Irritable-bowel syndrome

Diarrhea is a common problem that is usually self-limiting and of short duration. Increased accumulations of small intestinal and colonic contents are known to be responsible for producing diarrhea. The former may be caused by increased intestinal secretion which may be enterotoxin-induced, eg, cholera and E. col] or hormone and dmg-induced, eg, caffeine, prostaglandins, and laxatives decreased intestinal absorption because of decreased mucosal surface area, mucosal disease, eg, tropical spme, or osmotic deficiency, eg, disaccharidase or lactase deficiency and rapid transit of contents. An increased accumulation of colonic content may be linked to increased colonic secretion owing to hydroxy fatty acid or bile acids, and exudation, eg, inflammatory bowel disease or amebiasis decreased colonic absorption caused by decreased surface area, mucosal disease, and osmotic factors and rapid transit, eg, irritable bowel syndrome. 

Irritable bowel syndrome (DBS) is an exceedingly common condition in all societies, characterized by abdominal discomfort or pain in association with altered bowel habit or incomplete stool evacuation, bloating and constipation or diarrhoea, easily go undetected and do not show up with common tests such as blood tests or x-rays. The estimated prevalence in the community is about 10%. Irritable bowel syndrome and its variants, collectively called functional gastrointestinal disorders, constitute 40-50% of all the patients seen by gastroenterologists in Western countries. 

IRAK Family Iron Chelator Irreversible Antagonists Irritable Bowel Syndrome (DBS)... 

A laxative is most often prescribed for the short-term relief or prevention of constipation. Certain stimulant, emollient, and saline laxatives are used to evacuate the colon for rectal and bowel examinations. Fecal softeners or mineral oil are used prophylactically in patients who should not strain during defecation, such as after anorectal surgery or a myocardial infarction. Psyllium may be used in patients with irritable bowel syndrome and diverticular disease. Fblycarbophil may be prescribed for constipation or diarrhea associated with irritable bowel syndrome and diverticulosis. Mineral oil is... 

Roffman RA, Barnhart R Assessing need for marijuana dependence treatment through an anonymous telephone interview. Int J Addict 22 639-631, 1987 Russo EB Clinical endocannabinoid deficiency (CECD) can this concept explain therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions Neuro Endocrinol Lett 25(1-2) 31—39, 2004... 

The usually accepted prevalences for generalized anxiety disorder (GAD) are around 1.6% for current, 3.1% for 1 year and 5.1% lifetime (Roy-Byrne, 1996). The condition is twice as common in women as in men (Pigott, 1999). A small minority (10%) have GAD alone, and about the same proportion suffer from mixed anxiety and depression. Morbidity is high. About a half of those with uncomplicated GAD seek professional help, but two-thirds of those with comorbid GAD do so. Up to a half take medication at some point. The condition may coexist with other anxiety disorders such as phobias, with affective disorders, or with medical conditions such as unexplained chest pain and irritable bowel syndrome. 

Rice bran fiber has fructo-oligosaccharides - a pre-biotic that helps friendly bacteria to proliferate in the gastrointestinal environment and improves intestinal and colon health (Tomlin and Read, 1988). Recent studies in humans (Kahlon and Chow, 1997) have revealed that rice bran fiber not only normalizes bowel function, but also helps in conditions such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD) and Crohn s disease, and lowers the lipid levels. Rice bran fiber has been shown to significantly reduce renal stones (Jahnen et al., 1992). It is a good source of fiber in weight loss programs and therapeutic fiber diets for diabetics and heart patients. Fiber diets prevent cancer of the colon and large bowel, control obesity and improve bowel function. 

The fiber of rice bran products, especially the RiceMucil is helpful in maintaining normal gastrointestinal and colon health (Tomlin and Read, 1988). It helps in bowel regularity. Patients with irritable bowel syndrome, inflammatory bowel disease and colitis get excellent relief with RiceMucil . As has been mentioned in the earlier part of this chapter, the fiber of rice bran is non-bloating and lactose free, and the acidic environment the fiber creates during the fermentation of undigested food improves colon health and induces all the healthy enzymes and fnendly bacteria to proliferate (Folino et al, 1995 Life Sciences News Letter, 1999). It has been scientifically demonstrated to have an excellent nutritional support for gut and colon health. 

