Women's colonic digestive health.

Digestive problems in women are common and sometimes debilitating. Twenty percent of women suffer from irritable bowel syndrome, 20% have constipation, and all American women will need screening for colon cancer, the number two cause of cancer death in women. This article reviews management of these disorders as well as lower gastrointestinal symptoms associated with menses, hysterectomy, fecal incontinence, and rectal bleeding.     

Dietary fiber for constipation in older adults: a systematic review

Objective: The purpose of this systematic review is to describe and evaluate the quality and results of published trials of dietary fiber for constipation in older adults, and summarize the evidence for the effectiveness of this treatment.Methods: Published trials of dietary fiber treatment for constipation in older adults were included if they presented quantified outcomes for at least one measure of bowel function. Methodological quality was critically appraised according to defined criteria. The clinical results of randomized, controlled and/or double-blinded studies were analyzed and summarized.Results: Of 20 studies, 19 were conducted in institution-dwelling samples. Eight studies met review criteria. There were two double-blinded randomized controlled trials. Their results were contradictory. Declines in laxative use were observed in five of six studies, three of the five were unblinded. Contradictory results were reported for fecal incontinence and comfort with defecation.Conclusion: There is not strong or consistent evidence for the effectiveness of treating constipation in institution-dwelling older adults with dietary fiber. This is partly due to weak study design.     

Colorectal cancer: Etiology and pathophysiology

Much has been learned about the development of colorectal cancer. Risk factors appear to include genetic predisposition, nonspecific injury, precursor conditions such as inflammatory bowel disease and adenomatous polyps, and diet. Epidemiologic studies strongly implicate the Western diet (high fat, low fiber) in development of colorectal cancer; this has been borne out by experimental studies that indicate that high fat intake “promotes” colorectal cancer while high fiber intake plays a “protective” role. The implications for dietary modification are clear.

The fact that many colorectal cancers are locally invasive or distantly metastatic at diagnosis underscores the need for effective screening and earlier diagnosis. At present the best screening option is fecal occult blood testing; however, many problems are associated with its use, and the search for a specific, sensitive, and cost-effective screening mechanism continues. In the meantime, we must educate the public and the profession regarding early symptoms of colorectal cancer, the benefits of earlier diagnosis, and recommended screening protocols.     

Inflammatory bowel disease and irritable bowel syndrome

The irritable bowel syndrome accounts for 30 to 50 per cent of patients cared for by gastroenterology practices. Irritable bowel syndrome is more common than inflammatory bowel disease. Therefore, it should not be surprising that some patients with inflammatory bowel disease are initially told that they have irritable bowel syndrome before a diagnosis of inflammatory bowel disease is firmly established. This article contends that many people have both irritable bowel syndrome and inflammatory bowel disease.     

Cytomegalovirus colitis induced segmental colonic hypoganglionosis in an immunocompetent patient: A case report

BACKGROUNDCytomegalovirus (CMV) colitis is usually seen in immunocompromised patients with risk factors such as human immunodeficiency virus infection, solid organ transplant, inflammatory bowel disease, or malignancy. Therefore, many clinicians usually do not consider the possibility of CMV colitis in immunocompetent patients. We reported a rare case of segmental colonic hypoganglionosis associated with CMV colitis in an immunocompetent patient. CASE SUMMARYA 48-year-old woman with no underlying disease was admitted to our hospital for severe abdominal pain and constipation. Computed tomography of the abdomen showed diffuse dilatation of the small intestine and the entire colon. Initial sigmoidoscopic findings and result of polymerase chain reaction (PCR) for CMV revealed the compatible findings of CMV colitis, the patient was treated with intravenous ganciclovir. After treatment, sigmoidoscopic findings and CMV PCR results improved. However the patient continued to suffered from constipation. Eight months after the initial admission, patient visited the emergency department with severe abdominal pain and imaging revealed aggravation of fecal impaction and bowel dilatation. We performed subtotal colectomy to control patient’s symptom. Histological examination of the resected specimen showed significantly reduced number of mature ganglion cells in the sigmoid colon compared to that in the proximal colon.CONCLUSIONOur case demonstrates that CMV colitis can develop even in patients with no other underlying disease, and that CMV colitis can be one of the causes for developing colonic hypoganglionosis.     

