Irritable bowel syndrome

Of easily readable size and presenting its material in an attractive format, this work is oriented toward the medical student. It covers the subject under major headings of splanchnic circulation, motor mechanisms, secretion, digestion, and absorption. The bibliography is brief, and controversial points generally are passed over. Although opinions differ over what the medical student should be taught and how material should be presented, coverage certainly offers an adequate background in most areas of gastrointestinal physiology. Hepatic physiology, however, is incompletely examined, and the authors seem not to have decided how to approach this complicated subject. Perhaps hepatic physiology, now so extensive, can be covered adequately only in a separate volume. Some of the material is presented and discussed in a confusing or inadequate manner, especially for a book designed as an introductory text for students. For example, the authors mention results obtained by using a Pavlov pouch, but they

Physiology of the Gastrointestinal Tract

AGA technical review on anorectal testing techniques

The irritable bowel syndrome is a common chronic disorder having a broad clinical spectrum of severity. Although only a small proportion of those afflicted seek medical help for their symptoms, a subset have severe and intractable symptoms. A positive diagnosis should be established from the history and physical examination; endoscopic and radiologic investigations should be minimized. We suggest that the physician also assess the severity of the illness based on its symptomatic and functional features and the patient's behavioral response. Classifying the disorder in this manner permits a graduated treatment approach that emphasizes education, reassurance, and dietary adjustment for mild symptoms. Moderate symptom severity requires, in addition, identification and modification of factors exacerbating symptoms, psychotherapeutic and behavioral techniques and, if a certain symptom type predominates, pharmacologic agents directed toward the presumed gastrointestinal motor dysfunction. For severe symptoms, physician-based behavior modification and psychopharmacologic agents are helpful. When the disorder is intractable, referral may be needed, for example, to a pain treatment center. In all cases, the skillful physician must ensure continued psychosocial support to enhance coping and continued focus on the palliative aspects of care rather than on cure.

The Irritable Bowel Syndrome: Review and a Graduated Multicomponent Treatment Approach

Background Although constipation can be a chronic and severe problem, it is largely treated empirically Evidence for the efficacy of some of the older laxatives from well-designed trials is limited Patients often report high levels of dissatisfaction with their treatment, which is attributed to a lack of efficacy or unpleasant side-effects Management guidelines and recommendations are limited and are not sufficiently current to include treatments that became available more recently, such as prokinetic agents in Europe Purpose We present an overview of the pathophysiology, diagnosis, current management and available guidelines for the treatment of chronic constipation, and include recent data on the efficacy and potential clinical use of the more newly available therapeutic agents Based on published algorithms and guidelines on the management of chronic constipation, secondary pathologies and causes are first excluded and then diet, lifestyle, and, if available, behavioral measures adopted If these fail, bulk-forming, osmotic, and stimulant laxatives can be used If symptoms are not satisfactorily resolved, a prokinetic agent such as prucalopride can be prescribed Biofeedback is recommended as a treatment for chronic constipation in patients with disordered defecation Surgery should only be considered once all other treatment options have been exhausted

/pdf/diagnosis-and-treatment-of-chronic-constipation-a-european-2ff733yeca.pdf

Diagnosis and treatment of chronic constipation – a European perspective

As relatively little is known of human colonic motor activity either in health, or in pathological conditions, we investigated mass movements in 14 chronically constipated patients and 18 healthy volunteers. Mass movements were recorded from proximal and distal colon during 24 h (12 noon-12 noon) by a colonoscopically positioned multilumen manometric probe and low compliance infusion system. Patients and controls differed significantly in the number (mean 2.6 (0.7) v 6.1 (0.9) (SE), p = 0.02) and duration (mean 8.2 (1.6) v 14.1 (0.8) s, p = 0.04) of mass movements. The data suggest that one pathophysiological mechanism of constipation may be decreased propulsive activity. A circadian pattern, with a significant difference between day and night distribution, was documented in both groups. The patients reported decreased defecatory stimulus concomitant with the mass movements.

https://gut.bmj.com/content/gutjnl/29/9/1173.full.pdf

Colonic mass movements in idiopathic chronic constipation.

Nifedipine reduces the colonic motor response to eating in patients with the irritable colon syndrome.

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