Trauma transitional care coordination: A mature system at work.

PubMed

Hall, Erin C; Tyrrell, Rebecca L; Doyle, Karen E; Scalea, Thomas M; Stein, Deborah M

2018-05-01

We have previously demonstrated effectiveness of a Trauma Transitional Care Coordination (TTCC) Program in reducing 30-day readmission rates for trauma patients most at risk. With program maturation, we achieved improved readmission rates for specific patient populations. TTCC is a nursing driven program that supports patients at high risk for 30-day readmission. The TTCC interventions include calls to patients within 72 hours of discharge, complete medication reconciliation, coordination of medical appointments, and individualized problem solving. Account IDs were used to link TTCC patients with the Health Services Cost Review Commission database to collect data on statewide unplanned 30-day readmissions. Four hundred seventy-five patients were enrolled in the TTCC program from January 2014 to September 2016. Only 10.5% (n = 50) of TTCC enrollees were privately insured, 54.5% had Medicaid (n = 259), and 13.5% had Medicare (n = 64). Seventy-three percent had Health Services Cost Review Commission severity of injury ratings of 3 or 4 (maximum severity of injury = 4). The most common All Patient Refined Diagnosis Related Groups for participants were: lower-extremity procedures (n = 67, 14%); extensive abdominal/thoracic procedures (n = 40, 8.4%); musculoskeletal procedures (n = 37, 7.8%); complicated tracheostomy and upper extremity procedures (n = 29 each, 6.1%); infectious disease complications (n = 14, 2.9%); major chest/respiratory trauma, major small and large bowel procedures and vascular procedures (n = 13 each, 2.7%). The TTCC participants with lower-extremity injury, complicated tracheostomy, and bowel procedures had 6-point reduction (10% vs. 16%, p = 0.05), 11-point reduction (13% vs. 24%, p = 0.05), and 16-point reduction (11% vs. 27%, p = 0.05) in 30-day readmission rates, respectively, compared to those without TTCC. Targeted outpatient support for high-risk patients can decrease 30-day readmission rates. As our TTCC program matured, we reduced 30-day readmission in patients with lower-extremity injury, complicated tracheostomy and bowel procedures. This represents over one million-dollar savings for the hospital per year through quality-based reimbursement. Therapeutic/care management, level III.

A structured bowel management program for patients with severe functional constipation can help decrease emergency department visits, hospital admissions, and healthcare costs.

PubMed

Reck-Burneo, Carlos A; Vilanova-Sanchez, Alejandra; Gasior, Alessandra C; Dingemans, Alexander J M; Lane, Victoria A; Dyckes, Robert; Nash, Onnalisa; Weaver, Laura; Maloof, Tassiana; Wood, Richard J; Zobell, Sarah; Rollins, Michael D; Levitt, Marc A

2018-03-24

Published health-care costs related to constipation in children in the USA are estimated at $3.9 billion/year. We sought to assess the effect of a bowel management program (BMP) on health-care utilization and costs. At two collaborating centers, BMP involves an outpatient week during which a treatment plan is implemented and objective assessment of stool burden is performed with daily radiography. We reviewed all patients with severe functional constipation who participated in the program from March 2011 to June 2015 in center 1 and from April 2014 to April 2016 in center 2. ED visits, hospital admissions, and constipation-related morbidities (abdominal pain, fecal impaction, urinary retention, urinary tract infections) 12 months before and 12 months after completion of the BMP were recorded. One hundred eighty-four patients were included (center 1 = 96, center 2 = 88). Sixty-three (34.2%) patients had at least one unplanned visit to the ED before treatment. ED visits decreased to 23 (12.5%) or by 64% (p < 0.0005). Unplanned hospital admissions decreased from 65 to 28, i.e., a 56.9% reduction (p < 0.0005). In children with severe functional constipation, a structured BMP decreases unplanned visits to the ED, hospital admissions, and costs for constipation-related health care. 3. Copyright © 2018. Published by Elsevier Inc.

[Effects of a Patient Educational Video Program on Bowel Preparation Prior to Colonoscopy].

PubMed

Cho, You Young; Kim, Hyeon Ok

2015-10-01

The purpose of this study was to evaluate the effects of an educational video program on bowel preparation for a colonoscopy. The study used a non-equivalent control group and non-synchronized design as a quasi-experimental research involving 101 participants undergoing bowel preparation for a colonoscopy (experimental group 51, control group 50 subjects) at W. university hospital, from Aug. 7 to Oct. 31, 2013. The control group received verbal education with an explanatory note while the experimental group received education using a video program. To measure knowledge of diet restrictions and compliance with ingesting bowel preparation solutions, a questionnaire, based on The Korean Society of Gastrointestinal Endoscopy's Guide (2003), developed by Sam-Sook You, was used after revisions and supplementation was done. To measure bowel cleanness, the 'Aronchick Bowel Preparation Scale' was adopted. Data were analyzed using the SPSS WIN 12.0 program. A higher proportion of the experimental group showed a positive change in knowledge level on diet restrictions (U=1011.50, p=.035) and ingestion of bowel preparation solutions (U=980.50, p=.019), a higher level of compliance with diet restrictions (U=638.50, p<.001), ingesting bowel preparation solutions (U=668.00, p<.001) and the level of bowel cleanness (χ²=17.00, p<.001) than the control group. The results of this study indicate that a video educational program for patients having a colonoscopy can improve knowledge, level of compliance with diet restrictions, ingestion of bowel preparation solutions, and bowel cleanness. Therefore video educational program should be used with this patient group.

Knowledge, attitudes, beliefs and behaviour intentions for three bowel management practices in intensive care: effects of a targeted protocol implementation for nursing and medical staff.

PubMed

Knowles, Serena; Lam, Lawrence T; McInnes, Elizabeth; Elliott, Doug; Hardy, Jennifer; Middleton, Sandy

2015-01-01

Bowel management protocols have the potential to minimize complications for critically ill patients. Targeted implementation can increase the uptake of protocols by clinicians into practice. The theory of planned behaviour offers a framework in which to investigate clinicians' intention to perform the behaviour of interest. This study aimed to evaluate the effect of implementing a bowel management protocol on intensive care nursing and medical staffs' knowledge, attitude, subjective norms, perceived behavioural control, behaviour intentions, role perceptions and past behaviours in relation to three bowel management practices. A descriptive before and after survey using a self-administered questionnaire sent to nursing and medical staff working within three intensive care units before and after implementation of our bowel management protocol (pre: May - June 2008; post: Feb - May 2009). Participants had significantly higher knowledge scores post-implementation of our protocol (pre mean score 17.6; post mean score 19.3; p = 0.004). Post-implementation there was a significant increase in: self-reported past behaviour (pre mean score 5.38; post mean score 7.11; p = 0.002) and subjective norms scores (pre mean score 3.62; post mean score 4.18; p = 0.016) for bowel assessment; and behaviour intention (pre mean score 5.22; post mean score 5.65; p = 0.048) for administration of enema. This evaluation, informed by the theory of planned behaviour, has provided useful insights into factors that influence clinician intentions to perform evidence-based bowel management practices in intensive care. Addressing factors such as knowledge, attitudes and beliefs can assist in targeting implementation strategies to positively affect clinician behaviour change. Despite an increase in clinicians' knowledge scores, our implementation strategy did not, however, significantly change clinician behaviour intentions for all three bowel management practices. Further research is required to explore the influence of opinion leaders and organizational culture on clinicians' behaviour intentions related to bowel management for intensive care patients.

Characteristics of neurogenic bowel in spinal cord injury and perceived quality of life.

PubMed

Pardee, Connie; Bricker, Diedre; Rundquist, Jeanine; MacRae, Christi; Tebben, Cherisse

2012-01-01

To investigate the association between characteristics of individuals with spinal cord injury and neurogenic bowel and their perceived quality of life. The study design is an exploratory, descriptive correlational design. To measure the variables of the study the Quality of Life Survey developed by Randell et al. (2001) was used to measure perceived quality of life related to bowel management. Individual bowel management preferences and subjective costs and benefits of the preferences were gathered through the Neurogenic Bowel Characteristics Survey. PARTICIPANTS/METHOD: Data were collected from a random half of the individuals who met the inclusion criteria from the patient database (n=1193). Two hundred and forty one surveys were analyzed for this study. More than half of the sample (n=134) provided their own bowel management consisting of digital stimulation, suppositories, and other aids; 8% (n=19) had a colostomy. Regardless of the bowel management program 54% (n=127) were satisfied with current methods. Although time reported to complete bowel programs ranged from 1 to 120 minutes, there was no difference in rating of satisfaction with time. There was a statistically significant difference between those satisfied and dissatisfied with current bowel management and quality of life; those satisfied demonstrated a higher quality of life on three subscales, work function (p= .021), bowel problems (p< .001), and social function (p< .001). Those dissatisfied with their bowel program perceived a lower quality of life and indicated problems of time (p= .001), pain or discomfort (p= .033), and poor results (p< .001). Research data provide the patient's perspective on bowel management characteristics, complications, satisfaction, and their perceived quality of life. Results of this research will be incorporated into bowel management education and possible modification of the current inpatient bowel management program. © 2012 Association of Rehabilitation Nurses.

A theoretical framework to guide a study of patients' bowel symptoms and self-care strategies following sphincter-saving surgery for rectal cancer.

PubMed

Landers, Margaret; McCarthy, Geraldine; Savage, Eileen

2013-08-01

A paucity of research is available on patients' bowel symptom experiences and self-care strategies following sphincter-saving surgery for rectal cancer. Most research undertaken to date on patients' bowel symptoms following surgery for rectal cancer has been largely atheoretical. The purpose of this paper is to describe the process of choosing a theoretical framework to guide a study of patients' bowel symptoms and self-care strategies following sphincter-saving surgery for rectal cancer. As a result of a thorough literature review, we determined that the Symptom Management Theory provided the most comprehensive framework to guide our research. Copyright © 2013 Elsevier Inc. All rights reserved.

Medical and psychological aspects of irritable bowel syndrome.

PubMed

Kim, E C; Dundon, M

1998-01-01

Irritable bowel syndrome is a disease process commonly encountered by primary care providers. Although the cause of this illness is unknown, much is known about the pathophysiology and strong psychosocial influences. Medical practitioners often are aware of the medical aspects of managing irritable bowel syndrome but are not familiar with specific psychologic options. Long-term care of these patients may be aided by collaboration with mental health professionals.

A protocol for a trial of homeopathic treatment for irritable bowel syndrome

PubMed Central

2012-01-01

Background Irritable bowel syndrome is a chronic condition with no known cure. Many sufferers seek complementary and alternative medicine including homeopathic treatment. However there is much controversy as to the effectiveness of homeopathic treatment. This three-armed study seeks to explore the effectiveness of individualised homeopathic treatment plus usual care compared to both an attention control plus usual care and usual care alone, for patients with irritable bowel syndrome. Methods/design This is a three-armed pragmatic randomised controlled trial using the cohort multiple randomised trial methodology. Patients are recruited to an irritable bowel syndrome cohort from primary and secondary care using GP databases and consultants lists respectively. From this cohort patients are randomly selected to be offered, 5 sessions of homeopathic treatment plus usual care, 5 sessions of supportive listening plus usual care or usual care alone. The primary clinical outcome is the Irritable Bowel Syndrome Symptom Severity at 26 weeks. From a power calculation, it is estimated that 33 people will be needed for the homeopathic treatment arm and 132 for the usual care arm, to detect a minimal clinical difference at 80 percent power and 5 percent significance allowing for loss to follow up. An unequal group size has been used for reasons of cost. Analysis will be by intention to treat and will compare homeopathic treatment with usual care at 26 weeks as the primary analysis, and homeopathic treatment with supportive listening as an additional analysis. Discussion This trial has received NHS approval and results are expected in 2013. Trial registration Current Controlled Trials ISRCTN90651143 PMID:23131064

Intestinal Rehabilitation Programs in the Management of Pediatric Intestinal Failure and Short Bowel Syndrome.

PubMed

Merritt, Russell J; Cohran, Valeria; Raphael, Bram P; Sentongo, Timothy; Volpert, Diana; Warner, Brad W; Goday, Praveen S

2017-11-01

Intestinal failure is a rare, debilitating condition that presents both acute and chronic medical management challenges. The condition is incompatible with life in the absence of the safe application of specialized and individualized medical therapy that includes surgery, medical equipment, nutritional products, and standard nursing care. Intestinal rehabilitation programs are best suited to provide such complex care with the goal of achieving enteral autonomy and oral feeding with or without intestinal transplantation. These programs almost all include pediatric surgeons, pediatric gastroenterologists, specialized nurses, and dietitians; many also include a variety of other medical and allied medical specialists. Intestinal rehabilitation programs provide integrated interdisciplinary care, more discussion of patient management by involved specialists, continuity of care through various treatment interventions, close follow-up of outpatients, improved patient and family education, earlier treatment of complications, and learning from the accumulated patient databases. Quality assurance and research collaboration among centers are also goals of many of these programs. The combined and coordinated talents and skills of multiple types of health care practitioners have the potential to ameliorate the impact of intestinal failure and improve health outcomes and quality of life.

Preventative Care in the Patient with Inflammatory Bowel Disease: What Is New?

PubMed

Reich, Jason S; Farraye, Francis A; Wasan, Sharmeel K

2016-08-01

Patients with inflammatory bowel disease (IBD) do not receive routine preventative care at the same rate as general medical patients. This patient population is at increased risk of vaccine preventable illness such as influenza and pneumococcal pneumonia. This review will discuss health maintenance needs and preventative care issues in patients with IBD.

Pediatric irritable bowel syndrome patient and parental characteristics differ by care management type

USDA-ARS?s Scientific Manuscript database

This study evaluates whether certain patient or parental characteristics are associated with gastroenterology (GI) referral versus primary pediatrics care for pediatric irritable bowel syndrome (IBS). A retrospective clinical trial sample of patients meeting pediatric Rome III IBS criteria was assem...

Quality of Health Care in the United States: Implications for Pediatric Inflammatory Bowel Disease

PubMed Central

Boyle, Brendan M.; Palmer, Lena; Kappelman, Michael D.

2015-01-01

The Institute of Medicine’s publications To Error is Human and Crossing the Quality Chasm publicized the widespread deficits in U.S. health care quality. Emerging studies continue to reveal deficits in the quality of adult and pediatric care, including subspecialty care. In recent years, key stakeholders in the health care system including providers, purchasers, and the public have been applying various quality improvement methods to address these concerns. Lessons learned from these efforts in other pediatric conditions, including asthma, cystic fibrosis, neonatal intensive care, and liver transplantation may be applicable to the care of children with inflammatory bowel disease. This review is intended to be a primer on the quality of care movement in the United States, with a focus on pediatric inflammatory bowel disease. In this article, we review the history, rationale, and methods of quality measurement and improvement, and we discuss the unique challenges in adapting these general strategies to pediatric IBD care. PMID:19633570

Protocol for a randomized controlled study of Iyengar yoga for youth with irritable bowel syndrome

PubMed Central

2011-01-01

Introduction Irritable bowel syndrome affects as many as 14% of high school-aged students. Symptoms include discomfort in the abdomen, along with diarrhea and/or constipation and other gastroenterological symptoms that can significantly impact quality of life and daily functioning. Emotional stress appears to exacerbate irritable bowel syndrome symptoms suggesting that mind-body interventions reducing arousal may prove beneficial. For many sufferers, symptoms can be traced to childhood and adolescence, making the early manifestation of irritable bowel syndrome important to understand. The current study will focus on young people aged 14-26 years with irritable bowel syndrome. The study will test the potential benefits of Iyengar yoga on clinical symptoms, psychospiritual functioning and visceral sensitivity. Yoga is thought to bring physical, psychological and spiritual benefits to practitioners and has been associated with reduced stress and pain. Through its focus on restoration and use of props, Iyengar yoga is especially designed to decrease arousal and promote psychospiritual resources in physically compromised individuals. An extensive and standardized teacher-training program support Iyengar yoga's reliability and safety. It is hypothesized that yoga will be feasible with less than 20% attrition; and the yoga group will demonstrate significantly improved outcomes compared to controls, with physiological and psychospiritual mechanisms contributing to improvements. Methods/Design Sixty irritable bowel syndrome patients aged 14-26 will be randomly assigned to a standardized 6-week twice weekly Iyengar yoga group-based program or a wait-list usual care control group. The groups will be compared on the primary clinical outcomes of irritable bowel syndrome symptoms, quality of life and global improvement at post-treatment and 2-month follow-up. Secondary outcomes will include visceral pain sensitivity assessed with a standardized laboratory task (water load task), functional disability and psychospiritual variables including catastrophizing, self-efficacy, mood, acceptance and mindfulness. Mechanisms of action involved in the proposed beneficial effects of yoga upon clinical outcomes will be explored, and include the mediating effects of visceral sensitivity, increased psychospiritual resources, regulated autonomic nervous system responses and regulated hormonal stress response assessed via salivary cortisol. Trial registration ClinicalTrials.gov NCT01107977. PMID:21244698

Protocol for a randomized controlled study of Iyengar yoga for youth with irritable bowel syndrome.

PubMed

Evans, Subhadra; Cousins, Laura; Tsao, Jennie C I; Sternlieb, Beth; Zeltzer, Lonnie K

2011-01-18

Irritable bowel syndrome affects as many as 14% of high school-aged students. Symptoms include discomfort in the abdomen, along with diarrhea and/or constipation and other gastroenterological symptoms that can significantly impact quality of life and daily functioning. Emotional stress appears to exacerbate irritable bowel syndrome symptoms suggesting that mind-body interventions reducing arousal may prove beneficial. For many sufferers, symptoms can be traced to childhood and adolescence, making the early manifestation of irritable bowel syndrome important to understand. The current study will focus on young people aged 14-26 years with irritable bowel syndrome. The study will test the potential benefits of Iyengar yoga on clinical symptoms, psychospiritual functioning and visceral sensitivity. Yoga is thought to bring physical, psychological and spiritual benefits to practitioners and has been associated with reduced stress and pain. Through its focus on restoration and use of props, Iyengar yoga is especially designed to decrease arousal and promote psychospiritual resources in physically compromised individuals. An extensive and standardized teacher-training program support Iyengar yoga's reliability and safety. It is hypothesized that yoga will be feasible with less than 20% attrition; and the yoga group will demonstrate significantly improved outcomes compared to controls, with physiological and psychospiritual mechanisms contributing to improvements. Sixty irritable bowel syndrome patients aged 14-26 will be randomly assigned to a standardized 6-week twice weekly Iyengar yoga group-based program or a wait-list usual care control group. The groups will be compared on the primary clinical outcomes of irritable bowel syndrome symptoms, quality of life and global improvement at post-treatment and 2-month follow-up. Secondary outcomes will include visceral pain sensitivity assessed with a standardized laboratory task (water load task), functional disability and psychospiritual variables including catastrophizing, self-efficacy, mood, acceptance and mindfulness. Mechanisms of action involved in the proposed beneficial effects of yoga upon clinical outcomes will be explored, and include the mediating effects of visceral sensitivity, increased psychospiritual resources, regulated autonomic nervous system responses and regulated hormonal stress response assessed via salivary cortisol. ClinicalTrials.gov NCT01107977.

Do Intra-anal Bowel Management Devices Reduce Incontinence-Associated Dermatitis and/or Pressure Injuries?

PubMed

Beeson, Terrie; Eifrid, Bethany; Pike, Caitlin A; Pittman, Joyce

The purpose of this article was to examine the evidence and provide recommendations related to the effectiveness of intra-anal bowel management systems including intra-anal bowel catheters and rectal trumpets in reducing incontinence-associated dermatitis and pressure injuries. Does the use of an intra-anal bowel management system (intra-anal bowel catheter or rectal trumpet) reduce incontinence-associated skin damage and/or hospital-acquired pressure injuries in the acute care adult patient population? A search of the literature was performed by a trained university librarian, which resulted in 133 articles that examined intra-anal bowel management systems (intra-anal bowel catheter and rectal trumpet), incontinence-associated dermatitis, and pressure injuries. A systematic approach was used to review titles, abstracts, and text yielding 6 studies that met inclusion criteria. Strength of the evidence was rated using rating methodology from Essential Evidence Plus: Levels of evidence and Oxford Center for Evidence-based Medicine, adapted by Gray and colleagues. Five of the 6 studies reported positive results concerning the effectiveness of intra-anal bowel management systems to reduce incontinence-associated dermatitis and/or pressure injuries. One randomized control trial found no improvement in incontinence-associated dermatitis in the intra-anal bowel management system (intra-anal bowel catheter or rectal trumpet) groups or pressure injuries as compared to usual care. The strength of the evidence for the identified studies was moderate (2 level A, 3 level B, and 1 level C). An important finding in 2 of the studies was the safety of the intra-anal bowel management systems-both intra-anal bowel catheter and rectal trumpet. Evidence indicates intra-anal bowel management system (intra-anal bowel catheters and rectal trumpet) provides a viable option for fecal incontinence management and these devices reduce incontinence-associated dermatitis and/or pressure injuries.

Challenges of modern day transition care in inflammatory bowel disease: From inflammatory bowel disease to biosimilars.

PubMed

Hakizimana, Ali; Ahmed, Iftikhar; Russell, Rachel; Wright, Mark; Afzal, Nadeem A

2017-07-07

In this article we discuss the challenges of delivering a high quality Transition care. A good understanding of the adolescent needs with good communication between Transition care physicians and the patient is essential for good continuity of care. Despite availability of several guidelines, one model doesn't fit all and any transition service development should be determined by the local need and available healthcare facilities.

Women's experiences of living with neurogenic bladder and bowel after spinal cord injury: life controlled by bladder and bowel.

PubMed

Nevedal, Andrea; Kratz, Anna L; Tate, Denise G

2016-01-01

Neurogenic bladder and bowel (NBB) is a chronic condition hindering the functioning and quality of life (QOL) of people with spinal cord injury (SCI). NBB research has focused on men with SCI leaving unanswered questions about women's experiences of living with NBB. The purpose of this study was to identify and describe women's experiences of living with SCI and NBB. Secondary analysis of semi-structured interviews from a larger qualitative study of women with SCI (N = 50) was carried out. Transcripts were coded for bowel and bladder content. Pile-sorting techniques were used to identify emergent themes related to NBB. Meta-themes were categorized under the International Classification of Functioning, Disability and Health. Bladder and bowel topics were spontaneously discussed by 46 out of 50 study participants suggesting the salience of this issue for women with SCI. We identified 6 meta-themes: life controlled by bladder and bowel, bladder and bowel accidents, women's specific challenges, life course disruption, bladder and bowel medical management, and finding independence. Findings describe concerns, strategies, and the detrimental impact of NBB in the lives of women with SCI. Findings inform policy makers, health care and rehabilitation professionals to improve accessibility and quality of life for women with NBB. Women with spinal cord injury (SCI) reported gender specific challenges to living with neurogenic bladder and bowel (NBB). Interventions designed for women with SCI can address these problems and provide recommendations for prevention and treatment. Women described the detrimental impact of NBB on life course expectations, emotional, social, physical health, and quality of life domains. Psychosocial and educational programs can be developed to address these challenges and improve overall quality of life. Recommendations for special treatment and policy considerations are needed to maximize women's independence and health while living with NBB after SCI.

North American Pediatric Gastroenterology Fellowship Needs Assessment in Inflammatory Bowel Disease: Trainee and Program Director Perspectives.

PubMed

Dotson, Jennifer L; Falaiye, Tolulope; Bricker, Josh B; Strople, Jennifer; Rosh, Joel

2016-07-01

Pediatric inflammatory bowel disease (IBD) care is complex and rapidly evolving. The Crohn's and Colitis Foundation of America and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition cosponsored a needs assessment survey of pediatric gastroenterology trainees and program directors (PDs) to inform on educational programming. A Web-based, self-completed survey was provided to North American trainees and PDs during the 2013-2014 academic year. Standard descriptive statistics summarized demographics and responses. One hundred sixty-six of 326 (51%) trainees (62% female) and 37 of 74 (50%) PDs responded. Median trainees per program = 5 and median total faculty = 10 (3 IBD experts); 15% of programs did not have a self-identified "IBD expert" faculty member. Sixty-nine percent of trainees were confident/somewhat confident in their IBD inpatient training, whereas 54% were confident/somewhat confident in their outpatient training. Trainees identified activities that would most improve their education, including didactics (55%), interaction with national experts (50%), trainee-centered IBD Web resources (42%), and increased patient exposure (42%). Trainees were most confident in managing inpatient active Crohn's disease/ulcerative colitis, phenotype classification, managing biological therapies, and using clinical disease activity indices. They were least confident in managing J-pouch complications, performing pouchoscopy, managing extraintestinal manifestations, and ostomy-related complications. Eighty-five percent would like an IBD-focused training elective. Most directors (86%) would allow trainees to do electives at other institutions. This IBD needs assessment survey of pediatric gastroenterology trainees and PDs demonstrated a strong resource commitment to IBD training and clinical care. Areas for educational enrichment emerged, including pouch and ostomy complications.

Is an opportunistic primary care-based intervention for non-responders to bowel screening feasible and acceptable? A mixed-methods feasibility study in Scotland

PubMed Central

Calanzani, Natalia; Cavers, Debbie; Vojt, Gabriele; Orbell, Sheina; Steele, Robert J C; Brownlee, Linda; Smith, Steve; Patnick, Julietta; Weller, David; Campbell, Christine

2017-01-01

Objectives We aimed to test whether a brief, opportunistic intervention in general practice was a feasible and acceptable way to engage with bowel screening non-responders. Design This was a feasibility study testing an intervention which comprised a brief conversation during routine consultation, provision of a patient leaflet and instructions to request a replacement faecal occult blood test kit. A mixed-methods approach to evaluation was adopted. Data were collected from proformas completed after each intervention, from the Bowel Screening Centre database and from questionnaires. Semi-structured interviews were carried out. We used descriptive statistics, content and framework analysis to determine intervention feasibility and acceptability. Participants Bowel screening non-responders (as defined by the Scottish Bowel Screening Centre) and primary care professionals working in five general practices in Lothian, Scotland. Primary and secondary outcome measures Several predefined feasibility parameters were assessed, including numbers of patients engaging in conversation, requesting a replacement kit and returning it, and willingness of primary care professionals to deliver the intervention. Results The intervention was offered to 258 patients in five general practices: 220 (87.0%) engaged with the intervention, 60 (23.3%) requested a new kit, 22 (8.5%) kits were completed and returned. Interviews and questionnaires suggest that the intervention was feasible, acceptable and consistent with an existing health prevention agenda. Reported challenges referred to work-related pressures, time constraints and practice priorities. Conclusions This intervention was acceptable and resulted in a modest increase in non-responders participating in bowel screening, although outlined challenges may affect sustained implementation. The strategy is also aligned with the increasing role of primary care in promoting bowel screening. PMID:29025829

Improvements in safety and recovery following cystectomy: reassessing the role of pre-operative bowel preparation and interventions to speed return of post-operative bowel function.

PubMed

Zaid, Harras B; Kaffenberger, Samuel D; Chang, Sam S

2013-04-01

For radical cystectomy, historical practice trends have favored the use of preoperative bowel preparations to reduce complications, including surgical site infections, ileus, and anastomotic leaks. However, emerging data has questioned this practice. Postoperative cystectomy care also remains in flux, as new pharmacologic agents that may potentiate earlier return of bowel function are studied. We review the current literature with regards to preoperative and postoperative cystectomy bowel management.

Adverse Perinatal Conditions Associated With Prenatally Detected Fetal Echogenic Bowel in Nova Scotia.

PubMed

Findley, Rachelle; Allen, Victoria M; Brock, Jo-Ann K

2018-05-01

This study sought to estimate the association of adverse perinatal outcomes with pregnancies complicated by fetal echogenic bowel. Data for pregnancies complicated with echogenic bowel identified in the second trimester were derived from the tertiary referral IWK Health Centre (Halifax, NS) Viewpoint Ultrasound Database augmented by medical chart review. The study was undertaken between 2003 and 2014. Rates of positive cytomegalovirus and toxoplasmosis infection were determined using maternal serology and amniocentesis results. Rates of intrauterine growth restriction, abnormal karyotype, cystic fibrosis, antenatal bleeding, and bowel abnormalities were also determined. Neonatal information included newborn urine culture results and postnatal genetic testing. Univariate analyses compared rates of infection with isolated echogenic bowel and echogenic bowel with other ultrasound findings, with statistical significance set at P <0.05. There were 422 pregnancies identified prenatally with echogenic bowel (82% had isolated echogenic bowel). Of these, 92 (22%) had at least one of the foregoing associated abnormalities. Three percent of women had serologic test results positive for cytomegalovirus or toxoplasmosis, with <1% documented newborn infections. Cystic fibrosis and other genetic diagnoses were observed in 8%, intrauterine growth restriction in 14%, antenatal bleeding in 19%, and bowel abnormalities in 3% of the cases of echogenic bowel. Pregnancies with isolated echogenic bowel had an 80% reduction in risk for these significant outcomes, in contrast to a four- to 11-fold increased risk of specific outcomes when additional ultrasound findings were present. An overall rate of adverse conditions of 22% with prenatally detected echogenic bowel serves to inform women and health care providers and emphasizes the importance of careful screening fetal ultrasound studies and timely referral for comprehensive assessment with findings of echogenic bowel for evaluation for associated findings. Copyright © 2018 Society of Obstetricians and Gynaecologists of Canada. Published by Elsevier Inc. All rights reserved.

Palliative Management of Malignant Bowel Obstruction in Terminally Ill Patient

PubMed Central

Thaker, Darshit A; Stafford, Bruce C; Gaffney, Luke S

2010-01-01

Mr. P was a 57-year-old man who presented with symptoms of bowel obstruction in the setting of a known metastatic pancreatic cancer. Diagnosis of malignant bowel obstruction was made clinically and radiologically and he was treated conservatively (non-operatively)with octreotide, metoclopromide and dexamethasone, which provided good control over symptoms and allowed him to have quality time with family until he died few weeks later with liver failure. Bowel obstruction in patients with abdominal malignancy requires careful assessment. The patient and family should always be involved in decision making. The ultimate goals of palliative care (symptom management, quality of life and dignity of death) should never be forgotten during decision making for any patient. PMID:21811356

Standardized application of laxatives and physical measures in neurosurgical intensive care patients improves defecation pattern but is not associated with lower intracranial pressure.

PubMed

Kieninger, Martin; Sinner, Barbara; Graf, Bernhard; Grassold, Astrid; Bele, Sylvia; Seemann, Milena; Künzig, Holger; Zech, Nina

2014-01-01

Background. Inadequate bowel movements might be associated with an increase in intracranial pressure in neurosurgical patients. In this study we investigated the influence of a structured application of laxatives and physical measures following a strict standard operating procedure (SOP) on bowel movement, intracranial pressure (ICP), and length of hospital stay in patients with a serious acute cerebral disorder. Methods. After the implementation of the SOP patients suffering from a neurosurgical disorder received pharmacological and nonpharmacological measures to improve bowel movements in a standardized manner within the first 5 days after admission to the intensive care unit (ICU) starting on day of admission. We compared mean ICP levels, length of ICU stay, and mechanical ventilation to a historical control group. Results. Patients of the intervention group showed an adequate defecation pattern significantly more often than the patients of the control group. However, this was not associated with lower ICP values, fewer days of mechanical ventilation, or earlier discharge from ICU. Conclusions. The implementation of a SOP for bowel movement increases the frequency of adequate bowel movements in neurosurgical critical care patients. However, this seems not to be associated with reduced ICP values.

Diverticulitis

MedlinePlus

... sections of bowel or the bowel and bladder. Peritonitis, which can occur if the infected or inflamed ... ruptures, spilling intestinal contents into your abdominal cavity. Peritonitis is a medical emergency and requires immediate care. ...

The role of ethnicity and culture on functional status in children with spina bifida.

PubMed

Chowanadisai, Montida; de la Rosa Perez, Deeni L; Weitzenkamp, David A; Wilcox, Duncan T; Clayton, Gerald H; Wilson, Pamela E

2013-01-01

Spina bifida is a common cause of pediatric disability and more prevalent in the Hispanic population. Significant health disparities exist in minority populations. Culturally adapted health interventions have been attempted in conditions such as pediatric asthma with improvement. This study aims to explore the influence of ethnicity and culture with regards to functional status and care satisfaction. Study participants were recruited from the Children's Hospital Colorado Spinal Defects Clinic. Demographics and past medical and surgical history were obtained via chart review. A questionnaire assessed ethnicity, acculturation, self-care, mobility, bowel and bladder function, and care satisfaction. A total of 70 subjects with spina bifida were included in the statistical analysis. There was no difference in PEDI self-care and mobility scores between ethnicities. The Hispanic group had higher urinary incontinence rates, higher percentage with bladder accidents, and lower satisfaction with bladder management. Regarding bowel function, the Hispanic group had lower satisfaction rates and a trend towards lower bowel continence. Further work is needed to understand the social and cultural differences between Hispanic and Non-Hispanic children and their families that impact bowel and bladder continence and care satisfaction. Once identified, culturally sensitive interventions may be implemented that can alleviate these apparent health disparities.

The effectiveness of a structured educational intervention on disease-related misconception and quality of life in patients with irritable bowel syndrome.

PubMed

Yu, Wen-Zhen; Ouyang, Yan-Qiong; Zhang, Qian; Li, Kong-Ling; Chen, Ji-Hong

2014-01-01

A significant number of patients with irritable bowel syndrome hold misconceptions about their disease and experience more impaired quality of life compared with the general population and people suffering from other chronic diseases. This study was designed to explore the effectiveness of a structured educational intervention on disease-related misconceptions and quality of life in patients with irritable bowel syndrome in Wuhan, China. A convenience sample of 23 patients with irritable bowel syndrome participated in an educational program that consisted of 4 weekly sessions in a group setting. Instruments, including an irritable bowel syndrome-related misconception scale and irritable bowel syndrome quality-of-life scale, were used for evaluation at baseline and 3 months after the sessions. Three months after the structured educational intervention, the score for irritable bowel syndrome-related misconception was significantly decreased (p < .001), and the score for irritable bowel syndrome quality of life was significantly improved (p < .001). We conclude that the structured educational intervention seems to be a proper method to reduce the disease-related misconceptions and improve the quality of life in patients with irritable bowel syndrome. Planning and implementing such clinical education programs will be helpful in decreasing disease-related misconceptions and promoting quality of life in patients with irritable bowel syndrome.

Is an opportunistic primary care-based intervention for non-responders to bowel screening feasible and acceptable? A mixed-methods feasibility study in Scotland.

PubMed

Calanzani, Natalia; Cavers, Debbie; Vojt, Gabriele; Orbell, Sheina; Steele, Robert J C; Brownlee, Linda; Smith, Steve; Patnick, Julietta; Weller, David; Campbell, Christine

2017-10-11

We aimed to test whether a brief, opportunistic intervention in general practice was a feasible and acceptable way to engage with bowel screening non-responders. This was a feasibility study testing an intervention which comprised a brief conversation during routine consultation, provision of a patient leaflet and instructions to request a replacement faecal occult blood test kit. A mixed-methods approach to evaluation was adopted. Data were collected from proformas completed after each intervention, from the Bowel Screening Centre database and from questionnaires. Semi-structured interviews were carried out. We used descriptive statistics, content and framework analysis to determine intervention feasibility and acceptability. Bowel screening non-responders (as defined by the Scottish Bowel Screening Centre) and primary care professionals working in five general practices in Lothian, Scotland. Several predefined feasibility parameters were assessed, including numbers of patients engaging in conversation, requesting a replacement kit and returning it, and willingness of primary care professionals to deliver the intervention. The intervention was offered to 258 patients in five general practices: 220 (87.0%) engaged with the intervention, 60 (23.3%) requested a new kit, 22 (8.5%) kits were completed and returned. Interviews and questionnaires suggest that the intervention was feasible, acceptable and consistent with an existing health prevention agenda. Reported challenges referred to work-related pressures, time constraints and practice priorities. This intervention was acceptable and resulted in a modest increase in non-responders participating in bowel screening, although outlined challenges may affect sustained implementation. The strategy is also aligned with the increasing role of primary care in promoting bowel screening. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Repeated Small Bowel Obstruction Caused by Chestnut Ingestion without the Formation of Phytobezoars.

PubMed

Satake, Ryu; Chinda, Daisuke; Shimoyama, Tadashi; Satake, Miwa; Oota, Rie; Sato, Satoshi; Yamai, Kiyonori; Hachimori, Hisashi; Okamoto, Yutaka; Yamada, Kyogo; Matsuura, Osamu; Hashizume, Tadashi; Soma, Yasushi; Fukuda, Shinsaku

2016-01-01

A small number of cases of small bowel obstruction caused by foods without the formation of phytobezoars have been reported. Repeated small bowel obstruction due to the ingestion of the same food is extremely rare. We present the case of 63-year-old woman who developed small bowel obstruction twice due to the ingestion of chestnuts without the formation of phytobezoars. This is the first reported case of repeated small bowel obstruction caused by chestnut ingestion. Careful interviews are necessary to determine the meal history of elderly patients and psychiatric patients.

[Clinical nutrition therapy in patients with short bowel syndrome in line with principles of personalized medicine].

PubMed

Sahin, Péter; Molnár, Andrea; Varga, Mária; Bíró, Ilona; Kőmíves, Csilla; Fejér, Csaba; Futó, Judit; Tomsits, Erika; Topa, Lajos

2014-12-21

Home parenteral nutrition administered in selected care centres has been financed in Hungary since January, 2013. The authors discuss diagnostic issues, treatment and nutrition therapy of short bowel syndrome patients in line with the principles of personalised medicine. The most severe form of short bowel syndrome occurs in patients having jejunostomy, whose treatment is discussed separately. The authors give a detailed overview of home parenteral feeding, its possible complications, outcomes and adaptation of the remaining bowel. They describe how their own care centre operates where they administer home parenteral nutrition to 12 patients with short bowel syndrome (5 females and 7 males aged 51.25±14.4 years). The body mass index was 19.07±5.08 kg/m2 and 20.87±3.3 kg/m2, skeletal muscle mass was 25.7±6.3 kg and 26.45±5.38 kg, and body fat mass was 14.25±8.55 kg and 11.77±2.71 kg at the start of home parenteral nutrition and presently, respectively. The underlying conditions of short bowel syndrome were tumours in 4 patients, bowel ischaemia in four patients, surgical complications in three patients, Crohn's disease in one patient, and Crohn's disease plus tumour in one patient.

Standardized Application of Laxatives and Physical Measures in Neurosurgical Intensive Care Patients Improves Defecation Pattern but Is Not Associated with Lower Intracranial Pressure

PubMed Central

Kieninger, Martin; Sinner, Barbara; Graf, Bernhard; Grassold, Astrid; Bele, Sylvia; Seemann, Milena; Künzig, Holger; Zech, Nina

2014-01-01

Background. Inadequate bowel movements might be associated with an increase in intracranial pressure in neurosurgical patients. In this study we investigated the influence of a structured application of laxatives and physical measures following a strict standard operating procedure (SOP) on bowel movement, intracranial pressure (ICP), and length of hospital stay in patients with a serious acute cerebral disorder. Methods. After the implementation of the SOP patients suffering from a neurosurgical disorder received pharmacological and nonpharmacological measures to improve bowel movements in a standardized manner within the first 5 days after admission to the intensive care unit (ICU) starting on day of admission. We compared mean ICP levels, length of ICU stay, and mechanical ventilation to a historical control group. Results. Patients of the intervention group showed an adequate defecation pattern significantly more often than the patients of the control group. However, this was not associated with lower ICP values, fewer days of mechanical ventilation, or earlier discharge from ICU. Conclusions. The implementation of a SOP for bowel movement increases the frequency of adequate bowel movements in neurosurgical critical care patients. However, this seems not to be associated with reduced ICP values. PMID:25628896

Delivering High Value Inflammatory Bowel Disease Care Through Telemedicine Visits.

PubMed

Li, Shawn X; Thompson, Kimberly D; Peterson, Tracey; Huneven, Shelley; Carmichael, Jamie; Glazer, Fredric J; Darling, Katelyn; Siegel, Corey A

2017-10-01

Patients with inflammatory bowel disease (IBD) require regular follow-up to manage their care, which requires significant amount of time and out-of-pocket costs. Telemedicine in the form of video virtual visits could serve as an alternative to in-office visits. The aim of this project was to understand if telemedicine can provide high value care (defined as quality/cost) to outpatients with IBD. Patients who participated in the IBD telemedicine clinic in the second half of 2015 were included. Patient-reported survey data before and after the virtual visit were collected. A retrospective review was performed on the study cohort for quality outcome measures a year before and after starting the telemedicine clinic. Outcomes were analyzed using simple descriptive statistics. Differences in quality outcomes were compared using odds ratios. Forty-eight patients were included in the analysis. Most patients travel more than 25 miles each way, take half a day off, and on average incur an additional out-of-pocket cost of $62 for an in-office visit. Most patients (98%) agreed that there was enough time spent with their physician, 91% agreed that they felt like the physician understood their disease state, and 78% reported that they clearly understood the follow-up plan after the visit. Analysis of quality outcome measures did not show any drop in the overall quality of care, after initiating the telemedicine program. Telemedicine offers a low cost and convenient alternative for patients with IBD without compromising quality of care.

Ileostomy - caring for your stoma

MedlinePlus

... Abdominal pouch - stoma care; End ileostomy - stoma care; Ostomy - stoma care; Crohn disease - stoma care; Inflammatory bowel ... stick. Removing the hair may help. Ask your ostomy nurse about the best way to shave the ...

Irritable bowel syndrome in quiescent inflammatory bowel disease: a review.

PubMed

Burgell, R E; Asthana, A K; Gibson, P R

2015-12-01

Ongoing troublesome bowel symptoms despite quiescent inflammatory disease are a frequent management challenge when caring for patients with inflammatory bowel disease (IBD). Even when active disease has been excluded the prevalence of residual gastrointestinal symptoms is surprisingly high and the cause often obscure. The presence of a concurrent functional disorder such as irritable bowel syndrome (IBS) is associated with worse quality of life, worse physical functioning, higher prevalence of anxiety and greater health care utilization. Potential etiological mechanisms leading to the development of IBS like symptoms include the development of visceral hypersensitivity following the original inflammatory insult, alteration in cortical processing, dysbiosis and residual subacute inflammation. Therapeutic options for managing IBS in patients with IBD include dietary modification, interventions targeted at correction of visceral sensory dysfunction or cortical processing and modulation of the gut microbiota. As there are few studies specifically examining the treatment of IBS in patients with IBD, the majority of therapeutic interventions are extrapolated from the IBS literature. Given the frequency of residual functional symptoms in IBS, significantly more research is warranted in this field.

Review article: the economic impact of the irritable bowel syndrome.

PubMed

Canavan, C; West, J; Card, T

2014-11-01

Irritable bowel syndrome (IBS) is a chronic functional disorder of the gastrointestinal system affecting a large number of people worldwide. Whilst it has no attributable mortality, it has substantial impact on patients' quality of life (QoL) and is associated with considerable healthcare resource use. To review the economic impact of IBS, firstly on the individual, secondly on healthcare systems internationally and thirdly to society. Appropriate databases were searched for relevant papers using the terms: Irritable Bowel Syndrome; IBS; irritable colon; functional bowel/colonic disease; economics; health care/service costs; health expenditure/resources; health care/service utilisation; productivity. Irritable bowel syndrome impacts most substantially on patients' work and social life. Reduction in QoL is such that on average patients would sacrifice between 10 and 15 years of their remaining life expectancy for an immediate cure. Between 15% and 43% of patients pay for remedies. No studies quantify loss of earnings related to IBS. Direct care costs are substantial; 48% of patients incur some costs in any year with annual international estimates per patient of: USA $742-$7547, UK £90-£316, France €567-€862, Canada $259, Germany €791, Norway NOK 2098 (€262) and Iran $92. Minimising extensive diagnostic investigations could generate savings and has been shown as not detrimental to patients. Cost to industry internationally through absenteeism and presenteeism related to IBS is estimated between £400 and £900 per patient annually. Irritable bowel syndrome is associated with substantial costs to patients, healthcare systems and society. Considerable benefit could be obtained from effective interventions. © 2014 John Wiley & Sons Ltd.

One-day bowel preparation with polyethylene glycol 3350: an effective regimen for colonoscopy in children.

PubMed

Adamiak, Tonya; Altaf, Muhammad; Jensen, Michael K; Sultan, Mutaz; Ramprasad, Jonathan; Ciecierega, Thomas; Sherry, Karen; Miranda, Adrian

2010-03-01

Polyethylene glycol (PEG) 3350 is commonly used and has been proven safe and effective for the treatment of chronic constipation and as a 4-day bowel preparation in children. A 1-day PEG 3350 bowel preparation regimen has been recently developed for adults; however, data regarding its use in children are lacking. To evaluate the safety and effectiveness of a 1-day PEG 3350 regimen for bowel preparation in children before colonoscopy. Retrospective review. Tertiary-care center. This study involved all children prescribed a 1-day PEG 3350 bowel preparation regimen before colonoscopy at our center in 2008. We reviewed medical records of patients (< or = 18 years of age) who underwent colonoscopy during 2008 and received the 1-day bowel preparation regimen. Adequate preparation for colonoscopy, success of colonoscopy, and factors associated with inadequate bowel preparation. Inclusion criteria were met by 272 patients. The median age of the children receiving the 1-day PEG 3350 preparation regimen was 13.7 years (range 1.08-17.92 years). Fifty-two percent were male; 48% were female. The most common indications for colonoscopy included abdominal pain (65%), bloody stools (29%), diarrhea (21%), and weight loss (18%). The 1-day bowel preparation regimen was effective in 253 patients (93%). The indication for colonoscopy, the age of the child, or a history of constipation did not significantly alter the success rate of colonoscopy. A retrospective study at one tertiary-care center. The 1-day PEG 3350 bowel preparation regimen is safe and effective and should be considered for use as preparation for colonoscopy in children. 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

Kegel exercises - self-care

MedlinePlus

... may also have problems with urine leakage or bowel control. Kegel exercises can be done any time you are sitting ... better and have fewer symptoms. Keep doing the exercises, but do ... or move your bowels. Some notes of caution: Once you learn how ...

Establishing an inflammatory bowel disease service.

PubMed

Pearson, Catherine

Specialist nurses make a valuable contribution to the care of the individual with inflammatory bowel disease yet there are still relatively few of these nurses in post. This article discusses the development of the role within the Bolton Hospitals NHS Trust.

Beliefs about personal control and self-management in 30-40 year olds living with Inflammatory Bowel Disease: a qualitative study.

PubMed

Cooper, Joanne M; Collier, Jacqueline; James, Veronica; Hawkey, Christopher J

2010-12-01

Inflammatory Bowel Disease is a collective term for two distinct long term conditions: Ulcerative Colitis and Crohn's disease. There is increasing emphasis on patients taking greater personal control and self-management of this condition, reflecting earlier research into the management of chronic illness. Nurses play a pivotal role in this process, yet how optimal personal control is self-assessed and self-managed in Inflammatory Bowel Disease is poorly understood. This study set out to explore beliefs about personal control and self-management of Inflammatory Bowel Disease. It focused on the role of physical, psychological and socio-economic factors within the individual's life experience. A qualitative approach was used comprising 24, one-to-one, semi-structured interviews with participants aged 30-40 years. Participants with a histological diagnosis of Inflammatory Bowel Disease for at least 12 months were eligible and recruited by gastrointestinal specialist staff from outpatient clinics at a large National Health Service Trust in the United Kingdom. Interviews were transcribed verbatim. Data analysis was informed by existing theories of personal control and used the 'systematic framework analysis' approach. In addition to existing theories of personal control, self-discrepancy theory helped to explain how people viewed the control and self-management of Inflammatory Bowel Disease. One main theme emerged from the findings: 'Reconciliation of the self in IBD', this was supported by three sub-themes and eight basic themes. Some participants found that being unable to control and predict the course of their condition was distressing, however for others this limited control was not viewed as a negative outcome. Being able to share control of IBD with specialist health care staff was beneficial, and participants stated that other priorities in life were as equally important to manage and control. A key barrier to ensuring greater personal control and self-management was a lack of knowledge and awareness by non-specialist health care staff, employers and the wider society. Nurses involved in the care of individuals with Inflammatory Bowel Disease should support and prepare patients for the discrepancies and uncertainties of living with the condition. Greater training about Inflammatory Bowel Disease is recommended, specifically for non-specialist health care staff and employers. Copyright © 2010 Elsevier Ltd. All rights reserved.

A Business Case Analysis of the Direct Health Care Provider Program Womack Army Medical Center, Fort Bragg, N.C.

DTIC Science & Technology

2001-05-01

Unspecified (959.01) Hypovolemia (276.5) Medicine Headache, Migraine Variant (346.20) Infectious Mononucleosis (075) Alcohol Abuse, Unspecified (305.00...under the FTCA. In an article entitled “Can the Feres Doctrine Survive TRICARE, and Should It?”, the author examines issues that complicate the...Enteritis – Infectious (009.1) Irritable Bowel Syndrome (564.1) Epilepsy NOS (345.90) Herpes Simplex, NOS (054.9) Ulcerative Colitis (556.9) Head Injury

A comparison of sennosides-based bowel protocols with and without docusate in hospitalized patients with cancer.

PubMed

Hawley, Philippa Helen; Byeon, Jai Jun

2008-05-01

Constipation is a common and distressing condition in patients with cancer, especially those taking opioid analgesics. Many institutions prevent and treat constipation with titrated laxatives, which is known as a bowel protocol. An effective and well-tolerated bowel protocol is a very important component of cancer care, and there is little evidence on which to base selection of the most appropriate agents. This study compares a protocol of the stimulant laxative sennosides alone with a protocol of sennosides plus the stool softener docusate, in hospitalized patients at an oncology center. The docusate-containing protocol had an initial docusate-only step for patients not taking opioids, and four to six 100-mg capsules of docusate sodium in addition to the sennosides for the rest of the protocol. Thirty patients received the sennosides-only (S) protocol and 30 the sennosides plus docusate (DS) protocol. The efficacy and adverse effects of the protocols were monitored for 5-12 days. The two protocols were used sequentially, creating two cohorts, one on each protocol. Eighty percent of patients were taking oral opioids and 72% were admitted for symptom control/supportive care. Over a total of 488 days of observation it was found that the S protocol produced more bowel movements than the DS protocol, and in the symptom control/supportive care patients this difference was statistically significant (p < 0.05). In the S group admitted for symptom control/supportive care 62.5% had a bowel movement more than 50% of days, as compared with 32% in those receiving the DS protocol. Fifty-seven percent of the DS group required additional interventions (lactulose, suppositories or enemas) compared to 40% in the S group. Cramps were reported equally by 3 (10%) patients in each group. Eight patients (27%) experienced diarrhea in the S group compared to 4 (13%) in the DS group. The addition of the initial docusate-only step and adding docusate 400-600 mg/d to the sennosides did not reduce bowel cramps, and was less effective in inducing laxation than the sennosides-only protocol. Further research into the appropriate use of docusate and into the details of bowel protocol design are required.

Gastrointestinal tract recovery in patients undergoing bowel resection: results of a randomized trial of alvimopan and placebo with a standardized accelerated postoperative care pathway.

PubMed

Ludwig, Kirk; Enker, Warren E; Delaney, Conor P; Wolff, Bruce G; Du, Wei; Fort, John G; Cherubini, Maryann; Cucinotta, James; Techner, Lee

2008-11-01

To investigate the efficacy and safety of alvimopan, 12 mg, administered orally 30 to 90 minutes preoperatively and twice daily postoperatively in conjunction with a standardized accelerated postoperative care pathway for managing postoperative ileus after bowel resection. This multicenter, randomized, placebo-controlled, double-blind, phase 3 trial enrolled adult patients undergoing partial bowel resection with primary anastomosis by laparotomy and scheduled to receive intravenous, opioid-based, patient-controlled analgesia. A standardized accelerated postoperative care pathway including early ambulation, oral feeding, and postoperative nasogastric tube removal was used to facilitate gastrointestinal (GI) tract recovery in all of the patients. The primary end point was time to GI-2 recovery (toleration of solid food and first bowel movement). Secondary end points included time to GI-3 recovery (toleration of solid food and first flatus or bowel movement), hospital discharge order written, and actual hospital discharge. Postoperative length of hospital stay based on calendar day of hospital discharge order written, opioid consumption, and overall postoperative ileus-related morbidity were recorded. Alvimopan, 12 mg, was well tolerated and significantly accelerated GI-2 recovery, GI-3 recovery, and actual hospital discharge compared with a standardized accelerated postoperative care pathway alone (hazard ratio = 1.5, 1.5, and 1.4, respectively; P < .001 for all). Time to hospital discharge order written as measured by hazard ratio (1.4) and by postoperative calendar days (mean for alvimopan, 5.2 days; mean for placebo, 6.2 days) was also accelerated. Opioid consumption was comparable between groups, and alvimopan was associated with reduced postoperative ileus-related morbidity compared with placebo. Alvimopan, 12 mg, administered 30 to 90 minutes before and twice daily after bowel resection is well tolerated, accelerates GI tract recovery, and reduces postoperative ileus-related morbidity without compromising opioid analgesia.

Gum chewing combined with oral intake of a semi-liquid diet in the postoperative care of patients after gynaecologic laparoscopic surgery.

PubMed

Pan, Yuping; Chen, Li; Zhong, Xiaorong; Feng, Suwen

2017-10-01

To evaluate the effects of gum chewing combined with a semi-liquid diet on patients after gynaecologic laparoscopic surgery. Previous studies suggested that chewing gum before traditional postoperative care promotes the postoperative recovery of bowel motility and function after open and laparoscopic surgery. However, gum chewing combined with a semi-liquid diet has not been reported in postoperative care of patients following gynaecologic laparoscopic surgery. A prospective randomised study. Total 234 patients were randomly assigned after elective gynaecologic laparoscopic surgery to a gum chewing and semi-liquid diet group, a semi-liquid only diet group or a liquid diet group. The gum chewing and semi-liquid diet group chewed sugar-free gum with an oral intake of a semi-liquid diet six hours postoperatively. The semi-liquid only diet and liquid diet groups received a semi-liquid diet or a liquid diet, respectively. The time to first bowel sounds, time to first regular postoperative bowel sounds, time to first passage of flatus, time to first defecation, serum gastrin and incidences of hunger, nausea, vomiting and abdominal distension were recorded. Hunger and gastrointestinal sensations were assessed using a four-point scale. Serum gastrin was assayed pre- and postoperatively using a gastrin radioimmunoassay kit. The gum chewing and semi-liquid diet group had first bowel sounds, first regular bowel sounds, first passage of flatus and first defecation earlier than the semi-liquid only and liquid groups. Increased serum gastrin was observed in the gum chewing and semi-liquid diet group. Incidences of nausea, vomiting and abdominal distention were not significantly different between these groups. Chewing gum combined with an oral intake of a semi-liquid diet is safe and accelerates the postoperative recovery of bowel function. It might be recommended as a better postoperative care regimen for patients after gynaecologic laparoscopic surgery. This study developed a new postoperative diet regimen to improve the postoperative care of patients undergoing laparoscopic gynecologic surgery. © 2016 John Wiley & Sons Ltd.

A Formal Palliative Care Service Improves the Quality of Care in Patients with Stage IV Cancer and Bowel Obstruction.

PubMed

Gabriel, Emmanuel; Kukar, Moshim; Groman, Adrienne; Alvarez-Perez, Amy; Schneider, Jaclyn; Francescutti, Valerie

2017-02-01

Patients with stage IV cancer and bowel obstruction present a complicated management problem. The aim of this study was to evaluate the role of the palliative care service (PC) in the management of this complex disease process. A retrospective analysis was conducted of all patients admitted to Roswell Park Cancer Institute with stage IV cancer and bowel obstruction from 2009 to 2012 after the institution of a formal PC. This cohort was matched to similar patients from 2005 to 2008 (no palliative care service or NPC). Patient characteristics and outcomes included baseline demographics, comorbid conditions, do-not-resuscitate (DNR) status, laboratory parameters, medical and surgical management, length of stay, symptom relief, and disposition status. A total of 19 patients were identified in the PC group. Based on the PC group baseline characteristics, 19 patients were identified for the NPC group using matched values. Regarding outcomes, there were significant differences in the medication regimens (narcotics, octreotide, and Decadron) between the 2 groups. In the PC group, 14 of 19 patients showed improvement compared to 9 of 19 in the NPC group. Nearly 60% of patients in the PC group had a formal DNR order versus 10.5% in NPC ( P = .002). A significantly higher percentage of patients were discharged to hospice in the PC group (47.4% vs 0.0%, P = .006). Palliative care consultation improves the quality of care for patients with stage IV cancer and bowel obstruction, with particular benefits in symptom management, end-of-life discussion, and disposition to hospice.

The role of quality of care in health-related quality of life in patients with IBD.

PubMed

van der Eijk, Ingrid; Vlachonikolis, Ioannis G; Munkholm, Pia; Nijman, Judy; Bernklev, Tomm; Politi, Patrizia; Odes, Selwyn; Tsianos, Epameinondas V; Stockbrügger, Reinhold W; Russel, Maurice G

2004-07-01

In the literature there are indications of associations between health-related quality of life (HRQoL) in inflammatory bowel disease and disease activity, psychological status, coping, stressful life events, and social support. The aim of this study was to examine whether a relation exists between quality of health care and HRQoL, taking possible confounding variables into account. For this purpose, one single questionnaire was compiled from existing validated questionnaires. A population-based inception cohort of 1056 patients with inflammatory bowel disease in eight countries, diagnosed 6 to 8 years prior to the study, was approached to participate. In total, 824 patients responded (78%), and 517 could be included in statistical analyses. It was shown that in inflammatory bowel disease HRQoL was indeed influenced by quality of care (particularly with regard to the parameters of "providing information," "costs," and "courtesy"), as well as by disease activity, psychological status, type of hospital, social support, stressful life events, and way of administration of the questionnaire. Patients with active disease had lower psychological status and HRQoL scores at the time of the survey than patients without active disease. However, quality of care scores did not differ between these groups. The care aspect "costs" was scored worse by CD compared with UC patients, probably caused by a potentially more expensive treatment. In conclusion, it is shown in a large exploratory study, for the first time, that in inflammatory bowel disease, quality of care has a significant role in determining health-related quality of life.

Multidetector CT of Surgically Proven Blunt Bowel and Mesenteric Injury.

PubMed

Bates, David D B; Wasserman, Michael; Malek, Anita; Gorantla, Varun; Anderson, Stephan W; Soto, Jorge A; LeBedis, Christina A

2017-01-01

Blunt traumatic injury is one of the leading causes of morbidity and mortality in the United States. Unintentional injury represents the leading cause of death in the United States for all persons between the ages of 1 and 44 years. In the setting of blunt abdominal trauma, the reported rate of occurrence of bowel and mesenteric injuries ranges from 1% to 5%. Despite the relatively low rate of blunt bowel and mesenteric injury in patients with abdominal and pelvic trauma, delays in diagnosis are associated with increased rates of sepsis, a prolonged course in the intensive care unit, and increased mortality. During the past 2 decades, as multidetector computed tomography (CT) has emerged as an essential tool in emergency radiology, several direct and indirect imaging features have been identified that are associated with blunt bowel and mesenteric injury. The imaging findings in cases of blunt bowel and mesenteric injury can be subtle and may be seen in the setting of multiple complex injuries, such as multiple solid-organ injuries and spinal fractures. Familiarity with the various imaging features of blunt bowel and mesenteric injury, as well as an understanding of their clinical importance with regard to the care of the patient, is essential to making a timely diagnosis. Once radiologists are familiar with the spectrum of findings of blunt bowel and mesenteric injury, they will be able to make timely diagnoses that will lead to improved patient outcomes. © RSNA, 2017.

The effect of irritable bowel syndrome on health-related quality of life and health care expenditures.

PubMed

Agarwal, Nikhil; Spiegel, Brennan M R

2011-03-01

Irritable bowel syndrome (IBS) is a highly prevalent condition with a large health economic burden of illness marked by impaired health-related quality of life (HRQOL), diminished work productivity, and high expenditures. Clinicians should routinely screen for diminished HRQOL by performing a balanced biopsychosocial history rather than focusing just on bowel symptoms. HRQOL decrements should be acknowledged and addressed when making treatment decisions. Published by Elsevier Inc.

Rehabilitation R&D Progress Reports 1995, Volume 33, June 1996

DTIC Science & Technology

1996-06-01

Stimulation 72 Rehabilitation of the Colon after Spinal Cord Injury: A Pilot Study 73 Electrical Control of Bladder and Bowel following Spinal Cord Injury...A. General 130 Design of New Toilet Prototypes for Elderly and Disabled Veterans 131 Design of a New Bowel Care/Shower Chair for SCI Veterans...and Rehabilitation 292 Functional Restoration of Grasp: A Pilot Study 293 High-Frequency Magnetic Stimulation of the Bladder and Bowel 294 Treatment

How is inflammatory bowel disease managed in Spanish gastroenterology departments? The results of the GESTIONA-EII survey.

PubMed

Barreiro-de Acosta, Manuel; Argüelles-Arias, Federico; Hinojosa, Joaquín; Júdez Gutiérrez, Francisco Javier; Tenías Burillo, Jose Maria

2016-10-01

Not all national health centers include specialized units or clinicians devoted to inflammatory bowel disease. The goal of the survey was to gain an insight into the management of this disease within Spanish gastroenterology departments via a survey among their members. An online survey was conducted in February and March 2015, among SEPD members (2017 clinician members), who were split into three categories: heads of department, general gastroenterologists, and experts in this disease. The results of the last two surveys are reported, including demography-related questions and specific questions on the strategies and resources available for the care of these patients. A total of 166 responses were received (response rate 8.19%), excluding those from heads of department (previously published). Sixty gastroenterologists considered themselves experts in inflammatory bowel disease, and 106 non-experts in it, the latter being either general gastroenterologists or specialists in other areas, mainly endoscopy. Twenty-eight percent of non-expert gastroenterologists said their hospitals had specific units, with a monographic clinic in 46%. However, 26% reported that they were treating affected patients themselves. Experts in inflammatory bowel disease reported that their institute had resources to support their work, but there was a lack of surgeons with expertise in this condition, particularly in county hospitals. At least, within SEPD members, 2 out of 3 experts in inflammatory bowel disease seem to have the resources available for their work (nurses, day unit, telephone line, database, referrals, joint sessions). Although there is room for improvement (email to contact patients, devoted surgeon, absence of referral protocols), and 2 out of 3 are concerned about pharmacy costs. Since a substantial number of patients remain treated by general practitioners, rapid referral programs might be helpful in this setting.

Self-Management Education for Rehabilitation Inpatients Suffering from Inflammatory Bowel Disease: A Cluster-Randomized Controlled Trial

ERIC Educational Resources Information Center

Reusch, A.; Weiland, R.; Gerlich, C.; Dreger, K.; Derra, C.; Mainos, D.; Tuschhoff, T.; Berding, A.; Witte, C.; Kaltz, B.; Faller, H.

2016-01-01

Although inflammatory bowel disease (IBD) affects patients' psychological well-being, previous educational programs have failed to demonstrate effects on psychosocial outcomes and quality of life. Therefore, we developed a group-based psychoeducational program that combined provision of both medical information and psychological self-management…

[Early detection of bowel cancer in occupational surveillance examinations: switching from a guaiak-based to an immunochemical fecal occult blood test].

PubMed

Webendörfer, S; Riemann, J F

2014-01-01

If the diagnosis is made early the cure rate of bowel cancer is more than 90 %. Occupational preventative medical care required by law and carried out by company physicians can be supplemented by a medical consultation and by simple screenings to interest employees in cancer prevention and refer them to registered general practitioners and specialist doctors for further diagnosis and treatment. Since 2001, BASF SE in Ludwigshafen, Germany offers its employees aged 45 and more a program to detect intestinal cancer early. The employees receive personal invitations for this program once a year. The participants answer a standard questionnaire about risk factors for bowel cancer and an endoscopic diagnosis, if this has already been carried out, and receive a FOBT. Since 2010 an immunological test system was used. We compare the results from two consecutive years with a Guajacum test system (g-FOBT) and an immunological test (i-FOBT). The German Association of Digestive and Metabolic Diseases, DGVS, recommends a colonoscopy if test results are positive or a family member has suffered from bowel cancer. Between 2008 and 2011, a total of 52,797 invitations were sent to employees aged 45 and over. Overall, 16,730 men (37.7 % of 46,245) and 1,585 women (24.4 % of 6,552) took part (in some cases more than once). The return rate of the FOBT increased from 66.7 % in 2008 to 79.5 % in 2011. Due to positive results and/or suspicious information in the questionnaire, 2,441 colonoscopies were recommended, 849 of them because of a positive FOBT. The medical department was informed of 224 endoscopy diagnoses. In 8 cases, manifested cancer (6 × colon, 2 × rectum) and in 57 cases adenomatous polyps were diagnosed as preliminary stages of cancer. Most of these diagnoses were made using the i-FOBT, the simultaneous increase in positive test results and therefore more frequent recommendations for a colonoscopy. The additional offer of a program for early detection of bowel cancer as part of an occupational surveillance examination helps detecting bowel cancer early in employees who show no symptoms. Since men on average fall ill earlier, it makes sense to offer these tests at the age of 45.  Personal invitations lead to consistently high participant rates and the simplicity of the i-FOBT leads to high return rates of tests. The rate of positive test results is higher compared to g-FOBT. In our follow-up, significantly more intestinal cancer and possible preliminary stages were detected through screening with the immunological test. © Georg Thieme Verlag KG Stuttgart · New York.

Clinical Aspects of Idiopathic Inflammatory Bowel Disease: A Review for Pathologists.

PubMed

Lee, Hwajeong; Westerhoff, Maria; Shen, Bo; Liu, Xiuli

2016-05-01

-Idiopathic inflammatory bowel disease manifests with different clinical phenotypes showing varying behavior and risk for neoplasia. The clinical questions that are posed to pathologists differ depending on phase of the disease and the clinical circumstances. Understanding the clinical aspects of the dynamic disease process will enhance the role of pathology in optimizing the care of patients with inflammatory bowel disease. -To review clinical and surgical aspects of inflammatory bowel disease that are relevant to practicing pathologists. -The literature was reviewed. -Diagnosis and management of inflammatory bowel disease require an integrated evaluation of clinical, endoscopic, radiologic, and pathologic features. Therefore, close interaction between clinicians and pathologists is crucial. Having this team approach improves understanding of the pertinent clinical and surgical aspects of the disease and assists in the recognition of unusual presentation of variants, as well as mimics of idiopathic inflammatory bowel disease, by pathologists.

Vaccination and Health Maintenance Issues to Consider in Patients With Inflammatory Bowel Disease

PubMed Central

Wasan, Sharmeel K.; Farraye, Francis A.

2017-01-01

Patients with inflammatory bowel disease (IBD) do not receive routine preventive care at the same rate as the general population. IBD places patients at increased risk for developing vaccine-preventable illnesses. This risk is further exacerbated by immunosuppressive therapy. This article highlights the necessary vaccinations for IBD patients and the timing of vaccination for immunosuppressed patients, and discusses the health maintenance needs and preventive care issues related to heart disease, smoking, osteoporosis, mental health, cervical cancer, and skin cancer. PMID:29339947

Surgical treatment of complex small bowel Crohn disease.

PubMed

Michelassi, Fabrizio; Sultan, Samuel

2014-08-01

The clinical presentations of Crohn disease of the small bowel vary from low to high complexity. Understanding the complexity of Crohn disease of the small bowel is important for the surgeon and the gastroenterologist caring for the patient and may be relevant for clinical research as a way to compare outcomes. Here, we present a categorization of complex small bowel Crohn disease and review its surgical treatment as a potential initial step toward the establishment of a definition of complex disease. The complexity of small bowel Crohn disease can be sorted into several categories: technical challenges, namely, fistulae, abscesses, bowel or ureteral obstruction, hemorrhage, cancer and thickened mesentery; extensive disease; the presence of short gut; a history of prolonged use of medications, particularly steroids, immunomodulators, and biological agents; and a high risk of recurrence. Although the principles of modern surgical treatment of Crohn disease have evolved to bowel conservation such as strictureplasty techniques and limited resection margins, such practices by themselves are often not sufficient for the management of complex small bowel Crohn disease. This manuscript reviews each category of complex small bowel Crohn disease, with special emphasis on appropriate surgical strategy.

Bowel Prep Quality in Patients of Low Socioeconomic Status Undergoing Screening Colonoscopy With Patient Navigation.

PubMed

Miller, Sarah Johanna; Itzkowitz, Steven H; Shah, Brijen; Jandorf, Lina

2016-10-01

The effectiveness of colonoscopy is directly affected by the quality of the patient's bowel preparation. Patients with lower socioeconomic status (SES) are at increased risk of having suboptimal bowel prep quality. Patient navigators can play a key role in clarifying bowel prep instructions. The aim of the present study was to examine the quality of bowel prep and its predictors among individuals of low SES undergoing screening colonoscopy with patient navigation. Participants (N = 607) were individuals of low SES who completed a screening colonoscopy with patient navigation. Demographic information was collected after the participants received a primary care referral for a screening colonoscopy. After the colonoscopy was completed, medical charts were reviewed to document the colonoscopists' bowel prep quality ratings. A total of 6.8% (41/607) of the sample had poor bowel prep, which significantly correlated with having a colonoscopy that did not reach the cecum. If fair preps were included, approximately 19.3% (117/607) of our cohort would be considered to have suboptimal bowel prep. Our suboptimal bowel prep rates were better than those reported from other low SES samples. © 2015 Society for Public Health Education.

Cost analysis and cost determinants in a European inflammatory bowel disease inception cohort with 10 years of follow-up evaluation.

PubMed

Odes, Selwyn; Vardi, Hillel; Friger, Michael; Wolters, Frank; Russel, Maurice G; Riis, Lene; Munkholm, Pia; Politi, Patrizia; Tsianos, Epameinondas; Clofent, Juan; Vermeire, Severine; Monteiro, Estela; Mouzas, Iannis; Fornaciari, Giovanni; Sijbrandij, Jildou; Limonard, Charles; Van Zeijl, Gilbert; O'morain, Colm; Moum, Bjørn; Vatn, Morten; Stockbrugger, Reinhold

2006-09-01

Economic analysis in chronic diseases is a prerequisite for planning a proper distribution of health care resources. We aimed to determine the cost of inflammatory bowel disease, a lifetime illness with considerable morbidity. We studied 1321 patients from an inception cohort in 8 European countries and Israel over 10 years. Data on consumption of resources were obtained retrospectively. The cost of health care was calculated from the use of resources and their median prices. Data were analyzed using regression models based on the generalized estimating equations approach. The mean annual total expenditure on health care was 1871 Euro/patient-year for inflammatory bowel disease, 1524 Euro/patient-year for ulcerative colitis, and 2548 Euro/patient-year for Crohn's disease (P < .001). The most expensive resources were medical and surgical hospitalizations, together accounting for 63% of the cost in Crohn's disease and 45% in ulcerative colitis. Total and hospitalization costs were much higher in the first year after diagnosis than in subsequent years. Differences in medical and surgical hospitalizations were the primary cause of substantial intercountry variations of cost; the mean cost of health care was 3705 Euro/patient-year in Denmark and 888 Euro/patient-year in Norway. The outlay for mesalamine, a costly medication with extensive use, was greater than for all other drugs combined. Patient age at diagnosis and sex did not affect costs. In this multinational, population-based, time-dependent characterization of the health care cost of inflammatory bowel disease, increased expenditure was driven largely by country, diagnosis, hospitalization, and follow-up year.

Transcutaneous bowel sonography for inflammatory bowel disease is sensitive and specific when performed in a nonexpert low-volume North American center.

PubMed

Sey, Michael Sai Lai; Gregor, Jamie; Chande, Nilesh; Ponich, Terry; Bhaduri, Mousumi; Lum, Andrea; Zaleski, Witek; Yan, Brian

2013-08-01

Transcutaneous bowel sonography is a nonionizing imaging modality used in inflammatory bowel disease. Although available in Europe, its uptake in North America has been limited. Since the accuracy of bowel sonography is highly operator dependent, low-volume centers in North America may not achieve the same diagnostic accuracy reported in the European literature. Our objective was to determine the diagnostic accuracy of bowel sonography in a nonexpert low-volume center. All cases of bowel sonography at a single tertiary care center during an 18-month period were reviewed. Bowel sonography was compared with reference standards, including small-bowel follow-through, computed tomography, magnetic resonance imaging, colonoscopy, and surgical findings. A total of 103 cases were included for analysis during the study period. The final diagnoses included Crohn disease (72), ulcerative colitis (8), hemolytic uremic syndrome (1), and normal (22). The sensitivity and specificity of bowel sonography for intestinal wall inflammation were 87.8% and 92.6%, respectively. In the subset of patients who had complications of Crohn disease, the sensitivity and specificity were 50% and 100% for fistulas and 14% and 100% for strictures. One patient had an abscess, which was detected by bowel sonography. Abnormal bowel sonographic findings contributed to the escalation of treatment in 55% of cases. Bowel sonography for inflammatory bowel disease can be performed in low-volume centers and provides diagnostic accuracy for luminal disease comparable with published data, although it is less sensitive for complications of Crohn disease.

Patient health communication mediating effects between gastrointestinal symptoms and gastrointestinal worry in pediatric inflammatory bowel disease

USDA-ARS?s Scientific Manuscript database

To investigate the effects of patient health communication regarding their inflammatory bowel disease (IBD) to their health care providers and significant others in their daily life as a mediator in the relationship between gastrointestinal symptoms and gastrointestinal worry in pediatric patients. ...

Parent perceptions of health promotion for school-age children with spina bifida.

PubMed

Luther, Brenda L; Christian, Becky J

2017-01-01

To gain insight into how parents develop their beliefs of health promotion for their children with spina bifida (SB) and how they develop and promote health promotion practices for their children. Qualitative, exploratory design with semi-structured interviews of parents of children between 6 and 12 years of age diagnosed with SB was used for this study. Perceptions of health promotion were maintaining healthy bowel function and managing SB care. Good bowel function and SB management is health promotion and adequate bowel function is viewed as a marker of health. Maintaining healthy bowel function was identified by parents as the key marker of health for their children with SB. Further, the term health promotion brought up plans, concerns, and goals more related to their child's physiologic functioning and health care needs rather than promoting health and avoiding preventable disease. Nurses and healthcare providers are in unique and powerful positions for strategizing with parents on how to integrate health promotion into the lives of children with SB. Team-based, whole-person, holistic assessment and teaching inclusive of promoting healthy lifestyle behaviors in addition to providing excellent care related to their physiologic systems affected by SB can improve how we promote health for these children. © 2017 Wiley Periodicals, Inc.

Development of hydronephrosis secondary to poorly managed neurogenic bowel requiring surgical disimpaction in a patient with spinal cord injury: A case report

PubMed Central

Downs, Jairon; Wolfe, Tracy; Walker, Heather

2014-01-01

Context Case of an adult patient with paraplegia managing neurogenic bladder with intermittent catheterization who was not performing a standard bowel program for management of neurogenic bowel. Findings Patient presented with increasing spasticity, fecal incontinence, and abdominal pain and ultimately was hospitalized for management. Imaging revealed massive fecal impaction, resulting in ureteral obstruction and hydronephrosis. Despite repeated aggressive bowel regimens, serial abdominal X-rays showed continued large stool burden. Ultimately surgical intervention was required to evacuate the colon and subsequently the hydronephrosis resolved. Conclusion/Clinical relevance This case illustrates the importance of proper management of neurogenic bowel, as significant medical complications, such as hydronephrosis can occur with poorly managed neurogenic bowel. PMID:24617444

Irritable bowel syndrome: contemporary nutrition management strategies.

PubMed

Mullin, Gerard E; Shepherd, Sue J; Chander Roland, Bani; Ireton-Jones, Carol; Matarese, Laura E

2014-09-01

Irritable bowel syndrome is a complex disorder whose pathophysiology involves alterations in the enteric microbiota, visceral hypersensitivity, gut immune/barrier function, hypothalamic-pituitary-adrenal axis regulation, neurotransmitters, stress response, psychological factors, and more. The importance of diet in the management of irritable bowel syndrome has taken center stage in recent times as the literature validates the relationship of certain foods with the provocation of symptoms. Likewise, a number of elimination dietary programs have been successful in alleviating irritable bowel syndrome symptoms. Knowledge of the dietary management strategies for irritable bowel syndrome will help guide nutritionists and healthcare practitioners to deliver optimal outcomes. This tutorial reviews the nutrition management strategies for irritable bowel syndrome. © 2014 American Society for Parenteral and Enteral Nutrition.

Inflammatory bowel disease registries for collection of patient iron parameters in Europe

PubMed Central

Halfvarson, Jonas; Cummings, Fraser; Grip, Olof; Savoye, Guillaume

2018-01-01

Iron deficiency without anemia and iron deficiency anemia are common and frequently overlooked complications of inflammatory bowel disease. Despite the frequency and impact of iron deficiency in inflammatory bowel disease, there are gaps in our understanding about its incidence, prevalence and natural history and, consequently, patients may be undertreated. Medical registries have a key role in collecting data on the disease’s natural history, the safety and effectiveness of drugs in routine clinical practice, and the quality of care delivered by healthcare services. Even though iron deficiency impacts inflammatory bowel disease patients and healthcare systems substantially, none of the established European inflammatory bowel disease registries systematically collects information on iron parameters and related outcomes. Collection of robust iron parameter data from patient registries is one way to heighten awareness about the importance of iron deficiency in this disease and to generate data to improve the quality of patient care, patient outcomes, and thus quality of life. This objective could be achieved through collection of specific laboratory, clinical, and patient-reported measurements that could be incorporated into existing registries. This review describes the status of current European inflammatory bowel disease registries and the data they generate, in order to highlight their potential role in collecting iron data, to discuss how such information gathering could contribute to our understanding of iron deficiency anemia, and to provide practical information in regard to the incorporation of accumulated iron parameter data into registries. PMID:29563751

[Usefulness of peristalsis, flatulence and evacuation for predicting oral route tolerance in patients subjected to major abdominal surgery].

PubMed

Hernández-Hernández, Betsabé; Figueroa-Gallaga, Luis; Sánchez-Castrillo, Christian; Belmonte-Montes, Carlos

2007-01-01

to evaluate the usefulness of bowel sounds, flatus and bowel movement presence to predict tolerance of oral intake in patients following major abdominal surgery. nutrition is one of the most important factors in the management of postoperative care. The early oral intake has shown to contribute to a faster recovery. Traditionally the beginning of postoperative feeding after major abdominal surgery is delayed until bowel sounds, flatus and/or bowel movement are present although there is no enough medical evidence for their usefulness. We studied 88 patients following major abdominal surgery. We registered the presence of bowel sounds, flatus and bowel movement each 24 hours in the postoperative period. We analized the relationship between the presence of these signs and the ability to tolerate oral intake. Predictive values, sensitivity, specificity and ROC curves were calculated. results shown that bowel sounds have an acCeptable sensibility but a very low specificity to predict the ability to tolerate oral intake. Unlike bowel sounds, bowel movements shown a low sensibility and a high specificity. Flatus turned out to have and intermediate sensitivity and specificity in the prediction of tolerance of oral feeding. in this study any of these signs were shown as a reliable indicator for beginning oral feeding because they have a moderate to low usefulness.

Irritable bowel syndrome in general practice: an overview.

PubMed

Oberndorff-Klein Woolthuis, A H; Brummer, R J M; de Wit, N J; Muris, J W M; Stockbrügger, R W

2004-01-01

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder that is frequently seen in gastroenterological practice. Population-based studies have shown that at any point in time IBS symptoms are present in about 3%-22% of the general Western population. In general practice, half of all new patients have functional disorders and IBS is responsible for about five consultations per week. General practitioners (GPs) manage the majority of IBS patients, but most knowledge (and research) is based on the smaller percentage of patients managed in secondary care. There is a paucity of literature on differences or similarities between these two groups with regard to clinical characteristics or diagnostic approach. The literature published in English about IBS in general practice was reviewed. Irritable bowel syndrome is frequently encountered in primary care. Primary care IBS patients, compared to secondary care patients, are likely to be young, female and to have less severe symptoms. But this is only true for some symptoms; for example, non-abdominal complaints are equally reported in both groups. The disorder can be diagnosed safely using internationally agreed symptom-based criteria, such as the Rome II criteria. Additional diagnostic measures will be necessary to support the diagnosis in only a minority of situations. Many primary care IBS patients can be managed given adequate reassurance and education, frequently without additional pharmacological treatment.

Predictors of Enteral Autonomy in Children with Intestinal Failure: A Multicenter Cohort Study.

