Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0022104 (irritable bowel syndrome)
 8,033 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A patient over 40 years of age who complains of lower abdominal pain, constipation or diarrhea or both, and increased flatulence should be suspected of having diverticulosis. When pain becomes more severe and persistent, diverticulitis must be considered. Diagnosis depends on roentgen demonstration of the presence of diverticula. Sigmoidoscopy and barium enema study are essential to exclude coexisting disease but in diverticulitis may need to be postponed until severe local and systemic signs of inflammation have subsided. A number of diseases can simulate diverticulitis, and differential diagnosis may present considerable difficulty. Irritable colon syndrome and acute appendicitis may be indistinguishable clinically from diverticulitis. Differentiation from carcinoma is usually not difficult, but exclusion of coexistent carcinoma may be impossible except by resection. Ulcerative colitis is also easily distinguished except when, rarely, it coexists. Crohn's disease of the colon is less easily differentiated, especially in patients over 40, in whom the two diseases often coexist. Other colonic diseases, such as ischemic colitis, and pelvic inflammatory diseases usually show characteristic features which make them readily distinguishable from diverticulitis.
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PMID:Diagnosis and differential diagnosis of colonic diverticulitis. 103 35

The role of mycobacterial heat shock proteins (Hsp) of the 65 kilodalton Hsp family as a possible factor governing cell-mediated immune responses, leading to chronic mucosal inflammation, was examined. Purified peripheral blood mononuclear cells (PBMC) from patients with CD and ulcerative colitis (UC), and from healthy and disease controls were stimulated in culture with a highly purified, recombinant 65 kilodalton Hsp (rHsp65) of M. bovis BCG for 5 d. Cultures were then pulsed with 3H-thymidine for 24 h and uptake determined by liquid scintillation. We found that PBMC from patients with active CD exhibited a significant proliferative response to the soluble rHsp65 as compared with normal controls. In contrast, the proliferative responses of PBMC from patients with inactive CD, inactive and active UC, pancreatitis and cecal carcinoma were found to be not different from controls. Purified T cells or non-T cells of PBMC in the absence of antigen-presenting cells from active CD patients exhibited a lack of proliferative responses to the rHsp65 stimulation in culture. The data indicate an aberrant sensitization of T cells to the 65 kilodalton mycobacterial Hsp in a specific type of IBD, and thus may provide an important clue for the etiopathogenesis of Crohn's disease.
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PMID:Evidence for T lymphocyte reactivity to the 65 kilodalton heat shock protein of mycobacterium in active Crohn's disease. 128 31

IBD CT is the single best modality for diagnosis and staging of patients with suspected pancreatic carcinoma. While carefully performed real-time US is an excellent technique for determining the level and etiology of bile duct obstruction, it is of more limited value for diagnosis of tumors in the body and tail of the gland, and is less accurate than IBD CT for assessment of tumor resectability. Thus, most patients require IBD CT for accurate, nonoperative staging. ERCP and angiography continue to be useful adjunctive procedures for evaluation of patients with suspected pancreatic carcinoma, particularly for evaluation of equivocal CT or US findings. An isolated pancreatic mass, that is, a mass with no ancillary CT or US findings of carcinoma (local extension, distant metastases), is a non-specific finding and requires further evaluation with either ERCP or angiography, and perhaps most importantly, with FNAB. Other neoplasms may mimic pancreatic ductal carcinoma, particularly islet cell carcinoma and lymphoma. Pancreatitis also can result in a focal pancreatic mass, simulating a neoplasm. These diseases usually respond to therapy and thus it is essential to confirm the radiologic diagnosis of pancreatic carcinoma with biopsy, particularly if surgery is not planned or if chemoradiation therapy is anticipated.
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PMID:Radiologic diagnosis and staging of pancreatic ductal adenocarcinoma. 253 84

The MHC status of epithelial cells from 32 primary colorectal neoplasms, villous adenomata (VA; 2) and inflammatory bowel disease (IBD; 3) were evaluated using a panel of monoclonal antibodies (mAbs). Class I antigens and beta 2 microglobulin (beta 2m) were expressed on all normal, benign, inflammatory and malignant epithelia with the exception of two carcinomas. A more complex pattern of reactivity was encountered with anti-class II mAbs. Some expression was detected on normal glandular and luminal epithelium, particularly adjacent to the tumour. Inflammatory tissues, VA and 23/32 carcinomas were also antigen-positive, the proportion of stained epithelial cells ranging from 5% to 90%. Expression was usually non-coordinate, DR being the predominant specificity followed by DP and DQ, which is suggestive of independent D region gene regulation. The hypothesis that class II expression is induced in vivo by locally generated IFN gamma was not confirmed by in vitro treatment with this agent of epithelial colorectal carcinoma-derived cell lines. These provisional data suggest that although IFN gamma may be a necessary stimulus for class II expression it is insufficient and that other factors also influence the responsiveness of tumour cells in this respect.
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PMID:Expression of MHC class II products on human colorectal cancer. An immunohistological and flow cytometric study. 346 76

