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Query: UMLS:C0022104 (irritable bowel syndrome)
 8,033 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Patients with chronic constipation may have one of several physiologic disorders, not all of which are amenable to operative therapy. The aim of this study was to test colonic and pelvic floor function preoperatively, to identify patients suitable for surgery based on these studies, and to determine operative outcome over time. Between 1987 and January 1991, 277 patients referred for severe symptoms of chronic intractable constipation underwent colon transit studies, measurement of anal canal pressures and reflexes, and measurements of anorectal angle movements and efficiency of evacuation. Balloon expulsion studies, electromyography of the pelvic floor, and defecating proctograms also were done. Based on these studies, patients were categorized as having: slow transit constipation (STC), 29 patients; pelvic floor dysfunction (PFD), 37 patients; STC + PFD, combined slow transit and pelvic floor dysfunction, 14 patients; and irritable bowel syndrome (IBS), 197 patients. Slow transit constipation patients underwent abdominal colectomy and reanastomosis. Pelvic floor dysfunction patients underwent pelvic floor retraining only. Patients with STC + PFD underwent pelvic floor retraining followed by abdominal colectomy. Irritable bowel syndrome patients were treated symptomatically. Among the 38 patients operated on (STC and STC + PFD), there was no operative mortality. Prolonged ileus developed in 13%, and small bowel obstruction occurred in 11% of patients. On follow-up, a mean of 20 months after ileorectostomy, no patient was constipated, none required a laxative, and none was incontinent. The mean number of stools per day was four. The authors concluded that a prospective evaluation of colonic and pelvic floor function reliably delineated constipated patients with slow transit, suitable for operative management, from those with pure pelvic floor dysfunction or irritable bowel syndrome, who were not. Abdominal colectomy and ileorectostomy in the slow transit patients was safe and effective, resulting in prompt and prolonged relief of constipation.
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PMID:Evaluation and surgical treatment of severe chronic constipation. 195 96

Motility disturbances of the small and large intestines are based on changes in the smooth-muscle potential, whereby the number of amplitudes and configuration of slow waves and of spike potentials as well as pattern, speed of propagation, and duration of the MMC are of crucial importance. Whereas the electromechanical principles of intestinal motility are sufficiently known, changes in the electromechanical activity in clinically manifest motility disturbances have as yet not been given due regard. Only recently, electromechanical measurements in the upper gastrointestinal tract and colon were performed in several gastrointestinal diseases of internal medicine. In the small intestine, changes in slow waves, spike potentials, and the MMC could be disclosed which are typical for hyperthyrosis, hypothyrosis, irritable bowel syndrome, bacterial diarrhea, primary and secondary intestinal pseudo-obstruction, short-bowel syndrome, postoperative bowel atonia, mechanical bowel obstruction, vagotomy, and diabetic enteropathy with disturbed gastric emptying. Regarding the colon, a disturbance in the electromechanical characteristics was found in irritable bowel syndrome, bacterial overgrowth in the small bowel, chronic constipation, and idiopathic intestinal pseudo-obstruction, which is probably identical with the clinical picture of adynamic ileus. Based on a thorough examination of the literature and on own results from electromechanical measurements in children, electromechanical disturbances have been narrowly defined.
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PMID:Electrophysiological principles of motility disturbances in the small and large intestines--review of the literature and personal experience. 251 98

The Authors report a case of sigmoid obstruction due to endometriosis and review the literature about. Unusual localisation and difficult preoperative differential diagnosis with IBD and bowel carcinoma are stressed. A 45-years old woman with previous history of oophorectomy was admitted at the hospital with symptomatic bowel obstruction. A barium enema showed a sigmoid stenosis thought to a carcinoma of bowel. A laparoscopic approach confirmed the diagnosis and a laparotomy was performed with a subsequent anterior resection (end-to-end anastomosis with stapler) plus myomectomy. The Authors do believed, during surgery, to be treating a carcinoma which disappeared with opening the specimen. The mucosa were intact and muscular layers so think to form a strong ring to be able to invaginate the upper colon for 3-4 cm. A stromal tumor was supposed and the definite diagnosis of endometriosis was very surprisingly. Intestinal resection to be necessary, with associated salpingo-oophorectomy and hysterectomy in older patients and treatment with oral contraceptive in younger female. Laparoscopy may be helpful in the diagnosis showing pelvic endometriosis with bowel wall involvement. Laparoscopic treatment in our opinion must be confirmed to particular situation and to well experience of surgeons.
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PMID:[Sigmoid occlusion due to endometriosis. A case report]. 1181 43