Influence of diets high and low in animal fat on bowel habit, gastrointestinal transit time, fecal microflora, bile acid, and fat excretion.

Epidemiological observations and animal experiments suggest that large bowel cancer is related to serveral factors. Among them, high dietary intakes of animal fat, the presence in the colon of relatively high levels of bile acids, specific patterns of intestinal microflora, slow transit through the gut, and low stool weights. Under metabolic conditions we have observed the effect on these variables of dietes containing 62 or 152 g/day of fat mainly of animal origin in six healthy young men over 4-wk periods. No change attributable to the diet was observed in the subjects' bowel habit, fecal weight, mean transit time through the gut, or in the excretion of dry matter. Total fecal bile acid excretion was significantly higher on the high fat diet (320 +/- 120 mg/day) than on the low fat diet (139.7) +/- 63 mg/day) t test = 7.78 P less than 0.001 as also was the total fecal fatty acid excretion, 3.1+/-0.71 and 1.14+/-0.35 g/day, respectively t test = 11.4 P less than 0.001). The fecal microflora including the nuclear dehydrogenating clostridia were unaltered by the dietary changes as was fecal beta-glucuronidase activity. Dietary changes which increase animal fat intake clearly influence fecal bile acid excretion in a way that would favor the development of large bowel cancer if current theories prove to be true. Dietary fat however has no effect on overall colonic function so other components of the diet must be responsible for the observed associations of bowel cancer with slow transit and reduced fecal bulk.     

Self-care strategies for the management of bowel symptoms following sphincter-saving surgery for rectal cancer

The primary aim of this article is to identify the self-care strategies that patients use to manage bowel symptoms experienced following sphincter-saving surgery for rectal cancer. Comparisons will be made with self-care strategies used by patients to manage chronic fecal incontinence and the bowel symptoms associated with other chronic bowel diseases, such as irritable bowel syndrome and inflammatory bowel disease. Published studies and conceptual literature from 2000-2010 were the data sources. Three major themes emerged from the literature reflecting the self-care strategies used by patients to manage bowel symptoms: functional self-care strategies (e.g., taking medication), social activity-related self-care strategies (e.g., planning social events), and alternative self-care strategies (e.g., complementary therapies). An analysis of studies highlighted that, through the process of trial and error, patients learned the strategies that were most effective in the management of their bowel symptoms. Knowledge of such strategies will be beneficial to healthcare professionals when educating patients about effective management of bowel symptoms following sphincter-saving surgery.     

炎症性肠病患者大便失禁现状及管理的研究进展

大便失禁是炎症性肠病患者常见的症状之一,常导致患者日常人际交往和活动受限,严重影响患者的心理状态、生活及工作质量。该文概述了炎症性肠病患者大便失禁的概念、发生现状、不良影响、评估工具以及干预措施,旨在为该类患者大便失禁的管理及相关临床研究的开展提供参考依据。     

Dietary treatment in patients with irritable bowel syndrome]

The author claims that dietary treatment of irritable bowel syndrome (IBS) consists of methods aiming at improvement of abdominal symptoms and functional disorder of the bowel. Patients with constipation are recommended to take dietary fiber positively, while those with diarrhea should consume sparingly food which may cool their body. Both should avoid overeating and overdrinking, and have regular dietary habits. In order to improve the functional disorder of the bowel, it is necessary for those patients (1) to be careful not to take often refined cereals or manufactured foods, (2) to eat green and yellow vegetables and seaweeds positively, as well as, protein and fat in proper quantity, and (3) to take care of the well-balanced intake of various kinds of vitamins, minerals and other nutriments.     

A comparison of mebeverine with high-fibre dietary advice and mebeverine plus ispaghula in the treatment of irritable bowel syndrome: an open, prospectively randomised, parallel group study

