Natural Approach to Gastroenterology 2nd ed
by Eric Yarnell
Textbook
The eagerly anticipated second edition of this popular textbook has finally arrived, with copious updates and... more
The eagerly anticipated second edition of this popular textbook has finally arrived, with copious updates and additional insights based on Dr. Yarnell's extensive clinical practice, teaching experiences, and delineation of advances in medical research over the past ten years. Students of any medical orientation studying gastroenterology for the first time will find this new edition gives them a superior advantage in approaching this complicated system. The comprehensive material provided for each area gives the reader an in-depth understanding of how the gastrointestinal system works and how to approach its many complexities and pathologies from a holistic and integrated perspective.
Practitioners looking for rapid review, quick reminders, or new tips also find much that benefits them in Natural Approach to Gastroenterology 2nd edition. Natural and conventional information are included. Its ease of use, strong organization, clear writing, clinical usefulness, and many research references will provide the busy clinician with an invaluable resource. Rich in diagrams, algorithms, tables, and extensively indexed for rapid access of material, the book is appropriate in the clinic or the classroom.
Complete Table of Contents: Toxemia · Leaky Gut · Gut Flora · Intestinal Immune System · Enteric Nervous System · Diagnosis, Signs and Symptoms · Elevated Serum Transaminases · Metabolic Liver Disease · Alcoholic Liver Disease · Cirrhosis · Gilbert Syndrome · Hemochromatosis · Hepatocellular Cancer · Hepatitis A · Hepatitis B · Hepatitis C · Hepatoprotectives · Interferons · Cholelithiasis · Biliary Dyskinesia · Biliary Cirrhosis · Biliary Cancer · Cholecystitis · Cholagogue and Choleretics · Anal Fissure · Pruritis Ani · Hemorrhoids · Anal Fistula · Anal Cancer · Constipation · Diverticulosis · IBS · Ulcerative Colitis · Microscopic Colitis · Colon Polyps and Cancer · Colonoscopy · Diarrhea · Anthelmintic Treatment · Antimicrobial Herbs · Amebiasis · Ascariasis · Blastocystosis · Cholera · Enterobiasis · Giardiasis · Food Poisoning · Clostridium difficile · Intestinal Candidiasis · Escherichia coli Enteritis · Shigellosis · Tapeworms · Viral Diarrhea · Traveler's Diarrhea · Cryptosporidiosis · Appendicitis · Celiac Disease · Crohn's Disease · Immunosuppressive Drugs · Lactose Intolerance · Nausea and Vomiting · Functional Dyspepsia · Gastritis · Hypochlorhydria · Peptic Ulcer Disease · Helicobacter · Gastrinoma · Secretolytics · Gastric Cancer · Pernicious Anemia · Bitters · Spasmolytics/Carminatives · HiatalHernia · GERD · Barrett's Esophagus · Acid Blockers · Demulcents · Esophageal Cancer · Zenker Diverticulum · Aphthous Stomatitis · Stomatitis (Non-Aphthous) · Erythroplakia · Acute Pancreatitis · Chronic Pancreatitis · Pancreatic Cancer · Bariatric Surgery · Asplenia · Inflammation Modulators · Prokinetic Drugs · Abbreviations · Cancer Treatment · Elimination-Challenge Diet · GI Epidemiology · GI Drugs · Patient-Reported Outcome Forms
Patient experiences of MR colonography and colonoscopy: a qualitative study
by Samuel Smith
Hafeez, R., von Wagner, C., Smith, S., Boulos, P., Halligan, S., Bloom, S., Taylor, S. (in press) British Journal of Radiology
Objectives: The aim of this study was to apply qualitative techniques to assimilate data on patient experience and... more Objectives: The aim of this study was to apply qualitative techniques to assimilate data on patient experience and attitudes during MR colonography (MRC) and colonoscopy (CC). Methods: 18 patients (11 male, 7 female, median age 40.5 years), 10 of which had known colonic inflammatory bowel disease (IBD) and 7 who were under investigation for suspected colonic neoplasia (non-IBD), underwent MRC and conventional CC. Semi-structured interviews were performed to assimilate test experiences and preferences, and themes were extracted using thematic analysis. Results: Thematic analysis identified three main themes: (i) physical experience, (ii) information provision and (iii) overall preference. Patients expressed mixed views about the physical experience of MRC but specifically identified water filling, breath holding and lying still as problematic. Anxiety was expressed regarding potential incontinence. Scanner noise interfered with the understanding of instructions, particularly amongst non-IBD patients. Non-IBD patients expressed greater anxiety over the delay in receiving the MRC report than IBD patients. In general MRI was considered as the more informative and safer investigation. Patients reported more physical discomfort during CC (notably IBD patients) related to air insufflation and colonoscopic manipulation but were more satisfied with the feedback they received. 10 patients (56%) stated an overall preference for MRC and 5 (28%) preferred CC. Reasons for preferences stated by the patients included discomfort, speed of the test, safely, perceived diagnostic ability and the ability to take biopsies. Conclusion: Experiences of MRC and CC are complex and influenced by clinical indication. Individuals place different weightings on the relative importance of test attributes including discomfort, noise, immobility, feedback, safety and fear of incontinence and this defines overall preference.