PubMed

Khan, Faraz A; Squires, Robert H; Litman, Heather J; Balint, Jane; Carter, Beth A; Fisher, Jeremy G; Horslen, Simon P; Jaksic, Tom; Kocoshis, Samuel; Martinez, J Andres; Mercer, David; Rhee, Susan; Rudolph, Jeffrey A; Soden, Jason; Sudan, Debra; Superina, Riccardo A; Teitelbaum, Daniel H; Venick, Robert; Wales, Paul W; Duggan, Christopher

2015-07-01

In a large cohort of children with intestinal failure (IF), we sought to determine the cumulative incidence of achieving enteral autonomy and identify patient and institutional characteristics associated with enteral autonomy. A multicenter, retrospective cohort analysis from the Pediatric Intestinal Failure Consortium was performed. IF was defined as severe congenital or acquired gastrointestinal diseases during infancy with dependence on parenteral nutrition (PN) >60 days. Enteral autonomy was defined as PN discontinuation >3 months. A total of 272 infants were followed for a median (IQR) of 33.5 (16.2-51.5) months. Enteral autonomy was achieved in 118 (43%); 36 (13%) remained PN dependent and 118 (43%) patients died or underwent transplantation. Multivariable analysis identified necrotizing enterocolitis (NEC; OR 2.42, 95% CI 1.33-4.47), care at an IF site without an associated intestinal transplantation program (OR 2.73, 95% CI 1.56-4.78), and an intact ileocecal valve (OR 2.80, 95% CI 1.63-4.83) as independent risk factors for enteral autonomy. A second model (n = 144) that included only patients with intraoperatively measured residual small bowel length found NEC (OR 3.44, 95% CI 1.36-8.71), care at a nonintestinal transplantation center (OR 6.56, 95% CI 2.53-16.98), and residual small bowel length (OR 1.04 cm, 95% CI 1.02-1.06 cm) to be independently associated with enteral autonomy. A substantial proportion of infants with IF can achieve enteral autonomy. Underlying NEC, preserved ileocecal valve, and longer bowel length are associated with achieving enteral autonomy. It is likely that variations in institutional practices and referral patterns also affect outcomes in children with IF. Copyright © 2015 Elsevier Inc. All rights reserved.

Spinal cord injury in the emergency context: review of program outcomes of a spinal cord injury rehabilitation program in Sri Lanka

PubMed Central

2014-01-01

Background The final months of the conflict in Sri Lanka in 2009 resulted in massive displacement of the civilian population and a high volume of orthopedic trauma including spinal cord injury. In response to this need, Médecins Sans Frontières implemented a multidisciplinary rehabilitation program. Methods Patients were admitted to the program if they had a spinal cord injury, a stable spine and absence of a high-grade pressure ulcer. All patients were assessed on admission with a standardized functional scale the Spinal Cord Independence Measure II (SCIM) and the American Spinal Injury Association Impairment Scale (ASIA). A multidisciplinary team provided nursing care, physiotherapy, bowel and bladder training, mental health care, and vocational rehabilitation. Patients were discharged from the program when medically stable and able to perform activities of daily living independently or with assistance of a caregiver. The primary outcome measures were discharge to the community, and change in SCIM score on discharge. Secondary outcome measures were measured at 6-12 weeks post-discharge, and included SCIM score and presence of complications (pressure ulcers, urinary tract infections and bowel problems). Results 89 patients were admitted. The majority of injuries were to the thoracic region or higher (89%). The injuries were classified as ASIA grade A in 37 (43%), grade B in 17(20%), grade C in 15 (17%) and grade D in 17(20%). 83.2% met the criteria for discharge, with a further 7.9% patients requiring transfer to hospital for surgical care of pressure ulcers. There was a significant change in SCIM score from 55 on admission to 71 on discharge (p < 0.01). 79.8% and 66.7% achieved a clinically significant and substantially significant SCIM score improvement, respectively. Amongst those with follow up data, there was a reduction in post spinal cord injury complications from those experienced either at or during admission. A further 79% of SCIM scores were stable or improved compared to the score on discharge. Conclusions Provision of effective rehabilitation for spinal cord injury is possible in complex humanitarian emergency situations. A multidisciplinary approach, including psychological support along with partnerships with local and international organizations with specialized expertise, was key to the program’s success. PMID:24650231

The impact of value-based healthcare for inflammatory bowel diseases on healthcare utilization: a pilot study.

PubMed

van Deen, Welmoed K; Spiro, Arlen; Burak Ozbay, A; Skup, Martha; Centeno, Adriana; Duran, Natalie E; Lacey, Precious N; Jatulis, Darius; Esrailian, Eric; van Oijen, Martijn G H; Hommes, Daniel W

2017-03-01

Value-based healthcare (VBHC) is considered to be the solution that will improve quality and decrease costs in healthcare. Many hospitals are implementing programs on the basis of this strategy, but rigorous scientific reports are still lacking. In this pilot study, we present the first-year outcomes of a VBHC program for inflammatory bowel disease (IBD) management that focuses on highly coordinated care, task differentiation of providers, and continuous home monitoring. IBD patients treated within the VBHC program were identified in an administrative claims database from a commercial insurer allowing comparisons to matched controls. Only patients for whom data were available the year before and after starting the program were included. Healthcare utilization including visits, hospitalizations, laboratory and imaging tests, and medications were compared between groups. In total, 60 IBD patients treated at the VBHC Center were identified and were matched to 177 controls. Significantly fewer upper endoscopies were performed (-10%, P=0.012), and numerically fewer surgeries (-25%, P=0.49), hospitalizations (-28%, 0=0.71), emergency department visits (-37%, P=0.44), and imaging studies (-25 to -86%) were observed. In addition, 65% fewer patients (P=0.16) used steroids long term. IBD-related costs were 16% ($771) lower than expected (P=0.24). These are the first results of a successfully implemented VBHC program for IBD. Encouraging trends toward fewer emergency department visits, hospitalizations, and long-term corticosteroid use were observed. These results will need to be confirmed in a larger sample with more follow-up.

Defining and diagnosing irritable bowel syndrome.

PubMed

Schuster, M M

2001-07-01

Approximately 20% of the general population has irritable bowel syndrome (IBS). Although the majority of these individuals do not consult a physician, IBS accounts for 25% of visits to a gastroenterologist and up to 12% of visits to a primary care physician. Consequently, the direct and indirect costs associated with IBS are estimated at $8 billion annually. IBS symptoms, with no apparent structural pathology, include altered bowel habits, abdominal pain/discomfort, and bloating. The Rome II criteria, a standardized guideline for the diagnosis of IBS, contains in its definition abdominal pain or discomfort associated with altered bowel habits. Bloating may often be present. Three patient subgroups are defined according to the predominant bowel symptom: constipation, diarrhea, or alternating constipation and diarrhea. Hematology, fecal occult blood test, flexible sigmoidoscopy, and lactose intolerance evaluations are recommended for all patients demonstrating symptoms of IBS. When indicated, tests are recommended to rule out bacterial or parasitic infections, pelvic floor muscle dyssynergia, colonic inertia, peptic ulcer, or inflammatory bowel disease.

Management of faecal incontinence and constipation in adults with central neurological diseases.

PubMed

Coggrave, Maureen; Norton, Christine

2013-12-18

People with central neurological disease or injury have a much higher risk of both faecal incontinence and constipation than the general population. There is often a fine line between the two symptoms, with any management intended to ameliorate one risking precipitating the other. Bowel problems are observed to be the cause of much anxiety and may reduce quality of life in these people. Current bowel management is largely empirical, with a limited research base. This is an update of a Cochrane review first published in 2001 and subsequently updated in 2003 and 2006. The review is relevant to individuals with any disease directly and chronically affecting the central nervous system (post-traumatic, degenerative, ischaemic or neoplastic), such as multiple sclerosis, spinal cord injury, cerebrovascular disease, Parkinson's disease and Alzheimer's disease. To determine the effects of management strategies for faecal incontinence and constipation in people with a neurological disease or injury affecting the central nervous system. We searched the Cochrane Incontinence Group Trials Register (searched 8 June 2012), which includes searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and MEDLINE In-Process as well as handsearching of journals and conference proceedings; and all reference lists of relevant articles. Randomised and quasi-randomised trials evaluating any type of conservative or surgical intervention for the management of faecal incontinence and constipation in people with central neurological disease or injury were selected. Specific therapies for the treatment of neurological diseases that indirectly affect bowel dysfunction were also considered. Two review authors independently assessed the risk of bias of eligible trials and independently extracted data from the included trials using a range of pre-specified outcome measures. Twenty trials involving 902 people were included.Oral medicationsThere was evidence from individual small trials that people with Parkinson's disease had a statistically significant improvement in the number of bowel motions or successful bowel care routines per week when fibre (psyllium) (mean difference (MD) -2.2 bowel motions, 95% confidence interval (CI) -3.3 to -1.4) or oral laxative (isosmotic macrogol electrolyte solution) (MD 2.9 bowel motions per week, 95% CI 1.48 to 4.32) are used compared with placebo. One trial in people with spinal cord injury showed statistically significant improvement in total bowel care time comparing intramuscular neostigmine-glycopyrrolate (anticholinesterase plus an anticholinergic drug) with placebo (MD 23.3 minutes, 95% CI 4.68 to 41.92).Five studies reported the use of cisapride and tegaserod in people with spinal cord injuries or Parkinson's disease. These drugs have since been withdrawn from the market due to adverse effects; as they are no longer available they have been removed from this review.Rectal stimulantsOne small trial in people with spinal cord injuries compared two bisacodyl suppositories, one polyethylene glycol-based (PGB) and one hydrogenated vegetable oil-based (HVB). The trial found that the PGB bisacodyl suppository significantly reduced the mean defaecation period (PGB 20 minutes versus HVB 36 minutes, P < 0.03) and mean total time for bowel care (PGB 43 minutes versus HVB 74.5 minutes, P < 0.01) compared with the HVB bisacodyl suppository.Physical interventionsThere was evidence from one small trial with 31 participants that abdominal massage statistically improved the number of bowel motions in people who had a stroke compared with no massage (MD 1.7 bowel motions per week, 95% CI 2.22 to 1.18). A small feasibility trial including 30 individuals with multiple sclerosis also found evidence to support the use of abdominal massage. Constipation scores were statistically better with the abdominal massage during treatment although this was not supported by a change in outcome measures (for example the neurogenic bowel dysfunction score).One small trial in people with spinal cord injury showed statistically significant improvement in total bowel care time using electrical stimulation of abdominal muscles compared with no electrical stimulation (MD 29.3 minutes, 95% CI 7.35 to 51.25).There was evidence from one trial with a low risk of bias that for people with spinal cord injury transanal irrigation, compared against conservative bowel care, statistically improved constipation scores, neurogenic bowel dysfunction score, faecal incontinence score and total time for bowel care (MD 27.4 minutes, 95% CI 7.96 to 46.84). Patients were also more satisfied with this method.Other interventionsIn one trial in stroke patients, there appeared to be a short term benefit (less than six months) to patients in terms of the number of bowel motions per week with a one-off educational intervention from nurses (a structured nurse assessment leading to targeted education versus routine care), but this did not persist at 12 months. A trial in individuals with spinal cord injury found that a stepwise protocol did not reduce the need for oral laxatives and manual evacuation of stool.Finally, one further trial reported in abstract form showed that oral carbonated water (rather than tap water) improved constipation scores in people who had had a stroke. There is still remarkably little research on this common and, to patients, very significant issue of bowel management. The available evidence is almost uniformly of low methodological quality. The clinical significance of some of the research findings presented here is difficult to interpret, not least because each intervention has only been addressed in individual trials, against control rather than compared against each other, and the interventions are very different from each other.There was very limited evidence from individual trials in favour of a bulk-forming laxative (psyllium), an isosmotic macrogol laxative, abdominal massage, electrical stimulation and an anticholinesterase-anticholinergic drug combination (neostigmine-glycopyrrolate) compared to no treatment or controls. There was also evidence in favour of transanal irrigation (compared to conservative management), oral carbonated (rather than tap) water and abdominal massage with lifestyle advice (compared to lifestyle advice alone). However, these findings need to be confirmed by larger well-designed controlled trials which should include evaluation of the acceptability of the intervention to patients and the effect on their quality of life.

Laparoscopy for bowel obstruction--a contradiction? Results of a multi-institutional survey in Germany.

PubMed

Zimmermann, M; Hoffmann, M; Laubert, T; Bruch, H P; Keck, T; Benecke, C; Schlöricke, E

2016-05-01

The purpose of the present study was to investigate on the acceptance and frequency of laparoscopic surgery for the management of acute and chronic bowel obstruction in a general patient population in German hospitals. To receive an authoritative opinion on laparoscopic treatment of bowel obstruction in Germany, a cross-sectional online study was conducted. We designed an online-based survey, supported by the German College of Surgeons (Berufsverband der Deutschen Chirurgen, BDC) to get multi-institutional-based data from various level providers of patient care. Between January and February 2014, we received completed questionnaires from 235 individuals (16.7 %). The participating surgeons were a representative sample of German hospitals with regard to hospital size, level of center size, and localization. A total of 74.9 % (n = 176) of all responders stated to use laparoscopy as the initial step of exploration in expected bowel obstruction. This procedure was highly statistically associated with the frequency of overall laparoscopic interventions and laparoscopic experience. The overall conversion rate was reported to be 29.4 %. This survey, investigating on the use of laparoscopic exploration or interventions in bowel obstruction, was able to show that by now, a majority of the responding surgeons accept laparoscopy as an initial step for exploration of the abdomen in the case of bowel obstruction. Laparoscopy was considered to be at least comparable to open surgery in an emergency setting. Furthermore, data analysis demonstrated generally accepted advantages and disadvantages of the laparoscopic approach. Indications for or against laparoscopy are made after careful consideration in each individual case.

Bowel preparation for pediatric colonoscopy: report of the NASPGHAN endoscopy and procedures committee.

PubMed

Pall, Harpreet; Zacur, George M; Kramer, Robert E; Lirio, Richard A; Manfredi, Michael; Shah, Manoj; Stephen, Thomas C; Tucker, Neil; Gibbons, Troy E; Sahn, Benjamin; McOmber, Mark; Friedlander, Joel; Quiros, J A; Fishman, Douglas S; Mamula, Petar

2014-09-01

Pediatric bowel preparation protocols used before colonoscopy vary greatly, with no identified standard practice. The present clinical report reviews the evidence for several bowel preparations in children and reports on their use among North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition members. Publications in the pediatric literature for bowel preparation regimens are described, including mechanisms of action, efficacy and ease of use, and pediatric studies. A survey distributed to pediatric gastroenterology programs across the country reviews present national practice, and cleanout recommendations are provided. Finally, further areas for research are identified.

Predictors of health care seeking for irritable bowel syndrome: a population based study

PubMed Central

Talley, N; Boyce, P; Jones, M

1997-01-01

Background—It has been suggested that psychological factors rather than symptoms drive subjects with irritable bowel syndrome (IBS) to seek medical care, but this issue has not been tackled in a population based study. 
Aim—To identify whether psychological factors or abuse explain health care seeking for IBS. 
Methods—A sample of residents of Penrith (a Sydney suburb representative of the Australian population) selected randomly from the electoral rolls (that by law include the entire population ⩾18 years) was mailed a validated self-report questionnaire. Measured were gastrointestinal symptoms including the Manning (and Rome) criteria for IBS, health care seeking, neuroticism (Eysenck Personality Questionnaire), psychological morbidity (General Health Questionnaire: GHQ) and sexual, physical and emotional abuse (including the standardised Drossman questions). 
Results—Among 730 subjects, 96 (13%, 95% confidence interval (CI) 11-16%) had IBS by the Manning criteria. Of those with IBS, 73% (95% CI 63-81%) had sought medical care for abdominal pain or discomfort. Only increasing pain severity (odds ratio (OR) = 2.10, 95% CI 1.11-3.95) and duration of pain (OR=1.53, 95% CI 1.10-2.13) were independently associated with seeking health care for IBS. Pain severity was also predictive of recent care seeking (OR=1.74, 95% CI 1.12-1.96). Neuroticism, psychological morbidity and abuse history were not significant predictors. 
Conclusion—Psychological factors do not seem to explain health care seeking among community subjects with IBS. 

 Keywords: epidemiology; irritable bowel syndrome; abuse; neuroticism PMID:9378398

[The Effectiveness of Abdominal Massage on Neurogenic Bowel Dysfunction in Patients With Spinal Cord Injury: A Systematic Review].

PubMed

Wu, Tzu-Jung; Lin, Chiu-Chu; Wang, Hsiu-Hung

2017-02-01

Neurogenic bowel dysfunction is a common comorbidity in spinal cord injury patients that may result in fecal incontinence. Abdominal massage is one intestinal training method that is used to improve bowel movement and defecation. To review the effectiveness of abdominal massage on neurogenic bowel dysfunction in patients with spinal cord injury. A systematic review of Chinese and English-language articles was performed in six databases using the following key words: spinal cord injury, abdominal massage, neurogenic bowel dysfunction, and bowel training. Relevant studies published prior to June 2016 that met the inclusion and exclusion criteria were selected. The Downs and Black scale was used to appraise the quality of each of the included studies. Eight studies were included in the final analysis. Four of these studies indicated that abdominal massage significantly improved bowel functions and the regularity and frequency of bowel movements. Although two of the studies indicated that abdominal massage significantly reduced the use of glycerin and laxatives, the remaining six did not. The eight studies earned respective quality scores ranging between 13 and 25. The current literature lacks consensus on the efficacy of abdominal massage in terms of improving bowel dysfunction in patients with spinal cord injuries. Future studies should use more stringent experimental designs such as randomized controlled studies to explore the correlations among massage time and frequency and bowel function improvements in order to provide guidelines for clinical care applications.

Predictors of Home Care Expenditures and Death at Home for Cancer Patients in an Integrated Comprehensive Palliative Home Care Pilot Program

PubMed Central

Howell, Doris M.; Abernathy, Tom; Cockerill, Rhonda; Brazil, Kevin; Wagner, Frank; Librach, Larry

2011-01-01

Purpose: Empirical understanding of predictors for home care service use and death at home is important for healthcare planning. Few studies have examined these predictors in the context of the publicly funded Canadian home care system. This study examined predictors for home care use and home death in the context of a “gold standard” comprehensive palliative home care program pilot in Ontario where patients had equal access to home care services. Methods: Secondary clinical and administrative data sources were linked using a unique identifier to examine multivariate factors (predisposing, enabling, need) on total home care expenditures and home death for a cohort of cancer patients enrolled in the HPCNet pilot. Results: Subjects with gastrointestinal symptoms (OR: 1.64; p=0.03) and those with higher income had increased odds of dying at home (OR: 1.14; p<0.001), whereas age, number of GP visits, gastrointestinal symptoms (i.e., nausea, vomiting, bowel obstruction) and eating problems (i.e., anorexia/cachexia) predicted home care expenditures. Conclusions: Predictors of home death found in earlier studies appeared less important in this comprehensive palliative home care pilot. An income effect for home death observed in this study requires examination in future controlled studies. Relevance: Access to palliative home care that is adequately resourced and organized to address the multiple domains of issues that patients/families experience at the end of life has the potential to enable home death and shift care appropriately from limited acute care resources. PMID:22294993

Failure of gastroenterologists to apply intestinal ultrasound in inflammatory bowel disease in the Asia-Pacific: a need for action.

PubMed

Asthana, Anil Kumar; Friedman, Antony B; Maconi, Giovanni; Maaser, Christian; Kucharzik, Torsten; Watanabe, Mamoru; Gibson, Peter R

2015-03-01

Intestinal ultrasound (IUS) is a cheap, noninvasive, risk-free procedure that is significantly underutilized in the diagnosis and management of patients with inflammatory bowel disease (IBD) in the Asia-Pacific region. More cost-effective methods of monitoring disease activity are required in light of the increasing global burden of IBD (especially in Asia), the advent of personalized medicine, and the rising cost of healthcare. IUS is a prime example of a technique that meets these needs. Its common clinical applications include assessing the activity and complications of IBD. In continental Europe, countries such as Germany and Italy use this imaging tool as the standard of care and have integrated it into management protocols. There are formal training programs in these countries to train gastroenterologists in IUS, and it is used in an outpatient setting during patient consultations. Barriers to its use in the Asia-Pacific region include lack of experience and research data, and there are few established centers with active training programs. These concerns can be addressed by investing more in IUS service provision and by increasing allocation of resources toward local research and training. Increased uptake of IUS will ultimately benefit patients with IBD. © 2014 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

Rifaximin and eluxadoline - newly approved treatments for diarrhea-predominant irritable bowel syndrome: what is their role in clinical practice alongside alosetron?

PubMed

Cash, Brooks D; Lacy, Brian E; Rao, Tharaknath; Earnest, David L

2016-01-01

Diarrhea-predominant irritable bowel syndrome (IBS-D) is a common functional gastrointestinal condition in which patients experience abdominal pain, diarrhea, bloating, cramps, flatulence, fecal urgency, and incontinence. We review two recently approved therapies that focus on treating underlying pathogenic mechanisms of IBS-D: (1) the non-absorbable antibiotic rifaximin, and (2) the opioid receptor agonist/antagonist eluxadoline. We compare the safety and efficacy data emerging from rifaximin and eluxadoline registration trials with safety and efficacy data from the alosetron clinical development program. The rifaximin and eluxadoline clinical development programs for IBS-D have demonstrated significant improvement in IBS-D endpoints compared to placebo. Direct comparison of primary endpoint results from the alosetron, rifaximin, and eluxadoline pivotal trials is not possible; however, general estimates of efficacy can be made, and these demonstrate similar and significantly greater responses to 'adequate relief' and a composite endpoint of abdominal pain/stool form for each agent compared to placebo. With the recent approval in the United States of rifaximin and eluxadoline for IBS-D, how should clinicians employ these agents? We suggest that they be utilized sequentially, taking into consideration patient symptoms and severity, prior medical history, mode of action, cost, availability, managed care coverage, and adverse event profiles.

Predicting outcomes to optimize disease management in inflammatory bowel disease in Japan: their differences and similarities to Western countries.

PubMed

Kobayashi, Taku; Hisamatsu, Tadakazu; Suzuki, Yasuo; Ogata, Haruhiko; Andoh, Akira; Araki, Toshimitsu; Hokari, Ryota; Iijima, Hideki; Ikeuchi, Hiroki; Ishiguro, Yoh; Kato, Shingo; Kunisaki, Reiko; Matsumoto, Takayuki; Motoya, Satoshi; Nagahori, Masakazu; Nakamura, Shiro; Nakase, Hiroshi; Tsujikawa, Tomoyuki; Sasaki, Makoto; Yokoyama, Kaoru; Yoshimura, Naoki; Watanabe, Kenji; Katafuchi, Miiko; Watanabe, Mamoru; Hibi, Toshifumi

2018-04-01

Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), is a chronic inflammatory disease of the gastrointestinal tract, with increasing prevalence worldwide. IBD Ahead is an international educational program that aims to explore questions commonly raised by clinicians about various areas of IBD care and to consolidate available published evidence and expert opinion into a consensus for the optimization of IBD management. Given differences in the epidemiology, clinical and genetic characteristics, management, and prognosis of IBD between patients in Japan and the rest of the world, this statement was formulated as the result of literature reviews and discussions among Japanese experts as part of the IBD Ahead program to consolidate statements of factors for disease prognosis in IBD. Evidence levels were assigned to summary statements in the following categories: disease progression in CD and UC; surgery, hospitalization, intestinal failure, and permanent stoma in CD; acute severe UC; colectomy in UC; and colorectal carcinoma and dysplasia in IBD. The goal is that this statement can aid in the optimization of the treatment strategy for Japanese patients with IBD and help identify high-risk patients that require early intervention, to provide a better long-term prognosis in these patients.

Predicting outcomes to optimize disease management in inflammatory bowel disease in Japan: their differences and similarities to Western countries

PubMed Central

Kobayashi, Taku; Suzuki, Yasuo; Ogata, Haruhiko; Andoh, Akira; Araki, Toshimitsu; Hokari, Ryota; Iijima, Hideki; Ikeuchi, Hiroki; Ishiguro, Yoh; Kato, Shingo; Kunisaki, Reiko; Matsumoto, Takayuki; Motoya, Satoshi; Nagahori, Masakazu; Nakamura, Shiro; Nakase, Hiroshi; Tsujikawa, Tomoyuki; Sasaki, Makoto; Yokoyama, Kaoru; Yoshimura, Naoki; Watanabe, Kenji; Katafuchi, Miiko; Watanabe, Mamoru; Hibi, Toshifumi

2018-01-01

Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), is a chronic inflammatory disease of the gastrointestinal tract, with increasing prevalence worldwide. IBD Ahead is an international educational program that aims to explore questions commonly raised by clinicians about various areas of IBD care and to consolidate available published evidence and expert opinion into a consensus for the optimization of IBD management. Given differences in the epidemiology, clinical and genetic characteristics, management, and prognosis of IBD between patients in Japan and the rest of the world, this statement was formulated as the result of literature reviews and discussions among Japanese experts as part of the IBD Ahead program to consolidate statements of factors for disease prognosis in IBD. Evidence levels were assigned to summary statements in the following categories: disease progression in CD and UC; surgery, hospitalization, intestinal failure, and permanent stoma in CD; acute severe UC; colectomy in UC; and colorectal carcinoma and dysplasia in IBD. The goal is that this statement can aid in the optimization of the treatment strategy for Japanese patients with IBD and help identify high-risk patients that require early intervention, to provide a better long-term prognosis in these patients.

A call for new standard of care in perioperative gynecologic oncology practice: Impact of enhanced recovery after surgery (ERAS) programs.

PubMed

Miralpeix, Ester; Nick, Alpa M; Meyer, Larissa A; Cata, Juan; Lasala, Javier; Mena, Gabriel E; Gottumukkala, Vijaya; Iniesta-Donate, Maria; Salvo, Gloria; Ramirez, Pedro T

2016-05-01

Enhanced recovery after surgery (ERAS) programs aim to hasten functional recovery and improve postoperative outcomes. However, there is a paucity of data on ERAS programs in gynecologic surgery. We reviewed the published literature on ERAS programs in colorectal surgery, general gynecologic surgery, and gynecologic oncology surgery to evaluate the impact of such programs on outcomes, and to identify key elements in establishing a successful ERAS program. ERAS programs are associated with shorter length of hospital stay, a reduction in overall health care costs, and improvements in patient satisfaction. We suggest an ERAS program for gynecologic oncology practice involving preoperative, intraoperative, and postoperative strategies including; preadmission counseling, avoidance of preoperative bowel preparation, use of opioid-sparing multimodal perioperative analgesia (including loco-regional analgesia), intraoperative goal-directed fluid therapy (GDT), and use of minimally invasive surgical techniques with avoidance of routine use of nasogastric tube, drains and/or catheters. Postoperatively, it is important to encourage early feeding, early mobilization, timely removal of tubes and drains, if present, and function oriented multimodal analgesia regimens. Successful implementation of an ERAS program requires a multidisciplinary team effort and active participation of the patient in their goal-oriented functional recovery program. However, future outcome studies should evaluate the efficacy of an intervention within the pathway, include objective measures of symptom burden and control, study measures of functional recovery, and quantify outcomes of the program in relation to the rates of adherence to the key elements of care in gynecologic oncology such as oncologic outcomes and return to intended oncologic therapy (RIOT). Copyright © 2016 Elsevier Inc. All rights reserved.

Imaging of the small bowel in Crohn's disease: A review of old and new techniques

PubMed Central

Saibeni, Simone; Rondonotti, Emanuele; Iozzelli, Andrea; Spina, Luisa; Tontini, Gian Eugenio; Cavallaro, Flaminia; Ciscato, Camilla; de Franchis, Roberto; Sardanelli, Francesco; Vecchi, Maurizio

2007-01-01

The investigation of small bowel morphology is often mandatory in many patients with Crohn’s disease. Traditional radiological techniques (small bowel enteroclysis and small bowel follow-through) have long been the only suitable methods for this purpose. In recent years, several alternative imaging techniques have been proposed. To review the most recent advances in imaging studies of the small bowel, with particular reference to their possible application in Crohn’s disease, we conducted a complete review of the most important studies in which traditional and newer imaging methods were performed and compared in patients with Crohn’s disease. Several radiological and endoscopic techniques are now available for the study of the small bowel; each of them is characterized by a distinct profile of favourable and unfavourable features. In some cases, they may also be used as complementary rather than alternative techniques. In everyday practice, the choice of the technique to be used stands upon its availability and a careful evaluation of diagnostic accuracy, clinical usefulness, safety and cost. The recent development of innovative imaging techniques has opened a new and exciting area in the exploration of the small bowel in Crohn’s disease patients. PMID:17659666

Inflammatory Bowel Disease Care: What to Do When There Is a Breach of Contract between the Patient and Physician?

PubMed

Lewis, James D

2018-04-30

Care for patients is generally delivered under the context of an unwritten contract with few clauses, among them being that the physician will educate the patient about treatment options and recommend the treatment that they believe will be most likely to help the patient and that the patient will do their best to follow the agreed upon treatment plan. As the treatments for inflammatory bowel disease have become more complex, the demands placed on patients to complete pretreatment screening, monitoring, and health maintenance activities have also increased. Physicians caring for these patients face challenging decisions when patients do not adhere to the recommended protocol. This commentary discusses potential implications of different approaches to this clinical dilemma.

Intestinal or bowel obstruction - discharge

MedlinePlus

... a chance your intestine may become blocked again. Self-care Follow instructions for how to take care of ... avoid solid foods for a while and try drinking only clear fluids. Your surgeon may want you ...

Abdominal emergency in elderly: a case of small bowel obstruction and ischemia caused by bulky IA ovarian cancer.

PubMed

Assenza, M; Campana, G; Centonze, L; Simonelli, L; Romeo, V; Marchese, S; Andreoli, C; Modini, C

2013-01-01

Bowel obstruction resulting from colorectal and ovarian cancer is a serious and distressing complication of these malignancies. This may be caused by diffuse peritoneal carcinomatosis, bulky masses filling the pelvis and abdomen or postoperative adhesions, and should be carefully worked out by pre-operative imaging. We report the case of a small bowel obstruction and intestinal ischemia caused by a bulky (20x40 cm in diameter) cystic ovarian neoplasm that was found to be a stage IA G2 cystadenocarcinoma, successfully managed by uterus-sparing surgery.

Common Functional Gastroenterologic Disorders Associated With Abdominal Pain

PubMed Central

Bharucha, Adil E.; Chakraborty, Subhankar; Sletten, Christopher D.

2016-01-01

Although abdominal pain is a symptom of several structural gastrointestinal disorders (eg, peptic ulcer disease), this comprehensive review will focus on the 4 most common nonstructural, or functional, disorders associated with abdominal pain: functional dyspepsia, constipation-predominant and diarrhea-predominant irritable bowel syndrome, and functional abdominal pain syndrome. Together, these conditions affect approximately 1 in 4 people in the United States. They are associated with comorbid conditions (eg, fibromyalgia, depression), impaired quality of life, and increased health care utilization. Symptoms are explained by disordered gastrointestinal motility and sensation, which are implicated in a variety of peripheral (eg, postinfectious inflammation, luminal irritants) and/or central (eg, stress and anxiety) factors. These disorders are defined and can generally be diagnosed by symptoms alone. Often prompted by alarm features, selected testing is useful to exclude structural disease. Identifying the specific diagnosis (eg, differentiating between functional abdominal pain and irritable bowel syndrome) and establishing an effective patient-physician relationship are the cornerstones of therapy. Many patients with mild symptoms can be effectively managed with limited tests, sensible dietary modifications, and over-the-counter medications tailored to symptoms. If these measures are not sufficient, pharmacotherapy should be considered for bowel symptoms (constipation or diarrhea) and/or abdominal pain; opioids should not be used. Behavioral and psychological approaches (eg, cognitive behavioral therapy) can be very helpful, particularly in patients with chronic abdominal pain who require a multidisciplinary pain management program without opioids. PMID:27492916

EHealth: self-management in inflammatory bowel disease and in irritable bowel syndrome using novel constant-care web applications. EHealth by constant-care in IBD and IBS.

PubMed

Pedersen, Natalia

2015-12-01

Inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) are chronic gastrointestinal disorders of unknown aetiology of increasing incidence and changing disease activity or severity. Approximately 60-80% of IBD patients suffer from IBS. Monitoring and treatment goals of IBD are to optimise the disease course by prolonging remission periods and preventing or shortening periods of active disease. Constant-care web-monitoring and treatment approaches with active patient involvement have been proven effective in UC, increasing patients' adherence and improving the disease outcomes.   To assess the feasibility and efficacy of the novel constant-care eHealth applications in: i) CD patients treated with infliximab (IFX), ii) UC patients with active disease on mesalazine, iii) IBS patients and iv) IBD patients with IBS on a low FODMAP diet (LFD).   New constant-care web applications www.cd.constant-care.dk, www.meza.constant-care.dk and www.ibs.constant-care.dk in IBD patients were developed and assessed in this thesis. An integrated inflammatory burden measure of disease activity, consisting of a subjective (clinical indices) and of an objective (faecal calprotectin) part and a treatment guide to drug doses and intervals, was incorporated into the web applications and used by patients. Web-guided IFX treatment in CD demonstrated patients' inter- and intra-individual variability in infusion intervals and provided patients with individualised treatment according to their needs. Web-guided treatment with multimatrix mesalazine was efficacious in a majority of UC patients with mild-to-moderate disease activity. Web-guided IBS-monitoring in IBD and in IBS patients on LFD was shown to be a feasible method that actively involved patients in their disease management and had a positive short-term impact on the disease. Moreover, the new constant-care concepts were demonstrated to be safe and to have a positive impact on quality of life and adherence to treatment and helped to reduce the costs.   The novel constant-care web applications have proven feasible in improving the disease outcomes in CD patients on IFX, in UC patients on mesalazine, and in monitoring IBS. These applications are expected to be implemented in the clinical practice of gastroenterology in Denmark in the coming years. Future studies will help to assess whether the natural disease course can be improved in the long-term.

A descriptive model for a multidisciplinary unit for colorectal and pelvic malformations.

PubMed

Vilanova-Sanchez, Alejandra; Halleran, Devin R; Reck-Burneo, Carlos A; Gasior, Alessandra C; Weaver, Laura; Fisher, Meghan; Wagner, Andrea; Nash, Onnalisa; Booth, Kristina; Peters, Kaleigh; Williams, Charae; Brown, Sarah Mayer; Lu, Peter; Fuchs, Molly; Diefenbach, Karen; Leonard, Jeffrey R; Hewitt, Geri; McCracken, Kate; Di Lorenzo, Carlo; Wood, Richard J; Levitt, Marc A

2018-04-19

Patients with anorectal malformations (ARM), Hirschsprung disease (HD), and colonic motility disorders often require care from specialists across a variety of fields, including colorectal surgery, urology, gynecology, and GI motility. We sought to describe the process of creating a collaborative process for the care of these complex patients. We developed a model of a devoted center for these conditions that includes physicians, psychologists, social workers, nurses, and advanced practice nurses. Our weekly planning strategy includes a meeting with representatives of all specialties to review all patients prior to evaluation in our multidisciplinary clinic, followed by combined exams under anesthesia or surgical intervention as needed. There are 31 people working directly in the Center at present. From the Center's start in 2014 until 2017, 1258 patients were cared for from all 50 United States and 62 countries. 360 patients had an ARM (110 had a cloacal malformation, 11 had cloacal exstrophy), 223 presented with HD, 71 had a spinal malformation or injury causing neurogenic bowel, 321 had severe functional constipation or colonic dysmotility, and 162 had other diagnoses including familial polyposis, Crohn's disease, or ulcerative colitis. We have had 170 multidisciplinary meetings, 170 multispecialty outpatient, and 52 nurse practitioner clinics. In our bowel management program we have seen a total of 514 patients in 36 sessions. This is the first report describing the design of a multidisciplinary team approach for patients with colorectal and complex pelvic malformations. We found that approaching these patients in a collaborative way allows for combined medical and surgical decisions with many providers simultaneously, facilitates therapy, and can potentially improve patient outcomes. We hope that this model will help establish new-devoted centers in other locations to encourage centralized care for these rare malformations. IV. Copyright © 2018. Published by Elsevier Inc.

Prevalence of gastrointestinal symptoms six months after bacterial gastroenteritis and risk factors for development of the irritable bowel syndrome: postal survey of patients.

PubMed Central

Neal, K. R.; Hebden, J.; Spiller, R.

1997-01-01

OBJECTIVE: To measure the prevalence of gastrointestinal symptoms six months after bacterial gastroenteritis and determine risk factors and associations with postdysenteric symptoms. DESIGN: Postal questionnaire. SETTING: Nottingham Health Authority. SUBJECTS: 544 people with microbiologically confirmed bacterial gastroenteritis between July 1994 and December 1994. MAIN OUTCOME MEASURES: Prevalence of gastrointestinal symptoms and relative risks for development of the irritable bowel syndrome and self reported altered bowel habit. RESULTS: A quarter of subjects reported persistence of altered bowel habit six months after an episode of infective gastroenteritis. Increasing duration of diarrhoea, younger age, and female sex increased this risk, whereas vomiting as part of the illness reduced the risk. One in 14 developed the irritable bowel syndrome with an increased risk seen in women (relative risk 3.4: 95% confidence interval 1.2 to 9.8) and with duration of diarrhoea (6.5; 1.3 to 34 for 15-21 days). CONCLUSIONS: Persistence of bowel symptoms commonly occurs after bacterial gastroenteritis and is responsible for considerable morbidity and health care costs. PMID:9080994

Systematic review: the perceptions, diagnosis and management of irritable bowel syndrome in primary care--a Rome Foundation working team report.

PubMed

Hungin, A P S; Molloy-Bland, M; Claes, R; Heidelbaugh, J; Cayley, W E; Muris, J; Seifert, B; Rubin, G; de Wit, N

2014-11-01

To review studies on the perceptions, diagnosis and management of irritable bowel syndrome (IBS) in primary care. Systematic searches of PubMed and Embase. Of 746 initial search hits, 29 studies were included. Relatively few primary care physicians were aware of (2-36%; nine studies) or used (0-21%; six studies) formal diagnostic criteria for IBS. Nevertheless, most could recognise the key IBS symptoms of abdominal pain, bloating and disturbed defaecation. A minority of primary care physicians [7-32%; one study (six European countries)] preferred to refer patients to a specialist before making an IBS diagnosis, and few patients [4-23%; three studies (two European, one US)] were referred to a gastroenterologist by their primary care physician. Most PCPs were unsure about IBS causes and treatment effectiveness, leading to varied therapeutic approaches and broad but frequent use of diagnostic tests. Diagnostic tests, including colon investigations, were more common in older patients (>45 years) than in younger patients [<45 years; five studies (four European, one US)]. There has been much emphasis about the desirability of an initial positive diagnosis of IBS. While it appears most primary care physicians do make a tentative IBS diagnosis from the start, they still tend to use additional testing to confirm it. Although an early, positive diagnosis has advantages in avoiding unnecessary investigations and costs, until formal diagnostic criteria are conclusively shown to sufficiently exclude organic disease, bowel investigations, such as colonoscopy, will continue to be important to primary care physicians. © 2014 John Wiley & Sons Ltd.

The Potential Role of a Self-Management Intervention for Ulcerative Colitis: A Brief Report From the Ulcerative Colitis Hypnotherapy Trial

PubMed Central

Keefer, Laurie; Kiebles, Jennifer L.; Kwiatek, Monika A.; Palsson, Olafur; Taft, Tiffany H.; Martinovich, Zoran; Barrett, Terrence A.

2013-01-01

Inflammatory bowel diseases (IBD) are chronic inflammatory illnesses marked by unpredictable disease flares, which occur spontaneously and/or in response to external triggers, especially personal health behaviors. Behavioral triggers of flare may be responsive to disease self-management programs. We report on interim findings of a randomized controlled trial of gut-directed hypnotherapy (HYP, n = 19) versus active attention control (CON, n = 17) for quiescent ulcerative colitis (UC). To date, 43 participants have enrolled; after 5 discontinuations (1 in HYP) and 2 exclusions due to excessive missing data, 36 were included in this preliminary analysis. Aim 1 was to determine the feasibility and acceptability of HYP in UC. This was achieved, demonstrated by a reasonable recruitment rate at our outpatient tertiary care clinic (20%), high retention rate (88% total), and our representative IBD sample, which is reflected by an equal distribution of gender, an age range between 21 and 69, recruitment of ethnic minorities (~20%), and disease duration ranging from 1.5 to 35 years. Aim 2 was to estimate effect sizes on key clinical outcomes for use in future trials. Effect sizes (group × time at 20 weeks) were small to medium for IBD self-efficacy (.34), Inflammatory Bowel Disease Questionnaire (IBDQ) total score (.41), IBDQ bowel (.50), and systemic health (.48). Between-group effects were observed for the IBDQ bowel health subscale (HYP > CON; p = .05) at 20 weeks and the Short Form 12 Health Survey Version 2 (SF-12v2) physical component (HYP > CON; p < .05) at posttreatment and 20 weeks. This study supports future clinical trials testing gut-directed HYP as a relapse prevention tool for IBD. PMID:21362636

Are Interferential Electrical Stimulation and Diaphragmatic Breathing Exercises Beneficial in Children With Bladder and Bowel Dysfunction?

PubMed

Zivkovic, Vesna D; Stankovic, Ivona; Dimitrijevic, Lidija; Kocic, Mirjana; Colovic, Hristina; Vlajkovic, Marina; Slavkovic, Andjelka; Lazovic, Milica

2017-04-01

To evaluate the effects of interferential current (IC) stimulation and diaphragmatic breathing exercises (DBEs) in children with bladder and bowel dysfunction. Seventy-nine children with dysfunctional voiding and chronic constipation who were failures of primary care interventions were included in the prospective clinical study. All the children were checked for their medical history regarding lower urinary tract symptoms and bowel habits. Physical examination, including abdominal and anorectal digital examination, was performed. Children kept a bladder and bowel diary, and underwent urinalyses and urine culture, ultrasound examination of bladder and kidneys, and uroflowmetry with pelvic floor electromyography. Eligible children were divided into 3 groups (A, B, and C). All groups were assigned education and behavioral modifications. Additionally, group A underwent DBEs and IC stimulation, whereas group B received only DBEs. The treatment was conducted for 2 weeks in the clinic in all 3 groups,. The behavioral modifications and DBEs were continued at home for 1 month. Clinical manifestations, uroflowmetry parameters, and postvoided residual urine were analyzed before and after 6 weeks of therapy. After the treatment, significant improvement in defecation frequency and fecal incontinence was noticed only in group A (P < .001 and P < .05, respectively). These children demonstrated significant improvement in lower urinary tract symptoms and postvoided residual urine (P < .001 and P < .05, respectively). Bell-shaped uroflowmetry curve was observed in 73.3% of group A patients (P < .001). IC stimulation and DBEs are beneficial in chronically constipated dysfunctional voiders. Further trials are needed to define the long-term effects of this program. Copyright © 2016 Elsevier Inc. All rights reserved.

Transition of pediatric to adult care in inflammatory bowel disease: Is it as easy as 1, 2, 3?

PubMed

Afzali, Anita; Wahbeh, Ghassan

2017-05-28

Inflammatory bowel disease (IBD) is a heterogeneous group of chronic diseases with a rising prevalence in the pediatric population, and up to 25% of IBD patients are diagnosed before 18 years of age. Adolescents with IBD tend to have more severe and extensive disease and eventually require graduation from pediatric care toadult services. The transition of patients from pediatric to adult gastroenterologists requires careful preparation and coordination, with involvement of all key players to ensure proper collaboration of care and avoid interruption in care. This can be challenging and associated with gaps in delivery of care. The pediatric and adult health paradigms have inherent differences between health care models, as well as health care priorities in IBD. The readiness of the young adult also influences this transition of care, with often times other overlaps in life events, such as school, financial independence and moving away from home. These patients are therefore at higher risk for poorer clinical disease outcomes. The aim of this paper is to review concepts pertinent to transition of care of young adults with IBD to adult care, and provides resources appropriate for an IBD pediatric to adult transition of care model.

Technical report: an ePRO patient reported outcome program for the evaluation of patients with irritable bowel syndrome.

PubMed

Gerson, C D; Gerson, M-J

2014-02-01

Patient reported outcome (PRO) is an important healthcare concept that describes patient's participation in their care by self-evaluation, usually in the form of questionnaires. This report describes an unique computerized technique, electronic PRO (ePRO), for following the progress of patients with irritable bowel syndrome (IBS). Patients first completed a series of questionnaires, including questions about their illness history, symptom severity, and, in this application, psychological and relationship issues. The symptom severity and psychological questionnaires were then completed at intervals by the patients on their own computers. The ePRO was constructed to allow scores to be automatically summed and placed on a time-line graph for review at the time of the next office visit. Of the 32 patients who completed the initial set of questionnaires, 20 maintained participation in the program for a 6-month period. Of those 20 patients, median number of submissions was 7.0; median interval between questionnaire submissions was 3.0 weeks, whereas median interval between office visits was 5.9 weeks. On average, questionnaire completion took less than 5 min and was positively experienced by the patients. The ePRO program proved to be technically feasible, clinically useful, and positively experienced by the patients. It provides a focus on a collaborative conversation between physician and patient. It has significant potential as a technique for evaluating outcome in response to various therapies. © 2013 John Wiley & Sons Ltd.

Taking Care of Your Bowels--The Basics

MedlinePlus

Home » Information & Education » Pamphlets About Us Patient Care Resources Information & Education SCI Empowerment Project Projects & Research FAQ © 2018 University of Washington SCI Pamphlets: Staying Healthy after a Spinal Cord Injury The pamphlet ...

Ulcerative Colitis and Crohn's Disease: Implications for College Health Programs

ERIC Educational Resources Information Center

Gelphi, A. P.

1977-01-01

The author reviews clinical patterns of inflammatory bowel disorders, establishes a perspective for recognizing ulcerative colitis, ulcerative proctitis, and Crohn's disease in relation to other bowel inflammations, and suggests some epidemiologic strategies for studying etiology, pathogenesis, and natural history of the diseases. (MJB)

A model for assessment and referral of clients with bowel symptoms in community pharmacies.

PubMed

Sriram, Deepa; McManus, Alexandra; Emmerton, Lynne M; Parsons, Richard W; Jiwa, Moyez

2016-01-01

To expedite diagnosis of serious bowel disease, efforts are required to signpost patients with high-risk symptoms to appropriate care. Community pharmacies are a recognized source of health advice regarding bowel symptoms. This study aimed to examine the effectiveness of a validated self-administered questionnaire, Jodi Lee Test (JLT), for detection, triage, and referral of bowel symptoms suggestive of carcinoma, in pharmacies. 'Usual Practice' was monitored for 12 weeks in 21 pharmacies in Western Australia, documenting outcomes for 84 clients presenting with bowel symptoms. Outcome measures were: acceptance of verbal advice from the pharmacist; general practitioner consultation; and diagnosis. Trial of the JLT involved staff training in the research protocol and monitoring of outcomes for 80 recruited clients over 20 weeks. Utility of the JLT was assessed by post-trial survey of pharmacy staff. Significantly more referrals were made by staff using the JLT than during Usual Practice: 30 (38%) vs 17 (20%). Clients' acceptance of referrals was also higher for the intervention group (40% vs 6%). Two-thirds of pharmacy staff agreed that the JLT could be incorporated into pharmacy practice, and 70% indicated they would use the JLT in the future. A pre-post design was considered more appropriate than a randomized control trial due to an inability to match pharmacies. Limitations of this study were: lack of control over adherence to the study protocol by pharmacy staff; no direct measure of client feedback on the JLT; and loss to follow-up. The JLT was effective in prompting decision-making by pharmacy staff and inter-professional care between pharmacies and general practice, in triage of clients at risk of bowel cancer.

Variation in Care of Inflammatory Bowel Diseases Patients in Crohn's and Colitis Foundation of America Partners: Role of Gastroenterologist Practice Setting in Disease Outcomes and Quality Process Measures.

PubMed

Weaver, Kimberly N; Kappelman, Michael D; Sandler, Robert S; Martin, Christopher F; Chen, Wenli; Anton, Kristen; Long, Millie D

2016-11-01

As variation in care has previously been linked to quality, we aimed to describe variations in inflammatory bowel diseases care by gastroenterology (GI) practice setting. We performed a cross-sectional study within the Crohn's and Colitis Foundation of America Partners and used bivariate analyses to compare patient characteristics by GI practice setting (GI-academic [GIA], GI-private, or GI-other). Regression models were used to describe the effects of provider type on steroid use, disease activity, and the quality of life. The study included 12,083 patients with inflammatory bowel diseases (7576 with Crohn's disease [CD] and 4507 with ulcerative colitis [UC]). Nearly 95% reported visiting a GI provider annually. Also, CD patients seen by GIA were younger, better educated, used less 5-aminosalicylate agents, and had higher biologic and immunomodulator use (P < 0.001 for all). On multivariate analysis of CD patients, GIA used less steroids when compared with GI-private (odds ratio, 0.84; 95% confidence interval, 0.67-1.06) or GI-other (odds ratio, 0.66; 95% confidence interval, 0.49-0.89). GIA patients were more likely to be in remission, have flu vaccine, and have better quality of life. UC patients seen by GIA were younger, had more hospitalizations, and previous surgery (P < 0.001 for all). No differences existed for steroid use, remission, flu vaccine, or quality of life for UC care on bivariate or multivariate analyses. Significant variations in care patterns and quality measures exist for CD across GI provider types, without similar variation in UC care. Interventions to reduce variations in care could improve the quality of care in CD.

Effectiveness of an organized bowel management program in the management of severe chronic constipation in children.

PubMed

Russell, Katie W; Barnhart, Douglas C; Zobell, Sarah; Scaife, Eric R; Rollins, Michael D

2015-03-01

Chronic constipation is a common problem in children. The cause of constipation is often idiopathic, when no anatomic or physiologic etiology can be identified. In severe cases, low dose laxatives, stool softeners and small volume enemas are ineffective. The purpose of this study was to assess the effectiveness of a structured bowel management program in these children. We retrospectively reviewed children with chronic constipation without a history of anorectal malformation, Hirschsprung's disease or other anatomical lesions seen in our pediatric colorectal center. Our bowel management program consists of an intensive week where treatment is assessed and tailored based on clinical response and daily radiographs. Once a successful treatment plan is established, children are followed longitudinally. The number of patients requiring hospital admission during the year prior to and year after initiation of bowel management was compared using Fisher's exact test. Forty-four children with refractory constipation have been followed in our colorectal center for greater than a year. Fifty percent had at least one hospitalization the year prior to treatment for obstructive symptoms. Children were treated with either high-dose laxatives starting at 2mg/kg of senna or enemas starting at 20ml/kg of normal saline. Treatment regimens were adjusted based on response to therapy. The admission rate one-year after enrollment was 9% including both adherent and nonadherent patients. This represents an 82% reduction in hospital admissions (p<0.001). Implementation of a structured bowel management program similar to that used for children with anorectal malformations, is effective and reduces hospital admissions in children with severe chronic constipation. Copyright © 2015 Elsevier Inc. All rights reserved.

Perioperative strategy in colonic surgery; LAparoscopy and/or FAst track multimodal management versus standard care (LAFA trial)

PubMed Central

Wind, Jan; Hofland, Jan; Preckel, Benedikt; Hollmann, Markus W; Bossuyt, Patrick MM; Gouma, Dirk J; van Berge Henegouwen, Mark I; Fuhring, Jan Willem; Dejong, Cornelis HC; van Dam, Ronald M; Cuesta, Miguel A; Noordhuis, Astrid; de Jong, Dick; van Zalingen, Edith; Engel, Alexander F; Goei, T Hauwy; de Stoppelaar, I Erica; van Tets, Willem F; van Wagensveld, Bart A; Swart, Annemiek; van den Elsen, Maarten JLJ; Gerhards, Michael F; de Wit, Laurens Th; Siepel, Muriel AM; van Geloven, Anna AW; Juttmann, Jan-Willem; Clevers, Wilfred; Bemelman, Willem A

2006-01-01

Background Recent developments in large bowel surgery are the introduction of laparoscopic surgery and the implementation of multimodal fast track recovery programs. Both focus on a faster recovery and shorter hospital stay. The randomized controlled multicenter LAFA-trial (LAparoscopy and/or FAst track multimodal management versus standard care) was conceived to determine whether laparoscopic surgery, fast track perioperative care or a combination of both is to be preferred over open surgery with standard care in patients having segmental colectomy for malignant disease. Methods/design The LAFA-trial is a double blinded, multicenter trial with a 2 × 2 balanced factorial design. Patients eligible for segmental colectomy for malignant colorectal disease i.e. right and left colectomy and anterior resection will be randomized to either open or laparoscopic colectomy, and to either standard care or the fast track program. This factorial design produces four treatment groups; open colectomy with standard care (a), open colectomy with fast track program (b), laparoscopic colectomy with standard care (c), and laparoscopic surgery with fast track program (d). Primary outcome parameter is postoperative hospital length of stay including readmission within 30 days. Secondary outcome parameters are quality of life two and four weeks after surgery, overall hospital costs, morbidity, patient satisfaction and readmission rate. Based on a mean postoperative hospital stay of 9 +/- 2.5 days a group size of 400 patients (100 each arm) can reliably detect a minimum difference of 1 day between the four arms (alfa = 0.95, beta = 0.8). With 100 patients in each arm a difference of 10% in subscales of the Short Form 36 (SF-36) questionnaire and social functioning can be detected. Discussion The LAFA-trial is a randomized controlled multicenter trial that will provide evidence on the merits of fast track perioperative care and laparoscopic colorectal surgery in patients having segmental colectomy for malignant disease. PMID:17134506

Acid Reflux

MedlinePlus

... term maintenance therapy is generally required. Occasionally, a health care plan seeks to limit use of proton pump ... and not the medication. Please consult with your care provider if you have any questions. ... Health Centers Colorectal Cancer Hepatitis C Inflammatory Bowel Disease ...

A cross-cultural perspective on irritable bowel syndrome.

PubMed

Gerson, Charles D; Gerson, Mary-Joan

2010-01-01

Irritable bowel syndrome is a functional gastrointestinal illness, defined by symptoms. Irritable bowel syndrome has been described as a biopsychosocial condition, in which colonic dysfunction is affected by psychological and social factors. As a result of this unusual constellation, irritable bowel syndrome may be subject to cultural variables that differ in different parts of the globe. In this article, we describe some of the ways in which irritable bowel syndrome may be experienced differently, depending on local belief systems, psychological pressures, acceptance or resistance to a mind-body paradigm, and breakdown in support or relationship structure. Examples are given in which irritable bowel syndrome investigators from countries around the world describe various aspects of the syndrome that may affect the illness experience of their patients. We describe our own research studies that have demonstrated possible adverse effects on disease severity from relationship conflict, attribution of symptoms to physical rather than emotional cause, and the belief that irritable bowel syndrome is enduring and mysterious. Also described is our finding that symptom patterns may differ significantly between different geographic locations. Finally, we discuss the importance of "cultural competence" on the part of healthcare professionals in regard to caring for patients of diverse cultural backgrounds. © 2010 Mount Sinai School of Medicine.

Population Health Management for Inflammatory Bowel Disease.

PubMed

Dulai, Parambir S; Singh, Siddharth; Ohno-Machado, Lucilla; Sandborn, William J

2018-01-01

Inflammatory bowel diseases (IBDs) are chronic and impose significant, multidimensional burdens on patients and health care systems. The increasing prevalence of IBD will only worsen this problem globally-population health management (PHM) strategies are needed to increase quality of care and population health outcomes while reducing health care costs. We discuss the key components of PHM in IBD. Effective implementation of PHM strategies requires accurate identification of at-risk patients and key areas of variability in care. Improving outcomes of the at-risk population requires implementation of a multicomponent chronic care model designed to shift delivery of ambulatory care from acute, episodic, and reactive encounters, to proactive, planned, long-term care. This is achieved through team care of an activated patient with the help of remote monitoring, clinical information systems, and integrated decision support, with accompanying changes in delivery systems. Performance measurement is integral to any PHM strategy. This involves developing and implementing meaningful metrics of different phases of quality of IBD care and measuring them efficiently using modern clinical information systems. Such an integrated framework of PHM in IBD will facilitate the delivery of high-value care to patients. Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.

A systematic review of alternative therapies in the irritable bowel syndrome.

PubMed

Spanier, Jennifer A; Howden, Colin W; Jones, Michael P

2003-02-10

The irritable bowel syndrome is a common disorder associated with a significant burden of illness, poor quality of life, high rates of absenteeism, and high health care utilization. Management can be difficult and treatment unrewarding; these facts have led physicians and patients toward alternative therapies. We explored a variety of treatments that exist beyond the scope of commonly used therapies for irritable bowel syndrome. Guarded optimism exists for traditional Chinese medicine and psychological therapies, but further well-designed trials are needed. Oral cromolyn sodium may be useful in chronic unexplained diarrhea and appears as effective as and safer than elimination diets. The roles of lactose and fructose intolerance remain poorly understood. Alterations of enteric flora may play a role in irritable bowel syndrome, but supporting evidence for bacterial overgrowth or probiotic therapy is lacking.

Prospective analysis of factors associated with inadequate bowel preparation for colonoscopy in actual clinical practice

PubMed Central

Woo, Dae Hyung; Jeong, Da Eun; Nam, Yoon Jeong; Lee, Si Hyung; Jang, Byung Ik; Kim, Tae Nyeun

2018-01-01

Background/Aims Inadequate bowel preparation can result in prolonged procedure time and increased missed lesion and complication rates. This prospective study aimed to evaluate bowel preparation quality and identify the predictive factors for inadequate bowel preparation in actual clinical practice. Methods We included 399 patients who underwent colonoscopy between June 2015 and July 2016. Using the Aronchick bowel preparation scale, we defined a score ≤2 as adequate preparation and a score >2 as inadequate preparation. Results Mean patient age was 58.38±12.97 years; 60.6% were male. Indications for colonoscopy included screening (69.7%) and surveillance after polyp removal (21.3%). A split-dose regimen was prescribed to 55.4% of patients. The inadequate bowel preparation rate was 28.1%. Overall, the median time between the last bowel preparation agent dose and start of colonoscopy was 5.0 hours (range, 1.5–16.0 hours); that of the adequate group was 5.0 hours (range, 1.5–16.0 hours); and that of the inadequate group was 5 hours (range, 2–23 hours). The mean bowel preparation scale score of the ascending colon (1.94±0.25) was significantly higher than that of other colon segments. On multivariate analysis, elderly age, history of cerebrovascular disease, history of gastrectomy or appendectomy, and total preparation solution uptake <2 L were the independent predictors of inadequate bowel preparation. Conclusions The inadequate bowel preparation rate was 28.1%. Risk factors included elderly age and history of cerebrovascular disease or abdominal surgery. Patients with these risk factors require special care and education. PMID:29743843

Allied Health Professional Support in Pediatric Inflammatory Bowel Disease: A Survey from the Canadian Children Inflammatory Bowel Disease Network—A Joint Partnership of CIHR and the CH.I.L.D. Foundation

PubMed Central

Benchimol, Eric I.; Mack, David; Huynh, Hien Q.; Critch, Jeff; Otley, Anthony; Deslandres, Colette; Jacobson, Kevan; deBruyn, Jennifer; Carroll, Matthew W.; Van Limbergen, Johan; Sherlock, Mary; Bax, Kevin; Lawrence, Sally; Seidman, Ernest; Issenman, Robert; Church, Peter; Griffiths, Anne M.

2017-01-01

Objectives The current number of healthcare providers (HCP) caring for children with inflammatory bowel disease (IBD) across Canadian tertiary-care centres is underinvestigated. The aim of this survey was to assess the number of healthcare providers (HCP) in ambulatory pediatric IBD care across Canadian tertiary-care centres. Methods Using a self-administered questionnaire, we examined available resources in academic pediatric centres within the Canadian Children IBD Network. The survey evaluated the number of HCP providing ambulatory care for children with IBD. Results All 12 tertiary pediatric gastroenterology centres participating in the network responded. Median full-time equivalent (FTE) of allied health professionals providing IBD care at each site was 1.0 (interquartile range (IQR) 0.6–1.0) nurse, 0.5 (IQR 0.2–0.8) dietitian, 0.3 (IQR 0.2–0.8) social worker, and 0.1 (IQR 0.02–0.3) clinical psychologists. The ratio of IBD patients to IBD physicians was 114 : 1 (range 31 : 1–537 : 1), patients to nurses/physician assistants 324 : 1 (range 150 : 1–900 : 1), dieticians 670 : 1 (range 250 : 1–4500 : 1), social workers 1558 : 1 (range 250 : 1–16000 : 1), and clinical psychologists 2910 : 1 (range 626 : 1–3200 : 1). Conclusions There was a wide variation in HCP support among Canadian centres. Future work will examine variation in care including patients' outcomes and satisfaction across Canadian centres. PMID:28593172

Validation of an instrument to assess barriers to care-seeking for accidental bowel leakage in women: the BCABL questionnaire

PubMed Central

Brown, Heidi Wendell; Wise, Meg E.; Westenberg, Danielle; Schmuhl, Nicholas B.; Brezoczky, Kelly Lewis; Rogers, Rebecca G.; Constantine, Melissa L.

2017-01-01

Introduction and hypothesis Fewer than 30% of women with accidental bowel leakage (ABL) seek care, despite the existence of effective, minimally invasive therapies. We developed and validated a condition-specific instrument to assess barriers to care-seeking for ABL in women. Methods Adult women with ABL completed an electronic survey about condition severity, patient activation, previous care-seeking, and demographics. The Barriers to Care-seeking for Accidental Bowel Leakage (BCABL) instrument contained 42 potential items completed at baseline and again 2 weeks later. Paired t tests evaluated test–retest reliability. Factor analysis evaluated factor structure and guided item retention. Cronbach’s alpha evaluated internal consistency. Within and across factor item means generated a summary BCABL score used to evaluate scale validity with six external criterion measures. Results Among 1,677 click-throughs, 736 (44%) entered the survey; 95% of eligible female respondents (427 out of 458) provided complete data. Fifty-three percent of respondents had previously sought care for their ABL; median age was 62 years (range 27–89); mean Vaizey score was 12.8 (SD = 5.0), indicating moderate to severe ABL. Test–retest reliability was excellent for all items. Factor extraction via oblique rotation resulted in the final structure of 16 items in six domains, within which internal consistency was high. All six external criterion measures correlated significantly with BCABL score. Conclusions The BCABL questionnaire, with 16 items mapping to six domains, has excellent criterion validity and test–retest reliability when administered electronically in women with ABL. The BCABL can be used to identify care-seeking barriers for ABL in different populations, inform targeted interventions, and measure their effectiveness. PMID:28236039

Bowel and bladder-control anxiety: a preliminary description of a viscerally-centred phobic syndrome.

PubMed

Kamboj, Sunjeev K; Langhoff, Christine; Pajak, Rosanna; Zhu, Alex; Chevalier, Agnes; Watson, Sue

2015-03-01

People with anxiety disorders occasionally report fears about losing control of basic bodily functions in public. These anxieties often occur in the absence of physical disorder and have previously been recognized as "obsessive" anxieties reflecting a preoccupation with loss of bowel/bladder control. Motivated by our observations of the non-trivial occurrence of such anxieties in our clinical practice we sought to fill a gap in the current understanding of "bowel/bladder-control anxieties". Eligible participants completed an internet survey. Bowel/bladder-control anxieties (n = 140) tended to emerge in the mid to late 20s and were associated with high levels of avoidance and functional impairment. There was a high prevalence of panic attacks (78%); these were especially prevalent among those with bowel-control anxiety. Of those with panic attacks, 62% indicated that their main concern was being incontinent during a panic attack. Significantly, a proportion of respondents (~16%) reported actually being incontinent during a panic attack. Seventy percent of participants reported intrusive imagery related to loss of bowel/bladder control. Intrusion-related distress was correlated with agoraphobic avoidance and general role impairment. Some differences were noted between those with predominantly bowel-, predominantly bladder- and those with both bowel and bladder-control anxieties. This preliminary characterization indicates that even in a non-treatment seeking community sample, bowel/bladder-control anxieties are associated with high levels of distress and impairment. Further careful characterization of these anxieties will clarify their phenomenology and help us develop or modify treatment protocols in a way that takes account of any special characteristics of such viscerally-centred phobic syndromes.

Analysis of chronic morphologic changes of small bowel in electrically stimulated canine island-flap rectus abdominis muscle stomal sphincters.

PubMed

Majzoub, R K; Bardoel, J W; Ackermann, D; Maldonado, C; Barker, J; Stadelmann, W K

2001-11-01

Dynamic myoplasty to achieve fecal continence has been used in humans with varying results. A potential complication of the use of dynamic skeletal sphincters to attain fecal continence is the development of ischemic strictures within the bowel encircled by the functional sphincter. This study examines the histologic changes present in the bowel wall used to create a functional dynamic island-flap stomal sphincter in a chronic canine model. The rectus abdominis muscles of canines were used to create island-flap stomal sphincters. Eight dynamic island-flap stomal sphincters were created from the rectus abdominis muscles in mongrel dogs by wrapping them around a blind loop of distal ileum that was no longer in continuity with the terminal small bowel. Temporary pacing electrodes were secured intramuscularly near the intercostal nerve entry point and connected to a subcutaneously placed pulse stimulator. Two different training protocols resulting in different contractile properties were used: Program A (n = 4) and Program B (n = 4). The island-flap sphincters were trained over 3 months to generate stomal intraluminal pressures of more than 60 mmHg in all animals. The intact sphincters, normal bowel, and contralateral stomal bowel were obtained when the animals were killed. Specimens were processed with paraffin embedding, sectioned, and stained with trichrome and hematoxylin-and-eosin stains. Measurements of the different bowel layers were made with a micrometer. The muscular sphincters were biopsied before and after training. Fiber-type histochemistry was performed with a monoclonal antibody to the fast isoforms of myosin. Pretrained and posttrained skeletal muscle specimens were examined histologically. The bowel wall within the functional dynamic stomal sphincter did not exhibit any significant architectural changes related to ischemic fibrosis or mucosal damage. A significant fiber-type conversion was achieved in both training groups with Programs A and B, with a >50 percent conversion from fatigue-prone (type II) muscle fibers to fatigue-resistant (type I) muscle fibers. Biopsy specimens revealed that fiber-type transformation was uniform throughout the sphincters. Skeletal muscle fibers within both groups demonstrated a reduction in their fiber diameter. There was no evidence of significant fibrosis or deposition of fat within the skeletal muscle of the sphincters. Results of our experiment suggest that our anterior abdominal wall dynamic island-flap stomal sphincter, which generates a contractile force over the bowel wall capable of producing enough stomal pressure to achieve fecal continence, is not intrinsically harmful to the bowel that it encircles. The transformation of skeletal muscle to fatigue-resistant (type I) fibers occurred uniformly throughout the skeletal muscle sphincters without evidence of muscle fiber damage or significant fibrosis.

High resolution colonoscopy in a bowel cancer screening program improves polyp detection

PubMed Central

Banks, Matthew R; Haidry, Rehan; Butt, M Adil; Whitley, Lisa; Stein, Judith; Langmead, Louise; Bloom, Stuart L; O’Bichere, Austin; McCartney, Sara; Basherdas, Kalpesh; Rodriguez-Justo, Manuel; Lovat, Laurence B

2011-01-01

AIM: To compare high resolution colonoscopy (Olympus Lucera) with a megapixel high resolution system (Pentax HiLine) as an in-service evaluation. METHODS: Polyp detection rates and measures of performance were collected for 269 colonoscopy procedures. Five colonoscopists conducted the study over a three month period, as part of the United Kingdom bowel cancer screening program. RESULTS:There were no differences in procedure duration (χ2 P = 0.98), caecal intubation rates (χ2 P = 0.67), or depth of sedation (χ2 P = 0.64). Mild discomfort was more common in the Pentax group (χ2 P = 0.036). Adenoma detection rate was significantly higher in the Pentax group (χ2 test for trend P = 0.01). Most of the extra polyps detected were flat or sessile adenomas. CONCLUSION: Megapixel definition colonoscopes improve adenoma detection without compromising other measures of endoscope performance. Increased polyp detection rates may improve future outcomes in bowel cancer screening programs. PMID:22090787

Magnetic Resonance Imaging-Guided High-Intensity Focused Ultrasound Ablation of Uterine Fibroids: Effect of Bowel Interposition on Procedure Feasibility and a Unique Bowel Displacement Technique.

PubMed

Kim, Young-Sun; Lim, Hyo Keun; Rhim, Hyunchul

2016-01-01

To evaluate the effect of bowel interposition on assessing procedure feasibility, and the usefulness and limiting conditions of bowel displacement techniques in magnetic resonance imaging-guided high-intensity focused ultrasound (MR-HIFU) ablation of uterine fibroids. Institutional review board approved this study. A total of 375 screening MR exams and 206 MR-HIFU ablations for symptomatic uterine fibroids performed between August 2010 and March 2015 were retrospectively analyzed. The effect of bowel interposition on procedure feasibility was assessed by comparing pass rates in periods before and after adopting a unique bowel displacement technique (bladder filling, rectal filling and subsequent bladder emptying; BRB maneuver). Risk factors for BRB failure were evaluated using logistic regression analysis. Overall pass rates of pre- and post-BRB periods were 59.0% (98/166) and 71.7% (150/209), and in bowel-interposed cases they were 14.6% (7/48) and 76.4% (55/72), respectively. BRB maneuver was technically successful in 81.7% (49/60). Through-the-bladder sonication was effective in eight of eleven BRB failure cases, thus MR-HIFU could be initiated in 95.0% (57/60). A small uterus on treatment day was the only significant risk factor for BRB failure (B = 0.111, P = 0.017). The BRB maneuver greatly reduces the fraction of patients deemed ineligible for MR-HIFU ablation of uterine fibroids due to interposed bowels, although care is needed when the uterus is small.

A multicenter prospective quasi-experimental study on the impact of a transition-oriented generic patient education program on health service participation and quality of life in adolescents and young adults.

PubMed

Schmidt, Silke; Herrmann-Garitz, Carsten; Bomba, Franziska; Thyen, Ute

2016-03-01

The aim of the study was to test the effects of a generic transition-oriented patient education program on adolescents' health service participation and quality of life (QoL). We conducted a controlled trial comparing participants of 29 transition workshops with treatment as usual in 274 adolescents (16.8 mean age, SD=1.76) diagnosed with type I diabetes (DM), cystic fibrosis (CF) or inflammatory bowel disease (IBD). A two-day transition workshop was carried out at 12 sites in Germany, focusing in standardized modules on adjustment to adult care settings, organization of future disease management, career choices and partnership. Study outcomes were health-related transition competence, self-efficacy, satisfaction with care, patient activation and QoL. Measures were assessed at baseline and six-month follow-up. Repeated-measurement covariance analysis using age as a covariate showed that the transition workshop significantly affected transition competence, self-efficacy and satisfaction with school care six months post intervention. The intervention did not significantly affect patient activation and QoL. However, post-hoc analysis suggested different effects across conditions. The program has a positive effect on the competence of adolescents in the transition phase. The study demonstrates that an intervention can be effective in preparing adolescents with chronic conditions for transitions. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Common Functional Gastroenterological Disorders Associated With Abdominal Pain.

PubMed

Bharucha, Adil E; Chakraborty, Subhankar; Sletten, Christopher D

2016-08-01

Although abdominal pain is a symptom of several structural gastrointestinal disorders (eg, peptic ulcer disease), this comprehensive review will focus on the 4 most common nonstructural, or functional, disorders associated with abdominal pain: functional dyspepsia, constipation-predominant and diarrhea-predominant irritable bowel syndrome, and functional abdominal pain syndrome. Together, these conditions affect approximately 1 in 4 people in the United States. They are associated with comorbid conditions (eg, fibromyalgia and depression), impaired quality of life, and increased health care utilization. Symptoms are explained by disordered gastrointestinal motility and sensation, which are implicated in various peripheral (eg, postinfectious inflammation and luminal irritants) and/or central (eg, stress and anxiety) factors. These disorders are defined and can generally be diagnosed by symptoms alone. Often prompted by alarm features, selected testing is useful to exclude structural disease. Identifying the specific diagnosis (eg, differentiating between functional abdominal pain and irritable bowel syndrome) and establishing an effective patient-physician relationship are the cornerstones of therapy. Many patients with mild symptoms can be effectively managed with limited tests, sensible dietary modifications, and over-the-counter medications tailored to symptoms. If these measures are not sufficient, pharmacotherapy should be considered for bowel symptoms (constipation or diarrhea) and/or abdominal pain; opioids should not be used. Behavioral and psychological approaches (eg, cognitive behavioral therapy) can be helpful, particularly in patients with chronic abdominal pain who require a multidisciplinary pain management program without opioids. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

What Are the Top 10 Research Questions in the Treatment of Inflammatory Bowel Disease? A Priority Setting Partnership with the James Lind Alliance.

PubMed

Hart, Ailsa L; Lomer, Miranda; Verjee, Azmina; Kemp, Karen; Faiz, Omar; Daly, Ann; Solomon, Julie; McLaughlin, John

2017-02-01

Many uncertainties remain regarding optimal therapies and strategies for the treatment of inflammatory bowel disease. Setting research priorities addressing therapies requires a partnership between health care professionals, patients and organisations supporting patients. We aimed to use the structure of the James Lind Alliance Priority Setting Partnership, which has been used in other disease areas, to identify and prioritise unanswered questions about treatments for inflammatory bowel disease. The James Lind Priority Setting Partnership uses methods agreed and adopted in other disease areas to work with patients and clinicians: to identify uncertainties about treatments; to agree by consensus a prioritised list of uncertainties for research; then to translate these uncertainties into research questions which are amenable to hypothesis testing; and finally to take results to research commissioning bodies to be considered for funding. A total of 1636 uncertainties were collected in the initial survey from 531 respondents, which included 22% health care professionals and 78% patients and carers. Using the rigorously applied processes of the priority setting partnership, this list was distilled down to the top 10 research priorities for inflammatory bowel disease. The top priorities were: identifying treatment strategies to optimise efficacy, safety and cost-effectiveness; and stratifying patients with regard to their disease course and treatment response. Diet and symptom control [pain, incontinence and fatigue] were also topics which were prioritised. A partnership involving multidisciplinary clinicians, patients and organisations supporting patients has identified the top 10 research priorities in the treatment of patients with inflammatory bowel disease. © European Crohn’s and Colitis Organisation 2016.

An innovative solution to raise public awareness using a mobile colorectal clinic - The 'bowel bus'.

PubMed

Naguib, N; Lewis, M; Iredale, R; Pugh, R; Haray, P N

2017-03-01

Colorectal cancer is the fourth most common cancer in the United Kingdom; however, figures show that the uptake for bowel cancer screening lags behind other cancer screening programmes. This is a report of a multi-staged development of an outreach colorectal clinical community service provided through a Mobile Unit (a Bowel Bus). The unit delivers a one-stop colorectal clinic that provides a rapid access pathway to members of the public who have concerns about, or symptoms of, bowel cancer. The aims of the project were to increase public awareness about colorectal cancer and to provide an outreach clinic as a supplement to the hospital based colorectal clinic. This service is a result of collaborative efforts between Tenovus Cancer Care (TCC) and the colorectal surgery department of the local NHS Hospital. During one year, the Bowel Bus has provided services to 772 members of the local community. 244 patients were examined by the colorectal nurse specialist including 66 drop-in patients and 135 patients referred by the GPs. The service led to decrease in the waiting list for routine referrals to be seen in the colorectal clinic at the hospital from a mean of 10.5 weeks-5.9 weeks. A feedback questionnaire from 180 patients, used to audit the quality of the service, has confirmed an overwhelming satisfaction with the service. The Mobile Unit is a novel solution to addressing the ever increasing demand for specialist outpatient services without compromising the quality of care whilst enhancing the patient experience. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

Young people's beliefs about the risk of bowel cancer and its link with physical activity.

PubMed

Newby, Katie V; Cook, Chloe; Meisel, Susanne F; Webb, Thomas L; Fisher, Bernadette; Fisher, Abi

2017-09-01

The primary objective was to explore young people's risk appraisals of bowel cancer, including whether they had a coherent understanding of the protective effects of physical activity (PA). A secondary objective was to examine whether the illness risk representations (IRRs) framework could be used to understand beliefs underlying bowel cancer risk appraisals. Qualitative. Framework analysis of semi-structured interviews with 19 people aged 14-17 years. Participants judged their risk of getting bowel cancer as low. This was based on a lack of family history of cancer and their current lifestyle behaviours, which were viewed as having a protective effect, or because they planned on making change to their lifestyle in the future when disease risk became more relevant. Participants were not aware of, and struggled to understand, the link between PA and bowel cancer. They also lacked knowledge of the effects of, or treatments for, bowel cancer. Beliefs underlying judgements about the risk of bowel cancer fitted the IRR framework reasonably well. The present research suggests that interventions designed to increase PA with a view to reducing the risk of bowel cancer should aim to make the future risk of bowel cancer feel more tangible, help young people to understand the full range of consequences, explain how and why preventative behaviours such as PA are effective in reducing risk, and emphasize that the typical late presentation of symptoms, and therefore investigation by health care services, reduces treatability. Statement of contribution What is already known on this subject? Physical activity (PA) performed throughout the lifespan can have a protective effect on bowel cancer, but levels of PA are low among young people. Changing beliefs about the risk of getting bowel cancer may be a useful strategy in motivating PA. What does this study add? Increased understanding of how young people think about bowel cancer and the relationship between PA and cancer. Identification of strategies for increasing young adults' appraisals of the likelihood and severity of bowel cancer. Evidence to support the validity of illness risk representations framework. © 2017 The British Psychological Society.

International bowel function basic spinal cord injury data set.

PubMed

Krogh, K; Perkash, I; Stiens, S A; Biering-Sørensen, F

2009-03-01

International expert working group. To develop an International Bowel Function Basic Spinal Cord Injury (SCI) Data Set presenting a standardized format for the collection and reporting of a minimal amount of information on bowel function in daily practice or in research. Working group consisting of members appointed by the American Spinal Injury Association (ASIA) and the International Spinal Cord Society (ISCoS). A draft prepared by the working group was reviewed by Executive Committee of the International SCI Standards and Data Sets, and later by ISCoS Scientific Committee and the ASIA Board. Relevant and interested scientific and professional (international) organizations and societies (approximately 40) were also invited to review the data set and it was posted on the ISCoS and ASIA websites for 3 months to allow comments and suggestions. The ISCoS Scientific Committee, Council and ASIA Board received the data set for final review and approval. The International Bowel Function Basic SCI Data Set includes the following 12 items: date of data collection, gastrointestinal or anal sphincter dysfunction unrelated to SCI, surgical procedures on the gastrointestinal tract, awareness of the need to defecate, defecation method and bowel care procedures, average time required for defecation, frequency of defecation, frequency of fecal incontinence, need to wear pad or plug, medication affecting bowel function/constipating agents, oral laxatives and perianal problems. An International Bowel Function Basic SCI Data Set has been developed.

Urachal Cyst Causing Small Bowel Obstruction in an Adult with a Virgin Abdomen.

PubMed

O'Leary, Michael P; Ashman, Zane W; Plurad, David S; Kim, Dennis Y

2016-01-01

Introduction . A patent urachus is a rare congenital or acquired pathology, which can lead to complications later in life. We describe a case of urachal cystitis as the etiology of small bowel obstruction in an adult without prior intra-abdominal surgery. Case Report . A 64-year-old male presented to the acute care surgery team with a 5-day history of right lower quadrant abdominal pain, distention, nausea, and vomiting. He had a two-month history of urinary retention and his past medical history was significant for benign prostate hyperplasia. On exam, he had evidence of small bowel obstruction. Computed tomography revealed high-grade small bowel obstruction secondary to presumed ruptured appendicitis. In the operating room, an infected urachal cyst was identified with adhesions to the proximal ileum. After lysis of adhesions and resection of the cyst, the patient was subsequently discharged without further issues. Conclusion . Although rare, urachal pathology should be considered in the differential diagnosis when evaluating a patient with small bowel obstruction without prior intraabdominal surgery, hernia, or malignancy.

Complementary and alternative medicine use and cost in functional bowel disorders: a six month prospective study in a large HMO.

PubMed

van Tilburg, Miranda A L; Palsson, Olafur S; Levy, Rona L; Feld, Andrew D; Turner, Marsha J; Drossman, Douglas A; Whitehead, William E

2008-07-24

Functional Bowel Disorders (FBD) are chronic disorders that are difficult to treat and manage. Many patients and doctors are dissatisfied with the level of improvement in symptoms that can be achieved with standard medical care which may lead them to seek alternatives for care. There are currently no data on the types of Complementary and Alternative Medicine (CAM) used for FBDs other than Irritable Bowel Syndrome (IBS), or on the economic costs of CAM treatments. The aim of this study is to determine prevalence, types and costs of CAM in IBS, functional diarrhea, functional constipation, and functional abdominal pain. 1012 Patients with FBD were recruited through a health care maintenance organization and followed for 6 months. Questionnaires were used to ascertain: Utilization and expenditures on CAM, symptom severity (IBS-SS), quality of life (IBS-QoL), psychological distress (BSI) and perceived treatment effectiveness. Costs for conventional medical care were extracted from administrative claims. CAM was used by 35% of patients, at a median yearly cost of $200. The most common CAM types were ginger, massage therapy and yoga. CAM use was associated with female gender, higher education, and anxiety. Satisfaction with physician care and perceived effectiveness of prescription medication were not associated with CAM use. Physician referral to a CAM provider was uncommon but the majority of patients receiving this recommendation followed their physician's advice. CAM is used by one-third of FBD patients. CAM use does not seem to be driven by dissatisfaction with conventional care. Physicians should discuss CAM use and effectiveness with their patients and refer patients if appropriate.