OBJECTIVE To compare the efficacy and acceptability of mebeverine and high-fibre dietary advice versus mebeverine and ispaghula in fixed combination in the treatment of irritable bowel syndrome in adults. DESIGN Open, prospectively randomised, parallel group comparison of mebeverine/dietary advice and mebeverine/ispaghula during an eight-week study period. SETTING General practices in the UK. PATIENTS One hundred and eleven patients with irritable bowel syndrome diagnosed by symptom profile or negative investigations between the ages of 18 and 75 years were entered. All patients had a history of abdominal pain occurring at least once a week for a period of three months or more. INTERVENTION Dosage was 135 mg of mebeverine hydrochloride, three times daily before meals, together with advice on high-fibre dietary intake, or 135 mg of mebeverine hydrochloride plus 3.5 g of ispaghula husk twice or three times daily before meals. MEASUREMENTS AND RESULTS Details of abdominal pain severity and frequency, bowel frequency and stool consistency were recorded by means of clinicians' assessments and patient diaries. Pre-treatment assessments revealed no significant differences between the two groups with respect to any of the parameters. Both treatment groups demonstrated highly significant improvements in the numbers of pain attacks and their severity; no statistically significant differences between the two groups were demonstrated. Five patients in the mebeverine/dietary advice group reported five concurrent effects and nine patients in the mebeverine/ispaghula group reported 13 concurrent effects. All of the mebeverine/dietary advice group found their treatment acceptable but up to 28% of the mebeverine/ispaghula group found their treatment unpalatable. CONCLUSION Both treatments are effective in the treatment of irritable bowel syndrome in adults. The fixed combination of mebeverine/ispaghula, however, was found to be unpalatable by up to 28% of the patients in that group. There does not, therefore, appear to be any advantage in using fixed combination therapy in this condition.     

Evolving molecular targets in the treatment of nonmalignant gastrointestinal diseases

Novel treatments for gastrointestinal (GI) diseases are based on molecular targets. Novel pharmacologic and biological agents with greater selectivity and specificity are being developed for a variety of epithelial diseases, including eosinophilic esophagitis (EoE), gastroesophageal reflux disease (GERD), celiac disease, short bowel syndrome (SBS), and inflammatory bowel diseases (IBDs; Crohn's disease and ulcerative colitis). Motility and secretory agents are being developed for gastroparesis, irritable bowel syndrome (IBS), functional constipation, and diarrhea. Here we focus on data from clinical trials involving validated pharmacodynamic or patient response outcomes.     

Irritable bowel syndrome

Irritable bowel syndrome is a common gastrointestinal disorder characterized by abdominal pain and a change in bowel habits. It is estimated to occur in 9% to 22% of the US population, and is more often diagnosed in women than in men. There are no diagnostic markers for irritable bowel syndrome and no evidence of organic disease. Moreover, the pathophysiology is not completely understood; however, abnormal gastrointestinal motility, altered sensory activity, central neural dysfunction, psychological disturbances, and luminal factors have been proposed. Treatment requires a multifaceted approach. Education, dietary measures, fiber supplementation, and pharmacological and psychological interventions have been used in the management of this disorder.     

Diet triggers symptoms in women with irritable bowel syndrome. The patient's perspective.

The purpose of this phenomenological analysis was to describe perceptions of women with irritable bowel syndrome regarding the relationship of diet to their symptoms. Thirty-five women ages 18-45 with a medical diagnosis of irritable bowel syndrome or symptoms compatible with a diagnosis of irritable bowel syndrome were interviewed and completed questionnaires as part of a larger study. During the interview, the women were asked what they thought caused their symptoms. Overall, women tried to adjust their diet to achieve a "Range of Comfort" so their symptoms were tolerable or manageable. To do this, women used a process of "Trial and Error." If a link could be made to diet, then women developed "Self-care Strategies" to maintain a "Healthy Diet." Women who failed to find a relationship during the "Trial and Error" process either felt the frustration of "Uncertainty" or, for a few women, decided that adjusting their diet was not worth the bother. This study suggests diet and eating behaviors are an important starting point for many women as they try to manage their irritable bowel syndrome symptoms.     

Diagnostic approach to chronic constipation in adults

Constipation is traditionally defined as three or fewer bowel movements per week. Risk factors for constipation include female sex, older age, inactivity, low caloric intake, low-fiber diet, low income, low educational level, and taking a large number of medications. Chronic constipation is classified as functional (primary) or secondary. Functional constipation can be divided into normal transit, slow transit, or outlet constipation. Possible causes of secondary chronic constipation include medication use, as well as medical conditions, such as hypothyroidism or irritable bowel syndrome. Frail older patients may present with nonspecific symptoms of constipation, such as delirium, anorexia, and functional decline. The evaluation of constipation includes a history and physical examination to rule out alarm signs and symptoms. These include evidence of bleeding, unintended weight loss, iron deficiency anemia, acute onset constipation in older patients, and rectal prolapse. Patients with one or more alarm signs or symptoms require prompt evaluation. Referral to a subspecialist for additional evaluation and diagnostic testing may be warranted.     

