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

Osteoporosis occurs during childhood and adolescence as a heritable condition such as OI, with acquired disease (eg, IBD), or iatrogenically as a result of high-dose glucocorticoid therapy. However, the number of children affected by osteoporosis during youth is small compared to the numbers who will develop osteoporosis in adulthood. Prevention of adult osteoporosis requires that an optimal environment for the achievement of peak bone mass be established during the growing years. Detection of low BMD can be achieved using modalities such as DXA and pQCT. Standard radiologic studies, especially vertebral radiography, may also be helpful in children and adolescents at high risk for osteoporosis. It is critical to the development of healthy bones that adolescents have proper nutrition with adequate calcium and vitamin D intake and that they participate in regular physical activity (especially weight-bearing exercise). In the recent past, the dual goals of proper nutrition and exercise were not being achieved by many, if not most, adolescents. Those caring for adolescents should strive to educate teens and their families on the importance of dietary calcium and vitamin D as well as advocate for supportive environments in schools and communities that foster the development of healthy habits with regard to diet and exercise. In order to help identify the population at risk for osteoporosis, a bone health screen with assessment of calcium intake and determination of family history of adult osteoporosis (hip fracture, kyphosis) should be a routine part of adolescent health care. Universal screening of healthy adolescents with serum 25OHD levels is not recommended. Adolescents with conditions associated with reduced bone mass should undergo bone densitometry or other studies as a baseline, and BMD should be monitored at intervals no more frequently than yearly. Although controversy remains regarding the optimum dose of vitamin D for treatment of osteoporosis, all would agree that vitamin D should be provided, and in doses somewhat higher than previously recommended. Excessive vitamin D should be avoided. The use of bisphosphonates is recommended for the treatment of OI, as well as for treatment of select children with severe osteoporosis associated with chronic conditions that lead to frequent or painful fragility fractures. In such situations, bisphosphonates should be prescribed only in the context of a comprehensive clinical program with specialists knowledgeable in the management of osteoporosis in children.
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PMID:Bone Health in Adolescence. 2699 74

The recent development of advanced sequencing techniques has revealed the complexity and diverse functions of the gut microbiota. Furthermore, alterations in the composition or balance of the intestinal microbiota, or dysbiosis, are associated with many gastrointestinal diseases. The looming question is whether dysbiosis is a cause or effect of these diseases. In this review, we will evaluate the contribution of intestinal microbiota in obesity, fatty liver, inflammatory bowel disease, and irritable bowel syndrome. Promising results from microbiota or metabolite transfer experiments in animals suggest the microbiota may be sufficient to reproduce disease features in the appropriate host in certain disorders. Less compelling causal associations may reflect complex, multi-factorial disease pathogenesis, in which dysbiosis is a necessary condition. Understanding the contributions of the microbiota in GI diseases should offer novel insight into disease pathophysiology and deliver new treatment strategies such as therapeutic manipulation of the microbiota.
Best Pract Res Clin Gastroenterol 2016 Feb
PMID:Dysbiosis in gastrointestinal disorders. 2704 92

Patients with inflammatory bowel disease involving the colon are at increased risk for developing colorectal cancer. Colonoscopy surveillance is important to identify and treat IBD associated dysplasia. The SCENIC consensus provides evidence-based recommendations for optimal surveillance and management of dysplasia in IBD. Chromoendoscopy, with the surface application of dyes to enhance mucosal visualization, is the superior endoscopic surveillance strategy to detect dysplasia. Most dysplasia is visible, and can be endoscopically resected. Future studies should determine the effect of new surveillance strategies on the incidence of CRC and mortality in patients with IBD.
Best Pract Res Clin Gastroenterol 2016 Dec
PMID:Surveillance of patients with inflammatory bowel disease. 2793 89

Irritable bowel syndrome (IBS) is heterogeneous. Patients need proper assessment and explanation of IBS pathophysiology and appropriate therapies. A low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet effectively reduces symptoms in 75% of patients. Best treatment for those nonresponsive will depend on the pathophysiological basis for symptom genesis, with the following possible abnormalities: (i) Visceral hypersensitivity and/or enhanced gut-brain communication: a low FODMAP diet is mainly targeted for this patient group. A dietitian may also recommend antispasmodic agents, including peppermint oil. Another dietary treatment is a low food chemical diet, although this diet is often extremely limited, and therefore, not suited for some populations. Psychological therapies are also clinically beneficial. (ii) Altered motility: in patients with fast transit, a dietitian may recommend a reduction in all FODMAPs or targeted monosaccharides and disaccharides, which are more osmotic in nature. If not effective, patients may benefit from psyllium, which has an exceptional water-holding capacity aimed to promote more formed stools. Patients with slow or uncoordinated transit are often more difficult to treat. Dietary interventions have some success and usually comprise a combination of adequate fiber and fluid, osmotic laxatives, and stimulating agents such as caffeine, senna, and exercise. (iii) Altered microbiome: supplementary probiotics and prebiotics have weak evidence of efficacy with some notable exceptions. A dietitian may trial supplementary Bifidobacterium infantis or oligosaccharides, usually as an adjunct therapy. Guidance from a dietitian will encompass dietary methods to treat IBS but additionally identify where dietary treatment is not indicated to ensure that diet is correctly used and patients are not nutritionally or psychologically compromised.
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PMID:When the low FODMAP diet does not work. 2824 66