Complementary and alternative medicine use and cost in functional bowel disorders: A six month prospective study in a large HMO

PubMed Central

van Tilburg, Miranda AL; Palsson, Olafur S; Levy, Rona L; Feld, Andrew D; Turner, Marsha J; Drossman, Douglas A; Whitehead, William E

2008-01-01

Background Functional Bowel Disorders (FBD) are chronic disorders that are difficult to treat and manage. Many patients and doctors are dissatisfied with the level of improvement in symptoms that can be achieved with standard medical care which may lead them to seek alternatives for care. There are currently no data on the types of Complementary and Alternative Medicine (CAM) used for FBDs other than Irritable Bowel Syndrome (IBS), or on the economic costs of CAM treatments. The aim of this study is to determine prevalence, types and costs of CAM in IBS, functional diarrhea, functional constipation, and functional abdominal pain. Methods 1012 Patients with FBD were recruited through a health care maintenance organization and followed for 6 months. Questionnaires were used to ascertain: Utilization and expenditures on CAM, symptom severity (IBS-SS), quality of life (IBS-QoL), psychological distress (BSI) and perceived treatment effectiveness. Costs for conventional medical care were extracted from administrative claims. Results CAM was used by 35% of patients, at a median yearly cost of $200. The most common CAM types were ginger, massage therapy and yoga. CAM use was associated with female gender, higher education, and anxiety. Satisfaction with physician care and perceived effectiveness of prescription medication were not associated with CAM use. Physician referral to a CAM provider was uncommon but the majority of patients receiving this recommendation followed their physician's advice. Conclusion CAM is used by one-third of FBD patients. CAM use does not seem to be driven by dissatisfaction with conventional care. Physicians should discuss CAM use and effectiveness with their patients and refer patients if appropriate. PMID:18652682

Value-based health care for inflammatory bowel diseases.

PubMed

van Deen, Welmoed K; Esrailian, Eric; Hommes, Daniel W

2015-05-01

Increasing healthcare costs worldwide put the current healthcare systems under pressure. Although many efforts have aimed to contain costs in medicine, only a few have achieved substantial changes. Inflammatory bowel diseases rank among the most costly of chronic diseases, and physicians nowadays are increasingly engaged in health economics discussions. Value-based health care [VBHC] has gained a lot of attention recently, and is thought to be the way forward to contain costs while maintaining quality. The key concept behind VBHC is to improve achieved outcomes per encountered costs, and evaluate performance accordingly. Four main components need to be in place for the system to be effective: [1] accurate measurement of health outcomes and costs; [2] reporting of these outcomes and benchmarking against other providers; [3] identification of areas in need of improvement based on these data and adjusting the care delivery processes accordingly; and [4] rewarding high-performing participants. In this article we will explore the key components of VBHC, we will review available evidence focussing on inflammatory bowel diseases, and we will present our own experience as a guide for other providers. Copyright © 2015 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Balance of Autonomic Nervous System Predicts Who Benefits from a Self-management Intervention Program for Irritable Bowel Syndrome.

PubMed

Jarrett, Monica E; Cain, Kevin C; Barney, Pamela G; Burr, Robert L; Naliboff, Bruce D; Shulman, Robert; Zia, Jasmine; Heitkemper, Margaret M

2016-01-31

To determine if potential biomarkers can be used to identify subgroups of people with irritable bowel syndrome (IBS) who will benefit the most or the least from a comprehensive self-management (CSM) intervention. In a two-armed randomized controlled trial a CSM (n = 46) was compared to a usual care (n = 46) group with follow-up at 3 and 6 months post randomization. Biomarkers obtained at baseline included heart rate variability, salivary cortisol, interleukin-10 produced by unstimulated peripheral blood mononuclear cells, and lactulose/mannitol ratio. Linear mixed models were used to test whether these biomarkers predicted improvements in the primary outcomes including daily abdominal pain, Gastrointestinal Symptom score and IBS-specific quality of life. The nurse-delivered 8-session CSM intervention is more effective than usual care in reducing abdominal pain, reducing Gastrointestinal Symptom score, and enhancing quality of life. Participants with lower nighttime high frequency heart rate variability (vagal modulation) and increased low frequency/high frequency ratio (sympathovagal balance) had less benefit from CSM on abdominal pain. Salivary cortisol, IL-10, and lactulose/mannitol ratio were not statistically significant in predicting CSM benefit. Baseline symptom severity interacts with treatment, namely the benefit of CSM is greater in those with higher baseline symptoms. Cognitively-focused therapies may be less effective in reducing abdominal pain in IBS patients with higher sympathetic tone. Whether this a centrally-mediated patient characteristic or related to heightened arousal remains to be determined.

An app for patient education and self-audit within an enhanced recovery program for bowel surgery: a pilot study assessing validity and usability.

PubMed

Pecorelli, Nicolò; Fiore, Julio F; Kaneva, Pepa; Somasundram, Abarna; Charlebois, Patrick; Liberman, A Sender; Stein, Barry L; Carli, Franco; Feldman, Liane S

2018-05-01

While patient engagement and clinical audit are key components of successful enhanced recovery programs (ERPs), they require substantial resource allocation. The objective of this study was to assess the validity and usability of a novel mobile device application for education and self-reporting of adherence for patients undergoing bowel surgery within an established ERP. Prospectively recruited patients undergoing bowel surgery within an ERP used a novel app specifically designed to provide daily recovery milestones and record adherence to 15 different ERP processes and six patient-reported outcomes (PROs). Validity was measured by the agreement index (Cohen's kappa coefficient for categorical, and interclass correlation coefficient (ICC) for continuous variables) between patient-reported data through the app and data recorded by a clinical auditor. Acceptability and usability of the app were measured by the System Usability Scale (SUS). Forty-five patients participated in the study (mean age 61, 64% male). Overall, patients completed 159 of 179 (89%) of the available questionnaires through the app. Median time to complete a questionnaire was 2 min 49 s (i.q.r. 2'32″-4'36″). Substantial (kappa > 0.6) or almost perfect agreement (kappa > 0.8) and strong correlation (ICC > 0.7) between data collected through the app and by the clinical auditor was found for 14 ERP processes and four PROs. Patient-reported usability was high; mean SUS score was 87 (95% CI 83-91). Only 6 (13%) patients needed technical support to use the app. Forty (89%) patients found the app was helpful to achieve their daily goals, and 34 (76%) thought it increased their motivation to recover after surgery. This novel application provides a tool to record patient adherence to care processes and PROs, with high agreement with traditional clinical audit, high usability, and patient satisfaction. Future studies should investigate the use of mobile device apps as strategies to increase adherence to perioperative interventions.

Pain symptoms and stooling patterns do not drive diagnostic costs for children with functional abdominal pain and irritable bowel syndrome in primary or tertiary care.

PubMed

Lane, Mariella M; Weidler, Erica M; Czyzewski, Danita I; Shulman, Robert J

2009-03-01

The objectives of this study were to (1) compare the cost of medical evaluation for children with functional abdominal pain or irritable bowel syndrome brought to a pediatric gastroenterologist versus children who remained in the care of their pediatrician, (2) compare symptom characteristics for the children in primary versus tertiary care, and (3) examine if symptom characteristics predicted the cost of medical evaluation. Eighty-nine children aged 7 to 10 years with functional abdominal pain or irritable bowel syndrome seen by a gastroenterologist (n = 46) or seen only by a pediatrician (n = 43) completed daily pain and stool diaries for 2 weeks. Mothers provided retrospective reports of their children's symptoms in the previous year. Cost of medical evaluation was calculated via chart review of diagnostic tests and application of prices as if the patients were self-pay. Child-reported diary data reflected no significant group differences with respect to pain, interference with activities, or stool characteristics. In contrast, mothers of children evaluated by a gastroenterologist viewed their children as having higher maximum pain intensity in the previous year. Excluding endoscopy costs, cost of medical evaluation was fivefold higher for children evaluated by a gastroenterologist, with higher cost across blood work, stool studies, breath testing, and diagnostic imaging. Symptom characteristics did not predict cost of care for either group. Despite the lack of difference in symptom characteristics between children in primary and tertiary care, a notable differential in cost of evaluation exists in accordance with level of care. Symptom characteristics do not seem to drive diagnostic evaluation in either primary or tertiary care. Given the lack of differences in child-reported symptoms and the maternal perspective that children evaluated by a gastroenterologist had more severe pain, we speculate that parent perception of child symptoms may be a primary factor in seeking tertiary care.

Can Contrast-Enhanced Sonography Detect Bowel Wall Fibrosis in Mixed Inflammatory and Fibrotic Crohn Disease Lesions in an Animal Model?

PubMed

Dillman, Jonathan R; Rubin, Jonathan M; Johnson, Laura A; Moons, David S; Higgins, Peter D R

2017-03-01

To determine whether contrast-enhanced sonographic quantitative perfusion parameters can detect bowel wall fibrosis in the setting of mixed inflammatory and fibrotic lesions in a Crohn disease animal model. This study was approved by the institutional Committee on the Use and Care of Animals. Multiple (range, 1-5) 2,4,6-trinitrobenzenesulfonic acid-ethanol enemas were used to create intestinal inflammatory lesions with variable fibrosis in female Lewis rats. Low-mechanical index contrast-enhanced sonography was performed 3 days after the final enema using a 0.2-mL bolus of sulfur hexafluoride microbubbles injected through a tail vein. Contrast-enhanced sonographic data were analyzed with software that converts video data into echo-power (linearized) data. Colorectal lesions were scored for histopathologic inflammation and fibrosis; bowel wall collagen was quantified by Western blotting. The Spearman correlation was used to assess associations between contrast-enhanced sonographic quantitative parameters and bowel wall collagen; the Kruskal-Wallis test was used to compare continuous results between histopathologic groups. Thirty-one animals were included in our analysis. Animals were placed into 3 histopathologic cohorts: (1) severe bowel wall inflammation/minimal or no fibrosis (n = 11); (2) severe bowel wall inflammation/moderate fibrosis (n = 9); and (3) severe bowel wall inflammation/severe fibrosis (n = 11). Western blotting showed a significant difference in bowel wall collagen between histopathologic cohorts (P = .0001). There was no correlation between any contrast-enhanced sonographic quantitative parameter and bowel wall collagen (P > .05). There was no difference between histopathologic cohorts for any contrast-enhanced sonographic quantitative parameter (P > .05). Contrast-enhanced sonographic quantitative perfusion parameters failed to effectively detect bowel wall fibrosis in the setting of superimposed inflammation in a Crohn disease animal model. © 2017 by the American Institute of Ultrasound in Medicine.

Combining Adult Learning Theory with Occupational Therapy Intervention for Bladder and Bowel Management after Spinal Cord Injury: A Case Report.

PubMed

Gallagher, Gina; Bell, Alison

2016-01-01

Bladder and bowel management is an important goal of rehabilitation for clients with spinal cord injury. Dependence is these areas have been linked to a variety of secondary complications, including decreased quality of life, urinary tract infections and pressure ulcers (Hammell, 2010; Hicken et al, 2001). Occupational therapists have been identified as important members of the health care team in spinal cord injury rehabilitation; however, specific roles and interventions have not been clearly described. This case report will describe occupational therapy interventions embedded with principles of adult learning theory to address bladder and bowel management with an adult client who sustained an incomplete thoracic level spinal cord injury.

Anesthesia and perioperative management of colorectal surgical patients - A clinical review (Part 1).

PubMed

Patel, Santosh; Lutz, Jan M; Panchagnula, Umakanth; Bansal, Sujesh

2012-04-01

Colorectal surgery is commonly performed for colorectal cancer and other pathology such as diverticular and inflammatory bowel disease. Despite significant advances, such as laparoscopic techniques and multidisciplinary recovery programs, morbidity and mortality remain high and vary among surgical centers. The use of scoring systems and assessment of functional capacity may help in identifying high-risk patients and predicting complications. An understanding of perioperative factors affecting colon blood flow and oxygenation, suppression of stress response, optimal fluid therapy, and multimodal pain management are essential. These fundamental principles are more important than any specific choice of anesthetic agents. Anesthesiologists can significantly contribute to enhance recovery and improve the quality of perioperative care.

Short bowel syndrome in infants: the critical role of luminal nutrients in a management program.

PubMed

Roy, Claude C; Groleau, Véronique; Bouthillier, Lise; Pineault, Marjolain; Thibault, Maxime; Marchand, Valérie

2014-07-01

Short bowel syndrome develops when the remnant mass of functioning enterocytes following massive resections cannot support growth or maintain fluid-electrolyte balance and requires parenteral nutrition. Resection itself stimulates the intestine's inherent ability to adapt morphologically and functionally. The capacity to change is very much related to the high turnover rate of enterocytes and is mediated by several signals; these signals are mediated in large part by enteral nutrition. Early initiation of enteral feeding, close clinical monitoring, and ongoing assessment of intestinal adaptation are key to the prevention of irreversible intestinal failure. The length of the functional small bowel remnant is the most important variable affecting outcome. The major objective of intestinal rehabilitation programs is to achieve early oral nutritional autonomy while maintaining normal growth and nutrition status and minimizing total parenteral nutrition related comorbidities such as chronic progressive liver disease. Remarkable progress has been made in terms of survivability and quality of life, especially in the context of coordinated multidisciplinary programs, but much work remains to be done.

Insufficient knowledge of korean gastroenterologists regarding the vaccination of patients with inflammatory bowel disease.

PubMed

Jung, Yoon Suk; Park, Jung Ho; Kim, Hong Joo; Cho, Yong Kyun; Sohn, Chong Il; Jeon, Woo Kyu; Kim, Byung Ik; Park, Dong Il

2014-05-01

There is an increased risk for inflammatory bowel disease (IBD) patients to develop infections due to the use of immunomodulators and biologics. Several infections are preventable by immunizations. This study investigated the knowledge and awareness of Korean gastroenterologists regarding the vaccination of patients with IBD. A self-reported questionnaire was sent by e-mail to the faculty members of tertiary hospitals. Gastroenterologists were asked ten questions regarding the immunization of patients with IBD. A total of 56 gastroenterologists completed the questionnaire. A majority of gastroenterologists (>60%) had rarely or never recorded an immunization history from their patients with IBD. Moreover, 50% to 70% of the gastroenterologists did not know that live vaccines should be avoided in immunosuppressed patients. The most commonly mentioned resistance to vaccinations was "the lack of concern and knowledge regarding vaccination." Gastroenterologists more frequently asked about the immunization history of influenza, pneumococcal, hepatitis A, and hepatitis B vaccines and recommended these vaccines more often than others. Korean gastroenterologists' awareness and knowledge regarding the vaccination of patients with IBD were very poor. Intensive educational programs on immunization guidelines directed toward gastroenterologists who care for patients with IBD are required to ensure that these patients receive the necessary vaccinations.

[Comparison of the results of laparotomy and laparoscopic surgery in patients with Crohn's disease].

PubMed

Horváth, Gyula; Simonka, Zsolt; Lázár, György

2014-01-05

Crohn's disease is an inflammatory bowel disease which may affect different parts of the gastrointestinal tract. To compare retrospectively the results of laparotomy and laparoscopic surgery performed in patients with Crohn's disease between January 1, 2005 and October 31, 2012 in the Department of Surgery, University of Szeged, Hungary. Patients were divided into two groups based on the types of surgery; 103 patients underwent laparotomy and 30 patients had laparoscopic surgery programmed. 22 patients had 24 primary acute interventions. The mean age was significantly lower in the laparoscopic surgery group (p = 0.042). The laparoscopic ileocecal resections have been found significantly shorter than laparotomies (p = 0.033). When ileocecal resection was performed the operation time was significantly longer (p = 0.033) while hospitalization time (p = 0.025) and intensive care unit treatment time (p<0.001) were shorter and the bowel passage also started earlier in the laparoscopic group as compared to the laparotomy group. Laparoscopic surgery results in smaller surgical trauma, better cosmetic outcome, shorter hospitalization time and not higher complication- and morbidity-rate as well as shorter operation time in certain cases. However, it requires more qualified surgical team and the operation expenses are higher.

Comparison of outcomes following laparoscopic and open treatment of emergent small bowel obstruction: an 11-year analysis of ACS NSQIP.

PubMed

Patel, Richa; Borad, Neil P; Merchant, Aziz M

2018-06-04

Small bowel obstruction (SBO) continues to be a common indication for acute care surgery. While open procedures are still widely used for treatment, laparoscopic procedures may have important advantages in certain patient populations. We aim to analyze differences in outcomes between the two for treatment of bowel obstruction. The American College of Surgeons National Surgical Quality Improvement Program was used to find patients that underwent emergent or non-elective surgery for SBO. Propensity matching was used to create comparable groups. Logistic regression was used to assess differences in the primary outcome of interest, return to operating room, and morbidity and mortality outcomes. Logistic regression was also used to assess the contribution of various preoperative demographic and comorbidity characteristics to 30-day mortality. A total of 24,028 patients underwent surgery for SBO from 2005 to 2011. Of those, 3391 were laparoscopic. Propensity matching resulted in 6782 matched patients. Laparoscopic cases had significantly decreased odds of experiencing any morbidity and wound complications compared to open cases in bowel-resection and adhesiolysis-only cases. There was no significant difference found for odds of returning to operating room. Laparoscopic cases resulted in significantly shorter hospital stays than open cases (7.18 vs.10.84 days, p < 0.0001). Increasing age, American Society of Anesthesiologists class greater than three, and the presence of respiratory comorbidities resulted in increased odds of mortality. Underweight body mass index (BMI) (< 18.5) increased odds of mortality while greater than normal BMI (> 25) decreased odds of mortality. Analysis of emergent SBO cases between 2005 and 2015 demonstrates that laparoscopy is not utilized as often as open approaches in surgical treatment. Laparoscopic surgery resulted in reduced postoperative morbidity and significantly shorter hospital stays compared to open intervention and was not associated with significant differences in odds of reoperation compared to open surgery.

Young children with functional abdominal pain (FAP) and irritable bowel syndrome (IBS) followed in pediatric gastroenterology (PED-GI) vs primary pediatric care (PED): Differences in outcomes

USDA-ARS?s Scientific Manuscript database

The American Academy of Pediatrics suggests that children with recurrent abdominal pain without alarm signs be managed in pediatric rather than specialty care. However, many of these children are seen in tertiary care. In a longitudinal examination of physical and psychological symptoms, we hypothes...

[Diverticular disease of the large bowel - surgical treatment].

PubMed

Levý, M; Herdegen, P; Sutoris, K; Simša, J

2013-07-01

Surgical treatment, despite the rapid development of the numerous modern miniinvasive intervention techniques, remains essential in the treatment of complicated diverticular disease. The aim of this work is to summarize indications for surgical treatment in both acute and elective patients suffering from diverticular disease of the large bowel. Review of the literature and recent findings concerning indications for surgical intervention in patients with diverticulosis of the colon. The article describes indications, types of procedures, techniques and postoperative care in patients undergoing surgical intervention for diverticular disease.

Advanced Practice Nursing in Pediatric Urology: experience report in the Federal District.

PubMed

Souza, Bruna Marcela Lima de; Salviano, Cristiane Feitosa; Martins, Gisele

2018-01-01

To describe the creation and implementation of the extension program Advanced Practice Nursing in Pediatric Urology, developed in the outpatient clinic of a teaching hospital in the Federal District. This is an experience report regarding the implementation of an outpatient service aimed at children and adolescents with symptoms of bladder and bowel dysfunction. Because it is an extension program linked to the university, it follows a different model of care, valuing empowerment, informed and shared decision making, which results in a stronger bond between patients, family and the Pediatric Urology nursing team. It has also become a privileged space for the production and use of scientific knowledge, associated with the principles of evidence-based practice. This project shows a different performance of the nurse-specialist-professor-researcher in Pediatric Urology Nursing, and it has become a reference in the Federal District, mainly for undergraduate and graduate nursing students.

When is irritable bowel syndrome not irritable bowel syndrome? Diagnosis and treatment of chronic functional abdominal pain.

PubMed

Grover, Madhusudan

2012-08-01

Functional abdominal pain syndrome (FAPS) is a distinct chronic gastrointestinal (GI) pain disorder characterized by the presence of constant or frequently recurring abdominal pain that is not associated with eating, change in bowel habits, or menstrual periods. The pain experience in FAPS is predominantly centrally driven as compared to other chronic painful GI conditions such as inflammatory bowel disease and chronic pancreatitis where peripherally acting factors play a major role in driving the pain. Psychosocial factors are often integrally associated with the disorder and can pose significant challenges to evaluation and treatment. Patients suffer from considerable loss of function, which can drive health care utilization. Treatment options are limited at best with most therapeutic regimens extrapolated from pain management of other functional GI disorders and chronic pain conditions. A comprehensive approach to management using a biopsychosocial construct and collaboration with pain specialists and psychiatry is most beneficial to the management of this disorder.

A randomised controlled trial on hypnotherapy for irritable bowel syndrome: design and methodological challenges (the IMAGINE study).

PubMed

Flik, Carla E; van Rood, Yanda R; Laan, Wijnand; Smout, André Jpm; Weusten, Bas Lam; Whorwell, Peter J; de Wit, Niek J

2011-12-20

Irritable Bowel Syndrome (IBS) is a common gastro-intestinal disorder in primary and secondary care, characterised by abdominal pain, discomfort, altered bowel habits and/or symptoms of bloating and distension. In general the efficacy of drug therapies is poor. Hypnotherapy as well as Cognitive Behaviour Therapy and short Psychodynamic Therapy appear to be useful options for patients with refractory IBS in secondary care and are cost-effective, but the evidence is still limited. The IMAGINE-study is therefore designed to assess the overall benefit of hypnotherapy in IBS as well as comparing the efficacy of individual versus group hypnotherapy in treating this condition. The design is a randomised placebo-controlled trial. The study group consists of 354 primary care and secondary care patients (aged 18-65) with IBS (Rome-III criteria). Patients will be randomly allocated to either 6 sessions of individual hypnotherapy, 6 sessions of group hypnotherapy or 6 sessions of educational supportive therapy in a group (placebo), with a follow up of 9 months post treatment for all patients. Ten hospitals and four primary care psychological practices in different parts of The Netherlands will collaborate in this study. The primary efficacy parameter is the responder rate for adequate relief of IBS symptoms. Secondary efficacy parameters are changes in the IBS symptom severity, quality of life, cognitions, psychological complaints, self-efficacy as well as direct and indirect costs of the condition. Hypnotherapy is expected to be more effective than the control therapy, and group hypnotherapy is expected not to be inferior to individual hypnotherapy. If hypnotherapy is effective and if there is no difference in efficacy between individual and group hypnotherapy, this group form of treatment could be offered to more IBS patients, at lower costs. ISRCTN: ISRCTN22888906.

Clinicians' adherence to international guidelines in the clinical care of adults with inflammatory bowel disease.

PubMed

Jackson, Belinda D; Con, Danny; Liew, Danny; De Cruz, Peter

2017-05-01

Although evidence-based guidelines have been developed for inflammatory bowel disease (IBD), the extent to which they are followed is unclear. The objective of this study was to review clinicians' adherence to international IBD guidelines. Retrospective data collection of patients attending a tertiary Australian hospital IBD clinic over a 12-month period. Management practices were audited and compared to ECCO (European Crohn's and Colitis Organization) guidelines. Data from 288 patients were collected: 47% (136/288) male; mean age 43; 140/288 (49%) patients had ulcerative colitis (UC); 145/288 (50%) patients had Crohn's disease (CD); 3/288 (1%) patients had IBD-unclassified (IBD-U). Patient care was undertaken by gastroenterologists, trainees and general practitioners. Overall adherence to disease management guidelines occurred in 204/288 (71%) of patient encounters. Discrepancies between guidelines and management were found in: 25/80 (31%) of patients with UC in remission receiving oral 5-aminosalicyclates (5-ASAs) as maintenance therapy, and; 46/110 (42%) of patients with small bowel and/or ileo-cecal CD receiving 5-ASA. Preventive Care: Adherence to ≥1 additional component of preventive care was observed in 73/288 (25%) of patient encounters: 12/133 (9%) on thiopurines underwent annual skin checks; 61/288 (21%) of patients with IBD underwent a bone scan; 46/288 (16%) patients were reminded to have their influenza vaccine. Psychological care: Assessment of psychological wellbeing was undertaken in only 16/288 (6%) of patients. There remains a gap between adherence to international guidelines and clinical practice. Standardizing practice using evidence-based clinical pathways may be a strategy towards improving the quality of IBD outpatient management.

Incidence and prevalence of inflammatory bowel diseases in gastroenterology primary care setting.

PubMed

Tursi, Antonio; Elisei, Walter; Picchio, Marcello

2013-12-01

The incidence of inflammatory bowel diseases (IBDs) has markedly increased over the last years, but no epidemiological study has been performed in gastroenterology primary care setting. We describe the epidemiology of IBD in a gastroenterology primary care unit using its records as the primary data source. Case finding used predefined read codes to systematically search computer diagnostic and prescribing records from January 2009 to December 2012. A specialist diagnosis of Ulcerative colitis (UC), Crohn's disease (CD), inflammatory bowel disease unclassified (IBDU) or segmental colitis associated with diverticulosis (SCAD), based on clinical, histological or radiological findings, was a prerequisite for the inclusion in the study. Secondary, infective and apparent acute self-limiting colitis were excluded. We identified 176 patients with IBD in a population of 94,000 with a prevalence 187.2/100,000 (95% CI: 160.6-217.0). Between 2009 and 2012 there were 61 new cases. In particular, there were 23 new cases of UC, 19 new cases of CD, 15 new cases of SCAD, and 4 new cases of IBDU. The incidence of IBD was 16.2/100,000 (95% CI 12.5-20.7) per year. The incidence per year was 6/100,000 (95% CI 3.8 to 8.9) for UC, 5/100,000 (95% CI 3.0-7.7) for CD, 4/100,000 (95% CI 2.3-6.5) for SCAD, and 1/100,000 (95% CI 0.3-2.6) for IBDU. We assessed for the first time which is the prevalence and incidence of IBD in a gastroenterology primary care unit. This confirms that specialist primary care unit is a key factor in providing early diagnosis of chronic diseases. Copyright © 2013 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

The inflammatory bowel disease live interinstitutional and interdisciplinary videoconference education (IBD LIVE) series.

PubMed

Regueiro, Miguel D; Greer, Julia B; Binion, David G; Schraut, Wolfgang H; Goyal, Alka; Keljo, David J; Cross, Raymond K; Williams, Emmanuelle D; Herfarth, Hans H; Siegel, Corey A; Oikonomou, Ioannis; Brand, Myron H; Hartman, Douglas J; Tublin, Mitchell E; Davis, Peter L; Baidoo, Leonard; Szigethy, Eva; Watson, Andrew R

2014-10-01

Managing patients with inflammatory bowel disease requires multidisciplinary coordination. Technological advances have enhanced access to care for patients and improved physician interactions. The primary aim of our project was to convene diverse institutions and specialties through a multisite virtual conferencing platform to discuss complex patient management. The case conference is designed to include multiple institutions to exchange ideas, review evidence-based data, and provide input on the management of patients with Crohn's disease and ulcerative colitis. Technology is supplied and coordinated by an information technology specialist and Chorus Call, Inc., an international teleconferencing service provider. The Inflammatory Bowel Disease Live Interinstitutional Interdisciplinary Videoconference Education (IBD LIVE) initiative is accredited by the University of Pittsburgh Medical Center (UPMC) Center for Continuing Education in the Health Sciences for 1 AMA PRA Category 1 Credit per weekly session. IBD LIVE began in 2009 comprising only adult gastroenterology and pediatric gastroenterology from UPMC Presbyterian and Children's Hospitals. Participation steadily increased from 5 sites in 2010 to 11 sites in 2014. Maximum attendance for a single conference was 73 participants with a median of 48. The Continuing Medical Education scores (1 = worst to 5 = best) have a high median overall score (4.6, range 3.2-5.0) with positive responses with regard to the degree to which the conference changed practice. IBD LIVE has been successful and continues to grow. Implementation of the Crohn's and Colitis Foundation of America Virtual Preceptor Program using the IBD LIVE platform will provide expanded national physician access to this professional education activity.

[Clinical practice guidelines: Irritable bowel syndrome with constipation and functional constipation in adults: Concept, diagnosis, and healthcare continuity. (Part 1 of 2)].

PubMed

Mearin, F; Ciriza, C; Mínguez, M; Rey, E; Mascort, J J; Peña, E; Cañones, P; Júdez, J

In this Clinical practice guide, an analysis is made of the diagnosis and treatment of adult patients with constipation and abdominal discomfort, under the spectrum of irritable bowel syndrome and functional constipation. These have an important personal, health and social impact, affecting the quality of life of these patients. In irritable bowel syndrome with a predominance of constipation, this is the predominant change in bowel movements, with recurrent abdominal pain, bloating and frequent abdominal distension. Constipation is characterised by infrequent or difficulty in bowel movements, associated with excessive straining during bowel movement or sensation of incomplete evacuation. There is often no underling cause, with an intestinal functional disorder being considered. They have many clinical and pathophysiological similarities, with a similar response of the constipation to common drugs. The fundamental difference is the presence or absence of pain, but not in a way evaluable way; "all or nothing". The severity depends on the intensity of bowel symptoms and other factors, a combination of gastrointestinal and extra-intestinal symptoms, level of involvement, forms of perception, and behaviour. The Rome criteria diagnose functional bowel disorders. This guide is adapted to the Rome criteria IV (May 2016) and in this first part an analysis is made of the alarm criteria, diagnostic tests, and the criteria for referral between Primary Care and Digestive Disease specialists. In the second part, a review will be made of the therapeutic alternatives available (exercise, diet, drug therapies, neurostimulation of sacral roots, or surgery), making practical recommendations for each one of them. Copyright © 2016 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

Clinical Practice Guideline: Irritable bowel syndrome with constipation and functional constipation in the adult.

PubMed

Mearin, Fermín; Ciriza, Constanza; Mínguez, Miguel; Rey, Enrique; Mascort, Juan José; Peña, Enrique; Cañones, Pedro; Júdez, Javier

2016-06-01

In this Clinical Practice Guideline we discuss the diagnostic and therapeutic approach of adult patients with constipation and abdominal complaints at the confluence of the irritable bowel syndrome spectrum and functional constipation. Both conditions are included among the functional bowel disorders, and have a significant personal, healthcare, and social impact, affecting the quality of life of the patients who suffer from them. The first one is the irritable bowel syndrome subtype, where constipation represents the predominant complaint, in association with recurrent abdominal pain, bloating, and abdominal distension. Constipation is characterized by difficulties with or low frequency of bowel movements, often accompanied by straining during defecation or a feeling of incomplete evacuation. Most cases have no underlying medical cause, and are therefore considered as a functional bowel disorder. There are many clinical and pathophysiological similarities between both disorders, and both respond similarly to commonly used drugs, their primary difference being the presence or absence of pain, albeit not in an "all or nothing" manner. Severity depends not only upon bowel symptom intensity but also upon other biopsychosocial factors (association of gastrointestinal and extraintestinal symptoms, grade of involvement, and perception and behavior variants). Functional bowel disorders are diagnosed using the Rome criteria. This Clinical Practice Guideline has been made consistent with the Rome IV criteria, which were published late in May 2016, and discuss alarm criteria, diagnostic tests, and referral criteria between Primary Care and gastroenterology settings. Furthermore, all the available treatment options (exercise, fluid ingestion, diet with soluble fiber-rich foods, fiber supplementation, other dietary components, osmotic or stimulating laxatives, probiotics, antibiotics, spasmolytics, peppermint essence, prucalopride, linaclotide, lubiprostone, biofeedback, antidepressants, psychological therapy, acupuncture, enemas, sacral root neurostimulation, surgery) are discussed, and practical recommendations are made regarding each of them.

[Clinical practice guidelines: Irritable bowel syndrome with constipation and functional constipation in adults: Concept, diagnosis, and healthcare continuity. (Part 1 of 2)].

PubMed

Mearin, F; Ciriza, C; Mínguez, M; Rey, E; Mascort, J J; Peña, E; Cañones, P; Júdez, J

2017-01-01

In this Clinical practice guide, an analysis is made of the diagnosis and treatment of adult patients with constipation and abdominal discomfort, under the spectrum of irritable bowel syndrome and functional constipation. These have an important personal, health and social impact, affecting the quality of life of these patients. In irritable bowel syndrome with a predominance of constipation, this is the predominant change in bowel movements, with recurrent abdominal pain, bloating and frequent abdominal distension. Constipation is characterised by infrequent or difficulty in bowel movements, associated with excessive straining during bowel movement or sensation of incomplete evacuation. There is often no underling cause, with an intestinal functional disorder being considered. They have many clinical and pathophysiological similarities, with a similar response of the constipation to common drugs. The fundamental difference is the presence or absence of pain, but not in a way evaluable way; "all or nothing". The severity depends on the intensity of bowel symptoms and other factors, a combination of gastrointestinal and extra-intestinal symptoms, level of involvement, forms of perception, and behaviour. The Rome criteria diagnose functional bowel disorders. This guide is adapted to the Rome criteria IV (May 2016) and in this first part an analysis is made of the alarm criteria, diagnostic tests, and the criteria for referral between Primary Care and Digestive Disease specialists. In the second part, a review will be made of the therapeutic alternatives available (exercise, diet, drug therapies, neurostimulation of sacral roots, or surgery), making practical recommendations for each one of them. Copyright © 2016. Publicado por Elsevier España, S.L.U.

Multicenter comparison of double-balloon enteroscopy and spiral enteroscopy.

PubMed

Rahmi, Gabriel; Samaha, Elia; Vahedi, Kouroche; Ponchon, Thierry; Fumex, Fabien; Filoche, Bernard; Gay, Gerard; Delvaux, Michel; Lorenceau-Savale, Camille; Malamut, Georgia; Canard, Jean-Marc; Chatellier, Gilles; Cellier, Christophe

2013-06-01

Spiral enteroscopy is a novel technique for small bowel exploration. The aim of this study is to compare double-balloon and spiral enteroscopy in patients with suspected small bowel lesions. Patients with suspected small bowel lesion diagnosed by capsule endoscopy were prospectively included between September 2009 and December 2010 in five tertiary-care academic medical centers. After capsule endoscopy, 191 double-balloon enteroscopy and 50 spiral enteroscopies were performed. Indications were obscure gastrointestinal bleeding in 194 (80%) of cases. Lesions detected by capsule endoscopy were mainly angioectasia. Double-balloon and spiral enteroscopy resulted in finding one or more lesions in 70% and 75% of cases, respectively. The mean diagnosis procedure time and the average small bowel explored length during double-balloon and spiral enteroscopy were, respectively, 60 min (45-80) and 55 min (45-80) (P=0.74), and 200 cm (150-300) and 220 cm (200-300) (P=0.13). Treatment during double-balloon and spiral enteroscopy was possible in 66% and 70% of cases, respectively. There was no significant major procedure-related complication. Spiral enteroscopy appears as safe as double-balloon enteroscopy for small bowel exploration with a similar diagnostic and therapeutic yield. Comparison between the two procedures in terms of duration and length of small bowel explored is slightly in favor of spiral enteroscopy but not significantly. © 2013 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

Providing Hospitalized Patients With an Educational Booklet Increases the Quality of Colonoscopy Bowel Preparation.

PubMed

Ergen, William F; Pasricha, Trisha; Hubbard, Francie J; Higginbotham, Tina; Givens, Tonya; Slaughter, James C; Obstein, Keith L

2016-06-01

Inadequate bowel preparation is a problem frequently encountered by gastroenterologists who perform colonoscopies on hospitalized patients. A method is needed to increase the quality of bowel preparation in inpatients. An educational booklet has been shown to increase the overall quality of bowel preparation for outpatients. We performed a prospective study to evaluate the effects of an educational booklet on the quality of bowel preparation in a group of hospitalized patients. We performed a randomized, single-blind, controlled trial of all inpatients at a tertiary care medical center scheduled for inpatient colonoscopy from October 2013 through March 2014. They were randomly assigned to groups that were (n = 45) or were not (controls, n = 40) given the booklet before bowel preparation the evening before their colonoscopy. All patients received a standard bowel preparation (clear liquid diet the day before the procedure, followed by split-dose GoLYTELY). At the colonoscopy, the Boston Bowel preparation scale (BBPS) was used to assess bowel preparation. The primary outcome measure was adequate bowel preparation (a total BBPS score ≥6 with all segment scores ≥2). Secondary outcomes assessed included total BBPS score, BBPS segment score, and a total BBPS score of 0. There were no differences between the groups in age, race, sex, body mass index, history of colonoscopy, history of polyps, or time of colonoscopy. Twenty-eight patients who received the booklet (62%) and 14 who did not (35%) had an adequate bowel preparation (P = .012). The number needed to treat to attain adequate bowel preparation was 4. After adjusting for age and history of prior colonoscopies, the odds of achieving an adequate bowel preparation and a higher total BBPS score after receipt of the booklet were 3.14 (95% confidence interval, 1.29-7.83) and 2.27 (95% confidence interval, 1.05-4.88), respectively. Three patients in the booklet group and 9 in the no-booklet group had a BBPS score of 0 (P = .036). The mean BBPS segment score was greater for the booklet group than the no-booklet group (right colon, P = .097; transverse colon, P = .023; left colon, P = .045). In a randomized controlled trial, we found that providing hospitalized patients with an educational booklet on colonoscopy preparation increases the odds of a quality bowel preparation more than 2-fold. Copyright © 2016 AGA Institute. Published by Elsevier Inc. All rights reserved.

Increasing Colonoscopy Screening in Disparate Populations: Results From an Evaluation of Patient Navigation in the New Hampshire Colorectal Cancer Screening Program

PubMed Central

Rice, Ketra; Gressard, Lindsay; DeGroff, Amy; Gersten, Joanne; Robie, Janene; Leadbetter, Steven; Glover-Kudon, Rebecca; Butterly, Lynn

2018-01-01

BACKGROUND To investigate uniformly successful results from a statewide program of patient navigation (PN) for colonoscopy, this comparison study evaluated the effectiveness of the PN intervention by comparing outcomes for navigated versus non-navigated patients in one of the community health clinics included in the statewide program. Outcomes measured included screening completion, adequacy of bowel preparation, missed appointments and cancellations, communication of test results, and consistency of follow-up recommendations with clinical guidelines. METHODS The authors compared a subset of 131 patients who were navigated to a screening or surveillance colonoscopy with a similar subset of 75 non-navigated patients at one endoscopy clinic. The prevalence and prevalence odds ratios were computed to measure the association between PN and each study outcome measure. RESULTS Patients in the PN intervention group were 11.2 times more likely to complete colonoscopy than control patients (96.2% vs 69.3%; P<.001), and were 5.9 times more likely to have adequate bowel preparation (P =.010). In addition, intervention patients had no missed appointments compared with 15.6% of control patients, and were 24.8 times more likely to not have a cancellation <24 hours before their appointment (P<.001). All navigated patients and their primary care providers received test results, and all follow-up recommendations were consistent with clinical guidelines compared with 82.4% of patients in the control group (P<.001). CONCLUSIONS PN appears to be effective for improving colonoscopy screening completion and quality in the disparate populations most in need of intervention. To the best of our knowledge, the results of the current study demonstrate some of the strongest evidence for the effectiveness of PN to date, and highlight its value for public health. PMID:28464213

Gastrointestinal bleeding

MedlinePlus

... conditions that are not serious, including: Anal fissure Hemorrhoids GI bleeding may also be a sign of ... the bowel Home Care There are home stool tests for microscopic blood that may be recommended for ...

Integrating Behavioral Health and Primary Care for Comorbid Behavioral and Medical Problems

ClinicalTrials.gov

2018-01-10

Arthritis; Asthma; Chronic Obstructive Lung Disease; Diabetes; Heart Failure; Hypertension; Anxiety; Chronic Pain; Depression; Fibromyalgia; Insomnia; Irritable Bowel Syndrome; Problem Drinking; Substance Use Disorder

MiraLAX is not as effective as GoLytely in bowel cleansing before screening colonoscopies.

PubMed

Hjelkrem, Michael; Stengel, Joel; Liu, Mark; Jones, David P; Harrison, Stephen A

2011-04-01

Successful colonoscopies require good bowel preparations-poor bowel preparations can increase medical costs, rates of missed lesions, and procedure duration. The combination of polyethylene glycol (PEG) 3350 without electrolytes (MiraLAX; Schering-Plough Healthcare Products, Inc, Kenilworth, NJ) and 64 oz of Gatorade (PepsiCo, Inc, Purchase, NY) has gained popularity as a bowel preparation regimen. However, the efficacy and tolerability of this approach has not been compared with standard bowel preparations in clinical trials. We compared split-dose (PEG) 3350 with electrolytes (GoLytely; Braintree Laboratories, Inc, Braintree, MA) with split-dose MiraLAX alone and in combination with pretreatment medications (bisacodyl or lubiprostone) to determine the efficacy and patient tolerability of MiraLAX as an agent for bowel preparation. We performed a prospective, randomized, blinded, controlled trial at a tertiary care center. Patients (n=403) were randomly assigned to groups given GoLytely, MiraLAX, MiraLAX with bisacodyl (10 mg), or MiraLAX with lubiprostone (24 μg). MiraLAX was combined with 64 oz of Gatorade. All patients were surveyed regarding preparation satisfaction and tolerability. The Ottawa bowel preparation scale was used to grade colon cleanliness. GoLytely was more effective at bowel cleansing (average Ottawa score, 5.1) than MiraLAX alone (average Ottawa score, 6.9) or in combination with lubiprostone (average Ottawa score, 6.8), or bisacodyl (average Ottawa score, 6.3) (P<.001). MiraLAX was associated with a trend toward longer procedure duration (P=.096). Groups given MiraLAX rated the overall experience as more satisfactory than those given GoLytely (P<.001). There were no differences between polyp detection rates (P=.346) or adverse events (P=.823). Split-dose MiraLAX in 64 oz of Gatorade is not as effective as 4 L split-dose GoLytely in bowel cleansing for screening colonoscopies. Copyright © 2011 AGA Institute. Published by Elsevier Inc. All rights reserved.

International spinal cord injury bowel function basic data set (Version 2.0).

PubMed

Krogh, K; Emmanuel, A; Perrouin-Verbe, B; Korsten, M A; Mulcahey, M J; Biering-Sørensen, F

2017-07-01

International expert working group. To revise the International Spinal Cord Injury (SCI) Bowel Function Basic Data Set as a standardized format for the collecting and reporting of a minimal amount of information on bowel function in clinical practice and research. Working group appointed by the American Spinal injury association (ASIA) and the International Spinal Cord Society (ISCoS). The draft prepared by the working group was reviewed by the International SCI Data Set Committee and later by members of the ISCoS Executive and Scientific Committees and the ASIA board. The revised data set was posted on the ASIA and ISCoS websites for 1 month to allow further comments and suggestions. Changes resulting from a Delphi process among experts in children with SCI were included. Members of ISCoS Executive and Scientific Committees and the ASIA board made a final review and approved the data set. The International SCI Bowel Function Basic Data Set (Version 2.0) consists of the following 16 items: date of data collection, gastrointestinal and anal sphincter dysfunction unrelated to SCI, surgical procedures on the gastrointestinal tract, defecation method and bowel-care procedures, average time required for defecation, frequency of defecation, uneasiness, headache or perspiration during defecation, digital stimulation or evacuation of the anorectum, frequency of fecal incontinence, flatus incontinence, need to wear pad or plug, oral laxatives and prokinetics, anti-diarrheal agents, perianal problems, abdominal pain and discomfort and the neurogenic bowel dysfunction score. The International SCI Bowel Function Basic Data Set (Version 2.0) has been developed.

Access to specialist gastroenterology care in Canada: Comparison of wait times and consensus targets

PubMed Central

Leddin, Desmond; Armstrong, David; Barkun, Alan NG; Chen, Ying; Daniels, Sandra; Hollingworth, Roger; Hunt, Richard H; Paterson, William G

2008-01-01

BACKGROUND: Monitoring wait times and defining targets for care have been advocated to improve health care delivery related to cancer, heart, diagnostic imaging, joint replacements and sight restoration. There are few data on access to care for digestive diseases, although they pose a greater economic burden than cancer or heart disease in Canada. The present study compared wait times for specialist gastroenterology care with recent, evidence-based, consensus-defined benchmark wait times for a range of digestive diseases. METHODS: Total wait times from primary care referral to investigation were measured for seven digestive disease indications by using the Practice Audit in Gastroenterology program, and were benchmarked against consensus recommendations. RESULTS: Total wait times for 1903 patients who were undergoing investigation exceeded targets for those with probable cancer (median 26 days [25th to 75th percentiles eight to 56 days] versus target of two weeks); probable inflammatory bowel disease (101 days [35 to 209 days] versus two weeks); documented iron deficiency anemia (71 days [19 to 142 days] versus two months); positive fecal occult blood test (73 days [36 to 148 days] versus two months); dyspepsia with alarm symptoms (60 days [23 to 140 days] versus two months); refractory dyspepsia without alarm symptoms (126 days [42 to 225 days] versus two months); and chronic constipation and diarrhea (141 days [68 to 264 days] versus two months). A minority of patients were seen within target times: probable cancer (33% [95% CI 20% to 47%]); probable inflammatory bowel disease (12% [95% CI 1% to 23%]); iron deficiency anemia (46% [95% CI 37% to 55%]); positive occult blood test (41% [95% CI 28% to 54%]); dyspepsia with alarm symptoms (51% [95% CI 41% to 60%]); refractory dyspepsia without alarm symptoms (33% [95% CI 19% to 47%]); and chronic constipation and diarrhea (21% [95% CI 14% to 29%]). DISCUSSION: Total wait times for the seven indications exceeded the consensus targets; 51% to 88% of patients were not seen within the target wait time. Multiple interventions, including adoption of evidence-based management guidelines and provision of economic and human resources, are needed to ensure appropriate access to digestive health care in Canada. Outcomes can be evaluated by the ‘point-of-care’, practice audit methodology used for the present study. PMID:18299735

Missed opportunities in educating Aboriginal Australians about bowel cancer screening: whose job is it anyway?

PubMed

Christou, Aliki; Thompson, Sandra C

2013-12-01

A culturally relevant educational flipchart targeting Aboriginal people was distributed across Western Australia to support education on bowel cancer screening and encourage participation in the National Bowel Cancer Screening Program. Respondents sampled from the flipchart distribution list were surveyed on the appropriateness, usefulness, and the extent to and manner in which they used the flipchart for educating Aboriginal clients. Despite praising the resource, few respondents used the flipchart as intended for various reasons, including the view that Aboriginal health education was the responsibility of Aboriginal health workers. Greater recognition by all health service providers is needed of their potential role in Aboriginal health education. Promoting a national health program of under-appreciated importance for a marginalised population is challenging. Effective utilisation of an educational tool is predicated on factors beyond its production quality and wide dissemination. Intended users require awareness of the underlying problem, and adequate time for and specific training in implementation of the tool.

Predictors of health care seeking for irritable bowel syndrome: a population based study.

PubMed

Talley, N J; Boyce, P M; Jones, M

1997-09-01

It has been suggested that psychological factors rather than symptoms drive subjects with irritable bowel syndrome (IBS) to seek medical care, but this issue has not been tackled in a population based study. To identify whether psychological factors or abuse explain health care seeking for IBS. A sample of residents of Penrith (a Sydney suburb representative of the Australian population) selected randomly from the electoral rolls (that by law include the entire population > or = 18 years) was mailed a validated self-report questionnaire. Measured were gastrointestinal symptoms including the Manning (and Rome) criteria for IBS, health care seeking, neuroticism (Eysenck Personality Questionnaire), psychological morbidity (General Health Questionnaire: GHQ) and sexual, physical and emotional abuse (including the standardised Drossman questions). Among 730 subjects, 96 (13%, 95% confidence interval (CI) 11-16%) had IBS by the Manning criteria. Of those with IBS, 73% (95% CI 63-81%) had sought medical care for abdominal pain or discomfort. Only increasing pain severity (odds ratio (OR) = 2.10, 95% CI 1.11-3.95) and duration of pain (OR = 1.53, 95% CI 1.10-2.13) were independently associated with seeking health care for IBS. Pain severity was also predictive of recent care seeking (OR = 1.74, 95% CI 1.12-1.96). Neuroticism, psychological morbidity and abuse history were not significant predictors. Psychological factors do not seem to explain health care seeking among community subjects with IBS.

Constipation in intensive care unit: incidence and risk factors.

PubMed

Nassar, Antonio Paulo; da Silva, Fernanda Maria Queiroz; de Cleva, Roberto

2009-12-01

Although gastrointestinal motility disorders are common in critically ill patients, constipation and its implications have received very little attention. We aimed to determine the incidence of constipation to find risk factors and its implications in critically ill patients During a 6-month period, we enrolled all patients admitted to an intensive care unit from an universitary hospital who stayed 3 or more days. Patients submitted to bowel surgery were excluded. Constipation occurred in 69.9% of the patients. There was no difference between constipated and not constipated in terms of sex, age, Acute Physiology and Chronic Health Evaluation II, type of admission (surgical, clinical, or trauma), opiate use, antibiotic therapy, and mechanical ventilation. Early (<24 hours) enteral nutrition was associated with less constipation, a finding that persisted at multivariable analysis (P < .01). Constipation was not associated with greater intensive care unit or mortality, length of stay, or days free from mechanical ventilation. Constipation is very common among critically ill patients. Early enteral nutrition is associated with earlier return of bowel function.

The effects of inpatient exercise therapy on the length of hospital stay in stages I-III colon cancer patients: randomized controlled trial.

PubMed

Ahn, Ki-Yong; Hur, Hyuk; Kim, Dong-Hyun; Min, Jihee; Jeong, Duck Hyoun; Chu, Sang Hui; Lee, Ji Won; Ligibel, Jennifer A; Meyerhardt, Jeffrey A; Jones, Lee W; Jeon, Justin Y; Kim, Nam Kyu

2013-05-01

This study aimed to examine the effects of a postsurgical, inpatient exercise program on postoperative recovery in operable colon cancer patients We conducted the randomized controlled trial with two arms: postoperative exercise vs. usual care. Patients with stages I-III colon cancer who underwent colectomy between January and December 2011 from the Colorectal Cancer Clinic, were recruited for the study. Subjects in the intervention group participated in the postoperative inpatient exercise program consisted of twice daily exercise, including stretching, core, balance, and low-intensity resistance exercises. The usual care group was not prescribed a structured exercise program. The primary endpoint was the length of hospital stay. Secondary endpoints were time to flatus, time to first liquid diet, anthropometric measurements, and physical function measurements. A total of 31 (86.1 %) patients completed the trial, with adherence to exercise interventions at 84.5 %. The mean length of hospital stay was 7.82 ± 1.07 days in the exercise group compared with 9.86 ± 2.66 days in usual care (mean difference, 2.03 days; 95 % confidence interval (CI), -3.47 to -0.60 days; p = 0.005) in per-protocol analysis. The mean time to flatus was 52.18 ± 21.55 h in the exercise group compared with 71.86 ± 29.2 h in the usual care group (mean difference, 19.69 h; 95 % CI, -38.33 to -1.04 h; p = 0.036). Low-to-moderate-intensity postsurgical exercise reduces length of hospital stay and improves bowel motility after colectomy procedure in patients with stages I-III colon cancer.

"Best practice" in inflammatory bowel disease: an international survey and audit.

PubMed

Van Der Eijk, Ingrid; Verheggen, Frank W.; Russel, Maurice G.; Buckley, Martin; Katsanos, Kostas; Munkholm, Pia; Engdahl, Ingemar; Politi, Patrizia; Odes, Selwyn; Fossen, Jan; Stockbrügger, Reinhold W.

2004-04-01

Background: An observational study was conducted at eight university and four district hospitals in eight countries collaborating in clinical and epidemiological research in inflammatory bowel disease (IBD) to compare European health care facilities and to define current "best practice" with regard to IBD. Methods: The approach used in this multi-national survey was unique. Existing quality norms, developed for total hospital care by a specialized organization, were restricted to IBD-specific care and adapted to the frame of reference of the study group. In each center, these norms were surveyed by means of questionnaires and professional audits in all participating centers. The collected data were reported to the center, compared to data from other hospitals, and used to benchmark. Group consensus was reached with regard to defining current "best practice". Results: The observations in each center involved patient-oriented processes, technical and patient safety, and quality of the medical standard. Several findings could be directly implemented to improve IBD care in another hospital (benchmarks). These included a confidential relationship between health care worker(s) and patients, and availability of patient data. Conclusions: The observed benchmarks, in combination with other subjectively chosen "positive" procedures, have been defined as current "best practice in IBD", representing practical guidelines towards better quality of care in IBD.

Passive exercise of the lower limbs and trunk alleviates decreased intestinal motility in patients in the intensive care unit after cardiovascular surgery.

PubMed

Morisawa, Tomoyuki; Takahashi, Tetsuya; Sasanuma, Naoki; Mabuchi, Satoshi; Takeda, Kenta; Hori, Naoto; Ohashi, Naotsugu; Ide, Takeshi; Domen, Kazuhisa; Nishi, Shinichi

2017-02-01

[Purpose] The purpose of this study was to clarify the effects of passive exercise of the lower limbs and trunk (PELT) in ICU patients after cardiovascular surgery with decreased bowel motility. [Subjects and Methods] Ten ICU patients with clinically-apparent decreased bowel motility during the period of April to July 2016 were enrolled this study. Bowel sounds (BS) for 5 minutes at rest and 5 minutes after PELT were recorded through an electronic stethoscope. A frequency analysis was performed and the BS before and after PELT were compared. In addition, the percent change in BS before and after PELT was determined, and the relationship between the percent change in BS and individual parameters (invasiveness of surgery, inflammation, nutrition, renal function) was examined. [Results] Average BS (integral value) for 5 minutes before and after PELT were 63.1 ± 41.3 mVsec and 115.0 ± 57.8 mVsec, respectively; therefore, BS was significantly increased by PELT. When compared to patients at rest, a significant increase was found 0-4 minutes after PELT. None of the individual parameters was significantly correlated with the percent change. [Conclusion] PELT can increase the bowel motility of ICU patients with decreased bowel motility.

Prevalence and risk factors of Clostridium difficile infection in patients hospitalized for flare of inflammatory bowel disease: a retrospective assessment.

PubMed

Regnault, Helene; Bourrier, Anne; Lalande, Valerie; Nion-Larmurier, Isabelle; Sokol, Harry; Seksik, Philippe; Barbut, Frederic; Cosnes, Jacques; Beaugerie, Laurent

2014-12-01

Recent studies have identified a high frequency of Clostridium difficile infections in patients with active inflammatory bowel disease. To retrospectively assess the determinants and results of Clostridium difficile testing upon the admission of patients hospitalized with active inflammatory bowel disease in a tertiary care centre and to determine the predicting factors of Clostridium difficile infections. We reviewed all admissions from January 2008 and December 2010 for inflammatory bowel disease flare-ups. A toxigenic culture and a stool cytotoxicity assay were performed for all patients tested for Clostridium difficile. Out of 813 consecutive stays, Clostridium difficile diagnostic assays have been performed in 59% of inpatients. The independent predictive factors for the testing were IBD (ulcerative colitis: OR 2.0, 95% CI 1.5-2.9; p<0.0001) and colonic involvement at admission (OR 2.2, 95% CI 1.5-3.1, p<0.0001). Clostridium difficile infection was present in 7.0% of the inpatients who underwent testing. In a multivariate analysis, the only independent predictor was the intake of nonsteroidal anti-inflammatory drugs within the two months before admission (OR 3.8, 95% CI 1.2-12.3; p=0.02). Clostridium difficile infection is frequently associated with active inflammatory bowel disease. Our study suggests that a recent intake of nonsteroidal anti-inflammatory drugs is a risk factor for inflammatory bowel disease -associated Clostridium difficile infection. Copyright © 2014 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Disability and participation in breast and bowel cancer screening in England: a large prospective study.

PubMed

Floud, S; Barnes, I; Verfürden, M; Kuper, H; Gathani, T; Blanks, R G; Alison, R; Patnick, J; Beral, V; Green, J; Reeves, G K

2017-11-21

There is limited information about participation in organised population-wide screening programmes by people with disabilities. Data from the National Health Service routine screening programmes in England were linked to information on disability reported by the Million Women Study cohort participants. Of the 473 185 women offered routine breast or bowel cancer screening, 23% reported some disability. Women with disabilities were less likely than other women to participate in breast cancer screening (RR=0.64, 95% CI: 0.62-0.65) and in bowel cancer screening (RR=0.75, 0.73-0.76). Difficulties with self-care or vision were associated with the greatest reduction in screening participation. Participation in routine cancer screening programmes in England is reduced in people with disabilities and participation varies by type of disability.

Hemorrhoids.

PubMed

Hussain, J N

1999-03-01

Hemorrhoids are one of the most frequent anorectal disorders encountered in the primary care setting. They are the most common cause of hematochezia, and are responsible for considerable patient suffering and disability. With the techniques of diagnosis and office-based interventions described in this article, the primary care provider can effectively relieve most patients' symptoms and ensure that more significant bowel disease is not overlooked.

Young Children with Functional Abdominal Pain (FAP) and Irritable Bowel Syndrome (IBS) Followed in Tertiary vs. Primary Care: Differences in Outcomes

USDA-ARS?s Scientific Manuscript database

Despite the fact that the American Academy of Pediatrics suggests that general pediatricians (PED) manage children with FAP/IBS without alarm signs many children are cared for by pediatric gastroenterologists (GI). In a longitudinal examination of physical symptoms, healthcare use, quality of life (...

Being a Living Donor: Risks

MedlinePlus

... bowel Fluid on the lungs Lung, Intestine, and Pancreas Pancreas, intestine, and lung living-donor transplants are very ... care of the live organ donor: lung, liver, pancreas, and intestine data and medical guidelines. Transplantation. 2006 ...

Genetics Home Reference: Hirschsprung disease

MedlinePlus

... MedlinePlus (5 links) Diagnostic Tests Drug Therapy Genetic Counseling Palliative Care Surgery and Rehabilitation Related Information How ... Patient Support and Advocacy Resources (4 links) Bowel Group for Kids International Foundation for Functional Gastrointestinal Disorders ...

Take the IBS Test

MedlinePlus

... Committed to Quality in Patient Care TAKE THE IBS TEST Do you have recurrent abdominal pain or ... have a real and treatable medical condition called irritable bowel syndrome (IBS). Your doctor now has new information and ...

Nurse-led hypnotherapy: an innovative approach to Irritable Bowel Syndrome.

PubMed

Bremner, Helen

2013-08-01

Irritable Bowel Syndrome (IBS) is a common, chronic functional illness, which can greatly reduce patients' quality of life, and consumes healthcare resources. Standard treatments include dietary changes and medication, though these are often ineffective. Clinical studies of hypnotherapy demonstrate improvement in symptoms and quality of life in over 80% of subjects with intractable IBS. Our experience of a nurse-led hypnotherapy service for IBS in a community setting provides evidence of comparable efficacy for symptom control, improved quality of life, reduced dependence on medication and improved general health measures. We address the challenges of setting up and maintaining the service in a changing healthcare environment. This model of care could act as a template for providers of gastroenterology and functional disease services wishing to provide IBS care. Copyright © 2013 Elsevier Ltd. All rights reserved.

Fecal containment in bedridden patients: economic impact of 2 commercial bowel catheter systems.

PubMed

Kowal-Vem, Areta; Poulakidas, Stathis; Barnett, Barbara; Conway, Deborah; Culver, Daniel; Ferrari, Michelle; Potenza, Bruce; Koenig, Michael; Mah, John; Majewski, Mary; Morris, Linda; Powers, Jan; Stokes, Elizabeth; Tan, Michael; Salstrom, Sara-Jane; Zaletel, Cindy; Ambutas, Shirley; Casey, Kathleen; Stein, Jayne; DeSane, Mary; Berry, Kathy; Konz, Elizabeth C; Riemer, Michael R; Cullum, Malford E

2009-05-01

Fecal contamination is a major challenge in patients in acute/critical care settings that is associated with increased cost of care and supplies and with development of pressure ulcers, incontinence dermatitis, skin and soft tissue infections, and urinary tract infections. To assess the economic impact of fecal containment in bedridden patients using 2 different indwelling bowel catheters and to compare infection rates between groups. A multicenter, observational study was done at 12 US sites (7 that use catheter A, 5 that use catheter B). Patients were followed from insertion of an indwelling bowel catheter system until the patient left the acute/critical care unit or until 29 days after enrollment, whichever came first. Demographic data, frequency of bedding/dressing changes, incidence of infection, and Braden scores (risk of pressure ulcers) were recorded. The study included 146 bedridden patients (76 with catheter A, 70 with catheter B) who had similar Braden scores at enrollment. The rate of bedding/dressing changes per day differed significantly between groups (1.20 for catheter A vs 1.71 for catheter B; P = .004). According to a formula that accounted for personnel resources and laundry cycle costs, catheter A cost $13.94 less per patient per day to use than did catheter B. Catheter A was less likely than was catheter B to be removed during the observational period (P = .03). Observed infection rates were low. Catheter A may be more cost-effective than catheter B because it requires fewer unscheduled linen changes per patient day.

Gastroenterologist and nurse management of symptoms after pelvic radiotherapy for cancer: an economic evaluation of a clinical randomized controlled trial (the ORBIT study).

PubMed

Jordan, Jake; Gage, Heather; Benton, Barbara; Lalji, Amyn; Norton, Christine; Andreyev, H Jervoise N

2017-01-01

Over 20 distressing gastrointestinal symptoms affect many patients after pelvic radiotherapy, but in the United Kingdom few are referred for assessment. Algorithmic-based treatment delivered by either a consultant gastroenterologist or a clinical nurse specialist has been shown in a randomized trial to be statistically and clinically more effective than provision of a self-help booklet. In this study, we assessed cost-effectiveness. Outcomes were measured at baseline (pre-randomization) and 6 months. Change in quality-adjusted life years (QALYs) was the primary outcome for the economic evaluation; a secondary analysis used change in the bowel subset score of the modified Inflammatory Bowel Disease Questionnaire (IBDQ-B). Intervention costs, British pounds 2013, covered visits with the gastroenterologist or nurse, investigations, medications and treatments. Incremental outcomes and incremental costs were estimated simultaneously using multivariate linear regression. Uncertainty was handled non-parametrically using bootstrap with replacement. The mean (SD) cost of treatment was £895 (499) for the nurse and £1101 (567) for the consultant. The nurse was dominated by usual care, which was cheaper and achieved better outcomes. The mean cost per QALY gained from the consultant, compared to usual care, was £250,455; comparing the consultant to the nurse, it was £25,875. Algorithmic care produced better outcomes compared to the booklet only, as reflected in the IBDQ-B results, at a cost of ~£1,000. Algorithmic treatment of radiation bowel injury by a consultant or a nurse results in significant symptom relief for patients but was not found to be cost-effective according to the National Institute for Health and Care Excellence (NICE) criteria.

A randomised controlled trial of self‐help interventions in patients with a primary care diagnosis of irritable bowel syndrome

PubMed Central

Robinson, A; Lee, V; Kennedy, A; Middleton, L; Rogers, A; Thompson, D G; Reeves, D

2006-01-01

Introduction Functional abdominal symptoms are very common and account for nearly two million primary care consultations in Britain every year and produce significant morbidity. The aims of this study were to evaluate the impact of two self‐help interventions on consultation rates and symptom severity in patients with a primary care diagnosis of irritable bowel syndrome. Methods A total of 420 patients from 54 primary care centres were randomised either to receive self‐help information in the form of a guidebook or the guidebook plus a “self‐help” group meeting or to be in a control group receiving neither intervention. Data were collected using questionnaires and primary care records. Results At one year, patients in the guidebook group had a 60% reduction in primary care consultations (p<0.001) and a reduction in perceived symptom severity (p<0.001) compared with controls. Allocation to the self‐help group conferred no additional benefit. Actual symptom scores did not change significantly in any group. Costs per patient were reduced by £73 (confidence interval £43, £103) or 40% per year. Conclusion Introduction of a self‐help guidebook results in a reduction in primary care consultations, a perceived reduction in symptoms, and significant health service savings. This suggests that patients attending their primary care physician with functional abdominal symptoms should be offered self‐help information as part of their management. PMID:16099784

The 5C Concept and 5S Principles in Inflammatory Bowel Disease Management

PubMed Central

Hibi, Toshifumi; Panaccione, Remo; Katafuchi, Miiko; Yokoyama, Kaoru; Watanabe, Kenji; Matsui, Toshiyuki; Matsumoto, Takayuki; Travis, Simon; Suzuki, Yasuo

2017-01-01

Abstract Background and Aims The international Inflammatory Bowel Disease [IBD] Expert Alliance initiative [2012–2015] served as a platform to define and support areas of best practice in IBD management to help improve outcomes for all patients with IBD. Methods During the programme, IBD specialists from around the world established by consensus two best practice charters: the 5S Principles and the 5C Concept. Results The 5S Principles were conceived to provide health care providers with key guidance for improving clinical practice based on best management approaches. They comprise the following categories: Stage the disease; Stratify patients; Set treatment goals; Select appropriate treatment; and Supervise therapy. Optimised management of patients with IBD based on the 5S Principles can be achieved most effectively within an optimised clinical care environment. Guidance on optimising the clinical care setting in IBD management is provided through the 5C Concept, which encompasses: Comprehensive IBD care; Collaboration; Communication; Clinical nurse specialists; and Care pathways. Together, the 5C Concept and 5S Principles provide structured recommendations on organising the clinical care setting and developing best-practice approaches in IBD management. Conclusions Consideration and application of these two dimensions could help health care providers optimise their IBD centres and collaborate more effectively with their multidisciplinary team colleagues and patients, to provide improved IBD care in daily clinical practice. Ultimately, this could lead to improved outcomes for patients with IBD. PMID:28981622

Usefulness of bowel sound auscultation: a prospective evaluation.

PubMed

Felder, Seth; Margel, David; Murrell, Zuri; Fleshner, Phillip

2014-01-01

Although the auscultation of bowel sounds is considered an essential component of an adequate physical examination, its clinical value remains largely unstudied and subjective. The aim of this study was to determine whether an accurate diagnosis of normal controls, mechanical small bowel obstruction (SBO), or postoperative ileus (POI) is possible based on bowel sound characteristics. Prospectively collected recordings of bowel sounds from patients with normal gastrointestinal motility, SBO diagnosed by computed tomography and confirmed at surgery, and POI diagnosed by clinical symptoms and a computed tomography without a transition point. Study clinicians were instructed to categorize the patient recording as normal, obstructed, ileus, or not sure. Using an electronic stethoscope, bowel sounds of healthy volunteers (n = 177), patients with SBO (n = 19), and patients with POI (n = 15) were recorded. A total of 10 recordings randomly selected from each category were replayed through speakers, with 15 of the recordings duplicated to surgical and internal medicine clinicians (n = 41) blinded to the clinical scenario. The sensitivity, positive predictive value, and intra-rater variability were determined based on the clinician's ability to properly categorize the bowel sound recording when blinded to additional clinical information. Secondary outcomes were the clinician's perceived level of expertise in interpreting bowel sounds. The overall sensitivity for normal, SBO, and POI recordings was 32%, 22%, and 22%, respectively. The positive predictive value of normal, SBO, and POI recordings was 23%, 28%, and 44%, respectively. Intra-rater reliability of duplicated recordings was 59%, 52%, and 53% for normal, SBO, and POI, respectively. No statistically significant differences were found between the surgical and internal medicine clinicians for sensitivity, positive predictive value, or intra-rater variability. Overall, 44% of clinicians reported that they rarely listened to bowel sounds, whereas 17% reported that they always listened. Auscultation of bowel sounds is not a useful clinical practice when differentiating patients with normal versus pathologic bowel sounds. The listener frequently arrives at an incorrect diagnosis. If routine abdominal auscultation is to be continued, our findings emphasize the need for improvements in training and education as well as advancements in the understanding of the objective acoustical properties of bowel sounds. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Disability and participation in breast and bowel cancer screening in England: a large prospective study

PubMed Central

Floud, S; Barnes, I; Verfürden, M; Kuper, H; Gathani, T; Blanks, R G; Alison, R; Patnick, J; Beral, V; Green, J; Reeves, G K

2017-01-01

Background: There is limited information about participation in organised population-wide screening programmes by people with disabilities. Methods: Data from the National Health Service routine screening programmes in England were linked to information on disability reported by the Million Women Study cohort participants. Results: Of the 473 185 women offered routine breast or bowel cancer screening, 23% reported some disability. Women with disabilities were less likely than other women to participate in breast cancer screening (RR=0.64, 95% CI: 0.62–0.65) and in bowel cancer screening (RR=0.75, 0.73–0.76). Difficulties with self-care or vision were associated with the greatest reduction in screening participation. Conclusion: Participation in routine cancer screening programmes in England is reduced in people with disabilities and participation varies by type of disability. PMID:28972966

Barriers and facilitators to successful transition from pediatric to adult inflammatory bowel disease care from the perspectives of providers.

PubMed

Paine, Christine W; Stollon, Natalie B; Lucas, Matthew S; Brumley, Lauren D; Poole, Erika S; Peyton, Tamara; Grant, Anne W; Jan, Sophia; Trachtenberg, Symme; Zander, Miriam; Mamula, Petar; Bonafide, Christopher P; Schwartz, Lisa A

2014-11-01

For adolescents and young adults (AYA) with inflammatory bowel disease (IBD), the transition from pediatric to adult care is often challenging and associated with gaps in care. Our study objectives were to (1) identify outcomes for evaluating transition success and (2) elicit the major barriers and facilitators of successful transition. We interviewed pediatric and adult IBD providers from across the United States with experience caring for AYAs with IBD until thematic saturation was reached after 12 interviews. We elicited the participants' backgrounds, examples of successful and unsuccessful transition of AYAs for whom they cared, and recommendations for improving transition using the Social-Ecological Model of Adolescent and Young Adult Readiness to Transition framework. We coded interview transcripts using the constant comparative method and identified major themes. Participants reported evaluating transition success and failure using health care utilization outcomes (e.g., maintaining continuity with adult providers), health outcomes (e.g., stable symptoms), and quality of life outcomes (e.g., attending school). The patients' level of developmental maturity (i.e., ownership of care) was the most prominent determinant of transition outcomes. The style of parental involvement (i.e., helicopter parent versus optimally involved parent) and the degree of support by providers (e.g., care coordination) also influenced outcomes. IBD transition success is influenced by a complex interplay of patient developmental maturity, parenting style, and provider support. Multidisciplinary IBD care teams should aim to optimize these factors for each patient to increase the likelihood of a smooth transfer to adult care.

Effective advocacy for patients with inflammatory bowel disease: communication with insurance companies, school administrators, employers, and other health care overseers.

PubMed

Jaff, Jennifer C; Arnold, Janis; Bousvaros, Athos

2006-08-01

In addition to their physical challenges, children and adolescents with inflammatory bowel disease (IBD) living in the United States face a number of administrative and regulatory hurdles that affect their quality of life. This article, written by a physician, attorney/patient advocate, and social worker, discusses a number of these challenges and describes how the provider can help his or her patient overcome them. Specifically, the article discusses 4 areas in detail: appeals of denials of coverage from insurance companies and third party payors; assisting children with IBD with classroom and school accommodations; assisting uninsured children in obtaining Social Security benefits; and aiding a parent to care for their child using the Family and Medical Leave Act. Although this article has a pediatric focus, adults have similar advocacy needs. Case examples and sample letters to third-party payors, schools, and employers are included in this article.

Capsule endoscopy in neoplastic diseases

PubMed Central

Pennazio, Marco; Rondonotti, Emanuele; de Franchis, Roberto

2008-01-01

Until recently, diagnosis and management of small-bowel tumors were delayed by the difficulty of access to the small bowel and the poor diagnostic capabilities of the available diagnostic techniques. An array of new methods has recently been developed, increasing the possibility of detecting these tumors at an earlier stage. Capsule endoscopy (CE) appears to be an ideal tool to recognize the presence of neoplastic lesions along this organ, since it is non-invasive and enables the entire small bowel to be visualized. High-quality images of the small-bowel mucosa may be captured and small and flat lesions recognized, without exposure to radiation. Recent studies on a large population of patients undergoing CE have reported small-bowel tumor frequency only slightly above that reported in previous surgical series (range, 1.6%-2.4%) and have also confirmed that the main clinical indication to CE in patients with small-bowel tumors is obscure gastrointestinal (GI) bleeding. The majority of tumors identified by CE are malignant; many were unsuspected and not found by other methods. However, it remains difficult to identify pathology and tumor type based on the lesion’s endoscopic appearance. Despite its limitations, CE provides crucial information leading in most cases to changes in subsequent patient management. Whether the use of CE in combination with other new diagnostic (MRI or multidetector CT enterography) and therapeutic (Push-and-pull enteroscopy) techniques will lead to earlier diagnosis and treatment of these neoplasms, ultimately resulting in a survival advantage and in cost savings, remains to be determined through carefully-designed studies. PMID:18785274

Home bowel cancer tests and informed choice--is current information sufficient?

PubMed

Howard, K; Salkeld, G

2003-10-01

To evaluate the type of information that is available to purchasers of home-based bowel cancer test kits. Manufacturers, pharmacies and independent testing programs were contacted to obtain faecal occult blood test (FOBT) kits. State cancer organisations were contacted for information on bowel cancer screening. Information on bowel cancer, the FOBT kit, the testing process and potential benefits and harms of the screening process were assessed using guidelines provided by the UK General Medical Council (GMC). FOBT kits and cancer organisation information provided adequate information on the purpose of screening, the screening process itself and potential benefits, but provided no information concerning uncertainties of screening or potential harms. On the basis of both the UK GMC criteria and patient desires for information, the information available at present falls short of being considered adequate for an informed decision to purchase a home-based FOBT. We must ensure adequate and balanced information is available to redress the present information asymmetry to facilitate informed participation in a potentially valuable public health initiative.

[Integrated management of patients with chronic inflammatory bowel disease in the Rhine-Main Region: results of the first integrated health-care project IBD in Germany].

PubMed

Blumenstein, I; Tacke, W; Filmann, N; Zosel, C; Bock, H; Heuzeroth, V; Zeuzem, S; Schröder, O

2013-07-01

In our previous studies investigating the drug therapy in patients suffering from inflammatory bowel disease (IBD) in the Rhein-Main region, Germany, we detected serious discrepancies between treatment reality and treatment guidelines. Consecutively, patient outcome in this cohort was compromised. Following this pilot project a network between primary deliverers of care for IBD patients and one large health-care insurance company [BKK Taunus (Gesundheit), the second largest insurance company in Hessen, Germany] was established. An analysis of treatment and socioeconomic data from 220 IBD patients (Crohn's disease - CD = 96, ulcerative colitis - UC = 124) entering the integrative health-care programme between 1.1.-30.9.2009 was performed. Remission rates for CD and UC in the integrated health-care programme could be improved from 60 - 73 % (CD) and from 61 - 79 % (UC). Guideline-conform treatment was observed in 81 % of patients with CD and 85 % with UC, respectively. Although medication costs increased, total costs could be cut by 162 304.- €, as secondary costs for hospitalisation and days off work could be reduced. The study shows that networking of deliverers of care for IBD patients with health insurances provides an excellent possibility to optimise medical treatment and can cut down costs significantly. © Georg Thieme Verlag KG Stuttgart · New York.

The Technical Quality of Delivered Care for People with Inflammatory Bowel Disease in Tabriz Gastroenterology Clinics.

PubMed

Tabrizi, Jafar Sadegh; Somi, Mohammad Hossein; Asghari, Sima; Asghari Jafarabadi, Mohammad; Gharibi, Farid; Alidoost, Saeideh

2015-01-01

The Inflammatory Bowel Disease (IBD) is considered as one of the chronic diseasesre-quiring complicated treatment. This study aimed to assess technical quality of providing care for pa-tients with IBD. This cross-sectional study was conducted on 94 people with IBD using interviews and simple random sampling methods in Gastroenterology, Endoscopy and clinic of Imam Reza Hospital and Golgasht Clinic in Tabriz in 2012. The data collection tool was a researcher-designed questionnaire whose validity and reliability had been confirmed. In order to investigate the statistical relationship between the background variables and compliance with the standards the Chi-square test was applied using SPSS 17 Software. "visit by the physician" and "diet advice by the dietitian" have had the highest and the lowest levels of compliance with the standard respectively, and "the care related to the disease exacerbation" and "the care provided by the other physicians" were not compatible with the standards in 80% of the cases. Data analyses also showed that there was a significant relationship between participant's age, job, education and the smoking status and compliance of some care with the relevant standards (P<0.05). The results indicate a substantial gap between provided care for the people with IBD and the relevant standards. This indicates the areas that need of improvement and requires the serious attention of the authorities.

Prevalence, health care utilization, and costs of fibromyalgia, irritable bowel, and chronic fatigue syndromes in the military health system, 2006-2010.

PubMed

Jeffery, Diana D; Bulathsinhala, Lakmini; Kroc, Michelle; Dorris, Joseph

2014-09-01

We compared prevalence, health care utilization, and costs over time for nonelderly adults diagnosed with fibromyalgia syndrome (FMS), irritable bowel syndrome (IBS), and chronic fatigue syndrome (CFS) in relation to timing of federal approvals for FMS drugs. We used military health care claims from October 2006 to September 2010. Retrospective, multiple-year comparisons were conducted using trend analyses, and time series regression-based generalized linear models. Over 5 years, FMS prevalence rates increased from 0.307% to 0.522%, whereas IBS and CFS prevalence rates remained stable. The largest increase in FMS prevalence occurred between 2007 and 2008. Health care utilization was higher for FMS cases compared to IBS and CFS cases. Over 5 years, the total cost for FMS-related care increased $163.2 million, whereas IBS costs increased $14.9 million and CFS cost increased $3.7 million. Between 2006 and 2010, total pharmacy cost for FMS cases increased from $55 million ($3,641/person) to $96.3 million ($3,557/person). Although cause and effect cannot be established, the advent of federally approved drugs for FMS in concert with pharmaceutical industry marketing of these drugs coincide with the observed changes in prevalence, health care utilization, and costs of FMS relative to IBS and CFS. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

Do Inflammatory Bowel Disease patients with anxiety and depressive symptoms receive the care they need?

PubMed

Bennebroek Evertsz', F; Thijssens, N A M; Stokkers, P C F; Grootenhuis, M A; Bockting, C L H; Nieuwkerk, P T; Sprangers, M A G

2012-02-01

Inflammatory Bowel Disease (IBD) patients with anxiety and/or depressive symptoms may not receive the care they need. Provision of care requires insight into the factors affecting these psychiatric symptoms. The study was designed to examine the extent to which: (1) IBD patients with anxiety and/or depressive symptoms receive mental treatment and (2) clinical and socio-demographic variables are associated with these symptoms. 231 adult IBD patients (79% response rate), attending a tertiary care center, completed standardized measures on anxiety and depressive symptoms (HADS), quality of life (SF-12) and mental health care use (TIC-P). Diagnosis and disease activity were determined by the gastroenterologist. 43% had high levels of anxiety and/or depressive symptoms, indicative of a psychiatric disorder (HADS ≥ 8), of whom 18% received psychological treatment and 21% used psychotropic medication. In multivariate analysis, high disease activity was associated with anxiety (OR=2.72 | p<0.03) and depression (OR=3.36 | p<0.01), while Crohn's disease was associated with anxiety (OR=2.60 | p<0.03). Despite high levels of anxiety and depressive symptoms and poor quality of life, psychiatric complaints in IBD patients were undertreated. Screening for and treatment of psychiatric symptoms should become an integral part of IBD medical care. Copyright © 2011 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

Abdominal massage for neurogenic bowel dysfunction in people with multiple sclerosis (AMBER - Abdominal Massage for Bowel Dysfunction Effectiveness Research): study protocol for a randomised controlled trial.

PubMed

McClurg, Doreen; Goodman, Kirsteen; Hagen, Suzanne; Harris, Fional; Treweek, Sean; Emmanuel, Anton; Norton, Christine; Coggrave, Maureen; Doran, Selina; Norrie, John; Donnan, Peter; Mason, Helen; Manoukian, Sarkis

2017-03-29

Multiple sclerosis (MS) is a life-long condition primarily affecting younger adults. Neurogenic bowel dysfunction (NBD) occurs in 50-80% of these patients and is the term used to describe constipation and faecal incontinence, which often co-exist. Data from a pilot study suggested feasibility of using abdominal massage for the relief of constipation, but the effectiveness remains uncertain. This is a multi-centred patient randomised superiority trial comparing an experimental strategy of once daily abdominal massage for 6 weeks against a control strategy of no massage in people with MS who have stated that their constipation is bothersome. The primary outcome is the Neurogenic Bowel Dysfunction Score at 24 weeks. Both groups will receive optimised advice plus the MS Society booklet on bowel management in MS, and will continue to receive usual care. Participants and their clinicians will not be blinded to the allocated intervention. Outcome measures are primarily self-reported and submitted anonymously. Central trial staff who will manage and analyse the trial data will be unaware of participant allocations. Analysis will follow intention-to-treat principles. This pragmatic randomised controlled trial will demonstrate if abdominal massage is an effective, cost-effective and viable addition to the treatment of NBD in people with MS. ClinicalTrials.gov, ISRCTN85007023 . Registered on 10 June 2014.

Clinical economics review: medical management of inflammatory bowel disease.

PubMed

Ward, F M; Bodger, K; Daly, M J; Heatley, R V

1999-01-01

Inflammatory bowel diseases, although they are uncommon and rarely fatal, typically present during the period of economically productive adult life. Patients may require extensive therapeutic intervention as a result of the chronic, relapsing nature of the diseases. Their medical management includes oral and topical 5-amino salicylic acid derivatives and corticosteroids, as well as antibiotics and immunosuppressive therapies. Assessing the cost-effectiveness of rival treatments requires valid, reliable global assessments of outcome which consider quality of life, as well as the usual clinical end-points. Macro-economic studies of the overall impact of inflammatory bowel disease on health care systems have so far been largely confined to North America, where the total annual US costs, both direct and indirect, incurred by the estimated 380 000-480 000 sufferers has been put at around US2bn. Drugs were estimated to account for only 10% of total costs, whereas surgery and hospitalization account for approximately half. Studies from Europe suggest that the proportion of patients with Crohn's disease and ulcerative colitis who are capable of full time work is 75% and 90%, respectively. However, whilst only a minority of inflammatory bowel disease patients suffer chronic ill health and their life expectancy is normal, obtaining life assurance may be problematic, suggesting a misconception that inflammatory bowel disease frequently results in a major impact on an individual's economic productivity.