Diagnosis and differential diagnosis of colonic diverticulitis.

A patient over 40 years of age who complains of lower abdominal pain, constipation or diarrhea or both, and increased flatulence should be suspected of having diverticulosis. When pain becomes more severe and persistent, diverticulitis must be considered. Diagnosis depends on roentgen demonstration of the presence of diverticula. Sigmoidoscopy and barium enema study are essential to exclude coexisting disease but in diverticulitis may need to be postponed until severe local and systemic signs of inflammation have subsided. A number of diseases can simulate diverticulitis, and differential diagnosis may present considerable difficulty. Irritable colon syndrome and acute appendicitis may be indistinguishable clinically from diverticulitis. Differentiation from carcinoma is usually not difficult, but exclusion of coexistent carcinoma may be impossible except by resection. Ulcerative colitis is also easily distinguished except when, rarely, it coexists. Crohn's disease of the colon is less easily differentiated, especially in patients over 40, in whom the two diseases often coexist. Other colonic diseases, such as ischemic colitis, and pelvic inflammatory diseases usually show characteristic features which make them readily distinguishable from diverticulitis.     

Inhibition of colonic motility by cholecystokinin.

Distal colonic motor activity was measured in 12 control subjects and seven constipation-predominant irritable bowel syndrome patients to examine the effects of intravenous administration of cholecystokinin. In the basal state, no significant motility differences were noted between these two groups. Following the intravenous administration of the hormone cholecystokinin, a statistically significant reduction in colonic motility in control subjects and a non-significant decrease in motility in irritable bowel syndrome patients was seen. Our results do not suggest an exaggeration of the colonic motor response to cholecystokinin occurs in irritable bowel syndrome.     

Irritable bowel syndrome: treatment update

Patients with irritable bowel syndrome may be classified as "psychologic reactors," "food reactors" or "mixed reactors." The management approach is tailored to the reactive pattern. Education and reassurance are paramount in the management of irritable bowel syndrome. Psychologic reactors may benefit from antidepressant therapy, psychotherapy, relaxation training and biofeedback. Eliminating offending foods from the diet may provide relief in food reactors. Regular exercise may be especially salutary in patients with constipation.     

Antegrade continence enema for the treatment of neurogenic constipation and fecal incontinence after spinal cord injury

OBJECTIVE: To describe the effects of an antegrade continence enema stoma formed in a paraplegic man with intractable constipation and fecal incontinence. DESIGN: Case report. SETTING: Spinal cord injury unit, Veterans Affairs hospital. PARTICIPANTS: Spinal cord injury (SCI) patient with T12 paraplegia. INTERVENTION: Surgical formation of antegrade continence enema stoma. MAIN OUTCOME MEASURES: Time of bowel program care, ease of fecal elimination, safety of procedure. RESULTS: Bowel care time was decreased from 2 hours to 50 minutes daily; 6 bowel medications were discontinued; fecal incontinence was eliminated; and no surgical or medical side effects noted after the procedure. CONCLUSION: The antegrade continence enema procedure is a safe and effective means of treating intractable constipation and fecal incontinence in the adult SCI patient. This option should be considered for those persons in whom medical management of bowel care has been unsuccessful.     

The role of barium enema in detecting colorectal disease. A radiologist's perspective.

The single-contrast barium enema examination remains useful for patients with acute diseases such as bowel obstruction, diverticulitis, appendicitis, and fistulas. It is also the procedure of choice for those patients who are too elderly, debilitated, or ill to cooperate with the maneuvers necessary for a double-contrast examination. The double-contrast technique is more sensitive than the single-contrast technique for detection of polyps, early inflammatory bowel disease, and lesions of the rectum. In the older population, there has been an increase in the incidence of colonic polyps and carcinomas in the right side of the colon. This emphasizes the need to examine the entire colon in these patients. The double-contrast barium enema is a safe, accurate, and cost-effective tool for accomplishing this. It is also recommended as the initial procedure in the examination of patients with positive results on fecal occult blood testing.