Chronic constipation: an evidence-based review. Leung L, Riutta T, Kotecha J, Rosser W.
J Am Board Fam Med. 2011 Jul-Aug;24(4):436-51
BACKGROUND:
Chronic constipation is a common condition seen in family practice among the elderly and women. There... more
BACKGROUND:
Chronic constipation is a common condition seen in family practice among the elderly and women. There is no consensus regarding its exact definition, and it may be interpreted differently by physicians and patients. Physicians prescribe various treatments, and patients often adopt different over-the-counter remedies. Chronic constipation is either caused by slow colonic transit or pelvic floor dysfunction, and treatment differs accordingly.
METHODS:
To update our knowledge of chronic constipation and its etiology and best-evidence treatment, information was synthesized from articles published in PubMed, EMBASE, and Cochrane Database of Systematic Reviews. Levels of evidence and recommendations were made according to the Strength of Recommendation taxonomy.
RESULTS:
The standard advice of increasing dietary fibers, fluids, and exercise for relieving chronic constipation will only benefit patients with true deficiency. Biofeedback works best for constipation caused by pelvic floor dysfunction. Pharmacological agents increase bulk or water content in the bowel lumen or aim to stimulate bowel movements. Novel classes of compounds have emerged for treating chronic constipation, with promising clinical trial data. Finally, the link between senna abuse and colon cancer remains unsupported.
CONCLUSIONS:
Chronic constipation should be managed according to its etiology and guided by the best evidence-based treatment
Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents
Fedorowicz Z, Jagannath VA, Carter B
This record should be cited as: Fedorowicz Z, Jagannath VA, Carter B. Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents. Cochrane Database of Systematic Reviews 2011, Issue 9. Art. No.: CD005506. DOI: 10.1002/14651858.CD005506.pub5
Abstract
Background
Vomiting is a common manifestation of acute gastroenteritis in children and... more
Abstract
Background
Vomiting is a common manifestation of acute gastroenteritis in children and adolescents. When untreated it can be a hindrance to oral rehydration therapy, which is the cornerstone in the management of acute gastroenteritis. Evidence is needed concerning the safety and efficacy of antiemetic use for vomiting in acute gastroenteritis in children.
Objectives
To assess the safety and effectiveness of antiemetics on gastroenteritis induced vomiting in children and adolescents.
Search strategy
We searched the Cochrane Upper Gastrointestinal and Pancreatic Diseases Group Trials Register comprising references identified from comprehensive electronic database searches and hand searches of relevant journals and abstract books of conferences.The search was re-run and is up to date as on 20 July 2010.
Selection criteria
Randomized controlled trials comparing antiemetics with placebo or no treatment, in children and adolescents under the age of 18, for vomiting due to gastroenteritis.
Data collection and analysis
Two review authors independently assessed trial quality and extracted data.
Main results
We included seven trials involving 1,020 participants. Mean time to cessation of vomiting in one study was 0.34 days less with dimenhydrinate suppository compared to placebo (P value = 0.036). Pooled data from three studies comparing oral ondansetron with placebo showed: a reduction in the immediate hospital admission rate (RR 0.40, NNT 17, 95% CI 10 to 100) but no difference between the hospitalization rates at 72 hours after discharge from the Emergency Department (ED); a reduction in IV rehydration rates both during the ED stay (RR 0.41, NNT 5, 95% CI 4 to 8), and in follow-up to 72 hours after discharge from the ED stay (worst-best scenario for ondansetron RR 0.57, NNT 6, 95% CI 4 to 13) and an increase in the proportion of patients with cessation of vomiting (RR 1.34, NNT 5, 95% CI 3 to 7)). No significant difference was noted in the revisit rates or adverse events, although diarrhea was reported as a side effect in four of the five ondansetron studies. In one study the proportion of patients with cessation of vomiting in 24 hours was (58%) with IV ondansetron, (17%) placebo and (33%) in the metoclopramide group (P value = 0.039).
Authors' conclusions
Oral ondansetron increased the proportion of patients who had ceased vomiting and reduced the number needing intravenous rehydration and immediate hospital admission. Intravenous ondansetron and metoclopramide reduced the number of episodes of vomiting and hospital admission, and dimenhydrinate as a suppository reduced the duration of vomiting.
Epidemiology of depression and distress in patients with inflammatory bowel disease (IBD) and validation of an indicator scale of perceived stress for psychosocial impairments.