Compare the features of chronic constipation with those of constipation-predominant irritable bowel syndrome (IBS). 

Gastrointestinal conditions (irritable bowel syndrome, diverticulitis, hemorrhoids)... 

CHAPTER 18 / CONSTIPATION, DIARRHEA, AND IRRITABLE BOWEL SYNDROME 309... 

From Spruill WJ, Wade WE. Diarrhea, constipation and irritable bowel syndrome. In DiPiro JT, Talbert RL, Yee CC, et al, (eds.) Pharmacotherapy A Pathophysiologic Approach. 6th ed. New York McGraw-Hill, Inc 677-692, with permission. 

Noninfectious causes of acute diarrhea include drugs and toxins (Table 18-3), laxative abuse, food intolerance, irritable bowel syndrome (IBS), inflammatory bowel disease, ischemic bowel disease, lactase deficiency, Whipple s disease, pernicious anemia, diabetes mellitus, malabsorption, fecal impaction, diverticulosis, and celiac sprue. 

In the United States, IBS affects women about twice as often as men. However, this may reflect a woman s tendency to seek medical care more often than a man may. Irritable bowel syndrome can occur at any age, but presentation is most common between the ages of 20 and 50 years. Onset beyond 60 years of age is rare. However, prevalence for older adults is the same as for young persons. Prevalence is similar in Caucasians and African-Americans but may be lower in people of Hispanic origin. A genetic link is unproven, but IBS seems more common in certain families. 

Irritable bowel syndrome (IBS) is a disorder of the gastrointestinal tract that interferes with the normal functions of the colon. At various points in the past, IBS has been referred to as mucous colitis, spastic colon, irritable colon, or nervous stomach. IBS is generally described as afunctional disorder rather than a disease per se. A functional disorder involves symptoms that cannot be attributed to a specific injury, infection, or other physical problem. A functional disorder occurs because of altered physiologic processes rather than structural or biochemical defects and may be subject to nervous system influence. IBS is associated with frequent fluctuation in symptoms, loss of productivity, and decreased quality of life. Although IBS has been referred to as functional bowel disease, true functional bowel disease may be more indicative of widespread gastrointestinal involvement including (but not limited to) the colon. 

TABLE 18-5. Common Pharmacologic Treatments for Irritable Bowel Syndrome... 

Boyce PM, Talley NJ, Balaam B, et al. A randomized controlled trial of cognitive behavior therapy, relaxation training, and routine clinical care for the irritable bowel syndrome. Am J Gastroenterol 2003 98 2209-2218. 

Cremonini F, Talley NJ. Irritable bowel syndrome epidemiology, natural history, health care seeking and emerging risk factors. Gastroenterol Clin North Am 2005 34 189-204. 

Mertz HR. Drug therapy irritable bowel syndrome. N Engl J Med 2003 349 2136-2146. 

Schoenfeld P. Efficacy of current drug therapies in irritable bowel syndrome What works and does not work. Gastroenterol Clin North Am 2005 34 319-335. 

Neuropathic pain is defined as spontaneous pain and hypersensitivity to pain associated with damage to or pathologic changes in the peripheral nervous system as in painful diabetic peripheral neuropathy (DPN), acquired immunodeficiency syndrome (AIDS), polyneuropathy, post-herpetic neuralgia (PHN) or pain originating in the central nervous system (CNS), that which occurs with spinal cord injury, multiple sclerosis, and stroke. Functional pain, a relatively newer concept, is pain sensitivity due to an abnormal processing or function of the central nervous system in response to normal stimuli. Several conditions considered to have this abnormal sensitivity or hyperresponsiveness include fibromyalgia and irritable bowel syndrome. 

MF is a large-framed 32-year-old Caucasian man who is 5 ft, 10 in (178 cm) tall and weighs 295 lb (134 kg). He has not been to the doctor in 5 years. He is diagnosed with irritable bowel syndrome today. He visits the local free clinic, and the following is discovered when labs and physical assessment are performed ... 

Spastic colon A synonym for irritable bowel syndrome. 

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