The Cost-Effectiveness of Vedolizumab for Inflammatory Bowel Disease: A Review of the Current Literature

PubMed Central

Saumoy, Monica; Cohen-Mekelburg, Shirley; Steinlauf, Adam F.; Scherl, Ellen J.

2016-01-01

The United States spends a greater share per gross domestic product on health care than any other developed country in the world. Cost-conscious, high-value care has an important role in the practice of medicine. Inflammatory bowel disease (IBD) affects 1.6 million people in the United States and is responsible for significant health care costs, with estimates as high as $31.6 billion annually, a large portion of which is attributable to the use of biologic therapies. As the number of therapeutic targets for IBD expands, gastroenterologists can anticipate the arrival of novel therapeutic agents on the market, and these may carry significant costs. Vedolizumab, a monoclonal antibody directed against the gut-selective integrin α4β7, is a novel biologic agent approved for the treatment of Crohn’s disease and ulcerative colitis. Cost-effectiveness is an area of research that aims to assess the added value (in terms of both cost and utility) of diagnostic or therapeutic interventions. This article reviews the current literature evaluating the cost-effectiveness of vedolizumab for the treatment of IBD. PMID:27917076

The effect of a sweet potato, footbath, and acupressure intervention in preventing constipation in hospitalized patients with acute coronary syndromes.

PubMed

Ren, Kai; Qiu, Jingbo; Wang, Xiaohua; Niu, Fenglin; Jiang, Tingbo

2012-01-01

Constipation is a common health problem that adversely affects quality of life and the prognosis of hospitalized patients with acute coronary syndromes (ACS). The purpose of this study was to develop and test the sweet potato/footbath/acupressure massage (SFA) intervention as a safe treatment for prevention of constipation and to increase satisfaction with bowel emptying in hospitalized patients with ACS. The study was a prospective, randomized controlled trial with a sample of 93 patients (SFA group, n = 44; usual care group, n = 49). Patients in the SFA group received SFA intervention combined with usual care. The results showed that there were statistical differences between the two groups in terms of (1) the incidence of constipation; (2) the use of laxatives and enemas; (3) patients' subjective satisfaction with their bowel emptying during hospitalization; and (4) sensation of incomplete evacuation and anorectal obstruction/blockade. The SFA intervention was more effective, economical, and practical than usual care alone in managing constipation and satisfaction with defecation in patients hospitalized with ACS.

Risk markers for both chronic fatigue and irritable bowel syndromes: a prospective case-control study in primary care.

PubMed

Hamilton, W T; Gallagher, A M; Thomas, J M; White, P D

2009-11-01

Fatigue syndromes and irritable bowel syndrome (IBS) often occur together. Explanations include being different manifestations of the same condition and simply sharing some symptoms. A matched case-control study in UK primary care, using data collected prospectively in the General Practice Research Database (GPRD). The main outcome measures were: health-care utilization, specific symptoms and diagnoses. Risk markers were divided into distant (from 3 years to 1 year before diagnosis) and recent (1 year before diagnosis). A total of 4388 patients with any fatigue syndrome were matched to two groups of patients: those attending for IBS and those attending for another reason. Infections were specific risk markers for both syndromes, with viral infections being a risk marker for a fatigue syndrome [odds ratios (ORs) 2.3-6.3], with a higher risk closer to onset, and gastroenteritis a risk for IBS (OR 1.47, compared to a fatigue syndrome). Chronic fatigue syndrome (CFS) shared more distant risk markers with IBS than other fatigue syndromes, particularly other symptom-based disorders (OR 3.8) and depressive disorders (OR 2.3), but depressive disorders were a greater risk for CFS than IBS (OR 2.4). Viral infections were more of a recent risk marker for CFS compared to IBS (OR 2.8), with gastroenteritis a greater risk for IBS (OR 2.4). Both fatigue and irritable bowel syndromes share predisposing risk markers, but triggering risk markers differ. Fatigue syndromes are heterogeneous, with CFS sharing predisposing risks with IBS, suggesting a common predisposing pathophysiology.

Patient Health Communication Mediating Effects Between Gastrointestinal Symptoms and Gastrointestinal Worry in Pediatric Inflammatory Bowel Disease.

PubMed

Varni, James W; Shulman, Robert J; Self, Mariella M; Saeed, Shehzad A; Patel, Ashish S; Nurko, Samuel; Neigut, Deborah A; Saps, Miguel; Zacur, George M; Dark, Chelsea V; Bendo, Cristiane B; Pohl, John F

2017-05-01

To investigate the effects of patient health communication regarding their inflammatory bowel disease (IBD) to their health care providers and significant others in their daily life as a mediator in the relationship between gastrointestinal symptoms and gastrointestinal worry in pediatric patients. The Pediatric Quality of Life Inventory Gastrointestinal Symptoms, Gastrointestinal Worry, and Communication Scales, and Pediatric Quality of Life Inventory 4.0 Generic Core Scales were completed in a 9-site study by 252 pediatric patients with IBD. Gastrointestinal Symptoms Scales measuring stomach pain, constipation, or diarrhea and patient communication were tested for bivariate and multivariate linear associations with Gastrointestinal Worry Scales specific to patient worry about stomach pain or bowel movements. Mediational analyses were conducted to test the hypothesized mediating effects of patient health communication as an intervening variable in the relationship between gastrointestinal symptoms and gastrointestinal worry. The predictive effects of gastrointestinal symptoms on gastrointestinal worry were mediated in part by patient health communication with health care providers/significant others in their daily life. In predictive models using multiple regression analyses, the full conceptual model of demographic variables, gastrointestinal symptoms (stomach pain, constipation, or diarrhea), and patient communication significantly accounted for 46, 43, and 54 percent of the variance in gastrointestinal worry (all Ps < 0.001), respectively, reflecting large effect sizes. Patient health communication explains in part the effects of gastrointestinal symptoms on gastrointestinal worry in pediatric patients with IBD. Supporting patient disease-specific communication to their health care providers and significant others may improve health-related quality of life for pediatric patients with IBD.

Naldemedine

MedlinePlus

... It works by protecting the bowel from the effects of opioid (narcotic) medications. ... to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in ...

Naloxegol

MedlinePlus

... It works by protecting the bowel from the effects of opiate (narcotic) medications. ... to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in ...

Methylnaltrexone

MedlinePlus

... It works by protecting the bowel from the effects of opioid (narcotic) medications. ... to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in ...

Asian Perspectives on Diagnostic and Therapeutic Strategies in Inflammatory Bowel Disease: Report and Analysis of a Survey with Questionnaires.

PubMed

Yoshida, Atsushi; Ueno, Fumiaki; Morizane, Toshio; Joh, Takashi; Kamiya, Takeshi; Takahashi, Shin''ichi; Tokunaga, Kengo; Iwakiri, Ryuichi; Kinoshita, Yoshikazu; Suzuki, Hidekazu; Naito, Yuji; Uchiyama, Kazuhiko; Fukodo, Shin; Chan, Francis K L; Halm, Ki-Baik; Kachintorn, Udom; Fock, Kwong Ming; Rani, Abdul Aziz; Syam, Ari Fahrial; Sollano, Jose D; Zhu, Qi

2017-01-01

Diagnostic and therapeutic strategies in inflammatory bowel disease (IBD) vary among countries in terms of availability of modalities, affordability of health care resource, health care policy and cultural background. This may be the case in different countries in Eastern Asia. The aim of this study was to determine and understand the differences in diagnostic and therapeutic strategies of IBD between Japan and the rest of Asian countries (ROA). Questionnaires with regard to clinical practice in IBD were distributed to members of the International Gastroenterology Consensus Symposium Study Group. The responders were allowed to select multiple items for each question, as multiple modalities are frequently utilized in the diagnosis and the management of IBD. Dependency and independency of selected items for each question were evaluated by the Bayesian network analysis. The selected diagnostic modalities were not very different between Japan and ROA, except for those related to small bowel investigations. Balloon-assisted enteroscopy and small bowel follow through are frequently used in Japan, while CT/MR enterography is popular in ROA. Therapeutic modalities for IBD depend on availability of such modalities in clinical practice. As far as modalities commonly available in both regions are concerned, there seemed to be similarity in the selection of each therapeutic modality. However, evaluation of dependency of separate therapeutic modalities by Bayesian network analysis disclosed some difference in therapeutic strategies between Japan and ROA. Although selected modalities showed some similarity, Bayesian network analysis elicited certain differences in the clinical approaches combining multiple modalities in various aspects of IBD between Japan and ROA. © 2016 S. Karger AG, Basel.

The Irritable Bowel Syndrome Outcome Study (IBSOS): Rationale and design of a randomized, placebo-controlled trial with 12 month follow up of self- versus clinician-administered CBT for moderate to severe irritable bowel syndrome

PubMed Central

Lackner, Jeffrey M.; Keefer, Laurie; Jaccard, James; Firth, Rebecca; Brenner, Darren; Bratten, Jason; Dunlap, Laura J.; Byroads, Mark

2012-01-01

Irritable bowel syndrome is a common, oftentimes disabling, gastrointestinal disorder whose full range of symptoms has no satisfactory medical or dietary treatment. One of the few empirically validated treatments includes a specific psychological therapy called cognitive behavior therapy which, if available, is typically administered over several months by trained practitioners in tertiary care settings. There is an urgent need to develop more efficient versions of CBT that require minimal professional assistance but retain the efficacy profile of clinic based CBT. The Irritable Bowel Syndrome Outcome Study (IBSOS) is a multicenter, placebo-controlled randomized trial to evaluate whether a self-administered version of CBT is, at least as efficacious as standard CBT and more efficacious than an attention control in reducing core GI symptoms of IBS and its burden (e.g. distress, quality of life impairment, etc) in moderately to severely affected IBS patients. Additional goals are to assess, at quarterly intervals, the durability of treatment response over a 12 month period; to identify clinically useful patient characteristics associated with outcome as a way of gaining an understanding of subgroups of participants for whom CBT is most beneficial; to identify theory-based change mechanisms (active ingredients) that explain how and why CBT works; and evaluate the economic costs and benefits of CBT. Between August 2010 when IBSOS began recruiting subjects and February 2012, the IBSOS randomized 171 of 480 patients. Findings have the potential to improve the health of IBS patients, reduce its social and economic costs, conserve scarce health care resources, and inform evidence-based practice guidelines. PMID:22846389

Barriers and facilitators to successful transition from pediatric to adult inflammatory bowel disease care from the perspectives of providers

PubMed Central

Paine, Christine Weirich; Stollon, Natalie B.; Lucas, Matthew S.; Brumley, Lauren D.; Poole, Erika S.; Peyton, Tamara; Grant, Anne W.; Jan, Sophia; Trachtenberg, Symme; Zander, Miriam; Mamula, Petar; Bonafide, Christopher P.; Schwartz, Lisa A.

2014-01-01

Background For adolescents and young adults (AYA) with inflammatory bowel disease (IBD), the transition from pediatric to adult care is often challenging and associated with gaps in care. Our study objectives were to (1) identify outcomes for evaluating transition success and (2) elicit the major barriers and facilitators of successful transition. Methods We interviewed pediatric and adult IBD providers from across the United States with experience caring for AYAs with IBD until thematic saturation was reached after 12 interviews. We elicited the participants' backgrounds, examples of successful and unsuccessful transition of AYAs for whom they cared, and recommendations for improving transition using the Social-ecological Model of Adolescent and Young Adult Readiness to Transition framework. We coded interview transcripts using the constant comparative method and identified major themes. Results Participants reported evaluating transition success and failure using healthcare utilization outcomes (e.g. maintaining continuity with adult providers), health outcomes (e.g. stable symptoms), and quality of life outcomes (e.g. attending school). The patients' level of developmental maturity (i.e. ownership of care) was the most prominent determinant of transition outcomes. The style of parental involvement (i.e. helicopter parent vs. optimally-involved parent) also influenced outcomes as well as the degree of support by providers (e.g. care coordination). Conclusion IBD transition success is influenced by a complex interplay of patient developmental maturity, parenting style, and provider support. Multidisciplinary IBD care teams should aim to optimize these factors for each patient to increase the likelihood of a smooth transfer to adult care. PMID:25137417

Assessment of Gaps in Care and the Development of a Care Pathway for Anemia in Patients with Inflammatory Bowel Diseases.

PubMed

Hou, Jason K; Gasche, Christoph; Drazin, Noam Z; Weaver, Sarah Alandra; Ehrlich, Orna G; Oberai, Ridhima; Zapala, Sophie; Siegel, Corey A; Melmed, Gil

2017-01-01

Anemia is a common complication among patients with inflammatory bowel diseases (IBD) and is associated with high rates of IBD-related complications, resource utilization, and impaired quality of life. Despite practice guidelines for anemia in patients with IBD, gaps remain in the perceptions of anemia among health care providers. The aims of this study were to identify gaps in care and to develop a care pathway for anemia in patients with IBD. The Crohn's & Colitis Foundation of America anemia care pathway was developed by a committee using principles of cognitive task analysis. Focus groups of providers of patients with IBD were performed to identify domains of perceptions and management decisions for anemia and IBD. Knowledge elicitation from subject experts in anemia was conducted using case-based scenarios of patients with IBD and anemia to determine decision-making branch points. The care pathway was modified in an iterative fashion to encompass clinical presentations of anemia in IBD and potential barriers to the recognition, management, and follow-up of anemia. Variations were observed in how providers define iron deficiency, thresholds for treatment of anemia, and route of iron therapy. A care pathway for anemia incorporating the World Health Organization definition of anemia, universal hemoglobin and ferritin screening, evaluation of iron stores using ferritin and transferrin saturation, management of anemia based on adequacy of iron stores, and follow-up was developed. The authors identified domains of how providers perceive and manage patients with IBD and anemia, and developed a care pathway to align clinical practices with guideline recommendations.

What Are the Treatments for Neural Tube Defects?

MedlinePlus

... get around, including braces, crutches, walkers, and wheelchairs. Urinary tract infections; lack of bladder and bowel control. People with ... from completely emptying, a condition that can cause urinary tract infections and kidney damage. Health care providers may address ...

Exemplar pediatric collaborative improvement networks: achieving results.

PubMed

Billett, Amy L; Colletti, Richard B; Mandel, Keith E; Miller, Marlene; Muething, Stephen E; Sharek, Paul J; Lannon, Carole M

2013-06-01

A number of pediatric collaborative improvement networks have demonstrated improved care and outcomes for children. Regionally, Cincinnati Children's Hospital Medical Center Physician Hospital Organization has sustained key asthma processes, substantially increased the percentage of their asthma population receiving "perfect care," and implemented an innovative pay-for-performance program with a large commercial payor based on asthma performance measures. The California Perinatal Quality Care Collaborative uses its outcomes database to improve care for infants in California NICUs. It has achieved reductions in central line-associated blood stream infections (CLABSI), increased breast-milk feeding rates at hospital discharge, and is now working to improve delivery room management. Solutions for Patient Safety (SPS) has achieved significant improvements in adverse drug events and surgical site infections across all 8 Ohio children's hospitals, with 7700 fewer children harmed and >$11.8 million in avoided costs. SPS is now expanding nationally, aiming to eliminate all events of serious harm at children's hospitals. National collaborative networks include ImproveCareNow, which aims to improve care and outcomes for children with inflammatory bowel disease. Reliable adherence to Model Care Guidelines has produced improved remission rates without using new medications and a significant increase in the proportion of Crohn disease patients not taking prednisone. Data-driven collaboratives of the Children's Hospital Association Quality Transformation Network initially focused on CLABSI in PICUs. By September 2011, they had prevented an estimated 2964 CLABSI, saving 355 lives and $103,722,423. Subsequent improvement efforts include CLABSI reductions in additional settings and populations.

Co-Designing a Collaborative Chronic Care Network (C3N) for Inflammatory Bowel Disease: Development of Methods

PubMed Central

Dellal, George; Peterson, Laura E; Provost, Lloyd; Gloor, Peter A; Fore, David Livingstone; Margolis, Peter A

2018-01-01

Background Our health care system fails to deliver necessary results, and incremental system improvements will not deliver needed change. Learning health systems (LHSs) are seen as a means to accelerate outcomes, improve care delivery, and further clinical research; yet, few such systems exist. We describe the process of codesigning, with all relevant stakeholders, an approach for creating a collaborative chronic care network (C3N), a peer-produced networked LHS. Objective The objective of this study was to report the methods used, with a diverse group of stakeholders, to translate the idea of a C3N to a set of actionable next steps. Methods The setting was ImproveCareNow, an improvement network for pediatric inflammatory bowel disease. In collaboration with patients and families, clinicians, researchers, social scientists, technologists, and designers, C3N leaders used a modified idealized design process to develop a design for a C3N. Results Over 100 people participated in the design process that resulted in (1) an overall concept design for the ImproveCareNow C3N, (2) a logic model for bringing about this system, and (3) 13 potential innovations likely to increase awareness and agency, make it easier to collect and share information, and to enhance collaboration that could be tested collectively to bring about the C3N. Conclusions We demonstrate methods that resulted in a design that has the potential to transform the chronic care system into an LHS. PMID:29472173

An accountable fistula management treatment plan.

PubMed

Thompson, Mary Jo; Epanomeritakis, Emanuel

An accountable fistula management treatment plan focuses on combining effective medical and nursing treatment with effective and efficient pouching technique and equipment to ensure patient comfort. Small bowel fistula following abdominal surgery can provide challenges in patients' medical and nursing management. This article describes a case study of the successful medical and nursing management of a patient post-abdominal surgery. Within days of surgery a small bowel fistula formed within an abdominal wound. Medical management involved the use of total parenteral nutrition, electrolyte balance management, nil orally and Sandostatin medication. The nursing interventions comprised accurate intake and output measurement, effective and efficient pouching systems and appropriate psychological care. The medical and nursing interventions provided during the healing process are outlined together with the assessment and evaluation of a new innovative wound management pouch. This system proved invaluable in the successful containment of a high small bowel effluent and skin preservation. In an attempt to share best practice a pictorial guide is provided to demonstrate the correct application of the pouching system and technique. This article provides details of an accountable fistula management treatment plan which resulted in the successful spontaneous closure of the small bowel fistula coupled with excellent cost-effectiveness and patient comfort.

'One sip won't do any harm . . .': temptation among women with inflammatory bowel disease/irritable bowel syndrome to engage in negative dietary behaviours, despite the consequences to their health.

PubMed

Schneider, Margaret A; Jamieson, Anne; Fletcher, Paula C

2009-04-01

The purpose of this research was to explore the dietary lived experiences of university-aged women suffering from inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS). This paper will address the decision-making process used by these women when contemplating the consumption of dietary temptations, despite the associated negative consequences. This phenomenological study was guided by heuristic inquiry. A purposive sample of eight women, between the ages of 18 and 23 years, who were living with IBD or IBS were recruited via postings and word-of-mouth. The findings indicate that these women occasionally felt compelled to give into dietary temptations, despite the consequences to their health. The decision-making process they used when considering these negative health behaviours involved three personally controlled parameters. These three parameters included: assessing the cost-benefit relationship before engaging in these behaviours; having a physical and/or psychological reliance on medications to treat resulting symptoms; and through controlling the timing and surroundings in which they indulged in these negative dietary behaviours. The practical implications for health-care professionals treating patients with IBD or IBS are discussed.

Constipation - self-care

MedlinePlus

... go. Try to get to know your normal bowel movement pattern, so that you can keep constipation from getting worse. ... Exercise regularly. Drink more water and eat more fiber. Try to walk, ... regular. It may help to go to the bathroom every day at the ...

Inflammatory Bowel Disease (IBD) and Pregnancy

MedlinePlus

... may be at an increased risk for having Vitamin K deficiency. Vitamin K is important in the blood clotting process. Women with IBD should have their nutritional status evaluated by their health care provider prior to and ... supplements may be necessary. What medications ...

The Difficult Stoma: Challenges and Strategies

PubMed Central

Strong, Scott A.

2016-01-01

The problems that a patient experiences after the creation of a temporary or permanent stoma can result from many factors, but a carefully constructed stoma located in an ideal location is typically associated with appropriate function and an acceptable quality of life. The construction of the stoma can be confounded by many concomitant conditions that increase the distance that the bowel must traverse or shorten the bowel's capacity to reach. Stomas can be further troubled by a variety of problems that potentially arise early in the recovery period or months later. Surgeons must be familiar with these obstacles and complications to avoid their occurrence and minimize their impact. PMID:27247541

The 5C Concept and 5S Principles in Inflammatory Bowel Disease Management.

PubMed

Hibi, Toshifumi; Panaccione, Remo; Katafuchi, Miiko; Yokoyama, Kaoru; Watanabe, Kenji; Matsui, Toshiyuki; Matsumoto, Takayuki; Travis, Simon; Suzuki, Yasuo

2017-10-27

The international Inflammatory Bowel Disease [IBD] Expert Alliance initiative [2012-2015] served as a platform to define and support areas of best practice in IBD management to help improve outcomes for all patients with IBD. During the programme, IBD specialists from around the world established by consensus two best practice charters: the 5S Principles and the 5C Concept. The 5S Principles were conceived to provide health care providers with key guidance for improving clinical practice based on best management approaches. They comprise the following categories: Stage the disease; Stratify patients; Set treatment goals; Select appropriate treatment; and Supervise therapy. Optimised management of patients with IBD based on the 5S Principles can be achieved most effectively within an optimised clinical care environment. Guidance on optimising the clinical care setting in IBD management is provided through the 5C Concept, which encompasses: Comprehensive IBD care; Collaboration; Communication; Clinical nurse specialists; and Care pathways. Together, the 5C Concept and 5S Principles provide structured recommendations on organising the clinical care setting and developing best-practice approaches in IBD management. Consideration and application of these two dimensions could help health care providers optimise their IBD centres and collaborate more effectively with their multidisciplinary team colleagues and patients, to provide improved IBD care in daily clinical practice. Ultimately, this could lead to improved outcomes for patients with IBD. Copyright © 2017 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com

Barriers to seeking care for accidental bowel leakage: a qualitative study

PubMed Central

Rogers, Rebecca G.; Wise, Meg E.

2016-01-01

Introduction and hypothesis Fewer than 50 % of women with urinary incontinence (UI) and 30 % of women with accidental bowel leakage (ABL) seek care. We sought to describe barriers to care seeking for ABL to inform development of an instrument to measure these barriers. Methods We recruited women with ABL with varied prior care-seeking experiences to participate in focus groups and cognitive interviews so we could understand factors that may have prevented or delayed care seeking. Focus groups continued until thematic saturation was reached using conventional content analysis. Final themes were established and characterized by comparing within and across the focus groups and with previously described UI and ABL care-seeking barriers. Cognitive interviews were confirmatory. Results Thirty-nine women (aged 46–85) participated in six focus groups and ten cognitive interviews; 89 % were white, 8 % African American, and 3 % Latina. We identified 12 barriers to seeking care for ABL: (1) Lack of knowledge about the condition; (2) Lack of knowledge about treatment; (3) Fear of testing/treatment; (4) Normative thinking; (5) Avoidance/ denial; (6) Life impact; (7) Embarrassment/shame; (8) Self-blame; (9) Stigma; (10) Isolation; (11) Provider barriers; (12) Access limitations. These 12 barriers encompassed three overarching themes: the internalized self in relation to ABL; perceptions about ABL and its treatments; and interaction with the healthcare system. Conclusions ABL care-seeking barriers are similar to those described for UI, with the notable addition of lack of knowledge that ABL is a medical condition experienced by others. Interventions to promote access to effective treatments for ABL should include information about prevalence and treatability. PMID:27844123

Barriers to seeking care for accidental bowel leakage: a qualitative study.

PubMed

Brown, Heidi Wendell; Rogers, Rebecca G; Wise, Meg E

2017-04-01

Fewer than 50 % of women with urinary incontinence (UI) and 30 % of women with accidental bowel leakage (ABL) seek care. We sought to describe barriers to care seeking for ABL to inform development of an instrument to measure these barriers. We recruited women with ABL with varied prior care-seeking experiences to participate in focus groups and cognitive interviews so we could understand factors that may have prevented or delayed care seeking. Focus groups continued until thematic saturation was reached using conventional content analysis. Final themes were established and characterized by comparing within and across the focus groups and with previously described UI and ABL care-seeking barriers. Cognitive interviews were confirmatory. Thirty-nine women (aged 46-85) participated in six focus groups and ten cognitive interviews; 89 % were white, 8 % African American, and 3 % Latina. We identified 12 barriers to seeking care for ABL: (1) Lack of knowledge about the condition; (2) Lack of knowledge about treatment; (3) Fear of testing/treatment; (4) Normative thinking; (5) Avoidance/denial; (6) Life impact; (7) Embarrassment/shame; (8) Self-blame; (9) Stigma; (10) Isolation; (11) Provider barriers; (12) Access limitations. These 12 barriers encompassed three overarching themes: the internalized self in relation to ABL; perceptions about ABL and its treatments; and interaction with the healthcare system. ABL care-seeking barriers are similar to those described for UI, with the notable addition of lack of knowledge that ABL is a medical condition experienced by others. Interventions to promote access to effective treatments for ABL should include information about prevalence and treatability.

[Irritable bowel syndrome with constipation and functional constipation in adults: Treatment (Part 2 of 2)].

PubMed

Mearin, F; Ciriza, C; Mínguez, M; Rey, E; Mascort, J J; Peña, E; Cañones, P; Júdez, J

2017-03-01

In this Clinical practice guide we examine the diagnostic and therapeutic management of adult patients with constipation and abdominal discomfort, at the confluence of the spectrum of irritable bowel syndrome and functional constipation. Both fall within the framework of functional intestinal disorders and have major personal, health and social impact, altering the quality of life of the patients affected. The former is a subtype of irritable bowel syndrome in which constipation and altered bowel habit predominate, often along with recurring abdominal pain, bloating and abdominal distension. Constipation is characterised by infrequent or hard-to-pass bowel movements, often accompanied by straining during defecation or the sensation of incomplete evacuation. There is no underlying organic cause in the majority of cases; it being considered a functional bowel disorder. There are many clinical and pathophysiological similarities between the two conditions, the constipation responds in a similar way to commonly used drugs, the fundamental difference being the presence or absence of pain, but not in an "all or nothing" way. The severity of these disorders depends not only on the intensity of the intestinal symptoms but also on other biopsychosocial factors: association of gastrointestinal and extraintestinal symptoms, degree of involvement, forms of perception and behaviour. Functional bowel disorders are diagnosed using the Rome criteria. This Clinical practice guide adapts to the Rome IV criteria published at the end of May 2016. The first part (96, 97, 98) examined the conceptual and pathophysiological aspects, alarm criteria, diagnostic test and referral criteria between Primary Care and Gastroenterology. This second part reviews all the available treatment alternatives (exercise, fluid ingestion, diet with soluble fibre-rich foods, fibre supplements, other dietary components, osmotic or stimulating laxatives, probiotics, antibiotics, spasmolytics, peppermint essence, prucalopride, linaclotide, lubiprostone, biofeedback, antdepressants, psychological treatment, acupuncture, enemas, sacral root neurostimulation and surgery), and practical recommendations are made for each. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Defining the Need for Surgery in Small-Bowel Obstruction.

PubMed

Kuehn, Florian; Weinrich, Malte; Ehmann, Sarah; Kloker, Katja; Pergolini, Ilaria; Klar, Ernst

2017-07-01

Small-bowel obstruction is a frequent disorder in emergency medicine and represents a major burden for patients and health care systems worldwide. Within the past years, progress has been made regarding the management of small-bowel obstructions, including the use of contrast agent swallow as a tool in the decision-making process. This is a prospective controlled study investigating the central role of contrast agent swallow in the diagnostic and treatment algorithm for small-bowel obstruction at a university department of surgery. Endpoints were the correct identification of patients who needed operative treatment and the accuracy of a conservative treatment decision including the analysis of dropout from this routine algorithm. We performed a single-center analysis of 181 consecutive patients diagnosed with a small-bowel obstruction based on clinical, radiologic, and sonographic findings. Patients with clinical signs of strangulation or peritonitis underwent immediate surgery (group 1). Patients without signs of peritonitis and incomplete stop in the initial abdominal plain film were considered eligible for Gastrografin® challenge (group 2). Seventy-six of the 181 patients (42.0%) underwent immediate surgery. A Gastrografin® challenge was initialized in 105 of the 181 patients (58.0%). Twenty of these 105 patients (19.1%) with persisting or progressive symptoms and absence of contrast agent in the colon after 12 and 24 h subsequently underwent surgery. Here, a segmental bowel resection was necessary in 6 of these 20 patients (30.0%). In 16 out of 20 patients (80.0%) who failed the Gastrografin® challenge, a corresponding correlate in terms of a strangulation was detected intraoperatively. The Gastrografin® challenge had a specificity of 96% and a sensitivity of 100%; accuracy to predict the need for exploration was 96%. A straightforward algorithm based mainly on contrast agent swallow for patients with small-bowel obstructions enabled a timely and very accurate differentiation between patients qualifying for conservative and operative treatment.

Bowel preparation for elective procedures in children: a systematic review and meta-analysis

PubMed Central

Karlsen, Fiona; Isaji, Sahira; Teck, Guan-Ong

2017-01-01

Objective Reviews have investigated preparation for colonoscopy, but not for surgery, They are also often limited to patients up to 16 years, despite many paediatric gastroenterologists caring for older patients. We carried out a systematic review investigating the optimum bowel preparation agents for all indications in children and young people. Design A Cochrane format systematic review of randomised controlled trials (RCTs). Data extraction and assessment of methodological quality were performed independently by two reviewers. Methodological quality was assessed using the Cochrane risk of bias tool. Patients Young people requiring bowel preparation for any elective procedure, as defined by the primary studies. Interventions RCTs comparing bowel preparation with placebo or other interventions. Main outcome measures Adequacy of bowel preparation, tolerability and adverse events. Results The search yielded 2124 results and 15 randomised controlled studies (n=1435)but heterogeneity limited synthesis. Meta-analysis of two studies comparing polyethylene glycol (PEG) with sodium phosphate showed no difference in the quality of bowel preparation (risk ratio (RR) 1.27(95% CI 0.66 to 2.44)). Two studies comparing sodium picosulfate/magnesium citrate with PEG found no difference in bowel preparation but significantly higher number of patients needing nasogastric tube insertion in the polyethylene glycol-electrolyte lavage solution (RR 0.04(95% CI 0.01 to 0.18), 45 of 117 in PEG group vs 2 of 121 in sodium picosulfate group). Meta-analysis of three studies (n=241) found no difference between PEG and sennasoids (RR 0.73(95% CI 0.31 to 1.71)). Conclusions The evidence base is clinically heterogeneous and methodologically at risk of bias. There is evidence that all regimens are equally effective. However, sodium picosulfate was better tolerated than PEG. Future research is needed with all agents and should seek to consider safety and tolerability as well as efficacy. PMID:29637141

Effects of gum chewing on postoperative bowel motility after caesarean section: a meta-analysis of randomised controlled trials.

PubMed

Zhu, Y-P; Wang, W-J; Zhang, S-L; Dai, B; Ye, D-W

2014-06-01

Gum chewing has been reported to enhance bowel motility and reduce postoperative ileus (POI). However, the efficacy remains imprecise for women following caesarean section. To summarise and evaluate the current evidence for postoperative gum chewing on the recovery of bowel function following caesarean section. We searched studies from the following electronic databases: PubMed, EMBASE, SCOPUS and Cochrane Library from inception to 30 May 2013. We included randomised controlled trials (RCTs) of women after caesarean section; these RCTs should compared gum chewing with no gum chewing and reported on at least one of the outcomes: time to flatus, time to bowel sound, time to passing stool and length of hospital stay (LOS). Study outcomes were presented as mean differences (for continuous data) with 95% confidence interval (95% CI). The risk of bias in the study results was assessed using the assessment tool from the Cochrane Handbook. Six RCTs including 939 women were included in our meta-analysis. The pooled results demonstrated that gum chewing is superior to no gum chewing with a reduction of 6.42 hours (95% CI -7.55 to -5.29) for time to first flatus, 3.62 hours (95% CI -6.41 to -0.83) for time to first bowel sound, 6.58 hours (95% CI -10.10 to -3.07) for time to first stool and 5.94 hours (95% CI -9.39 to -2.49) for LOS. In addition, no evidence emerged for any side effects caused by gum chewing. The current evidence suggests that gum chewing is associated with early recovery of bowel motility and shorter LOS for women after caesarean section. This safe and inexpensive intervention should be included in routine postoperative care following a caesarean section. © 2014 Royal College of Obstetricians and Gynaecologists.

Trends in health-care costs and utilization for inflammatory bowel disease from 2010 to 2014 in Korea: A nationwide population-based study.

PubMed

Kim, Jung-Wook; Lee, Chang Kyun; Rhee, Sang Youl; Oh, Chi Hyuck; Shim, Jae-Jun; Kim, Hyo Jong

2018-04-01

Data regarding health-care costs and utilization for inflammatory bowel disease (IBD) at the population level are limited in Asia. We aimed to investigate the nationwide prevalence and health-care cost and utilization of IBD in Korea. We tracked the IBD-attributable health-care costs and utilization from 2010 to 2014 using the public dataset obtained from Korean National Health Insurance Service claims. We estimated the nationwide prevalence of IBD using population census data from Statistics Korea during the same period. In total, 236 106 IBD patients were analyzed. The estimated IBD prevalence significantly increased from 85.1/100 000 in 2010 to 106/100 000 in 2014. The overall annual health-care costs for IBD increased from $23.2 million (US dollars) in 2010 to $49.7 million in 2014 (P < 0.001). During the same period, the health-care cost per capita also increased from $572.3 to $983.7 (P < 0.001). The outpatient to total cost ratio increased from 45.5% in 2010 to 66.6% in 2014. Regarding health-care utilization, the outpatient to total days of service use ratio increased from 73.1% in 2010 to 76.9% in 2014. Of the total days of service used, the proportions of tertiary, general, and community hospitals increased significantly with a concomitant decrease in that of primary clinics (all P values < 0.001). This population-based study confirmed the steadily rising rate of prevalence of IBD in Korea. It also demonstrated that the shifting to outpatient care and advanced care settings are drivers for the dramatic increase in IBD-related health-care costs in Korea. © 2017 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

Increasing colonoscopy screening in disparate populations: Results from an evaluation of patient navigation in the New Hampshire Colorectal Cancer Screening Program.

PubMed

Rice, Ketra; Gressard, Lindsay; DeGroff, Amy; Gersten, Joanne; Robie, Janene; Leadbetter, Steven; Glover-Kudon, Rebecca; Butterly, Lynn

2017-09-01

To investigate uniformly successful results from a statewide program of patient navigation (PN) for colonoscopy, this comparison study evaluated the effectiveness of the PN intervention by comparing outcomes for navigated versus non-navigated patients in one of the community health clinics included in the statewide program. Outcomes measured included screening completion, adequacy of bowel preparation, missed appointments and cancellations, communication of test results, and consistency of follow-up recommendations with clinical guidelines. The authors compared a subset of 131 patients who were navigated to a screening or surveillance colonoscopy with a similar subset of 75 non-navigated patients at one endoscopy clinic. The prevalence and prevalence odds ratios were computed to measure the association between PN and each study outcome measure. Patients in the PN intervention group were 11.2 times more likely to complete colonoscopy than control patients (96.2% vs 69.3%; P<.001), and were 5.9 times more likely to have adequate bowel preparation (P =.010). In addition, intervention patients had no missed appointments compared with 15.6% of control patients, and were 24.8 times more likely to not have a cancellation <24 hours before their appointment (P<.001). All navigated patients and their primary care providers received test results, and all follow-up recommendations were consistent with clinical guidelines compared with 82.4% of patients in the control group (P<.001). PN appears to be effective for improving colonoscopy screening completion and quality in the disparate populations most in need of intervention. To the best of our knowledge, the results of the current study demonstrate some of the strongest evidence for the effectiveness of PN to date, and highlight its value for public health. Cancer 2017;123:3356-66. © 2017 American Cancer Society. © 2017 American Cancer Society.

Frequency of bowel movements and the future risk of Parkinson's disease.

PubMed

Abbott, R D; Petrovitch, H; White, L R; Masaki, K H; Tanner, C M; Curb, J D; Grandinetti, A; Blanchette, P L; Popper, J S; Ross, G W

2001-08-14

Constipation is frequent in PD, although its onset in relation to clinical PD has not been well described. Demonstration that constipation can precede clinical PD could provide important clues to understanding disease progression and etiology. The purpose of this report is to examine the association between the frequency of bowel movements and the future risk of PD. Information on the frequency of bowel movements was collected from 1971 to 1974 in 6790 men aged 51 to 75 years without PD in the Honolulu Heart Program. Follow-up for incident PD occurred over a 24-year period. Ninety-six men developed PD an average of 12 years into follow-up. Age-adjusted incidence declined consistently from 18.9/10,000 person-years in men with <1 bowel movement/day to 3.8/10,000 person-years in those with >2/day (p = 0.005). After adjustment for age, pack-years of cigarette smoking, coffee consumption, laxative use, jogging, and the intake of fruits, vegetables, and grains, men with <1 bowel movement/day had a 2.7-fold excess risk of PD versus men with 1/day (95% CI: 1.3, 5.5; p = 0.007). The risk of PD in men with <1 bowel movement/day increased to a 4.1-fold excess when compared with men with 2/day (95% CI: 1.7, 9.6; p = 0.001) and to a 4.5-fold excess versus men with >2/day (95% CI: 1.2, 16.9; p = 0.025). Findings indicate that infrequent bowel movements are associated with an elevated risk of future PD. Further study is needed to determine whether constipation is part of early PD processes or is a marker of susceptibility or environmental factors that may cause PD.

Motivational interviewing in inflammatory bowel disease patients: a useful tool for outpatient counselling.

PubMed

Mocciaro, Filippo; Di Mitri, Roberto; Russo, Giuseppina; Leone, Salvo; Quercia, Valerio

2014-10-01

Most inflammatory bowel disease patients miss follow-up visits and are non-adherent to therapy due to the lack of an engaging patient-physician relationship. Motivational interviewing is a patient-centred counselling method used to elicit/strengthen motivation towards change. The aim of this study was to assess the role of motivational interviewing in patients affected by inflammatory bowel disease. The study included consecutive patients with inflammatory bowel disease presenting for the first consultation (June 2012-February 2013). All consultations were carried out applying the motivational interviewing approach. After each consultation, patients filled out a questionnaire asking demographic data, and their past and current experience. Overall, 23 males (51.1%) and 22 females (48.9%), mean age 36.1±15.2 years, were enrolled. Before and after experiencing the motivational interviewing approach (mean visit duration 41.5±8.7min) "overall satisfaction rate", "physician's communication skills", and "perceived empathy" were 60% vs 100%, 40% vs 95.6%, and 40% vs 100%, respectively. Satisfaction was lower in patients affected by indeterminate colitis (p=0.004), and of younger age (p=0.02). The motivational interview approach is appreciated by inflammatory bowel disease patients. Despite being time-consuming, the motivational interview appears considerably worthwhile at the first visit and in younger patients. Motivational interviewing can help physicians to deal with their patients, moving from "cure" to "care". Copyright © 2014 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Definitive Surgical Treatment of Infected or Exposed Ventral Hernia Mesh

PubMed Central

Szczerba, Steven R.; Dumanian, Gregory A.

2003-01-01

Objective To discuss the difficulties in dealing with infected or exposed ventral hernia mesh, and to illustrate one solution using an autogenous abdominal wall reconstruction technique. Summary Background Data The definitive treatment for any infected prosthetic material in the body is removal and substitution. When ventral hernia mesh becomes exposed or infected, its removal requires a solution to prevent a subsequent hernia or evisceration. Methods Eleven patients with ventral hernia mesh that was exposed, nonincorporated, with chronic drainage, or associated with a spontaneous enterocutaneous fistula were referred by their initial surgeons after failed local wound care for definitive management. The patients were treated with radical en bloc excision of mesh and scarred fascia followed by immediate abdominal wall reconstruction using bilateral sliding rectus abdominis myofascial advancement flaps. Results Four of the 11 patients treated for infected mesh additionally required a bowel resection. Transverse defect size ranged from 8 to 18 cm (average 13 cm). Average procedure duration was 3 hours without bowel repair and 5 hours with bowel repair. Postoperative length of stay was 5 to 7 days without bowel repair and 7 to 9 days with bowel repair. Complications included hernia recurrence in one case and stitch abscesses in two cases. Follow-up ranges from 6 to 54 months (average 24 months). Conclusions Removal of infected mesh and autogenous flap reconstruction is a safe, reliable, and one-step surgical solution to the problem of infected abdominal wall mesh. PMID:12616130

New psychological therapies for irritable bowel syndrome: mindfulness, acceptance and commitment therapy (ACT).

PubMed

Sebastián Sánchez, Beatriz; Gil Roales-Nieto, Jesús; Ferreira, Nuno Bravo; Gil Luciano, Bárbara; Sebastián Domingo, Juan José

2017-09-01

The current goal of treatment in irritable bowel syndrome (IBS) focuses primarily on symptom management and attempts to improve quality of life. Several treatments are at the disposal of physicians; lifestyle and dietary management, pharmacological treatments and psychological interventions are the most used and recommended. Psychological treatments have been proposed as viable alternatives or compliments to existing care models. Most forms of psychological therapies studied have been shown to be helpful in reducing symptoms and in improving the psychological component of anxiety/depression and health-related quality of life. According to current NICE/NHS guidelines, physicians should consider referral for psychological treatment in patients who do not respond to pharmacotherapy for a period of 12 months and develop a continuing symptom profile (described as refractory irritable bowel syndrome). Cognitive behavioral therapy (CBT) is the best studied treatment and seems to be the most promising therapeutic approach. However, some studies have challenged the effectiveness of this therapy for irritable bowel syndrome. One study concluded that cognitive behavioral therapy is no more effective than placebo attention control condition and another study showed that the beneficial effects wane after six months of follow-up. A review of mind/body approaches to irritable bowel syndrome has therefore suggested that alternate strategies targeting mechanisms other than thought content change might be helpful, specifically mindfulness and acceptance-based approaches. In this article we review these new psychological treatment approaches in an attempt to raise awareness of alternative treatments to gastroenterologists that treat this clinical syndrome.

Management of common gastrointestinal disorders: quality criteria based on patients' views and practice guidelines

PubMed Central

Jones, Roger; Hunt, Claire; Stevens, Richard; Dalrymple, Jamie; Driscoll, Richard; Sleet, Sarah; Smith, Jonathan Blanchard

2009-01-01

Background Although gastrointestinal disorders are common in general practice, clinical guidelines are not always implemented, and few patient-generated quality criteria are available to guide management. Aim To develop quality criteria for the management of four common gastrointestinal disorders: coeliac disease, gastro-oesophageal reflux disease (GORD), inflammatory bowel disease, and irritable bowel syndrome. Design of study Qualitative study including thematic analysis of transcripts from patient focus groups and content analysis of published clinical practice guidelines. Emergent themes were synthesised by a consensus panel, into quality criteria for each condition. Setting Community-based practice in England, UK. Methods Fourteen focus groups were conducted (four for coeliac disease, irritable bowel syndrome, and inflammatory bowel disease, and two for GORD) involving a total of 93 patients (64 females, 29 males; mean age 55.4 years). Quality criteria were based on patients' views and expectations, synthesised with an analysis of clinical practice guidelines. Results A chronic disease management model was developed for each condition. Key themes included improving the timeliness and accuracy of diagnosis, appropriate use of investigations, better provision of information for patients, including access to patient organisations, better communication with, and access to, secondary care providers, and structured follow-up and regular review, particularly for coeliac disease and inflammatory bowel disease. Conclusion This study provides a model for the development of quality markers for chronic disease management in gastroenterology, which is likely to be applicable to other chronic conditions. PMID:19520018

Pediatric Irritable Bowel Syndrome Patient and Parental Characteristics Differ by Care Management Type.

PubMed

Hollier, John M; Czyzewski, Danita I; Self, Mariella M; Weidler, Erica M; Smith, E O'Brian; Shulman, Robert J

2017-03-01

This study evaluates whether certain patient or parental characteristics are associated with gastroenterology (GI) referral versus primary pediatrics care for pediatric irritable bowel syndrome (IBS). A retrospective clinical trial sample of patients meeting pediatric Rome III IBS criteria was assembled from a single metropolitan health care system. Baseline socioeconomic status (SES) and clinical symptom measures were gathered. Various instruments measured participant and parental psychosocial traits. Study outcomes were stratified by GI referral versus primary pediatrics care. Two separate analyses of SES measures and GI clinical symptoms and psychosocial measures identified key factors by univariate and multiple logistic regression analyses. For each analysis, identified factors were placed in unadjusted and adjusted multivariate logistic regression models to assess their impact in predicting GI referral. Of the 239 participants, 152 were referred to pediatric GI, and 87 were managed in primary pediatrics care. Of the SES and clinical symptom factors, child self-assessment of abdominal pain duration and lower percentage of people living in poverty were the strongest predictors of GI referral. Among the psychosocial measures, parental assessment of their child's functional disability was the sole predictor of GI referral. In multivariate logistic regression models, all selected factors continued to predict GI referral in each model. Socioeconomic environment, clinical symptoms, and functional disability are associated with GI referral. Future interventions designed to ameliorate the effect of these identified factors could reduce unnecessary specialty consultations and health care overutilization for IBS.

Behavioral risk factors of constipation in palliative care patients.

PubMed

Dzierżanowski, Tomasz; Ciałkowska-Rysz, Aleksandra

2015-06-01

Constipation is frequently encountered in palliative care patients and remains a significant therapeutic problem. The etiology of constipation is multifactorial. Nutritional and behavioral factors are considered common causes of constipation; however, their impact has not yet been assessed precisely. The aim of this study was to assess the correlation between the frequency of bowel movements (FoBM) and risk factors of constipation in palliative care patients. A cohort retrospective study was performed in three palliative care centers, including outpatient, home, and inpatient care cancer patients using questionnaires on bowel dysfunction symptoms, behavioral risk factors, and opioid use. The inclusion criterion was adult patients examined on the day of admission. The exclusion criterion was Karnofsky performance status score ≤20. Spearman's rank correlation coefficient was used to measure the statistical dependence between two variables and frequency analysis was performed using the chi-squared test and Fisher's exact test. Two hundred thirty-seven valid questionnaires were collected. We found the correlation between FoBM and insufficient food and fluid intake (p < 0.0001), as well as for inadequate conditions of privacy (p = 0.0008), dependency on a caregiver (p = 0.0059), and the patient's overall performance status (p = 0.013). We did not manage to prove bed rest as the independent risk factor of constipation. The main risk factors of constipation in palliative care patients appeared to be insufficient fluid and food intake, inadequate conditions of privacy, dependency on a caregiver, as well as poor general performance status.

Teenage constipation: a case study.

PubMed

Streeter, Bonnie L

2002-01-01

Constipation is a problem of significant magnitude. It can have a devastating impact on a patient's personal life. There are many causes of constipation. Among them are dietary factors such as decreased fiber and low fluid intake, decreased activity, lack of privacy for defecation, pharmacologic agents, physiologic problems such as bowel obstruction or metabolic disorders, and psychosocial distress. A young teenage boy is followed through a series of emergency room visits, office visits, and a hospitalization related to his experiences with constipation. A bowel program was identified and instituted with successful outcomes.

Satisfaction of health care professionals managing patients with inflammatory bowel disease.

PubMed

Casellas, Francesc; Ginard, Daniel; Vera, Isabel; Torrejón, Antonio

2013-08-01

The aim of the present study was to analyze the satisfaction of health care professionals who attend patients with inflammatory bowel disease (IBD) and to determine the variables more related with satisfaction/dissatisfaction. Cross-sectional, self-administered written 15-item questionnaire was evaluated using a Likert scale, completed by Spanish gastroenterologists and nurse practitioners specialized in IBD patient care. A total of 202 surveys, 133 physicians (65.8%) and 69 nurses (34.2%) were conducted. Global scoring of satisfaction was 54.0 for physicians and 64.2 for nurses (p<0.001). In both groups the highest scores were achieved in those items related to their professional careers and management of personal and professional lives as well as those that refer to their interdisciplinary relationship with other medical units, management of patients within the hospital setting and finally communication with the patient. The items that attained the lowest score included those related to the length and staff available for the medical consult, work environment and the balance among health care provider needs for contribution, recognition and fulfillment. With regard to the variables involved with satisfaction, the results show that those physicians that only took care of IBD patients achieved a higher degree of satisfaction. This could be related with the fulfillment of their own professional expectations. The level of satisfaction of health care professionals that take care of IBD patients is low and may impact on patient care. Therefore, new strategies to increase the degree of satisfaction of IBD health care providers should be implemented. Copyright © 2012 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

National audit of continence care: adherence to National Institute for Health and Clinical Excellence (NICE) guidance in older versus younger adults with faecal incontinence.

PubMed

Harari, Danielle; Husk, Janet; Lowe, Derek; Wagg, Adrian

2014-11-01

previous UK National Audits of Continence Care showed low rates of assessment and treatment of faecal incontinence (FI) in older people. the 2009 audit assessed adherence to the National Institute for Health and Clinical Excellence guidelines on management of FI and compared care in older versus younger patients. fifteen older (65+) and 15 younger (18-65) patients with FI were to be audited in hospital (inpatient or outpatient), primary care (PC) and care home sites. data were submitted for n = 2,930 cases from 133 hospitals, n = 1,729 from 97 PC surgeries and n = 693 from 63 care homes. Bowel history was not documented in 41% older versus 24% younger patients in hospitals and 27 versus 19% in PC (both P < 0.001). In older people, there was no documented focused examination in one-third in hospitals, one-half in PC and three-quarters in care homes. Overall, <50% had documented treatment for an identified bowel-related cause of FI. FI was frequently attributed to co-morbidity. Few patients received copies of their treatment plan. Quality-of-life impact was poorly documented particularly in hospitals. this national audit shows deficits in documented assessment, diagnosis and treatment for adults with FI despite availability of clinical guidance. Overall care is significantly poorer for older people. Clinicians, including geriatricians, need to lead on improving care in older people including comprehensive assessment where needed. Improvement in some indicators in older people with successive audits suggests that ongoing national audit with linked information resources can be useful as both monitor and agent for change. © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Impact of introduction of an acute surgical unit on management and outcomes of small bowel obstruction.

PubMed

Musiienko, Anton M; Shakerian, Rose; Gorelik, Alexandra; Thomson, Benjamin N J; Skandarajah, Anita R

2016-10-01

The acute surgical unit (ASU) is a recently established model of care in Australasia and worldwide. Limited data are available regarding its effect on the management of small bowel obstruction. We compared the management of small bowel obstruction before and after introduction of ASU at a major tertiary referral centre. We hypothesized that introduction of ASU would correlate with improved patient outcomes. A retrospective review of prospectively maintained databases was performed over two separate 2-year periods, before and after the introduction of ASU. Data collected included demographics, co-morbidity status, use of water-soluble contrast agent and computed tomography. Outcome measures included surgical intervention, time to surgery, hospital length of stay, complications, 30-day readmissions, use of total parenteral nutrition, intensive care unit admissions and overall mortality. Total emergency admissions to the ASU increased from 2640 to 4575 between the two time periods. A total of 481 cases were identified (225 prior and 256 after introduction of ASU). Mortality decreased from 5.8% to 2.0% (P = 0.03), which remained significant after controlling for confounders with multivariate analysis (odds ratio = 0.24, 95% confidence interval 0.08-0.73, P = 0.012). The proportion of surgically managed patients increased (20.9% versus 32.0%, P = 0.003) and more operations were performed within 5 days from presentation (76.6% versus 91.5%, P = 0.02). Fewer patients received water-soluble contrast agent (27.1% versus 18.4%, P = 0.02), but more patients were investigated with a computed tomography (70.7% versus 79.7%, P = 0.02). The ASU model of care resulted in decreased mortality, shorter time to intervention and increased surgical management. Overall complications rate and length of stay did not change. © 2015 Royal Australasian College of Surgeons.

The Role of Diet in Inflammatory Bowel Disease.

PubMed

Shivashankar, Raina; Lewis, James D

2017-05-01

Diet may play both a causal and therapeutic role for inflammatory bowel disease (IBD). Physicians caring for patients with IBD are often asked to make dietary recommendations. However, there are no well-established guidelines on the use of diet as a treatment of IBD. In this review, we describe the evidence supporting diet as a potential cause for IBD, patient-perceived symptoms based on diet, current research on various diets as a treatment for IBD, and areas of future research. New studies in murine models suggest that dietary emulsifiers may trigger the gut inflammatory cascade. New studies of restriction diets in patients have shown a relationship between dietary intake, symptoms, and bowel inflammation. Until several ongoing clinical trials are completed, a reasonable approach to dietary recommendations for patients with IBD is to propose a well-balanced, healthy (low-fat, low-sugar) diet prepared from fresh ingredients, such as the Mediterranean diet, with exclusions of self-identified foods that worsen or trigger IBD-related symptoms.

Irritable bowel syndrome

PubMed Central

Enck, Paul; Aziz, Qasim; Barbara, Giovanni; Farmer, Adam D.; Fukudo, Shin; Mayer, Emeran A.; Niesler, Beate; Quigley, Eamonn M. M.; Rajilić-Stojanović, Mirjana; Schemann, Michael; Schwille-Kiuntke, Juliane; Simren, Magnus; Zipfel, Stephan; Spiller, Robin C.

2016-01-01

Irritable bowel syndrome (IBS) is a functional gastrointestinal disease with a high population prevalence. The disorder can be debilitating in some patients, whereas others may have mild or moderate symptoms. The most important single risk factors are female sex, younger age and preceding gastrointestinal infections. Clinical symptoms of IBS include abdominal pain or discomfort, stool irregularities and bloating, as well as other somatic, visceral and psychiatric comorbidities. Currently, the diagnosis of IBS is based on symptoms and the exclusion of other organic diseases, and therapy includes drug treatment of the predominant symptoms, nutrition and psychotherapy. Although the underlying pathogenesis is far from understood, aetiological factors include increased epithelial hyperpermeability, dysbiosis, inflammation, visceral hypersensitivity, epigenetics and genetics, and altered brain–gut interactions. IBS considerably affects quality of life and imposes a profound burden on patients, physicians and the health-care system. The past decade has seen remarkable progress in our understanding of functional bowel disorders such as IBS that will be summarized in this Primer. PMID:27159638

Perspectives of paediatric and adult gastroenterologists on transfer and transition care of adolescents with inflammatory bowel disease.

PubMed

Wright, E K; Williams, J; Andrews, J M; Day, A S; Gearry, R B; Bampton, P; Moore, D; Lemberg, D; Ravikumaran, R; Wilson, J; Lewindon, P; Radford-Smith, G; Rosenbaum, J; Catto-Smith, A; Desmond, P V; Connell, W R; Cameron, D; Alex, G; Bell, S J; De Cruz, P

2014-05-01

Programmes specific to inflammatory bowel disease (IBD) that facilitate transition from paediatric to adult care are currently lacking. We aimed to explore the perceived needs of adolescents with IBD among paediatric and adult gastroenterologists and to identify barriers to effective transition. A web-based survey of paediatric and adult gastroenterologists in Australia and New Zealand employed both ranked items (Likert scale; from 1 not important to 5 very important) and forced choice items regarding the importance of various factors in facilitating effective transition of adolescents from paediatric to adult care. Response rate among 178 clinicians was 41%. Only 23% of respondents felt that adolescents with IBD were adequately prepared for transition to adult care. Psychological maturity (Mean = 4.3, standard deviation (SD) = 0.70) and readiness as assessed by adult caregiver (Mean = 4, SD = 0.72) were prioritised as the most important factors in determining timing of transfer. Self-efficacy and readiness as assessed by adult caregiver were considered the two most important factors to determine timing of transition by both groups of gastroenterologists. Poor medical and surgical handover (Mean = 4.10, SD = 0.8) and patients' lack of responsibility for their own care (Mean= 4.10, SD = 0.82) were perceived as major barriers to successful transition by both paediatric and adult gastroenterologists. Deficiencies exist in current transition care of adolescents with IBD in Australia and New Zealand. Standardising transition care practices with strategies aimed at optimising communication, patient education, self-efficacy and adherence may improve outcomes. © 2014 The Authors; Internal Medicine Journal © 2014 Royal Australasian College of Physicians.

Cancer screening education: can it change knowledge and attitudes among culturally and linguistically diverse communities in Queensland, Australia?

PubMed

Cullerton, Katherine; Gallegos, Danielle; Ashley, Ella; Do, Hong; Voloschenko, Anna; Fleming, MaryLou; Ramsey, Rebecca; Gould, Trish

2016-06-29

Issue addressed: Screening for cancer of the cervix, breast and bowel can reduce morbidity and mortality. Low participation rates in cancer screening have been identified among migrant communities internationally. Attempting to improve low rates of cancer screening, the Ethnic Communities Council of Queensland developed a pilot Cancer Screening Education Program for breast, bowel and cervical cancer. This study determines the impact of education sessions on knowledge, attitudes and intentions to participate in screening for culturally and linguistically diverse (CALD) communities living in Brisbane, Queensland. Methods: Seven CALD groups (Arabic-speaking, Bosnian, South Asian (including Indian and Bhutanese), Samoan and Pacific Island, Spanish-speaking, Sudanese and Vietnamese) participated in a culturally-tailored cancer screening education pilot program that was developed using the Health Belief Model. A pre- and post-education evaluation session measured changes in knowledge, attitudes and intention related to breast, bowel and cervical cancer and screening. The evaluation focussed on perceived susceptibility, perceived seriousness and the target population's beliefs about reducing risk by cancer screening. Results: There were 159 participants in the three cancer screening education sessions. Overall participants' knowledge increased, some attitudes toward participation in cancer screening became more positive and intent to participate in future screening increased (n=146). Conclusion: These results indicate the importance of developing screening approaches that address the barriers to participation among CALD communities and that a culturally-tailored education program is effective in improving knowledge, attitudes about and intentions to participate in cancer screening. So what?: It is important that culturally-tailored programs are developed in conjunction with communities to improve health outcomes.

Autoimmune, atopic, and mental health comorbid conditions associated with alopecia areata in the United States.

PubMed

Huang, Kathie P; Mullangi, Samyukta; Guo, Ye; Qureshi, Abrar A

2013-07-01

To evaluate the prevalence of comorbid conditions among patients with alopecia areata (AA) seen at tertiary care hospitals in Boston, Massachusetts, during an 11-year period. Retrospective cross-sectional study. Tertiary care hospitals in Boston, including Brigham and Women's Hospital and Massachusetts General Hospital. We identified 3568 individuals with AA seen in the Partners health care system in Boston between January 1, 2000, and January 1, 2011. We performed comprehensive searches of the Research Patient Data Repository using International Classification of Diseases, Ninth Revision code 704.01. We randomly selected 350 patients and manually reviewed their medical records to train and validate a novel artificial intelligence program. This program then used natural language processing to review free-text medical records and confirm a diagnosis of AA. To confirm the algorithm, we manually reviewed a subset of records and found 93.9% validity. The prevalence of comorbid conditions was assessed. Common comorbid conditions included autoimmune diagnoses (thyroid disease in 14.6%, diabetes mellitus in 11.1%, inflammatory bowel disease in (2.0%) [corrected], systemic lupus erythematosus in 4.3%, rheumatoid arthritis in 3.9%, and psoriasis and psoriatic arthritis in (6.3%) [corrected], atopy (allergic rhinitis, asthma, and/or eczema in 38.2% and contact dermatitis and other eczema in 35.9%), and mental health problems (depression or anxiety in 25.5%). We also found high prevalences of hyperlipidemia (24.5%), hypertension (21.9%), and gastroesophageal reflux disease (17.3%). This profile was different from that seen in a comparison psoriasis and psoriatic arthritis group. We found a high prevalence of comorbid conditions among individuals with AA presenting to academic medical centers in Boston. Physicians caring for patients with AA should consider screening for comorbid conditions.

Contrast-Enhanced Ultrasound and Near-Infrared Spectroscopy of the Neonatal Bowel: Novel, Bedside, Noninvasive, and Radiation-Free Imaging for Early Detection of Necrotizing Enterocolitis.

PubMed

Al-Hamad, Suzanne; Hackam, David J; Goldstein, Seth D; Huisman, Thierry A G M; Darge, Kassa; Hwang, Misun

2018-05-31

Despite extensive research and improvements in the field of neonatal care, the morbidity and mortality associated with necrotizing enterocolitis (NEC) have remained unchanged over the past three decades. Early detection of ischemia and necrotic bowel is vital in improving morbidity and mortality associated with NEC; however, strategies for predicting and preventing NEC are lacking. Contrast-enhanced ultrasound (CEUS) and near-infrared spectroscopy (NIRS) are novel techniques in pediatrics that have been proven as safe modalities. CEUS has benefits over conventional ultrasound (US) by its improved real-time evaluation of the micro- and macrovascularities of normally and abnormally perfused tissue. US has been implemented as a useful adjunct to X-ray for earlier evaluation of NEC. NIRS is another noninvasive technique that has shown promise in improving early detection of NEC. The purpose of this article is to review the current understanding of changes in bowel perfusion in NEC, discuss the accuracy of abdominal US in detecting NEC, and explain how the use of CEUS and NIRS will enhance the precise and early detection of altered/pathological bowel wall perfusion in the initial development and course of NEC. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Lower urinary tract functions in a series of Charcot-Marie-Tooth neuropathy patients.

PubMed

Krhut, J; Mazanec, R; Seeman, P; Mann-Gow, T; Zvara, P

2014-05-01

To evaluate lower urinary tract (LUT), bowel, and sexual dysfunctions in a series of patients with Charcot-Marie-Tooth disease (CMT). A cohort of 58 patients and 54 healthy controls filled out the International Prostate Symptoms Score (IPSS) and the International Consultation on Incontinence Modular (ICIQ) Questionnaires to assess their symptoms and their impact on the patient's quality of life. On the IPSS questionnaire, CMT patients reported a significantly higher score compared with the healthy controls in 7 of 8 questions. The ICIQ-male LUT symptoms questionnaire revealed a significantly higher score in 7 of 26 questions. In the ICIQ-female LUT questionnaire, a significantly higher score was observed in 13 of 24 questions. When assessing the bowel function in CMT patients using the ICIQ-bowel questionnaire, a significantly higher score in 30 of 40 questions was noted. No differences in sexual function were found in either group. The occurrence of the LUT symptoms and bowel dysfunctions in CMT patients was significantly higher when compared with an age-matched control group. The symptoms were more frequent in female patients. The findings suggest that autonomic dysfunction should be evaluated and included in the diagnostic approach and care of CMT patients. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Challenges in the design of a Home Telemanagement trial for patients with ulcerative colitis.

PubMed

Cross, Raymond K; Finkelstein, Joseph

2009-12-01

Nonadherence, inadequate monitoring, and side-effects result in suboptimal outcomes in ulcerative colitis (UC). We hypothesize that telemanagement for UC will improve symptoms, quality of life, adherence, and decrease costs. This article describes the challenges encountered in the design of the home telemanagement in patients with UC trial. In a randomized trial to assess the effectiveness of telemanagement for UC compared to best available care, 100 patients will be enrolled. Subjects in the intervention arm will complete self-testing with telemanagement weekly; best available care subjects will receive scheduled follow up, educational fact sheets, and written action plans. Telemanagement consists of a home-unit, decision support server, and web-based clinician portal. The home-unit includes a scale and laptop. Subjects will respond to questions about symptoms, side-effects, adherence, and knowledge weekly; subjects will receive action plans after self-testing. Outcome variables to be assessed every 4 months include: disease activity, using the Seo index; quality of life, using the Inflammatory Bowel Disease Questionnaire; adherence, using pharmacy refill data and the Morisky Medication Adherence Scale; utilization of healthcare resources, using urgent care visits and hospitalizations. We encountered several challenges during design and implementation of our trial. First, we selected a randomized controlled trial design. We could have selected a quasiexperimental design to decrease the sample size needed and costs. Second, identification of a control group was challenging. Telemanagement patients received self-care plans and an educational curriculum. Since controls would not receive these interventions, we thought our results would be biased in favor of telemanagement. In addition, we wanted to evaluate the mode of delivery of these components of care. Therefore, we included written action plans and educational materials for patients in the control group ('best available care'). Third, we could not blind subjects to group assignment. In an attempt to decrease bias, staff was masked to group assignment to decrease measurement bias. Fourth, we selected outcome measures that were not invasive to decrease risks to subjects and to enhance recruitment. Our results may not be generalizable as our program is a tertiary center. Further, subjects are not blinded to the intervention potentially resulting in bias; we attempt to minimize this bias by having staff masked to treatment group at the time of assessment of outcome measures. To the best of our knowledge, our trial will be the first randomized controlled trial to evaluate telemedicine in subjects with gastrointestinal disease. We describe several issues encountered in design and implementation of our trial that will aid investigators when planning telemedicine trials in inflammatory bowel disease.

Enhanced Recovery after Urological Surgery: A Contemporary Systematic Review of Outcomes, Key Elements, and Research Needs.

PubMed

Azhar, Raed A; Bochner, Bernard; Catto, James; Goh, Alvin C; Kelly, John; Patel, Hiten D; Pruthi, Raj S; Thalmann, George N; Desai, Mihir

2016-07-01

Enhanced Recovery after Surgery (ERAS) programs are multimodal care pathways that aim to decrease intra-operative blood loss, decrease postoperative complications, and reduce recovery times. To overview the use and key elements of ERAS pathways, and define needs for future clinical trials. A comprehensive systematic MEDLINE search was performed for English language reports published before May 2015 using the terms "postoperative period," "postoperative care," "enhanced recovery after surgery," "enhanced recovery," "accelerated recovery," "fast track recovery," "recovery program," "recovery pathway", "ERAS," and "urology" or "cystectomy" or "urologic surgery." We identified 18 eligible articles. Patient counseling, physical conditioning, avoiding excessive alcohol and smoking, and good nutrition appeared to protect against postoperative complications. Fasting from solid food for only 6h and perioperative liquid-carbohydrate loading up to 2h prior to surgery appeared to be safe and reduced recovery times. Restricted, balanced, and goal-directed fluid replacement is effective when individualized, depending on patient morbidity and surgical procedure. Decreased intraoperative blood loss may be achieved by several measures. Deep vein thrombosis prophylaxis, antibiotic prophylaxis, and thermoregulation were found to help reduce postsurgical complications, as was a multimodal approach to postoperative nausea, vomiting, and analgesia. Chewing gum, prokinetic agents, oral laxatives, and an early resumption to normal diet appear to aid faster return to normal bowel function. Further studies should compare anesthetic protocols, refine analgesia, and evaluate the importance of robot-assisted surgery and the need/timing for drains and catheters. ERAS regimens are multidisciplinary, multimodal pathways that optimize postoperative recovery. This review provides an overview of the use and key elements of Enhanced Recovery after Surgery programs, which are multimodal, multidisciplinary care pathways that aim to optimize postoperative recovery. Additional conclusions include identifying effective procedures within Enhanced Recovery after Surgery programs and defining needs for future clinical trials. Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Extreme hyperphosphatemia and hypocalcemic coma associated with phosphate enema.

PubMed

Hsu, Heng Jung; Wu, Mai-Szu

2008-01-01

Fleet enema (sodium phosphate, C.B. Fleet Co., Inc., Lynchburg, Virginia) is widely used for bowel preparation or constipation relief in the hospital and over the counter. The potential risks, including hyperphosphatemia and hypocalcemic coma should be kept in mind of primary care physician. The patients with older age, bowel obstruction, small intestinal disorders, poor gut motility, and renal disease are contraindicated or should be administered with caution. We present a patient with old age and chronic renal failure who developed severe hyperphosphatemia and hypocalcemic tetany with coma after sodium phosphate enema. We recommend the use of alternative enema preparations, such as simple tap water or saline solution enemas, which can prevent fatal complications in high risk patients.

Medico-legal significance of service difficulties and clinical errors in the management of patients with inflammatory bowel diseases.

PubMed

Farrukh, Affifa; Mayberry, John F

2015-03-01

There is a significant growth in medical litigation, and cases involving the care and management of patients with inflammatory bowel disease are becoming common. There is no central register of such cases, and the majority are settled before court proceedings. As a result, there is no specific case law related to such conditions, and secrecy usually surrounds the outcome with "no admission of guilt" by the defendant and a clause about non-disclosure and discussion linked to the financial compensation received by the claimant. This review discusses common areas of potential litigation. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Pregnancy and the Patient with Inflammatory Bowel Disease: Fertility, Treatment, Delivery, and Complications.

PubMed

McConnell, Ryan A; Mahadevan, Uma

2016-06-01

For many women with inflammatory bowel disease (IBD), the illness coincides with their childbearing years. IBD increases the risk of pregnancy complications and adverse pregnancy outcomes. The multidisciplinary care team should emphasize the importance of medication adherence to achieve preconception disease control and maintain corticosteroid-free remission throughout pregnancy. Medication adjustments to reduce fetal exposure may be considered on an individualized basis in quiescent disease; however, any benefits of such adjustments remain theoretic and there is risk of worsening disease activity. Mode of delivery is determined by obstetric indications, except for women with active perianal disease who should consider cesarean delivery. Copyright © 2016 Elsevier Inc. All rights reserved.

Ranitidine: forgotten drug of delayed gastric emptying.

PubMed

Veevers, Abbie E; Oxberry, Stephen G

2017-09-01

Delayed gastric emptying in the presence or absence of mechanical bowel obstruction can cause distressing symptoms in palliative care patients. We present two patients, both with vomiting due to delayed gastric emptying and gastric outlet obstruction secondary to pancreatic cancer, treated with subcutaneous ranitidine resulting in a symptomatic response. We hypothesise that ranitidine is a useful adjunct to standard treatment with prokinetic agents or octreotide in such patients and potentially those with proximal mechanical bowel obstruction from other malignancies with associated delayed gastric emptying. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Challenges in Designing a National Surveillance Program for Inflammatory Bowel Disease in the United States

PubMed Central

Long, Millie D.; Hutfless, Susan; Kappelman, Michael D.; Khalili, Hamed; Kaplan, Gil; Bernstein, Charles N.; Colombel, Jean Frederic; Herrinton, Lisa; Velayos, Fernando; Loftus, Edward V.; Nguyen, Geoffrey C.; Ananthakrishnan, Ashwin N.; Sonnenberg, Amnon; Chan, Andrew; Sandler, Robert S.; Atreja, Ashish; Shah, Samir A.; Rothman, Kenneth; Leleiko, Neal S.; Bright, Renee; Boffetta, Paolo; Myers, Kelly D.; Sands, Bruce E.

2015-01-01

This review describes the history of US government funding for surveillance programs in IBD, provides current estimates of the incidence and prevalence of inflammatory bowel diseases (IBD) in the United States (US), and enumerates a number of challenges faced by current and future IBD surveillance programs. A rationale for expanding the focus of IBD surveillance beyond counts of incidence and prevalence, in order to provide a greater understanding of the burden of IBD, disease etiology and pathogenesis, is provided. Lessons learned from other countries are summarized, as well as potential resources that may be used to optimize a new form of IBD surveillance in the US. A consensus recommendation on the goals and available resources for a new model for disease surveillance are provided. This new model should focus upon “surveillance of the burden of disease,” including 1) natural history of disease and 2) outcomes and complications of the disease and/or treatments. PMID:24280882

Inflammatory bowel disease nurses in Canada: an examination of Canadian gastroenterology nurses and their role in inflammatory bowel disease care.

PubMed

Stretton, Jennifer G; Currie, Barbara K; Chauhan, Usha K

2014-02-01

Inflammatory bowel disease (IBD) is a chronic relapsing illness primarily including Crohn disease and ulcerative colitis. The disease course often fluctuates over time, and requires maintenance therapy and acute interventions to target disease flares. IBD management requires a multidisciplinary approach, with care from physicians, nurses, dieticians, social workers and psychologists. Because nurses play a pivotal role in managing chronic disease, the aim of the present study was to assess and determine how many nurses work primarily with IBD patients in Canada. A 29-question survey was developed using an Internet-based survey tool (www.surveymonkey.com) to investigate nursing demographics, IBD nursing roles and nursing services provided across Canada. Distribution included the Canadian Society of Gastroenterology Nurses and Associates, the Canadian Association of Gastroenterology, Progress (AbbVie Corporation, USA) and BioAdvance (Janssen Inc, USA) coordinators (via e-mail), and online availability for 15 weeks. Of 275 survey respondents, 98.2% were female nurses, with 68.7% employed in full-time positions. Among them, 42.5% were between 51 and 60 years of age, and 32.4% were between 41 and 50 years of age. In addition, 53.8% were diploma-prepared registered nurses, 35.3% were Baccalaureate-prepared nurses and 4.4% were Masters-prepared nurses. Almost one-half (44% [n=121]) were employed in Ontario, followed by 19.6% (n=54) in Alberta and 9.1% (n=25) in British Columbia. All provinces were represented with the exception of Nunavut and the Northwest Territories. Forty-three per cent (n=119) of nurses identified as working in endoscopy units. Of the 90% who responded as working with IBD patients, only 30% (n=79) had a primary role in IBD care. Among these 79 nurses with a primary role in IBD care, 79.7% worked with the adult population, 10.1% with the pediatric population, and 10.1% worked with both adult and pediatric patients. Their major service was an outpatient setting (67.1%). Survey results showed that only a small percentage of Canadian gastroenterology nurses provide clinical IBD care. Many have multiple roles and responsibilities, and provide a variety of services. The exact depth of care and service is unclear and further study is needed.

Current Landscape of Telemedicine Practice in Inflammatory Bowel Disease.

PubMed

Patil, Seema A; Cross, Raymond K

2018-04-28

Inflammatory bowel disease (IBD), comprised of Crohn's disease and ulcerative colitis, affects 1.6 million people in the United States. Although effective medical treatments exist to treat the disease, outcomes are still suboptimal. The reasons for poor outcomes vary but include nonadherence to therapy, inadequate monitoring of patients, limited access to IBD specialty care, concurrent psychiatric disease, limited patient knowledge of the disease and treatments, and patient provider discordance. Telemedicine is a candidate intervention that can be used to improve patient outcomes through more frequent monitoring, patient self-management, delivery of education (patient and provider), and to increase access to multidisciplinary IBD care. Telemedicine includes remote monitoring, telehealth, teleconsultation, and teleconferencing.Telemedicine systems have been used in patients with IBD with widespread patient acceptance of the technology. However, early clinical trials demonstrated high attrition rates among intervention patients. In general, use of telemedicine systems have been associated with improved quality of life, improved patient knowledge, and decreased utilization of health care resources. Early studies evaluating telehealth visits report high patient satisfaction, decreased indirect costs to patients, and no decrease in quality of care delivered.Due to widespread access to computers and smart phones among patients, telemedicine will continue to expand in the care of patients with IBD. To optimize use and effectiveness of telemedicine, barriers for use including concerns over increased liability, need for informed consent, licensure restrictions to providing interstate telehealth visits, and cybersecurity need to be addressed.

Expanding the scope of quality measurement in surgery to include nonoperative care: Results from the American College of Surgeons National Surgical Quality Improvement Program emergency general surgery pilot.

PubMed

Wandling, Michael W; Ko, Clifford Y; Bankey, Paul E; Cribari, Chris; Cryer, H Gill; Diaz, Jose J; Duane, Therese M; Hameed, S Morad; Hutter, Matthew M; Metzler, Michael H; Regner, Justin L; Reilly, Patrick M; Reines, H David; Sperry, Jason L; Staudenmayer, Kristan L; Utter, Garth H; Crandall, Marie L; Bilimoria, Karl Y; Nathens, Avery B

2017-11-01

Patients managed nonoperatively have been excluded from risk-adjusted benchmarking programs, including the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP). Consequently, optimal performance evaluation is not possible for specialties like emergency general surgery (EGS) where nonoperative management is common. We developed a multi-institutional EGS clinical data registry within ACS NSQIP that includes patients managed nonoperatively to evaluate variability in nonoperative care across hospitals and identify gaps in performance assessment that occur when only operative cases are considered. Using ACS NSQIP infrastructure and methodology, surgical consultations for acute appendicitis, acute cholecystitis, and small bowel obstruction (SBO) were sampled at 13 hospitals that volunteered to participate in the EGS clinical data registry. Standard NSQIP variables and 16 EGS-specific variables were abstracted with 30-day follow-up. To determine the influence of complications in nonoperative patients, rates of adverse outcomes were identified, and hospitals were ranked by performance with and then without including nonoperative cases. Two thousand ninety-one patients with EGS diagnoses were included, 46.6% with appendicitis, 24.3% with cholecystitis, and 29.1% with SBO. The overall rate of nonoperative management was 27.4%, 6.6% for appendicitis, 16.5% for cholecystitis, and 69.9% for SBO. Despite comprising only 27.4% of patients in the EGS pilot, nonoperative management accounted for 67.7% of deaths, 34.3% of serious morbidities, and 41.8% of hospital readmissions. After adjusting for patient characteristics and hospital diagnosis mix, addition of nonoperative management to hospital performance assessment resulted in 12 of 13 hospitals changing performance rank, with four hospitals changing by three or more positions. This study identifies a gap in performance evaluation when nonoperative patients are excluded from surgical quality assessment and demonstrates the feasibility of incorporating nonoperative care into existing surgical quality initiatives. Broadening the scope of hospital performance assessment to include nonoperative management creates an opportunity to improve the care of all surgical patients, not just those who have an operation. Care management, level IV; Epidemiologic, level III.

Assessing overall patient satisfaction in inflammatory bowel disease using structural equation modeling.

PubMed

Soares, João-Bruno; Marinho, Ana S; Fernandes, Dália; Moreira Gonçalves, Bruno; Camila-Dias, Cláudia; Gonçalves, Raquel; Magro, Fernando

2015-08-01

Structural equation modeling (SEM) is a very popular data-analytic technique for the evaluation of customer satisfaction. We aimed to measure the overall satisfaction of inflammatory bowel disease (IBD) patients with healthcare in Portugal and to define its main determinants using SEM. The study included three steps: (i) specification of a patient satisfaction model that included the following dimensions: Image, Expectations, Facilities, Admission process, Assistant staff, Nursing staff, Medical staff, Treatment, Inpatient care, Outpatient care, Overall quality, Overall satisfaction, and Loyalty; (ii) sample survey from 2000 patients, members of the Portuguese Association of the IBD; and (iii) estimation of the satisfaction model using partial least squares (XLSTAT-PLSPM). We received 498 (25%) valid questionnaires from 324 (66%) patients with Crohn's disease and 162 (33%) patients with ulcerative colitis. Our model provided a substantial explanation for Overall satisfaction (R=0.82). The mean index of overall satisfaction was 74.4 (0-100 scale). The main determinants of Overall satisfaction were the Image (β=0.26), Outpatient care (β=0.23), and Overall quality (β=0.21), whose mean indices were 83, 75, and 81, respectively. Facilities and Inpatient care were the variables with a significant impact on Overall satisfaction and the worst mean indices. SEM is useful for the evaluation of IBD patient satisfaction. The Overall satisfaction of IBD patients with healthcare in Portugal is good, but to increase it, IBD services need to focus on the improvement of Outpatient care, Facilities, and Inpatient care. Our model could be a matrix for a global model of IBD patient satisfaction.

Optimising the Inflammatory Bowel Disease Unit to Improve Quality of Care: Expert Recommendations.

PubMed

Louis, Edouard; Dotan, Iris; Ghosh, Subrata; Mlynarsky, Liat; Reenaers, Catherine; Schreiber, Stefan

2015-08-01

The best care setting for patients with inflammatory bowel disease [IBD] may be in a dedicated unit. Whereas not all gastroenterology units have the same resources to develop dedicated IBD facilities and services, there are steps that can be taken by any unit to optimise patients' access to interdisciplinary expert care. A series of pragmatic recommendations relating to IBD unit optimisation have been developed through discussion among a large panel of international experts. Suggested recommendations were extracted through systematic search of published evidence and structured requests for expert opinion. Physicians [n = 238] identified as IBD specialists by publications or clinical focus on IBD were invited for discussion and recommendation modification [Barcelona, Spain; 2014]. Final recommendations were voted on by the group. Participants also completed an online survey to evaluate their own experience related to IBD units. A total of 60% of attendees completed the survey, with 15% self-classifying their centre as a dedicated IBD unit. Only half of respondents indicated that they had a defined IBD treatment algorithm in place. Key recommendations included the need to develop a multidisciplinary team covering specifically-defined specialist expertise in IBD, to instil processes that facilitate cross-functional communication and to invest in shared care models of IBD management. Optimising the setup of IBD units will require progressive leadership and willingness to challenge the status quo in order to provide better quality of care for our patients. IBD units are an important step towards harmonising care for IBD across Europe and for establishing standards for disease management programmes. © European Crohn’s and Colitis Organisation 2015.

