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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.

Colonic Diseases↗

Diet and bowel diseases--past history and future prospects.

Changes in diet from ancient times until the present are described. Previously relatively low in energy and animal products yet high in fibre-containing foods, diets are now high in energy and animal products (particularly fat), yet contain less fibre. The changing incidences of bowel disorders and diseases are described, with assessments of the role of diet. Clearly, diet is implicated as regards predisposition to constipation, appendicitis, colorectal cancer and diverticular disease; however, a meaningful dietary role in irritable bowel syndrome, ulcerative colitis and Crohn's disease is doubtful. In South Africa the rarity of bowel diseases in rural blacks compared with whites affords valuable aetiological information about some bowel diseases. The low occurrence thereof (except inflammatory bowel disease) in Indian and coloured populations is not readily explicable. While dietary changes in whites are being widely urged in order to combat degenerative diseases, the magnitude of changes made is unlikely to reduce the occurrence of bowel diseases. The progressive westernization of the diets and lifestyles of less-privileged populations is likely to be associated with increases in the incidences of these diseases.

Black or African American↗

The role of dietary fiber in gastrointestinal disease.

The most consistent benefit of consumption of adequate dietary fiber is regular laxation; this effect alone justifies inclusion of fiber in the diet, in view of the enormous expenditure on drugs for digestive diseases. Dietary fiber has proved effective in decreasing symptoms of diverticular disease, Crohn's disease, and hemorrhoids in a limited number of small clinical studies. Fiber may also reduce the incidence of gallstone formation. Fiber is currently being touted as protection against colon cancer. However, the epidemiological and experimental data do not provide convincing evidence that fiber alone is a major determinant of risk for colon cancer. Furthermore, the data from international comparisons indicating that fiber is protective against colon cancer can be used in a similar simplistic manner to suggest that fiber may be a risk factor for stomach cancer. This should not dissuade individuals from obtaining adequate fiber from a wide variety of foods but should caution them against consumption of excessive amounts of fiber from a single source or from dietary supplements.

Animals↗

[The role of monoamine oxidase in large intestine pathology].

The activity of monoamine oxidase (MAO) was studied during functional, inflammatory and tumoral diseases of the large intestine. In the patients with the irritable colon syndrome, the enzymatic activity was decreased by 34% at the acute stage of the disease and in those with nonspecific ulcerative colitis it was increased by 44%. Follow-ups of MAO activity may serve as an indicator of the adequacy and efficiency of the treatment performed.

Adult↗

Myoelectrical activity of the sigmoid colon in patients with diverticular disease and the irritable colon syndrome suffering from diarrhoea.

It is often suggested that the irritable colon syndrome is a pre-diverticular condition and that patients with diverticular disease and predominant diarrhoea are in fact suffering from the irritable colon syndrome. In this study colonic motor function in diverticular disease (7 patients with predominant diarrhoea), in the irritable colon syndrome (7 patients with predominant diarrhoea) and in 8 normal subjects were compared. Patients with diarrhoea were matched for symptom score, stool weight and transit time. Slow wave electrical activity was measured by an intraluminal suction electrode and patients with the irritable colon syndrome displayed a predominant frequency at 3 cpm. This was not found in patients with diverticular disease. No myoelectrical evidence to link the two conditions was found.

Adult↗

Diagnostic value of ileoscopy: a report from India.

Our aim was to present a report about the usefulness of ileoscopy as an adjunct to colonoscopy, as studied in India, in the face of a dearth of such reports from the developing countries and to study the role of ileoscopy in increasing the yield of diagnosis reached and modified. In a prospective study in 66 consecutive patients undergoing colonoscopy for various indications, colonoscopy/ileoscopy was performed with a forward viewing fiberoptic colonoscope. Details of ileal mucosa, time taken to reach ileum, and length of ileum intubated were noted. Of the 66 patients undergoing colonoscopy, cecum could be reached in 62, whereas ileum was successfully intubated in 57 (86.4%). In 13 (22.5%) cases, additional information was obtained. In eight (14.4%) cases, diagnosis was established on ileoscopy. Of these, two were of lower gastrointestinal (GI) bleed (typhoid ulcer and nonsteroidal antiinflammatory drug ulcer), one had lymphoma, two had tuberculosis, and three were cases of reactive arthritis with ulcers in terminal ileum. After ileoscopy, the diagnosis was altered in five (8.7%) cases. Time taken to reach ileum from cecum was 3.3 +/- 2.5 minutes and the length of examined ileum was 17.3 +/- 7.5 cm. Ileoscopy is a useful adjunct to colonoscopy that not only helps to modify the diagnosis but also established them.

Adenomatous Polyposis Coli↗

Management of post-operative recurrent diverticulitis: a review of the literature.

Recurrent abdominal symptoms following resection for diverticular disease occur in 1-10% of patients. Not all of these patients have recurrent diverticulitis. Other conditions such as carcinoma, irritable bowel syndrome, inflammatory bowel disease and ischaemic colitis should be considered in the differential diagnosis. A thorough investigation including computerized tomography (CT) scanning, contrast studies and colonoscopy must be undertaken. The cause of recurrent diverticulitis may be the result of inadequate previous resection or progression of disease. Re-resection has been required in 0-3.1% of patients in a collected series. Re-resection may be technically demanding although permanent colostomy is usually not necessary. The best method of prevention is adequate initial resection.

Carcinoma↗

Managing diarrhoea. Current thinking.

This article reviews the assessment of a patient presenting with diarrhoea. Brief comments are provided about certain specific causes of diarrhoea. Recent changes are highlighted and reference is made to some of the available booklets and pamphlets about the various causes of diarrhoea. This educational material may be useful to both general practitioners and their patients.

Celiac Disease↗

Chronic diarrhea: evaluation and treatment.

Chronic diarrhea is defined as the passage of more than 200 g of stool per day for more than three weeks. This condition may result from decreased absorption of gastrointestinal contents or increased fluid secretion into the bowel. Although chronic diarrhea can have many etiologies, irritable bowel syndrome, lactose intolerance, dietary factors, inflammatory bowel disease and colon cancer are the causes most frequently encountered in primary care practice. An orderly work-up, beginning with a complete history an a thorough physical examination, is essential. Whenever possible, treatment should be directed at the underlying cause of the diarrheal condition. If the diarrhea persists and the etiology remains obscure, administration of opiates or bile-sequestering agents often is helpful in alleviating symptoms. New approaches to decreasing secretions, such as the use of clonidine therapy, are being studied.

Antidiarrheals↗