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Query: UMLS:C1291077 (bloating)
 1,674 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The small bowel is a hollow organ involved in the transit and absorption of food. In relation to its anatomical location, a significant amount of this organ is exposed in whole or in part to ionizing radiation in external radiotherapy during abdominal or pelvic irradiation either for primary cancers or metastasis. The acute functional changes during external beam radiation are mainly leading to diarrhea, abdominal pain and bloating. The main late side effects of irradiation of the small intestine are chronic diarrhea, malabsorption with steatorrhea, abdominal spasms, intestinal obstruction, bleeding and fistulas. The architecture of the small intestine may be considered as parallel with a significant correlation between the irradiated volume of small bowel and the likelihood of acute toxicity, whatever the dose. The literature analysis recommends to consider the volume of small bowel receiving 15 Gy (threshold of 100 to 200 cm(3)) but also 30 and 50 Gy (thresholds of 35 to 300 cm(3), depending on the level of dose considered). Modern techniques of conformal radiotherapy with modulated intensity will probably have beneficial impact on small bowel toxicity.
Cancer Radiother 2010 Jul
PMID:[Normal tissue tolerance to external beam radiation therapy: small bowel]. 2148 45

Functional dyspepsia includes one or more of four cardinal symptoms: postprandial fullness, early satiety, pain or burning in the epigastrum. According to the Rome III diagnostic criteria for functional dyspepsia, these symptoms must be present for the last 3 months with symptom onset at least 6 months prior to diagnosis. Functional dyspepsia is not the result of an underlying structural abnormality, but rather the consequence of multiple pathophysiological mechanisms such as abnormal gastric motility, gastric and duodenal hypersensitivity to acid, Helicobacter pylori infection. Dyspeptic patients over 50 or those with alarm symptoms should be investigated to detect any structural abnormality such as cancer, peptic ulcer or esophagitis. After structural abnormalities and gastroesophageal reflux disease are excluded the management of functional dyspepsia consists of either a test and treat approach (non invasive detection of Helicobacter pylori infection followed by eradication therapy) or empirical therapy. Although endoscopy was traditionally reserved for those patients without symptom relief after 6-8 weeks of therapy, the significant percentage of patients with functional dyspepsia with symptom breakthrough or relapse after antisecretory or prokinetic therapy discontinuation makes an initial endoscopic study a logical choice. Therapy with proton pump inhibitors yields results especially in those patients with regurgitation and epigastric burning sensation, while prokinetic agents with no extrapyramidal side effects (such as Domperidone and Itopride) alleviate satiation, bloating and nausea by accelerating gastric emptying. Second-line drugs with encouraging results in clinical trials which can be used in functional dyspepsia are low-dose tricyclic antidepressants as well as selective serotonine reuptake inhibitors.
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PMID:Functional dyspepsia: a pragmatic approach. 2118 Feb 36

Irritable bowel syndrome is a common functional disorder of the gut. The cause is not known. Symptoms can be quite variable and include abdominal pain, bloating, and sometimes bouts of diarrhea and/or constipation. It causes a great deal of discomfort and distress, but it does not permanently harm the intestine and does not lead to a serious disease, such as cancer. There are numerous treatment options in functional gastrointestinal disorders acting peripherally by influencing motility and visceral sensitivity. However, older 5-HT4 receptor agonists had limited clinical success because they were associated with changes in the cardiac function. New generation 5-HT4 receptor agonists, 5-HT, antagonists or partial antagonists are promising approaches to treat gastrointestinal dysmotility, particularly colonic diseases. A further new approach is the activation of chloride cannels within the gastrointestinal wall by the prostaglandin E metabolite lubiprostone. In patients with chronic constipation, lubiprostone produced a bowel movement, with sustained improvement in frequency as well as other constipation symptoms. Ongoing clinical trials suggest that linaclotide, a first-in-class, 14-amino acid peptide guanylate cyclase C (GC-C) receptor agonist and intestinal secretagogue is also an effective treatment for chronic constipation. The pharmacological profile suggests that orally administered linaclotide may be capable of improving the abdominal symptoms and bowel habits of patients suffering from of constipation-predominant irritable bowel syndrome and chronic constipation. Data are emerging, but the efficacy and safety profile of these agents in the treatment irritable bowel disease appears encouraging. Further randomized controlled trials are warranted.
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PMID:[New therapeutical approaches for treatment of irritable bowel syndrome]. 2118 48

