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PubMed1993

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↗
PubMed1995

Common gastrointestinal syndromes diseases.

Gastrointestinal syndromes are an important contributory cause of morbidity for women, although in many cases, the gynecologist may primarily diagnose and treat uncomplicated disease. The role of endoscopy in the management of more difficult cases requires referral. The role of flexible sigmoidoscopy performed by the gynecologist for colorectal screening is intriguing.

Antacids↗
PubMed1976

Colitis cystica profunda.

Colitis cystica profunda is a benign disease characterized by variably sized mucin-filled cysts beneath the muscularis mucosae. The clinocpathologic features of five patients are described. The accumulated evidence suggests that awareness of this entity both by clinicians and pathologists with help differentiate it from carcinoma and decrease the need for radical surgery.

Adult↗
PubMed1994

[Diagnostic strategy in constipation, including irritable bowel syndrome].

Constipation is not a disease but a symptom. Underlying causes include side effects of drugs, metabolic, endocrine, neurologic, psychiatric and intestinal diseases. Constipation is part of the so-called irritable bowel syndrome. The diagnosis is based on history, physical examination and a few laboratory tests. Second-line diagnostic procedures include endoscopy, colonic transit time and physiological investigations of the anorectum like anorectal manometry or defecography.

Adult↗
PubMed1975

[Complications following colon surgery].

615 transperitoneal operations on the colon and rectum produced the following results. 377 abdominoperineal resections, anterior resections, partial and subtotal colectomies and proctocolectomies, 87 closures of colostomies and 151 operations with resection. 66% of the operations were required due to tumors. The death rate with 545 preopreratively prepared and scheduled operations was 8.1% whereas with the 70 emergency operations it was 25.7%. In 254 or 41.3% of the cases there were postoperative complications. Severe postoperative complications due to infection were the most frequent, followed by cardiopulmonary, haemorrhagic, urological and complications due to ileus. The quotient of insufficiency with the 356 anastomoses was 16%, the death rate 1.4%.

Abscess↗
PubMed2004

Tegaserod for the treatment of irritable bowel syndrome.

BACKGROUND: IBS is a complex disorder that encompasses a wide profile of symptoms. Current drug treatments for irritable bowel syndrome (IBS) are of limited value. Many target specific symptoms only. Tegaserod, a 5HT(4) partial agonist, represents a novel mechanism of action in the treatment of IBS. OBJECTIVES: The objective of this review was to evaluate the efficacy and tolerability of tegaserod for the treatment of IBS in adults and adolescents aged 12 years and above. SEARCH STRATEGY: MEDLINE 1966-November 2002 and EMBASE 1980-November 2002 were searched. The text and key words used included "tegaserod", "HTF 919", "irritable bowel", and "colonic diseases, functional". The Cochrane Central Register of Controlled Trials, the Inflammatory Bowel Disease Review Group Specialized Trials Register, and Science Citation Index were also searched. Proceedings from the British Society of Gastroenterology Annual Meeting, and Digestive Disease Week (1998-2002) were hand searched. The manufacturer of tegaserod was contacted. Relevant articles were retrieved, and their reference lists were also reviewed. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials comparing tegaserod with placebo, no treatment or any other intervention (pharmacological or non-pharmacological) in subjects aged 12 years and above with a diagnosis of IBS, focusing on clinical endpoints were considered for review. DATA COLLECTION AND ANALYSIS: Study inclusion and exclusion, data extraction and quality assessment was undertaken by two reviewers independently. Meta-analysis was performed where study populations, designs, outcomes, and statistical reporting allowed combination of data in a valid way, using the summary statistic relative risk with 95% CI. Eight short-term placebo-controlled studies fulfilled our inclusion criteria. These were predominantly conducted in women. Seven studies evaluated the efficacy of tegaserod on global gastrointestinal (GI) symptoms in patients with constipation-predominant IBS (C-IBS). One small study evaluated safety in patients with diarrhoea-predominant IBS. MAIN RESULTS: The relative risk (RR) of being a responder in terms of global relief of GI symptoms was significantly higher with tegaserod 12 mg (RR 1.19, 95% CI 1.09, 1.29) and tegaserod 4 mg (RR 1.15, 95% CI 1.02, 1.31) compared with placebo, with a number needed to treat (NNT) of 14 and 20 respectively. When all tegaserod doses were combined and compared with placebo (n=4040), the RR of being a responder was 1.17 (95% CI 1.08, 1.27), with a NNT of 17. Although the pooled results indicate statistically significant benefit with tegaserod, the a priori minimal clinically important differences set in two of the four pooled studies were not reached. Tegaserod did not significantly improve the patients' individual symptoms of abdominal pain and discomfort although bowel habit showed a statistically significant improvement with tegaserod 4 mg and there was a non-significant trend in favour of tegaserod 12 mg. When GI symptoms were assessed separately, those indicative of GI motility such as number of bowel movements and days without bowel movements were generally improved with tegaserod although the proportion of patients experiencing diarrhoea was significantly higher in the tegaserod 12 mg group compared with placebo (RR 2.75, 95% CI 1.90, 3.97), with a number needed to harm (NNH) of 20. Effects of tegaserod on GI symptoms such as bloating, stool consistency, and straining were not consistent across the studies. REVIEWER'S CONCLUSIONS: Tegaserod appears to improve the overall symptomatology of IBS but there are currently few data on its effect on quality of life. In addition, more information is needed about its efficacy in men. It would also be of interest to know whether treatment with tegaserod leads either directly, or indirectly, to changes in visceral sensitivity or psychopathology, which are also considered important in the pathophysiology of this condition.

