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Biomedical subjects

M H Floch

Publications and source records attributed to M H Floch.

At least 19 recordsLinked to original sources
PubMed1994

Clinical evaluation and treatment of constipation.

Constipation is a symptom but can generally be defined as less than three bowel movements per week. The history and physical examination should be evaluated for stool size, frequency, and straining and discomfort on defecation. The influence of age, gender, and society should also be considered. The etiologies of constipation can be classified as 1. dietary; 2. drug induced; 3. metabolic; 4. neurologic; or 5. anatomic. If hard or small stools are part of the initial evaluation, then a dietary approach of increased dietary fiber intake can be used as a therapeutic trial. If it does not succeed or the history and physical evaluation indicate an etiology other than dietary, then barium-contrast enema, flexible sigmoidoscopy, colonoscopy, transit time, or anorectal manometry can be used selectively in further evaluation. Detailed methods of treatment are described, such as how to increase fiber intake by use of dietary history and recommendation of appropriate fiber, food, or supplement intake. Methods of using behavioral changes such as laxation and toilet-training programs are described. In selected situations pharmacologic therapy and, rarely, surgical intervention, can be useful.

Adult↗
PubMed1993

Using enteral nutrition formulas.

A review of enteral tube feeding formulations is presented. When choosing an enteral formula product for a patient one must first determine the calorie and protein needs of the patient. Then one must determine the level of gastrointestinal tract function. First ask, to what degree is the small bowel functioning: totally, partially, or not at all? Has the small bowel lost surface area because of atrophy, inflammation, or surgical removal? Is the gut edematous because of hypoalbuminemia or congestive heart failure? Is bowel motility impaired by opioids, anticholinergics, or mechanical ileus? Is digestion limited by pancreatic or bile acid insufficiency? Has absorption been decreased by intestinal ischemia or gastrointestinal bleeding? Decreased surface area, bowel edema, and diminished digestive juices are only partial losses of small bowel function. An elemental formula should be tried first in these situations. Any of the other problems alone or in combination probably preclude the use of the small bowel and the patient will need total parenteral nutrition. If gastrointestinal function is adequate, then other organ failures that result in specific nutrient intolerance must be ruled out. If gastrointestinal function is adequate and no other organ failures preclude the use of a polymeric formula, then one must decide if stress and hypermetabolism are present. Enteral feeding is the preferred method of providing specialized nutrition support. Bowel rest reduces the barrier functions of the gut and malnutrition reduces cell-mediated immunity. The indications and relative contraindications for enteral tube feeding are also reviewed. The rationale for the formula design and the evidence for formula efficacy are presented. Polymeric, elemental, organ-specific, and immune-modulating formulas are discussed. Guidelines for formula selection are suggested.

Enteral Nutrition↗
PubMed1991

Diet and nutrition in ulcer disease.

In this era of H2-inhibitors, the available evidence does not support the need to place peptic ulcer disease patients on restrictive diets. The major goal of diet is to avoid extreme elevations of gastric acid secretion and the direct irritation of gastric mucosa. In view of this, only slight modifications in the patient's usual diet are recommended. Table 1 depicts a sample menu for chronic peptic ulcer disease. Frequent milk ingestion as previously prescribed is not encouraged. This is owing to the transient buffering effect and significant gastric acid secretion effect of milk. The fat content of milk has no influence on these effects. Spices, in particular black pepper, red pepper, and chili powder, may produce dyspepsia. One study shows red chili powder to have no detrimental effect on duodenal ulcer healing. It has also been proposed that daily pepper ingestion may have a beneficial adaptive cytoprotective response. While still controversial and under evaluation, peptic ulcer patients should avoid any spice that causes discomfort, especially during exacerbation of peptic disease. Currently, studies indicate that it is prudent to avoid alcohol. This is especially true for the concentrated forms, such as 40% (80 proof) alcohol. Coffee should be avoided on the basis of its strong acid secretagogue property. Coffee can induce dyspepsia. Whether noncoffee caffeine-containing beverages (tea, soft drinks) induce peptic ulcer is unknown, but they are acid secretion stimulators. Decaffeinated coffee has an acid stimulating effect as well. It is reasonable to have peptic ulcer patients restrict decaffeinated coffee and all caffeine-containing beverages. There appears to be no evidence to restrict dietary fiber. Some fiber-containing foods may possess factors that are protective against ulcer disease. According to the Mayo Clinic Diet Manual, previously recommended small frequent feedings have not been shown to be more effective than three meals per day in the treatment of chronic peptic ulcer disease. This reference cites authorities advising against extra feedings because of increased acid secretion and unnecessary complication of eating patterns. However, some patients claim to be relieved of symptoms with more frequent feedings, especially during acute phases. Citric acid juices may induce reflux and cause discomfort in selective patients. Stomach distention with large quantities of food should be discouraged. Although there is now little role for dietary therapy, one should note that bland and ulcer diets probably are not detrimental to most persons if they are used for a short time and may have some psychological benefit.(ABSTRACT TRUNCATED AT 400 WORDS)

Alcohol Drinking↗
PubMed1989

Dietary therapy of steatorrhea.

The dietary treatment of steatorrhea requires knowledge of the cause of the disease associated with the steatorrhea. Once the cause is established, then an approach to the dietary management can be adopted. Guidelines for treatment are reviewed in this article. Recommendations for either the treatment of the primary disease, limitation of fat intake, nutritional support, or pancreatic-enzyme replacement are made depending on the disease process. The most common disease entities causing steatorrhea are discussed in detail. Specific recommendations are made for the treatment of steatorrhea in cystic fibrosis of the child and adult, pancreatic insufficiency caused by chronic pancreatitis, gluten enteropathy, and the short-bowel syndrome. Emphasis is placed on the fact that each patient must be managed by correlating the cause of the steatorrhea with specific modalities of therapy.

Celiac Disease↗
PubMed1986

Digestion and absorption of fiber carbohydrate in the colon.

Most dietary carbohydrates are digested and absorbed in the small bowel. However, fiber carbohydrate and other carbohydrates can be metabolized by the normal flora of the colon. The substrate for bacterial fermentation includes compounds for which small bowel digestive and absorptive mechanisms may, or may not, exist and soluble and some insoluble fiber. Products of fermentation include gases and volatile fatty acids which may be absorbed or nourish the colon mucosa. Total body nutrition and metabolism may also be affected by the products digested and absorbed in the colon.

Animals↗