Eosinophilic enteritis is a rare condition of unknown aetiology, although it is generally believed to be due to intestinal allergy. It may mimic peptic ulcer, subacute (or chronic) intestinal obstruction, gastroenteritis, irritable bowel syndrome, and inflammatory bowel disease. The diagnosis is often difficult to make and most cases are only diagnosed after laparotomy/ laparoscopy and biopsy. It can be successfully treated with corticosteroids. We report a case of Eosinophilic enteritis in a 27 year old woman the symptoms of which appeared within six weeks of childbirth. With repeated episodes of abdominal pain, vomiting, occasional loose stools with weight loss, she was investigated and treated for many weeks in three hospitals without success. All investigations were inconclusive. Finally laparotomy revealed inflamed segments of small bowel, a biopsy of which showed Eosinophilic enteritis. The patient was subsequently treated successfully with Prednisolone.
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PMID:Eosinophilic enteritis--a diagnostic dilemma. 1274 85

Both irritable bowel syndrome and endometriosis are common conditions, although symptomatic gastrointestinal endometriosis is extremely rare. We report the case of a patient initially thought to have irritable bowel syndrome, in whom the diagnosis of endometriosis only became clear following a laparotomy for small bowel obstruction. This case highlights the need to question the diagnosis in patients with irritable bowel syndrome when there is any uncertainty, and also to appreciate that other pathology can arise, even when the diagnosis is secure.
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PMID:Irritable bowel syndrome or endometriosis, or both? 1450 24

Emergency complications of IBD are rare, but may be life-threatening, require surgery, and result in permanent end organ damage. The most common complications associated with UC are fulminant colitis, toxic megacolon, and bleeding. Each of these complications may resolve with aggressive medical therapy but often result in a total proctocolectomy. The most common complications associated with CD are abscesses and intestinal obstruction. Although initial treatment includes medical treatment, these Crohn's-related complications usually require a surgical intervention and intestinal resection. Finally, the most common extraintestinal manifestations that present as an emergency include thromboembolic events, ocular complications, and hepatobiliary disease. Some of these complications may parallel the course of the underlying disease and respond to IBD treatment, but thromboemboli, uveitis, and PSC do not. In the last decade there has been an explosion of knowledge and discovery into the pathogenesis of IBD. These findings have led to better and earlier treatment of IBD that it is hoped will alter the natural course of disease and prevent many of the complications outlined in this article.
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PMID:Inflammatory bowel disease emergencies. 1469 7

Chronic constipations in elderly people proved to be an important medical and social problem due to their high prevalence and serious complications caused by the very disease and administration of stimulating laxatives. They include as follows: anorectic incontinence, large intestine obstruction, stercoral ulcers, laxative dependence and bowels toxic affection (Cathartic colon). Morphological and physiological prerequisites of chronic constipation and anorectic incontinence occurrence are examined in this review. Drugs and tactics for monitoring constipations depending on their severity, dominance of transit and evacuation disturbances, occurrence of anorectic incontinence are described. Characteristics of laxatives and intestinal motility regulators, range of side effects as well as experience of their application in elderly patients with functional constipations and irritable bowel syndrome are presented.
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PMID:[Chronic constipations in elderly people]. 1556 69