The purpose of this paper is to highlight the incidence and scope of lower gastrointestinal tract (GIT) diseases in the Eastern Province of the Kingdom of Saudi Arabia. Between August 1981 and April 1984, 288 patients with significant complaints and physical signs attributable to the lower GIT were prospectively evaluated. A complete patient history was taken in each case followed by physical examination, routine laboratory studies and a sigmoidoscopic examination. In 128 patients (44.5%), sigmoidoscopy and rectal and/or colonic biopsies did not reveal any pathological abnormalities. These patients were considered to have various disorders such as irritable bowel syndrome or parasitic infestation. Eighty-one patients (28%) were found to have mild to moderate non-specific colitis or proctitis. In another 49 patients (17%) the diagnosis of schistosomiasis mansoni was made. Ulcerative colitis and colorectal carcinoma were detected in only 11 (4%) and 4 (1.5%) patients respectively. In the remaining 15 patients (5%), other lower GIT diseases were found. Comparative analysis of the disease pattern in our series has demonstrated some differences from other series from within the Kingdom and also from other countries.
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PMID:The pattern of colonic diseases in the Eastern Province of Saudi Arabia. 374 90

CT was performed prior to surgery in 103 patients with colorectal carcinoma to assess its value in staging the tumor. Preoperative IBD scans had sensitivities and specificities of 72.7% and 98.9% in detection of liver metastases, 25.9% and 96% in detection of lymph node metastases, and 61.2% and 80.6% in detection of local extension. Compared with the Duke's classification, CT correctly staged only 47.5% of patients: 16.6% were upstaged, and 83.3% were downstaged. Recurrent tumors developed in 11 of 67 patients followed for more than 24 months. CT depicted recurrence in six patients scanned prior to 12 months. Routine scans obtained at 12 months depicted unsuspected tumor recurrence in three of four patients with proved recurrent disease (one patient with pulmonary metastases did not undergo CT). This study indicates that because of the poor accuracy of CT in preoperative local staging of colorectal carcinoma, it has virtually no useful clinical role in this regard. However, preoperative CT evaluation of the liver can be useful. Routine postoperative CT, combined with fine-needle aspiration biopsy, is useful for detection of recurrent tumor.
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PMID:Colorectal carcinoma evaluation with CT: preoperative staging and detection of postoperative recurrence. 394 61

The ultrasonic diagnosis "cockade sign" in patients with unexplained abdominal complaints was investigated by means of endoscopy and X-ray studies of the gastrointestinal tract. The following final diagnoses were established: gastric cancer in 24 patients (16,2%), colonic carcinoma in 31 patients (21%), intraabdominal tumor without infiltration of the GI-tract in 19 patients (12,8%), inflammatory bowel disease in 35 patients (23,6%). In 39 patients (26,4%) no inflammatory or neoplastic process of the GI-tract could be found. Most of these patients were suffering of a spastic colon. If a tumor of the gastrointestinal tract can be made visible by ultrasonography, this may shorten the diagnostic procedure. However, ultrasonic investigation of the abdomen cannot exclude an abdominal inflammatory or neoplastic process. Therefore, it is only useful as a screening procedure.
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PMID:[Clinical relevance of the "cockade phenomenon" in abdominal ultrasonic diagnosis]. 684 87

Irritable bowel syndrome and (or) non complicated diverticulosis, associated with fever, could simulate diverticulitis. Cancer of the sigmoid colon appears the main differential diagnosis, when diverticulitis is associated with an atypical or complete colonic stenosis on opaque enema, with a vesicoenteric fistula or with a peritonitis due to a colonic perforation. Even at laparotomy, a pseudotumoral diverticulitis cannot easily be differentiated from a colonic carcinoma. Acute diverticulitis of the caecum or ascending colon is usually mistaken for acute appendicitis. When massive and life-threatening bleeding occurs, the diverticular origin is difficult to assess. Bleeding due to peptic ulcer disease and thermometric ulceration being precluded, arteriography performed on emergency is necessary to differentiate between diverticular bleeding and angiodysplasia.
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PMID:[Diagnostic pitfalls of complicated colonic diverticulosis]. 776 84

A prospective study of dyspepsia was carried out in a primary referral hospital between 1974-1987 including 1540 patients of whom 1433 were seen as outpatients. The study protocol was agreed in advance and a structured questionnaire was used to elicit relevant clinical information: up to three diagnoses were permitted for each patient. The commonest principal diagnoses were duodenal ulcer (26%), functional dyspepsia (22%), and irritable bowel syndrome (IBS) (15%); alcohol related dyspepsia (4%) was as common as gastric carcinoma or symptomatic gall stones. Multiple diagnoses were common (31% given two diagnoses, and 6% given three) so that in all 2111 diagnoses were given to 1540 patients; the functional disorders (IBS and functional dyspepsia) considered together accounted for 39% of all diagnoses made. Whereas organic conditions were diagnosed by clinicians with confidence (63-98% considered 'certain'), even when given as the principal or first diagnosis IBS was considered 'certain' in only 61% and functional dyspepsia 48%. The demographic symptom data, together with information on tobacco and alcohol use, and work lost are described in detail.
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PMID:A database on dyspepsia. 830 69

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.
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PMID:Management of post-operative recurrent diverticulitis: a review of the literature. 919 13


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