Common digestive concerns Flashcards
most common disorder diagnosed by gastroenterologists?
IBS
how many people in Canada with celiac?
1/133
0.008%
common symptoms of GERD?
- heartburn
- regurgitation
- sleep disturbance
- postprandial fullness
- localized or diffuse or retrosternal pain or epigastric pain
- early satiety
- upper abdominal distension
complications of GERD?
- Barrett’s epithelium
- erosive esophagitis
- esophageal stricture
- ulceration and bleeding
- esophageal adenocarcinoma
- upper respiratory complaints (wheezing, chronic coughing or throat clearing)
risk factors for developing GERD?
obesity smoking age esophageal stricture parental or family hx of GI diseases high cholesterol diet lung transplantation cystic fibrosis
how to classify IBS-D?
- loose stools >25% of the time
- hard stools
how to classify IBS-C?
- hard stools >25% of the time
- loose stools
how to classify IBS-M?
- both hard and soft stools >25% of the time
- 1/3 to 1/2 of cases
how to classify un-subtyped IBS?
insufficient abnormality of stool consistency to meet criteria IBS-C or M
diagnostic criteria for IBS
- onset of symptoms at least 6 months before diagnosis
- recurrent abdominal pain or discomfort for >3 days per month during previous 3 months
- at least 2 of the following features:
- improvement with defecation
- association with change in stool frequency
- association with change in stool form
describe SIBO etiology
small bowel bacteria should resemble that of oropharyngeal flora (gram +ve aerobic)
in overgrowth, dominated by E Coli, clostridia, bacteroides (gram -ve)
factors: structural lesions, excessive bacterial load, decreased motility, deficiency in host defences
symptoms of SIBO?
diarrhea, anorexia, nausea, weight loss, anemia, pain, malabsorption (low B12, high folate, decrease Hb, increased MCV
diagnosis of SIBO?
predisposing factors, history
testing is either cumbersome and invasive or indirect or non specific/sensitive
tx of SIBO?
optimal tx not yet determined
usually 7-10 day course of antibiotics
which never has peri-anal disease? UC or CD?
UC
endoscopic findings for crohn’s disease?
deep and snake-like ulcers
endoscopic findings for ulcerative colitis?
diffuse ulceration endoscopic changes can be mild
depth of inflammation in UC?
shallow, mucosal
depth of inflammation in CD?
may be transmural, extending through or affecting the entire thickness of the wall of an organ or cavity deep into tissues
which disease commonly has fistulas between organs? CD or UC?
CD
how does a history of smoking affect risk of developing CD vs UC?
increases risk for CD
decreases risk for UC
complications of CD?
blockage of intestine due to swelling or formation of scar tissue, abscesses, pseudo polyps, sores or ulcers (fistulas);
malnutrition
complications of UC?
bleeding from ulcerations, perforation (rupture) of the bowel;
malnutrition
primary test ordered to screen for celiac disease?
anti-tissue trans glutaminase antibodies, IgA
most sensitive & specific blood test for celiac disease - preferred by American College of Gastroenterology
definitive diagnosis of celiac requires?
jejunal biopsy demonstrating villous atrophy
What is the mechanism of esophageal protection, gastroprotection and ulcer healing by melatonin.
- potent reactive oxygen metabolite scavenger and AO
- secretion, motility, digestion and absorption
- GI mucosal integrity
- ulcer healing
- enhancement of mucosal generation of PGE2 and gastrin levels
- inhibits metalloproteinases -3 and -9
National Institute for Health and Clinical Excellence (NICE) recommends discussion of which 3 interventions for IBS?
- healthy diets
- psychological interventions (CBT, hypnotherapy, psychological therapy)
- biofeedback
what is the pharmacological strategy to treat IBS, considering that no single drug has been shown to be beneficial for the IBS symptom complex?
specific IBS symptoms may be amenable to drug therapy
first identify predominant symptom
predictors of positive response to psychological treatment?
1) awareness of stress exacerbation
2) at least mild anxiety or depression
3) predominant sxs is pain or diarrhea
4) abdominal pain waxes and wanes
5) sxs are of relatively short duration
6) catastrophizing behaviour
what was the effect of the elimination diet on IBS?
identifying and appropriately addressing food sensitivity in IBS patients not previously responding to standard therapy results in sustained clinical response and impacts on overall well being and QOL
effect of acupuncture for IBS?
BMC Gastroenterology 2012
Acupuncture for IBS provided an additional benefit over usual care alone. The magnitude of the effect was sustained over the longer term. Acupuncture should be considered as a treatment option to be offered in primary care alongside other evidence based treatments.
Ingredients of Iberogast (STW 5)?
German chamomile flower Clown's mustard plant Angelica root and rhizome Caraway fruit Milk Thistle fruit Lemon Balm leaf Celandine aerial part Licorice root Peppermint leaf
effect of melatonin in IBS?
Compared with placebo, melatonin taken for 8 weeks significantly improved overall IBS score (45% vs 16.6%)
3mg melatonin at bedtime x 8 weeks decreased severity & frequency of pain, bloating improved bowel habits decreased h/a. nausea, GERD improved QOL
n=18
effect of glutamine in IBD?
oral glutamine supplements (7g tid) do not seem to restore impaired permeability in patients with Crohn’s disease