Optimising the Inflammatory Bowel Disease Unit to Improve Quality of Care: Expert Recommendations

PubMed Central

Dotan, Iris; Ghosh, Subrata; Mlynarsky, Liat; Reenaers, Catherine; Schreiber, Stefan

2015-01-01

Introduction: The best care setting for patients with inflammatory bowel disease [IBD] may be in a dedicated unit. Whereas not all gastroenterology units have the same resources to develop dedicated IBD facilities and services, there are steps that can be taken by any unit to optimise patients’ access to interdisciplinary expert care. A series of pragmatic recommendations relating to IBD unit optimisation have been developed through discussion among a large panel of international experts. Methods: Suggested recommendations were extracted through systematic search of published evidence and structured requests for expert opinion. Physicians [n = 238] identified as IBD specialists by publications or clinical focus on IBD were invited for discussion and recommendation modification [Barcelona, Spain; 2014]. Final recommendations were voted on by the group. Participants also completed an online survey to evaluate their own experience related to IBD units. Results: A total of 60% of attendees completed the survey, with 15% self-classifying their centre as a dedicated IBD unit. Only half of respondents indicated that they had a defined IBD treatment algorithm in place. Key recommendations included the need to develop a multidisciplinary team covering specifically-defined specialist expertise in IBD, to instil processes that facilitate cross-functional communication and to invest in shared care models of IBD management. Conclusions: Optimising the setup of IBD units will require progressive leadership and willingness to challenge the status quo in order to provide better quality of care for our patients. IBD units are an important step towards harmonising care for IBD across Europe and for establishing standards for disease management programmes. PMID:25987349

Prevalence, causes and management outcome of intestinal obstruction in Adama Hospital, Ethiopia.

PubMed

Soressa, Urgessa; Mamo, Abebe; Hiko, Desta; Fentahun, Netsanet

2016-06-04

In Africa, acute intestinal obstruction accounts for a great proportion of morbidity and mortality. Ethiopia is one of the countries where intestinal obstruction is a major cause of morbidity and mortality. This study aims to determine prevalence, causes and management outcome of intestinal obstruction in Adama Hospital in Oromia region, Ethiopia. A hospital based cross-sectional study design was used. Data covering the past three years were collected from hospital medical records of sampled patients. The collected data were checked for any inconsistency, coded and entered into SPSS version 16.0 for data processing and analysis. Descriptive and logistic regression analyses were used. Statistical significance was based on confidence interval (CI) of 95 % at a p-value of < 0.05. 262 patients were admitted with intestinal obstruction. The prevalence of intestinal obstruction was 21.8 % and 4.8 % among patients admitted for acute abdomen surgery and total surgical admissions, respectively. The mortality rate was 2.5 % (6 of 262). The most common cause of small bowel obstruction was intussusceptions in 48 patients (30.9 %), followed by small bowel volvulus in 47 patients (30.3 %). Large bowel obstruction was caused by sigmoid volvulus in 60 patients (69.0 %) followed by colonic tumor in 12 patients (13.8 %). After controlling for possible confounding factors, the major predictors of management outcome of intestinal obstruction were: duration of illness before surgical intervention (adjusted odds ratio (AOR) = 0.49, 95 % CI: 0.25-0.97); intra-operative findings [Viable small bowel volvulus (SBV) (AOR = 0.08, 95 % CI: 0.01-0.95) and viable (AOR = 0.17, 95 % CI: 0.03-0.88)]; completion of intra-operative procedures (bowel resection & anastomosis (AOR = 3.05, 95 % CI: 1.04-8.94); and length of hospital stay (AOR = 0.05, 95 % CI: 0.01-0.16). Small bowel obstruction was more prevalent than large bowel obstruction. Intussusceptions and sigmoid volvulus were the leading causes of small and large bowel obstruction. Laparotomy was the most common methods of intestinal obstruction management. Bowel resection and anastomosis was the commonest intra-operative procedure done and is associated with postoperative complications. Wound infection in the affected area should be improved because it is the most common postoperative complication. This can be decreased by appropriate surgical technique and wound care with sterile techniques.

The multidisciplinary health care team in the management of stenosis in Crohn’s disease

PubMed Central

Gasparetto, Marco; Angriman, Imerio; Guariso, Graziella

2015-01-01

Background Stricture formation is a common complication of Crohn’s disease (CD), occurring in approximately one-third of all patients with this condition. Our aim was to summarize the available epidemiology data on strictures in patients with CD, to outline the principal evidence on diagnostic imaging, and to provide an overview of the current knowledge on treatment strategies, including surgical and endoscopic options. Overall, the unifying theme of this narrative review is the multidisciplinary approach in the clinical management of patients with stricturing CD. Methods A Medline search was performed, using “Inflammatory Bowel Disease”, “stricture”, “Crohn’s Disease”, “Ulcerative Colitis”, “endoscopic balloon dilatation” and “strictureplasty” as keywords. A selection of clinical cohort studies and systematic reviews were reviewed. Results Strictures in CD are described as either inflammatory or fibrotic. They can occur de novo, at sites of bowel anastomosis or in the ileal pouch. CD-related strictures generally show a poor response to medical therapies, and surgical bowel resection or surgical strictureplasty are often required. Over the last three decades, the potential role of endoscopic balloon dilatation has grown in importance, and nowadays this technique is a valid option, complementary to surgery. Conclusion Patients with stricturing CD require complex clinical management, which benefits from a multidisciplinary approach: gastroenterologists, pediatricians, radiologists, surgeons, specialist nurses, and dieticians are among the health care providers involved in supporting these patients throughout diagnosis, prevention of complications, and treatment. PMID:25878504

In vivo differentiation of complementary contrast media at dual-energy CT.

PubMed

Mongan, John; Rathnayake, Samira; Fu, Yanjun; Wang, Runtang; Jones, Ella F; Gao, Dong-Wei; Yeh, Benjamin M

2012-10-01

To evaluate the feasibility of using a commercially available clinical dual-energy computed tomographic (CT) scanner to differentiate the in vivo enhancement due to two simultaneously administered contrast media with complementary x-ray attenuation ratios. Approval from the institutional animal care and use committee was obtained, and National Institutes of Health guidelines for the care and use of laboratory animals were observed. Dual-energy CT was performed in a set of iodine and tungsten solution phantoms and in a rabbit in which iodinated intravenous and bismuth subsalicylate oral contrast media were administered. In addition, a second rabbit was studied after intravenous administration of iodinated and tungsten cluster contrast media. Images were processed to produce virtual monochromatic images that simulated the appearance of conventional single-energy scans, as well as material decomposition images that separate the attenuation due to each contrast medium. Clear separation of each of the contrast media pairs was seen in the phantom and in both in vivo animal models. Separation of bowel lumen from vascular contrast medium allowed visualization of bowel wall enhancement that was obscured by intraluminal bowel contrast medium on conventional CT scans. Separation of two vascular contrast media in different vascular phases enabled acquisition of a perfectly coregistered CT angiogram and venous phase-enhanced CT scan simultaneously in a single examination. Commercially available clinical dual-energy CT scanners can help differentiate the enhancement of selected pairs of complementary contrast media in vivo. © RSNA, 2012.

In Vivo Differentiation of Complementary Contrast Media at Dual-Energy CT

PubMed Central

Mongan, John; Rathnayake, Samira; Fu, Yanjun; Wang, Runtang; Jones, Ella F.; Gao, Dong-Wei

2012-01-01

Purpose: To evaluate the feasibility of using a commercially available clinical dual-energy computed tomographic (CT) scanner to differentiate the in vivo enhancement due to two simultaneously administered contrast media with complementary x-ray attenuation ratios. Materials and Methods: Approval from the institutional animal care and use committee was obtained, and National Institutes of Health guidelines for the care and use of laboratory animals were observed. Dual-energy CT was performed in a set of iodine and tungsten solution phantoms and in a rabbit in which iodinated intravenous and bismuth subsalicylate oral contrast media were administered. In addition, a second rabbit was studied after intravenous administration of iodinated and tungsten cluster contrast media. Images were processed to produce virtual monochromatic images that simulated the appearance of conventional single-energy scans, as well as material decomposition images that separate the attenuation due to each contrast medium. Results: Clear separation of each of the contrast media pairs was seen in the phantom and in both in vivo animal models. Separation of bowel lumen from vascular contrast medium allowed visualization of bowel wall enhancement that was obscured by intraluminal bowel contrast medium on conventional CT scans. Separation of two vascular contrast media in different vascular phases enabled acquisition of a perfectly coregistered CT angiogram and venous phase–enhanced CT scan simultaneously in a single examination. Conclusion: Commercially available clinical dual-energy CT scanners can help differentiate the enhancement of selected pairs of complementary contrast media in vivo. © RSNA, 2012 PMID:22778447

Improvements in bladder, bowel and sexual outcomes following task-specific locomotor training in human spinal cord injury.

PubMed

Hubscher, Charles H; Herrity, April N; Williams, Carolyn S; Montgomery, Lynnette R; Willhite, Andrea M; Angeli, Claudia A; Harkema, Susan J

2018-01-01

Locomotor training (LT) as a therapeutic intervention following spinal cord injury (SCI) is an effective rehabilitation strategy for improving motor outcomes, but its impact on non-locomotor functions is unknown. Given recent results of our labs' pre-clinical animal SCI LT studies and existing overlap of lumbosacral spinal circuitries controlling pelvic-visceral and locomotor functions, we addressed whether LT can improve bladder, bowel and sexual function in humans at chronic SCI time-points (> two years post-injury). Prospective cohort study; pilot trial with small sample size. Eight SCI research participants who were undergoing 80 daily one-hour sessions of LT on a treadmill using body-weight support, or one-hour of LT and stand training on alternate days, as part of another research study conducted at the Kentucky Spinal Cord Injury Research Center, University of Louisville, were enrolled in this pilot trial. Urodynamic assessments were performed and International Data Set questionnaire forms completed for bladder, bowel and sexual functions at pre-and post-training time points. Four usual care (non-trained; regular at-home routine) research participants were also enrolled in this study and had the same assessments collected twice, at least 3 months apart. Filling cystometry documented significant increases in bladder capacity, voiding efficiency and detrusor contraction time as well as significant decreases in voiding pressure post-training relative to baseline. Questionnaires revealed a decrease in the frequency of nocturia and urinary incontinence for several research participants as well as a significant decrease in time required for defecation and a significant increase in sexual desire post-training. No significant differences were found for usual care research participants. These results suggest that an appropriate level of sensory information provided to the spinal cord, generated through task-specific stepping and/or loading, can positively benefit the neural circuitries controlling urogenital and bowel functions. ClinicalTrials.gov NCT03036527.

Improvements in bladder, bowel and sexual outcomes following task-specific locomotor training in human spinal cord injury

PubMed Central

Williams, Carolyn S.; Montgomery, Lynnette R.; Willhite, Andrea M.; Angeli, Claudia A.; Harkema, Susan J.

2018-01-01

Objective Locomotor training (LT) as a therapeutic intervention following spinal cord injury (SCI) is an effective rehabilitation strategy for improving motor outcomes, but its impact on non-locomotor functions is unknown. Given recent results of our labs’ pre-clinical animal SCI LT studies and existing overlap of lumbosacral spinal circuitries controlling pelvic-visceral and locomotor functions, we addressed whether LT can improve bladder, bowel and sexual function in humans at chronic SCI time-points (> two years post-injury). Study design Prospective cohort study; pilot trial with small sample size. Methods Eight SCI research participants who were undergoing 80 daily one-hour sessions of LT on a treadmill using body-weight support, or one-hour of LT and stand training on alternate days, as part of another research study conducted at the Kentucky Spinal Cord Injury Research Center, University of Louisville, were enrolled in this pilot trial. Urodynamic assessments were performed and International Data Set questionnaire forms completed for bladder, bowel and sexual functions at pre-and post-training time points. Four usual care (non-trained; regular at-home routine) research participants were also enrolled in this study and had the same assessments collected twice, at least 3 months apart. Results Filling cystometry documented significant increases in bladder capacity, voiding efficiency and detrusor contraction time as well as significant decreases in voiding pressure post-training relative to baseline. Questionnaires revealed a decrease in the frequency of nocturia and urinary incontinence for several research participants as well as a significant decrease in time required for defecation and a significant increase in sexual desire post-training. No significant differences were found for usual care research participants. Conclusions These results suggest that an appropriate level of sensory information provided to the spinal cord, generated through task-specific stepping and/or loading, can positively benefit the neural circuitries controlling urogenital and bowel functions. Trial registration ClinicalTrials.gov NCT03036527 PMID:29385166

Complementary and alternative medicine (CAM) use in children with functional abdominal pain (FAP) and irritable bowel syndrome (IBS) differs in tertiary vs. primary care and is related to mother's view of child disability

USDA-ARS?s Scientific Manuscript database

We sought to determine if CAM use was greater in children in tertiary vs. primary care, and whether child or parent report of pain characteristics, and/or child and mother's psychological characteristics differed between those who did/did not use CAM. We identified children 7-10 years of age with FA...

Childhood inflammatory bowel disease: parental concerns and expectations.

PubMed

Day, A-S; Whitten, K-E; Bohane, T-D

2005-02-21

To document the concerns and expectations of parents of children with inflammatory bowel disease (IBD) within the context of a multidisciplinary IBD clinic, and to highlight the importance of a holistic approach to the care of these children. The parents of 60 children with IBD were surveyed by mailed questionnaire. Parents were asked to provide details of their concerns regarding their child's condition and to express their expectations of medical care. In addition, enquiry was made in respect to the respondents' learning about IBD. Forty-six questionnaires (77%) returned. Fifty-two percent of the patients were male. Patients were aged a mean of 10.9 (+/-4.1) years and diagnosed at an average age of 2.1 (+/-1.8) years previously. The most common concerns expressed by the parents related to the side- effects of medications and the future prospects for their child. Overall, parents were satisfied with aspects of care within the IBD clinic but many suggested additional personnel such as counselors or educators should be available. Parents also reported the need for continuing education and easy access to up-to-date information. Parents of children and adolescents with IBD have many common concerns regarding their child's condition. On-going attention to holistic care, including psychosocial and educational elements for patients and families, is appropriate in the context of the chronic and unpredictable nature of IBD.

Childhood inflammatory bowel disease: Parental concerns and expectations

PubMed Central

Day, AS; Whitten, KE; Bohane, TD

2005-01-01

AIM: To document the concerns and expectations of parents of children with inflammatory bowel disease (IBD) within the context of a multidisciplinary IBD clinic, and to highlight the importance of a holistic approach to the care of these children. METHODS: The parents of 60 children with IBD were surveyed by mailed questionnaire. Parents were asked to provide details of their concerns regarding their child’s condition and to express their expectations of medical care. In addition, enquiry was made in respect to the respondents’ learning about IBD. RESULTS: Forty-six questionnaires (77%) returned. Fifty-two percent of the patients were male. Patients were aged a mean of 10.9 (±4.1) years and diagnosed at an average age of 2.1 (±1.8) years previously. The most common concerns expressed by the parents related to the side- effects of medications and the future prospects for their child. Overall, parents were satisfied with aspects of care within the IBD clinic but many suggested additional personnel such as counselors or educators should be available. Parents also reported the need for continuing education and easy access to up-to-date information. CONCLUSION: Parents of children and adolescents with IBD have many common concerns regarding their child’s condition. On-going attention to holistic care, including psychosocial and educational elements for patients and families, is appropriate in the context of the chronic and unpredictable nature of IBD. PMID:15742408

Confidence-Based Learning CME: Overcoming Barriers in Irritable Bowel Syndrome with Constipation

ERIC Educational Resources Information Center

Cash, Brooks; Mitchner, Natasha A.; Ravyn, Dana

2011-01-01

Introduction: Performance of health care professionals depends on both medical knowledge and the certainty with which they possess it. Conventional continuing medical education interventions assess the correctness of learners' responses but do not determine the degree of confidence with which they hold incorrect information. This study describes…

Agreement between prospective diary data and retrospective questionnaire report of abdominal pain and stooling symptoms in children with irritable bowel syndrome

USDA-ARS?s Scientific Manuscript database

In functional gastrointestinal disorders, patient recall of symptoms drives diagnostic decisions and evaluation of treatment response, and research conclusions about potential treatments. In pediatrics, parent report also impacts assessment and care. Hence, identifying methods for accurately capturi...

38 CFR 51.120 - Quality of care.

Code of Federal Regulations, 2010 CFR

2010-07-01

... as much normal bowel function as possible. (f) Range of motion. Based on the comprehensive assessment... without a limited range of motion does not experience reduction in range of motion unless the resident's clinical condition demonstrates that a reduction in range of motion is unavoidable; and (2) A resident with...

38 CFR 51.120 - Quality of care.

Code of Federal Regulations, 2011 CFR

2011-07-01

... as much normal bowel function as possible. (f) Range of motion. Based on the comprehensive assessment... without a limited range of motion does not experience reduction in range of motion unless the resident's clinical condition demonstrates that a reduction in range of motion is unavoidable; and (2) A resident with...

[Irritable bowel syndrome with constipation and functional constipation in adults: Treatment (Part 2 of 2)].

PubMed

Mearin, F; Ciriza, C; Mínguez, M; Rey, E; Mascort, J J; Peña, E; Cañones, P; Júdez, J

2017-03-01

In this Clinical practice guide we examine the diagnostic and therapeutic management of adult patients with constipation and abdominal discomfort, at the confluence of the spectrum of irritable bowel syndrome and functional constipation. Both fall within the framework of functional intestinal disorders and have major personal, health and social impact, altering the quality of life of the patients affected. The former is a subtype of irritable bowel syndrome in which constipation and altered bowel habit predominate, often along with recurring abdominal pain, bloating and abdominal distension. Constipation is characterised by infrequent or hard-to-pass bowel movements, often accompanied by straining during defecation or the sensation of incomplete evacuation. There is no underlying organic cause in the majority of cases; it being considered a functional bowel disorder. There are many clinical and pathophysiological similarities between the two conditions, the constipation responds in a similar way to commonly used drugs, the fundamental difference being the presence or absence of pain, but not in an "all or nothing" way. The severity of these disorders depends not only on the intensity of the intestinal symptoms but also on other biopsychosocial factors: association of gastrointestinal and extraintestinal symptoms, degree of involvement, forms of perception and behaviour. Functional bowel disorders are diagnosed using the Rome criteria. This Clinical practice guide adapts to the Rome IV criteria published at the end of May 2016. The first part (96, 97, 98) examined the conceptual and pathophysiological aspects, alarm criteria, diagnostic test and referral criteria between Primary Care and Gastroenterology. This second part reviews all the available treatment alternatives (exercise, fluid ingestion, diet with soluble fibre-rich foods, fibre supplements, other dietary components, osmotic or stimulating laxatives, probiotics, antibiotics, spasmolytics, peppermint essence, prucalopride, linaclotide, lubiprostone, biofeedback, antdepressants, psychological treatment, acupuncture, enemas, sacral root neurostimulation and surgery), and practical recommendations are made for each. Copyright © 2017 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

Effect of bowel cleansing on colonic transit in constipation due to slow transit or evacuation disorder.

PubMed

Sloots, C E J; Felt-Bersma, R J F

2002-02-01

Colon transit time measurement with radio-opaque markers is a method of studying the passage of luminal contents throughout the colon. Overall colonic transit time (CTT), as well as segmental transit times [right (RTT), left (LTT) and rectosigmoid (RSTT)], can be calculated. We hypothesize that CTT is influenced by faecal impaction when the rectum is emptied infrequently. The aim of this study is to investigate the effect of bowel cleansing on colonic transit time in patients with chronic constipation. In 25 women (age 41 years; range 20-65 years) with constipation according to Thompson criteria, CTT measurement was performed in an unprepared situation and repeated after cleansing with 4 L of Klean-Prepreg. Ten healthy female volunteers (age 41 years; range 27-57 years) were used as controls. In constipated patients, CTT decreased from a median 70 h (range 10-130 h) to 48 h (5-94 h) in the cleansed state (P < 0.001). A shortening of transit time was found in all three segments. In 10 patients with slow transit (ST) (CTT > 86 h), CTT decreased from 110 h (range 94-130) to 86 (38-94) (P < 0.001). Five of the 10 patients with ST before bowel cleansing had a CTT below 86 h after cleansing. In female controls, uncleansed CTT and RSTT shortened from 39 h (23 to 62) and 17 h (8-29) to 29 h (17-48) and 10 h (0-20) after bowel cleansing (P=0.058 and P=0.046). Colonic intraluminal contents have a substantial effect on colonic transit. In female controls, bowel cleansing shortened rectosigmoid transit. Women with constipation had faster transit in the cleansed state, however, the distribution of markers was not altered. Despite the effect of bowel cleansing on CTT, it seems unnecessary to prepare the bowel in clinical practice because the differentiation of patients between slow transit constipation and outlet obstruction is not changed. However, because in an infrequent defecation pattern, the influence of faecal impaction is considerable, CTT should be applied with care for critical clinical decisions in the treatment of constipation.

Redefining short bowel syndrome in the 21st century.

PubMed

Cohran, Valeria C; Prozialeck, Joshua D; Cole, Conrad R

2017-04-01

In 1968, Wilmore and Dudrick reported an infant sustained by parenteral nutrition (PN) providing a potential for survival for children with significant intestinal resections. Increasing usage of TPN over time led to some patients developing Intestinal Failure Associated Liver Disease (IFALD), a leading cause of death and indication for liver/intestinal transplant. Over time, multidisciplinary teams called Intestinal Rehabilitation Programs (IRPs) began providing meticulous and innovative management. Usage of alternative lipid emulsions and lipid minimization strategies have resulted in the decline of IFALD and an increase in long-term and transplant-free survival, even in the setting of ultrashort bowel (< 20 cm). Autologous bowel reconstructive surgeries, such as the serial tapering enteroplasty procedure, have increased the likelihood of achieving enteral autonomy. Since 2007, the number of pediatric intestinal transplants performed has sharply declined and likely attributed to the newer innovations healthcare. Recent data support the need for changes in the listing criteria for intestinal transplantation given the overall improvement in outcomes. Over the last 50 y, the diagnosis of short bowel syndrome has changed from a death sentence to one of hope with a vast improvement of quality of life and survival.

Epidemiological overview, advances in diagnosis, prevention, treatment and management of epithelial ovarian cancer in Mexico.

PubMed

Gallardo-Rincón, Dolores; Espinosa-Romero, Raquel; Muñoz, Wendy Rosemary; Mendoza-Martínez, Roberto; Villar-Álvarez, Susana Del; Oñate-Ocaña, Luis; Isla-Ortiz, David; Márquez-Manríquez, Juan Pablo; Apodaca-Cruz, Ángel; Meneses-García, Abelardo

2016-04-01

The epithelial ovarian cancer (EOC) has been underdiagnosed because it does not have a specific clinical presentation, and the signs and symptoms are similar to the irritable bowel syndrome and pelvic inflammatory disease. EOC is less common than breast and cervical cancer, but it is more lethal. On the whole, EOC has an early dissemination to peritoneal cavity, which delays a timely diagnosis and increases the rate of advanced diagnosed disease. The diagnosis usually surprises the women and the primary care physician. Therefore, it is necessary to count on prevention and early diagnosis programs. EOC has 80% response to surgical treatment, but nearly 70% of the patients may relapse in five years. The objectives of this document are presenting a summary of the EOC epidemiology and comment about advancements in prevention, diagnosis, and treatment of this cancer. That will raise awareness about the importance of this disease.

Evaluation of a vaccination regimen and care in relation to follow-up and treatment of patients with inflammatory bowel disease.

PubMed

Yamamoto-Furusho, J K; Sarmiento-Aguilar, A; Parra-Holguín, N N; Bozada-Gutiérrez, K E

2018-03-28

During the clinical course of inflammatory bowel disease, different causes can compromise kidney, liver, and bone marrow function and increase the risk for osteoporosis, infections, and neoplasias. The aim of the present study was to describe the follow-up of Mexican patients with inflammatory bowel disease in relation to their vaccination regimen, treatment-associated risks, and cancer screening. A retrospective cross-sectional study was conducted within the time frame of February and June 2017. One hundred patients that had a histopathologic diagnosis of inflammatory bowel disease were surveyed about their follow-up vaccination regimen, treatment-associated risks, and cancer screening. SPSS v24 software was employed for the statistical analysis. One hundred patients with inflammatory bowel disease were studied (90% with ulcerative colitis and 10% with Crohn's disease; 60% women, 40% men): 75% stated that they had no vaccination regimen. A total of 71.4% of the women had at least one Pap smear in their lives and 28.6% did not have them done annually. Twenty-four percent of the patients wore sun block daily. A total of 18.2% of the patients with more than a 10-year progression of ulcerative colitis had an annual colonoscopy. Yearly kidney function was registered in 57.1% of the patients, 92.9% had a yearly complete blood count, and 78.6% had yearly liver function tests. A total of 34.8% of patients had no bone densitometry in their case records. These results are a red flag suggesting the need to reinforce the role of the primary healthcare providers in relation to vaccination follow-up and the need to improve the education of the patient in relation to inflammatory bowel disease. Copyright © 2018 Asociación Mexicana de Gastroenterología. Publicado por Masson Doyma México S.A. All rights reserved.

Costs and cost-effectiveness of full implementation of a biennial faecal occult blood test screening program for bowel cancer in Australia.

PubMed

Pignone, Michael P; Flitcroft, Kathy L; Howard, Kirsten; Trevena, Lyndal J; Salkeld, Glenn P; St John, D James B

2011-02-21

To examine the costs and cost-effectiveness of full implementation of biennial bowel cancer screening for Australian residents aged 50-74 years. Identification of existing economic models from 1993 to 2010 through searches of PubMed and economic analysis databases, and by seeking expert advice; and additional modelling to determine the costs and cost-effectiveness of full implementation of biennial faecal occult blood test screening for the five million adults in Australia aged 50-74 years. Estimated number of deaths from bowel cancer prevented, costs, and cost-effectiveness (cost per life-year gained [LYG]) of biennial bowel cancer screening. We identified six relevant economic analyses, all of which found colorectal cancer (CRC) screening to be very cost-effective, with costs per LYG under $55,000 per year in 2010 Australian dollars. Based on our additional modelling, we conservatively estimate that full implementation of biennial screening for people aged 50-74 years would have gross costs of $150 million, reduce CRC mortality by 15%-25%, prevent 300-500 deaths from bowel cancer, and save 3600-6000 life-years annually, for an undiscounted cost per LYG of $25,000-$41,667, compared with no screening, and not taking cost savings as a result of treatment into consideration. The additional expenditure required, after accounting for reductions in CRC incidence, savings in CRC treatment costs, and existing ad-hoc colonoscopy use, is likely to be less than $50 million annually. Full implementation of biennial faecal occult blood test screening in Australia can reduce bowel cancer mortality, and is an efficient use of health resources that would require modest additional government investment.

In the Absence of a Mechanical Bowel Prep, Does the Addition of Pre-Operative Oral Antibiotics to Parental Antibiotics Decrease the Incidence of Surgical Site Infection after Elective Segmental Colectomy?

PubMed

Atkinson, Sarah J; Swenson, Brian R; Hanseman, Dennis J; Midura, Emily F; Davis, Bradley R; Rafferty, Janice F; Abbott, Daniel E; Shah, Shimul A; Paquette, Ian M

2015-12-01

Pre-operative oral antibiotics administered the day prior to elective colectomy have been shown to decrease the incidence of surgical site infections (SSI) if a mechanical bowel prep (MBP) is used. Recently, the role for mechanical bowel prep has been challenged as being unnecessary and potentially harmful. We hypothesize that if MBP is omitted, oral antibiotics do not alter the incidence of SSI following colectomy. We selected patients who underwent an elective segmental colectomy from the 2012 and 2013 National Surgical Quality Improvement Program colectomy procedure targeted database. Indications for surgery included colon cancer, diverticulitis, inflammatory bowel disease, or benign polyp. Patients who received mechanical bowel prep were excluded. The primary outcome measured was surgical site infection, defined as the presence of superficial, deep or, organ space infection within 30 d from surgery. A total of 6,399 patients underwent elective segmental colectomy without MBP. The incidence of SSI differed substantially between patients who received oral antibiotics, versus those who did not (9.7% vs. 13.7%, p=0.01). Multivariate analysis indicated that age, smoking status, operative time, perioperative transfusions, oral antibiotics, and surgical approach were associated with post-operative SSI. When controlling for confounding factors, the use of pre-operative oral antibiotics decreased the incidence of surgical site infection (odds ratio=0.66, 95% confidence interval=0.48-0.90, p=0.01). Even in the absence of mechanical bowel prep, pre-operative oral antibiotics appear to reduce the incidence of surgical site infection following elective colectomy.

Combination oral and mechanical bowel preparations decreases complications in both right and left colectomy.

PubMed

Midura, Emily F; Jung, Andrew D; Hanseman, Dennis J; Dhar, Vikrom; Shah, Shimul A; Rafferty, Janice F; Davis, Bradley R; Paquette, Ian M

2018-03-01

Before elective colectomy, many advocate mechanical bowel preparation with oral antibiotics, whereas enhanced recovery pathways avoid mechanical bowel preparations. The optimal preparation for right versus left colectomy is also unclear. We sought to determine which strategy for bowel preparation decreases surgical site infection (SSI) and anastomotic leak (AL). Elective colectomies from the National Surgical Quality Improvement Program colectomy database (2012-2015) were divided by (1) type of bowel preparation: no preparation (NP), mechanical preparation (MP), oral antibiotics (PO), or mechanical and oral antibiotics (PO/MP); and (2) type of colonic resection: right, left, or segmental colectomy. Univariate and multivariate analyses identified predictors of SSI and AL, and their risk-adjusted incidence was determined by logistic regression. When analyzed as the odds ratio compared with NP, the PO and PO/MP groups were associated with a decrease in SSI (PO = 0.70 [0.55-0.88] and PO/MP = 0.47 [0.42-0.53]; P < .01). Use of PO/MP was associated with a decrease in SSI across all types of resections (right colectomy = 0.40 [0.33-0.50], left colectomy = 0.57 [0.47-0.68], and segmental colectomy = 0.43 (0.34-0.54); P < .01). Similarly, use of PO/MP was associated with a decrease in AL in left colectomy = 0.50 ([0.37-0.69]; P < .01) and segmental colectomy = 0.53 ([0.36-0.80]; P < .01). Mechanical bowel preparation with oral antibiotics is the preferred preoperative preparation strategy in elective colectomy because of decreased incidence of SSI and AL. Copyright © 2017 Elsevier Inc. All rights reserved.

Posttransplant complications in adult recipients of intestine grafts without bowel decontamination.

PubMed

Clouse, Jared W; Kubal, Chandrashekhar A; Fridell, Jonathan A; Mangus, Richard S

2018-05-01

Selective digestive decontamination is commonly used to decrease lumenal bacterial flora. Preoperative bowel decontamination may be associated with a lower wound infection rate but has not been shown to decrease risk of intra-abdominal abscess or lower leak rate for enteric anastomoses. Alternatively, the decontamination disrupts the normal flora of the gastrointestinal tract and may affect normal physiology, including immunologic function. This study reports complication rates of an intestine transplant program that has never used bowel decontamination. All adult patients who underwent intestine transplant from 2003 to 2015 at a single center were reviewed. Posttransplant complications included intra-abdominal abscess, enteric fistula, and leak from the enteric anastomosis. Viral, fungal, and bacterial infections in the first year after transplant are reported. There were 184 adult patients who underwent deceased donor intestine transplant during the study period. Among these patients, 30% developed an infected postoperative fluid collection, 4 developed an enteric fistula (2%), and 16 had an enteric or anastomotic leak (8%). The rate of any bacterial infection was 91% in the first year, with a wound infection rate of 25%. Fungal infection occurred in 47% of patients. Rejection rates were 55% at 1 y for isolated intestine patients and 17% for multivisceral (liver inclusive) patients. Among this population of intestine transplant patients in which no bowel decontamination was used, rates of surgical complications, infections, and rejection were similar to those reported by other centers. Bowel decontamination provides no identifiable benefit in intestine transplantation. Copyright © 2018 Elsevier Inc. All rights reserved.

Issues in irrigation for people with a permanent colostomy: a review.

PubMed

Varma, Sarah

Colostomy irrigation is a way of achieving faecal continence and is offered as an alternative method of stoma care management to wearing and emptying a colostomy appliance. This article summarizes an extensive literature review carried out to determine the benefits of irrigation to colostomists and barriers to its uptake. Colostomy irrigation is a method of stoma care management offering 'control' over bowel habit thus assisting the colostomist in the adjustment and adaptation towards their new way of life.

Iyengar Yoga for Adolescents and Young Adults With Irritable Bowel Syndrome

PubMed Central

Evans, Subhadra; Lung, Kirsten C.; Seidman, Laura C.; Sternlieb, Beth; Zeltzer, Lonnie K.; Tsao, Jennie C.I.

2014-01-01

Objectives Irritable bowel syndrome (IBS) is a chronic, disabling condition that greatly compromises patient functioning. The aim of this study was to assess the impact of a 6-week twice per week Iyengar yoga (IY) program on IBS symptoms in adolescents and young adults (YA) with IBS compared with a usual-care waitlist control group. Methods Assessments of symptoms, global improvement, pain, health-related quality of life, psychological distress, functional disability, fatigue, and sleep were collected pre- and posttreatment. Weekly ratings of pain, IBS symptoms, and global improvement were also recorded until 2-month follow-up. A total of 51 participants completed the intervention (yoga = 29; usual-care waitlist = 22). Results Baseline attrition was 24%. On average, the yoga group attended 75% of classes. Analyses were divided by age group. Relative to controls, adolescents (14–17 years) assigned to yoga reported significantly improved physical functioning, whereas YA (18–26 years) assigned to yoga reported significantly improved IBS symptoms, global improvement, disability, psychological distress, sleep quality, and fatigue. Although abdominal pain intensity was statistically unchanged, 44% of adolescents and 46% of YA reported a minimally clinically significant reduction in pain following yoga, and one-third of YA reported clinically significant levels of global symptom improvement. Analysis of the uncontrolled effects and maintenance of treatment effects for adolescents revealed global improvement immediately post-yoga that was not maintained at follow-up. For YA, global improvement, worst pain, constipation, and nausea were significantly improved postyoga, but only global improvement, worst pain, and nausea maintained at the 2-month follow-up. Conclusions The findings suggest that a brief IY intervention is a feasible and safe adjunctive treatment for young people with IBS, leading to benefits in a number of IBS-specific and general functioning domains for YA. The age-specific results suggest that yoga interventions may be most fruitful when developmentally tailored. PMID:25025601

Iyengar yoga for adolescents and young adults with irritable bowel syndrome.

PubMed

Evans, Subhadra; Lung, Kirsten C; Seidman, Laura C; Sternlieb, Beth; Zeltzer, Lonnie K; Tsao, Jennie C I

2014-08-01

Irritable bowel syndrome (IBS) is a chronic, disabling condition that greatly compromises patient functioning. The aim of this study was to assess the impact of a 6-week twice per week Iyengar yoga (IY) program on IBS symptoms in adolescents and young adults (YA) with IBS compared with a usual-care waitlist control group. Assessments of symptoms, global improvement, pain, health-related quality of life, psychological distress, functional disability, fatigue, and sleep were collected pre- and posttreatment. Weekly ratings of pain, IBS symptoms, and global improvement were also recorded until 2-month follow-up. A total of 51 participants completed the intervention (yoga = 29; usual-care waitlist = 22). Baseline attrition was 24%. On average, the yoga group attended 75% of classes. Analyses were divided by age group. Relative to controls, adolescents (14-17 years) assigned to yoga reported significantly improved physical functioning, whereas YA (18-26 years) assigned to yoga reported significantly improved IBS symptoms, global improvement, disability, psychological distress, sleep quality, and fatigue. Although abdominal pain intensity was statistically unchanged, 44% of adolescents and 46% of YA reported a minimally clinically significant reduction in pain following yoga, and one-third of YA reported clinically significant levels of global symptom improvement. Analysis of the uncontrolled effects and maintenance of treatment effects for adolescents revealed global improvement immediately post-yoga that was not maintained at follow-up. For YA, global improvement, worst pain, constipation, and nausea were significantly improved postyoga, but only global improvement, worst pain, and nausea maintained at the 2-month follow-up. The findings suggest that a brief IY intervention is a feasible and safe adjunctive treatment for young people with IBS, leading to benefits in a number of IBS-specific and general functioning domains for YA. The age-specific results suggest that yoga interventions may be most fruitful when developmentally tailored.

Primary Care Management of Chronic Constipation in Asia: The ANMA Chronic Constipation Tool

PubMed Central

Ghoshal, Uday C; Gonlachanvit, Sutep; Chua, Andrew Seng Boon; Myung, Seung-Jae; Rajindrajith, Shaman; Patcharatrakul, Tanisa; Choi, Myung-Gyu; Wu, Justin C Y; Chen, Min-Hu; Gong, Xiao-Rong; Lu, Ching-Liang; Chen, Chien-Lin; Pratap, Nitesh; Abraham, Philip; Hou, Xiao-Hua; Ke, Meiyun; Ricaforte-Campos, Jane D; Syam, Ari Fahrial; Abdullah, Murdani

2013-01-01

Chronic constipation (CC) may impact on quality of life. There is substantial patient dissatisfaction; possible reasons are failure to recognize underlying constipation, inappropriate dietary advice and inadequate treatment. The aim of these practical guidelines intended for primary care physicians, and which are based on Asian perspectives, is to provide an approach to CC that is relevant to the existing health-care infrastructure. Physicians should not rely on infrequent bowel movements to diagnose CC as many patients have one or more bowel movement a day. More commonly, patients present with hard stool, straining, incomplete feeling, bloating and other dyspeptic symptoms. Physicians should consider CC in these situations and when patients are found to use laxative containing supplements. In the absence of alarm features physicians may start with a 2-4 week therapeutic trial of available pharmacological agents including osmotic, stimulant and enterokinetic agents. Where safe to do so, physicians should consider regular (as opposed to on demand dosing), combination treatment and continuous treatment for at least 4 weeks. If patients do not achieve satisfactory response, they should be referred to tertiary centers for physiological evaluation of colonic transit and pelvic floor function. Surgical referral is a last resort, which should be considered only after a thorough physiological and psychological evaluation. PMID:23667746

Malignant Bowel Obstruction in Advanced Gynecologic Cancers: An Updated Review from a Multidisciplinary Perspective

PubMed Central

Lee, Yeh Chen; Jivraj, Nazlin; O'Brien, Catherine; Chawla, Tanya; Shlomovitz, Eran; Buchanan, Sarah; Lau, Jenny; Croke, Jennifer; Allard, Johane P.; Dhar, Preeti; Laframboise, Stephane; Ferguson, Sarah E.; Dhani, Neesha; Butler, Marcus; Ng, Pamela; Stuart-McEwan, Terri; Savage, Pamela; Tinker, Lisa; Oza, Amit M.

2018-01-01

Malignant bowel obstruction (MBO) is a major complication in women with advanced gynecologic cancers which imposes a significant burden on patients, caregivers, and healthcare systems. Symptoms of MBO are challenging to palliate and result in progressive decompensation of already vulnerable patients with limited therapeutic options and a short prognosis. However, there is a paucity of guidelines or innovative approaches to improve the care of women who develop MBO. MBO is a complex clinical situation that requires a multidisciplinary approach to ensure the appropriate treatment modality and interprofessional care to optimally manage these patients. This review summarizes the current literature on the different approaches targeting MBO management including surgical intervention, chemotherapy, total parenteral nutrition, and pharmacological treatment. In addition, the impact of MBO management on patients' quality of life (QOL) is examined. This article focuses on the challenges in developing evidence-based treatment guidelines for MBO and barriers in clinical trial design for MBO and proposes strategies to advance the MBO management. Collaboration is essential to design studies that may improve the overall care and quality of life for these patients. Prospective data are needed to inform clinical practice, establish a new benchmark for evidence-based MBO management, and better understand the biology of MBO. PMID:29887891

Beliefs and Attitudes to Bowel Cancer Screening in Patients with CKD: A Semistructured Interview Study.

PubMed

James, Laura J; Wong, Germaine; Craig, Jonathan C; Ju, Angela; Williams, Narelle; Lim, Wai H; Cross, Nicholas; Tong, Allison

2017-04-03

Bowel cancer is a leading cause of cancer-related death in people with CKD. Shared decision making regarding cancer screening is particularly complex in CKD and requires an understanding of patients' values and priorities, which remain largely unknown. Our study aimed to describe the beliefs and attitudes to bowel cancer screening in patients with CKD. Face to face, semistructured interviews were conducted from April of 2014 to December of 2015 with 38 participants ages 39-78 years old with CKD stages 3-5, on dialysis, or transplant recipients from four renal units in Australia and New Zealand. Thematic analysis was used to analyze the transcripts. Five themes were identified: invisibility of cancer (unspoken stigma, ambiguity of risk, and absence of symptomatic prompting); prioritizing kidney disease (preserving the chance of transplantation, over-riding attention to kidney disease, protecting graft survival, and showing loyalty to the donor); preventing the crisis of cancer (evading severe consequences and cognizant of susceptibility); cognitive resistance (reluctance to perform a repulsive procedure, intensifying disease burden threshold, anxiety of a positive test, and accepting the inevitable); and pragmatic accessibility (negligible financial effect, convenience, and protecting anonymity). Patients with CKD understand the potential health benefits of bowel cancer screening, but they are primarily committed to their kidney health. Their decisions regarding screening revolve around their present health needs, priorities, and concerns. Explicit consideration of the potential practical and psychosocial burdens that bowel cancer screening may impose on patients in addition to kidney disease and current treatment is suggested to minimize decisional conflict and improve patient satisfaction and health care outcomes in CKD. Copyright © 2017 by the American Society of Nephrology.

Beliefs and Attitudes to Bowel Cancer Screening in Patients with CKD: A Semistructured Interview Study

PubMed Central

Wong, Germaine; Craig, Jonathan C.; Ju, Angela; Williams, Narelle; Lim, Wai H.; Cross, Nicholas; Tong, Allison

2017-01-01

Background and objectives Bowel cancer is a leading cause of cancer-related death in people with CKD. Shared decision making regarding cancer screening is particularly complex in CKD and requires an understanding of patients’ values and priorities, which remain largely unknown. Our study aimed to describe the beliefs and attitudes to bowel cancer screening in patients with CKD. Design, setting, participants, & measurements Face to face, semistructured interviews were conducted from April of 2014 to December of 2015 with 38 participants ages 39–78 years old with CKD stages 3–5, on dialysis, or transplant recipients from four renal units in Australia and New Zealand. Thematic analysis was used to analyze the transcripts. Results Five themes were identified: invisibility of cancer (unspoken stigma, ambiguity of risk, and absence of symptomatic prompting); prioritizing kidney disease (preserving the chance of transplantation, over-riding attention to kidney disease, protecting graft survival, and showing loyalty to the donor); preventing the crisis of cancer (evading severe consequences and cognizant of susceptibility); cognitive resistance (reluctance to perform a repulsive procedure, intensifying disease burden threshold, anxiety of a positive test, and accepting the inevitable); and pragmatic accessibility (negligible financial effect, convenience, and protecting anonymity). Conclusions Patients with CKD understand the potential health benefits of bowel cancer screening, but they are primarily committed to their kidney health. Their decisions regarding screening revolve around their present health needs, priorities, and concerns. Explicit consideration of the potential practical and psychosocial burdens that bowel cancer screening may impose on patients in addition to kidney disease and current treatment is suggested to minimize decisional conflict and improve patient satisfaction and health care outcomes in CKD. PMID:28153937

Traumatic diaphragmatic rupture through the central tendon with herniation of the stomach and coils of small bowel into the pericardial cavity.

PubMed

Nwafor, I A; Eze, J C; Aminu, M B

2011-01-01

Traumatic diaphragmatic rupture through the central tendon with herniation of the stomach and coils of small bowel into the pericardial cavity. Case note of a patient managed for traumatic diaphragmatic rupture through the central tendon with herniation of the stomach and coils of small bowel into the pericardial cavity was used with a review of relevant literature. A 49-year old civil engineer who presented with 2-year history of easy fatigability and palpitations as well as a 6-month history of hypertension and was initially managed as a case dilated cardiomyopathy to rule out incipient CCF secondary to hypertension, was evaluated and found to have chronic diaphragmatic hernia through the central tendon with evisceration of the stomach and coils of the small bowel into the pericardial cavity. Though there was history of motor vehicle crash preceding the development of the symptoms, but the long history of effort dyspnoea and palpitations added to enlarged cardiac silhouette on posterior anterior chest x-ray, a diagnostic challenge was posed which was resolved by thoracoabdominal CT scan. Patient had left sided posteriorlateral thoracotomy via 7h intercostal space followed with reduction of thq stomach and coils of small bowel after careful adhesiolysis and repair of the defect in double layers. High index of suspicion is very important in the diagnosis of diaphragmatic central tendon injury considering the rarity of the injury and diagnostic challenges it poses in chronic form. However, where the facilities are available, CT scan and 2-D echo will most of the time clinch the diagnosis; also is upper gastrointestinal series.

Prevalence and risk factors for functional bowel disorders in South China: a population based study using the Rome III criteria.

PubMed

Long, Y; Huang, Z; Deng, Y; Chu, H; Zheng, X; Yang, J; Zhu, Y; Fried, M; Fox, M; Dai, N

2017-01-01

Functional bowel disorders (FBDs) such as irritable bowel syndrome (IBS) impact on quality of life and health care resources. It is uncertain whether patients with functional digestive symptoms have similar characteristics in different populations. This population-based study assessed the prevalence and identified risk factors for these disorders in South-East China. Five communities were selected at random and invitations distributed to a representative sample (block randomization). Questionnaires were completely supervised by investigators. Demographic and medical data with FBD symptoms (Rome III criteria), psychological condition, life event stress, and quality of life were collected. Functional bowel disorder prevalence was 41.6% in 1999/2115 (94.5%) completed questionnaires: 9.9% functional constipation (FC), 6.8% bloating (FB), 6.5% diarrhea (FD), 5.9% IBS (IBS-D 47.1%, IBS-M 23.9%, IBS-C 12.8%, IBS-U 16.2%), and 12.6% unspecified. Similar numbers of men and women had FBDs or IBS (overall; 51.3% male vs 48.7% female, P=.796); however, there was female predominance in FC (62.1%, P<.001) and FB (58.5%, P=.038). FBDs were associated with greater anxiety, depression, life event stress, and a lower quality of life compared with those without symptoms (all, P<.0001). Logistic regression identified medical co-morbidity, anxiety/depression, and life event stress as independent risk factors for these disorders. Functional bowel disorders are as common in South China as in western populations. A similar number of men and women report FBDs and IBS. Only FC and FB are more prevalent in females. Independent risk factors associated with FBDs included physical and psychosocial stressors. © 2016 John Wiley & Sons Ltd.

Postoperative ileus-related morbidity profile in patients treated with alvimopan after bowel resection.

PubMed

Wolff, Bruce G; Weese, James L; Ludwig, Kirk A; Delaney, Conor P; Stamos, Michael J; Michelassi, Fabrizio; Du, Wei; Techner, Lee

2007-04-01

Postoperative ileus (POI), an interruption of coordinated bowel motility after operation, is exacerbated by opioids used to manage pain. Alvimopan, a peripherally acting mu-opioid receptor antagonist, accelerated gastrointestinal (GI) recovery after bowel resection in randomized, double-blind, placebo-controlled, multicenter phase III POI trials. The effect of alvimopan on POI-related morbidity for patients who underwent bowel resection was evaluated in a post-hoc analysis. Incidence of POI-related postoperative morbidity (postoperative nasogastric tube insertion or POI-related prolonged hospital stay or readmission) was analyzed in four North American trials for placebo or alvimopan 12 mg administered 30 minutes or more preoperatively and twice daily postoperatively until hospital discharge (7 or fewer postoperative days). GI-related adverse events and opioid consumption were summarized for each treatment. Estimations of odds ratios of alvimopan to placebo and number needed to treat (NNT) to prevent one patient from experiencing an event of POI-related morbidity were derived from the analysis. Patients receiving alvimopan 12 mg were less likely to experience POI-related morbidity than patients receiving placebo (odds ratio = 0.44, p < 0.001). Fewer patients receiving alvimopan (alvimopan, 7.6%; placebo, 15.8%; NNT = 12) experienced POI-related morbidity. There was a lower incidence of postoperative nasogastric tube insertion, and other GI-related adverse events on postoperative days 3 to 6 in the alvimopan group than the placebo group. Opioid consumption was comparable between groups. Alvimopan 12 mg was associated with reduced POI-related morbidity compared with placebo, without compromising opioid-based analgesia in patients undergoing bowel resection. Relatively low NNTs are clinically meaningful and reinforce the potential benefits of alvimopan for the patient and health care system.

Impact of new-generation parenteral lipid emulsions in pediatric nutrition

USDA-ARS?s Scientific Manuscript database

Advancements in the care of premature infants and infants with severe bowel disease have occurred in which long-term use of i.v. nutrition is a cornerstone of successful therapy. Concern about the role of i.v. lipid emulsions in causing severe liver damage to high-risk infants receiving long-term i....

[Persistent diarrhea in the returned traveler].

PubMed

de Saussure, P; Hadengue, A

2006-05-10

Persistent diarrhea in a returned traveler is a frequent presenting complaint and may result from three etiologic groups: persistant infections, non-infectious post-gastroenteritis processes (in particular postinfectious irritable bowel syndrome) and appearance of an unrelated cause of chronic diarrhea. This article reviews the most frequent diseases involved and provides management guidelines for primary care physicians.

Incidence of Pulmonary Disease in Inflammatory Bowel Disease

DTIC Science & Technology

2017-03-30

were conducted according to the principles set forth in the National Institute of Health Publication No. 80·23, Guide for the Care and Use of...Multi- Market . This was used as the study group and was cross referenced by the SAMMC HCO for the ICD-9 codes of pulmonary diagnoses (See table 1 ). The

Diarrhoea, constipation and intestinal transit in a northern Nigerian population.

PubMed

Fakunle, Y M; Ajagbonna, S O; Ani, O E; Awofeso, O

1978-07-01

Healthy Nigerians from Zaria have a short intestinal transit time. It is usual for them to open their bowels daily and their concept of diarrhoea and constipation differs widely from the standard medical definition. To avoid confusion care must be taken to inquire exactly what patients mean when they present with these symptoms.

Prospective Integration of Cultural Consideration in Biomedical Research for Patients with Advanced Cancer: Recommendations from an International Conference on Malignant Bowel Obstruction in Palliative Care

PubMed Central

Fineberg, Iris Cohen; Grant, Marcia; Aziz, Noreen M.; Payne, Richard; Kagawa-Singer, Marjorie; Dunn, Geoffrey P.; Kinzbrunner, Barry M.; Palos, Guadalupe; Shinagawa, Susan Matsuko; Krouse, Robert S.

2007-01-01

In the setting of an international conference on malignant bowel obstruction as a model for randomized control trials (RCT) in palliative care, we discuss the importance of incorporating prospective cultural considerations in research design. The approach commonly used in biomedical research has traditionally valued the RCT as the ultimate “way of knowing” about how to best treat a medical condition. The foremost limitation of this approach is the lack of recognition of the impact of cultural viewpoints on research outcomes. We propose that interest relevant cultural viewpoints should be emphasized in conceptualizing and interpreting research questions, designs, and results. In addition to recognizing our cultural biases as individuals and researchers, we recommend two major shifts in designing and implementing RCTs: a) inclusion of a multidisciplinary team of researchers to inform the diversity of perspectives and expertise brought to the research, and b) use of mixed methods of inquiry, reflecting both deductive and inductive modes of inference. PMID:17532174

[Management and Nursing care for a patient with Lynch syndrome: A case report].

PubMed

Pacheco-Pérez, Luis Arturo; Guevara Valtier, Milton Carlos

2016-01-01

Colorectal cancer is one of the leading causes of death from cancer worldwide. Main interventions to reduce the impact are aimed to enhance prevention and early detection. Results of several studies show that tests such as the fecal occult blood test and colonoscopy are effective for early diagnosis. There are hereditary syndromes such as Lynch Syndrome that can lead to certain types of cancers, including bowel neoplasms, therefore early detection needs to be included as part of the treatment. In these cases, family genetic testing is recommended if the bowel cancer is diagnosed before 50 years old. A care plan including the NANDA (North American Nursing Diagnosis Association), NOC (Nursing Outcomes Classification) and NIC (Nursing Interventions Classification) was developed for a patient with suspected Lynch Syndrome. Nurses should be qualified to identify potential cases of cancer associated with this syndrome, and thus, reduce the likelihood that family members develop the disease, through genetic counseling and education of environmental risk factors. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

[Clinical and therapeutical considerations regarding the diagnosis and treatment in meconial disease].

PubMed

Sabetay, C; Ciobanu, O; Zavate, A; Ciucă, M; Malos, A; Marin-Diu, B

2010-01-01

The meconium disease represents a problem of great impact over the vital prognosis of the newborn, the mortality of this disease being rated in various studies between 30 and 50%. The meconial disease that reunites the meconial ileus and the meconial peritonitis is often associated with cystic fibrosis a disease of general impact over the entire organism increasing the gravity and influencing the vital prognosis of these patients. The authors' purpose is to evaluate the results obtained after the treatment of the meconial disease in the Pediatric Surgery Clinic of the Emergency Hospital of Craiova over a period of 10 years. The study has been made on a number of 16 cases of meconial ileus, plug and peritonitis analising the difficulty of the diagnostic process, the preoperative care as well as the possibilities of surgical treatment. The surgical treatment is composed of multiple procedures including simple suture of the bowel defect and segmentary bowel resections with primary anastomosis and/or secondary anastomosis after ileostoma. The mortality on the studied cases was of 37.5% despite recent progresses achieved in postoperative care of these type of patients.

Cannabis and Pediatric Inflammatory Bowel Disease: Change Blossoms a Mile High.

PubMed

Hoffenberg, Edward J; Newman, Heike; Collins, Colm; Tarbell, Sally; Leinwand, Kristina

2017-02-01

The trend toward decriminalization of cannabis (marijuana) continues sweeping across the United States. Colorado has been a leader of legalization of medical and recreational cannabis use. The growing public interest in the medicinal properties of cannabis and its use by patients with a variety of illnesses including inflammatory bowel disease (IBD) makes it important for pediatric gastroenterologists to understand this movement and its potential effect on patients. This article describes the path to legalization and "medicalization" of cannabis in Colorado and the public perception of safety despite the known adverse health effects of use. We delineate the mammalian endocannabinoid system and our experience of caring for children and adolescents with IBD in an environment of increasing awareness and acceptance of its use. We then summarize the rationale for considering that cannabis may have beneficial and harmful effects for patients with IBD. Finally, we highlight the challenges federal laws impose on conducting research on cannabis in IBD. The intent of this article is to inform health care providers about the issues around cannabis use and research in adolescents and young adults with IBD.

Treatment of nausea and vomiting in terminally ill cancer patients.

PubMed

Glare, Paul A; Dunwoodie, David; Clark, Katherine; Ward, Alicia; Yates, Patsy; Ryan, Sharon; Hardy, Janet R

2008-01-01

Nausea and vomiting is a common and distressing symptom complex in patients with far-advanced cancer, affecting up to 60% of individuals at some stage of their illness. The current approach to the palliative care of patients with nausea and vomiting is based on identifying the cause, understanding its pathophysiology and knowing the pharmacology of the drugs available for its amelioration. The following six main syndromes are identified: gastric stasis, biochemical, raised intracranial pressure, vestibular, mechanical bowel obstruction and ileus. A careful history, focused physical examination and appropriate investigations are needed to elucidate the syndrome and its cause, so that therapy is rational. Drugs are the mainstay of treatment in terminal cancer, and the main classes of antiemetic agents are prokinetics, dopamine antagonists, antihistamines, anticholinergics and serotonin antagonists. Dexamethasone and octreotide are also used, especially in bowel obstruction. Non-drug measures are important in relieving the associated distress. Patients should be able to die comfortably, without tubes. Despite decades of practice affirming this approach, the evidence base is weak and well designed studies are urgently needed.

Cannabis and pediatric inflammatory bowel disease: change blossoms a mile high

PubMed Central

Hoffenberg, Edward J.; Newman, Heike; Collins, Colm; Leinwand, Kristina; Tarbell, Sally

2016-01-01

The trend towards decriminalization of cannabis (marijuana) continues sweeping across the United States. Colorado has been a leader of legalization of medical and recreational cannabis use. The growing public interest in the medicinal properties of cannabis and its use by patients with a variety of illnesses including inflammatory bowel disease (IBD) makes it important for pediatric gastroenterologists to understand this movement and its potential impact on patients. This article describes the path to legalization and “medicalization” of cannabis in Colorado as well as the public perception of safety despite the known adverse health effects of use. We delineate the mammalian endocannabinoid system and our experience of caring for children and adolescents with IBD in an environment of increasing awareness and acceptance of its use. We then summarize the rationale for considering that cannabis may have beneficial as well as harmful effects for IBD patients. Finally, we highlight the challenges federal laws impose on conducting research on cannabis in IBD. The intent of this article is to inform health care providers about the issues around cannabis use and research in adolescents and young adults with IBD. PMID:27579692

Low Rates of Dermatologic Care and Skin Cancer Screening Among Inflammatory Bowel Disease Patients.

PubMed

Anderson, Alyce; Ferris, Laura K; Click, Benjamin; Ramos-Rivers, Claudia; Koutroubakis, Ioannis E; Hashash, Jana G; Dunn, Michael; Barrie, Arthur; Schwartz, Marc; Regueiro, Miguel; Binion, David G

2018-04-30

Dermatologic manifestations of inflammatory bowel disease (IBD) are common, and certain IBD medications increase the risk of skin cancer. To define the rates of care and factors associated with dermatologic utilization with a focus on skin cancer screening. We utilized a prospective, natural history IBD research registry to evaluate all outpatient healthcare encounters from 2010 to 2016. Gastrointestinal, dermatologic and primary care visits per individual were identified. We calculated the proportion of patients obtaining care, categorized primary indications for dermatologic visits, determined the incidence of melanoma and non-melanoma skin cancers, and used logistic regression to determine factors associated with dermatology utilization. Of the 2127 IBD patients included, 452 (21.3%) utilized dermatology over the study period, and 55 (2.6%) had a total body skin examination at least once. The 452 patients incurred 1633 dermatology clinic visits, 278 dermatologic procedures, and 1108 dermatology telephone encounters. The most frequent indication was contact dermatitis or dermatitis. Factors associated with dermatology use were family history of skin cancer, employment, systemic steroids, longer disease duration, emergency room use, and the number of IBD-related clinic visits. Between 8.3 and 11% of IBD patients recommended for skin cancer screening visited dermatology each year, and the resulting incidence of non-melanoma skin cancer was 35.4/10,000 [95% CI 23.3-51.5] and melanoma was 6.56/10,000 [95% CI 2.1-15.3]. Less than one in ten IBD patients obtain dermatologic care. Given the increased risk of skin cancers among IBD patients, an emphasis on education, prevention, and screening merits attention.

Validation of the 'United Registries for Clinical Assessment and Research' [UR-CARE], a European Online Registry for Clinical Care and Research in Inflammatory Bowel Disease.

PubMed

Burisch, Johan; Gisbert, Javier P; Siegmund, Britta; Bettenworth, Dominik; Thomsen, Sandra Bohn; Cleynen, Isabelle; Cremer, Anneline; Ding, Nik John Sheng; Furfaro, Federica; Galanopoulos, Michail; Grunert, Philip Christian; Hanzel, Jurij; Ivanovski, Tamara Knezevic; Krustins, Eduards; Noor, Nurulamin; O'Morain, Neil; Rodríguez-Lago, Iago; Scharl, Michael; Tua, Julia; Uzzan, Mathieu; Ali Yassin, Nuha; Baert, Filip; Langholz, Ebbe

2018-04-27

The 'United Registries for Clinical Assessment and Research' [UR-CARE] database is an initiative of the European Crohn's and Colitis Organisation [ECCO] to facilitate daily patient care and research studies in inflammatory bowel disease [IBD]. Herein, we sought to validate the database by using fictional case histories of patients with IBD that were to be entered by observers of varying experience in IBD. Nineteen observers entered five patient case histories into the database. After 6 weeks, all observers entered the same case histories again. For each case history, 20 key variables were selected to calculate the accuracy for each observer. We assumed that the database was such that ≥ 90% of the entered data would be correct. The overall proportion of correctly entered data was calculated using a beta-binomial regression model to account for inter-observer variation and compared to the expected level of validity. Re-test reliability was assessed using McNemar's test. For all case histories, the overall proportion of correctly entered items and their confidence intervals included the target of 90% (Case 1: 92% [88-94%]; Case 2: 87% [83-91%]; Case 3: 93% [90-95%]; Case 4: 97% [94-99%]; Case 5: 91% [87-93%]). These numbers did not differ significantly from those found 6 weeks later [NcNemar's test p > 0.05]. The UR-CARE database appears to be feasible, valid and reliable as a tool and easy to use regardless of prior user experience and level of clinical IBD experience. UR-CARE has the potential to enhance future European collaborations regarding clinical research in IBD.

Betel leaf in stoma care.

PubMed

Banu, Tahmina; Talukder, Rupom; Chowdhury, Tanvir Kabir; Hoque, Mozammel

2007-07-01

Construction of a stoma is a common procedure in pediatric surgical practice. For care of these stomas, commercially available devices such as ostomy bag, either disposable or of longer duration are usually used. These are expensive, particularly in countries like Bangladesh, and proper-sized ones are not always available. We have found an alternative for stoma care, betel leaf, which is suitable for Bangladeshis. We report the outcome of its use. After construction of stoma, at first zinc oxide paste was applied on the peristomal skin. A betel leaf with shiny, smooth surface outwards and rough surface inwards was put over the stoma with a hole made in the center according to the size of stoma. Another intact leaf covers the stomal opening. When bowel movement occurs, the overlying intact leaf was removed and the fecal matter was washed away from both. The leaves were reused after cleaning. Leaves were changed every 2 to 3 days. From June 1998 to December 2005, in the department of pediatric surgery, Chittagong Medical College and Hospital, Chittagong, Bangladesh, a total of 623 patients had exteriorization of bowel. Of this total, 495 stomas were cared for with betel leaves and 128 with ostomy bags. Of 623 children, 287 had sigmoid colostomy, 211 had transverse colostomy, 105 had ileostomy, and 20 had jejunostomy. Of the 495 children under betel leaf stoma care, 13 patients (2.6%) developed skin excoriation. There were no allergic reactions. Of the 128 patients using ostomy bag, 52 (40.65%) had skin excoriation. Twenty-four (18.75%) children developed some allergic reactions to adhesive. Monthly costs for betel leaves were 15 cents (10 BDT), whereas ostomy bags cost about US$24. In the care of stoma, betel leaves are cheap, easy to handle, nonirritant, and nonallergic.

Defining quality indicators for best-practice management of inflammatory bowel disease in Canada

PubMed Central

Nguyen, Geoffrey C; Devlin, Shane M; Afif, Waqqas; Bressler, Brian; Gruchy, Steven E; Kaplan, Gilaad G; Oliveira, Liliana; Plamondon, Sophie; Seow, Cynthia H; Williams, Chadwick; Wong, Karen; Yan, Brian M; Jones, Jennifer

2014-01-01

BACKGROUND: There is a paucity of published data regarding the quality of care of inflammatory bowel disease (IBD) in Canada. Clinical quality indicators are quantitative end points used to guide, monitor and improve the quality of patient care. In Canada, where universal health care can vary significantly among provinces, quality indicators can be used to identify potential gaps in the delivery of IBD care and standardize the approach to interprovincial management. METHODS: The Emerging Practice in IBD Collaborative (EPIC) group generated a shortlist of IBD quality indicators based on a comprehensive literature review. An iterative voting process was used to select quality indicators to take forward. In a face-to-face meeting with the EPIC group, available evidence to support each quality indicator was presented by the EPIC member aligned to it, followed by group discussion to agree on the wording of the statements. The selected quality indicators were then ratified in a final vote by all EPIC members. RESULTS: Eleven quality indicators for the management of IBD within the single-payer health care system of Canada were developed. These focus on accurate diagnosis, appropriate and timely management, disease monitoring, and prevention or treatment of complications of IBD or its therapy. CONCLUSIONS: These quality indicators are measurable, reflective of the evidence base and expert opinion, and define a standard of care that is at least a minimum that should be expected for IBD management in Canada. The next steps for the EPIC group involve conducting research to assess current practice across Canada as it pertains to these quality indicators and to measure the impact of each of these indicators on patient outcomes. PMID:24839622

Health Care Cost Analysis in a Population-based Inception Cohort of Inflammatory Bowel Disease Patients in the First Year of Diagnosis.

PubMed

Niewiadomski, Olga; Studd, Corrie; Hair, Christopher; Wilson, Jarrad; McNeill, John; Knight, Ross; Prewett, Emily; Dabkowski, Paul; Dowling, Damian; Alexander, Sina; Allen, Benjamin; Tacey, Mark; Connell, William; Desmond, Paul; Bell, Sally

2015-11-01

There are limited prospective population-based data on the health care cost of IBD in the post-biologicals era. A prospective registry that included all incident cases of inflammatory bowel disease [IBD] was established to study disease progress and health cost. To prospectively assess health care costs in the first year of diagnosis among a well-characterised cohort of newly diagnosed IBD patients. Incident cases of IBD were prospectively identified in 2007-2008 and 2010-2013 from multiple health care providers, and enrolled into the population-based registry. Health care resource utilisation for each patient was collected through active surveillance of case notes and investigations including specialist visits, diagnostic tests, medications, medical hospitalisation, and surgery. Off 276 incident cases of IBD, 252 [91%] were recruited to the registry, and health care cost was calculated for 242 (146 Crohn's disease [CD] and 96 ulcerative colitis [UC] patients). The median cost in CD was higher at A$5905 per patient (interquartile range [IQR]: A$1571-$91,324) than in UC at A$4752 [IQR: A$1488-A$58,072]. In CD, outpatient resources made up 55% of all cost, with medications accounting for 32% of total cost [15% aminosalicylates, 15% biological therapy], followed by surgery [31%], and diagnostic testing [21%]. In UC, medications accounted for 39% of total cost [of which 37% was due to 5-aminosalicylates, and diagnostics 29%; outpatient cost contributed 71% to total cost. In the first year of diagnosis, outpatient resources account for the majority of cost in both CD and UC. Medications are the main cost driver in IBD. Copyright © 2015 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Using best practice to create a pathway to improve management of irritable bowel syndrome: aiming for timely diagnosis, effective treatment and equitable care.

PubMed

Williams, Marianne; Barclay, Yvonne; Benneyworth, Rosie; Gore, Steve; Hamilton, Zoe; Matull, Rudi; Phillips, Iain; Seamark, Leah; Staveley, Kate; Thole, Steve; Greig, Emma

2016-10-01

Irritable bowel syndrome (IBS) costs the National Health Service almost £12 million per annum. Despite national guidelines advising primary care management, these have failed to stem secondary care referrals of patients with likely IBS for unnecessary and costly assessment and investigation without necessarily achieving resolution of their symptoms. In 2011, an integrated team from primary and secondary care developed a business case using baseline data to create a Somerset-wide IBS pathway using Clinical Commissioning Group funding. This provided face-to-face general practitioners (GP) education, developed a diagnostic pathway and funded faecal calprotectin (FC) testing to exclude inflammatory pathology for patients aged 16-45 years with likely IBS and no alarm symptoms. For those with FC≤50 μg/g, we provided a management algorithm and community-based dietetic treatment. Audit results measured usage and outcomes from FC testing, changes in patterns and costs of new patients reviewed in gastroenterology outpatients and dietetic IBS treatment outcomes. The proportion of new patient slots used reduced from 14.3% to 8.7% over 10 months while overall costs reduced by 25% for patients with no alarm symptoms and likely IBS aged 16-45 years. FC results confirmed research findings with no inflammatory pathology, if FC≤50 μg/g over 2 years. 63% of patients had satisfactory control of their IBS after specialist dietetic input with 74% reporting improved quality of life. The combination of GP education, providing diagnosis and management pathways, using FC to exclude inflammatory pathology and providing an effective treatment for patients with likely IBS appeared successful in our pilot. This proved cost-effective, reduced secondary care involvement and improved patient care.

Comparison between different colon cleansing products for screening colonoscopy. A noninferiority trial in population-based screening programs in Italy.

PubMed

Zorzi, Manuel; Valiante, Flavio; Germanà, Bastianello; Baldassarre, Gianluca; Coria, Bartolomea; Rinaldi, Michela; Heras Salvat, Helena; Carta, Alessandra; Bortoluzzi, Francesco; Cervellin, Erica; Polo, Maria Luisa; Bulighin, Gianmarco; Azzurro, Maurizio; Di Piramo, Daniele; Turrin, Anna; Monica, Fabio

2016-03-01

The high volume and poor palatability of 4 L of polyethylene glycol (PEG)-based bowel cleansing preparation required before a colonoscopy represent a major obstacle for patients. The aim of this study was to compare two low volume PEG-based preparations with standard 4 L PEG in individuals with a positive fecal immunochemical test (FIT) within organized screening programs in Italy. A total of 3660 patients with a positive FIT result were randomized to receive, in a split-dose regimen, 4 L PEG or 2 L PEG plus ascorbate (PEG-A) or 2 L PEG with citrate and simethicone plus bisacodyl (PEG-CS). The noninferiority of the low volume preparations vs. 4 L PEG was tested through the difference in proportions of adequate cleansing. A total of 2802 patients were included in the study. Adequate bowel cleansing was achieved in 868 of 926 cases (93.7 %) in the 4 L PEG group, in 872 out of 911 cases in the PEG-A group (95.7 %, difference in proportions  + 1.9 %, 95 % confidence interval [CI]  - 0.1 to 3.9), and in 862 out of 921 cases in the PEG-CS group (93.6 %, difference in proportions  - 0.2 %, 95 %CI  - 2.4 to 2.0). Bowel cleansing was adequate in 95.5 % of cases when the preparation-to-colonoscopy interval was between 120 and 239 minutes, whereas it dropped to 83.3 % with longer intervals. Better cleansing was observed in patients with regular bowel movements (95.6 %) compared with those with diarrhea (92.4 %) or constipation (90.8 %). Low volume PEG-based preparations administered in a split-dose regimen guarantee noninferior bowel cleansing compared with 4 L PEG. Constipated patients require a personalized preparation. EudraCT 2012 - 003958 - 82. © Georg Thieme Verlag KG Stuttgart · New York.

Prevalence of irritable bowel syndrome in caregivers of patients with chronic diseases.

PubMed

Remes-Troche, J M; Torres-Aguilera, M; Montes-Martínez, V; Jiménez-García, V A; Roesch-Dietlen, F

2015-06-01

Caregivers are an at-risk population for psychic and physical diseases such as irritable bowel syndrome (IBS). However, it is not known whether providing care for the chronically ill patient can be considered a risk factor for developing IBS. In this study, our aim was to evaluate the prevalence of IBS according to the Rome II criteria in a group of caregivers. A cross-sectional study was conducted through an evaluation of caregivers of chronically ill patients. Subjects completed questionnaires including the Rome II Modular Questionnaire, the Hospital Anxiety and Depression Scale, the Zarit Caregiver Burden Interview (ZCBI) (an instrument for evaluating the burden experienced by caregivers), and the irritable bowel syndrome quality of life (IBS-QoL) questionnaire. Ninety-six primary caregivers (mean age was 43.6 ± 13.7 years and 87% were women) were evaluated. The mean length of time providing care was 37.6 months (3-288 months). Forty-seven caregivers (49%) presented with IBS. The caregivers with IBS had higher scores in the global ZCBI score (47 ± 8 vs 28 ± 8, p = 0.001) and on the anxiety and depression scale (p = 0.001) than those that did not have IBS. A total of 72% were diagnosed with caregiver stress syndrome; 42 of them had IBS according to the Rome II questionnaire (60% vs 18%, p = 0.001, relative risk 3.28, 95% CI: 1.4-7.4). Caregivers of chronically ill patients have a high prevalence of IBS, which is associated with depression, anxiety, and poor QoL. © 2015 John Wiley & Sons Ltd.

Crohn Disease: Epidemiology, Diagnosis, and Management.

PubMed

Feuerstein, Joseph D; Cheifetz, Adam S

2017-07-01

Crohn disease is a chronic idiopathic inflammatory bowel disease condition characterized by skip lesions and transmural inflammation that can affect the entire gastrointestinal tract from the mouth to the anus. For this review article, we performed a review of articles in PubMed through February 1, 2017, by using the following Medical Subject Heading terms: crohns disease, crohn's disease, crohn disease, inflammatory bowel disease, and inflammatory bowel diseases. Presenting symptoms are often variable and may include diarrhea, abdominal pain, weight loss, nausea, vomiting, and in certain cases fevers or chills. There are 3 main disease phenotypes: inflammatory, structuring, and penetrating. In addition to the underlying disease phenotype, up to a third of patients will develop perianal involvement of their disease. In addition, in some cases, extraintestinal manifestations may develop. The diagnosis is typically made with endoscopic and/or radiologic findings. Disease management is usually with pharmacologic therapy, which is determined on the basis of disease severity and underlying disease phenotype. Although the goal of management is to control the inflammation and induce a clinical remission with pharmacologic therapy, most patients will eventually require surgery for their disease. Unfortunately, surgery is not curative and patients still require ongoing therapy even after surgery for disease recurrence. Importantly, given the risks of complications from both Crohn disease and the medications used to treat the disease process, primary care physicians play an important role in optimizing the preventative care management to reduce the risk of complications. Copyright © 2017 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Diagnosis of inflammatory bowel disease in Asia: the results of a multinational web-based survey in the 2(nd) Asian Organization for Crohn's and Colitis (AOCC) meeting in Seoul.

PubMed

Kim, Eun Soo; Chen, Minhu; Lee, Jun; Lee, Chang-Kyun; Kim, You Sun

2016-07-01

As the number of Asian patients with inflammatory bowel disease (IBD) has increased recently, there is a growing need to improve IBD care in this region. This study is aimed at determining how Asian countries are currently dealing with their IBD patients in terms of diagnosis. A questionnaire was designed by the organizing committee of Asian Organization for Crohn's and Colitis, for a multinational web-based survey conducted between March 2014 and May 2014. A total of 353 Asian medical doctors treating IBD patients responded to the survey (114 in China, 88 in Japan, 116 in Korea, and 35 in other Asian countries). Most of the respondents were gastroenterologists working in an academic teaching hospital. While most of the doctors from China, Japan, and Korea use their own national guidelines for IBD diagnosis, those from other Asian countries most commonly adopt the European Crohn's Colitis Organisation's guideline. Japanese doctors seldom adopt the Montreal classification for IBD. The most commonly used activity scoring system for ulcerative colitis is the Mayo score in all countries except China, whereas that for Crohn's disease (CD) is the Crohn's Disease Activity Index. The most available tool for small-bowel evaluation in CD patients differs across countries. Many physicians administer empirical anti-tuberculous medications before the diagnosis of CD. The results of this survey demonstrate that Asian medical doctors have different diagnostic approaches for IBD. This knowledge would be important in establishing guidelines for improving the care of IBD patients in this region.

Snapshot of an integrated psychosocial gastroenterology service.

PubMed

Kinsinger, Sarah W; Ballou, Sarah; Keefer, Laurie

2015-02-14

To characterize the patients utilizing a gastroenterology behavioral medicine service and examine the effect of treatment on health care utilization. Patients were referred by their gastroenterologists for psychological treatment during a 15 mo period. Patients seen for an intake with a psychologist completed the Brief Symptom Inventory (BSI) and a checklist of psychosocial concerns. A subset of patients with functional bowel disorders also completed a disease specific quality of life measure. Chart review was conducted to obtain information on type and frequency of sessions with the psychologist, the number of outpatient gastroenterology visits, and number of gastroenterology-related medical procedures during the 6 mo following psychological intake. Of 259 patients referred for treatment, 118 (46%) completed an intake with a psychologist. Diagnoses included: irritable bowel syndrome (42%), functional dyspepsia (20%), inflammatory bowel diseases (20%), esophageal symptoms (10%), and "other" (8%). Demographic variables and disease type did not differentiate between those who did and did not schedule an intake. Mean t-scores for the BSI global score index and the depression, anxiety, and somatization subscales fell below the cutoff for clinical significance (t = 63). Treatments were predominantly gut-directed hypnosis (48%) and cognitive behavioral therapy (44%). Average length of treatment was 4 sessions. Among functional gastrointestinal (GI) patients, those patients who initiated treatment received significantly fewer GI-related medical procedures during the 6 mo following the referral than patients who did not schedule an intake [t (197) = 2.69, P < 0.01]. Patients are receptive to psychological interventions for GI conditions and there is preliminary evidence that treatment can decrease health-care utilization among patients with functional GI conditions.

Mechanical bowel preparation and oral antibiotic prophylaxis in colorectal surgery: Analysis of evidence and narrative review.

PubMed

Badia, Josep M; Arroyo-García, Nares

2018-05-14

The role of oral antibiotic prophylaxis and mechanical bowel preparation in colorectal surgery remains controversial. The lack of efficacy of mechanical preparation to improve infection rates, its adverse effects, and multimodal rehabilitation programs have led to a decline in its use. This review aims to evaluate current evidence on antegrade colonic cleansing combined with oral antibiotics for the prevention of surgical site infections. In experimental studies, oral antibiotics decrease the bacterial inoculum, both in the bowel lumen and surgical field. Clinical studies have shown a reduction in infection rates when oral antibiotic prophylaxis is combined with mechanical preparation. Oral antibiotics alone seem to be effective in reducing infection in observational studies, but their effect is inferior to the combined preparation. In conclusion, the combination of oral antibiotics and mechanical preparation should be considered the gold standard for the prophylaxis of postoperative infections in colorectal surgery. Copyright © 2018 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

Long-term effects of hypnotherapy in patients with refractory irritable bowel syndrome.

PubMed

Lindfors, Perjohan; Unge, Peter; Nyhlin, Henry; Ljótsson, Brjánn; Björnsson, Einar S; Abrahamsson, Hasse; Simrén, Magnus

2012-04-01

Gut-directed hypnotherapy is considered to be an effective treatment in irritable bowel syndrome (IBS) but few studies report the long-term effects. This retrospective study aims to evaluate the long-term perceived efficacy of gut-directed hypnotherapy given outside highly specialized hypnotherapy centers. 208 patients, who all had received gut-directed hypnotherapy, were retrospectively evaluated. The Subjective Assessment Questionnaire (SAQ) was used to measure changes in IBS symptoms, and patients were classified as responders and non-responders. Patients were also asked to report changes in health-care seeking, use of drugs for IBS symptoms, use of alternative non-pharmacological treatments, and if they still actively used hypnotherapy. Immediately after hypnotherapy, 103 of 208 patients (49%) were responders and 75 of these (73%) had improved further at the follow-up 2-7 years after hypnotherapy (mean 4 years). A majority of the responders still used hypnotherapy on a regular basis at follow-up (73%), and the responders reported a greater reduction in health-care seeking than non-responders. A total of 87% of all patients reported that they considered gut-directed hypnotherapy to be worthwhile, and this differed between responders and non-responders (100% vs. 74%; p < 0.0001). This long-term follow-up study indicates that gut-directed hypnotherapy in refractory IBS is an effective treatment option with long-lasting effects, also when given outside highly specialized hypnotherapy centers. Apart from the clinical benefits, the reduction in health-care utilization has the potential to reduce the health-care costs.

Development of quality standards in inflammatory bowel disease management and design of an evaluation tool of nursing care.

PubMed

Torrejón, Antonio; Oltra, Lorena; Hernández-Sampelayo, Paloma; Marín, Laura; García-Sánchez, Valle; Casellas, Francesc; Alfaro, Noelia; Lázaro, Pablo; Vera, María Isabel

2013-01-01

nursing management of inflammatory bowel disease (IBD) is highly relevant for patient care and outcomes. However, there is evidence of substantial variability in clinical practices. The objectives of this study were to develop standards of healthcare quality for nursing management of IBD and elaborate the evaluation tool "Nursing Care Quality in IBD Assessment" (NCQ-IBD) based on these standards. a 178-item healthcare quality questionnaire was developed based on a systematic review of IBD nursing management literature. The questionnaire was used to perform two 2-round Delphi studies: Delphi A included 27 IBD healthcare professionals and Delphi B involved 12 patients. The NCQ-IBD was developed from the list of items resulting from both Delphi studies combined with the Scientific Committee´s expert opinion. the final NCQ-IBD consists of 90 items, organized in13 sections measuring the following aspects of nursing management of IBD: infrastructure, services, human resources, type of organization, nursing responsibilities, nurse-provided information to the patient, nurses training, annual audits of nursing activities, and nursing research in IBD. Using the NCQ-IBD to evaluate these components allows the rating of healthcare quality for nursing management of IBD into 4 categories: A (highest quality) through D (lowest quality). the use of the NCQ-IBD tool to evaluate nursing management quality of IBD identifies areas in need of improvement and thus contribute to an enhancement of care quality and reduction in clinical practice variations.

Complications in pediatric intestine transplantation in the absence of peri-operative donor or recipient bowel decontamination.

PubMed

Clouse, Jared W; Kubal, Chandrashekhar A; Fridell, Jonathan A; Mangus, Richard S

2018-05-01

This study reports the clinical complication and infection rates of an active pediatric IT program that has never utilized bowel decontamination in either the donor or the recipient. All patients undergoing IT from 2003 to 2015 at a single pediatric IT center were reviewed. Post-transplant surgical, infectious, and immunosuppressive complications are reported. There were 52 patients who underwent IT during the study period. Among these patients, 4% developed a postoperative abscess, one developed an enteric fistula (2%), and one had an enteric or anastomotic leak (2%). The rate of any bacterial infection was 90% in the first year, with a wound infection rate of 23%. Any fungal infection occurred in 25% of patients. Any viral infection occurred in 75% of patients. Gastrointestinal viruses were diagnosed in 52% of patients, and cytomegalovirus infections occurred in 17%. Rejection rates were 39% at any time post-transplant (isolated 44% and 35% for multivisceral patients). At this center in which no bowel decontamination was used, rates of surgical complications, infections, and rejection were similar to those reported by other centers. These findings suggest bowel decontamination may provide no significant benefit in this population of high-risk transplant patients. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

A controlled trial of an intervention to improve urinary and fecal incontinence and constipation.

