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PubMed2005

Hypnotherapy for functional gastrointestinal disorders.

About 20% of people in the UK have functional gastrointestinal disorders such as irritable bowel syndrome and functional dyspepsia. These conditions account for about 4% of GP consultations and 50% of gastroenterologists' workload. Forsome, the symptoms affect quality of life and ability to work. Drug treatment aimed at relieving symptoms is often ineffective. Other options include psychological treatments such as cognitive behavioural therapy, brief psychotherapy and gut-directed hypnotherapy. Here we discuss whether hypnotherapy has a role in the treatment of patients with irritable bowel syndrome or functional dyspepsia.

Colonic Diseases, Functional↗
PubMedDate not supplied

Clinical experience with flexible sigmoidoscopy in asymptomatic and symptomatic patients.

The purpose of this study was to evaluate the diagnostic yield of flexible sigmoidoscopy when performed as a routine procedure in asymptomatic patients over the age of 40 being referred for a complete physical examination. The preliminary results of this ongoing program are presented together with the diagnostic yield in 408 patients with symptoms and signs suggestive of colorectal disease who were of similar age (56.6 vs. 56.5 years) and sex distribution (79 percent male) to the asymptomatic population, and who underwent flexible sigmoidoscopy as an indicated part of their evaluation. In the 122 asymptomatic patients, the mean distance examined by the procedure was 50.8 cm with the instrument being advanced beyond the optimal rigid sigmoidoscopy distance of 20 cm in 100 percent of patients. Adenomatous and hyperplastic polyps were identified in 16 patients, 13.1 percent, in the asymptomatic group, a similar percentage to the symptomatic population, 15.4 percent. Adenomatous polyps were diagnosed in 7.4 percent of the asymptomatic subjects and 9.1 percent of the symptomatic group. Colonic cancer was diagnosed in 0.8 percent of asymptomatic patients vs. 3.2 percent of the symptomatic group (p < 0.05). Seventy-seven percent of the neoplastic polyps detected in the asymptomatic patients and 60 percent in the symptomatic group were beyond 20 cm from the anus. Diverticulosis was diagnosed in a similar percentage of patients, 13.1 percent in the asymptomatic and 10.0 percent in the symptomatic group. No complications were encountered and the procedure was well tolerated without analgesia. It is concluded that: (1) in an asymptomatic population over the age of 40, flexible sigmoidoscopy, as a routine examination, results in a diagnostic yield not possible with rigid proctosigmoidoscopy and which approaches that observed in a symptomatic population of similar age; (2) for the internist trained in this procedure, flexible sigmoidoscopy has a future role in the detection of colorectal lesions and as an interval screening examination for premalignant lesions and colorectal cancer in asymptomatic and symptomatic patients.

Adenoma↗
PubMed1988

Sigmoid motility in diverticular disease and the irritable bowel syndrome.

Intraluminal pressures were measured with four open ended, water perfused tubes in the fasting state and after a standard liquid meal (400 KCal, 375 ml, protein 15 g, carbohydrate 55 g, lipid 13.4 g) in six patients with sigmoid diverticular disease, 20 with the irritable bowel syndrome and in 13 controls. The pressure sensors were positioned in the true sigmoid colon at colonoscopy at 25, 35, 45, and 55 cm from the anus. Colonic pressures were significantly higher in diverticular disease than in controls before (p less than 0.02) and after the meal (p less than 0.002), some pressure amplitudes exceeding 300 cm H2O. Patients with the irritable bowel syndrome had lower (p less than 0.05) pressures than controls before the meal. Postprandial sigmoid pressures were within the mean +/- 2 SD of controls in 10, above in two and below in eight patients with the irritable bowel. Hypercontractility of the sigmoid colon in the irritable bowel syndrome was not confirmed under the conditions of this study. The association between sigmoid diverticulosis and high intraluminal pressures is confirmed.

Adult↗
PubMed2002

Clinical and functional results after elective colonic resection in 75 consecutive patients with diverticular disease.

BACKGROUND: Functional results after elective colonic resection in patients with diverticular disease have seldom been studied. METHODS: Seventy-five consecutive patients were reviewed and sent a questionnaire about abdominal symptoms and functional results. Possible associations between patients' characteristics and postoperative complications or functional outcome were analyzed. RESULTS: Major complications including anastomotic leakage, bleeding, and bowel obstruction occurred in 10 patients (13%). Six patients (8%) had recurrent diverticulitis. No significant associations were found between clinical characteristics and postoperative complications or recurrent disease. Fifty patients classified their final result as excellent or good. Functional symptoms or symptoms suggestive of irritable bowel syndrome before the operation predicted a less successful result (P <0.05). CONCLUSIONS: Elective surgery in patients with diverticular disease was hampered by postoperative complications but resulted in most cases in good functional outcome and a low rate of recurrent disease. Those with functional bowel symptoms before surgery had significantly worse results.

Adult↗
PubMed1993

Pathophysiology of colonic motility disorders.

When no identifiable organic cause for colonic symptoms can be found, it is easy for the busy clinician to label the patient neurotic. It is evident that many of these "functional" disorders do reflect an underlying motility disorder, although our understanding is far from clear. However, currently, patients with severe constipation are evaluated in a much more rational manner and, as a consequence, are offered a reasonable therapeutic approach that can be predicted to have a good chance for success. We can hope that as our understanding of irritable bowel syndrome is strengthened, treatment will become more efficacious than the unproved and costly medications that are in use currently. Until dietary modification becomes commonplace, it is unlikely that the incidence of diverticular disease or its complications will change. Already, our understanding of ileus has allowed us to realize the benefits of laparoscopic surgery, and as our knowledge of the various gut hormones and the inhibitory role that some play in intestinal motility grows, ileus, and its resulting prolongation of hospital stay, may become less problematic.

Animals↗