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)

The association of diverticulosis with a thickened muscle wall in the pelvic colon is well known. There appeared to be a possibility that this muscular thickening might give rise to the rectosigmoidal mucosal puckering often seen through a sigmoidoscope. In 278 colonic motility studies, mucosal puckering was correlated with patient age, diverticulosis, and the symptomatology of the irritable colon syndrome. The prevalence of mucosal puckering increased with age at the same rate as that of diverticulosis, but the different percentage levels were reached some 25 years earlier in life. Mucosal puckering, which persisted in all subsequent examinations, showed no correlation with the clinical characteristics of irritable colon syndrome. Resistance of the bowel wall to distention was significantly greater in association with puckered rectosigmoidal mucosa than when the mucosa appeared smooth. It is concluded that rectosigmoidal mucosal puckering is probably caused by thickening of the underlying muscle; it is a precursor of diverticulois, and patients who have it should be kept on a high-residue diet.
Dis Colon Rectum 1975 Apr
PMID:Rectosigmoidal mucosal puckering and diverticulosis. 114 50

This study was done to understand the different available methods used to calculate colorectal transit times. A single abdominal radiograph is taken following six successive daily ingestions of the same number of identical radiopaque markers. This method correlates well (P less than 0.001) with that using a single ingestion of markers with daily x-ray films until total expulsion. In techniques used to measure colorectal transit time with multiple ingestion of markers, the number of days of ingestion depends on the kinetics of marker defecation. This was found to differ markedly in various groups of control subjects and constipated patients (P less than 0.001) and can be used to obtain reliable data, even in subjects with severe constipation. When they ingest 20 markers, constipated patients are found to retain eight or more markers three days after ingestion, and taking a plain film of the abdomen on that day is sufficient to make a diagnosis of constipation. Transit time studies are reproducible from month to month in patients with an irritable bowel syndrome. Control subjects who claim that their bowel habits are not modified by stress have shorter transit times, similar in both sexes, than those who say they are (P less than 0.001). This may explain why a large percentage of constipated patients have been found by most authors to have "normal" colorectal transit times. The choice of control subjects is thus a key element in studies of functional bowel motor disorders. Stool frequency and consistency, in health, correlate only to rectosigmoid transit time.
Dis Colon Rectum 1992 Aug
PMID:What is the meaning of colorectal transit time measurement? 164 2

A retrospective review of 27 patients undergoing anal fistulography is presented. The etiology of the 27 fistulas studied are as follows: cryptoglandular infection in 18, IBD in 7 (Crohn's 6, CUC 1), iatrogenic in 1, and foreign body perforation in 1. Twenty-six fistulograms revealed either direct communication with the anus or rectum, or abscess cavities/tracts, or both. Two fistulograms revealed no radiographic evidence of fistula (one patient had two fistulograms). In 13 of the 27 patients (48 percent) information obtained from the fistulograms revealed either unexpected pathology (n = 7) or directly altered surgical management (n = 6). We conclude that anal fistulography in properly selected patients may add useful information for the definitive management of fistula-in-ano.
Dis Colon Rectum 1991 Feb
PMID:The role of fistulography in fistula-in-ano. Report of five cases. 199 16

A prospective study was undertaken to investigate the feasibility and diagnostic yield of ileoscopy as an extension of total colonoscopy. The distal 15 to 40 cm of the terminal ileum were visualized in 400 of 555 consecutive patients submitted to total colonoscopy (72 percent). Intubation of the terminal ileum was not successful in 42 patients (8 percent), not tried in 63 (11 percent), and hampered by inadequate colonic cleansing in 50 (9 percent). We observed 13 patients with terminal ileitis and seven rare findings such as nonspecific ileal ulcer or non-Meckelian diverticulum, etc., adding to a total of 20 pathologic findings in 400 examinations (5 percent). In a further group of 98 patients, useful diagnostic information was gained by the demonstration of normal ileal findings, making ileoscopy clinically valuable in 118 of 400 examinations (29.5 percent) in this series. We suggest routine endoscopy of the terminal ileum in all patients with suspected or established inflammatory bowel disease and/or persistent diarrhea, lower gastrointestinal tract bleeding, or irritable bowel syndrome, in whom the diagnostic procedure includes colonoscopy. In patients with colorectal tumors or polyps, the diagnostic yield will be unrewarding.
Dis Colon Rectum 1985 Jul
PMID:Endoscopy of the terminal ileum. Diagnostic yield in 400 consecutive examinations. 401 10

