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)

Chronic idiopathic constipation is defined as the emission of less than 3 stools per week. Beside signs evoking a severe form (Hirschsprung's disease, idiopathic megacolon), a treatment with bran, at a dose of 20 grams per day, is instituted right away, which cures almost 60% of the patients (constipation secondary to dietetic errors). If this is not the case, the study of the colonic transit time of markers, anorectal manometry, defecation radiographs, enables to recognize various etiological forms (colonic inertia, irritable colon, anism, descending perineum, etc...) which require a specific treatment.
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PMID:[Constipation--a new approach]. 282 71

This presentation describes the progress during 1982-1986 of the OMGE Multinational Survey of patients with inflammatory bowel disease. After a brief description of the study design and protocol, the status of the survey in 1986 is presented. In all, 40 centres contributed 3175 cases at that time, data collection being meticulous via previously designed proformata. Diagnostic criteria are next discussed. Little change between 1976 and 1986 is noted, with wide congruence of diagnostic thought, now codified into a simple (and recommended) OMGE diagnostic scoring system. Patients seen prior to 1978 were reviewed in 1986. Where attempted, a follow-up of over 86% was achieved, usually more than 4 years after the original presentation involving no less than 5215 'patient-years' of observed follow-up. Following these overall considerations, details of four subprojects are annexed, each of which was presented as a 'free paper' at the 8th World Congress and concerning, respectively, the changing natural history of IBD, risks of perforation and toxic megacolon in the 1980s, IBD in elderly patients, and features associated with recurrence in Crohn's disease.
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PMID:The OMGE multinational inflammatory bowel disease survey 1976-1986. A further report on 3175 cases. 316 50

First, it is important to find out whether the patient is complaining of infrequent defaecation, excessive straining at defaecation, abdominal pain or bloating, a general sense of malaise attributed to constipation, soiling, or a combination of more than one symptom. Second, one must decide if there is a definable abnormality as a cause of the symptom(s). Is the colon apparently normal or is its lumen widened (megacolon)? Is the upper gut normal or is there evidence of neuropathy or myopathy? Is the ano-rectum normal or is there evidence of a weak pelvic floor, mucosal prolapse, major rectocele, an internal intussusception or solitary rectal ulcer? Is there any systemic component such as hypothyroidism, hypercalcaemia, neurological or psychiatric disorder or relevant drug therapy? Choice of treatment will depend on this clinical evaluation. The range of treatments available is: Reassurance and stop current treatment: Patients with a bowel obsession may take laxatives or rectal preparations regularly without need. Increase dietary fibre: Most cases of 'simple' constipation respond to increased dietary fibre, possibly with an added supplement of natural bran. Toilet training and altered routine of life: Young people particularly may need to recognise the call to stool and alter their daily routine to permit and encourage regular defaecation. Medicinal bulking agent: Ispaghula, methyl cellulose, concentrated wheat germ or bran, and similar preparations are useful when patients with a normal colon find it difficult to take adequate dietary fibre. These preparations increase the bulk of stool and soften its consistency. They may be useful for those patients with the constipated form of irritable bowel syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Clinical management of constipation. 823 32

The successful management of constipation depends on defining the patient's symptoms, excluding secondary causes, and characterizing the abnormality of defecation. Constipation without gut dilatation is found commonly in pregnancy, the elderly, and those with the irritable bowel syndrome. In addition, there is a group of patients that has intractable, severe idiopathic constipation. Some have 'slow transit' and open their bowels every 1-4 weeks. Others have a defecatory disorder with normal colonic transit. Constipation with gut dilatation is seen in Hirschsprung's disease, idiopathic megarectum and megacolon, chronic intestinal pseudo-obstruction and Chagas' disease. Constipation can also result from disturbance to the autonomic outflow of the gastrointestinal tract, and colonic function may be also affected by psychological factors. This review article discusses the presentation, investigation and management of patients with constipation.
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PMID:Review article: the management of constipation in adults. 828 Aug 17

The IBD patient should be optimistic about a potential pregnancy. Inactive IBD is not associated with decreased fertility. Inactive IBD does not affect the course of pregnancy; however, IBD has been associated with increased preterm deliveries. Active IBD during pregnancy is associated with increased stillbirths and spontaneous abortions but not with increased congenital abnormalities. Pregnancy does not cause exacerbation of previously quiescent IBD. If the disease is active at conception, it remains active or worsens in approximately two thirds of patients. Corticosteroids, sulfasalazine, and 5-ASA drugs are safe and should be used to maintain or induce remission. Antimetabolites may possibly be proved safe in the future during pregnancy but cannot yet be recommended. Both enteral nutrition and total parenteral nutrition can and should be used safely and effectively during pregnancy. Radiographs are to be used in diagnosis if an emergent condition, such as perforation or toxic megacolon, is suspected. The chance of an offspring developing IBD is about 9% but rises to 34% if both parents have IBD.
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PMID:Pregnancy and nursing. 880 43

