflammatory bowel disease

Research increasingly demonstrates the bidirectional communication between gut microbiota and the brain, enhancing the role of gut microbiota modulation in the treatment of central nervous system (CNS) disorders. The first five years of life are extremely important as it affects the development of gut microbiota, immune system and, consequently, the onset of psychometric alterations, particularly in genetically predisposed individuals.In this review, we focus on the link between specific microbial genera, gastrointestinal (GI) disorders, anxiety and depression and on the effects of different therapeutic strategies for mood disorders on gut microbiota.     

Outcomes of Transcatheter Aortic Valve Replacement in Mixed Aortic Valve Disease

ObjectivesThe aim of this study was to compare outcomes after transcatheter aortic valve replacement (TAVR) in patients with pure aortic stenosis (AS) (i.e., no or trivial associated aortic regurgitation [AR]) with those in patients with AS and mild or more severe AR (i.e., mixed aortic valve disease [MAVD]).BackgroundTAVR is indicated in treating patients with severe AS. Limited data exist regarding the outcomes of TAVR in patients with MAVD.MethodsA total of 1,133 patients who underwent TAVR between January 2014 and December 2017 were included. The primary outcome was all-cause mortality. The comparison was adjusted to account for post-TAVR AR development in both groups. The secondary outcomes included composite endpoints of early safety and clinical efficacy as specified in the Valve Academic Research Consortium-2 criteria. Variables were compared using Mann-Whitney, chi-square, and Fisher exact tests, while Kaplan-Meier analyses were used to compare survival.ResultsA total of 688 patients (61%) had MAVD (median age 83 years , 43% women). Among these, 17% developed mild, 2% moderate, and <1% severe post-TAVR AR. Overall, patients with MAVD had better survival compared with patients with pure AS (p = 0.03). Among patients who developed post-TAVR AR, those in the MAVD group had better survival (p = 0.04). In contrast, in patients who did not develop post-TAVR AR, pre-TAVR AR did not improve survival (p = 0.11).ConclusionsPatients with MAVD who underwent TAVR had better survival compared with patients with pure AS. This is explained by the better survival of patients with MAVD who developed post-TAVR AR, likely due to left ventricular adaptation to AR.     

New treatments for inflammatory bowel disease

ＩＮＴＲＯＤＵＣＴＩＯＮＡｌｔｈｏｕｇｈｉｎｆｌａｍｍａｔｏｒｙｂｏｗｅｌｄｉｓｅａｓｅ（ＩＢＤ）ｉｓａｐｐａｒｅｎｔｌｙｓｔｉｌｒｅｌａｔｉｖｅｌｙｒａｒｅｉｎｔｈｅＥａｓｔ，ｅｖｉｄｅｎｃｅｆｒｏｍＨｏｎｇＫｏｎｇｓｕｇｇｅｓｔｓｔｈａｔｏｖｅｒ...     

YouTube® and inflammatory bowel disease

Background and aimsNearly half of all patients with inflammatory bowel disease (IBD) use the Internet as a source of information for their disease. We analyzed the source, content and accuracy of IBD videos found on YouTube® – one of the most popular websites in the United States – and assessed the demographic variables of the viewers.MethodsThe 100 most viewed videos with relevant information on IBD were analyzed. We included only English language videos that were less than 20 min in length and primarily focused on IBD. Those with no sound/poor sound quality were excluded. More than 30 variables were analyzed.ResultsAdults of 45–54 years old (95.1%) comprised the most common age group of viewers. Forty-eight percent of videos focused on Crohn's disease (CD), 32.0% on ulcerative colitis (UC), and 20.0% on both. Overall content for patient education was poor. Videos discussing alternative treatment options were more likely to depict patients' personal experience (73.9% vs. 2.4%) (p < 0.001) and be an advertisement compared to patient education videos (78.3% vs. 0) (p < 0.001). Videos discussing patient education had a higher number of favorites (mean 25.0 vs. 5.5) (p < 0.001), comments (mean 22.0 vs. 5.0) (p < 0.022) and “likes” (mean 19.0 vs. 9.0) (p = 0.025) than the ones discussing alternative treatment options.ConclusionsYouTube® videos on IBD are popular but a poor source of patient education. Healthcare providers and professional societies should provide more educational materials using this powerful Internet tool to counteract the misleading information, especially for the targeted age group (45–54 years).     

Endoscopic monitoring in small bowel transplantation

ＥｎｄｏｓｃｏｐｉｃｍｏｎｉｔｏｒｉｎｇｉｎｓｍａｌｂｏｗｅｌｔｒａｎｓｐｌａｎｔａｔｉｏｎＬＩＹｏｕＳｈｅｎｇ，ＬＩＪｉｅＳｈｏｕ，ＬＩＮｉｎｇ，ＪＩＡＮＧＺｈｉＷｅｉ，ＬＩＹｕａｎＸｉｎａｎｄＬＩＸｉａｏＨｕａＳｕｂｊｅｃｔｓｈｅａｄｉ...     

Kirsner＇s inflammatory bowel disease

Very few medical textbooks have so thoroughly dominated,and even defined a field, as has Inflammatory Bowel Diseases by Joe Kirsner. Originally co-edited with Roy Shorter of Mayo Clinic, this book, beginning with its first edition in 1975, encapsulated the science and art of caring for patients with Crohn‘s disease and ulcerative colitis. Thus it is with considerable respect, and indeed some awe and trepidation,that we eagerly embraced the opportunity to assume the editorship of this preeminent textbook and the obligation to transition it to reflect the changing, increasingly complex pathophysiology and treatment of these diseases.