PubMed

Schnelle, John F; Leung, Felix W; Rao, Satish S C; Beuscher, Linda; Keeler, Emmett; Clift, Jack W; Simmons, Sandra

2010-08-01

To evaluate effects of a multicomponent intervention on fecal incontinence (FI) and urinary incontinence (UI) outcomes. Randomized controlled trial. Six nursing homes (NHs). One hundred twelve NH residents. Intervention subjects were offered toileting assistance, exercise, and choice of food and fluid snacks every 2 hours for 8 hours per day over 3 months. Frequency of UI and FI and rate of appropriate toileting as determined by direct checks from research staff. Anorectal assessments were completed on a subset of 29 residents. The intervention significantly increased physical activity, frequency of toileting, and food and fluid intake. UI improved (P=.049), as did frequency of bowel movements (P<.001) and percentage of bowel movements (P<.001) in the toilet. The frequency of FI did not change. Eighty-nine percent of subjects who underwent anorectal testing showed a dyssynergic voiding pattern, which could explain the lack of efficacy of this intervention program alone on FI. This multicomponent intervention significantly changed multiple risk factors associated with FI and increased bowel movements without decreasing FI. The dyssynergic voiding pattern and rectal hyposensitivity suggest that future interventions may have to be supplemented with bulking agents (fiber), biofeedback therapy, or both to improve bowel function. © 2010, Copyright the Authors. Journal compilation © 2010, The American Geriatrics Society.

Small- bowel mucosal changes and antibody responses after low- and moderate-dose gluten challenge in celiac disease

PubMed Central

2011-01-01

Background Due to the restrictive nature of a gluten-free diet, celiac patients are looking for alternative therapies. While drug-development programs include gluten challenges, knowledge regarding the duration of gluten challenge and gluten dosage is insufficient. We challenged adult celiac patients with gluten with a view to assessing the amount needed to cause some small-bowel mucosal deterioration. Methods Twenty-five celiac disease adults were challenged with low (1-3 g) or moderate (3-5g) doses of gluten daily for 12 weeks. Symptoms, small-bowel morphology, densities of CD3+ intraepithelial lymphocytes (IELs) and celiac serology were determined. Results Both moderate and low amounts of gluten induced small-bowel morphological damage in 67% of celiac patients. Moderate gluten doses also triggered mucosal inflammation and more gastrointestinal symptoms leading to premature withdrawals in seven cases. In 22% of those who developed significant small- intestinal damage, symptoms remained absent. Celiac antibodies seroconverted in 43% of the patients. Conclusions Low amounts of gluten can also cause significant mucosal deterioration in the majority of the patients. As there are always some celiac disease patients who will not respond within these conditions, sample sizes must be sufficiently large to attain to statistical power in analysis. PMID:22115041

Bowel Retraining: Strategies for Establishing Bowel Control

MedlinePlus

... Us Search Bowel Retraining: Strategies for Establishing Bowel Control Home Bowel Retraining Details Treatment Last Updated: 29 ... help people with bowel disorders establish or reestablish control. Individuals with symptoms of inability to control bowel ...

Percutaneous Emergency Needle Caecostomy for Prevention of Caecal Perforation.

PubMed

Limmer, Alexandra M; Clement, Zackariah

2017-01-01

Caecal perforation is a life-threatening complication of large bowel obstruction with a reported mortality of 34% to 72%. This case describes the novel use of percutaneous needle caecostomy as a life-saving measure to prevent imminent caecal perforation in a 68-year-old lady with large bowel obstruction secondary to an incarcerated incisional hernia. After careful review of computed tomography images and measurement of distances from the abdominal wall to the caecum, the patient's caecum was decompressed in the emergency department using a needle under local anaesthetic. The patient subsequently underwent laparoscopic hernia repair and had an uncomplicated recovery. When conducted safely and with precision in an appropriate patient, percutaneous needle caecostomy can provide immediate symptom relief, reduce risk of caecal perforation, and allow a laparoscopic surgical approach.

Percutaneous Emergency Needle Caecostomy for Prevention of Caecal Perforation

PubMed Central

Clement, Zackariah

2017-01-01

Caecal perforation is a life-threatening complication of large bowel obstruction with a reported mortality of 34% to 72%. This case describes the novel use of percutaneous needle caecostomy as a life-saving measure to prevent imminent caecal perforation in a 68-year-old lady with large bowel obstruction secondary to an incarcerated incisional hernia. After careful review of computed tomography images and measurement of distances from the abdominal wall to the caecum, the patient's caecum was decompressed in the emergency department using a needle under local anaesthetic. The patient subsequently underwent laparoscopic hernia repair and had an uncomplicated recovery. When conducted safely and with precision in an appropriate patient, percutaneous needle caecostomy can provide immediate symptom relief, reduce risk of caecal perforation, and allow a laparoscopic surgical approach. PMID:28894618

Validation of the phase II feasibility study in a palliative care setting: gastrografin in malignant bowel obstruction.

PubMed

Lee, Cindy; Vather, Ryash; O'Callaghan, Anne; Robinson, Jackie; McLeod, Briar; Findlay, Michael; Bissett, Ian

2013-12-01

Malignant bowel obstruction (MBO) is common in patients with advanced cancer. To perform a phase II study to assess the feasibility of conducting a phase III trial investigating the therapeutic value of gastrografin in MBO. Randomized double-blinded placebo-controlled feasibility study. Participants received 100 mL of either gastrografin or placebo. Over 8 months, 57 patients were screened and 9 enrolled (15.8% recruitment rate). Of the 9 enrolled, 4 received gastrografin (with 2 completing assessment) and 5 received placebo (with 4 completing assessment). It is not feasible to conduct a phase III trial using the same study protocol. This study validates the use of the phase II feasibility study to assess protocol viability in a palliative population prior to embarking on a larger trial.

Hypnosis and upper digestive function and disease

PubMed Central

Chiarioni, Giuseppe; Palsson, Olafur S; Whitehead, William E

2008-01-01

Hypnosis is a therapeutic technique that primarily involves attentive receptive concentration. Even though a small number of health professionals are trained in hypnosis and lingering myths and misconceptions associated with this method have hampered its widespread use to treat medical conditions, hypnotherapy has gained relevance as an effective treatment for irritable bowel syndrome not responsive to standard care. More recently, a few studies have addressed the potential influence of hypnosis on upper digestive function and disease. This paper reviews the efficacy of hypnosis in the modulation of upper digestive motor and secretory function. The present evidence of the effectiveness of hypnotherapy as a treatment for functional and organic diseases of the upper bowel is also summarized, coupled with a discussion of potential mechanisms of its therapeutic action. PMID:19009639

Budget-impact model for colonoscopy cost calculation and comparison between 2 litre PEG+ASC and sodium picosulphate with magnesium citrate or sodium phosphate oral bowel cleansing agents.

PubMed

Gruss, H-J; Cockett, A; Leicester, R J

2012-01-01

With the availability of several bowel cleansing agents, physicians and hospitals performing colonoscopies will often base their choice of cleansing agent purely on acquisition cost. Therefore, an easy to use budget impact model has been developed and established as a tool to compare total colon preparation costs between different established bowel cleansing agents. The model was programmed in Excel and designed as a questionnaire evaluating information on treatment costs for a range of established bowel cleansing products. The sum of costs is based on National Health Service reference costs for bowel cleansing products. Estimations are made for savings achievable when using a 2-litre polyethylene glycol with ascorbate components solution (PEG+ASC) in place of other bowel cleansing solutions. Test data were entered into the model to confirm validity and sensitivity. The model was then applied to a set of audit cost data from a major hospital colonoscopy unit in the UK. Descriptive analysis of the test data showed that the main cost drivers in the colonoscopy process are the procedure costs and costs for bed days rather than drug acquisition costs, irrespective of the cleansing agent. Audit data from a colonoscopy unit in the UK confirmed the finding with a saving of £107,000 per year in favour of PEG+ASC when compared to sodium picosulphate with magnesium citrate solution (NaPic+MgCit). For every patient group the model calculated overall cost savings. This was irrespective of the higher drug expenditure associated with the use of PEG+ASC for bowel preparation. Savings were mainly realized through reduced costs for repeat colonoscopy procedures and associated costs, such as inpatient length of stay. The budget impact model demonstrated that the primary cost driver was the procedure cost for colonoscopy. Savings can be realized through the use of PEG+ASC despite higher drug acquisition costs relative to the comparator products. From a global hospital funding perspective, the acquisition costs of bowel preparations should not be used as the primary reason to select the preferred treatment agent, but should be part of the consideration, with an emphasis on the clinical outcome.

Spectral analysis of bowel sounds in intestinal obstruction using an electronic stethoscope.

PubMed

Ching, Siok Siong; Tan, Yih Kai

2012-09-07

To determine the value of bowel sounds analysis using an electronic stethoscope to support a clinical diagnosis of intestinal obstruction. Subjects were patients who presented with a diagnosis of possible intestinal obstruction based on symptoms, signs, and radiological findings. A 3M™ Littmann(®) Model 4100 electronic stethoscope was used in this study. With the patients lying supine, six 8-second recordings of bowel sounds were taken from each patient from the lower abdomen. The recordings were analysed for sound duration, sound-to-sound interval, dominant frequency, and peak frequency. Clinical and radiological data were reviewed and the patients were classified as having either acute, subacute, or no bowel obstruction. Comparison of bowel sound characteristics was made between these subgroups of patients. In the presence of an obstruction, the site of obstruction was identified and bowel calibre was also measured to correlate with bowel sounds. A total of 71 patients were studied during the period July 2009 to January 2011. Forty patients had acute bowel obstruction (27 small bowel obstruction and 13 large bowel obstruction), 11 had subacute bowel obstruction (eight in the small bowel and three in large bowel) and 20 had no bowel obstruction (diagnoses of other conditions were made). Twenty-five patients received surgical intervention (35.2%) during the same admission for acute abdominal conditions. A total of 426 recordings were made and 420 recordings were used for analysis. There was no significant difference in sound-to-sound interval, dominant frequency, and peak frequency among patients with acute bowel obstruction, subacute bowel obstruction, and no bowel obstruction. In acute large bowel obstruction, the sound duration was significantly longer (median 0.81 s vs 0.55 s, P = 0.021) and the dominant frequency was significantly higher (median 440 Hz vs 288 Hz, P = 0.003) when compared to acute small bowel obstruction. No significant difference was seen between acute large bowel obstruction and large bowel pseudo-obstruction. For patients with small bowel obstruction, the sound-to-sound interval was significantly longer in those who subsequently underwent surgery compared with those treated non-operatively (median 1.29 s vs 0.63 s, P < 0.001). There was no correlation between bowel calibre and bowel sound characteristics in both acute small bowel obstruction and acute large bowel obstruction. Auscultation of bowel sounds is non-specific for diagnosing bowel obstruction. Differences in sound characteristics between large bowel and small bowel obstruction may help determine the likely site of obstruction.

Spectral analysis of bowel sounds in intestinal obstruction using an electronic stethoscope

PubMed Central

Ching, Siok Siong; Tan, Yih Kai

2012-01-01

AIM: To determine the value of bowel sounds analysis using an electronic stethoscope to support a clinical diagnosis of intestinal obstruction. METHODS: Subjects were patients who presented with a diagnosis of possible intestinal obstruction based on symptoms, signs, and radiological findings. A 3M™ Littmann® Model 4100 electronic stethoscope was used in this study. With the patients lying supine, six 8-second recordings of bowel sounds were taken from each patient from the lower abdomen. The recordings were analysed for sound duration, sound-to-sound interval, dominant frequency, and peak frequency. Clinical and radiological data were reviewed and the patients were classified as having either acute, subacute, or no bowel obstruction. Comparison of bowel sound characteristics was made between these subgroups of patients. In the presence of an obstruction, the site of obstruction was identified and bowel calibre was also measured to correlate with bowel sounds. RESULTS: A total of 71 patients were studied during the period July 2009 to January 2011. Forty patients had acute bowel obstruction (27 small bowel obstruction and 13 large bowel obstruction), 11 had subacute bowel obstruction (eight in the small bowel and three in large bowel) and 20 had no bowel obstruction (diagnoses of other conditions were made). Twenty-five patients received surgical intervention (35.2%) during the same admission for acute abdominal conditions. A total of 426 recordings were made and 420 recordings were used for analysis. There was no significant difference in sound-to-sound interval, dominant frequency, and peak frequency among patients with acute bowel obstruction, subacute bowel obstruction, and no bowel obstruction. In acute large bowel obstruction, the sound duration was significantly longer (median 0.81 s vs 0.55 s, P = 0.021) and the dominant frequency was significantly higher (median 440 Hz vs 288 Hz, P = 0.003) when compared to acute small bowel obstruction. No significant difference was seen between acute large bowel obstruction and large bowel pseudo-obstruction. For patients with small bowel obstruction, the sound-to-sound interval was significantly longer in those who subsequently underwent surgery compared with those treated non-operatively (median 1.29 s vs 0.63 s, P < 0.001). There was no correlation between bowel calibre and bowel sound characteristics in both acute small bowel obstruction and acute large bowel obstruction. CONCLUSION: Auscultation of bowel sounds is non-specific for diagnosing bowel obstruction. Differences in sound characteristics between large bowel and small bowel obstruction may help determine the likely site of obstruction. PMID:22969233

Pelvic Normal Tissue Contouring Guidelines for Radiation Therapy: A Radiation Therapy Oncology Group Consensus Panel Atlas

PubMed Central

Gay, Hiram A.; Barthold, H. Joseph; O’Meara, Elizabeth; Bosch, Walter R.; El Naqa, Issam; Al-Lozi, Rawan; Rosenthal, Seth A.; Lawton, Colleen; Lee, W. Robert; Sandler, Howard; Zietman, Anthony; Myerson, Robert; Dawson, Laura A.; Willett, Christopher; Kachnic, Lisa A.; Jhingran, Anuja; Portelance, Lorraine; Ryu, Janice; Small, William; Gaffney, David; Viswanathan, Akila N.; Michalski, Jeff M.

2012-01-01

Purpose To define a male and female pelvic normal tissue contouring atlas for Radiation Therapy Oncology Group (RTOG) trials. Methods and Materials One male pelvis computed tomography (CT) data set and one female pelvis CT data set were shared via the Image-Guided Therapy QA Center. A total of 16 radiation oncologists participated. The following organs at risk were contoured in both CT sets: anus, anorectum, rectum (gastrointestinal and genitourinary definitions), bowel NOS (not otherwise specified), small bowel, large bowel, and proximal femurs. The following were contoured in the male set only: bladder, prostate, seminal vesicles, and penile bulb. The following were contoured in the female set only: uterus, cervix, and ovaries. A computer program used the binomial distribution to generate 95% group consensus contours. These contours and definitions were then reviewed by the group and modified. Results The panel achieved consensus definitions for pelvic normal tissue contouring in RTOG trials with these standardized names: Rectum, AnoRectum, SmallBowel, Colon, BowelBag, Bladder, UteroCervix, Adnexa_R, Adnexa_L, Prostate, SeminalVesc, PenileBulb, Femur_R, and Femur_L. Two additional normal structures whose purpose is to serve as targets in anal and rectal cancer were defined: AnoRectumSig and Mesorectum. Detailed target volume contouring guidelines and images are discussed. Conclusions Consensus guidelines for pelvic normal tissue contouring were reached and are available as a CT image atlas on the RTOG Web site. This will allow uniformity in defining normal tissues for clinical trials delivering pelvic radiation and will facilitate future normal tissue complication research. PMID:22483697

Neurogenic bowel management after spinal cord injury: A systematic review of the evidence

PubMed Central

Krassioukov, Andrei; Eng, Janice J.; Claxton, Geri; Sakakibara, Brodie M.; Shum, Serena

2011-01-01

OBJECTIVE To systematically review evidence for the management of neurogenic bowel in individuals with spinal cord injuries (SCI). DATA SOURCES Literature searches were conducted for relevant articles, as well as practice guidelines, using numerous electronic databases. Manual searches of retrieved articles from 1950 to July 2009 were also conducted to identify literature. STUDY SELECTION Randomized controlled trials, prospective cohort, case-control, and pre-post studies, and case reports that assessed pharmacological and non-pharmacological intervention for the management of the neurogenic bowel in SCI were included. DATA EXTRACTION Two independent reviewers evaluated each study’s quality, using the PEDro scale for RCTs and the Downs & Black scale for all other studies. Results were tabulated and levels of evidence assigned. DATA SYNTHESIS 2956 studies were found as a result of the literature search. Upon review of the titles and abstracts, 52 studies met the inclusion criteria. Multi-faceted programs are the first approach to neurogenic bowel and are supported by lower levels of evidence. Of the non-pharmacological (conservative and non-surgical) interventions, transanal irrigation is a promising treatment to reduce constipation and fecal incontinence. When conservative management is not effective, pharmacological interventions (e.g., prokinetic agents) are supported by strong evidence for the treatment of chronic constipation. When conservative and pharmacological treatments are not effective, surgical interventions may be considered and are supported by lower levels of evidence in reducing complications. CONCLUSIONS Often, more than one procedure is necessary to develop an effective bowel routine. Evidence is low for non-pharmacological approaches and high for pharmacological interventions. PMID:20212501

Evaluation of a constipation risk assessment scale.

PubMed

Zernike, W; Henderson, A

1999-06-01

This project was undertaken in order to evaluate the utility of a constipation risk assessment scale and the accompanying bowel management protocol. The risk assessment scale was primarily introduced to teach and guide staff in managing constipation when caring for patients. The intention of the project was to reduce the incidence of constipation in patients during their admission to hospital.

The nursing management of diarrhoea and constipation before and after the implementation of a bowel management protocol.

PubMed

McKenna, S; Wallis, M; Brannelly, A; Cawood, J

2001-02-01

Intensive care unit (ICU) patients frequently suffer problems associated with both diarrhoea and constipation. Strategies to optimise the management of these conditions need to focus on improving the communication between staff and ensuring effective treatment is implemented. The team involved in this study developed a Bowel Management Protocol (BMP). The effect of this BMP on the documentation of assessment and management of diarrhoea and constipation was evaluated using a quasi-experimental research design. Data were collected via a retrospective audit of medical records. Two groups of patient records were randomly sampled. The records of 60 patients who were admitted to ICU in the 6 months before the introduction of the BMP were accessed together with the records of 60 patients admitted in the 6 months following the introduction of the BMP. Data were collected regarding patient demographics and the assessment and management of bowel function before and after BMP introduction. The results indicated that a BMP improved documentation of the assessment of bowel function. In addition, there was an improvement in the documentation of nursing intervention in the presence of constipation and diarrhoea. These results have to be interpreted with caution because, despite random sampling over two 6 month periods, there were statistically significant differences in age, length of stay, method of feeding and medical diagnosis between the two groups. Further research into the effectiveness of using a BMP is recommended.

Lubiprostone in constipation: clinical evidence and place in therapy

PubMed Central

Wilson, Nicholas

2015-01-01

Constipation is one of the most common function bowel disorders encountered by primary care providers and gastroenterologists. Disorders of chronic constipation, including irritable bowel syndrome with constipation, chronic idiopathic constipation, and opioid-induced chronic constipation, are associated with significant medical costs and a negative impact on quality of life. Although there is evidence supporting the effectiveness of some over-the-counter laxatives in chronic constipation, currently there is no evidence supporting lifestyle modification, dietary change or over-the-counter laxatives as effective long-term therapy for patients with chronic constipation. Lubiprostone is a prostaglandin-derived bicyclic fatty acid available to use for long-term treatment of constipation. Lubiprostone works by increasing intraluminal chloride ion secretion, which results in a passive influx of water and sodium, leading to increased intestinal peristalsis and colonic laxation with decreased intestinal stool transit time. Randomized, double-blind, placebo-controlled trials of lubiprostone in patients with chronic constipation, irritable bowel syndrome and opioid-induced constipation have shown it to be effective and free of serious adverse effects. The most common side effects associated with lubiprostone are mild to moderate nausea and diarrhea. Currently lubiprostone is approved for treatment of chronic constipation and opioid-induced constipation for men and women at 24 µg twice daily and for treatment of irritable bowel syndrome with constipation in women at 8 µg twice daily. Additional research continues to shed light on the molecular mechanisms of lubiprostone and further work may expand its clinical applications. PMID:25729555

Lubiprostone in constipation: clinical evidence and place in therapy.

PubMed

Wilson, Nicholas; Schey, Ron

2015-03-01

Constipation is one of the most common function bowel disorders encountered by primary care providers and gastroenterologists. Disorders of chronic constipation, including irritable bowel syndrome with constipation, chronic idiopathic constipation, and opioid-induced chronic constipation, are associated with significant medical costs and a negative impact on quality of life. Although there is evidence supporting the effectiveness of some over-the-counter laxatives in chronic constipation, currently there is no evidence supporting lifestyle modification, dietary change or over-the-counter laxatives as effective long-term therapy for patients with chronic constipation. Lubiprostone is a prostaglandin-derived bicyclic fatty acid available to use for long-term treatment of constipation. Lubiprostone works by increasing intraluminal chloride ion secretion, which results in a passive influx of water and sodium, leading to increased intestinal peristalsis and colonic laxation with decreased intestinal stool transit time. Randomized, double-blind, placebo-controlled trials of lubiprostone in patients with chronic constipation, irritable bowel syndrome and opioid-induced constipation have shown it to be effective and free of serious adverse effects. The most common side effects associated with lubiprostone are mild to moderate nausea and diarrhea. Currently lubiprostone is approved for treatment of chronic constipation and opioid-induced constipation for men and women at 24 µg twice daily and for treatment of irritable bowel syndrome with constipation in women at 8 µg twice daily. Additional research continues to shed light on the molecular mechanisms of lubiprostone and further work may expand its clinical applications.

Prevention of internal hernias and pelvic adhesions following laparoscopic left-sided colorectal resection: the role of fibrin sealant.

PubMed

Angelini, Pierluigi; Sciuto, Antonio; Cuccurullo, Diego; Pirozzi, Felice; Reggio, Stefano; Corcione, Francesco

2017-07-01

Laparoscopy has increasingly become the standard of care for patients who undergo colorectal surgery for both benign and malignant diseases. This growing experience has also resulted in more reports of postoperative complications from the minimally invasive approach to primary colorectal resection. Small bowel obstruction from internal hernias and pre-sacral adhesions is an uncommon but not negligible complication. However, there is little literature specific to this topic with recommendations for different methods to prevent it. We report our original technique of closing the mesenteric defect and covering the pre-sacral fascia by using fibrin sealant to prevent this complication. From January 2005 to December 2014, a total of 1079 patients underwent elective laparoscopic left colorectal resection (left hemicolectomy or anterior rectal resection) in our department. In the first 298 procedures, the mesenteric defect was left open, while in the following 781 procedures, it was closed using fibrin sealant with the aim of preventing postoperative small bowel obstruction. Among the first 298 patients, three (1%) required reoperation for small bowel obstruction due to internal hernia (0.33%) or critical pre-sacral adhesions (0.66%). These complications did not occur in the subsequent series in which all 781 patients were treated with fibrin sealant prophylactic closure of the mesenteric defect. In our experience, fibrin sealant closure of the mesenteric defect has demonstrated to be safe and effective in preventing postoperative small bowel obstruction that remains a complication both in open and in laparoscopic colorectal surgeries.

Management of ulcerative colitis in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease

PubMed Central

Wei, Shu-Chen; Chang, Ting-An; Chao, Te-Hsin; Chen, Jinn-Shiun; Chou, Jen-Wei; Chou, Yenn-Hwei; Chuang, Chiao-Hsiung; Hsu, Wen-Hung; Huang, Tien-Yu; Hsu, Tzu-Chi; Lin, Chun-Chi; Lin, Hung-Hsin; Lin, Jen-Kou; Lin, Wei-Chen; Ni, Yen-Hsuan; Shieh, Ming-Jium; Shih, I-Lun; Shun, Chia-Tung; Tsang, Yuk-Ming; Wang, Cheng-Yi; Wang, Horng-Yuan; Weng, Meng-Tzu; Wu, Deng-Chyang; Wu, Wen-Chieh; Yen, Hsu-Heng

2017-01-01

Ulcerative colitis (UC) is an inflammatory bowel disease characterized by chronic mucosal inflammation of the colon, and the prevalence and incidence of UC have been steadily increasing in Taiwan. A steering committee was established by the Taiwan Society of Inflammatory Bowel Disease to formulate statements on the diagnosis and management of UC taking into account currently available evidence and the expert opinion of the committee. Accurate diagnosis of UC requires thorough clinical, endoscopic, and histological assessment and careful exclusion of differential diagnoses, particularly infectious colitis. The goals of UC therapy are to induce and maintain remission, reduce the risk of complications, and improve quality of life. As outlined in the recommended treatment algorithm, choice of treatment is dictated by severity, extent, and course of disease. Patients should be evaluated for hepatitis B virus and tuberculosis infection prior to immunosuppressive treatment, especially with steroids and biologic agents, and should be regularly monitored for reactivation of latent infection. These consensus statements are also based on current local evidence with consideration of factors, and could be serve as concise and practical guidelines for supporting clinicians in the management of UC in Taiwan. PMID:28670225

Prevalence of irritable bowel syndrome in young adult Malaysians: a survey among medical students.

PubMed

Tan, Yan-Mei; Goh, Khean L; Muhidayah, Raja; Ooi, Chee L; Salem, Omar

2003-12-01

Irritable bowel syndrome (IBS) is a common functional bowel disease in the West. Information on the prevalence of IBS in the Asian population is relatively scanty. The aims of the present study were to determine the prevalence of IBS and to assess the symptom subgroups based on the predominant bowel habit in a young adult population of Asian origin. Basic demographic data and symptoms of IBS using the Rome I criteria were sought using a questionnaire administered to all apparently healthy students in a medical school. Other questions asked related to alcohol intake, smoking, chili consumption, dietary fiber intake, and to psychological and psychosomatic symptoms of anxiety, depression, insomnia, headache, and backache. The health-care seeking behavior of the subjects was also analyzed. Of the 610 questionnaires administered, 533 complete responses were received (response rate of 87.4%). The responders comprised 229 men (43.0%) and 304 (57.0%) women with a mean age of 22 +/- 1.8 years. The ethnic distribution was Malays 278 (52.2%), Chinese 179 (33.6%), Indians 46 (8.6%), and others 30 (5.6%). Eighty-four (15.8%) reported symptoms consistent with the diagnosis of IBS, predominantly women. Sixty-five (77.4%) and six (7.1%) were of the constipation-predominant and diarrhea-predominant IBS subgroups, respectively. Thirteen (15.5%) subjects fell into the non-specific IBS subgroup. The self-reported psychological and psychosomatic symptoms of anxiety (P = 0.02), depression (P = 0.002), insomnia (P = 0.006), headache (P = 0.04), and backache (P = 0.006) were encountered more frequently in the subjects with IBS. Only 13.1% of the IBS group had consulted their health-care practitioner, and 20.2% reported self-medication. Symptoms supportive of the diagnosis of IBS were common among young Malaysians, with a prevalence rate of 15.8%. There were significantly more women with IBS than men. Within the IBS population, the majority (77.4%) was of the constipation-predominant IBS subgroup. A significantly higher prevalence of psychological and psychosomatic symptoms was found in individuals with IBS. Only a minority sought medical advice for their symptoms.

Enterocutaneous Fistula: Different Surgical Intervention Techniques for Closure along with Comparative Evaluation of Aluminum Paint, Karaya Gum (Hollister) and Gum Acacia for Peristomal Skin Care

PubMed Central

Namrata; Ahmad, Shabi

2015-01-01

Introduction Gastrointestinal fistulas are serious complications and are associated with high morbidity and mortality rates. In majority of the patients, fistulas are treatable. However, the treatment is very complex and often multiple therapies are required. These highly beneficial treatment options which could shorten fistula closure time also result in considerable hospital cost savings. Aim This study was planned to study aetiology, clinical presentation, morbidity and mortality of enterocutaneous fistula and to evaluate the different surgical intervention techniques for closure of enterocutaneous fistula along with a comparative evaluation of different techniques for management of peristomal skin with special emphasis on aluminum paint, Karaya gum (Hollister) and Gum Acacia. Materials and Methods This prospective observational study was conducted in the Department of Surgery, M.L.N. Medical College, Allahabad and its associated hospital (S.R.N. Hospital, Allahabad) for a period of five years. Results Majority of enterocutaneous fistula were of small bowel and medium output fistulas (500-1000 ml/24hours). Most of the patients were treated with conservative treatment as compared to surgical intervention. Large bowel fistula has maximum spontaneous closure rate compare to small bowel and duodenum. Number of orifice whether single or multiple does not appear to play statistically significant role in spontaneous closure of fistula. Serum Albumin is a significantly important predictor of spontaneous fistula closure and mortality. Surgical management appeared to be the treatment of choice in distal bowel fistula. The application of karaya gum (Hollister kit), Gum Acacia and Aluminum Paint gave similar outcome. Conclusion Postoperative fistulas are the most common aetiology of enterocutaneous fistula and various factors do play role in management. Peristomal skin care done with Karaya Gum, Gum Acacia and Aluminum Paint has almost equal efficiency in management of skin excoriation. However, role of Gum Acacia was found to be good with inflamed, excoriated and ulcerative skin in comparison to Aluminum Paint and as efficacious as Karaya Gum but at much lower cost. PMID:26816943

Focus groups for developing a peer mentoring program to improve self-management in pediatric inflammatory bowel disease.

PubMed

Mackner, Laura M; Ruff, Jessica M; Vannatta, Kathryn

2014-10-01

Inflammatory bowel disease (IBD) presents challenges for self-management in many areas. A peer mentoring program may offer advantages over other forms of self-management interventions because youth may be more receptive to learning self-management skills from a peer than from a parent or professional. The purpose of the present study was to identify themes from focus groups to inform development of a peer mentoring program for improving self-management in pediatric IBD. Focus groups were conducted for youth ages 12 to 17, stratified by age (3 groups; n = 14), young adults ages 18 to 20 (1 group; n = 5), and parents of the youth (3 groups; n = 17). Broad questions covered program goals, general program characteristics, mentor/mentee characteristics, and family involvement, and transcriptions were analyzed via directed content analysis, with the a priori codes specified as the broad questions above. Participants identified the primary goals of a program as support, role model, information/education, and fun. They described a program that would include a year-long, 1-on-1 mentor relationship with a peer who has had IBD for at least a year, educational group activities, fun activities that are not focused on IBD, expectations for in-person contact 1 to 2 times per month, and mentor-to-mentor and parent support. Many of the suggestions from the focus groups correspond with research findings associated with successful mentoring programs. Using participants' suggestions and empirically based best practices for mentoring may result in an effective peer mentoring program for improving self-management in youth with IBD.

Childhood onset inflammatory bowel disease and risk of cancer: a Swedish nationwide cohort study 1964-2014

PubMed Central

Askling, J; Sachs, MC; Frumento, P; Neovius, M; Smedby, KE; Ekbom, A; Malmborg, P; Ludvigsson, JF

2017-01-01

Objective To assess risk of cancer in patients with childhood onset inflammatory bowel disease in childhood and adulthood. Design Cohort study with matched general population reference individuals using multivariable Cox regression to estimate hazard ratios. Setting Swedish national patient register (both inpatient and non-primary outpatient care) 1964-2014. Participants Incident cases of childhood onset (<18 years) inflammatory bowel disease (n=9405: ulcerative colitis, n=4648; Crohn’s disease, n=3768; unclassified, n=989) compared with 92 870 comparators from the general population matched for sex, age, birth year, and county. Main outcome measures Any cancer and cancer types according to the Swedish Cancer Register. Results During follow-up through adulthood (median age at end of follow-up 27 years), 497 (3.3 per 1000 person years) people with childhood onset inflammatory bowel disease had first cancers, compared with 2256 (1.5 per 1000 person years) in the general population comparators (hazard ratio 2.2, 95% confidence interval 2.0 to 2.5). Hazard ratios for any cancer were 2.6 in ulcerative colitis (2.3 to 3.0) and 1.7 in Crohn’s disease (1.5 to 2.1). Patients also had an increased risk of cancer before their 18th birthday (2.7, 1.6 to 4.4; 20 cancers in 9405 patients, 0.6 per1000 person years). Gastrointestinal cancers had the highest relative risks, with a hazard ratio of 18.0 (14.4 to 22.7) corresponding to 202 cancers in patients with inflammatory bowel disease. The increased risk of cancer (before 25th birthday) was similar over time (1964-1989: 1.6, 1.0 to 2.4; 1990-2001: 2.3, 1.5 to 3.3); 2002-06: 2.9, 1.9 to 4.2; 2007-14: 2.2, 1.1 to 4.2). Conclusion Childhood onset inflammatory bowel disease is associated with an increased risk of any cancer, especially gastrointestinal cancers, both in childhood and later in life. The higher risk of cancer has not fallen over time. PMID:28931512

Optimal Bowel Preparation for Video Capsule Endoscopy

PubMed Central

Song, Hyun Joo; Moon, Jeong Seop; Shim, Ki-Nam

2016-01-01

During video capsule endoscopy (VCE), several factors, such as air bubbles, food material in the small bowel, and delayed gastric and small bowel transit time, influence diagnostic yield, small bowel visualization quality, and cecal completion rate. Therefore, bowel preparation before VCE is as essential as bowel preparation before colonoscopy. To date, there have been many comparative studies, consensus, and guidelines regarding different kinds of bowel cleansing agents in bowel preparation for small bowel VCE. Presently, polyethylene glycol- (PEG-) based regimens are given primary recommendation. Sodium picosulphate-based regimens are secondarily recommended, as their cleansing efficacy is less than that of PEG-based regimens. Sodium phosphate as well as complementary simethicone and prokinetics use are considered. In this paper, we reviewed previous studies regarding bowel preparation for small bowel VCE and suggested optimal bowel preparation of VCE. PMID:26880894

Effect of Psychotherapy on Health Care Utilization in Children With Inflammatory Bowel Disease and Depression.

PubMed

Keerthy, Divya; Youk, Ada; Srinath, Arvind I; Malas, Nasuh; Bujoreanu, Simona; Bousvaros, Athos; Keljo, David; DeMaso, David R; Szigethy, Eva M

2016-12-01

Pediatric patients with inflammatory bowel disease (IBD) are at an increased risk of developing depression compared with community controls. Depression often negatively influences illness behaviors such as resource utilization. We sought to investigate the effects of treating depression on utilization of medical resources in depressed pediatric patients with IBD by comparing rates of health care utilization 1 year before and after psychotherapy. Two hundred seventeen subjects ages 9 to 17 years with IBD and depression received 3 months of psychotherapy for depression as part of a multicenter randomized controlled trial. Of these 217 subjects, 70 had utilization data available 1 year prior and 1 year after receiving 3 months of psychotherapy. Primary outcomes included frequency of hospitalizations, inpatient hospital days, outpatient gastrointestinal visits, and number of emergency room visits, radiological examinations, and endoscopies. Within subject analyses were completed comparing health care utilization 12 months before psychotherapy compared with the 12 months after the conclusion of psychotherapy. Fifty-one and 19 patients had CD and UC, respectively. A total of 55.7% of patients had major depression and 44.3% had minor depression. Overall, all study measures of health care utilization were significantly reduced after psychotherapy (P < 0.01)-including gastrointestinal-related (mean values) hospitalization frequency, inpatient days, outpatient visit, emergency room visits, radiological examinations, and endoscopies. Psychotherapy for comorbid depression in pediatric patients with IBD is associated with decreased GI-related health care utilization. The present study highlights the importance of screening for depression in a pediatric population with IBD, and that psychotherapy may be a reasonable adjunctive treatment for pediatric patients with IBD and comorbid depression.

Providing Our Fellows in Training with Education on Inflammatory Bowel Disease Health Maintenance to Improve the Quality of Care in Our Health Care System.

PubMed

Lee, Ann Joo; Kraemer, Dale F; Smotherman, Carmen; Eid, Emely

2016-01-01

Inflammatory bowel disease (IBD) quality measures were established in an effort to standardize IBD health care. Despite effort to improve clinical performance, considerable variations in practice still exist. To further improve IBD health care, we propose incorporating an in-service educational session on IBD health maintenance to provide trainees with increasing awareness and knowledge on IBD management. Fifty electronic medical charts were randomly selected, and the level of quality documentation was assessed for 15 core IBD quality measures. Data were reported as the percentage of charts meeting audit criteria (compliance score). Fellows then attended an in-service educational session to review IBD quality measures and reinforce practice expectations. A second audit was then performed on an additional 50 patient charts to determine whether documentation practices improved after the educational session. We found a positive correlation between an in-service educational session and fellows' compliance with IBD health maintenance. Overall, the fellows' compliance score increased by 18% (before intervention, 65%; after intervention, 83%; P < 0.0001). The intervention was equally beneficial irrespective of training level. Although the magnitude of improvement was comparable, the mean compliance score was highest in year 2 at 81% (year 1: 72% [P = 0.019] and year 3: 70% [P = 0.002]). Fellows expressed a high degree of satisfaction with the educational intervention and emphasized the value in reviewing the conceptual bases for IBD health maintenance. Incorporating a standard curriculum on IBD health maintenance provides fellows in training with increased awareness and guidance on managing the unique preventive care needs of patients with IBD.

Oral versus intravenous iron therapy in patients with inflammatory bowel disease and iron deficiency with and without anemia in Germany – a real-world evidence analysis

PubMed Central

Haas, Jennifer Scarlet; Ong, Siew Hwa; Borchert, Kathrin; Hardt, Thomas; Lechat, Elmira; Nip, Kerry; Foerster, Douglas; Braun, Sebastian; Baumgart, Daniel C

2018-01-01

Background Iron-deficiency anemia and iron deficiency are common comorbidities associated with inflammatory bowel disease (IBD) resulting in impaired quality of life and high health care costs. Intravenous iron has shown clinical benefit compared to oral iron therapy. Aim This study aimed to compare health care outcomes and costs after oral vs intravenous iron treatment for IBD patients with iron deficiency or iron deficiency anemia (ID/A) in Germany. Methods IBD patients with ID/A were identified by ICD-10-GM codes and newly commenced iron treatment via ATC codes in 2013 within the InGef (formerly Health Risk Institute) research claims database. Propensity score matching was performed to balance both treatment groups. Non-observable covariates were adjusted by applying the difference-in-differences (DID) approach. Results In 2013, 589 IBD patients with ID/A began oral and 442 intravenous iron treatment. After matching, 380 patients in each treatment group were analyzed. The intravenous group had fewer all-cause hospitalizations (37% vs 48%) and ID/A-related hospitalizations (5% vs 14%) than the oral iron group. The 1-year preobservation period comparison revealed significant health care cost differences between both groups. After adjusting for cost differences by DID method, total health care cost savings in the intravenous iron group were calculated to be €367. While higher expenditure for medication (€1,876) was observed in the intravenous iron group, the inpatient setting achieved most cost savings (€1,887). Conclusion IBD patients receiving intravenous iron were less frequently hospitalized and incurred lower total health care costs compared to patients receiving oral iron. Higher expenditures for pharmaceuticals were compensated by cost savings in other domains. PMID:29440920

Vaccination practices in patients with inflammatory bowel disease among general internal medicine physicians in the USA.

PubMed

Gurvits, Grigoriy E; Lan, Gloria; Tan, Amy; Weissman, Arlene

2017-06-01

Increasing prevalence of inflammatory bowel disease (IBD) poses significant challenges to medical community. Preventive medicine, including vaccination against opportunistic infections, is important in decreasing morbidity and mortality in patients with IBD. We conduct first study to evaluate general awareness and adherence to immunisation guidelines by primary care physicians in the USA. We administered an electronic questionnaire to the research panel of the American College of Physicians (ACP) assessing current vaccination practices, barriers to vaccination and provider responsibility for administering vaccinations and compared responses with the European Crohn's and Colitis Organization consensus guidelines and expert opinion from the USA. All of surveyed physicians (276) had experience with patients with IBD and spent majority of their time in direct patient care. 49% of physicians took immunisation history frequently or always, and 76% reported never or rarely checking immunisation antibody titres with only 2% doing so routinely. 65% of physicians believed that primary care providers (PCPs) were responsible for determining patient's immunisation. Vaccine administration was felt to be the duty of primary care doctor 80% of the time. 2.5% of physicians correctly recommended vaccinations all the time. Physicians were more likely to recommend vaccination to immunocompetent than immunocompromised patients. Up to 23% of physicians would incorrectly recommend live vaccine to immunocompromised patients with IBD. Current knowledge and degree of comfort among PCPs in the USA in preventing opportunistic infections in IBD population remain low. Management of patients with IBD requires structured approach to their healthcare maintenance in everyday practice, including enhanced educational policy aimed at primary care physicians. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Oral versus intravenous iron therapy in patients with inflammatory bowel disease and iron deficiency with and without anemia in Germany - a real-world evidence analysis.

PubMed

Stein, Jürgen; Haas, Jennifer Scarlet; Ong, Siew Hwa; Borchert, Kathrin; Hardt, Thomas; Lechat, Elmira; Nip, Kerry; Foerster, Douglas; Braun, Sebastian; Baumgart, Daniel C

2018-01-01

Iron-deficiency anemia and iron deficiency are common comorbidities associated with inflammatory bowel disease (IBD) resulting in impaired quality of life and high health care costs. Intravenous iron has shown clinical benefit compared to oral iron therapy. This study aimed to compare health care outcomes and costs after oral vs intravenous iron treatment for IBD patients with iron deficiency or iron deficiency anemia (ID/A) in Germany. IBD patients with ID/A were identified by ICD-10-GM codes and newly commenced iron treatment via ATC codes in 2013 within the InGef (formerly Health Risk Institute) research claims database. Propensity score matching was performed to balance both treatment groups. Non-observable covariates were adjusted by applying the difference-in-differences (DID) approach. In 2013, 589 IBD patients with ID/A began oral and 442 intravenous iron treatment. After matching, 380 patients in each treatment group were analyzed. The intravenous group had fewer all-cause hospitalizations (37% vs 48%) and ID/A-related hospitalizations (5% vs 14%) than the oral iron group. The 1-year preobservation period comparison revealed significant health care cost differences between both groups. After adjusting for cost differences by DID method, total health care cost savings in the intravenous iron group were calculated to be €367. While higher expenditure for medication (€1,876) was observed in the intravenous iron group, the inpatient setting achieved most cost savings (€1,887). IBD patients receiving intravenous iron were less frequently hospitalized and incurred lower total health care costs compared to patients receiving oral iron. Higher expenditures for pharmaceuticals were compensated by cost savings in other domains.

Evaluation of Outcomes in Adolescent Inflammatory Bowel Disease Patients Following Transfer From Pediatric to Adult Health Care Services: Case for Transition.

PubMed

Cole, Rebecca; Ashok, Dhandapani; Razack, Abdul; Azaz, Amer; Sebastian, Shaji

2015-08-01

We aimed to evaluate the impact of a transition service on clinical and developmental outcomes in adolescent Inflammatory Bowel Disease (IBD) patients on transfer to adult health care services. We reviewed the records of IBD patients diagnosed in pediatric care following their transfer/attendance to the adult IBD service. The data on patients who attended the transition service were compared with those who did not pass through the transition service. Seventy-two patients were included in the study 41M and 31F. Forty-four patients went through the transition system (Group A), and 28 had no formalized transition arrangement before transfer (Group B). A significantly higher number of Group B patients needed surgery within 2 years of transfer when compared with patients in Group A (46% vs. 25%, p = .01). Sixty-one percent of patients in Group B needed at least one admission within 2 years of transfer when compared with 29% of Group A patients (p = .002). Nonattendance at clinics was higher in Group B patients with 78% having at least one nonattendance, whereas 29% of Group A failed to attend at least one appointment (p = .001). In addition, drug compliance rates were higher in the transition group when compared with Group B (89% and 46%, respectively; p = .002). A higher proportion of transitioned patients achieved their estimated maximum growth potential when completing adolescence. There was a trend toward higher dependence on opiates and smoking in Group B patients. In adolescent IBD patients, transition care is associated with better disease specific and developmental outcomes. Prospective studies of different models of transition care in IBD are needed. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Irritable Bowel Syndrome

MedlinePlus

... Staying Safe Videos for Educators Search English Español Irritable Bowel Syndrome KidsHealth / For Teens / Irritable Bowel Syndrome What's in ... intestinal disorder called irritable bowel syndrome. What Is Irritable Bowel Syndrome? Irritable bowel syndrome (IBS) is a common intestinal ...

Understanding Experiences of Youth Growing Up with Anorectal Malformation or Hirschsprung's Disease to Inform Transition Care: A Qualitative In-Depth Interview Study.

PubMed

Nah, Shireen Anne; Ong, Caroline C P; Lie, Desiree; Marimuttu, Vicknesan Jeyan; Hong, Julian; Te-Lu, Yap; Low, Yee; Jacobsen, Anette Sundfor

2018-02-01

 The impact of anorectal malformation (ARM) or Hirschsprung's disease (HD) in children continues into adulthood despite early surgical correction. We aimed to explore the physical, social, and emotional impacts of these conditions on youth to inform best transition care strategies.  Eligible participants were those aged between 14 and 21 years who had undergone surgery for ARM/HD in our institution. We conducted one-on-one in-depth interviews to saturation using a question guide developed from literature review and clinician expertise. Deidentified transcripts were coded by four coders (two pediatric surgeons, one psychiatrist, and one qualitative expert) for major themes using a constant comparison approach. A theoretical model for understanding the transition experience was developed using grounded theory.  Out of 120 patients identified as eligible, 11 youth (6 males) participated in the study. Interviews lasted from 50 to 60 minutes. Four major themes emerged: (1) social support (subthemes: family as core, friends as outer support), (2) cognitive and emotional change (subthemes: realization/recognition of illness, matching emotional response), (3) impact of physical symptoms (subthemes: adverse effects of abnormal bowel habits, gaining bowel continence control leading to overall feeling of control, need to keep disease private), and (4) healthcare providers (viewed as important information sources). Themes did not differ by gender.  Our model suggests that participants' understanding of bowel disease evolved over time with a "lightbulb" moment in preteens or early teens accompanied by increasing disease ownership and self-management. Clinicians should independently engage with patients in late childhood to address evolving emotional and information needs and encourage increasing autonomy. Future studies should explore communication approaches to meet transition needs of patients. Georg Thieme Verlag KG Stuttgart · New York.

UK-based, multisite, prospective cohort study of small bowel obstruction in acute surgical services: National Audit of Small Bowel Obstruction (NASBO) protocol

PubMed Central

Sayers, Adele E; Drake, Thomas M; Hollyman, Marianne; Bradburn, Mike; Hind, Daniel; Wilson, Timothy R; Fearnhead, Nicola S; Abercrombie, John

2017-01-01

Introduction Small bowel obstruction (SBO) is a common indication for emergency laparotomy in the UK, which is associated with a 90-day mortality rate of 13%. There are currently no UK clinical guidelines for the management of this condition. The aim of this multicentre prospective cohort study is to describe the burden, variation in management and associated outcomes of SBO in the UK adult population. Methods and analysis UK hospitals providing emergency general surgery are eligible to participate. This study has three components: (1) a clinical preference questionnaire to be completed by consultants providing emergency general surgical care to assesses preferences in diagnostics and therapeutic approaches, including laparoscopy and nutritional interventions; (2) site resource profile questionnaire to indicate ease of access to diagnostic services, operating theatres, nutritional support teams and postoperative support including intensive care; (3) prospective cohort study of all cases of SBO admitted during an 8-week period at participating trusts. Data on diagnostics, operative and nutritional interventions, and in-hospital mortality and morbidity will be captured, followed by data validation. Ethics and dissemination This will be conducted as a national audit of practice in conjunction with trainee research collaboratives, with support from patient representatives, surgeons, anaesthetists, gastroenterologists and a clinical trials unit. Site-specific reports will be provided to each participant site as well as an overall report to be disseminated through specialist societies. Results will be published in a formal project report endorsed by stakeholders, and in peer-reviewed scientific reports. Key findings will be debated at a focused national meeting with a view to quality improvement initiatives. PMID:28982819

UK-based, multisite, prospective cohort study of small bowel obstruction in acute surgical services: National Audit of Small Bowel Obstruction (NASBO) protocol.

PubMed

Lee, Matthew J; Sayers, Adele E; Drake, Thomas M; Hollyman, Marianne; Bradburn, Mike; Hind, Daniel; Wilson, Timothy R; Fearnhead, Nicola S

2017-10-05

Small bowel obstruction (SBO) is a common indication for emergency laparotomy in the UK, which is associated with a 90-day mortality rate of 13%. There are currently no UK clinical guidelines for the management of this condition. The aim of this multicentre prospective cohort study is to describe the burden, variation in management and associated outcomes of SBO in the UK adult population. UK hospitals providing emergency general surgery are eligible to participate. This study has three components: (1) a clinical preference questionnaire to be completed by consultants providing emergency general surgical care to assesses preferences in diagnostics and therapeutic approaches, including laparoscopy and nutritional interventions; (2) site resource profile questionnaire to indicate ease of access to diagnostic services, operating theatres, nutritional support teams and postoperative support including intensive care; (3) prospective cohort study of all cases of SBO admitted during an 8-week period at participating trusts. Data on diagnostics, operative and nutritional interventions, and in-hospital mortality and morbidity will be captured, followed by data validation. This will be conducted as a national audit of practice in conjunction with trainee research collaboratives, with support from patient representatives, surgeons, anaesthetists, gastroenterologists and a clinical trials unit. Site-specific reports will be provided to each participant site as well as an overall report to be disseminated through specialist societies. Results will be published in a formal project report endorsed by stakeholders, and in peer-reviewed scientific reports. Key findings will be debated at a focused national meeting with a view to quality improvement initiatives. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Snapshot of an integrated psychosocial gastroenterology service

PubMed Central

Kinsinger, Sarah W; Ballou, Sarah; Keefer, Laurie

2015-01-01

AIM: To characterize the patients utilizing a gastroenterology behavioral medicine service and examine the effect of treatment on health care utilization. METHODS: Patients were referred by their gastroenterologists for psychological treatment during a 15 mo period. Patients seen for an intake with a psychologist completed the Brief Symptom Inventory (BSI) and a checklist of psychosocial concerns. A subset of patients with functional bowel disorders also completed a disease specific quality of life measure. Chart review was conducted to obtain information on type and frequency of sessions with the psychologist, the number of outpatient gastroenterology visits, and number of gastroenterology-related medical procedures during the 6 mo following psychological intake. RESULTS: Of 259 patients referred for treatment, 118 (46%) completed an intake with a psychologist. Diagnoses included: irritable bowel syndrome (42%), functional dyspepsia (20%), inflammatory bowel diseases (20%), esophageal symptoms (10%), and “other” (8%). Demographic variables and disease type did not differentiate between those who did and did not schedule an intake. Mean t-scores for the BSI global score index and the depression, anxiety, and somatization subscales fell below the cutoff for clinical significance (t = 63). Treatments were predominantly gut-directed hypnosis (48%) and cognitive behavioral therapy (44%). Average length of treatment was 4 sessions. Among functional gastrointestinal (GI) patients, those patients who initiated treatment received significantly fewer GI-related medical procedures during the 6 mo following the referral than patients who did not schedule an intake [t (197) = 2.69, P < 0.01]. CONCLUSION: Patients are receptive to psychological interventions for GI conditions and there is preliminary evidence that treatment can decrease health-care utilization among patients with functional GI conditions. PMID:25684957

Serious events in older Ontario residents receiving bowel preparations for outpatient colonoscopy with various comorbidity profiles: A descriptive, population-based study

PubMed Central

Ho, Joanne M; Gruneir, Andrea; Fischer, Hadas D; Fu, Longdi; Lipscombe, Lorraine L; Bell, Chaim M; Cavalcanti, Rodrigo B; Anderson, Geoffrey M; Rochon, Paula A

2012-01-01

BACKGROUND: Polyethylene glycol-based bowel preparations (PEGBPs) and sodium picosulfate (NaPS) are commonly used for bowel cleansing before colonoscopy. Little is known about adverse events associated with these preparations, particularly in older patients or patients with medical comorbidities. OBJECTIVE: To characterize the incidence of serious events following outpatient colonoscopy in patients using PEGBPs or NaPS. METHODS: The present population-based retrospective cohort study examined data from Ontario health care databases between April 1, 2005 and December 31, 2007, including patients ≥66 years of age who received either PEGBP or NaPS for an outpatient colonoscopy. Patients with cardiac or renal disease, long-term care residents or patients receiving concurrent diuretic therapy were identified as high risk for adverse events. The primary outcome was a serious event (SE) defined as a composite of nonelective hospitalization, emergency department visit or death within seven days of the colonoscopy. RESULTS: Of the 50,660 outpatients ≥66 years of age who underwent a colonoscopy, SEs were observed in 675 (2.4%) and 543 (2.4%) patients in the PEGBP and NaPS groups, respectively. Among high-risk patients (n=30,168), SEs occurred in 481 (2.8%) and 367 (2.8%) of patients receiving PEGBP and NaPS, respectively. CONCLUSIONS: The SE rate within seven days of outpatient colonoscopy was 24 per 1000 procedures, and among high-risk patients was 28 per 1000 procedures. The rates were similar for PEGBP and NaPS. Clinicians should be aware of the risks associated with colonoscopy in older patients with comorbidities. PMID:22803018

Pediatric Intestinal Rehabilitation and Transplantation Registry: Initial Report from a European Collaborative Registry.

PubMed

Totonelli, Giorgia; Tambucci, Roberto; Boscarelli, Alessandro; Hermans, Dominique; Dall'Oglio, Luigi; Diamanti, Antonella; d'Aische, Aloys du Bois; Pakarinen, Mikko; Reding, Raymond; Morini, Francesco; Bagolan, Pietro; Fusaro, Fabio

2018-02-01

 Short bowel syndrome (SBS) is the main cause of intestinal failure (IF) in the pediatric population. To promote the standardization of care of these patients, the registry of Pediatric Intestinal Rehabilitation and Transplantation (PIRAT) has been established. The aim of this study is to describe patients with IF using PIRAT database.  Data from two tertiary care European referral Centers registered in PIRAT (https://www.studeon.eu/pirat) were analyzed (1994-2015). Neonatal SBS-related IF was defined as need for parenteral nutrition (PN) to sustain life and growth for more than 75 days, after extensive bowel resection during neonatal period. Data included patient demographics, disease at birth, residual small intestine, and intestinal autonomy (PN on/off).  In this study, 114 children with SBS-related IF were identified (male 60%). Median gestational age was 35.3 weeks (interquartile range [IQR]: 33.0-38.0); median birth weight was 2,440 g (IQR: 1,700-2,990). The main causes of SBS were intestinal atresia in 31 (27%), midgut volvulus in 29 (25%), necrotizing enterocolitis in 23 (20%), and gastroschisis in 12 (11%). Nine (7.9%) patients died on PN (six sepsis, two IF-associated liver disease, and one multiorgan failure). Median residual small bowel length was 46 cm (IQR: 13.0-92.5). Ileocecal valve was resected in 48 patients (42%). Intestinal autonomy was achieved in 68% patients.  We present the web-based registry PIRAT and the first results of patients with IF registered from two European Centers. PIRAT could give the opportunity to create a dedicated international network (IF-net) to standardize, improve, and spread the therapeutic paths for the rare and heterogeneous condition of SBS-related IF. Georg Thieme Verlag KG Stuttgart · New York.

MBCP - Approach - Advanced Surgery | Center for Cancer Research

Cancer.gov

Advanced Surgery We have the expertise to do complex reconstructive procedures with robotic assistance. This results in: smaller incisions, less blood loss, and shorter stays in the hospital In the most challenging of cases of radical cystectomy, we remove the bladder and replace it with a bladder that we construct from bowel tissue. This is standard-of-care for advanced cases.

Prophylaxis against Pneumocystis pneumonia in patients with inflammatory bowel disease: toward a standard of care.

PubMed

Poppers, David M; Scherl, Ellen J

2008-01-01

Patients with Crohn's Disease and ulcerative colitis are increasingly treated with a host of immunomodulatory and immunosuppressive medications, including thiopurines and antibody-based biologic agents. Despite the known infectious complications associated with these therapies from the HIV and solid organ transplant literature, there are currently no well-defined concise guidelines to assist gastroenterologists and other physicians in the utility and indication for prophylaxis against Pneumocystis pneumonia and other infections in inflammatory bowel disease (IBD) patients. In this article, we discuss the evidence of various infections associated with immunocompromise in HIV/AIDS, organ transplantation, and in other immunocompromised states, and discuss the evidence for the efficacy and safety of various infectious prophylaxis protocols. In addition, we discuss the evidence for Pneumocystis and other infections in IBD patients treated with corticosteroids, azathioprine/6-MP, biologic agents and other therapies, and we present the case for various antibiotic (and antiviral) regimens to prevent such infections. Based on the review of the literature, this discussion represents a true call for guidelines for infection prophylaxis, to help guide gastroenterologists and all practitioners who care for the challenging population of IBD patients.

Self-management for people with inflammatory bowel disease

PubMed Central

Saibil, Fred; Lai, Emily; Hayward, Andrew; Yip, Jeanne; Gilbert, Cameron

2008-01-01

In North America and the United Kingdom, we are in the age of self-management. Many patients with chronic diseases are ready to participate in the therapeutic decision-making process, and join their physicians in a co-management model. It is particularly useful to consider this concept at a time when physician shortages and waiting times are on the front page every day, with no immediate prospect of relief. Conditions such as diabetes, asthma, chronic obstructive pulmonary disease, recurrent urinary tract infections and others lend themselves to this paradigm of medical care for the informed patient. The present paper reviews some of the literature on self-management for the patient with inflammatory bowel disease (IBD), and provides a framework for the use of self-management in the IBD population, with emphasis on the concept of a patient passport, and the use of e-mail, supported by an e-mail contract, as proposed by the Canadian Medical Protective Association. Examples of specific management strategies are provided for several different IBD scenarios. Eliminating the need for some office visits has clear environmental and economical benefits. Potential negative consequences of this form of patient care are also discussed. PMID:18354757

A Framework of Care in Multiple Sclerosis, Part 2

PubMed Central

Aliotta, Philip J.; Bainbridge, Jacquelyn; Bennett, Susan E.; Cutter, Gary; Fenton, Kaylan; Lublin, Fred; Northrop, Dorothy; Rintell, David; Walker, Bryan D.; Weigel, Megan; Zackowski, Kathleen; Jones, David E.

2017-01-01

Abstract The Consortium of Multiple Sclerosis Centers (CMSC) convened a Framework Taskforce composed of a multidisciplinary group of clinicians and researchers to examine and evaluate the current models of care in multiple sclerosis (MS). The methodology of this project included analysis of a needs assessment survey and an extensive literature review. The outcome of this work is a two-part continuing education series of articles. Part 1, published previously, covered the updated disease phenotypes of MS along with recommendations for the use of disease-modifying therapies. Part 2, presented herein, reviews the variety of symptoms and potential complications of MS. Mobility impairment, spasticity, pain, fatigue, bladder/bowel/sexual dysfunction, cognitive dysfunction, and neuropsychiatric issues are examined, and both pharmacologic and nonpharmacologic interventions are described. Because bladder and bowel symptoms substantially affect health-related quality of life, detailed information about elimination dysfunction is provided. In addition, a detailed discussion about mental health and cognitive dysfunction in people with MS is presented. Part 2 concludes with a focus on the role of rehabilitation in MS. The goal of this work is to facilitate the highest levels of independence or interdependence, function, and quality of life for people with MS. PMID:28243186

Upper GI tract lesions in familial adenomatous polyposis (FAP): enrichment of pyloric gland adenomas and other gastric and duodenal neoplasms.

PubMed

Wood, Laura D; Salaria, Safia N; Cruise, Michael W; Giardiello, Francis M; Montgomery, Elizabeth A

2014-03-01

Patients with familial adenomatous polyposis (FAP), an autosomal dominant cancer predisposition syndrome caused by mutations in the APC gene, develop neoplasms in both the upper and lower gastrointestinal (GI) tract. To clarify the upper GI tract lesions in FAP patients in a tertiary care setting, we reviewed specimens from 321 endoscopies in 66 patients with FAP. Tubular adenomas in the small bowel were the most common neoplasms (present in 89% of patients), although only 1 patient developed invasive carcinoma of the small bowel. Several types of gastric neoplasms were identified--65% of patients had at least 1 fundic gland polyp, and 23% of patients had at least 1 gastric foveolar-type gastric adenoma. Pyloric gland adenomas were also enriched, occurring in 6% of patients--this is a novel finding in FAP patients. Despite the high frequency of gastric neoplasms, only 1 patient developed carcinoma in the stomach. The very low frequency of carcinoma in these patients suggests that current screening procedures prevent the vast majority of upper GI tract carcinomas in patients with FAP, at least in the tertiary care setting.

A Personalized Approach to Managing Inflammatory Bowel Disease

PubMed Central

Kingsley, Michael J.

2016-01-01

The management of inflammatory bowel disease (IBD) requires a personalized approach to treat what is a heterogeneous group of patients with inherently variable disease courses. In its current state, personalized care of the IBD patient involves identifying patients at high risk for rapid progression to complications, selecting the most appropriate therapy for a given patient, using therapeutic drug monitoring, and achieving the individualized goal that is most appropriate for that patient. The growing body of research in this area allows clinicians to better predict outcomes for individual patients. Some paradigms, especially within the realm of therapeutic drug monitoring, have begun to change as therapy is targeted to individual patient results and goals. Future personalized medical decisions may allow specific therapeutic plans to draw on serologic, genetic, and microbial data for Crohn’s disease and ulcerative colitis patients. PMID:27499713

Traumatic hemorrhage of occult phaeochromocytoma in a patient with septic shock

PubMed Central

Moazzam, Mohammad Shahnawaz; Ahmed, Syed Moied; Bano, Shahjahan

2010-01-01

Phaeochromocytoma can have a variety of presentations; however, traumatic hemorrhage into a phaeochromocytoma is a very rare presentation. Diagnosing and managing a critically ill, septic patient with a Phaeochromocytoma can be very challenging. We report a case of 53 years old man with a previously undiagnosed Phaeochromocytoma, who presented initially with bowel perforation following an assault. Following a laparotomy for bowel resection and anastomosis, whilst on the intensive care unit, he developed paroxysmal severe hypertension overlying septic shock. Phaeochromocytoma was confirmed using a computed tomography scan and urinary assay of metanephrine and catecholamines. We managed the haemodynamic instability using labetalol and noradrenaline infusions. As his septic state improved he was convention therapy and following control of his symptoms over the next few weeks, he underwent an uncomplicated right sided adrenalectomy. He made a full recovery. PMID:20930983

Human Microbiome and Learning Healthcare Systems: Integrating Research and Precision Medicine for Inflammatory Bowel Disease

PubMed Central

Chuong, Kim H.; Mack, David R.; Stintzi, Alain

2018-01-01

Abstract Healthcare institutions face widespread challenges of delivering high-quality and cost-effective care, while keeping up with rapid advances in biomedical knowledge and technologies. Moreover, there is increased emphasis on developing personalized or precision medicine targeted to individuals or groups of patients who share a certain biomarker signature. Learning healthcare systems (LHS) have been proposed for integration of research and clinical practice to fill major knowledge gaps, improve care, reduce healthcare costs, and provide precision care. To date, much discussion in this context has focused on the potential of human genomic data, and not yet on human microbiome data. Rapid advances in human microbiome research suggest that profiling of, and interventions on, the human microbiome can provide substantial opportunity for improved diagnosis, therapeutics, risk management, and risk stratification. In this study, we discuss a potential role for microbiome science in LHSs. We first review the key elements of LHSs, and discuss possibilities of Big Data and patient engagement. We then consider potentials and challenges of integrating human microbiome research into clinical practice as part of an LHS. With rapid growth in human microbiome research, patient-specific microbial data will begin to contribute in important ways to precision medicine. Hence, we discuss how patient-specific microbial data can help guide therapeutic decisions and identify novel effective approaches for precision care of inflammatory bowel disease. To the best of our knowledge, this expert analysis makes an original contribution with new insights poised at the emerging intersection of LHSs, microbiome science, and postgenomics medicine. PMID:28282257

Use of Peristeen® transanal colonic irrigation for bowel management in children: a single-center experience.

PubMed

Pacilli, Maurizio; Pallot, David; Andrews, Afiya; Downer, Angela; Dale, Louiza; Willetts, Ian

2014-02-01

Transanal colonic irrigation has been shown to be effective in bowel management program in adults. However, there exist limited data in children. We appraised the effectiveness of this technique in a series of children with incontinence or constipation and overflow soiling. Following ethical approval, a review of children with incontinence or constipation on a bowel management program with Peristeen® transanal colonic irrigation treated between 2007 and 2012 was performed. Irrigations were performed with a volume of 10-20 ml/kg of water with schedules depending on patient response. Data are reported as median (range). Twenty-three patients were reviewed. Median age at commencement of irrigations was 7 (2-15) years. Median follow-up is 2 (0.7-3.4) years. Diagnoses include the following: spina bifida (n=11), anorectal anomaly (n=6), Hirschsprung's (n=1), and other complex anomalies (n=5). Sixteen (70%) patients had associated anomalies. Twelve (52%) had constipation and overflow soiling, and 11 (48%) had fecal incontinence. Twenty (87%) had associated urinary wetting. Sixteen (70%) children used alternate-day irrigations, 4 (17%) daily irrigations, and 3 (13%) every third-day irrigations. Nine (39%) patients were taking oral laxatives. Sixteen (70%) reported to be clean and 3 (13%) reported a significant improvement, although were having occasional soiling. Four patients (17%) did not tolerate the irrigations and underwent subsequent colostomy formation for intractable soiling. In our experience, Peristeen® transanal colonic irrigation is an effective method of managing patients with focal soiling in childhood. Majority (83%) of children achieve social fecal continence or a significant improvement with occasional soiling. This was accompanied by high parental satisfaction. Peristeen® transanal colonic irrigation is a valid alternative to invasive surgical procedures and should be considered the first line of treatment for bowel management in children with soiling where simple pharmacological maneuvers failed to be effective. Copyright © 2014 Elsevier Inc. All rights reserved.

Small Bowel Transplant

PubMed Central

2003-01-01

EXECUTIVE SUMMARY Objective The Medical Advisory Secretariat undertook a review of the evidence on the effectiveness and cost-effectiveness of small bowel transplant in the treatment of intestinal failure. Small Bowel Transplantation Intestinal failure is the loss of absorptive capacity of the small intestine that results in an inability to meet the nutrient and fluid requirements of the body via the enteral route. Patients with intestinal failure usually receive nutrients intravenously, a procedure known as parenteral nutrition. However, long-term parenteral nutrition is associated with complications including liver failure and loss of venous access due to recurrent infections. Small bowel transplant is the transplantation of a cadaveric intestinal allograft for the purpose of restoring intestinal function in patients with irreversible intestinal failure. The transplant may involve the small intestine alone (isolated small bowel ISB), the small intestine and the liver (SB-L) when there is irreversible liver failure, or multiple organs including the small bowel (multivisceral MV or cluster). Although living related donor transplant is being investigated at a limited number of centres, cadaveric donors have been used in most small bowel transplants. The actual transplant procedure takes approximately 12-18 hours. After intestinal transplant, the patient is generally placed on prophylactic antibiotic medication and immunosuppressive regimen that, in the majority of cases, would include tacrolimus, corticosteroids and an induction agent. Close monitoring for infection and rejection are essential for early treatment. Medical Advisory Secretariat Review The Medical Advisory Secretariat undertook a review of 35 reports from 9 case series and 1 international registry. Sample size of the individual studies ranged from 9 to 155. As of May 2001, 651 patients had received small bowel transplant procedures worldwide. According to information from the Canadian Organ Replacement Register, a total of 27 small bowel transplants were performed in Canada from 1988 to 2002. Patient Outcomes The experience in small bowel transplant is still limited. International data showed that during the last decade, patient survival and graft survival rates from SBT have improved, mainly because of improved immunosuppression therapy and earlier detection and treatment of infection and rejection. The Intestinal Transplant Registry reported 1-year actuarial patient survival rates of 69% for isolated small bowel transplant, 66% for small bowel-liver transplant, and 63% for multivisceral transplant, and a graft survival rate of 55% for ISB and 63% for SB-L and MV. The range of 1-year patient survival rates reported ranged from 33%-87%. Reported 1-year graft survival rates ranged from 46-71%. Regression analysis performed by the International Transplant Registry in 1997 indicated that centres that have performed at least 10 small bowel transplants had better patient and graft survival rates than centres that performed less than 10 transplants. However, analysis of the data up to May 2001 suggests that the critical mass of 10 transplants no longer holds true for transplants after 1995, and that good results can be achieved at any multiorgan transplant program with moderate patient volumes. The largest Centre reported an overall 1-year patient and graft survival rate of 72% and 64% respectively, and 5-year patient and graft survival of 48% and 40% respectively. The overall 1-year patient survival rate reported for Ontario pediatric small bowel transplants was 61% with the highest survival rate of 83% for ISB. The majority (70% or higher) of surviving small bowel transplant recipients was able to wean from parenteral nutrition and meet all caloric needs enterally. Some may need enteral or parenteral supplementation during periods of illness. Growth and weight gain in children after ISB were reported by two studies while two other studies reported a decrease in growth velocity with no catch-up growth. The quality of life after SBT was reported to be comparable to that of patients on home enteral nutrition. A study found that while the parents of pediatric SBT recipients reported significant limitations in the physical and psychological well being of the children compared with normal school children, the pediatric SBT recipients themselves reported a quality of life similar to other school children. Survival was found to be better in transplants performed since 1991. Patient survival was associated with the type of organ transplanted with better survival in isolated small bowel recipients. Adverse Events Despite improvement in patient and graft survival rates, small bowel transplant is still associated with significant mortality and morbidity. Infection with subsequent sepsis is the leading cause of death (51.3%). Bacterial, fungal and viral infections have all been reported. The most common viral infections are cytomegalorvirus (18-40%) and Epstein-Barr virus. The latter often led to ß-cell post-transplant lymphoproliferative disease. Graft rejection is the second leading cause of death after SBT (10.4%) and is responsible for 57% of graft removal. Acute rejection rates ranged from 51% to 83% in the major programs. Most of the acute rejection episodes were mild and responded to steroids and OKT3. Antilymphocyte therapy was needed in up to 27% of patients. Isolated small bowel allograft and positive lymphocytotoxic cross-match were found to be risk factors for acute rejection. Post-transplant lymphoproliferative disease occurred in 21% of SBT recipients and accounted for 7% of post-transplant mortality. The frequency was higher in pediatric recipients (31%) and in adults receiving composite visceral allografts (25%). The allograft itself is often involved in post-transplant lymphoproliferative disease. The reported incidence of host versus graft disease varied widely among centers (0% - 14%). Surgical complications were reported to occur in 85% of SB-L transplants and 25% of ISB transplants. Reoperations were required in 45% - 66% of patients in a large series and the most common reason for reoperation was intra-abdominal abscess. The median cost of intestinal transplant in the US was reported to be approximately $275,000US (approximately CDN$429,000) per case. A US study concluded that based on the US cost of home parenteral nutrition, small bowel transplant could be cost-effective by the second year after the transplant. Conclusion There is evidence that small bowel transplant can prolong the life of some patients with irreversible intestinal failure who can no longer continue to be managed by parenteral nutrition therapy. Both patient survival and graft survival rates have improved with time. However, small bowel transplant is still associated with significant mortality and morbidity. The outcomes are inferior to those of total parenteral nutrition. Evidence suggests that this procedure should only be used when total parenteral nutrition is no longer feasible. PMID:23074441

Pelvic Normal Tissue Contouring Guidelines for Radiation Therapy: A Radiation Therapy Oncology Group Consensus Panel Atlas

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gay, Hiram A., E-mail: hgay@radonc.wustl.edu; Barthold, H. Joseph; Beth Israel Deaconess Medical Center, Boston, MA

2012-07-01

Purpose: To define a male and female pelvic normal tissue contouring atlas for Radiation Therapy Oncology Group (RTOG) trials. Methods and Materials: One male pelvis computed tomography (CT) data set and one female pelvis CT data set were shared via the Image-Guided Therapy QA Center. A total of 16 radiation oncologists participated. The following organs at risk were contoured in both CT sets: anus, anorectum, rectum (gastrointestinal and genitourinary definitions), bowel NOS (not otherwise specified), small bowel, large bowel, and proximal femurs. The following were contoured in the male set only: bladder, prostate, seminal vesicles, and penile bulb. The followingmore » were contoured in the female set only: uterus, cervix, and ovaries. A computer program used the binomial distribution to generate 95% group consensus contours. These contours and definitions were then reviewed by the group and modified. Results: The panel achieved consensus definitions for pelvic normal tissue contouring in RTOG trials with these standardized names: Rectum, AnoRectum, SmallBowel, Colon, BowelBag, Bladder, UteroCervix, Adnexa{sub R}, Adnexa{sub L}, Prostate, SeminalVesc, PenileBulb, Femur{sub R}, and Femur{sub L}. Two additional normal structures whose purpose is to serve as targets in anal and rectal cancer were defined: AnoRectumSig and Mesorectum. Detailed target volume contouring guidelines and images are discussed. Conclusions: Consensus guidelines for pelvic normal tissue contouring were reached and are available as a CT image atlas on the RTOG Web site. This will allow uniformity in defining normal tissues for clinical trials delivering pelvic radiation and will facilitate future normal tissue complication research.« less

Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies.

PubMed

Ng, Siew C; Shi, Hai Yun; Hamidi, Nima; Underwood, Fox E; Tang, Whitney; Benchimol, Eric I; Panaccione, Remo; Ghosh, Subrata; Wu, Justin C Y; Chan, Francis K L; Sung, Joseph J Y; Kaplan, Gilaad G

2018-12-23

Inflammatory bowel disease is a global disease in the 21st century. We aimed to assess the changing incidence and prevalence of inflammatory bowel disease around the world. We searched MEDLINE and Embase up to and including Dec 31, 2016, to identify observational, population-based studies reporting the incidence or prevalence of Crohn's disease or ulcerative colitis from 1990 or later. A study was regarded as population-based if it involved all residents within a specific area and the patients were representative of that area. To be included in the systematic review, ulcerative colitis and Crohn's disease needed to be reported separately. Studies that did not report original data and studies that reported only the incidence or prevalence of paediatric-onset inflammatory bowel disease (diagnosis at age <16 years) were excluded. We created choropleth maps for the incidence (119 studies) and prevalence (69 studies) of Crohn's disease and ulcerative colitis. We used temporal trend analyses to report changes as an annual percentage change (APC) with 95% CI. We identified 147 studies that were eligible for final inclusion in the systematic review, including 119 studies of incidence and 69 studies of prevalence. The highest reported prevalence values were in Europe (ulcerative colitis 505 per 100 000 in Norway; Crohn's disease 322 per 100 000 in Germany) and North America (ulcerative colitis 286 per 100 000 in the USA; Crohn's disease 319 per 100 000 in Canada). The prevalence of inflammatory bowel disease exceeded 0·3% in North America, Oceania, and many countries in Europe. Overall, 16 (72·7%) of 22 studies on Crohn's disease and 15 (83·3%) of 18 studies on ulcerative colitis reported stable or decreasing incidence of inflammatory bowel disease in North America and Europe. Since 1990, incidence has been rising in newly industrialised countries in Africa, Asia, and South America, including Brazil (APC for Crohn's disease +11·1% [95% CI 4·8-17·8] and APC for ulcerative colitis +14·9% [10·4-19·6]) and Taiwan (APC for Crohn's disease +4·0% [1·0-7·1] and APC for ulcerative colitis +4·8% [1·8-8·0]). At the turn of the 21st century, inflammatory bowel disease has become a global disease with accelerating incidence in newly industrialised countries whose societies have become more westernised. Although incidence is stabilising in western countries, burden remains high as prevalence surpasses 0·3%. These data highlight the need for research into prevention of inflammatory bowel disease and innovations in health-care systems to manage this complex and costly disease. None. Copyright © 2017 Elsevier Ltd. All rights reserved.

Management of emergent conditions in palliative care.

PubMed

Wrede-Seaman, L D

2001-06-01

Emergent conditions arising in patients with advanced terminal disease are inevitable and create stressful situations for patients, caregivers, and health care personnel. Discussions regarding appropriate levels of intervention based on parameters such as patient wishes, proper access to documentation of those wishes, location of care, cognitive status and extent of clinical decline are important to have before crisis situations. Common emergencies to be addressed include those that may or may not be associated with advanced malignancies, including compression syndromes, superior vena cava syndrome, hypercalcemia, acute dyspnea, seizures, acute urinary and bowel obstructions, massive hemorrhage, cardiac tamponade, acute embolic phenomenon, and psychiatric emergencies. Although not all clinical scenarios will be addressed in this article, the more common ones will be discussed.

Bowel sparing in pediatric cranio-spinal radiotherapy: a comparison of combined electron and photon and helical TomoTherapy techniques to a standard photon method

DOE Office of Scientific and Technical Information (OSTI.GOV)

Harron, Elizabeth, E-mail: elizabeth.harron@nuh.nhs.uk; Lewis, Joanne

2012-07-01

The aim of this study was to compare the dose to organs at risk (OARs) from different craniospinal radiotherapy treatment approaches available at the Northern Centre for Cancer Care (NCCC), with a particular emphasis on sparing the bowel. Method: Treatment plans were produced for a pediatric medulloblastoma patient with inflammatory bowel disease using 3D conformal 6-MV photons (3DCP), combined 3D 6-MV photons and 18-MeV electrons (3DPE), and helical photon TomoTherapy (HT). The 3DPE plan was a modification of the standard 3DCP technique, using electrons to treat the spine inferior to the level of the diaphragm. The plans were compared inmore » terms of the dose-volume data to OARs and the nontumor integral dose. Results: The 3DPE plan was found to give the lowest dose to the bowel and the lowest nontumor integral dose of the 3 techniques. However, the coverage of the spine planning target volume (PTV) was least homogeneous using this technique, with only 74.6% of the PTV covered by 95% of the prescribed dose. HT was able to achieve the best coverage of the PTVs (99.0% of the whole-brain PTV and 93.1% of the spine PTV received 95% of the prescribed dose), but delivered a significantly higher integral dose. HT was able to spare the heart, thyroid, and eyes better than the linac-based techniques, but other OARs received a higher dose. Conclusions: Use of electrons was the best method for reducing the dose to the bowel and the integral dose, at the expense of compromised spine PTV coverage. For some patients, HT may be a viable method of improving dose homogeneity and reducing selected OAR doses.« less

No increase in toxicity of pelvic irradiation when intensity modulation is employed: clinical and dosimetric data of 208 patients treated with post-prostatectomy radiotherapy.

PubMed

Jereczek-Fossa, Barbara A; Ciardo, Delia; Ferrario, Silvia; Fossati, Piero; Fanetti, Giuseppe; Zerini, Dario; Zannoni, Davide; Fodor, Cristiana; Gerardi, Marianna A; Surgo, Alessia; Muto, Matteo; Cambria, Raffaella; De Cobelli, Ottavio; Orecchia, Roberto

2016-07-01

To compare the toxicity of image-guided intensity-modulated radiotherapy (IG-IMRT) to the pelvis or prostate bed (PB) only. To test the hypothesis that the potentially injurious effect of pelvic irradiation can be counterbalanced by reduced irradiated normal tissue volume using IG-IMRT. Between February 2010 and February 2012, 208 patients with prostate cancer were treated with adjuvant or salvage IG-IMRT to the PB (102 patients, Group PB) or the pelvis and prostate bed (P) (106 patients, Group P). The Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria were used to evaluate toxicity. Median follow-up was 27 months. Toxicity G ≥ 2 in Group PB: in the bowel acute and late toxicities were 11.8% and 10%, respectively; urinary acute and late toxicities were 10.8% and 15%, respectively. Toxicity G ≥ 2 in Group P: in the bowel acute and late toxicities were both 13.2%; urinary acute and late toxicities were 13.2% and 15.1%, respectively. No statistical difference in acute or late toxicity between the groups was found (bowel: p = 0.23 and p = 0.89 for acute and late toxicity, respectively; urinary: p = 0.39 and p = 0.66 for acute and late toxicity, respectively). Of the clinical variables, only previous abdominal surgery was correlated with acute bowel toxicity. Dosimetric parameters that correlated with bowel toxicity were identified. The toxicity rates were low and similar in both groups, suggesting that IG-IMRT allows for a safe post-operative irradiation of larger volumes. Further investigation is warranted to exclude bias owing to non-randomized character of the study. Our report shows that modern radiotherapy technology and careful planning allow maintaining the toxicity of pelvic lymph node treatment at the acceptable level, as it is in the case of PB radiotherapy.

Optimizing bowel preparation for colonoscopy: a guide to enhance quality of visualization

PubMed Central

Bechtold, Matthew L.; Mir, Fazia; Puli, Srinivas R.; Nguyen, Douglas L.