Slow transit constipation is a clinical syndrome predominantly affecting young women, characterized by constipation and delayed colonic transit, occasionally associated with pelvic floor dysfunction. The disorder spans a spectrum of variable severity, ranging from patients who have relatively mild delays in transit but who are otherwise indistinguishable from irritable bowel syndrome patients at one extreme, to patients with colonic inertia or chronic megacolon at the other extreme. Potential mechanisms for impaired colonic propulsion include fewer colonic HAPCs or a reduced colonic contractile response to a meal. The cause of the syndrome is unclear. The treatment is primarily medical; surgery is reserved for patients with severe disease or colonic inertia. Recognition and treatment of pelvic floor dysfunction is crucial for patients treated medically or surgically. Collaborative studies are necessary to determine the pathophysiology of this disorder and to ascertain the efficacy of novel prokinetic agents.
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PMID:Slow transit constipation. 1139 38

Idiopathic slow-transit constipation is a clinical syndrome predominantly affecting women, characterized by intractable constipation and delayed colonic transit. This syndrome is attributed to disordered colonic motor function. The disorder spans a spectrum of variable severity, ranging from patients who have relatively mild delays in transit but are otherwise indistinguishable from irritable bowel syndrome to patients with colonic inertia or chronic megacolon. The diagnosis is made after excluding colonic obstruction, metabolic disorders (hypothyroidism, hypercalcemia), drug-induced constipation, and pelvic floor dysfunction (as discussed by Wald ). Most patients are treated with one or more pharmacologic agents, including dietary fiber supplementation, saline laxatives (milk of magnesia), osmotic agents (lactulose, sorbitol, and polyethylene glycol 3350), and stimulant laxatives (bisacodyl and glycerol). A subtotal colectomy is effective and occasionally is indicated for patients with medically refractory, severe slow-transit constipation, provided pelvic floor dysfunction has been excluded or treated.
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PMID:Slow-transit Constipation. 1146 89

Severe acute colitis remains a challenge at every stage of its management. Once the diagnosis of acute colitis has been made, its severity is assessed according to the clinical and pathologic criteria of Truelove and Witt, in particular by morphologic and endoscopic criteria. Their recent descriptions may be used for prognostic evaluation and to guide therapeutic decision-making. In any case, the severe and complicated forms of acute colitis (perforation, massive hemorrhage, toxic megacolon) demand surgical intervention. In less severe cases, it is important to determine specific etiologies which may respond to medical therapy (primarily infections causes). The most frequent etiology by far is Inflammatory Bowel Disease (Crohn's Disease or Ulcerative Colitis); it is not always possible to make the distinction between these two entities. The first line of medical therapy for IBD is intravenous corticosteroids (1 mg/Kg) shifting over to an equivalent oral dose promptly if there has been a good response. If corticosteroids are ineffective, the second line of treatment is Cyclosporin (2 mg/Kg); this requires specific precautions and surveillance. If neither of these therapies is effective, surgical resection is indicated. Subtotal colectomy with proximal ileostomy and rectosigmoid mucous fistula is the best interventional choice to minimize septic complications and it does not limit the possibilities for a later stage reestablishment of intestinal continuity.
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PMID:[Management of severe acute colitis]. 1367 69

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

A careful clinical evaluation, exclusion of secondary causes (eg, colonic obstruction, metabolic conditions, and drug-induced constipation), and assessments of colonic transit and rectal evacuation are necessary to ascertain whether constipation is attributable to normal colonic transit, delayed colonic transit (ie, slow-transit constipation), or a rectal evacuation disorder (with or without delayed colonic transit). Idiopathic slow-transit constipation is a clinical syndrome predominantly affecting women and is characterized by intractable constipation and delayed colonic transit. This syndrome is attributed to disordered colonic motor function and spans a spectrum of variable severity ranging from patients who have relatively mild delays in transit, but are otherwise indistinguishable from irritable bowel syndrome, at one extreme to patients with colonic inertia or chronic megacolon at the other extreme. Most patients are treated with one or more pharmacological agent. A subtotal colectomy is effective and occasionally indicated for patients with medically refractory severe slow-transit constipation, provided that pelvic floor dysfunction has been excluded or treated. Pelvic floor dysfunction can be diagnosed by the clinical features and anorectal testing. Most patients with pelvic floor dysfunction will respond to pelvic floor retraining by biofeedback therapy.
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PMID:Treatment of Severe and Intractable Constipation. 1523 4


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