Coeliac disease (CD) develops in genetically susceptible individuals who, in response to unclear environmental triggers, develop an immune response triggered by gluten ingestion. It is now recognised as a global disease affecting about 0.7% of the world's population. The clinical presentation ranges from malabsorption to asymptomatic individuals diagnosed by screening high-risk groups. Diagnosis requires the demonstration of small intestinal villous atrophy in the presence of circulating coeliac auto-antibodies and/or an unequivocal response to a gluten-free diet (GFD). Recent guidelines suggest that, in a subset of children, duodenal biopsies can be avoided in the presence of strict symptomatic and serological criteria. While the majority of patients respond to a GFD, up to 20% of patients with CD have persistent or recurrent symptoms. There are several aetiologies for residual or new symptoms in a patient with CD on a GFD, with inadvertent exposure to gluten being the most common. Following a GFD can be challenging for patients with CD and understanding the barriers/challenges faced by patients in maintaining a GFD is crucial for compliance. Abbreviations: AGA: anti-gliadin antibodies; Anti-DGP-ab: anti-deamidated gliadin peptide antibodies; Anti-tTG-ab: anti-tissue transglutaminase antibodies; ATD: auto-immune thyroid disorders; BMD: bone mineral density; CD: coeliac disease; DH: dermatitis herpetiformis; EMA: anti-endomysial antibodies; FDR: first-degree relatives; GFD: gluten-free diet; HbA1c: haemoglobin A1c; HLA: human leucocyte antigen; IBS: irritable bowel syndrome; LMIC: low- and middle-income countries; NPV: negative predictive value; NRCD: non-responsive coeliac disease; POCT: point-of-care tests; SDR: second-degree relatives; SIBO: small intestinal bacterial overgrowth; T1DM: type 1 diabetes mellitus; ULN: upper limit of normal.
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PMID:Coeliac disease. 3009 30

OTSC Proctology is a minimally invasive sphincter-preserving technique for the surgical treatment of anorectal fistulas. It is based on a super-elastic Nitinol clip which closes the internal fistula opening to allow healing of the fistula tract. A systematic search of the literature was undertaken to identify publications about OTSC Proctology. All studies and reports identified were reviewed and evaluated to determine the feasibility, efficacy and safety of clip surgery. The assessment of all available studies with a total of more than 200 surgical cases strongly suggests that the clip procedure is safe and effective with a low rate of complications. The technique rendered convincing short and long term results with an overall healing rate of approximately 63%. Best results were achieved when OTSC Proctology was used as first-line treatment (healing rate 74%) and for cryptoglandular fistulas (healing rate 64%). However, its future clinical role for IBD-associated recurrent and anorecto-vaginal fistulas remains to be determined, due to a relatively low number of these patients in the evaluated studies. OTSC Proctology is part of the novel armamentarium for the treatment for anorectal fistulas, which is based on high-technology devices. They can be repeatedly used and even combined without causing irreversible sphincter damage.
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PMID:Minimally invasive surgical clip closure of anorectal fistulas: current status of OTSC Proctology. 3030 42