2016-01-01

Colonoscopy is an important screening and therapeutic modality for colorectal cancer. Unlike other screening tests, colonoscopy is dependent on pre-procedure bowel preparation. If the bowel preparation is poor, significant pathology may be missed. Many factors are known to improve bowel preparation. This review will highlight those factors that may optimize the bowel preparation, including choice of bowel preparation, grading or scoring of the bowel preparation, special factors that influence preparation, and diet prior to colonoscopy that affects bowel preparation. The aim of the review is to offer suggestions and guide endoscopists on how to optimize the bowel preparation for the patients undergoing colonoscopy. PMID:27065725

Fecal weight, colon cancer risk, and dietary intake of nonstarch polysaccharides (dietary fiber)

PubMed

Cummings, J H; Bingham, S A; Heaton, K W; Eastwood, M A

1992-12-01

Low fecal weight and slow bowel transit time are thought to be associated with bowel cancer risk, but few published data defining bowel habits in different communities exist. Therefore, data on stool weight were collected from 20 populations in 12 countries to define this risk more accurately, and the relationship between stool weight and dietary intake of nonstarch polysaccharides (NSP) (dietary fiber) was quantified. In 220 healthy U.K. adults undertaking careful fecal collections, median daily stool weight was 106 g/day (men, 104 g/day; women, 99 g/day; P = 0.02) and whole-gut transit time was 60 hours (men, 55 hours; women, 72 hours; P = 0.05); 17% of women, but only 1% of men, passed < 50 g stool/day. Data from other populations of the world show average stool weight to vary from 72 to 470 g/day and to be inversely related to colon cancer risk (r = -0.78). Meta-analysis of 11 studies in which daily fecal weight was measured accurately in 26 groups of people (n = 206) on controlled diets of known NSP content shows a significant correlation between fiber intake and mean daily stool weight (r = 0.84). Stool weight in many Westernized populations is low (80-120 g/day), and this is associated with increased colon cancer risk. Fecal output is increased by dietary NSP. Diets characterized by high NSP intake (approximately 18 g/day) are associated with stool weights of 150 g/day and should reduce the risk of bowel cancer.

Long-Term Cost-Effectiveness of Transanal Irrigation in Patients with Neurogenic Bowel Dysfunction.

PubMed

Emmanuel, Anton; Kumar, Gayathri; Christensen, Peter; Mealing, Stuart; Størling, Zenia M; Andersen, Frederikke; Kirshblum, Steven

2016-01-01

People suffering from neurogenic bowel dysfunction (NBD) and an ineffective bowel regimen often suffer from fecal incontinence (FI) and related symptoms, which have a huge impact on their quality of life. In these situations, transanal irrigation (TAI) has been shown to reduce these symptoms and improve quality of life. To investigate the long-term cost-effectiveness of initiating TAI in patients with NBD who have failed standard bowel care (SBC). A deterministic Markov decision model was developed to project the lifetime health economic outcomes, including quality-adjusted life years (QALYs), episodes of FI, urinary tract infections (UTIs), and stoma surgery when initiating TAI relative to continuing SBC. A data set consisting of 227 patients with NBD due to spinal cord injury (SCI), multiple sclerosis, spina bifida and cauda equina syndrome was used in the analysis. In the model a 30-year old individual with SCI was used as a base-case. A probabilistic sensitivity analysis was applied to evaluate the robustness of the model. The model predicts that a 30-year old SCI patient with a life expectancy of 37 years initiating TAI will experience a 36% reduction in FI episodes, a 29% reduction in UTIs, a 35% reduction in likelihood of stoma surgery and a 0.4 improvement in QALYs, compared with patients continuing SBC. A lifetime cost-saving of £21,768 per patient was estimated for TAI versus continuing SBC alone. TAI is a cost-saving treatment strategy reducing risk of stoma surgery, UTIs, episodes of FI and improving QALYs for NBD patients who have failed SBC.

How patients view probiotics: findings from a multicenter study of patients with inflammatory bowel disease and irritable bowel syndrome.

PubMed

Mercer, MaryBeth; Brinich, Margaret A; Geller, Gail; Harrison, Krista; Highland, Janelle; James, Katherine; Marshall, Patricia; McCormick, Jennifer B; Tilburt, Jon; Achkar, Jean-Paul; Farrell, Ruth M; Sharp, Richard R

2012-02-01

Patients with inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) have access to a growing number of probiotic products marketed to improve digestive health. It is unclear how patients make decisions about probiotics and what role they expect their gastroenterologists to play as they consider using probiotics. Understanding patients' knowledge, attitudes and expectations of probiotics may help gastroenterologists engage patients in collaborative discussions about probiotics. Focus groups were conducted with patients with IBD and IBS at the Cleveland Clinic, Mayo Clinic, and Johns Hopkins University. Inductive analytic methods were used to identify common themes and draw interpretations from focus group narratives. One hundred thirty-six patients participated in 22 focus groups between March and August 2009. Patients viewed probiotics as an appealing alternative to pharmaceutical drugs and understood probiotics as a more "natural," low-risk therapeutic option. Many patients were hesitant to use them without consulting their gastroenterologists. Patients would weigh the risks and benefits of probiotics, their disease severity and satisfaction with current treatments when considering probiotic use. Patients are interested in probiotics but have many unanswered questions about their use. Our findings suggest that patients with IBD and IBS will look to gastroenterologists and other clinicians as trustworthy advisors regarding the utility of probiotics as an alternative or supplement to pharmaceutical drugs. Gastroenterologists and other clinicians who care for patients with these diseases should be prepared to discuss the potential benefits and risks of probiotics and assist patients in making informed decisions about their use.

Dyssynergic defecation: a treatable cause of persistent symptoms when inflammatory bowel disease is in remission.

PubMed

Perera, Lilani P; Ananthakrishnan, Ashwin N; Guilday, Corinne; Remshak, Kristin; Zadvornova, Yelena; Naik, Amar S; Stein, Daniel J; Massey, Benson T

2013-12-01

Introduction of biologic agents in inflammatory bowel disease (IBD) has increased the likelihood of disease remission. Despite resolution of active inflammation, a subset of IBD patients report persistent defecatory symptoms. To evaluate a group of patients with inflammatory bowel disease with suspected functional defecatory disorders, by use of anorectal manometric testing and subsequent biofeedback therapy. A group of IBD patients with persistent defecatory problems despite clinical improvement were included in this study. These patients had no evidence of left-sided disease. Endoscopic and radiographic study findings and timing in relation to the manometry study were recorded. Anorectal manometry was performed by the standard protocol and included rectal sensory assessment, ability to expel a balloon, and pressure dynamics with simulated defecation. Thirty IBD patients (Crohn's 23 patients; ulcerative colitis six patients) presented with defecatory disorders including constipation (67%) increased stooling (10%), and rectal urgency and/or incontinence and rectal pain (6%). All but one patient had anorectal manometric criteria of dyssynergia (presence of anismus motor pattern and inability to expel the balloon). Of the patients who completed biofeedback therapy, 30% had a clinically significant (≥7-point) improvement in SIBDQ score, with a reduction in health-care utilization after a six-month period (p=0.02). Despite remission, some inflammatory bowel disease patients have persistent defecatory symptoms. Defecatory symptoms may not be predictive of an underlying inflammatory disorder. Lack of inflammatory activity and absence of left-sided disease should prompt investigation of functional disorders. Anorectal manometric testing and biofeedback therapy for patients with a diagnosis of dyssynergia may be a useful therapy.

Internal Hernia Following Laparoscopic Roux-en-Y Gastric Bypass: Prevention and Tips for Intra-operative Management.

PubMed

Nimeri, Abdelrahman A; Maasher, Ahmed; Al Shaban, Talat; Salim, Elnazeer; Gamaleldin, Maysoon M

2016-09-01

Laparoscopic Roux-en-Y gastric bypass (LRYGB) is considered the golden standard for bariatric surgery. However, the potential risk for internal hernia after LRYGB remains a significant concern to both patients and surgeons. In addition, patients presenting with abdominal pain after LRYGB warrant careful attention to avoid missing or delaying the diagnosis of internal hernia. The aim of this study was to describe our technique to prevent internal hernia after LRYGB, intra-operative findings, and our management strategies for patients with internal hernia after LRYGB. In this video, we review different technical tips and tricks to explore patients with suspected internal hernia after RYGB, how to reduce obstructed small bowel, and effectively close mesenteric defects to prevent internal hernia after LRYGB. A high index of suspicion and evaluation of the CT scan of the patient by an experienced bariatric surgeon is essential to avoid missing cases of internal hernia after LRYGB. In addition, patients presenting with incarcerated small bowel due to an internal hernia are best managed by standing on the left side of the patient with the left arm tucked and starting at the ileocecal valve and running the small bowel backwards towards the ligament of Treitz. Furthermore, patients with bowel obstruction due to internal hernia may need to have a gastrostomy placed at the remnant of the stomach. Recurrent abdominal pain is not uncommon after LRYGB. Systematic closure of mesenteric defects, the use of diagnostic laparoscopy, and high index of suspicion are all necessary to avoid delay in diagnosis.

How Patients View Probiotics: Findings from a Multicenter Study of Patients with Inflammatory Bowel Disease and Irritable Bowel Syndrome

PubMed Central

Mercer, MaryBeth; Brinich, Margaret A.; Geller, Gail; Harrison, Krista; Highland, Janelle; James, Katherine; Marshall, Patricia; McCormick, Jennifer B.; Tilburt, Jon; Achkar, Jean-Paul; Farrell, Ruth M.; Sharp, Richard R.

2011-01-01

Background Patients with inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) have access to a growing number of probiotic products marketed to improve digestive health. It is unclear how patients make decisions about probiotics and what role they expect their gastroenterologists to play as they consider using probiotics. Understanding patients’ knowledge, attitudes and expectations of probiotics may help gastroenterologists engage patients in collaborative discussions about probiotics. Study Focus groups were conducted with patients with IBD and IBS at the Cleveland Clinic, Mayo Clinic and Johns Hopkins University. Inductive analytic methods were utilized to identify common themes and draw interpretations from focus group narratives. Results One hundred thirty-six patients participated in 22 focus groups between March and August 2009. Patients viewed probiotics as an appealing alternative to pharmaceutical drugs and understood probiotics as a more “natural,” low-risk therapeutic option. Many patients were hesitant to use them without consulting their gastroenterologists. Patients would weigh the risks and benefits of probiotics, their disease severity and satisfaction with current treatments when considering probiotic use. Conclusions Patients are interested in probiotics but have many unanswered questions about their use. Our findings suggest that patients with IBD and IBS will look to gastroenterologists and other clinicians as trustworthy advisors regarding the utility of probiotics as an alternative or supplement to pharmaceutical drugs. Gastroenterologists and other clinicians who care for patients with these diseases should be prepared to discuss the potential benefits and risks of probiotics and assist patients in making informed decisions about their use. PMID:21716123

Agreement between prospective diary data and retrospective questionnaire report of abdominal pain and stooling symptoms in children with irritable bowel syndrome.

PubMed

Self, M M; Williams, A E; Czyzewski, D I; Weidler, E M; Shulman, R J

2015-08-01

In functional gastrointestinal disorders, patient recall of symptoms drives diagnostic decisions and evaluation of treatment response, and research conclusions about potential treatments. In pediatrics, parent report also impacts assessment and care. Hence, identifying methods for accurately capturing patient and parent report of irritable bowel syndrome (IBS) symptoms is important. This study evaluated correspondence between retrospective questionnaire (parent and child report) and prospective diary data for children and adolescents with IBS. Participants included 50 children/adolescents with IBS per Rome III criteria. Children completed a 2-week pain and stool diary. Children and parents subsequently completed a 2-week recall questionnaire, reporting number of pain days, maximum pain, days without bowel movement, and days with diarrhea during the diary interval. Intraclass correlation coefficients and Bland-Altman plots assessed agreement. For pain and days without bowel movement, overall agreement between child recall questionnaire and child diary was strong, although under conditions likely to facilitate agreement and with individual variation observed. Parent recall and child diary were less concordant, and agreement about diarrhea was poor for parent and child. Age did not significantly correlate with agreement. Child questionnaire with short recall interval may be a reasonable approximation for diary data, although this varies by individual and replication/investigation of lengthier recall are needed. Relying on parent questionnaire does not appear a suitable proxy, and recall of stool form by both parent and child appears more problematic. These results combined with existing literature support use of diary data whenever possible. © 2015 John Wiley & Sons Ltd.

Comparison of multi-modal early oral nutrition for the tolerance of oral nutrition with conventional care after major abdominal surgery: a prospective, randomized, single-blind trial.

PubMed

Sun, Da-Li; Li, Wei-Ming; Li, Shu-Min; Cen, Yun-Yun; Xu, Qing-Wen; Li, Yi-Jun; Sun, Yan-Bo; Qi, Yu-Xing; Lin, Yue-Ying; Yang, Ting; Lu, Qi-Ping; Xu, Peng-Yuan

2017-02-10

Early oral nutrition (EON) has been shown to improve recovery of gastrointestinal function, length of stay and mortality after abdominal surgery; however, early oral nutrition often fails during the first week after surgery. Here, a multi-modal early oral nutrition program is introduced to promote recovery of gastrointestinal function and tolerance of oral nutrition. Consecutive patients scheduled for abdominal surgery were randomized to the multimodal EON group or a group receiving conventional care. The primary endpoint was the time of first defecation. The secondary endpoints were outcomes and the cost-effectiveness ratio in treating infectious complications. The rate of infectious-free patients was regarded as the index of effectiveness. One hundred seven patients were randomly assigned to groups. Baseline characteristics were similar for both groups. In intention-to-treat analysis, the success rate of oral nutrition during the first week after surgery in the multimodal EON group was 44 (83.0%) versus 31 (57.4%) in the conventional care group (P = 0.004). Time to first defecation, time to flatus, recovery time of bowel sounds, and prolonged postoperative ileus were all less in the multimodal EON group (P < 0.05). The median postoperative length of stay in the multimodal EON group was 8 days (6, 12) versus 10 days (7, 18) in the conventional care group (P < 0.001). The total cost of treatment and nutritional support were also less in the multi-modal early oral nutrition group (P < 0.001). The effectiveness was 84.9 and 79.9% in the multimodal EON and conventional care group, respectively (P = 0.475). However, the cost-effectiveness ratio was USD 537.6 (506.1, 589.3) and USD 637.8 (593.9, 710.3), respectively (P < 0.001). The multi-modal early oral nutrition program was an effective way to improve tolerance of oral nutrition during the first week after surgery, decrease the length of stay and improve cost-effectiveness after abdominal surgery. Registration number: ChiCTR-TRC-14004395 . Registered 15 March 2014.

Comparison of medical costs generated by IBS patients in primary and secondary care in the Netherlands.

PubMed

Flik, Carla E; Laan, Wijnand; Smout, André J P M; Weusten, Bas L A M; de Wit, Niek J

2015-11-26

Irritable Bowel Syndrome (IBS) is a functional somatic syndrome characterized by patterns of persistent bodily complaints for which a thorough diagnostic workup does not reveal adequate explanatory structural pathology. Detailed insight into disease-specific health-care costs is critical because it co-determines the societal impact of the disease, enables the assessment of cost-effectiveness of existing and new treatments, and facilitates choices in treatment policy. In the present study the aim was, to compare the costs and magnitude of healthcare consumption for patients diagnosed with Irritable Bowel Syndrome (IBS) in primary and secondary care, compare these costs with the average health care expenditure for patients without IBS and describe these costs in further detail. Reimbursement data for patients diagnosed with IBS by a general practitioner (GP) or specialist between 2006 and 2009 were extracted from a healthcare insurance company and compared to an age and gender matched control group of patients without IBS. Using a case-control design, direct medical costs for GP consultations, specialist care and medication prescriptions were calculated. Data of 326 primary care and 9274 secondary care IBS patients were included in the analysis. For primary care patients, the mean total annual health care costs for the three years after diagnosis compared to the three years before diagnosis, increased with 486 Euro after IBS was diagnosed, whereas for secondary care patients, these costs increased with 2328 Euro. Total health care costs remained higher in the three years after the initial diagnosis when the patient is treated in secondary care, compared to primary care. This increase was significant for hospital specialist costs and medications, but not for GP contacts. For controls, there was no significant difference in mean total annual health costs in the three years before and the three years after the diagnosis and also no significant difference in cost increases between both primary- and secondary-care control patients. Total healthcare costs per patient substantially increase after a diagnosis of IBS and IBS related costs are significantly higher when patients are treated in secondary-care compared to primary-care. IBS patients should be treated in primary-care where possible, not only because guidelines recommend this from a quality of care viewpoint, but also to optimize use of health care resources. Referral should be restricted to those patients with alarm symptoms, with ill-matching symptoms, or other cases of diagnostic uncertainty.

Small bowel dilation in children with short bowel syndrome is associated with mucosal damage, bowel-derived bloodstream infections, and hepatic injury.

PubMed

Hukkinen, Maria; Mutanen, Annika; Pakarinen, Mikko P

2017-09-01

Liver disease occurs frequently in short bowel syndrome. Whether small bowel dilation in short bowel syndrome could influence the risk of liver injury through increased bacterial translocation remains unknown. Our aim was to analyze associations between small bowel dilation, mucosal damage, bloodstream infections, and liver injury in short bowel syndrome patients. Among short bowel syndrome children (n = 50), maximal small bowel diameter was measured in contrast series and expressed as the ratio to the height of the fifth lumbar vertebra (small bowel diameter ratio), and correlated retrospectively to fecal calprotectin and plasma citrulline-respective markers of mucosal inflammation and mass-bloodstream infections, liver biochemistry, and liver histology. Patients with pathologic small bowel diameter ratio >2.17 had increased fecal calprotectin and decreased citrulline (P < .04 each). Of 33 bloodstream infections observed during treatment with parenteral nutrition, 16 were caused by intestinal bacteria, cultured 15 times more frequently when small bowel diameter ratio was >2.17 (P < .001). Intestinal bloodstream infections were predicted by small bowel diameter ratio (odds ratio 1.88, P = .017), and their frequency decreased after operative tapering procedures (P = .041). Plasma bilirubin concentration, gamma-glutamyl transferase activity, and histologic grade of cholestasis correlated with small bowel diameter ratio (0.356-0.534, P < .014 each), and were greater in the presence of intestinal bloodstream infections (P < .001 for all). Bloodstream infections associated with portal inflammation, cholestasis, and fibrosis grades (P < .031 for each). In linear regression, histologic cholestasis was predicted by intestinal bloodstream infections, small bowel diameter ratio, and parenteral nutrition (β = 0.36-1.29; P < .014 each), while portal inflammation by intestinal bloodstream infections only (β = 0.62; P = .033). In children with short bowel syndrome, small bowel dilation correlates with mucosal damage, bloodstream infections of intestinal origin, and cholestatic liver injury. In addition to parenteral nutrition, small bowel dilation and intestinal bloodstream infections contribute to development of short bowel syndrome-associated liver disease. Copyright © 2017 Elsevier Inc. All rights reserved.

COLOSTOMY CARE

PubMed Central

Lee Marsh, Robert

1955-01-01

Psychic preparation of the patient for the necessity of colostomy is a long first step toward his adjustment to living with an artificial anus. Proper surgical placement of the outlet will ease care of the bowel. Control of fecal consistency and peristaltic rate should ideally produce constipation responsive only to habit or enemata. The object of the enema is to produce an evacuation thorough enough to prevent soiling for a day or two. The object of dietary variations is to produce a manageable volume and consistency of fecal stream. The technique of enemas and choice of diet can be individualized when the underlying principles are understood. PMID:13230924

Hematopoietic growth factors in neonatal medicine: the use of enterally administered hematopoietic growth factors in the neonatal intensive care unit.

PubMed

Calhoun, Darlene A; Christensen, Robert D

2004-03-01

The practice of complete bowel rest in prematurely delivered neonates and those who have undergone surgery for congenital anomalies of the gastrointestinal (GI) tract is common in neonatal intensive care units (NICU). However, increased recognition of the critical role of growth factors in GI development suggests that this practice might be modified to include the administration of synthetic amniotic fluid-like solutions designed to bridge the neonate between their intra-uterine environment and that of the NICU. This article reviews advances in administering synthetic amniotic fluid-like solutions in the NICU.

Using best practice to create a pathway to improve management of irritable bowel syndrome: aiming for timely diagnosis, effective treatment and equitable care

PubMed Central

Williams, Marianne; Barclay, Yvonne; Benneyworth, Rosie; Gore, Steve; Hamilton, Zoe; Matull, Rudi; Phillips, Iain; Seamark, Leah; Staveley, Kate; Thole, Steve; Greig, Emma

2016-01-01

Background Irritable bowel syndrome (IBS) costs the National Health Service almost £12 million per annum. Despite national guidelines advising primary care management, these have failed to stem secondary care referrals of patients with likely IBS for unnecessary and costly assessment and investigation without necessarily achieving resolution of their symptoms. Methods In 2011, an integrated team from primary and secondary care developed a business case using baseline data to create a Somerset-wide IBS pathway using Clinical Commissioning Group funding. This provided face-to-face general practitioners (GP) education, developed a diagnostic pathway and funded faecal calprotectin (FC) testing to exclude inflammatory pathology for patients aged 16–45 years with likely IBS and no alarm symptoms. For those with FC≤50 μg/g, we provided a management algorithm and community-based dietetic treatment. Audit results measured usage and outcomes from FC testing, changes in patterns and costs of new patients reviewed in gastroenterology outpatients and dietetic IBS treatment outcomes. Results The proportion of new patient slots used reduced from 14.3% to 8.7% over 10 months while overall costs reduced by 25% for patients with no alarm symptoms and likely IBS aged 16–45 years. FC results confirmed research findings with no inflammatory pathology, if FC≤50 μg/g over 2 years. 63% of patients had satisfactory control of their IBS after specialist dietetic input with 74% reporting improved quality of life. Conclusions The combination of GP education, providing diagnosis and management pathways, using FC to exclude inflammatory pathology and providing an effective treatment for patients with likely IBS appeared successful in our pilot. This proved cost-effective, reduced secondary care involvement and improved patient care. PMID:27761233

Reversing Maladaptive Plasticity to Cure Autonomic Dysreflexia after Spinal Cord Injury

DTIC Science & Technology

2015-10-01

Autonomic dysreflexia (AD) is a potential life threatening condition characterized as episodic vascular hypertension (often with bradycardia) that develops...subject, purpose and scope of the research. Autonomic dysreflexia (AD) is a life threatening condition of episodic vascular hypertension (often...months post-injury. Prevention (e.g., regular bladder/bowel care) and anti- hypertensive medications are currently the best way to “manage” AD

Using read codes to identify patients with irritable bowel syndrome in general practice: a database study

PubMed Central

2013-01-01

Background Estimates of the prevalence of irritable bowel syndrome (IBS) vary widely, and a large proportion of patients report having consulted their general practitioner (GP). In patients with new onset gastrointestinal symptoms in primary care it might be possible to predict those at risk of persistent symptoms. However, one of the difficulties is identifying patients within primary care. GPs use a variety of Read Codes to describe patients presenting with IBS. Furthermore, in a qualitative study, exploring GPs’ attitudes and approaches to defining patients with IBS, GPs appeared reluctant to add the IBS Read Code to the patient record until more serious conditions were ruled out. Consequently, symptom codes such as 'abdominal pain’, 'diarrhoea’ or 'constipation’ are used. The aim of the current study was to investigate the prevalence of recorded consultations for IBS and to explore the symptom profile of patients with IBS using data from the Salford Integrated Record (SIR). Methods This was a database study using the SIR, a local patient sharing record system integrating primary, community and secondary care information. Records were obtained for a cohort of patients with gastrointestinal disorders from January 2002 to December 2011. Prevalence rates, symptom recording, medication prescribing and referral patterns were compared for three patient groups (IBS, abdominal pain (AP) and Inflammatory Bowel Disease (IBD)). Results The prevalence of IBS (age standardised rate: 616 per year per 100,000 population) was much lower than expected compared with that reported in the literature. The majority of patients (69%) had no gastrointestinal symptoms recorded in the year prior to their IBS. However a proportion of these (22%) were likely to have been prescribed NICE guideline recommended medications for IBS in that year. The findings for AP and IBD were similar. Conclusions Using Read Codes to identify patients with IBS may lead to a large underestimate of the community prevalence. The IBS diagnostic Read Code was rarely applied in practice. There are similarities with many other medically unexplained symptoms which are typically difficult to diagnose in clinical practice. PMID:24295337

Using read codes to identify patients with irritable bowel syndrome in general practice: a database study.

PubMed

Harkness, Elaine F; Grant, Laura; O'Brien, Sarah J; Chew-Graham, Carolyn A; Thompson, David G

2013-12-02

Estimates of the prevalence of irritable bowel syndrome (IBS) vary widely, and a large proportion of patients report having consulted their general practitioner (GP). In patients with new onset gastrointestinal symptoms in primary care it might be possible to predict those at risk of persistent symptoms. However, one of the difficulties is identifying patients within primary care. GPs use a variety of Read Codes to describe patients presenting with IBS. Furthermore, in a qualitative study, exploring GPs' attitudes and approaches to defining patients with IBS, GPs appeared reluctant to add the IBS Read Code to the patient record until more serious conditions were ruled out. Consequently, symptom codes such as 'abdominal pain', 'diarrhoea' or 'constipation' are used. The aim of the current study was to investigate the prevalence of recorded consultations for IBS and to explore the symptom profile of patients with IBS using data from the Salford Integrated Record (SIR). This was a database study using the SIR, a local patient sharing record system integrating primary, community and secondary care information. Records were obtained for a cohort of patients with gastrointestinal disorders from January 2002 to December 2011. Prevalence rates, symptom recording, medication prescribing and referral patterns were compared for three patient groups (IBS, abdominal pain (AP) and Inflammatory Bowel Disease (IBD)). The prevalence of IBS (age standardised rate: 616 per year per 100,000 population) was much lower than expected compared with that reported in the literature. The majority of patients (69%) had no gastrointestinal symptoms recorded in the year prior to their IBS. However a proportion of these (22%) were likely to have been prescribed NICE guideline recommended medications for IBS in that year. The findings for AP and IBD were similar. Using Read Codes to identify patients with IBS may lead to a large underestimate of the community prevalence. The IBS diagnostic Read Code was rarely applied in practice. There are similarities with many other medically unexplained symptoms which are typically difficult to diagnose in clinical practice.

The treatment of irritable bowel syndrome.

PubMed

Lacy, Brian E; Weiser, Kirsten; De Lee, Ryan

2009-07-01

Irritable bowel syndrome (IBS) is a highly prevalent functional bowel disorder routinely encountered by healthcare providers. Although not life-threatening, this chronic disorder reduces patients' quality of life and imposes a significant economic burden to the healthcare system. IBS is no longer considered a diagnosis of exclusion that can only be made after performing a battery of expensive diagnostic tests. Rather, IBS should be confidently diagnosed in the clinic at the time of the first visit using the Rome III criteria and a careful history and physical examination. Treatment options for IBS have increased in number in the past decade and clinicians should not be limited to using only fiber supplements and smooth muscle relaxants. Although all patients with IBS have symptoms of abdominal pain and disordered defecation, treatment needs to be individualized and should focus on the predominant symptom. This paper will review therapeutic options for the treatment of IBS using a tailored approach based on the predominant symptom. Abdominal pain, bloating, constipation and diarrhea are the four main symptoms that can be addressed using a combination of dietary interventions and medications. Treatment options include probiotics, antibiotics, tricyclic antidepressants, selective serotonin reuptake inhibitors and agents that modulate chloride channels and serotonin. Each class of agent will be reviewed using the latest data from the literature.

Noninfectious interstitial lung disease during infliximab therapy: Case report and literature review

PubMed Central

Caccaro, Roberta; Savarino, Edoardo; D’Incà, Renata; Sturniolo, Giacomo Carlo

2013-01-01

Pulmonary abnormalities are not frequently encountered in patients with inflammatory bowel diseases. However, lung toxicity can be induced by conventional medications used to maintain remission, and similar evidence is also emerging for biologics. We present the case of a young woman affected by colonic Crohn’s disease who was treated with oral mesalamine and became steroid-dependent and refractory to azathioprine and adalimumab. She was referred to our clinic with a severe relapse and was treated with infliximab, an anti-tumor necrosis factor α (TNF-α) antibody, to induce remission. After an initial benefit, with decreases in bowel movements, rectal bleeding and C-reactive protein levels, she experienced shortness of breath after the 5th infusion. Noninfectious interstitial lung disease was diagnosed. Both mesalamine and infliximab were discontinued, and steroids were introduced with slow but progressive improvement of symptoms, radiology and functional tests. This represents a rare case of interstitial lung disease associated with infliximab therapy and the effect of drug withdrawal on these lung alterations. Given the increasing use of anti-TNF-α therapies and the increasing reports of pulmonary abnormalities in patients with inflammatory bowel diseases, this case underlines the importance of a careful evaluation of respiratory symptoms in patients undergoing infliximab therapy. PMID:23983443

Optimal preparation-to-colonoscopy interval in split-dose PEG bowel preparation determines satisfactory bowel preparation quality: an observational prospective study.

PubMed

Seo, Eun Hee; Kim, Tae Oh; Park, Min Jae; Joo, Hee Rin; Heo, Nae Yun; Park, Jongha; Park, Seung Ha; Yang, Sung Yeon; Moon, Young Soo

2012-03-01

Several factors influence bowel preparation quality. Recent studies have indicated that the time interval between bowel preparation and the start of colonoscopy is also important in determining bowel preparation quality. To evaluate the influence of the preparation-to-colonoscopy (PC) interval (the interval of time between the last polyethylene glycol dose ingestion and the start of the colonoscopy) on bowel preparation quality in the split-dose method for colonoscopy. Prospective observational study. University medical center. A total of 366 consecutive outpatients undergoing colonoscopy. Split-dose bowel preparation and colonoscopy. The quality of bowel preparation was assessed by using the Ottawa Bowel Preparation Scale according to the PC interval, and other factors that might influence bowel preparation quality were analyzed. Colonoscopies with a PC interval of 3 to 5 hours had the best bowel preparation quality score in the whole, right, mid, and rectosigmoid colon according to the Ottawa Bowel Preparation Scale. In multivariate analysis, the PC interval (odds ratio [OR] 1.85; 95% CI, 1.18-2.86), the amount of PEG ingested (OR 4.34; 95% CI, 1.08-16.66), and compliance with diet instructions (OR 2.22l 95% CI, 1.33-3.70) were significant contributors to satisfactory bowel preparation. Nonrandomized controlled, single-center trial. The optimal time interval between the last dose of the agent and the start of colonoscopy is one of the important factors to determine satisfactory bowel preparation quality in split-dose polyethylene glycol bowel preparation. Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

Self-management of older adolescents with inflammatory bowel disease: a pilot study of behavior and knowledge as prelude to transition.

PubMed

Fishman, Laurie N; Barendse, Renée M; Hait, Elizabeth; Burdick, Cynthia; Arnold, Janis

2010-12-01

Patients gradually assume responsibility for self-management. This study sought to determine whether adolescents with inflammatory bowel disease (IBD) have developed key skills of self-management prior to the age at which many transfer to adult care. Adolescents aged 16 to 18 years old in the Children's Hospital Boston IBD database (94 total) received a mailed survey assessing knowledge and confidence of their own health information and behaviors. Respondents (43%) could name medication and dose with confidence but had very poor knowledge of important side effects. Most patients deferred responsibility mostly or completely to parents for scheduling appointments (85%), requesting refills (75%), or contacting provider between visits (74%). Older adolescents with IBD have good recall of medications but not of side effects. Parents remain responsible for the majority of tasks related to clinic visits and the acquisition of medications.

An update on probiotics, prebiotics and symbiotics in clinical nutrition.

PubMed

Olveira, Gabriel; González-Molero, Inmaculada

2016-11-01

The concept of prebiotics, probiotics, and symbiotics and their use in different situations of daily clinical practice related to clinical nutrition is reviewed, as well as their role in the treatment/prevention of diarrhea (acute, induced by antibiotics, secondary to radiotherapy), inflammatory bowel disease (ulcerative colitis and pouchitis), in colonic health (constipation, irritable bowel), in liver disease (steatosis and minimum encephalopathy), and in intensive care, surgical, and liver transplantation. While their effectiveness for preventing antibiotic-induced diarrhea and pouchitis in ulcerative colitis appears to be shown, additional studies are needed to establish recommendations in most clinical settings. The risk of infection associated to use of probiotics is relatively low; however, there are selected groups of patients in whom they should be used with caution (as jejunum infusion). Copyright © 2016 SEEN. Publicado por Elsevier España, S.L.U. All rights reserved.

Gas and Bloating

PubMed Central

2006-01-01

Gaseous symptoms including eructation, flatulence, and bloating occur as a consequence of excess gas production, altered gas transit, or abnormal perception of normal amounts of gas within the gastrointestinal tract. There are many causes of gas and bloating including aerophagia, luminal obstructive processes, carbohydrate intolerance syndromes, small intestinal bacterial overgrowth, diseases of gut motor activity, and functional bowel disorders including irritable bowel syndrome (IBS). Because of the prominence of gaseous complaints in IBS, recent investigations have focused on new insights into pathogenesis and novel therapies of bloating. The evaluation of the patient with unexplained gas and bloating relies on careful exclusion of organic disease with further characterization of the underlying condition with directed functional testing. Treatment of gaseous symptomatology should be targeted to pathophysiologic defects whenever possible. Available therapies include lifestyle alterations, dietary modifications, enzyme preparations, adsorbents and agents which reduce surface tension, treatments that alter gut flora, and drugs that modulate gut transit. PMID:28316536

Mechanisms on spasmolytic and anti-inflammatory effects of a herbal medicinal product consisting of myrrh, chamomile flower, and coffee charcoal.

PubMed

Vissiennon, Cica; Goos, Karl-Heinz; Arnhold, Jürgen; Nieber, Karen

2017-05-01

Inflammatory bowel disease or irritable bowel syndrome are chronic gastrointestinal disorders which are associated with a lifelong therapeutic need. The disease results in physical, psychological, and social problems with an impact on partnership, sexuality, education, and career. Thus, the number of patients and health care professionals relying on traditional and complementary medicines and especially phytotherapy for the treatment of these chronic conditions is increasing over recent years. One traditional herbal medicinal product consisting of chamomile flower, myrrh, and coffee charcoal has been widely used in clinical practice within this indication area. Long-term experience and an increasing understanding of the pharmacological mechanisms substantiate its application and clinical effectiveness. Mainly the spasmolytic and anti-inflammatory effects provide a rationale for its therapeutic application. In addition, synergistic effects between the herbal components contribute to the overall effect of this medication.

An Elusive Bullet in the Gastrointestinal Tract: A Rare Case of Bullet Embolism in the Gastrointestinal Tract and a Review of Relevant Literature

PubMed Central

Biswas, Saptarshi

2014-01-01

Bullet embolism within the gastrointestinal system is extremely rare. Such bullet injuries are infrequently covered in the general literature, but the surgeon should be aware of the phenomenon. Smaller caliber bullets are more common in civilian gunshot wound (GSW) events. These bullets are able to tumble through the gastrointestinal tract and cause perforation of the intestinal lumen which is small enough to be easily missed. Bullets retained in the abdominal cavity should not be dismissed as fixed and should be carefully monitored to ensure that they do not embolize within the bowel and cause occult lesions during their migration. We present a unique case wherein a bullet caused a minute perforation in the small bowel, before migrating to the distal colon, which resulted in late presentation of sepsis secondary to peritonitis. PMID:24829839

Paediatric constipation: An approach and evidence-based treatment regimen

PubMed

Singh, Harveen; Connor, Frances

2018-05-01

Constipation affects 5-30% of children and is responsible for 3% of primary care visits. General practitioners (GPs) are frequently the first medical encounter for concerned parents regarding their child's bowel habit. The aim of this article is to review the assessment and management of children with constipation to empower GPs to initiate treatment and know when to refer to a paediatrician. In the absence of organic aetiology, childhood constipation is almost always functional and often due to painful bowel movements that prompt the child to withhold stool. It is important to initiate a clear management plan for the family, as what is an easily treatable condition can escalate into a vicious cycle of pain if not addressed early. The medical approach should consider organic disease, the use of appropriate toileting habits, and dietary modifications. Laxatives are often required to re-establish regular, painless defaecation.

Experience with early postoperative feeding after abdominal aortic surgery.

PubMed

Ko, Po-Jen; Hsieh, Hung-Chang; Liu, Yun-Hen; Liu, Hui-Ping

2004-03-01

Abdominal aortic surgery is a form of major vascular surgery, which traditionally involves long hospital stays and significant postoperative morbidity. Experiences with transit ileus are often encountered after the aortic surgery. Thus traditional postoperative care involves delayed oral feeding until the patients regain their normal bowel activities. This report examines the feasibility of early postoperative feeding after abdominal aortic aneurysm (AAA) open-repair. From May 2002 through May 2003, 10 consecutive patients with infrarenal AAA who underwent elective surgical open-repair by the same surgeon in our department were reviewed. All of them had been operated upon and cared for according to the early feeding postoperative care protocol, which comprised of adjuvant epidural anesthesia, postoperative patient controlled analgesia, early postoperative feeding and early rehabilitation. The postoperative recovery and length of hospital stay were reviewed and analyzed. All patients were able to sip water within 1 day postoperatively without trouble (Average; 12.4 hours postoperatively). All but one patient was put on regular diet within 3 days postoperatively (Average; 2.2 days postoperatively). The average postoperative length of stay in hospital was 5.8 days. No patient died or had major morbidity. Early postoperative feeding after open repair of abdominal aorta is safe and feasible. The postoperative recovery could be improved and the length of stay reduced by simply using adjuvant epidural anesthesia during surgery, postoperative epidural patient-controlled analgesia, early feeding, early ambulation, and early rehabilitation. The initial success of our postoperative recovery program of aortic repair was demonstrated.

Implementing a self-management strategy in inflammatory bowel disease (IBD): patient perceptions, clinical outcomes and the impact on service.

PubMed

Squires, Seth Ian; Boal, Allan John; Lamont, Selina; Naismith, Graham D

2017-10-01

Patient self-management and its service integration is not a new concept but it may be a key component in the long-term sustainability of inflammatory bowel disease (IBD) service provision, when considering growing disease prevalence and limited resources. The IBD team at the Royal Alexandra and Vale of Leven Hospitals in the Clyde Valley region developed a self-management tool, called the 'flare card'. Patients were asked to complete a questionnaire which reflected their opinion on its viability as a self-management intervention. In addition, its utility in terms of service use over a 10-month period in 2016 was compared with a similar cohort of patients over 10 months in 2015. Patients overall felt that the 'flare card' was a viable self-management tool. Positive feedback identified that the intervention could help them aid control over their IBD, improve medication adherence, reduce symptoms and reflected a feeling of patient-centred IBD care. The comparison between 2015 and 2016 service use revealed a significant reduction in IBD and non-IBD service usage, Steroid prescribing and unscheduled IBD care in the flare card supported cohort. IBD services must continue to adapt to changes within the National Health Service bearing in mind long-term sustainability and continued care provision. The 'flare card' goes further in an attempt to optimise Crohn's disease and ulcerative colitis management by harmonising clinician evaluation and patient's self-initiation of therapy and investigation.

Health benefits of seated speed, resistance, and power training for an individual with spastic quadriplegic cerebral palsy: A case report.

PubMed

Gannotti, Mary E; Fuchs, Robyn Kimberly; Roberts, Dawn E; Hobbs, Nedda; Cannon, Ian M

2015-01-01

Children with moderate to severe cerebral palsy are at risk for low bone mass for chronological age, which compounds risk in adulthood for progressive deformity and chronic pain. Physical activity and exercise can be a key component to optimizing bone health. In this case report we present a young adult male with non-ambulatory, spastic quadriplegia CP whom began a seated speed, resistance, and power training exercise program at age 14.5 years. Exercise program continued into adulthood as part of an active lifestyle. The individual had a history of failure to thrive, bowel and bladder incontinence, reduced bone mineral density (BMD) for age, and spinal deformity at the time exercise was initiated. Participation in the exercise program began once a week for 1.5-2 hours/session, and progressed to 3-5 times per week after two years. This exercise program is now a component of his habitual lifestyle. Over the 6 years he was followed, lumbar spine and total hip BMD Z-scores did not worsen, which may be viewed as a positive outcome given his level of gross motor impairment. Additionally, the individual reported less back pain, improved bowel and bladder control, increased energy level, and never sustained an exercise related injury. Findings from this case report suggest a regular program of seated speed, resistance, power training may promote overall well-being, are safe, and should be considered as a mechanism for optimizing bone health.

Self-management education for rehabilitation inpatients suffering from inflammatory bowel disease: a cluster-randomized controlled trial.

PubMed

Reusch, A; Weiland, R; Gerlich, C; Dreger, K; Derra, C; Mainos, D; Tuschhoff, T; Berding, A; Witte, C; Kaltz, B; Faller, H

2016-12-01

Although inflammatory bowel disease (IBD) affects patients' psychological well-being, previous educational programs have failed to demonstrate effects on psychosocial outcomes and quality of life. Therefore, we developed a group-based psychoeducational program that combined provision of both medical information and psychological self-management skills, delivered in an interactive manner, and evaluated it in a large, cluster-randomized trial. We assigned 540 rehabilitation inpatients suffering from IBD (mean age 43 years, 66% female) to either the new intervention or a control group comprising the same overall intensity and the same medical information, but only general psychosocial information. The primary outcome was patient-reported IBD-related concerns. Secondary outcomes included disease knowledge, coping, self-management skills, fear of progression, anxiety, depression and quality of life. Assessments took place at baseline, end of rehabilitation and after 3 and 12 months.The psychoeducational self-management program did not prove superior to the control group regarding primary and secondary outcomes. However, positive changes over time occurred in both groups regarding most outcomes. The superior effectiveness of the newly developed psychoeducational program could not be demonstrated. Since the intervention and control groups may have been too similar, this trial may have been too conservative to produce between-group effects. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Childhood onset inflammatory bowel disease and risk of cancer: a Swedish nationwide cohort study 1964-2014.

PubMed

Olén, O; Askling, J; Sachs, M C; Frumento, P; Neovius, M; Smedby, K E; Ekbom, A; Malmborg, P; Ludvigsson, J F

2017-09-20

Objective  To assess risk of cancer in patients with childhood onset inflammatory bowel disease in childhood and adulthood. Design  Cohort study with matched general population reference individuals using multivariable Cox regression to estimate hazard ratios. Setting  Swedish national patient register (both inpatient and non-primary outpatient care) 1964-2014. Participants  Incident cases of childhood onset (<18 years) inflammatory bowel disease (n=9405: ulcerative colitis, n=4648; Crohn's disease, n=3768; unclassified, n=989) compared with 92 870 comparators from the general population matched for sex, age, birth year, and county. Main outcome measures  Any cancer and cancer types according to the Swedish Cancer Register. Results  During follow-up through adulthood (median age at end of follow-up 27 years), 497 (3.3 per 1000 person years) people with childhood onset inflammatory bowel disease had first cancers, compared with 2256 (1.5 per 1000 person years) in the general population comparators (hazard ratio 2.2, 95% confidence interval 2.0 to 2.5). Hazard ratios for any cancer were 2.6 in ulcerative colitis (2.3 to 3.0) and 1.7 in Crohn's disease (1.5 to 2.1). Patients also had an increased risk of cancer before their 18th birthday (2.7, 1.6 to 4.4; 20 cancers in 9405 patients, 0.6 per1000 person years). Gastrointestinal cancers had the highest relative risks, with a hazard ratio of 18.0 (14.4 to 22.7) corresponding to 202 cancers in patients with inflammatory bowel disease. The increased risk of cancer (before 25th birthday) was similar over time (1964-1989: 1.6, 1.0 to 2.4; 1990-2001: 2.3, 1.5 to 3.3); 2002-06: 2.9, 1.9 to 4.2; 2007-14: 2.2, 1.1 to 4.2). Conclusion  Childhood onset inflammatory bowel disease is associated with an increased risk of any cancer, especially gastrointestinal cancers, both in childhood and later in life. The higher risk of cancer has not fallen over time. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Pathophysiological and Therapeutic Considerations for Non-Neurogenic Lower Urinary Tract Dysfunction in Children.

PubMed

Kakizaki, Hidehiro; Kita, Masafumi; Watanabe, Masaki; Wada, Naoki

2016-05-01

Non-neurogenic lower urinary tract dysfunction (LUTD) in children is very common in clinical practice and is important as an underlying cause of lower urinary tract symptoms, urinary tract infection and vesicoureteral reflux in affected children. LUTD in children is caused by multiple factors and might be related with a delay in functional maturation of the lower urinary tract. Behavioral and psychological problems often co-exist in children with LUTD and bowel dysfunction. Recent findings in functional brain imaging suggest that bladder bowel dysfunction and behavioral and psychiatric disorders in children might share common pathophysiological factors in the brain. Children with suspected LUTD should be evaluated properly by detailed history taking, validated questionnaire on voiding and defecation, voiding and bowel diary, urinalysis, screening ultrasound, uroflowmetry and post-void residual measurement. Invasive urodynamic study such as videourodynamics should be reserved for children in whom standard treatment fails. Initial treatment of non-neurogenic LUTD is standard urotherapy comprising education of the child and family, regular optimal voiding regimens and bowel programs. Pelvic floor muscle awareness, biofeedback and neuromodulation can be used as a supplementary purpose. Antimuscarinics and α-blockers are safely used for overactive bladder and dysfunctional voiding, respectively. For refractory cases, botulinum toxin A injection is a viable treatment option. Prudent use of urotherapy and pharmacotherapy for non-neurogenic LUTD should have a better chance to cure various problems and improve self-esteem and quality of life in affected children. © 2015 Wiley Publishing Asia Pty Ltd.

Necrotizing enterocolitis is associated with earlier achievement of enteral autonomy in children with short bowel syndrome.

PubMed

Sparks, Eric A; Khan, Faraz A; Fisher, Jeremy G; Fullerton, Brenna S; Hall, Amber; Raphael, Bram P; Duggan, Christopher; Modi, Biren P; Jaksic, Tom

2016-01-01

Necrotizing enterocolitis (NEC) remains one of the most common underlying diagnoses of short bowel syndrome (SBS) in children. The relationship between the etiology of SBS and ultimate enteral autonomy has not been well studied. This investigation sought to evaluate the rate of achievement of enteral autonomy in SBS patients with and without NEC. Following IRB approval, 109 patients (2002-2014) at a multidisciplinary intestinal rehabilitation program were reviewed. The primary outcome evaluated was achievement of enteral autonomy (i.e. fully weaning from parenteral nutrition). Patient demographics, primary diagnosis, residual small bowel length, percent expected small bowel length, median serum citrulline level, number of abdominal operations, status of the ileocecal valve (ICV), presence of ileostomy, liver function tests, and treatment for bacterial overgrowth were recorded for each patient. Median age at PN onset was 0 weeks [IQR 0-0]. Median residual small bowel length was 33.5 cm [IQR 20-70]. NEC was present in 37 of 109 (33.9%) of patients. 45 patients (41%) achieved enteral autonomy after a median PN duration of 15.3 [IQR 7.2-38.4]months. Overall, 64.9% of patients with NEC achieved enteral autonomy compared to 29.2% of patients with a different primary diagnosis (p=0.001, Fig. 1). Patients with NEC remained more likely than those without NEC to achieve enteral autonomy after two (45.5% vs. 12.0%) and four (35.7% vs. 6.3%) years on PN (Fig. 1). Logistic regression analysis demonstrated the following parameters as independent predictors of enteral autonomy: diagnosis of NEC (p<0.002), median serum citrulline level (p<0.02), absence of a jejunostomy or ileostomy (p=0.013), and percent expected small bowel length (p=0.005). Children with SBS because of NEC have a significantly higher likelihood of fully weaning from parenteral nutrition compared to children with other causes of SBS. Additionally, patients with NEC may attain enteral autonomy even after long durations of parenteral support. Copyright © 2016 Elsevier Inc. All rights reserved.

COMT Val158Met Polymorphism and Symptom Improvement Following a Cognitively-Focused Intervention for Irritable Bowel Syndrome

PubMed Central

Han, Claire J.; Kohen, Ruth; Jun, Sangeun; Jarrett, Monica E.; Cain, Kevin C.; Burr, Robert; Heitkemper, Margaret M.

2016-01-01

Background Our nurse-delivered Comprehensive Self-Management (CSM) program, a cognitive behavioral therapy intervention, is effective in reducing gastrointestinal and psychological distress symptoms in patients with irritable bowel syndrome (IBS). Findings from non-IBS studies indicate that the catechol-O-methyltransferase (COMT) Val158Met polymorphism may moderate the efficacy of cognitive behavioral therapy. It is unknown whether this COMT polymorphism is associated with symptom improvements in patients with IBS. Objective We tested whether this COMT Val158Met polymorphism influences the efficacy of our two-month CSM intervention. Methods We analyzed data from two published randomized controlled trials of CSM. The combined European-American sample included 149 women and 23 men with IBS (CSM, n =111; Usual Care [UC], n = 61). The primary outcomes were daily reports of abdominal pain, depression, anxiety, and feeling stressed measured three and six months after randomization. Secondary outcomes were additional daily symptoms, retrospective psychological distress, IBS quality of life, and cognitive beliefs about IBS. The interaction between COMT Val158Met polymorphism and treatment group (CSM vs. UC) in a generalized estimating equation model tested the main objective. Results At three months, participants with at least one Val allele benefited more from CSM than did those with the Met/Met genotype (p = .01 for anxiety and feeling stressed, and p < .16 for abdominal pain and depression). The moderating effect of genotype was weaker at six months. Discussion Persons with at least one Val allele may benefit more from CSM than those homozygous for the Met allele. Future studies with larger and more racially diverse samples are needed to confirm these findings. RCT Registration Parent studies were registered at ClinicalTrials.gov (NCT00167635 and NCT00907790). PMID:28252569

Health Services Utilization, Specialist Care, and Time to Diagnosis with Inflammatory Bowel Disease in Immigrants to Ontario, Canada: A Population-Based Cohort Study.

PubMed

Benchimol, Eric I; Manuel, Douglas G; Mojaverian, Nassim; Mack, David R; Nguyen, Geoffrey C; To, Teresa; Guttmann, Astrid

2016-10-01

Canada has amongst the highest incidence of inflammatory bowel disease (IBD) in the world, and the highest proportion of immigrants among G8 nations. We determined differences in prediagnosis delay, specialist care, health services use, and risk of surgery in immigrants with IBD. All incident cases of IBD in children (1994-2009) and adults (1999-2009) were identified from population-based health administrative data in Ontario, Canada. Linked immigration data identified those who arrived to Ontario after 1985. We compared time to diagnosis, postdiagnosis health services use (IBD specific and related), physician specialist care in immigrants and nonimmigrants, and risk of surgery between immigrants and nonimmigrants. Thousand two hundred two immigrants were compared with 22,990 nonimmigrants. Immigrants had similar time to diagnosis as nonimmigrants for Crohn's (hazard ratio [HR] 1.002; 95% confidence intervals [CIs] 0.89-1.12) and ulcerative colitis (HR 1.073; 95% CI 0.95-1.21). For outpatient visits, immigrants with IBD were seen by gastroenterologists more often than nonimmigrants. Immigrants had greater IBD-specific outpatient health services use after diagnosis (odds ratio 1.24; 95% CI 1.15-1.33), emergency department visits (odds ratio 1.57, 95% CI 1.30-1.91), and hospitalizations (odds ratio 1.19; 95% CI 1.02-1.40). In immigrants, there was lower risk of surgery for Crohn's (HR 0.66, 95% CI 0.43-0.99) and ulcerative colitis (HR 0.52, 95% CI 0.31-0.87). Immigrants to Canada had greater outpatient and specialty care and lower risk of surgery, with no delay in diagnosis, indicating appropriate use of the health system.

Telephone Encounters Predict Future High Financial Expenditures in Inflammatory Bowel Disease Patients: A 3-Year Prospective Observational Study.

PubMed

Click, Benjamin; Anderson, Alyce M; Ramos Rivers, Claudia; Koutroubakis, Ioannis E; Hashash, Jana G; Dunn, Michael A; Schwartz, Marc; Swoger, Jason; Barrie, Arthur; Szigethy, Eva; Regueiro, Miguel; Schoen, Robert E; Binion, David G

2018-04-01

Telephone activity is essential in management of complex chronic diseases including inflammatory bowel disease (IBD). Telephone encounters logged in the electronic medical record have recently been proposed as a surrogate marker of disease activity and impending health care utilization; however, the association between telephone calls and financial expenditures has not been evaluated. We performed a 3-year prospective observational study of telephone encounters logged at a tertiary referral IBD center. We analyzed patient demographics, disease characteristics, comorbidities, clinical activity, and health care financial charges by telephone encounter frequency. Eight hundred one patients met inclusion criteria (52.3% female; mean age, 44.1 y), accounted for 12,669 telephone encounters, and accrued $70,513,449 in charges over 3 years. High telephone encounter frequency was associated with female gender (P=0.003), anxiety/depression (P<0.001), and prior IBD surgery (P<0.001). High telephone encounter categories had significantly more hospitalizations (P<0.001), IBD surgery (P<0.001), worse quality of life (P<0.001), more corticosteroid (P<0.001), biological (P<0.001), and opiate prescriptions (P<0.001). High telephone encounter frequency patients amassed higher total available charges in each year (P<0.001) and over the 3 years (P<0.001). Telephone encounters in 2009 (P=0.02) and 2010 (P<0.001) were significantly associated with financial charges the following year after controlling for demographic, utilization, and medication covariates. Increased telephone encounters are associated with significantly higher health care utilization and financial expenditures. Increased call frequency is predictive of future health care spending. Telephone encounters are a useful tool to identify patients at risk of clinical deterioration and large financial expense.

The impact of an inflammatory bowel disease nurse-led biologics service

PubMed Central

Taylor, Nicola S; Bettey, Marion; Wright, Julia; Underhill, Caron; Kerr, Sarah; Perry, Kim; Cummings, JR Fraser

2016-01-01

Introduction Southampton General Hospital provides inflammatory bowel disease (IBD) services for a population of 650 000. Biological agents have impacted hugely on IBD but are costly drugs requiring careful supervision. These challenges led us to develop a specialist nurse-led biologics service to improve patient care. Method A 2010 case note audit highlighted areas for improvement in monitoring biologics and follow-up. A business case was developed to establish an IBD nurse to ensure identification and appropriate screening, education and review of biologics patients. A gain share was agreed with the local Care Commissioning Group (CCG) and £60 000 invested. Outcomes were reaudited in 2014. Results Biologic use has grown rapidly from 90 patients in 2011 to 330 in 2014. All records are now kept in a centralised database. Infection screening improved from 79% to 100%. In 2014, 96% of patients had follow-up ≤4 months post-induction to assess response, but two patients were seen at 7 months. 80% were followed up again at 9–12 months (100% at 9–14 months), all with treatment decisions. The initial investment was recouped via commissioners funding 368 additional outpatient appointments and 35 colonoscopies. Savings represented 15% total yearly biologic costs. Conclusions The introduction of the IBD biologics nurse-led service resulted in significant gains in care quality and costs. The need for improved follow-up of patients on biologics reflects increased pressures on clinic resources across the country. With continued biologics expansion, the introduction of a biologics nurse has provided invaluable support to patients and the IBD team at Southampton General Hospital. PMID:28839869

The Expenditures for Academic Inpatient Care of Inflammatory Bowel Disease Patients Are Almost Double Compared with Average Academic Gastroenterology and Hepatology Cases and Not Fully Recovered by Diagnosis-Related Group (DRG) Proceeds.

PubMed

Baumgart, Daniel C; le Claire, Marie

2016-01-01

Crohn's disease (CD) and ulcerative colitis (UC) challenge economies worldwide. Detailed health economic data of DRG based academic inpatient care for inflammatory bowel disease (IBD) patients in Europe is unavailable. IBD was identified through ICD-10 K50 and K51 code groups. We took an actual costing approach, compared expenditures to G-DRG and non-DRG proceeds and performed detailed cost center and type accounting to identify coverage determinants. Of all 3093 hospitalized cases at our department, 164 were CD and 157 UC inpatients in 2012. On average, they were 44.1 (CD 44.9 UC 43.3 all 58) years old, stayed 10.1 (CD 11.8 UC 8.4 vs. all 8) days, carried 5.8 (CD 6.4 UC 5.2 vs. all 6.8) secondary diagnoses, received 7.4 (CD 7.7 UC 7 vs. all 6.2) procedures, had a higher cost weight (CD 2.8 UC 2.4 vs. all 1.6) and required more intense nursing. Their care was more costly (means: total cost IBD 8477€ CD 9051€ UC 7903€ vs. all 5078€). However, expenditures were not fully recovered by DRG proceeds (means: IBD 7413€, CD 8441€, UC 6384€ vs all 4758€). We discovered substantial disease specific mismatches in cost centers and types and identified the medical ward personnel and materials budgets to be most imbalanced. Non-DRG proceeds were almost double (IBD 16.1% vs. all 8.2%), but did not balance deficits at total coverage analysis, that found medications (antimicrobials, biologics and blood products), medical materials (mostly endoscopy items) to contribute most to the deficit. DRGs challenge sophisticated IBD care.

Assessment of emergency general surgery care based on formally developed quality indicators.

PubMed

Ingraham, Angela; Nathens, Avery; Peitzman, Andrew; Bode, Allison; Dorlac, Gina; Dorlac, Warren; Miller, Preston; Sadeghi, Mahsa; Wasserman, Deena D; Bilimoria, Karl

2017-08-01

Emergency general surgery outcomes vary widely across the United States. The utilization of quality indicators can reduce variation and assist providers in administering care aligned with established recommendations. Previous quality indicators have not focused on emergency general surgery patients. We identified indicators of high-quality emergency general surgery care and assessed patient- and hospital-level compliance with these indicators. We utilized a modified Delphi technique (RAND Appropriateness Methodology) to develop quality indicators. Through 2 rankings, an expert panel ranked potential quality indicators for validity. We then examined historic compliance with select quality indicators after 4 nonelective procedures (cholecystectomy, appendectomy, colectomy, small bowel resection) at 4 academic centers. Of 25 indicators rated as valid, 13 addressed patient-level quality and 12 addressed hospital-level quality. Adherence with 18 indicators was assessed. Compliance with performing a cholecystectomy for acute cholecystitis within 72 hours of symptom onset ranged from 45% to 76%. Compliance with surgery start times within 3 hours from the decision to operate for uncontained perforated viscus ranged from 20% to 100%. Compliance with exploration of patients with small bowel obstructions with ischemia/impending perforation within 3 hours of the decision to operate was 0% to 88%. For 3 quality indicators (auditing 30-day unplanned readmissions/operations for patients previously managed nonoperatively, monitoring time to source control for intra-abdominal infections, and having protocols for bypass/transfer), none of the hospitals were compliant. Developing indicators for providers to assess their performance provides a foundation for specific initiatives. Adherence to quality indicators may improve the quality of emergency general surgery care provided for which current outcomes are potentially modifiable. Copyright © 2017 Elsevier Inc. All rights reserved.

How Accurately Do Consecutive Cohort Audits Predict Phase III Multisite Clinical Trial Recruitment in Palliative Care?

PubMed

McCaffrey, Nikki; Fazekas, Belinda; Cutri, Natalie; Currow, David C

2016-04-01

Audits have been proposed for estimating possible recruitment rates to randomized controlled trials (RCTs), but few studies have compared audit data with subsequent recruitment rates. To compare the accuracy of estimates of potential recruitment from a retrospective consecutive cohort audit of actual participating sites and recruitment to four Phase III multisite clinical RCTs. The proportion of potentially eligible study participants estimated from an inpatient chart review of people with life-limiting illnesses referred to six Australian specialist palliative care services was compared with recruitment data extracted from study prescreening information from three sites that participated fully in four Palliative Care Clinical Studies Collaborative RCTs. The predominant reasons for ineligibility in the audit and RCTs were analyzed. The audit overestimated the proportion of people referred to the palliative care services who could participate in the RCTs (pain 17.7% vs. 1.2%, delirium 5.8% vs. 0.6%, anorexia 5.1% vs. 0.8%, and bowel obstruction 2.8% vs. 0.5%). Approximately 2% of the referral base was potentially eligible for these effectiveness studies. Ineligibility for general criteria (language, cognition, and geographic proximity) varied between studies, whereas the reasons for exclusion were similar between the audit and pain and anorexia studies but not for delirium or bowel obstruction. The retrospective consecutive case note audit in participating sites did not predict realistic recruitment rates, mostly underestimating the impact of study-specific inclusion criteria. These findings have implications for the applicability of the results of RCTs. Prospective pilot studies are more likely to predict actual recruitment. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Conversations for Providers Caring for Rectal Cancer Patients: Comparison of Long-Term Patient-Centered Outcomes for Low Rectal Cancer Patients Facing Ostomy or Sphincter-Sparing Surgery

PubMed Central

Herrinton, Lisa J.; Altschuler, Andrea; McMullen, Carmit K.; Bulkley, Joanna E.; Hornbrook, Mark C.; Sun, Virginia; Wendel, Christopher S.; Grant, Marcia; Baldwin, Carol M.; Demark-Wahnefried, Wendy; Temple, Larissa K.F.; Krouse, Robert S.

2017-01-01

For some low rectal cancer patients, ostomy (with elimination into a pouch) may be the only realistic surgical option. However, some patients have a choice between ostomy and sphincter-sparing surgery. Sphincter-sparing surgery has been preferred over ostomy because it offers preservation of normal bowel function. However, this surgery can cause incontinence and bowel dysfunction. Increasingly, it has become evident that certain patients eligible for sphincter-sparing surgery may not be well served by the surgery and construction of an ostomy may be better. No validated assessment tool or decision aid has been published to help newly diagnosed patients decide between the two surgeries, or to help physicians elicit long-term surgical outcomes. Furthermore, comparison of long-term outcomes and late effects following the two surgeries has not been synthesized. We therefore conducted a systematic review to examine this ? This systematic review summarizes controlled studies that compared long-term survivorship outcomes between these two surgical groups. Our goals are: 1) improve understanding and shared decision-making among surgeons, oncologists, primary care providers, patients, and caregivers; 2) increase the patient’s participation in the decision; (3) alert the primary care provider to patient challenges that could be addressed by provider attention and intervention; and 4) ultimately, improve patients’ long-term quality of life. This report includes discussion points for health care providers to use with their patients during initial discussions of ostomy and sphincter-sparing surgery, as well as questions to ask during follow-up examinations to ascertain any long-term challenges facing the patient. PMID:26999757

Conversations for providers caring for patients with rectal cancer: Comparison of long-term patient-centered outcomes for patients with low rectal cancer facing ostomy or sphincter-sparing surgery.

PubMed

Herrinton, Lisa J; Altschuler, Andrea; McMullen, Carmit K; Bulkley, Joanna E; Hornbrook, Mark C; Sun, Virginia; Wendel, Christopher S; Grant, Marcia; Baldwin, Carol M; Demark-Wahnefried, Wendy; Temple, Larissa K F; Krouse, Robert S

2016-09-01

For some patients with low rectal cancer, ostomy (with elimination into a pouch) may be the only realistic surgical option. However, some patients have a choice between ostomy and sphincter-sparing surgery. Sphincter-sparing surgery has been preferred over ostomy because it offers preservation of normal bowel function. However, this surgery can cause incontinence and bowel dysfunction. Increasingly, it has become evident that certain patients who are eligible for sphincter-sparing surgery may not be well served by the surgery, and construction of an ostomy may be better. No validated assessment tool or decision aid has been published to help newly diagnosed patients decide between the two surgeries or to help physicians elicit long-term surgical outcomes. Furthermore, comparison of long-term outcomes and late effects after the two surgeries has not been synthesized. Therefore, this systematic review summarizes controlled studies that compared long-term survivorship outcomes between these two surgical groups. The goals are: 1) to improve understanding and shared decision-making among surgeons, oncologists, primary care providers, patients, and caregivers; 2) to increase the patient's participation in the decision; 3) to alert the primary care provider to patient challenges that could be addressed by provider attention and intervention; and 4) ultimately, to improve patients' long-term quality of life. This report includes discussion points for health care providers to use with their patients during initial discussions of ostomy and sphincter-sparing surgery as well as questions to ask during follow-up examinations to ascertain any long-term challenges facing the patient. CA Cancer J Clin 2016;66:387-397. © 2016 American Cancer Society. © 2016 American Cancer Society.

Inflammatory Bowel Disease Telemedicine Clinical Trial: Impact of Educational Text Messages on Disease-Specific Knowledge Over 1 Year.

PubMed

Abutaleb, Ameer; Buchwald, Andrea; Chudy-Onwugaje, Kenechukwu; Langenberg, Patricia; Regueiro, Miguel; Schwartz, David A; Tracy, J Kathleen; Ghazi, Leyla; Patil, Seema A; Quezada, Sandra M; Russman, Katharine M; Quinn, Charlene C; Jambaulikar, Guruprasad; Beaulieu, Dawn B; Horst, Sara; Cross, Raymond K

2018-05-18

Effective treatments are available for patients with inflammatory bowel disease (IBD); however, suboptimal outcomes occur and are often linked to patients' limited disease knowledge. The aim of this analysis was to determine if delivery of educational messages through a telemedicine system improves IBD knowledge. TELEmedicine for Patients with IBD (TELE-IBD) was a randomized controlled trial with visits at baseline, 6 months, and 12 months; patient knowledge was a secondary aim of the study. Patients were randomized to receive TELE-IBD every other week (EOW), weekly (TELE-IBD W), or standard of care. Knowledge was assessed at each visit with the Crohn's and Colitis Knowledge (CCKNOW) survey. The primary outcome was change in CCKNOW score over 1 year compared between the TELE-IBD and control groups. This analysis included 219 participants. Participants in the TELE-IBD arms had a greater improvement in CCKNOW score compared with standard care (TELE-IBD EOW +2.4 vs standard care +1.8, P = 0.03; TELE-IBD W +2.0 vs standard care +1.8, P = 0.35). Participants with lower baseline CCKNOW scores had a greater change in their score over time (P < 0.01). However, after adjusting for race, site, and baseline knowledge, there was no difference in CCKNOW score change between the control and telemedicine arms. Telemedicine improves IBD-specific knowledge through text messaging, although the improvement is not additive with greater frequency of text messages. However, after adjustment for confounding variables, telemedicine is not superior to education given through standard visits at referral centers. Further research is needed to determine if revised systems with different modes of delivery and/or frequency of messages improve disease knowledge.

Effectiveness of Disease-Specific Cognitive Behavioral Therapy on Anxiety, Depression, and Quality of Life in Youth With Inflammatory Bowel Disease: A Randomized Controlled Trial.

PubMed

Stapersma, Luuk; van den Brink, Gertrude; van der Ende, Jan; Szigethy, Eva M; Beukers, Ruud; Korpershoek, Thea A; Theuns-Valks, Sabine D M; Hillegers, Manon H J; Escher, Johanna C; Utens, Elisabeth M W J

2018-05-29

To evaluate the effectiveness of a disease-specific cognitive behavioral therapy (CBT) protocol on anxiety and depressive symptoms and health-related quality of life (HRQOL) in adolescents and young adults with inflammatory bowel disease (IBD). A parallel group randomized controlled trial was conducted in 6 centers of (pediatric) gastroenterology. Included were 70 patients and young adults (10-25 years) with IBD and subclinical anxiety and/or depressive symptoms. Patients were randomized into 2 groups, stratified by center: (a) standard medical care (care-as-usual [CAU]) plus disease-specific manualized CBT (Primary and Secondary Control Enhancement Training for Physical Illness; PASCET-PI), with 10 weekly sessions, 3 parent sessions, and 3 booster sessions (n = 37), or (b) CAU only (n = 33). Primary analysis concerned the reliable change in anxiety and depressive symptoms after 3 months (immediate posttreatment assessment). Exploratory analyses concerned (1) the course of anxiety and depressive symptoms and HRQOL in subgroups based on age, and (2) the influence of age, gender, and disease type on the effect of the PASCET-PI. Overall, all participants improved significantly in their anxiety and depressive symptoms and HRQOL, regardless of group, age, gender, and disease type. Primary chi-square tests and exploratory linear mixed models showed no difference in outcomes between the PASCET-PI (n = 35) and the CAU group (n = 33). In youth with IBD and subclinical anxiety and/or depressive symptoms, preliminary results of immediate post-treatment assessment indicated that a disease-specific CBT added to standard medical care did not perform better than standard medical care in improving psychological symptoms or HRQOL. ClinicalTrials.gov: NCT02265588.

Very Low Birth Weight Preterm Infants With Surgical Short Bowel Syndrome: Incidence, Morbidity and Mortality, and Growth Outcomes at 18 to 22 Months

PubMed Central

Cole, Conrad R.; Hansen, Nellie I.; Higgins, Rosemary D.; Ziegler, Thomas R.; Stoll, Barbara J.

2009-01-01

OBJECTIVES The objective of this study was to determine the (1) incidence of short bowel syndrome in very low birth weight (<1500 g) infants, (2) associated morbidity and mortality during initial hospitalization, and (3) impact on short-term growth and nutrition in extremely low birth weight (<1000 g) infants. METHODS Infants who were born from January 1, 2002, through June 30, 2005, and enrolled in the National Institute of Child Health and Human Development Neonatal Research Network were studied. Risk factors for developing short bowel syndrome as a result of partial bowel resection (surgical short bowel syndrome) and outcomes were evaluated for all neonates until hospital discharge, death, or 120 days. Extremely low birth weight survivors were further evaluated at 18 to 22 months’ corrected age for feeding methods and growth. RESULTS The incidence of surgical short bowel syndrome in this cohort of 12 316 very low birth weight infants was 0.7%. Necrotizing enterocolitis was the most common diagnosis associated with surgical short bowel syndrome. More very low birth weight infants with short bowel syndrome (20%) died during initial hospitalization than those without necrotizing enterocolitis or short bowel syndrome (12%) but fewer than the infants with surgical necrotizing enterocolitis without short bowel syndrome (53%). Among 5657 extremely low birth weight infants, the incidence of surgical short bowel syndrome was 1.1%. At 18 to 22 months, extremely low birth weight infants with short bowel syndrome were more likely to still require tube feeding (33%) and to have been rehospitalized (79%). Moreover, these infants had growth delay with shorter lengths and smaller head circumferences than infants without necrotizing enterocolitis or short bowel syndrome. CONCLUSIONS Short bowel syndrome is rare in neonates but has a high mortality rate. At 18 to 22 months’ corrected age, extremely low birth weight infants with short bowel syndrome were more likely to have growth failure than infants without short bowel syndrome. PMID:18762491

Influences and Impact of Anxiety and Depression in the Setting of Inflammatory Bowel Disease.

PubMed

Navabi, Seyedehsan; Gorrepati, Venkata Subhash; Yadav, Sanjay; Chintanaboina, Jaykrishna; Maher, Sarah; Demuth, Peter; Stern, Benjamin; Stuart, August; Tinsley, Andrew; Clarke, Kofi; Williams, Emmanuelle D; Coates, Matthew D

2018-05-17

Individuals with inflammatory bowel disease (IBD) are at increased risk of developing anxiety or depression (A&D). Crohn's disease (CD) and ulcerative colitis (UC) with comorbid A&D are both more challenging to manage. IBD providers need to better understand the causes and impact of A&D in order to improve care for IBD patients. We sought to identify clinical factors that influence development of A&D and healthcare utilization in IBD. This is a retrospective analysis using an IBD natural history registry from a single tertiary care referral center. Presence of A&D was determined based upon responses to the Hospital Anxiety and Depression Scale. Demographic and clinical factors were abstracted to evaluate for significant associations. Four hundred thirty-two IBD patients (132 UC, 256 CD, and 44 indeterminate colitis) were included in this study. One hundred ninety-two (44.4%) had anxiety or depression or both, and most were female (59.4%, P < 0.05). History of surgery (P < 0.05), female gender (P < 0.05), smoking (P < 0.05), and extra-intestinal manifestations (P < 0.01) were each independently predictive of A&D. Inflammatory bowel disease patients with A&D more often underwent imaging studies (53.6% vs 36.7%, P < 0.05), visited the ED (30.7% vs 20.8%, P < 0.05), or were hospitalized (31.7% vs 21.7%, P < 0.05). They were also more frequently prescribed corticosteroids (50.5% vs 36.7%, P < 0.01) and biologic medications (62.5% vs 51.3%, P < 0.05). Finally, they were more likely to have had at least 1 "no-show" (29.2% vs 16.7%, P < 0.01) and had a higher mean number of "no-shows" (0.69 +/- 0.1 vs 0.30 +/- 0.1, P < 0.01) over the study period. Anxiety and depression are common in the setting of IBD and are strongly associated with surgical history, disease complications (including extra-intestinal manifestations), smoking, and female gender. Inflammatory bowel disease patients with A&D are also more likely to require therapy and to utilize healthcare resources. This study refines our understanding of A&D development and its impact in IBD and provides additional considerations for management in this setting.

Bowel incontinence

MedlinePlus

Uncontrollable passage of feces; Loss of bowel control; Fecal incontinence; Incontinence - bowel ... older, women tend to have problems with bowel control more often than men. Children who have problems ...

Provider Adherence to Implementation of Clinical Practice Guidelines for Neurogenic Bowel in Adults With Spinal Cord Injury

PubMed Central

Goetz, Lance L; Nelson, Audrey L; Guihan, Marylou; Bosshart, Helen T; Harrow, Jeffrey J; Gerhart, Kevin D; Krasnicka, Barbara; Burns, Stephen P

2005-01-01

Background/Objectives: Clinical Practice Guidelines (CPGs) have been published on a number of topics in spinal cord injury (SCI) medicine. Research in the general medical literature shows that the distribution of CPGs has a minimal effect on physician practice without targeted implementation strategies. The purpose of this study was to determine (a) whether dissemination of an SCI CPG improved the likelihood that patients would receive CPG recommended care and (b) whether adherence to CPG recommendations could be improved through a targeted implementation strategy. Specifically, this study addressed the “Neurogenic Bowel Management in Adults with Spinal Cord Injury” Clinical Practice Guideline published in March 1998 by the Consortium for Spinal Cord Medicine Methods: CPG adherence was determined from medical record review at 6 Veterans Affairs SCI centers for 3 time periods: before guideline publication (T1), after guideline publication but before CPG implementation (T2), and after targeted CPG implementation (T3). Specific implementation strategies to enhance guideline adherence were chosen to address the barriers identified by SCI providers in focus groups before the intervention. Results: Overall adherence to recommendations related to neurogenic bowel did not change between T1 and T2 (P = not significant) but increased significantly between T2 and T3 (P < 0.001) for 3 of 6 guideline recommendations. For the other 3 guideline recommendations, adherence rates were noted to be high at T1. Conclusions: While publication of the CPG alone did not alter rates of provider adherence, the use of a targeted implementation plan resulted in increases in adherence rates with some (3 of 6) CPG recommendations for neurogenic bowel management. PMID:16869086

The Upturned Superior Mesenteric Artery Sign for First-Trimester Detection of Congenital Diaphragmatic Hernia and Omphalocele.

PubMed

Lakshmy, Ravi Selvaraj; Agnees, Joy; Rose, Nity

2017-03-01

The aim of this study was to follow the course of the superior mesenteric artery (SMA) in first-trimester fetuses to predict the location of the small bowel. Its abnormal course aids in early detection of congenital diaphragmatic hernia (CDH) and assessment of the contents of omphalocele. The SMA can be easily identified in a sagittal section of the fetus by using color Doppler sonography at the 11- to 14-week scan, and normally, it has a downward course caudally to supply the intestines. The course of the SMA points to the location of the bowel. We report a series of 7 cases detected in first trimester with an abnormal course of the SMA, 3 of which had CDH and 4 of which had omphalocele. In CDH, the intestines herniate into the thoracic cavity; hence, the SMA tends to have an upward course toward the thorax. In 4 cases of omphalocele, the SMA follows the exteriorized bowel into the base of the umbilical cord. Second-trimester sonography for detection of congenital malformations is a standardized protocol, but a careful anatomic survey at the 11- to 14-week scan is often rewarding. When there is a suspicion of an intrathoracic mass or a mediastinal shift, the upturned course of SMA serves as a valuable sign in confirmation of CDH. Chromosomal abnormalities are often reported in cases of omphalocele containing small bowel only, and the upward course of the SMA toward the base of the cord helps in its early prenatal diagnosis, which facilitates early genetic assessment in these fetuses. © 2017 by the American Institute of Ultrasound in Medicine.

An Atypical Eating Disorder with Crohn's Disease in a Fifteen-Year-Old Male: A Case Study.

ERIC Educational Resources Information Center

Holaday, Margot; And Others

1994-01-01

Discusses how 6 months after psychological intervention for an eating disorder, a 15-year-old male was diagnosed with Crohn's disease, a chronic inflammatory bowel disease. Addresses need for additional training for those from traditional school and counseling psychology programs. Advocates a team approach and consultations. (RJM)

American Gastroenterological Association

MedlinePlus

... 2017 Read More Press Release Para el Mes de la Herencia Hispana, una advertencia de salud importante Sept. 15, 2017 Read More Press ... Thomas Yen presents on life in private and group practices during the 2016 AGA Regional Practice Skills Workshops. ... Your IBS: An 8-Week Program to Control the Symptoms of Irritable Bowel Syndrome April 10, ...

Enterocutaneous Fistula: Proven Strategies and Updates

PubMed Central

Gribovskaja-Rupp, Irena; Melton, Genevieve B.

2016-01-01

Management of enterocutaneous fistula represents one of the most protracted and difficult problems in colorectal surgery with substantial morbidity and mortality rates. This article summarizes the current classification systems and successful management protocols, provides an in-depth review of fluid resuscitation, sepsis control, nutrition management, medication management of output quantity, wound care, nonoperative intervention measures, operative timeline, and considerations, and discusses special considerations such as inflammatory bowel disease and enteroatmospheric fistula. PMID:27247538

Proctalgia fugax.

PubMed

Potter, M A; Bartolo, D C

2001-11-01

Proctalgia fugax is a benign, self-limiting pain experienced in the perineum. It is common, but most sufferers do not seek medical advice. The aetiology is unclear, but a variation of irritable bowel syndrome, pelvic floor myalgia, and internal anal sphincter spasm have all been suggested. A careful history can elicit the characteristic history, and simple reassurance is often all that is necessary. For persistent symptoms, therapies that induce internal anal sphincter relaxation are of value.

Psychosocial issues in evidence-based guidelines on inflammatory bowel diseases: A review

PubMed Central

Häuser, Winfried; Moser, Gabriele; Klose, Petra; Mikocka-Walus, Antonina

2014-01-01

AIM: To study statements and recommendations on psychosocial issues as presented in international evidence-based guidelines on the management of inflammatory bowel diseases (IBD). METHODS: MEDLINE, guidelines International Network, National Guideline Clearing House and National Institute for Health and Care Excellence were searched from January 2006 to June 30, 2013 for evidence-based guidelines on the management of IBD. RESULTS: The search yielded 364 hits. Thirteen guidelines were included in the review, of which three were prepared in Asia, eight in Europe and two in the United States. Eleven guidelines made statements and recommendations on psychosocial issues. The guidelines were concordant in that mental health disorders and stress do not contribute to the aetiology of IBD, but that they can influence its course. It was recommended that IBD-patients should be screened for psychological distress. If indicated, psychotherapy and/or psychopharmacological therapy should be recommended. IBD-centres should collaborate with mental health care specialists. Tobacco smoking patients with Crohn’s disease should be advised to quit. CONCLUSION: Patients and mental health specialists should be able to participate in future guideline groups to contribute to establishing recommendations on psychosocial issues in IBD. Future guidelines should acknowledge the presence of psychosocial problems in IBD-patients and encourage screening for psychological distress. PMID:24707152

A single-blind trial of reflexology for irritable bowel syndrome.

PubMed Central

Tovey, Philip

2002-01-01

BACKGROUND: Irritable bowel syndrome (IBS) is a significant problem for primary care, as treatment options are limited and it can frequently develop into a chronic condition. Complementary and alternative medicine, including reflexology, is being turned to increasingly in an attempt to manage symptoms. There are currently no studies which address the effectiveness of reflexology for IBS. Despite this, it continues to be advocated and used. AIM: To provide the first evidence on the effectiveness of reflexology in the management of the core defining symptoms of IBS. DESIGN OF STUDY: A single-blind trial carried out in primary care settings. SETTING: Thirty-four participants diagnosed with IBS on the basis of the Rome Criteria. METHOD: Participants were allocated to receive either a reflexology foot massage or a non-reflexology foot massage control group. RESULTS: On none of the three symptoms monitored--abdominal pain, constipation/diarrhoea, and abdominal distention--was there a statistically or clinically significant difference between reflexology and control groups. CONCLUSION: On the basis of these results there is nothing to suggest that reflexology produces any specific benefit for patients with IBS. There is currently no evidence to support its use. However this was one (relatively) small scale study; further research that, for example, assesses the impact of therapist (professional and lay) versus therapy, is still needed. PMID:11791811

Advances in the Diagnosis and Management of Inflammatory Bowel Disease: Challenges and Uncertainties

PubMed Central

Mosli, Mahmoud; Al Beshir, Mohammad; Al-Judaibi, Bandar; Al-Ameel, Turki; Saleem, Abdulaziz; Bessissow, Talat; Ghosh, Subrata; Almadi, Majid

2014-01-01

Over the past two decades, several advances have been made in the management of patients with inflammatory bowel disease (IBD) from both evaluative and therapeutic perspectives. This review discusses the medical advancements that have recently been made as the standard of care for managing patients with ulcerative colitis (UC) and Crohn's Disease (CD) and to identify the challenges associated with implementing their use in clinical practice. A comprehensive literature search of the major databases (PubMed and Embase) was conducted for all recent scientific papers (1990–2013) giving the recent updates on the management of IBD and the data were extracted. The reported advancements in managing IBD range from diagnostic and evaluative tools, such as genetic tests, biochemical surrogate markers of activity, endoscopic techniques, and radiological modalities, to therapeutic advances, which encompass medical, endoscopic, and surgical interventions. There are limited studies addressing the cost-effectiveness and the impact that these advances have had on medical practice. The majority of the advances developed for managing IBD, while considered instrumental by some IBD experts in improving patient care, have questionable applications due to constraints of cost, lack of availability, and most importantly, insufficient evidence that supports their role in improving important long-term health-related outcomes. PMID:24705146

Living with constipation--older people's experiences and strategies with constipation before and during hospitalization.