Adolescent↗
PubMedDate not supplied

A combined flexible sigmoidoscopy and double-contrast barium enema service: initial experience.

BACKGROUND: A service has been instituted offering a combined single-stage procedure of flexible sigmoidoscopy and double-contrast barium enema (FS/DCBE). The results have been reviewed in the first 80 patients to undergo this examination (45 male: 35 female; mean age 61.4 years). METHODS: Indications for investigation were abdominal pain or suspected diverticular disease (22 patients), altered bowel habit (19), rectal bleeding (17), iron deficiency anemia (6), and miscellaneous (16). FS was followed immediately by DCBE. Radiographs were reviewed by two radiologists unaware of the FS findings. RESULTS: The extent of FS was to the proximal sigmoid or sigmoid descending colon or splenic flexure in 12.5%, and mid or distal sigmoid in 37.5%. Biopsies were performed at FS in 26 patients (33%). In 67 (84%) of DCBEs the barium coating was assessed as satisfactory or better. FS yielded pathological findings not seen at DCBE in 21 patients (26%). DCBE demonstrated additional abnormalities within the range of the FS examination in 15 patients (19%), almost entirely due to its increased sensitivity for diverticular disease. CONCLUSION: FS/DCBE is feasible as a one-stage combined procedure. The quality of DCBE following FS is satisfactory, and the extra yield of FS and its potential for biopsy make the combined FS/DCBE a useful technique in the investigation of large bowel disease.

Adult↗
PubMed1991

Case report: persistent colonic spasm concealing a carcinoma--an uncommon diagnostic pitfall of the barium enema examination.

Colonic carcinomas may be missed on the barium enema examination for a variety of perceptive, technical, and interpretive reasons. We report an uncommon source of error-persistent bowel spasm resulting in concealment of an underlying carcinoma. Awareness of this association is necessary in the effort to minimize diagnostic pitfalls of the barium enema examination.

Barium Sulfate↗
PubMed2002

[Ogilvie's syndrome. A report of 3 cases].