Worldwide, ovarian cancer accounts for 4% of all female cancers with over 190,000 new cases diagnosed each year. The incidence rates vary considerably across the globe with the highest rates seen in Europe and the USA and low rates in Africa and Asia. Ovarian cancer has been termed a 'silent' killer with the majority of patients presenting with advanced disease due to the vague, non-specific nature of the presenting symptoms such as abdominal discomfort and bloating in 50%. The most important determinant of survival for ovarian cancer patients is the disease stage at diagnosis. Therefore there is a thrust for early detection and two large screening trials are currently underway in the UK and USA. Ovarian cancer is most commonly staged using the International Federation of Gynecology and Obstetrics (FIGO) surgical-pathological staging system. Imaging findings are not a formal component of the staging system but in clinical practice they play a significant role in the diagnosis and management of suspected ovarian cancer. Adnexal masses which are shown to have benign features on imaging can undergo simple excision at a local unit by a non-oncological gynaecologist. If a mass has malignant characteristics on imaging, then a radical surgical approach is indicated and this should be performed by a gynaecological oncological surgeon at a specialist cancer centre, as optimal cytoreductive surgery has been reported to improve outcome. This review article discusses the role of various imaging modalities in the initial assessment of an adnexal mass, the contribution to management planning and to the follow-up of patients with ovarian cancer.
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PMID:Ovarian Cancer Management: the role of imaging and diagnostic challenges. 2139 7

Dyspepsia is perhaps the most common gastrointestinal disease universally. The prevalence of dyspepsia ranges from 7-40% in population based studies worldwide. These figures vary with definition of dyspepsia used and also with the survey methodology. As with Western studies, functional dyspepsia (FD) predominates in Asia. With a decline in peptic ulcer disease and gastric cancer, the proportion of FD is set to increase further. Studies have shown FD to account for 50-70% of cases of uninvestigated dyspepsia. In Malaysia dyspepsia has been reported in up to 15% of a rural and 25% of an urban population. No racial differences were seen in the rural survey. In the urban survey, Malays and Indians were found to have significantly more dyspepsia than Chinese. No clear explanation can be found for these racial differences. In clinical practice, Malays seem to complain a lot of wind and bloating in the "stomach." This is interesting to note when you compare it with the prevalence of H. pylori which is distinctly less common amongst Malays compared to the Indians and Chinese. As with many Asian populations, many Malaysians do not consult for complains of dyspepsia. Many will self medicate and others may even bear with their complains. This is probably true in the rural population. Traditional medications are often used and these are often ethnic based. Different types of lotions for example are used for massaging the putative area in the abdomen by Malay, Chinese and Indian patients. Moxibustion and acupuncture is still practiced by Chinese traditional physicians for treatment of dyspepsia. The notion that mood disorders may underlies dyspepsia is still poorly accepted by a less educated or rural population who consider a psychiatric consultation a taboo. Amongst urban dwellers where Westernized medical care is readily available and the awareness of potential serious disease like cancer is higher, consultation for dyspepsia is certainly higher. Indeed a higher education level has been identified as independent risk factors for dyspepsia in both an urban and rural population survey in Malaysia. With greater consultation for dyspepsia, there has also been a higher demand and utilization of endoscopy services for investigation of gastrointestinal diseases in the country.
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PMID:Clinical and epidemiological perspectives of dyspepsia in a multiracial Malaysian population. 2144 6

Irritable bowel syndrome (IBS) is a common gastrointestinal disorder that leads to crampy pain, gassiness, bloating, and changes in bowel habits in the absence of any currently identifiable organic disorder. Patients with IBS may be classified by their predominant bowel habit: diarrhea-predominant, constipation-predominant, or IBS with alternating bowel movements. IBS is often associated with stress or anxiety. Although IBS can be frustrating and concerning to patients with this disorder, it does not cause permanent harm to the intestines and does not lead to a serious disease such as cancer. Although treatments exist for its symptoms, there is no known cure.
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PMID:Irritable bowel syndrome. 2187 90

Despite the relatively low prevalence, ovarian cancer is the fifth leading cause of death from cancer among women. As such, an early diagnosis for establishing a timely surgical and/or chemotherapeutic treatment is essential for improving the outcome. The most reliable, but not always straightforward, approach to diagnose ovarian cancer relies on multiple, time-consuming and expensive investigative tools. These typically include clinical presentation (i.e., pelvic or abdominal pain, urinary frequency or urgency, increased abdominal size or bloating) with pelvic examination, transvaginal ultrasonography (US), and measurement of carbohydrate antigen 125 (CA125). Although the conventional pathway to develop and market a clinically useful biomarker is challenging, recent advances in genomic and proteomic technologies have led to the identification of previously unknown candidate markers of ovarian cancer. Some of these are currently under clinical validation. The human epididymis protein 4 (HE4) has recently been approved by the Food and Drug Administration for monitoring recurrence or progression of epithelial ovarian cancer. Nevertheless, reliable clinical evidence demonstrates that HE4, used alone or in combination with CA125, substantially improves the accuracy of screening and/or disease monitoring. This chapter will review the current knowledge on biologic and clinical applications of ovarian cancer biomarkers, with particular emphasis on the newly proposed marker, HE4.
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PMID:HE4 in ovarian cancer: from discovery to clinical application. 2212 21