Evaluation of abdominal pain requires an understanding of the possible causes(benign or malignant) and recognition of typical patterns and clinical presentation. Abdominal pain has multiple causes; associated signs and symptoms may aid in the diagnosis. Remember that some patients will not have a textbook presentation, and unusual causes for pain must be considered. Those with chronic pancreatitis with structural complications should be operated on early, whereas those with other types of chronic pancreatitis should receive medical therapy focusing on alleviating symptoms. Control of the most troublesome symptoms will provide the best management for IBS. Pharmacologic success in bowel obstruction depends on the level and degree of obstruction. Decision making is based on reasonable expectations of survival, treatment-related success, performance status, and goals of care. Quality of life will be enhanced by appropriate symptom management.
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PMID:Managing nonmalignant chronic abdominal pain and malignant bowel obstruction. 1653 Jan 16

Endometriosis is defined as the presence of endometrial tissue outside the uterus. The bowel is not often affected. There are no specific clinical findings for intestinal endometriosis. It is typically asymptomatic, but sometimes can present with abdominal pain, diarrhoea, constipation or intestinal obstruction. Ileal perforation is a rare complication of intestinal endometriosis and only a few cases have been reported in the literature. Intestinal endometriosis can mimic many gastrointestinal diseases, such as irritable bowel syndrome, inflammatory bowel disease, infections and neoplasms. The diagnosis is made by laparoscopy or laparotomy. We present a case of a woman with intermittent abdominal pain and ileal perforation secondary to intestinal endometriosis.
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PMID:[Ileal perforation secondary to intestinal endometriosis]. 1749 37

The purpose of this article is to review progress in the field of abdominopelvic adhesions and the validity of its two underlying assumptions: (1) The formation of adhesions results in infertility, bowel obstruction, or other complications. Reducing or avoiding adhesions will curb these sequelae. (2) "Adhesions" is a monolithic entity to be tackled without regard to any other condition. Evidence is discussed to validate the first assumption. We reviewed progress in the field by examining hospital data. We found a growing trend in the number and cost of discharges for just two adhesion-related diagnoses, and the low usage of adhesion barriers appears in at most 5% of appropriate procedures. Data from an Internet-based survey suggested that the problem may be partly due to ignorance among patients and physicians about adhesions and their prevention. Two other surveys of patients visiting the adhesions.org Web site defined more fully adhesion-related disorder (ARD). The first survey ( N = 466) described a patient with chronic pain, gastrointestinal disturbances, an average of nine bowel obstructions, and an inability to work or maintain family or social relationships. The second survey (687 U.S. women) found a high (co-) prevalence of abdominal or pelvic adhesions (85%), chronic abdominal or pelvic pain (69%), irritable bowel syndrome (55%), recurrent bowel obstruction (44%), endometriosis (40%), and interstitial cystitis (29%). This pattern suggests that although "adhesions" may start out as a monolithic entity, an adhesions patient may develop related conditions (ARD) until they merge into an independent entity where they are practically indistinguishable from patients with multiple symptoms originating from other abdominopelvic conditions such as pelvic or bladder pain. Rather than use terms that constrain the required multidisciplinary, biopsychosocial approach to these patients by the paradigms of the specialty related to the patient's initial symptom set, the term complex abdominopelvic and pain syndrome (CAPPS) is proposed. It is essential to understand not only the pathogenesis of the "initiating" conditions but also how they progress to CAPPS. In our ARD sample, not only was the frequency of women with hysterectomies (56%) higher than expected (21 to 33%), but also the rates of the "initiating" conditions was 40 to 400% higher in patients with hysterectomies than in those without. This may represent increased surgical trauma or the loss of protection against oxidative stress. Related was the higher frequency of ARD patients reporting hemochromatosis (HC; 5%) than expected (~0.5%) and the higher rates (20 to 700%) of initiating conditions in patients with HC than in those without HC. Together with findings related to the toxicity of Intergel, these findings raise the possibility that heterozygotes for genes regulating oxidative stress are at greater risk of developing surgical complications as well as more severe and progressive conditions such as CAPPS.
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PMID:Disorders of adhesions or adhesion-related disorder: monolithic entities or part of something bigger--CAPPS? 1875 13


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