Hardt J, Conrad S, Muche-Borowski C, Raspe H. Epidemiology of depression and distress in patients with inflammatory bowel disease (IBD) and validation of an indicator scale of perceived stress for psychosocial impairments. European Psychiatry 2011;26(S1):2217-2218
Inflammatory bowel diseases as multi-focal disorders: results from a multi-regional survey on bodily and psychosocial problems in IBD patients
Hardt J, Muche-Borowski C, Conrad S, Balzer K, Bokemeyer B, Raspe H.[Inflammatory bowel diseases as multi-focal disorders: results from a multi-regional survey on bodily and psychosocial problems in IBD patients].[Article in German].Z Gastroenterol. 2010 Mar;48(3):381-91.
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Patient acceptability of CT colonography compared with double contract barium enema: Results from a multicentre randomised controlled trial of symptomatic patients
by Samuel Smith
von Wagner, C., Smith, S., Halligan, S., Ghanouni, A., Power, E., Lilford, R. J., Morton, D., Dadswell, E., Atkin, W., Wardle, J. (in press)
European Journal of Radiology
Objectives
To determine patient acceptability of barium enema (BE) or CT colonography (CTC).
Methods... more
Objectives
To determine patient acceptability of barium enema (BE) or CT colonography (CTC).
Methods
After ethical approval, 921 consenting patients with symptoms suggestive of colorectal cancer who had been randomly assigned and completed either BE (N = 606) or CTC (N = 315) received a questionnaire to assess experience of the clinical episode including bowel preparation, procedure and complications. Satisfaction, worry and physical discomfort were assessed using an adapted version of a validated acceptability scale. Non-parametric methods assessed differences between the randomised tests and the effect of patient characteristics.
Results
Patients undergoing BE were significantly less satisfied (median 61, interquartile range [IQR] 54–67 vs. median 64, IQR 56–69; p = 0.003) and experienced more physical discomfort (median 40, IQR 29–52 vs. median 35.5, IQR 25–47; p < 0.001) than those undergoing CTC. Post-test, BE patients were significantly more likely to experience ‘abdominal pain/cramps’ (68% vs. 57%; p = 0.007), ‘soreness’ (57% vs. 37%; p < 0.001), ‘nausea/vomiting’ (16% vs. 8%; p = 0.009), ‘soiling’ (31% vs. 23%; p = 0.034) and ‘wind’ (92% vs. 84%; p = 0.001) and in the case of ‘wind’ to also rate it as severe (27% vs. 15%; p < 0.001).
Conclusion
CTC is associated with significant improvements in patient experience. These data support the case for CTC to replace BE.
Hepatitis B Treatment – How to Avoid Long-term Drug Cocktails
Author: Marcellin Patrick
Published: Touch European Gastroenterology & Hepatology Review
Role of PI3K/Akt signaling in TRAIL- and radiation-induced gastrointestinal apoptosis.
by Dr. Gary Kao and Dr. Jay Dorsey
Plastaras JP, Dorsey JF, Carroll K, Kim SH, Birnbaum MJ, El-Deiry WS.
Source
Laboratory of Molecular Oncology and Cell Cycle Regulation, The Institute for Translational Medicine and Therapeutics, Abramson Comprehensive Cancer Center, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
Activation of the PI3K/Akt pathway is associated with tumorigenesis and resistance to apoptosis and ionizing radiation... more Activation of the PI3K/Akt pathway is associated with tumorigenesis and resistance to apoptosis and ionizing radiation (IR). We sought to characterize the effects of physiologic and genetic manipulation of Akt signaling on IR-induced gastrointestinal (GI) apoptosis in mice. PI3K/Akt signaling is stimulated by insulin. We evaluated the time course of Akt stimulation by insulin and found it overlapped with protection from apoptosis induced by TRAIL (TNFalpha Related Apoptosis Inducing Ligand) in cell lines. Mice were treated with insulin and glucose and the kinetics of in vivo Akt stimulation were determined by phospho-Akt (S473) (P-Akt) immunofluorescence in the gut. Irradiation of mice by five Gy at 30 minutes after insulin/glucose administration induced apoptosis in the crypts of the ileum and colon after six hours, but induced little apoptosis in the liver or esophagus. Pre-treatment with insulin and glucose did not significantly alter levels of IR-induced apoptosis in the gut. IR alone led to sustained increases in P-Akt in the gut at six hours, a protective response that may have precluded additional protection from insulin/glucose. In Akt1-/- mice, there was significantly more apoptosis in ileum crypts of irradiated mice compared to Akt1+/+ mice, suggesting a role for the pathway in the GI tract in response to IR. Taken together, modulation of the PI3K/Akt pathway may sensitize or protect against cancer therapies in both tumor and normal tissues.
Developments in Biologic Therapy for Crohn s Disease and Ulcerative Colitis
Author: Haens Geert D
Published in Touch US Gastroenterology Review 2007 - Issue II - October 2007
Detection of Acid, Weakly Acidic and Gas Reflux
Authors: Emerenziani Sara, Sifrim Daniel
Published in Touch European Gastroenterology Review 2005 - September 2005
Detecting Neoplasia in Barrett s Oesophagus Advances in Imaging
Authors: Paresh Kamat, Sharmila Anandasabapathy
Published in Touch European Gastroenterology Review 2007 - December 2007