We present a case of solitary nonspecific ileal ulcer found by coloileoscopy in a patient with previously assumed irritable bowel syndrome. Follow-up endoscopies two weeks after initiation of short-term prednisone therapy, and again four months later, demonstrated rapid and persistent healing. This observation raises the question of whether or not primary ileal ulcers are indeed as rare as previously assumed when only surgical and autopsy findings were taken into consideration. Also, the natural history of this clinical entity, in general, could be somewhat more benign than suggested by those ulcers in which complications make surgery necessary, since these cases may not adequately reflect the full clinical spectrum of nonspecific small-bowel ulcers.
Dis Colon Rectum 1983 Nov
PMID:Solitary nonspecific ileal ulcer. Diagnosis by coloileoscopy in a patient with previously assumed irritable bowel syndrome. 662 47

The authors have investigated the frequency with which the rectum contains feces by recording the presence or absence of fecal contamination of the membrane or of discoloration by feces of the contents of dialysis bags placed in the unprepared rectum for one hour. Feces were present in the rectum in 31 per cent of 32 studies in normal control subjects, in 49 per cent of 80 studies in obese subjects (P less than 0.05 from controls), in 36 per cent of 28 studies in patients with the irritable bowel syndrome, and in 31 per cent of 103 studies in patients with ulcerative proctocolitis, whether or not they had diarrhea. Fecal staining of the bag and its contents occurred much more frequently in 27 studies in subjects with various other diarrheal diseases (67 per cent, P less than 0.02 from controls), including eight with steatorrhea (87 per cent, P less than 0.02 from controls). The frequency with which feces were present was unaffected by age, sex, or time of day of the study. These results provide quantitative support for the assertion that in subjects without diarrhea the rectum is usually empty. In patients with diarrhea or steatorrhea and no distal large intestinal inflammation, however, the rectum usually does contain fecal material.
Dis Colon Rectum
PMID:Is the rectum usually empty?--A quantitative study in subjects with and without diarrhea. 731 23

Prokinetic agents are currently being investigated as potential therapies for motility disorders of the lower gastrointestinal tract. Cholinergic agonists such as bethanechol are known to improve postoperative ileus but are limited because of side effects. Dopamine antagonists such as domperidone appear to have maximal prokinetic effect in the proximal gastrointestinal tract and are effective for such conditions as gastroparesis and gastroesophageal reflux, but they appear to have little physiologic effect in the colon or in colonic motility disorders. Naloxone, an opioid antagonist, appears to hold promise in patients with irritable bowel syndrome, small intestinal pseudo-obstruction, and constipation. Erythromycin exerts its prokinetic effect by acting as a motilin agonist; it has been used in the treatment of diabetic gastroparesis and appears to improve symptoms of colonic pseudo-obstruction and postoperative ileus. Metoclopramide, a combined cholinergic agonist and dopamine antagonist, is currently used exclusively for proximal motility dysfunction. Cisapride appears to hold the most promise for patients with colonic motility disorders. In patients with postoperative ileus, cisapride is associated with an increased return of bowel function compared with placebo. In patients with chronic constipation, cisapride increases stool frequency and decreases laxative abuse in both adults and children. Hopefully, as an understanding of gastrointestinal motility increases, effective prokinetic agents will be developed that will improve symptoms of patients with large bowel motility disorders and may also help to predict those patients who benefit from surgical management for constipation.
Dis Colon Rectum 1993 Jul
PMID:Prokinetic agents for lower gastrointestinal motility disorders. 813 79