In both hernia repair and pelvic organ prolapse surgery, polypropylene (PP) meshes are increasingly used. Although these technologies offer tremendous clinical benefits, the efficacy of these implants can be hindered by the body's immunologic reaction to the implanted material. Undesirable local effects such as chronic pain have been extensively described. Systemic effects, however, are not yet reported. Because systemic effects after implantation of other biomaterials have been described, we evaluated patients with implanted PP meshes for signs and symptoms of biomaterial-related systemic illnesses. Patients referred to an Autoimmunity Clinic between January 2014 and December 2017 were analyzed. In 40 patients, mesh implants were present. These patients were evaluated for the development of a systemic illness. Thirty-two consecutive women and eight men were included in the current study. Median age at the time of operation was 49.5 years (range, 28-75 years). Eighteen patients had a hernia repair and 22 patients had a vaginal mesh implant. Thirty-nine of 40 patients presented with chronic fatigue, and 38 of 40 patients had myalgia or muscle weakness. In most patients, these symptoms started shortly after the operation. All patients fulfilled the diagnostic criteria for autoinflammatory/autoimmunity syndrome induced by adjuvants (ASIA). In addition, most patients reported localized pain and (often-invalidating) irritable bowel syndrome. One quarter of the patients had an immunodeficiency, whereas a diagnosis of well-established systemic and/or localized autoimmune diseases was made in 45% of patients. Importantly, 75% of patients had a pre-existing allergic disease. In 6 patients, the hernia mesh could be completely removed, thereby resulting in (partial) recovery of the systemic disease. In conclusion, 40 patients developed symptoms of a systemic illness after a mesh operation. All patients fulfilled the diagnostic criteria for ASIA. One quarter of the patients had an immunodeficiency, whereas in approximately half of the patients, an autoimmune disease developed. We postulate that PP mesh implants may increase the risk of developing (auto)immune diseases by acting as an adjuvant.
Best Pract Res Clin Rheumatol 2018 08
PMID:Autoinflammatory/autoimmunity syndrome induced by adjuvants (Shoenfeld's syndrome) in patients after a polypropylene mesh implantation. 3117 20

By administering an anaerobic cultivated human intestinal microbiota (ACHIM) via upper gastrointestinal route using endoscopy we aimed to rectify intestinal dysbiosis and simultaneously achieve a treatment response in IBS patients. The study population fulfilled the Rome III IBS criteria and comprised 50 patients. During 10 days, patients recorded the irritable bowel syndrome symptom severity scale (IBS-SSS) along with the Bristol stool scale and number of stools/day. The enrolled patients were categorized as follows: 37 with diarrhea, 5 with constipation and 8 with mixed symptoms. The treatment response showed reduction in a majority of patients, 32 of which with 50-point reduction of IBS-SSS and 21 with a 100-point IBS-SSS reduction. The percentage improvement was 36 (23-49) and 28 (18-38) for women and men respectively. Short-chain fatty acids were not changed. We consider fecal microbiota transplantation in the form of ACHIM as an option for the future therapeutic armamentarium in IBS. REGISTERED TRIAL: www.clinicaltrials.gov NCT02857257.
Best Pract Res Clin Gastroenterol
PMID:Therapeutic potential of an anaerobic cultured human intestinal microbiota, ACHIM, for treatment of IBS. 3159 47

Irritable bowel syndrome (IBS) is a chronic gastrointestinal symptom complex defined by abdominal pain and disturbed bowel habits over 3 months within a period of 6 months, in absence of any identifiable organic pathology. Over the years, speculations of the pathophysiology of IBS has moved from elusive central nervous symptoms impinging on psychosomatic disease, to objective signs of intestinal fermentation with abdominal bloating and intestinal dysmotility. The specific subgroup of post-infectious IBS is of special interest since it opens the possibility of dysbiosis as the pivotal point for development of IBS in association with traveler's diarrhea or antibiotic treatment with ensuing dysbiosis and abdominal symptoms that may resolve over decades. The undefined disease mechanisms that take place within the gut seem responsible for the gut-brain signaling leading to activation of brain centers that drive the clinical picture of IBS, further modulated by the patient's social background and previous lifetime events.
Best Pract Res Clin Gastroenterol
PMID:Pathophysiology of the irritable bowel syndrome - Reflections of today. 3159 51

New diagnostic techniques have advanced our knowledge about the irritable bowel syndrome. The majority of patients that we believed to have a psychosomatic disorder have received other diagnoses explaining their symptoms. Endoscopy makes it possible to diagnose celiac disease before it leads to malnutrition and allows the detection of microscopic colitis as a cause of watery diarrhea. At the severe end of the symptom spectrum enteric dysmotility marks the border at which IBS ceases to be a functional disorder and becomes a genuine motility disorder. Joint hypermobility or Ehlers-Danlos syndrome is present in a substantial proportion of patients with enteric dysmotility. Chronic intestinal pseudo-obstruction is the end-stage of a large number of very rare disorders in which failed peristalsis is the common denominator. Nutritional needs and symptom control are essential in the management of pseudo-obstruction. Home parenteral nutrition is life saving in more than half of patients with chronic intestinal pseudo-obstruction.
Best Pract Res Clin Gastroenterol
PMID:Pseudo-obstruction, enteric dysmotility and irritable bowel syndrome. 3159 55


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