[Functional disorders in gastroenterology].
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Biomedical subjects
Publications and source records attributed to E Hafter.
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Meteorism might be a symptom of organic intestinal obstruction, which needs surgical treatment in most cases. However it is often a functional phenomenon. It may be produced by aerophagy, followed by sonor, non fetid flatulence. Large amounts of gas are produced by the contact of gastric acidity with alcaline pancreatic secretion and by enzymatic digestion of food. Most of these gases are absorbed by the intestine and exhaled. In the colon bacterial fermentation and putrefaction produce fetid gas which is expulsed as flatus. Overeating, bacterial invasion of the small intestin, inflammatory and circulatory disturbances of the small bowel and obstipation favour meteorism. The treatment depends of the origin of meteorism.
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Functional disorders are frequent in elderly patients. However the high incidence of organic lesions in advanced age demands a most careful examination. Each diagnosis of functional disorders made by exclusion of organic lesions has to be revised, if symptoms persist or symptomatic treatment remains inefficient. Gastroenterological diagnostic should not be restricted to an endoscopic or radiologic glance to the gastrointestinal tract. It includes the less spectacular but more human trial to get an insight to the soul of the patient. This may be more helpful than any treatment with the newest double blind tested medication.
In the 40 years since the foundation of the "Schweizerische Gesellschaft fur Gastroenterologie", medicine - and with it gastroenterology - have markedly changed. New diseases and syndromes have been discovered and others have disappeared. New knowledge in basic sciences influences progress in diagnosis and therapy. In diagnostic methods the most evident advances are fiberendoscopy, endophotography and biopsy, and progress in roentgenology and immunology. New drugs, new surgical methods and controlled trials have improved treatment. However, each advance has its drawbacks: the growing incidence of iatrogenic diseases, the overwhelming literature, the flood of congresses, the record-breaking mentality of many clinicians and the hunting and collecting instinct for "interesting cases". "Medical art", a notion difficult to define, is in danger of disappearing. It means a harmony of knowledge, skill experience, intuition and the predominant desire to help the patient. This means individualized medicine, which is only possible by sympathetic dialogue with the patient - not only by specialists in psychiatry or psychosomatics, but by every doctor. will be able to preserve medicine from inhumanity in spite of technology, rationalization and the computer?
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