A study was undertaken to assess the evaluation and treatment of chronic intractable rectal pain. Sixty consecutive patients, 23 males and 37 females with a mean age of 69 (range, 29-87) years and a mean length of symptoms of 4.5 years, were evaluated by questionnaire, office examination, anal manometry, electromyography, cinedefecography, and pudendal nerve study. In all cases, organic abdominopelvic and anorectal etiologies for the pain were excluded by extensive radiologic and endoscopic evaluation. All patients had failed conservative and medical therapy. Ninety-five percent of patients had one or more associated factors: constipation or dyschezia (57 percent), prior pelvic surgery (43 percent), prior anal surgery (32 percent), prior spinal surgery (8 percent), irritable bowel syndrome (10 percent), or psychiatric disorders (depression or anxiety; 25 percent). Possible etiologies for the pain included levator spasm or anismus in 62 percent, coccygodynia in 8 percent, and pudendal neuropathy in 24 percent of patients. Therapy for pain control included electrogalvanic stimulation (EGS) in 29, biofeedback (BF) in 14, and steroid caudal block (SCB) in 11 patients. Pain control was assessed by an independent observer at a mean of 15 (range, 2-36) months after completion of therapy. Continued successful pain relief was classified by patients as good or excellent after EGS in 38 percent, after BF in 43 percent, and after SCB in 18 percent; overall success was reported by 47 percent of patients. The presence of levator spasm, coccygodynia, or pudendal neuropathy did not influence outcome. The routine use of physiologic investigation of rectal pain may not be justifiable. Moreover, more than half of the patients were refractory to all three therapeutic options used in this study.
Dis Colon Rectum 1993 Feb
PMID:Evaluation and treatment of chronic intractable rectal pain--a frustrating endeavor. 1185 48

Pelvic pain associated with menstruation, i.e., dysmenorrhea, is a chronic pelvic pain that not only interferes with a woman's wellbeing for a large part of her life but also often co-occurs with other chronic painful conditions such as interstitial cystitis and irritable bowel syndrome and others. Little has been known about mechanisms underlying these chronic pelvic pains. This paper reviews 37 years of research in my laboratory at Florida State University on such mechanisms. Our research, mostly on rats, has contributed to the following findings: (1) Female reproductive organs are innervated in a topographic fashion by afferents in the pelvic (vagina/cervix) and hypogastric (cervix/uterine horn) nerves. (2) The input contributes to uterine and vaginal perceptions (nociception) that are modified by reproductive status. (3) Throughout the CNS, neurons responsive to stimulation of the reproductive tract also respond to stimulation of skin and other internal organs, in a manner modifiable by reproductive status and peripheral pathophysiology. (4) This dynamic physiological convergence may reflect extensive anatomical divergence of and interconnections between pathways entering the CNS via gateways through the spinal cord, dorsal column nuclei, and solitary nucleus. (5) The convergence also indicates the existence of extensive cross-system, viscero-visceral interactions within the CNS, that, while organized for coherent bodily functioning, serves as a substrate by which pathophysiology in one organ can influence physiology and responses to pathophysiology in other organs. (6) Some cross-system effects observed so far include: (a) Bladder inflammation reduces the rate of uterine contractions and the effects of drugs on the uterus. (b) Colon inflammation produces signs of inflammation in the otherwise healthy bladder and uterus. (c) A surgical model of endometriosis produces vaginal hyperalgesia, exacerbates pain behaviors induced by a ureteral stone, and reduces volume voiding thresholds if the bladder. These cross-system effects, which likely involve CNS mechanisms, likely also underlie co-occurrence of painful clinical conditions. Research continues on details of these mechanisms and their relevance for clinical diagnosis and therapy. None of this work could have been done without collegial support of colleagues and technical staff at Florida State University.
 ...
PMID:A life of pelvic pain. 1613 51

Serotonin (5-HT) is most commonly thought of as a neurotransmitter in the central nervous system. However, the predominant site of serotonin synthesis, storage, and release is the enterochromaffin cells of the intestinal mucosa. Within the intestinal mucosa, serotonin released from EC cells activates neural reflexes associated with intestinal secretion, motility, and sensation. Two important receptors for serotonin that are located in the neural circuitry of the intestines are the 5-HT(3) and 5-HT(4) receptors; these are the targets of drugs designed to treat gastrointestinal disorders. 5-HT(3) receptor antagonists are used to treat nausea and emesis associated with chemotherapy and for functional disorders associated with diarrhea. 5-HT(4) receptor agonists are used as promotility agents to promote gastric emptying and to alleviate constipation. Because of the importance of serotonin in normal gut function and sensation, a number of studies have investigated potential changes in mucosal serotonin signaling in pathologic conditions. Despite the inconsistencies in the current literature, changes in serotonin signaling have now been demonstrated in inflammatory bowel disease, irritable bowel syndrome, postinfectious irritable bowel syndrome, and idiopathic constipation. Emerging evidence has led to many contradictory theories regarding serotonin signaling and its roles in the pathology of gut disorders. This review summarizes the current medications affecting serotonin signaling and provides an overview of our current knowledge of the changes in serotonin that occur in pathologic conditions.
Dis Colon Rectum 2007 Mar
PMID:Serotonin and its role in colonic function and in gastrointestinal disorders. 1719 2


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