INTRODUCTION: Lumbar spine surgery represents a common procedure in Neurosurgery. Ogilvie's Syndrome is an infrequent complication of lumbar disc surgery, characterized by acute paralytic ileum as a result of acute colonic dilatation without mechanical obstruction. CLINICAL CASES: We present the clinical data, surgical findings and evolution of three patients operated on for large lumbar disc herniation. They presented with unilateral lumbociatic pain related with physical effort and monoradicular deficit. Diagnosis was established by CT scan and all patients were operated on through a standard laminectomy. Abdominal pain, distention and lack of bowels sounds began on the second postoperatory day. This complication was avoided by conservative treatment and parenteral administration of neostigmine. Ogilvie's Syndrome appeared in 3 cases out of more than 1000 patients undergoing lumbar disc surgery and is characterized by acute colonic dilatation including cecal distention. Other lumbar disc surgery complications such as gastrointestinal perforation, urethral injury or intra-abdominal vessels damage were excluded. Conservative treatment including parenteral neostigmine was always sucessful.

Adult↗
PubMed1999

Disturbances in large bowel motility.

Although there is a wide variability in symptoms, disorders of colonic motility are the most prominent features in irritable bowel syndrome (IBS). Stool weight is within the normal range but many patients appear to have abnormal rectal sensations. Straining even with soft stool is common. Dietary fibre stimulates ileocolonic flow and may induce more symptoms in IBS than normal. There is evidence of increased responsiveness of the IBS colon, both to the effect of eating and to stress. Defaecatory disorders are common and may reflect both increased or decreased rectal sensitivity. The normal colon is quiescent during sleep, but in IBS coma sleep is often abnormal, with more periods of arousal and the colon consequently more active. There is evidence of increased responsiveness to corticotrophin releasing factor, which mediates much of the effect of stress on the gut. Many patients show a sympathetic/vagal imbalance with relative excess of sympathetic influence in keeping with increased levels of psychological stress and anxiety. There is undoubtedly more than one cause of IBS and around 25% appear to develop symptoms after an infectious enteritis. This has effects on the entero-endocrine system which may take many years to subside.

Animals↗
PubMed2001

Lower intestinal bleeding.

Lower gastrointestinal tract bleeding is a frequent cause of physician consultations and hospital admissions. Clinical presentation is predictable and significantly influences subsequent patient management. Controversy surrounding diagnosis and treatment of lower gastrointestinal bleeding results from a surprising lack of prospective controlled data. Thus, selection of diagnostic and therapeutic manoeuvres often depends more on local expertise and availability than on an algorithm approach. Advances in endoscopic, radiological and surgical equipment and techniques offer promising new diagnostic and therapeutic modalities, particularly in concerted applications. Outcome studies on the appropriate sequence and linking of these modalities are urgently needed. The present chapter will address clinical presentation, aetiology, diagnosis and treatment of lower gastrointestinal tract bleeding.

Colitis↗
PubMed1976

Colitis cystica profunda.

The 50th reported case of colitis cystica profunda, with coexisting carcinoma in situ, was found. The diagnosis was made after a second excisional biopsy. The lesion was excised locally, and no recurrence has been observed one year after operation.

Adult↗
PubMed1986

Precancerous changes in the anal canal epithelium in resection specimens.

Systematic histological examination for precancerous changes was carried out on 139 anal canals resected for anal or colo-rectal tumours or for inflammatory bowel disease. Severe squamous dysplasia or carcinoma in situ were found in 13 of 16 anal canals harbouring variants of squamous carcinoma but not in others. The lesions were mainly or totally located to the anal transitional zone (ATZ) in 11 cases and only in 2 cases exclusively to the squamous zone below the dentate line. Dysplastic areas separate from the tumour were found in 6 of the 13 cases. Junctional melanocytic activity and atypical melanocytic hyperplasia located in the ATZ as well as the squamous zone were present in 1 of 3 cases of malignant melanoma. The findings underline the close relationship between dysplasia and invasive carcinoma in the anal canal. Further they support the concept that basaloid, mucoepidermoid and some ordinary squamous carcinomas arise in the ATZ, and that this may also be the point of origin for malignant melanoma. A search for precancerous changes for anal canal tumours should therefore include the whole ATZ, i.e. in some cases up to 2 cm above the dentate line and it should be borne in mind that the lesions may be spotty.

Adenocarcinoma↗