The patient was a 78-year-old woman with a chief complaint of abdominal bloating and constipation who was referred to us and was examined for an AV 12-15 cm, circumferential type 2 rectal cancer. The pathological diagnosis was adenocarcinoma (tub1+tub2). T4 and N2 were suspected based on the CT findings, and because the CEA value was high, the patient was treated with 7 courses of mFOLFOX6 neoadjuvant chemotherapy followed by salvage surgery(low anterior resection+D3). Examination of the surgical specimen revealed chronic inflammatory cell infiltration, including histiocytes accompanied by ulceration, and fibrosis was observed down to SS. No viable cancer cells were detected, and the tumor response was evaluated as a pathological CR. mFOLFOX6 appeared to be effective as neoadjuvant chemotherapy for advanced rectal cancer.
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PMID:[Complete clinical and pathological response to mFOLFOX6 neoadjuvant chemotherapy in a case of advanced rectal cancer]. 2250 2

Gastrointestinal (GI) symptoms including abdominal pain, bloating and diarrhoea are a relatively common reason for consulting a physician. They may be due to inflammatory bowel disease (inflammatory bowel disease; Crohn's disease, ulcerative colitis and indeterminate colitis), malignancy (colorectal cancer), infectious colitis or irritable bowel syndrome (IBS). Differentiation between these involves the use of clinical, radiological, endoscopic and serological techniques, which are invasive or involve exposure to radiation. Serological markers include C-reactive protein, erythrocyte sedimentation rate and antibodies (perinuclear antineutrophil cytoplasm antibody and anti-Saccharomyces cerevisiae antibody). Faecal markers that can aid in distinguishing inflammatory disorders from non-inflammatory conditions are non-invasive and generally acceptable to the patient. As IBS accounts for up to 50% of cases presenting to the GI clinic and is a diagnosis of exclusion (Rome III criteria), any test that can reliably distinguish IBS from organic disease could speed diagnosis and reduce endoscopy waiting times. Faecal calprotectin, lactoferrin, M2-PK and S100A12 will be reviewed.
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PMID:Faecal markers of gastrointestinal inflammation. 2281 30

Metformin may exert anti-cancer effects through indirect (insulin-mediated) or direct (insulin-independent) mechanisms. We report results of a neoadjuvant "window of opportunity" study of metformin in women with operable breast cancer. Newly diagnosed, untreated, non-diabetic breast cancer patients received metformin 500 mg tid after diagnostic core biopsy until definitive surgery. Clinical (weight, symptoms, and quality of life) and blood [fasting serum insulin, glucose, homeostasis model assessment (HOMA), C-reactive protein (CRP), and leptin] attributes were compared pre- and post-metformin as were terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) and Ki67 scores (our primary endpoint) in tumor tissue. Thirty-nine patients completed the study. Mean age was 51 years, and metformin was administered for a median of 18 days (range 13-40) up to the evening prior to surgery. 51 % had T1 cancers, 38 % had positive nodes, 85 % had ER and/or PgR positive tumors, and 13 % had HER2 overexpressing or amplified tumors. Mild, self-limiting nausea, diarrhea, anorexia, and abdominal bloating were present in 50, 50, 41, and 32 % of patients, respectively, but no significant decreases were seen on the EORTC30-QLQ function scales. Body mass index (BMI) (-0.5 kg/m(2), p < 0.0001), weight (-1.2 kg, p < 0.0001), and HOMA (-0.21, p = 0.047) decreased significantly while non-significant decreases were seen in insulin (-4.7 pmol/L, p = 0.07), leptin (-1.3 ng/mL, p = 0.15) and CRP (-0.2 mg/L, p = 0.35). Ki67 staining in invasive tumor tissue decreased (from 36.5 to 33.5 %, p = 0.016) and TUNEL staining increased (from 0.56 to 1.05, p = 0.004). Short-term preoperative metformin was well tolerated and resulted in clinical and cellular changes consistent with beneficial anti-cancer effects; evaluation of the clinical relevance of these findings in adequately powered clinical trials using clinical endpoints such as survival is needed.
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PMID:Metformin in early breast cancer: a prospective window of opportunity neoadjuvant study. 2293 30


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