PubMed

Munch, Lene; Tvistholm, Nina; Trosborg, Ingelise; Konradsen, Hanne

2016-01-01

Constipation is a common problem among older people. This study aimed to explore how older patients experience constipation and which strategies they used in handling the condition before and during hospitalization. A qualitative exploratory research design was used. Fourteen semi-structured interviews were conducted with patients (61-91 years of age) during hospitalization. Data were analyzed by using content analysis. Themes concerning experiences were Bodily signs and symptoms of constipation; the participants described severe pain during constipation, as well as pronounced relief after bowel movements, Impact on well-being and social activities; being constipated negatively impacted their mood and limited social activities, Striving for bowel balance; the participants experienced an ongoing strive for balancing between constipation and diarrhea. Themes related to strategies were Struggling to find a solution; they were aware of different strategies to prevent and treat constipation, though the most common solution described was the use of laxatives, Wait and see; the participants were awaiting to take action until they experienced constipation symptoms, Constipation is a private problem being challenged during hospitalization; constipation was considered a private issue rarely discussed with health-care professionals. This study illuminates the need for health-care professionals to be attentive to this issue and initiate the conversation with patients in order to advise on the management of constipation.

Utility of CT in the diagnosis and management of small-bowel obstruction in children.

PubMed

Wang, Qiuyan; Chavhan, Govind B; Babyn, Paul S; Tomlinson, George; Langer, Jacob C

2012-12-01

CT is often used in the diagnosis and management of small-bowel obstruction in children. To determine sensitivity of CT in delineating presence, site and cause of small-bowel obstruction in children. We retrospectively reviewed the CT scans of 47 children with surgically proven small-bowel obstruction. We noted any findings of obstruction and the site and cause of obstruction. Presence, absence or equivocal findings of bowel obstruction on abdominal radiographs performed prior to CT were also noted. We reviewed patient charts for clinical details and surgical findings, including bowel resection. Statistical analysis was performed using Fisher exact test to determine which CT findings might predict bowel resection. CT correctly diagnosed small-bowel obstruction in 43/47 (91.5%) cases. CT correctly indicated site of obstruction in 37/47 (78.7%) cases and cause of obstruction in 32/47 (68.1%) cases. Small-bowel feces sign was significantly associated with bowel resection at surgery (P = 0.0091). No other CT finding was predictive of bowel resection. Out of 41 children who had abdominal radiographs before CT, 29 (70.7%) showed unequivocal obstruction, six (14.6%) showed equivocal findings and six (14.6%) were unremarkable. CT is highly sensitive in diagnosing small-bowel obstruction in children and is helpful in determining the presence of small-bowel obstruction in many clinically suspected cases with equivocal or normal plain radiographs. CT also helps to determine the site and cause of the obstruction with good sensitivity.

Accuracy of abdominal auscultation for bowel obstruction.

PubMed

Breum, Birger Michael; Rud, Bo; Kirkegaard, Thomas; Nordentoft, Tyge

2015-09-14

To investigate the accuracy and inter-observer variation of bowel sound assessment in patients with clinically suspected bowel obstruction. Bowel sounds were recorded in patients with suspected bowel obstruction using a Littmann(®) Electronic Stethoscope. The recordings were processed to yield 25-s sound sequences in random order on PCs. Observers, recruited from doctors within the department, classified the sound sequences as either normal or pathological. The reference tests for bowel obstruction were intraoperative and endoscopic findings and clinical follow up. Sensitivity and specificity were calculated for each observer and compared between junior and senior doctors. Interobserver variation was measured using the Kappa statistic. Bowel sound sequences from 98 patients were assessed by 53 (33 junior and 20 senior) doctors. Laparotomy was performed in 47 patients, 35 of whom had bowel obstruction. Two patients underwent colorectal stenting due to large bowel obstruction. The median sensitivity and specificity was 0.42 (range: 0.19-0.64) and 0.78 (range: 0.35-0.98), respectively. There was no significant difference in accuracy between junior and senior doctors. The median frequency with which doctors classified bowel sounds as abnormal did not differ significantly between patients with and without bowel obstruction (26% vs 23%, P = 0.08). The 53 doctors made up 1378 unique pairs and the median Kappa value was 0.29 (range: -0.15-0.66). Accuracy and inter-observer agreement was generally low. Clinical decisions in patients with possible bowel obstruction should not be based on auscultatory assessment of bowel sounds.

Abdominal sounds

MedlinePlus

... intestines, or strangulation of the bowel and death ( necrosis ) of the bowel tissue. Very high-pitched bowel ... missing bowel sounds may be caused by: Blocked blood vessels prevent the intestines from getting proper blood flow. ...

Accuracy of abdominal auscultation for bowel obstruction

PubMed Central

Breum, Birger Michael; Rud, Bo; Kirkegaard, Thomas; Nordentoft, Tyge

2015-01-01

AIM: To investigate the accuracy and inter-observer variation of bowel sound assessment in patients with clinically suspected bowel obstruction. METHODS: Bowel sounds were recorded in patients with suspected bowel obstruction using a Littmann® Electronic Stethoscope. The recordings were processed to yield 25-s sound sequences in random order on PCs. Observers, recruited from doctors within the department, classified the sound sequences as either normal or pathological. The reference tests for bowel obstruction were intraoperative and endoscopic findings and clinical follow up. Sensitivity and specificity were calculated for each observer and compared between junior and senior doctors. Interobserver variation was measured using the Kappa statistic. RESULTS: Bowel sound sequences from 98 patients were assessed by 53 (33 junior and 20 senior) doctors. Laparotomy was performed in 47 patients, 35 of whom had bowel obstruction. Two patients underwent colorectal stenting due to large bowel obstruction. The median sensitivity and specificity was 0.42 (range: 0.19-0.64) and 0.78 (range: 0.35-0.98), respectively. There was no significant difference in accuracy between junior and senior doctors. The median frequency with which doctors classified bowel sounds as abnormal did not differ significantly between patients with and without bowel obstruction (26% vs 23%, P = 0.08). The 53 doctors made up 1378 unique pairs and the median Kappa value was 0.29 (range: -0.15-0.66). CONCLUSION: Accuracy and inter-observer agreement was generally low. Clinical decisions in patients with possible bowel obstruction should not be based on auscultatory assessment of bowel sounds. PMID:26379407

Large-bowel surgery, 1979: self-assessment.

PubMed Central

Matheson, N A; Valerio, D

1980-01-01

Evidence of wide variability in the immediate results of large-bowel surgery stimulated self-assessment during 1979. The hazards of large-bowel surgery can usually be avoided by good bowel preparation, sound anastomotic technique, primary resection in large bowel emergencies, avoidance of anastomosis when hazardous, and antibiotic lavage for extant or potential peritoneal and wound contamination. PMID:7427416

Objective and Subjective Intra-patient Comparison of Iohexol versus Diatrizoate for Bowel Preparation Quality at CT Colonography

PubMed Central

Johnson, Brandon; Hinshaw, J. Louis; Robbins, Jessica B.; Pickhardt, Perry J.

2017-01-01

Objective To objectively and subjectively compare nonionic iohexol and ionic diatrizoate iodinated oral contrast as part of a cathartic bowel regimen within the same CT colonography (CTC) cohort, with otherwise identical preparations. Materials and Methods In our IRB-approved retrospective study, 46 asymptomatic adults (mean age, 59.4 years; 26M/20F) returning for follow-up CTC over a 9-month interval underwent the same bowel preparation with the exception of 75 ml iohexol 350 (Omnipaque) in place of 60 ml diatrizoate (Gastrografin). All other preparation components (bisacodyl, magnesium citrate, and 2% barium) remained constant. Objective volumetric analysis of residual colonic fluid volume and fluid attenuation was performed. Additionally, two radiologists experienced with CTC, blinded to the specific bowel preparation, scored each of 6 colonic segments for adherent residual solid stool using a previously validated 4-point scale (0 for no stool; 1–3 for increasing residual stool). Paired t-test was used for comparison of the cohorts. Results No clear clinically-meaningful difference was found between the two preparations on overall objective or subjective evaluation. Mean (±SD) residual fluid volume was 173±126 ml with the iohexol preparation and 130±79 ml with the diatrizoate prep (p=0.02). Mean total colonic stool score was 2.5 (0.42/segment) with iohexol and 2.3 (0.38/segment) with diatrizoate (p=0.69). Mean (±SD) fluid attenuation was higher with iohexol (849±270HU) compared with diatrizoate (732±168HU) (p=0.03). Conclusions Based on this direct intra-patient comparison, we found that oral iohexol is a suitable alternative to diatrizoate for fluid tagging as part of a cathartic bowel preparation at CTC. Because this nonionic tagging agent is more palatable, less expensive, and likely safer than ionic diatrizoate, our CTC program now utilizes iohexol as the standard recommended regimen. PMID:27010251

Predicting Intestinal Adaptation in Pediatric Intestinal Failure: A Retrospective Cohort Study.

PubMed

Belza, Christina; Fitzgerald, Kevin; de Silva, Nicole; Avitzur, Yaron; Steinberg, Karen; Courtney-Martin, Glenda; Wales, Paul W

2017-12-04

The primary goal in intestinal failure (IF) is adaptation and enteral autonomy (EA). Our goals were to determine the proportion of patients treated for IF by an established intestinal rehabilitation program who achieved EA and to assess the predictors of EA. There have been considerable advancements in the management of IF over the last 15 years, children with short bowel syndrome with a reduction in mortality. Several studies have discussed variables that may influence the ability to attain EA; however, majority were written when mortality rates were considerably higher compared with the current contemporary experience. A retrospective analysis of infants <12 months with short bowel syndrome referred between 2006 and 2013 (n = 120). Data was collected on IF-related factors and nutritional intake. The cohort was stratified based on achievement of EA. Statistical testing completed using t test, Chi Square, and Cox Proportional Hazards regression (P < 0.05). EA was achieved in 84 (70.0%) patients. Patients who remained parenteral nutrition dependent were more likely to have volvulus (1.2 vs 22.2%, P < 0.001), shorter percent residual small bowel (29.4 vs 68.6%; P < 0.0001) and colon length (64.6 vs 86.0%; P = 0.001), and no ileocecal valve (61.1 vs 29.8%; P = 0.05). Mortality was also decreased in those who achieved EA (4 vs 22%; P = 0.004). Percent residual small bowel (HR = 1.03; 95% CI 1.02-1.03) and colon (HR = 1.01; 95% CI 1.00-1.02) length were positively associated with EA, while number of septic episodes was negatively associated (HR = 0.95; 95% CI 0.91-0.99). Seventy percent of infants with IF achieved EA. Residual small and large bowel length were the most important predictors of EA and septic events had a negative impact.

Bowel preparation for colonoscopy with magnesium sulphate and low-volume polyethylene glycol.

PubMed

Tepeš, Bojan; Mlakar, Dominika N; Metličar, Tanja

2014-06-01

Patient compliance with bowel cleansing procedures represents one of the most objectionable aspects of colonoscopy. Adverse reactions to the purgative may result in failure to complete the preparation, inadequate visualization of the colon, polyp and even carcinoma miss rate and unwillingness to attend a follow-up colonoscopy. The primary objective of the study was to evaluate the effectiveness of bowel cleansing with magnesium sulphate and low-volume polyethylene glycol (PEG) with electrolytes. The second objective was to evaluate whether bowel cleansing was better in participants scheduled for morning colonoscopies or afternoon colonoscopies. Magnesium sulphate mineral water (2 l) and 2 l of low-volume PEG and electrolytes solution were used as our bowel cleansing protocol. A total of 13 914 participants, who participated in the Slovenian colorectal cancer screening programme in the period between 2009 and 2011, were included. Excellent bowel preparation was achieved in 11 484 (82.61%) participants; 1894 (13.62%) participants had good bowel preparation, 439 (3.16%) participants had fair bowel preparation and 85 (0.61%) participants had poor bowel preparation. Better results were achieved in the afternoon colonoscopies and in younger participant groups (P<0.001). No serious side effects of bowel cleansing were reported. This is the first study to use magnesium sulphate mineral water and PEG plus electrolytes for bowel cleansing. We found excellent bowel cleansing in 82.61% participants and in more participants if colonoscopy was performed in the afternoon.

Bowel ultrasound imaging in patients with cystic fibrosis: Relationship with clinical symptoms and CFTR genotype.

PubMed

Fraquelli, Mirella; Baccarin, Alessandra; Corti, Fabiola; Conti, Clara Benedetta; Russo, Maria Chiara; Della Valle, Serena; Pozzi, Roberta; Cressoni, Massimo; Conte, Dario; Colombo, Carla

2016-03-01

Ultrasound imaging is used to assess bowel abnormalities in gastrointestinal diseases. We aimed to assess the rate of predefined bowel ultrasound signs and their relationship with gastrointestinal symptoms and the cystic fibrosis transmembrane conductance regulator (CFTR) genotype in cystic fibrosis patients in regular follow-up. Prospective study of 70 consecutive patients with cystic fibrosis and 45 controls who underwent abdominal ultrasound; pertinent findings were related to gastrointestinal symptoms and, in cystic fibrosis patients, to pancreatic status, malabsorption degree, lipase intake, CFTR genotype (classified as severe or mild against functional class of CFTR mutations). 96% patients showed at least one abnormal bowel ultrasound sign. Most frequent signs were lymph node enlargement (64%), bowel loop dilatation (55%), thick corpuscular intraluminal content (49%), bowel wall hypervascularization (26%), thickened bowel wall (22%) and intussusception (17%). Patients with recurrent abdominal pain showed more bowel wall hypervascularization than patients without recurrent pain (47% vs. 19%, respectively; p = 0.02) and intussusception (58% vs. 17%, respectively; p < 0.01). Genotype was not associated to specific bowel ultrasound signs. Patients with bowel loop intussusception showed greater lipase intake than those without intussusception (8.118 ± 2.083 vs. 5.994 ± 4.187, respectively; p < 0.01). Cystic fibrosis patients present a higher rate of bowel ultrasound abnormalities than controls. Bowel ultrasound abnormalities are associated with abdominal symptoms. Copyright © 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Effect of viscous fiber (guar) on postprandial motor activity in human small bowel.

PubMed

Schönfeld, J; Evans, D F; Wingate, D L

1997-08-01

Both caloric value and chemical composition of a meal have been shown to regulate postprandial small bowel motility in dog. In the same species, duration of and contractile activity within the postprandial period also depends on mean viscosity. It is unknown, however, whether meal viscosity and fiber content also regulate small bowel motor activity in man. In human volunteers, we therefore studied the effect of guar gum on small bowel motor response to liquid and solid meals. Twenty-six prolonged ambulatory small bowel manometry studies were performed in 12 volunteers. A total of 620 hr of recording were analyzed visually for phase III of the MMC and a validated computer program calculated the incidence and amplitude of contractions after ingestion of water (300 ml), a pure glucose drink (300 ml/330 kcal) or a solid meal (530 kcal) with and without 5 g of guar gum. Addition of 5 g of guar gum did not significantly delay reappearance of phase III after ingestion of water (59 +/- 11 vs 106 +/- 21 min; P = 0.09). However, guar gum significantly prolonged duration of postprandial motility pattern both after the glucose drink (123 +/- 19 vs 199 +/- 24 min; P < 0.05) and after the solid meal (310 +/- 92 vs 419 +/- 22 min; P = 0.005). Contractile activity during these periods was not affected by guar gum. This was true for mean incidence of contractions after water (1.9 +/- 0.3 vs 1.8 +/- 0.5 min-1), after the glucose drink (1.6 +/- 0.4 vs. 1.7 +/- 0.3 min-1) and after the solid meal (2.4 +/- 0.4 vs 2.6 +/- 0.4 min-1). Likewise, mean amplitude of contractions was not affected by guar gum after water (22.8 +/- 1.4 vs 20.9 +/- 1.9 mm Hg), after the glucose drink (20.5 +/- 1.4 vs 21.3 +/- 1.2), and after the solid meal (20.3 +/- 1.5 vs 21.5 +/- 1.6 mm Hg). Thus a guar gum-induced increase in chyme viscosity markedly prolonged duration of postprandial motor activity in the human small bowel. Contractile activity within the postprandial period, however, was not affected. We suggest that the postprandial motility pattern persisted longer after the more viscous meals, because gastric emptying and intestinal transit were delayed by guar gum. We conclude that it is essential to define meal viscosity and fiber contents when studying postprandial small bowel motility.

The national bowel cancer audit project: the impact of organisational structure on outcome in operative bowel cancer within the United Kingdom.

PubMed

Cornish, J A; Tekkis, P P; Tan, E; Tilney, H S; Thompson, M R; Smith, J J

2011-06-01

To investigate the relationship between organisational structure, process and surgical outcomes for bowel cancer surgery. An e-survey was sent to the members of the Association of Coloproctology of Great Britain and Ireland to determine the organisational structure of their Trusts. Responses were combined with the National Bowel Cancer Audit (NBOCAP) data. Items investigated included; number of consultants, nurse specialists, volume of cases and intensive care facilities. Main outcome measures included: 30-day risk-adjusted mortality, length of stay (LOS), lymph node yield and circumferential margin involvement (CRM). One hundred and seventeen Trusts responded (65.8%), matched to 7666 patient episodes (NBOCAP data) from 54 (62.8%)Trusts who submitted data to the audit. Trusts treating <190 cases/annum (p > 0.001), <4 colorectal consultants (p > 0.001), <4 HDU beds (p > 0001) and <8 ITU beds (p > 0001) were more likely to have a 30-day-risk-adjusted mortality twice that of the national mean. Sixty five percent (n = 1603) of Trusts treating ≥ 190 cases/annum harvested ≥ 12 lymph nodes vs. 58.3% (n = 1435) in Trusts <190 cases/annum (p < 0.001). Trusts with ≥ 2 pathologists with an interest in bowel cancer harvested ≥ 12 lymph nodes more frequently (p=<0.001) and were more likely to identify extramural vascular invasion in the specimen (p = 0.015). Negative CRM was achieved in 81.4% (n = 81.4) of patients in Trusts treating ≥ 190 cases vs. 66.5% (n = 569) in Trusts<190 cases/annum (p < 0.001). Trusts offering fast track discharge were more likely to have a LOS < 15 days (p = 0.006). Surgeons treating ≤ 35 cases/annum had increased major post-operative complications (<35 cases = 70.2% vs. ≥ 35 cases = 21.9%; p < 0.001), however 30 day risk adjusted mortality was not increased in surgeons treating <35 cases/annum. This study shows that the organisational infrastructure of hospitals appears to have as great an impact on patient outcomes as the volume of cases performed by hospital Trusts. Crown Copyright © 2010. Published by Elsevier Ltd. All rights reserved.

Small Bowel Obstruction Caused by Aloe vera Bezoars: A Case Report.

PubMed

Hong, In Taik; Cha, Jae Myung; Ki, Hye Jin; Kwak, Min Seob; Yoon, Jin Young; Shin, Hyun Phil; Jeoun, Jung Won; Choi, Sung Il

2017-05-25

Small bowel obstruction is a clinical condition commonly caused by postoperative adhesion, volvulus, intussusceptions, and hernia. Small bowel obstruction due to bezoars is clinically uncommon, accounting for approximately 2-4% of all obstructions. Computed tomography (CT) is a useful method in diagnosing the cause of small bowel obstruction. However, small bowel obstruction caused by bezoars may not be detected by an abdominal CT examination. Herein, we report a rare case of small bowel obstruction by Aloe vera bezoars, which were undetected by an abdominal CT. Phytobezoars should be included in the differential diagnosis of small bowel obstruction in patients with predisposing factors, such as excessive consumption of high-fiber food and diabetes.

Dysfunction of the lower urinary and distal gastrointestinal tracts in pediatric patients with known spinal cord problems.

PubMed

Churchill, B M; Abramson, R P; Wahl, E F

2001-12-01

Destruction of the urinary tract in children with elimination, storage, and holding dysfunction of the lower urinary and the distal GI tracts is caused primarily by high intravesical pressure. UTI accelerates this process. The LPP and the status of the urethral control mechanism and its relationship to the detrusor are the primary determinants of intravesical pressure. Intravesical pressures of more than 40 cm H2O are dangerous because they cause a pressure gradient that is transmitted proximally to the renal papillae, which results in the cessation of renal blood flow and a loss of renal function over time. Hydroureteronephrosis, VUR, UTI, urinary incontinence, and calculi formation also may occur. If these dangerously high intravesical pressures remain untreated, renal failure is likely to occur over time. These children then require dialysis or renal transplantation to survive, which is tragic and represents an enormous economic cost to society. Renal failure and upper urinary tract damage is nearly 100% preventable with early and appropriate evaluation and treatment. CIC is a crucial part of the management of these children and has been shown to be safe and effective, even in newborn boys. The use of the Credé maneuver (i.e., manual compression) to empty the bladder is obsolete and should be abandoned. The distal GI tract is inseparable from the lower urinary tract and must be treated simultaneously. Failure to treat the distal GI tract yields poor clinical results and much patient dissatisfaction and makes it difficult or impossible to treat the child's urinary tract problem successfully. Bowel-management programs must include daily high water and fiber intake, together with digital perianal stimulation or fecal extraction. Neuropathic bladder and bowel problems that are intractable to conservative medical and mechanical (i.e., CIC and digital perianal stimulation or fecal extraction, respectively) management almost always can be corrected surgically with high success rates in cooperative patients. Finally, neuropathic bladder and bowel problems can be extremely isolating and debilitating problems. Psychologic counseling and emotional support must be provided as needed. The care that these patients receive must be organized, comprehensive, and correlated with these patients' lifestyles. If these children are evaluated and treated early, they have the potential to live long, healthy, and productive lives.

Effects of coffee consumption on gut recovery after surgery of gynecological cancer patients: a randomized controlled trial.

PubMed

Güngördük, Kemal; Özdemir, İsa Aykut; Güngördük, Özgü; Gülseren, Varol; Gokçü, Mehmet; Sancı, Muzaffer

2017-02-01

Paralytic ileus that develops after elective surgery is a common and uncomfortable complication and is considered inevitable after an intraperitoneal operation. The purpose of this study was to investigate whether coffee consumption accelerates the recovery of bowel function after complete staging surgery of gynecologic cancers. In this randomized controlled trial, 114 patients were allocated preoperatively to either postoperative coffee consumption with 3 times daily (n=58) or routine postoperative care without coffee consumption (n=56). Total abdominal hysterectomy and bilateral salpingo-oophorectomy with systematic pelvic and paraaortic lymphadenectomy were performed on all patients as part of complete staging surgery for endometrial, ovarian, cervical, or tubal cancer. The primary outcome measure was the time to the first passage of flatus after surgery. Secondary outcomes were the time to first defecation, time to first bowel movement, and time to tolerance of a solid diet. The mean time to flatus (30.2±8.0 vs 40.2±12.1 hours; P<.001), mean time to defecation (43.1±9.4 vs 58.5±17.0 hours; P<.001), and mean time to the ability to tolerate food (3.4±1.2 vs 4.7±1.6 days; P<.001) were reduced significantly in patients who consumed coffee compared with control subjects. Mild ileus symptoms were observed in 17 patients (30.4%) in the control group compared with 6 patients (10.3%) in the coffee group (P=.01). Coffee consumption was well-tolerated and well-accepted by patients, and no intervention-related side-effects were observed. Coffee consumption after total abdominal hysterectomy and systematic paraaortic lymphadenectomy expedites the time to bowel motility and the ability to tolerate food. This simple, cheap, and well-tolerated treatment should be added as an adjunct to the postoperative care of gynecologic oncology patients. Copyright © 2016 Elsevier Inc. All rights reserved.

Postoperative pneumatosis intestinalis (PI) and portal venous gas (PVG) may indicate bowel necrosis: a 52-case study.

PubMed

Higashizono, Kazuya; Yano, Hideaki; Miyake, Ouki; Yamasawa, Kunihiro; Hashimoto, Masanori

2016-07-08

The significance of pneumatosis intestinalis (PI) and portal venous gas (PVG) is controversial. This retrospective study evaluated the risk factors for bowel necrosis in patients with PI and/or PVG. Between 2002 and 2015, 52 patients were diagnosed with PI and/or PVG and were included in this study. The patients were classified according to the presence or absence of bowel necrosis in surgical findings or at autopsy. Patient characteristics and clinical findings related to bowel necrosis were investigated. Bowel necrosis was diagnosed in 17 (32.7 %) patients. Amongst these 17, 10 patients received salvage surgical intervention, and seven of those diagnosed with bowel necrosis survived after the operation. The remaining 35 patients received conservative treatment with or without exploratory laparotomy. Between patients with and without bowel necrosis, laboratory data revealed significant differences in the levels of C-reactive protein (P = 0.0038), creatinine (P = 0.0054), and lactate (P = 0.045); clinical findings showed differences in abdominal pain (P = 0.019) and peritoneal irritation signs (P = 0.016); computed tomography detected ascites (P = 0.011) and changes of bowel wall enhancement (P = 0.03) that were significantly higher in patients with bowel necrosis. The rate of PI and/or PVG detected in patients postoperatively was significantly higher in patients with bowel necrosis (P < 0.0001). Multivariate analysis showed that bowel necrosis was significantly more likely when PI or PVG was detected in postoperative patients than in patients who had not had surgery (P = 0.003). PI and/or PVG, alone, are not automatically indicative of bowel necrosis. However, when these conditions occur postoperatively, they indicate bowel necrosis requiring reoperation.

Steroid Exposure, Acute Coronary Syndrome, and Inflammatory Bowel Disease: Insights into the Inflammatory Milieu

PubMed Central

Deaño, Roderick C.; Basnet, Sandeep; Onandia, Zurine Galvan; Gandhi, Sachin; Tawakol, Ahmed; Min, James K.; Truong, Quynh A.

2014-01-01

Background Steroids are anti-inflammatory agents commonly used to treat inflammatory bowel disease. Inflammation plays a critical role in the pathophysiology of both inflammatory bowel disease and acute coronary syndrome. We examined the relationship between steroid use in patients with inflammatory bowel disease and acute coronary syndrome. Methods In 177 patients with inflammatory bowel disease (mean age 67, 75% male, 44% Crohn's disease, 56% ulcerative colitis), we performed a 1:2 case-control study matched for age, sex and inflammatory bowel disease type and compared 59 patients with inflammatory bowel disease with acute coronary syndrome to 118 patients with inflammatory bowel disease without acute coronary syndrome. Steroid use was defined as current or prior exposure. Acute coronary syndrome was defined as myocardial infarction or unstable angina, confirmed by cardiac biomarkers and coronary angiography. Results In patients with inflammatory bowel disease, 34% with acute coronary syndrome had exposure to steroids versus 58% without acute coronary syndrome (p<0.01). Steroid exposure reduced the adjusted odds of acute coronary syndrome by 82% (odds ratio [OR] 0.39, 95% CI 0.20-0.74; adjusted OR 0.18, 95% CI 0.06-0.51) in patients with inflammatory bowel disease, 77% in Crohn's disease (OR 0.36, 95% CI 0.14-0.92; adjusted OR 0.23, 95% CI 0.06-0.98), and 78% in ulcerative colitis (OR 0.41, 95% CI 0.16-1.04; adjusted OR 0.22, 95% CI 0.06-0.90). There was no association between other inflammatory bowel disease medications and acute coronary syndrome. Conclusions In patients with inflammatory bowel disease, steroid use significantly reduces the odds of acute coronary syndrome. These findings provide further mechanistic insight into the inflammatory processes involved in inflammatory bowel disease and acute coronary syndrome. PMID:25446295

Diagnosis and management of symptomatic hemorrhoids.

PubMed

Sneider, Erica B; Maykel, Justin A

2010-02-01

Hemorrhoidal disease is a common problem that is managed by various physicians, ranging from primary care providers to surgeons. This article reviews the pathophysiology, clinical presentation, and updated treatment of hemorrhoids, including nonoperative options, office-based procedures, and surgical interventions from standard excision to stapled hemorrhoidopexy and Doppler-guided ligation. The article also covers complications and provides guidance for special circumstances, such as pregnancy, hemorrhoidal crisis, and inflammatory bowel disease. Copyright 2010 Elsevier Inc. All rights reserved.

Effects of Early Acute Care on Autonomic Outcomes in SCI: Bedside to Bench and Back

DTIC Science & Technology

2016-10-01

Journal of Neurotrauma (Hawlryluk GWH, Whetstone W, Saigal R, Ferguson AR, Talbott JF, Bresnahan JC, Dhall SS...Other 2 Blunt Injury 26 ISS on Arrival (N=19) 29.6 (10-75) Central Cord 13 History of Hypertension 10 Hospital Stay Transport Time (N...Specific Aim 3: Determine the effects of episodes of hypotension and hypertension on the recovery of locomotor and bladder and bowel function

How does comorbidity affect cost of health care in patients with irritable bowel syndrome? A cohort study in general practice.

PubMed

Johansson, Per A; Farup, Per G; Bracco, Andrea; Vandvik, Per O

2010-03-17

Irritable bowel syndrome (IBS) is associated with other disorders (comorbidity), reduced quality of life and increased use of health resources. We aimed to explore the impact of comorbidity on cost of health care in patients with IBS in general practice. In this cohort study 208 consecutive patients with IBS (Rome II) were recruited. Sociodemographic data, IBS symptoms, and comorbidity (somatic symptoms, organic diseases and psychiatric disorders) were assessed at baseline. Based on a follow up interview after 6-9 months and use of medical records, IBS and non-IBS related health resource use were measured as consultations, hospitalisations, use of medications and alternative health care products and sick leave days. Costs were calculated by national tariffs and reported in Norwegian Kroner (NOK, 1 EURO equals 8 NOK). Multivariate analyses were performed to identify predictors of costs. A total of 164 patients (mean age 52 years, 69% female, median duration of IBS 17 years) were available at follow up, 143 patients (88%) had consulted their GP of whom 31 (19%) had consulted for IBS. Mean number of sick- leave days for IBS and comorbidity were 1.7 and 16.3 respectively (p < 0.01), costs related to IBS and comorbidity were 954 NOK and 14854 NOK respectively (p < 0.001). Age, organic diseases and somatic symptoms, but not IBS severity, were significant predictors for total costs. Costs for health resource use among patients with IBS in general practice were largely explained by comorbidity, which generated ten times the costs for IBS.

How does comorbidity affect cost of health care in patients with irritable bowel syndrome? A cohort study in general practice

PubMed Central

2010-01-01

Background Irritable bowel syndrome (IBS) is associated with other disorders (comorbidity), reduced quality of life and increased use of health resources. We aimed to explore the impact of comorbidity on cost of health care in patients with IBS in general practice. Methods In this cohort study 208 consecutive patients with IBS (Rome II) were recruited. Sociodemographic data, IBS symptoms, and comorbidity (somatic symptoms, organic diseases and psychiatric disorders) were assessed at baseline. Based on a follow up interview after 6-9 months and use of medical records, IBS and non-IBS related health resource use were measured as consultations, hospitalisations, use of medications and alternative health care products and sick leave days. Costs were calculated by national tariffs and reported in Norwegian Kroner (NOK, 1 EURO equals 8 NOK). Multivariate analyses were performed to identify predictors of costs. Results A total of 164 patients (mean age 52 years, 69% female, median duration of IBS 17 years) were available at follow up, 143 patients (88%) had consulted their GP of whom 31 (19%) had consulted for IBS. Mean number of sick- leave days for IBS and comorbidity were 1.7 and 16.3 respectively (p < 0.01), costs related to IBS and comorbidity were 954 NOK and 14854 NOK respectively (p < 0.001). Age, organic diseases and somatic symptoms, but not IBS severity, were significant predictors for total costs. Conclusion Costs for health resource use among patients with IBS in general practice were largely explained by comorbidity, which generated ten times the costs for IBS. PMID:20233451

Emerging treatments in neurogastroenterology: a multidisciplinary working group consensus statement on opioid-induced constipation

PubMed Central

CAMILLERI, M.; DROSSMAN, D. A.; BECKER, G.; WEBSTER, L. R.; DAVIES, A. N.; MAWE, G. M.

2015-01-01

Background Opioids are effective for acute and chronic pain conditions, but their use is associated with often difficult-to-manage constipation and other gastrointestinal (GI) effects due to effects on peripheral μ-opioid receptors in the gut. The mechanism of opioid-induced constipation (OIC) differs from that of functional constipation (FC), and OIC may not respond as well to most first-line treatments for FC. The impact of OIC on quality of life (QoL) induces some patients to decrease or stop their opioid therapy to relieve or avoid constipation. Purpose At a roundtable meeting on OIC, a working group developed a consensus definition for OIC diagnosis across disciplines and reviewed current OIC treatments and the potential of treatments in development. By consensus, OIC is defined as follows: ‘A change when initiating opioid therapy from baseline bowel habits that is characterized by any of the following: reduced bowel movement frequency, development or worsening of straining to pass bowel movements, a sense of incomplete rectal evacuation, or harder stool consistency’. The working group noted the prior validation of a patient response outcome and end point for clinical trials and recommended future efforts to create treatment guidelines and QoL measures specific for OIC. Details from the working group’s discussion and consensus recommendations for patient care and research are presented in this article. PMID:25164154

Pattern of irritable bowel syndrome and its impact on quality of life in primary health care center attendees, Suez governorate, Egypt

PubMed Central

Abdulmajeed, Ahmed; Rabab, Mohamed A; Sliem, Hamdy A; Hebatallah, Nour Eldein

2011-01-01

Introduction Irritable bowel syndrome (IBS) is one of the most common disorders diagnosed by gastroenterologists and a common cause of general practice visits. Although this disease is not life threatening, patients with IBS seem to be seriously affected in their everyday life. The study was designed to explore the pattern of IBS in clinical practice and the impact on the quality of life. Methods This is a case control descriptive study. 117 individuals were included in this study. Rome II criteria were used for the diagnosis of IBS. Impact of IBS on patient's quality of life was determined by irritable bowel syndrome quality of life (IBS-QOL) questionnaire. Results Prevalence of IBS among the study sample was 34.2%. 10% were IBS-Diarrhea, 37.5% were IBS-Constipation and 52.5% were alternators. There is statistical insignificant relationship between IBS (+) and age while it was a significant relation regarding gender (more common among women 80%). There is statistical significance relationship between IBS (+) on one hand and marital status and occupational status on the other hand. Patients with IBS had statistically significant lower scores for all IBS- QOL domains compared with the control group. Conclusion IBS is a prevalent disorder that affects females more than males and it has significant impacts on work, lifestyle and social well-being. PMID:22145053

Pattern of irritable bowel syndrome and its impact on quality of life in primary health care center attendees, Suez governorate, Egypt.

PubMed

Abdulmajeed, Ahmed; Rabab, Mohamed A; Sliem, Hamdy A; Hebatallah, Nour Eldein

2011-01-01

Irritable bowel syndrome (IBS) is one of the most common disorders diagnosed by gastroenterologists and a common cause of general practice visits. Although this disease is not life threatening, patients with IBS seem to be seriously affected in their everyday life. The study was designed to explore the pattern of IBS in clinical practice and the impact on the quality of life. This is a case control descriptive study. 117 individuals were included in this study. Rome II criteria were used for the diagnosis of IBS. Impact of IBS on patient's quality of life was determined by irritable bowel syndrome quality of life (IBS-QOL) questionnaire. Prevalence of IBS among the study sample was 34.2%. 10% were IBS-Diarrhea, 37.5% were IBS-Constipation and 52.5% were alternators. There is statistical insignificant relationship between IBS (+) and age while it was a significant relation regarding gender (more common among women 80%). There is statistical significance relationship between IBS (+) on one hand and marital status and occupational status on the other hand. Patients with IBS had statistically significant lower scores for all IBS- QOL domains compared with the control group. IBS is a prevalent disorder that affects females more than males and it has significant impacts on work, lifestyle and social well-being.

Large bowel resection

MedlinePlus

... blockage in the intestine due to scar tissue Colon cancer Diverticular disease (disease of the large bowel) Other reasons for bowel resection are: Familial polyposis (polyps are growths on the lining of the colon or rectum) Injuries that damage the large bowel ...

Lymphangioma of the jejunal mesentery and jejunal polyps presenting as an acute abdomen in a teenager.

PubMed

Jayasundara, Jasb; Perera, E; Chandu de Silva, M V; Pathirana, A A

2017-03-01

Cystic lymphangioma of the small bowel mesentery is a rare clinical entity, especially after childhood. Medical literature reveals a limited number of such cases presenting as acute abdomen due to bowel obstruction, small bowel volvulus and bleeding into the tumour. We present the management experience of an 18-year-old woman who presented with rapid onset diffuse peritonism and raised inflammatory markers. Computed tomography showed a mass in the small bowel mesentery with suspicion of segmental bowel ischaemia. Emergency laparotomy revealed a mass in the mid-jejunal mesentery close to the bowel wall with no bowel ischaemia. The patient made an uncomplicated recovery after segmental bowel resection and end-to-end anastomosis. Histology confirmed the mass as a cystic lymphangioma involving the jejunal mesentery and two small jejunal polyps. Lymphangioma could be considered in the differential diagnosis of an acute abdomen in a young adult when the presentation is atypical.

Volvulus of the Small Bowel and Colon

PubMed Central

Kapadia, Muneera R.

2017-01-01

Volvulus of the intestines may involve either the small bowel or colon. In the pediatric population, small bowel volvulus is more common, while in the adult population, colonic volvulus is more often seen. The two most common types of colonic volvulus include sigmoid and cecal volvulus. Prompt diagnosis and treatment is imperative, otherwise bowel ischemia may ensue. Treatment often involves emergent surgical exploration and bowel resection. PMID:28144211

Managing a patient's constipation with physical therapy.

PubMed

Harrington, Kendra L; Haskvitz, Esther M

2006-11-01

Constipation is a prevalent condition in the United States, with typical treatment consisting of diet modification, stool softeners, and laxatives. These interventions, however, are not always effective. The purpose of this case report is to describe the use of abdominal massage in physical therapist management for a patient with constipation. An 85-year-old woman with constipation was referred for physical therapy following unsuccessful treatment with stool softeners. The patient was instructed in bowel management as well as a daily, 10-minute home abdominal massage program. Upon re-examination, the patient reported a return of normal bowel frequency and function without the need to strain or use digital evacuation. Physical therapy incorporating abdominal massage appeared to be helpful in resolving this patient's constipation. Unlike medical management of constipation, no known side effects have been identified with abdominal massage.

Guidelines for Bowel Preparation before Video Capsule Endoscopy

PubMed Central

Song, Hyun Joo; Do, Jae Hyuk; Cha, In Hye; Yang, Chang Hun; Choi, Myung-Gyu; Jeen, Yoon Tae; Kim, Hyun Jung

2013-01-01

The preparation for video capsule endoscopy (VCE) of the bowel suggested by manufacturers of capsule endoscopy systems consists only of a clear liquid diet and an 8-hour fast. While there is evidence for a benefit from bowel preparation for VCE, so far there is no domestic consensus on the preparation regimen in Korea. Therefore, we performed this study to recommend guidelines for bowel preparation before VCE. The guidelines on VCE were developed by the Korean Gut Image Study Group, part of the Korean Society of Gastrointestinal Endoscopy. Four key questions were selected. According to our guidelines, bowel preparation with polyethylene glycol (PEG) solution enhances small bowel visualization quality (SBVQ) and diagnostic yield (DY), but it has no effect on cecal completion rate (CR). Bowel preparation with 2 L of PEG solution is similar to that with 4 L of PEG in terms of the SBVQ, DY, and CR of VCE. Bowel preparation with fasting or PEG solution combined with simethicone enhances the SBVQ, but it does not affect the CR of VCE. Bowel preparation with prokinetics does not enhance the SBVQ, DY, or CR of VCE. PMID:23614124

Optimizing management of Crohn's disease within a project management framework: results of a pilot study.

PubMed

Keefer, Laurie; Doerfler, Bethany; Artz, Caroline

2012-02-01

Psychotherapy for Crohn's disease (CD) has focused on patients with psychological distress. Another approach to optimize management of CD is to target patients who do not exhibit psychological distress but engage in behaviors that undermine treatment efficacy / increase risk for flare. We sought to determine the feasibility/acceptability and estimate the effects of a program framed around Project Management (PM) principles on CD outcomes. Twenty-eight adults with quiescent CD without a history of psychiatric disorder were randomized to PM (n = 16) or treatment as usual (TAU; n = 12). Baseline and follow-up measures were Inflammatory Bowel Disease Questionnaire (IBDQ), Medication Adherence Scale (MAS), Perceived Stress Questionnaire (PSQ), and IBD Self-Efficacy Scale (IBD-SES). There were significant group × time effects favoring PM on IBDQ-Total Score (F(1) = 15.2, P = 0.001), IBDQ-Bowel (F(1) = 6.5, P = 0.02), and IBDQ-Systemic (F(1) = 9.3, P = 0.007) but not IBDQ-Emotional (F(1) = 1.9, P = ns) or IBDQ-Social (F(1) = 2.4, P = ns). There was a significant interaction effect favoring PM with respect to PSQ (F(1) = 8.4, P = 0.01) and IBD-SES (F(1) = 12.2, P = 0.003). There was no immediate change in MAS (F(1) = 4.3, P = ns). Moderate effect sizes (d > 0.30) were observed for IBDQ total score (d = 0.45), IBDQ bowel health (d = 0.45), and systemic health (d = 0.37). Effect sizes for PSQ (d = 0.13) and IBDSES (d = 0.17) were smaller. Behavioral programs that appeal to patients who may not seek psychotherapy for negative health behaviors may improve quality of life and potentially disease course and outcomes. Copyright © 2011 Crohn's & Colitis Foundation of America, Inc.

Clinical utility of the AlphaFIM® instrument in stroke rehabilitation.

PubMed

Lo, Alexander; Tahair, Nicola; Sharp, Shelley; Bayley, Mark T

2012-02-01

The AlphaFIM instrument is an assessment tool designed to facilitate discharge planning of stroke patients from acute care, by extrapolating overall functional status from performance in six key Functional Independence Measure (FIM) instrument items. To determine whether acute care AlphaFIM rating is correlated to stroke rehabilitation outcomes. In this prospective observational study, data were analyzed from 891 patients referred for inpatient stroke rehabilitation through an Internet-based referral system. Simple linear and stepwise regression models determined correlations between rehabilitation-ready AlphaFIM rating and rehabilitation outcomes (admission and discharge FIM ratings, FIM gain, FIM efficiency, and length of stay). Covariates including demographic data, stroke characteristics, medical history, cognitive deficits, and activity tolerance were included in the stepwise regressions. The AlphaFIM instrument was significant in predicting admission and discharge FIM ratings at rehabilitation (adjusted R² 0.40 and 0.28, respectively; P < 0.0001) and was weakly correlated with FIM gain and length of stay (adjusted R² 0.04 and 0.09, respectively; P < 0.0001), but not FIM efficiency. AlphaFIM rating was inversely related to FIM gain. Age, bowel incontinence, left hemiparesis, and previous infarcts were negative predictors of discharge FIM rating on stepwise regression. Intact executive function and physical activity tolerance of 30 to 60 mins were predictors of FIM gain. The AlphaFIM instrument is a valuable tool for triaging stroke patients from acute care to rehabilitation and predicts functional status at discharge from rehabilitation. Patients with low AlphaFIM ratings have the potential to make significant functional gains and should not be denied admission to inpatient rehabilitation programs.

Virtual Telemedicine Visits in Pediatric Home Parenteral Nutrition Patients: A Quality Improvement Initiative.

PubMed

Raphael, Bram P; Schumann, Caitlin; Garrity-Gentille, Sara; McClelland, Jennifer; Rosa, Carolyn; Tascione, Christina; Gallotto, Mary; Takvorian-Bené, Melissa; Carey, Alexandra N; McCarthy, Patrick; Duggan, Christopher; Ozonoff, Al

2018-05-04

Despite being less costly than prolonged hospitalization, home parenteral nutrition (HPN) is associated with high rates of post-discharge complications, including frequent readmissions and central line-associated bloodstream infections (CLABSIs). Telemedicine has been associated with improved outcomes and reduced healthcare utilization in other high-risk populations, but no studies to date have supported effectiveness of telemedicine in pediatric HPN. We prospectively collected data on pediatric patients managed at a single HPN program who participated in postdischarge telemedicine visits from March 1, 2014 to March 30, 2016. We excluded patients with a history of HPN and strictly palliative care goals. Univariate analysis was performed for primary outcomes: Community-acquired CLABSI and 30-day readmission rate. Twenty-six families participated in the pilot initiative with median (interquartile range) patient age 1.5 (5.7) years old, diagnosis of short bowel syndrome in 16 (62%), and in-state residence in 17 (55%). Ishikawa (fishbone) diagram identified causes of post-discharge HPN complications. Areas of focus during telemedicine visit included central venous catheter care methods, materials, clinical concerns, and equipment. Compared to historical comparison group, the telemedicine group experienced CLABSI rates of 1.0 versus 2.7 per 1,000 line days and readmission rates of 38% versus 17% (p = 0.03, 0.02, respectively). Telemedicine visits identified opportunities for improvement for families newly discharged on HPN. In a small cohort of patients who experienced telemedicine visits, we found lower CLABSI rates alongside higher readmission rates compared with a historical comparison group. Further studies are needed to optimize telemedicine in delivering care to this high-risk population.

Oral water soluble contrast for malignant bowel obstruction.

PubMed

Syrmis, William; Richard, Russell; Jenkins-Marsh, Sue; Chia, Siew C; Good, Phillip

2018-03-07

Malignant bowel obstruction (MBO) is a common problem in patients with intra-abdominal cancer. Oral water soluble contrast (OWSC) has been shown to be useful in the management of adhesive small bowel obstruction in identifying patients who will recover with conservative management alone and also in reducing the length of hospital stay. It is not clear whether the benefits of OWSC in adhesive small bowel obstruction are also seen in patients with MBO. To determine the reliability of OWSC media and follow-up abdominal radiographs in predicting the success of conservative treatment in resolving inoperable MBO with conservative management.To determine the efficacy and safety of OWSC media in reducing the duration of obstruction and reducing hospital stay in people with MBO. We identified studies from searching Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and MEDLINE in Process, Embase, CINAHL, Science Citation Index (Web of Science) and Conference Proceedings Citation Index - Science (Web of Science). We also searched registries of clinical trials and the CareSearch Grey Literature database. The date of the search was the 6 June 2017. Randomised controlled trials (RCTs), or prospective controlled studies, that evaluated the diagnostic potential of OWSC in predicting which malignant bowel obstructions will resolve with conservative treatment.RCTs, or prospective controlled studies, that assessed the therapeutic potential of OWSC in managing MBO at any level compared with placebo, no intervention or usual treatment or supportive care. We used standard methodological procedures expected by Cochrane. We assessed risk of bias and assessed the evidence using GRADE and created a 'Summary of findings' table. We found only one RCT meeting the selection criteria for the second objective (therapeutic potential) of this review. This study recruited nine participants. It compared the use of gastrografin versus placebo in adult patients with MBO with no indication for further intervention (surgery, endoscopy) apart from standardised conservative management.The overall risk of bias for the study was high due to issues with low numbers of participants, selective reporting of outcomes and a high attrition rate for the intervention arm.Primary outcomesThe included trial was a pilot study whose primary outcome was to test the feasibility for a large study. The authors reported specifically on the number of patients screened, the number recruited and reasons for exclusion; this was not the focus of our review.Due to the low number of participants, the authors of the study decided not to report on our primary outcome of assessing the ability of OWSC to predict the likelihood of malignant small bowel obstruction resolving with conservative treatment alone (diagnostic effect). It also did not report on our primary outcome of rate of resolution of MBO in patients receiving OWSC compared with those not receiving it (therapeutic effect).The study reported that no issues regarding safety or tolerability of either gastrografin or placebo were identified. The overall quality of the evidence for the incidence of adverse events with OWSC was very low, downgraded twice for serious limitations to study quality (high risk of selective reporting and attrition bias) and downgraded once for imprecision (sparse data).Secondary outcomesThe study planned to report on this review's secondary outcome measures of length of hospital stay and time from administration of OWSC to resolution of MBO. However the authors of the study decided not to do so due to the low numbers of patients recruited. The study did not report on our secondary outcome measure of survival times from onset of inoperable MBO until death. There is insufficient evidence from RCTs to determine the place of OWSC in predicting which patients with inoperable MBO will respond with conservative treatment alone. There is also insufficient evidence from RCTs to determine the therapeutic effects and safety of OWSC in patients with malignant small bowel obstruction.

Management of faecal incontinence and constipation in adults with central neurological diseases.

PubMed

Coggrave, M; Wiesel, P H; Norton, C

2006-04-19

People with neurological disease have a much higher risk of both faecal incontinence and constipation than the general population. There is often a fine line between the two conditions, with any management intended to ameliorate one risking precipitating the other. Bowel problems are observed to be the cause of much anxiety and may reduce quality of life in these people. Current bowel management is largely empirical with a limited research base. To determine the effects of management strategies for faecal incontinence and constipation in people with neurological diseases affecting the central nervous system. We searched the Cochrane Incontinence Group Specialised Trials Register (searched 26 January 2005), the Cochrane Central Register of Controlled Trials (Issue 2, 2005), MEDLINE (January 1966 to May 2005), EMBASE (January 1998 to May 2005) and all reference lists of relevant articles. All randomised or quasi-randomised trials evaluating any types of conservative or surgical measure for the management of faecal incontinence and constipation in people with neurological diseases were selected. Specific therapies for the treatment of neurological diseases that indirectly affect bowel dysfunction were also considered. Two reviewers assessed the methodological quality of eligible trials and two reviewers independently extracted data from included trials using a range of pre-specified outcome measures. Ten trials were identified by the search strategy, most were small and of poor quality. Oral medications for constipation were the subject of four trials. Cisapride does not seem to have clinically useful effects in people with spinal cord injuries (three trials). Psyllium was associated with increased stool frequency in people with Parkinson's disease but did not alter colonic transit time (one trial). Prucalopride, an enterokinetic did not demonstrate obvious benefits in this patient group (one study). Some rectal preparations to initiate defaecation produced faster results than others (one trial). Different time schedules for administration of rectal medication may produce different bowel responses (one trial). Mechanical evacuation may be more effective than oral or rectal medication (one trial). There appears to be a benefit to patients in one-off educational interventions from nurses. The clinical significance of any of these results is difficult to interpret. There is still remarkably little research on this common and, to patients, very significant condition. It is not possible to draw any recommendation for bowel care in people with neurological diseases from the trials included in this review. Bowel management for these people must remain empirical until well-designed controlled trials with adequate numbers and clinically relevant outcome measures become available.

Impact of restless legs syndrome in patients with inflammatory bowel disease on sleep, fatigue, and quality of life.

PubMed

Schindlbeck, Katharina A; Becker, Janek; Berger, Felix; Mehl, Arne; Rewitzer, Charlotte; Geffe, Sarah; Koch, Peter M; Preiß, Jan C; Siegmund, Britta; Maul, Jochen; Marzinzik, Frank

2017-01-01

Inflammatory bowel disease has been associated with neurological symptoms including restless legs syndrome. Here, we investigated the impact of restless legs syndrome in patients with inflammatory bowel disease on sleep, fatigue, mood, cognition, and quality of life. Two groups of inflammatory bowel disease patients, with and without restless legs syndrome, were prospectively evaluated for sleep disorders, fatigue, daytime sleepiness, depression, anxiety, and health-related quality of life. Furthermore, global cognitive function, executive function, attention, and concentration were assessed in both groups. Disease activity and duration of inflammatory bowel disease as well as current medication were assessed by interview. Inflammatory bowel disease patients with and without restless legs syndrome were matched for age, education, severity, and duration of their inflammatory bowel disease. Patients with inflammatory bowel disease and clinically relevant restless leg syndrome suffered significantly more frequent from sleep disturbances including sleep latency and duration, more fatigue, and worse health-related quality of life as compared to inflammatory bowel disease patients without restless legs syndrome. Affect and cognitive function including cognitive flexibility, attention, and concentration showed no significant differences among groups, indicating to be not related to restless legs syndrome. Sleep disorders including longer sleep latency, shorter sleep duration, and fatigue are characteristic symptoms of restless legs syndrome in inflammatory bowel disease patients, resulting in worse health-related quality of life. Therefore, clinicians treating patients with inflammatory bowel disease should be alert for restless legs syndrome.

Updates in vaccination: Recommendations for adult inflammatory bowel disease patients

PubMed Central

Chaudrey, Khadija; Salvaggio, Michelle; Ahmed, Aftab; Mahmood, Sultan; Ali, Tauseef

2015-01-01

Treatment regimens for inflammatory bowel disease (IBD) incorporate the use of a variety of immunosuppressive agents that increase the risk of infections. Prevention of many of these infections can be achieved by the timely and judicious use of vaccinations. IBD patients tend to be under-immunized. Some of the contributing factors are lack of awareness regarding the significance of vaccinating IBD patients, misperception about safety of vaccinations in immunocompromised patients, ambiguity about the perceived role of the gastroenterologist in contrast to the primary care physician and unavailability of vaccination guidelines focused on IBD population. In general, immunocompetent IBD patients can be vaccinated using standard vaccination recommendations. However there are special considerations for IBD patients receiving immunosuppressive therapy, IBD travelers and pregnant women with IBD. This review discusses current vaccination recommendations with updates for adult IBD patients. Centers for Disease Control and Prevention 2013 vaccination guidelines with 2014 updates and the Advisory Committee on Immunization Practices recommendations have been highlighted as a primary source of recommendations. PMID:25805924

Pharmacological treatments and infectious diseases in pediatric inflammatory bowel disease.

PubMed

Dipasquale, Valeria; Romano, Claudio

2018-03-01

The incidence of pediatric inflammatory bowel disease (IBD) is rising, as is the employment of immunosuppressive and biological drugs. Most patients with IBD receive immunosuppressive therapies during the course of the disease. These molecules are a double-edged sword; while they can help control disease activity, they also increase the risk of infections. Therefore, it is important that pediatricians involved in primary care, pediatric gastroenterologists, and infectious disease physicians have a thorough knowledge of the infections that can affect patients with IBD. Areas covered: A broad review of the major infectious diseases that have been reported in children and adolescents with IBD was performed, and information regarding surveillance, diagnosis and management were updated. The possible correlations with IBD pharmacological tools are discussed. Expert commentary: Opportunistic infections are possible in pediatric IBD, and immunosuppressive and immunomodulator therapy seems to play a causative role. Heightened awareness and vigilant surveillance leading to prompt diagnosis and treatment are important for optimal management.

Biomarkers in inflammatory bowel disease: current practices and recent advances.

PubMed

Iskandar, Heba N; Ciorba, Matthew A

2012-04-01

Crohn's disease and ulcerative colitis represent the two main forms of the idiopathic chronic inflammatory bowel diseases (IBD). Currently available blood and stool based biomarkers provide reproducible, quantitative tools that can complement clinical assessment to aid clinicians in IBD diagnosis and management. C-reactive protein and fecal based leukocyte markers can help the clinician distinguish IBD from noninflammatory diarrhea and assess disease activity. The ability to differentiate between forms of IBD and predict risk for disease complications is specific to serologic tests including antibodies against Saccharomyces cerevisiae and perinuclear antineutrophil cytoplasmic proteins. Advances in genomic, proteomic, and metabolomic array based technologies are facilitating the development of new biomarkers for IBD. The discovery of novel biomarkers, which can correlate with mucosal healing or predict long-term disease course has the potential to significantly improve patient care. This article reviews the uses and limitations of currently available biomarkers and highlights recent advances in IBD biomarker discovery. Copyright © 2012 Mosby, Inc. All rights reserved.

Significance of screening electrocardiogram before the initiation of amitriptyline therapy in children with functional abdominal pain.

PubMed

Patra, Kamakshya P; Sankararaman, Senthilkumar; Jackson, Robert; Hussain, Sunny Z

2012-09-01

Amitriptyline (AMT) is commonly used in the management of children with irritable bowel syndrome. AMT is pro-arrhythmogenic and increases the risk of sudden cardiac death. However, there is not enough data regarding the cardiac toxicity in therapeutic doses of AMT in children and the need for screening electrocardiogram (EKG). Errors in computer EKG interpretation are not uncommon. In a risk-prevention study, the authors sought to identify the true incidence of prolonged corrected QT (QTc) interval and other arrhythmias in children with irritable bowel syndrome before the initiation of AMT. Out of the 760 EKGs screened, 3 EKGs demonstrated a true prolonged QTc after the careful manual reading by a pediatric cardiologist and they were not picked by computer-generated reading. The authors conclude that screening EKG should always be performed on children before initiating AMT therapy. Also, the computer-generated EKG needs to be verified by a pediatric cardiologist to avoid serious misinterpretations.

Using a Treat-to-Target Management Strategy to Improve the Doctor-Patient Relationship in Inflammatory Bowel Disease.

PubMed

Rubin, David T; Krugliak Cleveland, Noa

2015-09-01

The doctor-patient relationship (DPR) in inflammatory bowel disease (IBD) has been facing new challenges, in part due to the substantial progress in medical and surgical management and also due to the rapid expansion of patient access to medical information. Not surprisingly, the complexity of IBD care and heterogeneity of the disease types may lead to conflict between a physician's therapeutic recommendations and the patient's wishes. In this commentary, we propose that the so-called "treat-to-target" approach of objective targets of disease control and serial adjustments to therapies can also strengthen the DPR in IBD by enabling defined trials of alternative approaches, followed by a more objective assessment and reconsideration of treatments. We contend that such respect for patient autonomy and the use of objective markers of disease activity improves the DPR by fostering trust and both engaging and empowering patients and physicians with the information necessary to make shared decisions about therapies.

Clinical characteristics and treatment of inflammatory bowel disease: A comparison of Eastern and Western perspectives

PubMed Central

Park, Soo Jung; Kim, Won Ho; Cheon, Jae Hee

2014-01-01

Inflammatory bowel disease (IBD) is a chronic, relapsing intestinal inflammatory disorder with unidentified causes. Both environmental factors and genetic aspects are believed to be crucial to the pathogenesis of IBD. The incidence and prevalence of IBD have recently been increasing throughout Asia, presumably secondary to environmental changes. This increasing trend in IBD epidemiology necessitates specific health care planning and education in Asia. To this end, we must gain a precise understanding of the distinctive clinical and therapeutic characteristics of Asian patients with IBD. The phenotypes of IBD reportedly differ considerably between Asians and Caucasians. Thus, use of the same management strategies for these different populations may not be appropriate. Moreover, investigation of the Asian-specific clinical aspects of IBD offers the possibility of identifying causative factors in the pathogenesis of IBD in this geographical area. Accordingly, this review summarizes current knowledge of the phenotypic manifestations and management practices of patients with IBD, with a special focus on a comparison of Eastern and Western perspectives. PMID:25206259

When Your Pregnancy Echoes Your Illness: Transition to Motherhood With Inflammatory Bowel Disease.

PubMed

Ghorayeb, Jihane; Branney, Peter; Selinger, Christian P; Madill, Anna

2018-03-01

Our aim is to provide an understanding of the experience of women with inflammatory bowel disease (IBD) who have made the transition to motherhood. A total of 22 mothers with IBD were recruited from around the United Kingdom. Semi-structured interviews were conducted and analyzed using thematic analysis. The central concept- Blurred Lines-offers a novel frame for understanding the transition to motherhood with IBD through identifying parallels between having IBD and becoming, and being, a mother. Parallels clustered into three main themes: Need for Readiness, Lifestyle Changes, and Monitoring Personal and Physical Development. Hence, women with IBD are in some ways well prepared for the challenges of motherhood even though, as a group, they tend to restrict their reproductive choices. We recommend health professionals initiate conversations about reproduction early and provide a multidisciplinary approach to pregnancy and IBD in which women have confidence that their ongoing treatment will be integrated successfully with their maternity care.

Bowel resection for deep endometriosis: a systematic review.

PubMed

De Cicco, C; Corona, R; Schonman, R; Mailova, K; Ussia, A; Koninckx, Pr

2011-02-01

deep endometriosis involving the bowel often is treated by segmental bowel resection. In a recent review of over 10000 segmental bowel resections for indications other than endometriosis, low rectum resections, in particular, were associated with a high long-term complication rate for bladder, bowel and sexual function. to review systematically segmental bowel resections for endometriosis for indications, outcome and complications according to the level of resection and the volume of the nodule. all published articles on segmental bowel resection for endometriosis identified through MEDLINE, EMBASE and ISI Web of Knowledge databases during 1997-2009. the terms 'bowel', 'rectal', 'colorectal', 'rectovaginal', 'rectosigmoid', 'resection' and 'endometriosis' were used. Articles describing more than five bowel resections for endometriosis, and with details of at least three of the relevant endpoints. data did not permit a meaningful meta-analysis. thirty-four articles were found describing 1889 bowel resections. The level of bowel resection and the size of the lesions were poorly reported. The indications to perform a bowel resection were variable and were rarely described accurately. The duration of surgery varied widely and endometriosis was not always confirmed by pathology. Although not recorded prospectively, pain relief was systematically reported as excellent for the first year after surgery. Recurrence of pain was reported in 45 of 189 women; recurrence requiring reintervention occurred in 61 of 314 women. Recurrence of endometriosis was reported in 37 of 267 women. The complication rate was comparable with that of bowel resection for indications other than endometriosis. Data on sexual function were not found. after a systematic review, it was found that the indication to perform a segmental resection was poorly documented and the data did not permit an analysis of indication and outcome according to localisation or diameter of the endometriotic nodule. Segmental resections were rectum resections in over 90%, and the postoperative complication rate was comparable with that of resections for indications other than endometriosis. No data were found evaluating sexual dysfunction.

Bowel Angioedema Associated With Iodinated Contrast Media: Incidence and Predisposing Factors.

PubMed

Seo, Nieun; Chung, Yong Eun; Lim, Joon Seok; Song, Mi Kyung; Kim, Myeong-Jin; Kim, Ki Whang

2017-09-01

Bowel angioedema is an acute adverse reaction to iodinated contrast media (CM) that involves the gastrointestinal tract. We aimed to investigate the incidence and predisposing factors of iodinated CM-associated bowel angioedema during computed tomography (CT) examinations. This study was approved by our institutional review board, and informed consent was waived due to its retrospective design. From July 2013 to July 2015, adult patients with a history of adverse reactions to iodinated CM during CT (group A, n = 427) and patients without adverse reactions matched for age and sex with the propensity-score matching method (group B, n = 427) were studied. Contrast media-associated bowel angioedema was determined when bowel wall thickness increased after contrast enhancement compared with the precontrast scan. Potential predisposing factors including patient demographics, symptoms and time of adverse reactions, and CM-related factors were compared between patients with and without angioedema in group A. In addition, the incidence of bowel angioedema was compared between groups A and B. The incidence of CM-associated bowel angioedema in group A was 3.3% (14/427) in the per-patient analysis and 2.6% (15/578) in the per-examination analysis. The CM-associated bowel angioedema involved the distal duodenum and/or proximal jejunum and showed long-segmental circumferential bowel wall thickening on CT. None of the studied predisposing factors was different between patients with and without bowel angioedema (P > 0.05). The incidence of CM-associated bowel angioedema in group B was 1.9% (8/427) and 1.7% (8/458) for per-patient and per-examination analyses, respectively, and these rates were not significantly different between groups A and B (P = 0.346 and P = 0.370, respectively). The incidence of CM-associated bowel angioedema during CT was 1.7% to 3.3%, and none of the studied predisposing factors was associated with bowel angioedema.

Factors affecting poor nutritional status after small bowel resection in patients with Crohn disease.

PubMed

Jang, Ki Ung; Yu, Chang Sik; Lim, Seok-Byung; Park, In Ja; Yoon, Yong Sik; Kim, Chan Wook; Lee, Jong Lyul; Yang, Suk-Kyun; Ye, Byong Duk; Kim, Jin Cheon

2016-07-01

In Crohn disease, bowel-preserving surgery is necessary to prevent short bowel syndrome due to repeated operations. This study aimed to determine the remnant small bowel length cut-off and to evaluate the clinical factors related to nutritional status after small bowel resection in Crohn disease.We included 394 patients (69.3% male) who underwent small bowel resection for Crohn disease between 1991 and 2012. Patients who were classified as underweight (body mass index < 17.5) or at high risk of nutrition-related problems (modified nutritional risk index < 83.5) were regarded as having a poor nutritional status. Preliminary remnant small bowel length cut-offs were determined using receiver operating characteristic curves. Variables associated with poor nutritional status were assessed retrospectively using Student t tests, chi-squared tests, Fisher exact tests, and logistic regression analyses.The mean follow-up period was 52.9 months and the mean patient ages at the time of the last bowel surgery and last follow-up were 31.2 and 35.7 years, respectively. The mean remnant small bowel length was 331.8 cm. Forty-three patients (10.9%) underwent ileostomy, 309 (78.4%) underwent combined small bowel and colon resection, 111 (28.2%) had currently active disease, and 105 (26.6%) underwent at least 2 operations for recurrent disease. The mean body mass index and modified nutritional risk index were 20.6 and 100.8, respectively. The independent factors affecting underweight status were remnant small bowel length ≤240 cm (odds ratio: 4.84, P < 0.001), ileostomy (odds ratio: 4.70, P < 0.001), and currently active disease (odds ratio: 4.16, P < 0.001). The independent factors affecting high nutritional risk were remnant small bowel length ≤230 cm (odds ratio: 2.84, P = 0.012), presence of ileostomy (odds ratio: 3.36, P = 0.025), and currently active disease (odds ratio: 4.90, P < 0.001).Currently active disease, ileostomy, and remnant small bowel length ≤230 cm are risk factors affecting the poor nutritional status of patients with Crohn disease after small bowel resection.

Living with constipation—older people's experiences and strategies with constipation before and during hospitalization

PubMed Central

Munch, Lene; Tvistholm, Nina; Trosborg, Ingelise; Konradsen, Hanne

2016-01-01

Background Constipation is a common problem among older people. This study aimed to explore how older patients experience constipation and which strategies they used in handling the condition before and during hospitalization. Methods A qualitative exploratory research design was used. Fourteen semi-structured interviews were conducted with patients (61–91 years of age) during hospitalization. Data were analyzed by using content analysis. Results Themes concerning experiences were Bodily signs and symptoms of constipation; the participants described severe pain during constipation, as well as pronounced relief after bowel movements, Impact on well-being and social activities; being constipated negatively impacted their mood and limited social activities, Striving for bowel balance; the participants experienced an ongoing strive for balancing between constipation and diarrhea. Themes related to strategies were Struggling to find a solution; they were aware of different strategies to prevent and treat constipation, though the most common solution described was the use of laxatives, Wait and see; the participants were awaiting to take action until they experienced constipation symptoms, Constipation is a private problem being challenged during hospitalization; constipation was considered a private issue rarely discussed with health-care professionals. Conclusion This study illuminates the need for health-care professionals to be attentive to this issue and initiate the conversation with patients in order to advise on the management of constipation. PMID:27121271

Anal Health Care Basics

PubMed Central

Chang, Jason; McLemore, Elisabeth; Tejirian, Talar

2016-01-01

Despite the fact that countless patients suffer from anal problems, there tends to be a lack of understanding of anal health care. Unfortunately, this leads to incorrect diagnoses and treatments. When treating a patient with an anal complaint, the primary goals are to first diagnose the etiology of the symptoms correctly, then to provide an effective and appropriate treatment strategy. The first step in this process is to take an accurate history and physical examination. Specific questions include details about bowel habits, anal hygiene, and fiber supplementation. Specific components of the physical examination include an external anal examination, a digital rectal examination, and anoscopy if appropriate. Common diagnoses include pruritus ani, anal fissures, hemorrhoids, anal abscess or fistula, fecal incontinence, and anal skin tags. However, each problem presents differently and requires a different approach for management. It is of paramount importance that the correct diagnosis is reached. Common errors include an inaccurate diagnosis of hemorrhoids when other pathology is present and subsequent treatment with a steroid product, which is harmful to the anal area. Most of these problems can be avoided by improving bowel habits. Adequate fiber intake with 30 g to 40 g daily is important for many reasons, including improving the quality of stool and preventing colorectal and anal diseases. In this Special Report, we provide an overview of commonly encountered anal problems, their presentation, initial treatment options, and recommendations for referral to specialists. PMID:27723447

Fecal Microbiota Transplantation in Inflammatory Bowel Disease: A Primer for Internists.

PubMed

Syal, Gaurav; Kashani, Amir; Shih, David Q

2018-03-29

Inflammatory bowel disease consists of disorders characterized by chronic idiopathic bowel inflammation. The concept of host-gut-microbiome interaction in the pathogenesis of various complex immune-mediated chronic diseases, including inflammatory bowel disease, has recently generated immense interest. Mounting evidence confirms alteration of intestinal microflora in patients with inflammatory bowel disease. Thus, restoration of normal gut microbiota has become a focus of basic and clinical research in recent years. Fecal microbiota transplantation is being explored as one such therapeutic strategy and has shown encouraging results in the management of patients with inflammatory bowel disease. Copyright © 2018 Elsevier Inc. All rights reserved.

Efficiency of bowel preparation for capsule endoscopy examination: a meta-analysis.

PubMed

Niv, Yaron

2008-03-07

Good preparation before endoscopic procedures is essential for successful visualization. The small bowel is difficult to evaluate because of its length and complex configuration. A meta-analysis was conducted of studies comparing small bowel visualization by capsule endoscopy with and without preparation. Medical data bases were searched for all studies investigating the preparation for capsule endoscopy of the small bowel up to July 31, 2007. Studies that scored bowel cleanness and measured gastric and small bowel transit time and rate of cecum visualization were included. The primary endpoint was the quality of bowel visualization. The secondary endpoints were transit times and proportion of examinations that demonstrated the cecum, with and without preparation. Meta-analysis was performed with StatDirect Statistical software, version 2.6.1 (http://statsdirect.com). Eight studies met the inclusion criteria. Bowel visualization was scored as "good" in 78% of the examinations performed with preparation and 49% performed without (P<0.0001). There were no significant differences in transit times or in the proportion of examinations that demonstrated the cecum with and without preparation. Capsule endoscopy preparation improves the quality of small bowel visualization, but has no effect on transit times, or demonstration of the cecum.

Efficiency of bowel preparation for capsule endoscopy examination: A meta-analysis

PubMed Central

Niv, Yaron

2008-01-01

Good preparation before endoscopic procedures is essential for successful visualization. The small bowel is difficult to evaluate because of its length and complex configuration. A meta-analysis was conducted of studies comparing small bowel visualization by capsule endoscopy with and without preparation. Medical data bases were searched for all studies investigating the preparation for capsule endoscopy of the small bowel up to July 31, 2007. Studies that scored bowel cleanness and measured gastric and small bowel transit time and rate of cecum visualization were included. The primary endpoint was the quality of bowel visualization. The secondary endpoints were transit times and proportion of examinations that demonstrated the cecum, with and without preparation. Meta-analysis was performed with StatDirect Statistical software, version 2.6.1 (http://statsdirect.com). Eight studies met the inclusion criteria. Bowel visualization was scored as “good” in 78% of the examinations performed with preparation and 49% performed without (P < 0.0001). There were no significant differences in transit times or in the proportion of examinations that demonstrated the cecum with and without preparation. Capsule endoscopy preparation improves the quality of small bowel visualization, but has no effect on transit times, or demonstration of the cecum. PMID:18322940

Growth and development issues in adolescents with ostomies: a primer for the WOC nurses.

PubMed

Mohr, Lynn D

2012-01-01

Caring for the adolescent (13-18 years of age) with an ostomy presents multiple challenges. The purpose of this article is to provide strategies to assist the WOC nurse in minimizing the potential impact on growth and development for this age group with an ostomy. This is relevant to the WOC nurse since it is estimated that between 6% and 14% of all adolescents have symptoms of irritable bowel disease, and many will require an ostomy. Thus the WOC nurse will be called upon to provide care to this age group. This article discusses normal adolescent growth and development and provides strategies to support the normal growth and development.

Frequency of functional bowel disorders among healthy volunteers in Mexico City.

PubMed

Schmulson, Max; Ortíz, Orianna; Santiago-Lomeli, Mariana; Gutiérrez-Reyes, Gabriela; Gutiérrez-Ruiz, María Concepción; Robles-Díaz, Guillermo; Morgan, Douglas

2006-01-01

The frequency of functional bowel disorders (FBD) in Mexico using the Rome II criteria is unknown. The Rome II Modular Questionnaire (RII-MQ) was translated into Spanish in coordination with the Rome Committee and their Latin American program. Volunteers were recruited by advertisement in Mexico City, and administered the RII-MQ. The study population consisted of 324 healthy volunteers, with a mean age of 35.7; 66% were female. The most prevalent disorders were heartburn 35%, irritable bowel syndrome (IBS) 35%, functional bloating 21%, proctalgia fugax 21%, and functional constipation 19%. Based on gender, IBS-C was 4 times more frequent in females than males (19 vs. 4.6%) and functional bloating 3 times more frequent (10 vs. 3.7%). Differences according to occupation included a higher prevalence of ulcer-like dyspepsia (p = 0.04), IBS-C (p = 0.018) and proctalgia fugax (p = 0.034) among students. This is the first study to use RII-MQ to determine the prevalence of FBD in urban Mexico. The prevalence of IBS was significant and is related to a number of factors, including the stress of living in an overpopulated city. Selection bias is likely operative. A community-based study is warranted. Copyright 2006 S. Karger AG, Basel

Alosetron for severe diarrhea-predominant irritable bowel syndrome: safety and efficacy in perspective.

PubMed

Lewis, James H

2010-02-01

Irritable bowel syndrome affects 5-10% of North Americans, with an estimated one-third having a diarrhea-predominant form. Alosetron hydrochloride (Lotronex) is a serotonin receptor type 3 antagonist approved in early 2000 for use in women with diarrhea-predominant irritable bowel syndrome (IBS-D). Initial use was widespread, but infrequent serious adverse events of ischemic colitis and severe constipation-related complications prompted alosetron's voluntary withdrawal from the US market in November 2000. Unprecedented public request prompted its reintroduction in 2002 under a Risk Management Plan, including a more restricted indication and a Prescribing Program for Lotronex. Despite these measures, the use of alosetron has been very limited since its reintroduction. Possible deterrents to its use include concerns over safety and the possible medical-legal implications raised by the Risk Management Plan. It is also possible that changes in the natural history and/or diagnosis of IBS-D have reduced the target population. Given the unique regulatory history of alosetron, these issues continue to engender controversy. This article profiles these concerns and reviews the pharmacology, clinical efficacy and safety, and post-marketing experience with alosetron. Myths and misconceptions related to alosetron use, or lack thereof, are addressed to provide the reader with the evidence needed to make informed treatment decisions for their female patients with severe IBS-D.

Constipation in the acutely hospitalized older patients.

PubMed

Cardin, Fabrizio; Minicuci, Nadia; Droghi, Annapaola Teggia; Inelmen, Emine Meral; Sergi, Giuseppe; Terranova, Oreste

2010-01-01

The aim of this work was to establish the factors that determine the onset of constipation in acutely hospitalized older patients with a view to contributing towards an evidence-based identification of which patients warrant early, specific preventive measures. To evade the problem posed by the definition of constipation, we have considered parameters that are part of the daily routine in the hospital ward, such as the prescription of laxatives, also paying attention to how the co-operative older person subjectively interpret this condition. One thirds of the 192 hospitalized older patients needed a laxative at least once every 3 days. Multivariate analysis identified the use of laxatives at home as the only risk factor for objective constipation while in hospital (odds ratio (OR)=3.0). A significant risk of being dissatisfied with their bowel emptying emerged among patients who were bedridden for more than 2 weeks (OR=6.0), and in those who experienced cerebrovascular events (OR=3.1). The use of laxatives at home and awareness that satisfaction with bowel movements drops in patients obliged to stay in bed for lengthy periods of time and in those who have suffered cerebrovascular damage, should provide the grounds for a screening program to establish rational guidelines on bowel movement therapy. Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.

Evaluation of the axonics modulation technologies sacral neuromodulation system for the treatment of urinary and fecal dysfunction.

PubMed

Cohn, Joshua A; Kowalik, Casey G; Kaufman, Melissa R; Reynolds, W Stuart; Milam, Douglas F; Dmochowski, Roger R

2017-01-01

Sacral neuromodulation (SNM) remains one of the few effective treatments for refractory bladder and bowel dysfunction. However, SNM is associated with frequent need for surgical intervention, in many cases because of a failed battery. A rechargeable SNM system, with a manufacturer-reported battery life of 15 years or more, has entered post-market clinical testing in Europe but has not yet been approved for clinical testing in the United States. Areas covered: We review existing neuromodulation technologies for the treatment of lower urinary tract and bowel dysfunction and explore the limitations of available technology. In addition, we discuss implantation technique and device specifications and programming of the rechargeable SNM system in detail. Lastly, we present existing evidence for the use of SNM in bladder and bowel dysfunction and evaluate the anticipated trajectory of neuromodulation technologies over the next five years. Expert commentary: A rechargeable system for SNM is a welcome technological advance. However surgical revision not related to battery changes is not uncommon. Therefore, while a rechargeable system would be expected to reduce costs, it will not eliminate the ongoing maintenance associated with neuromodulation. No matter the apparent benefits, all new technologies require extensive post-market monitoring to ensure safety and efficacy.

Historical analysis of experience with small bowel capsule endoscopy in a spanish tertiary hospital.

PubMed

Egea Valenzuela, Juan; Carrilero Zaragoza, Gabriel; Iglesias Jorquera, Elena; Tomás Pujante, Paula; Alberca de Las Parras, Fernando; Carballo Álvarez, Fernando

2017-02-01

Capsule endoscopy was approved by the FDA in 2001. Gastrointestinal bleeding and inflammatory bowel disease are the main indications. It has been available in our hospital since 2004. We retrospectively analysed data from patients who underwent small bowel capsule endoscopy in our hospital from October 2004 to April 2015. Indications were divided into: Obscure gastrointestinal bleeding (occult and overt), inflammatory bowel disease, and other indications. Findings were divided into: Vascular lesions, inflammatory lesions, other lesions, normal studies, and inconclusive studies. A total of 1027 out of 1291 small bowel studies were included. Mean patient age was 56.45 years; 471 were men and 556 women. The most common lesion observed was angiectasia, as an isolated finding or associated with other lesions. Findings were significant in up to 80% of studies when the indication was gastrointestinal bleeding, but in only 50% of studies in inflammatory bowel disease. Diagnostic yield was low in the group «other indications». No major complications were reported. Small bowel capsule endoscopy has high diagnostic yield in patients with gastrointestinal bleeding, but yield is lower in patients with inflammatory bowel disease. Our experience shows that capsule endoscopy is a safe and useful tool for the diagnosis of small bowel disease. The diagnostic yield of the technique in inflammatory bowel disease must be improved. Copyright © 2016 Elsevier España, S.L.U., AEEH y AEG. All rights reserved.

Effect of Functional Status on the Quality of Bowel Preparation in Elderly Patients Undergoing Screening and Surveillance Colonoscopy

PubMed Central

Kumar, Akash; Lin, Lisa; Bernheim, Oren; Bagiella, Emilia; Jandorf, Lina; Itzkowitz, Steven H.; Shah, Brijen J.

2016-01-01

Background/Aims Optimal bowel preparation is essential for successful screening or for surveillance colonoscopy (SC). Inadequate bowel preparation is associated with older age, the male gender, and the presence of certain comorbidities. However, the association between patients’ functional status and bowel preparation quality has not been studied. We prospectively examined the relationship between functional status, namely, the ability to perform activities of daily living (ADLs) and ambulate, and the quality of bowel preparation in elderly patients undergoing SC. Methods Before undergoing SC, 88 elderly patients were surveyed regarding their functional status, specifically regarding their ability to perform ADLs and ambulate a quarter of a mile. Gastroenterologists then determined the quality of the bowel preparation, which was classified as either adequate or inadequate. Then, the frequency of inadequate bowel preparation in patients who did or did not experience difficulty performing ADLs and ambulating was calculated. Results Difficulty ambulating (unadjusted odds ratio [OR], 4.83; p<0.001), difficulty performing ADLs (OR, 2.93; p=0.001), and history of diabetes (OR, 2.88; p=0.007) were significant univariate predictors of inadequate bowel preparation. After adjusting for the above variables, only difficulty ambulating (adjusted OR, 5.78; p=0.004) was an independent predictor of inadequate bowel preparation. Conclusions Difficulty with ambulation is a strong predictor of inadequate bowel preparation in elderly patients undergoing SC. PMID:27021501

[Intimate partner violence against women and physical and mental health consequences].

PubMed

Plazaola-Castaño, Juncal; Ruiz Pérez, Isabel

2004-04-03

Intimate partner violence is currently a public health issue of great relevance. The aim of this article is to present through a literature review, the physical and psychological health problems that, beyond physical injuries, can alert health care professionals of the presence of spouse abuse in their care centers. Literature consistently shows that victims of the so called domestic violence present, compared with no victims, more chronic health problems like fibromyalgia, gastrointestinal disorders like irritable bowel syndrome, and gynaecological signs including sexually transmitted diseases, as well as post-traumatic stress disorder, anxiety and depression among others. The broad range of pathologies associated with the abuse of a sexual intimate suggests that victims will attend different health care services. These could play a key role to help these women and refer them to the appropriate legal, social and/or community services.

Psychological Treatments in Functional Gastrointestinal Disorders: A Primer for the Gastroenterologist

PubMed Central

Palsson, Olafur S.; Whitehead, William E.

2013-01-01

The functional gastrointestinal disorders (FGIDs) often show inadequate response to usual medical care. Psychological treatments can help improve FGID patient outcomes, and such treatment should be considered for patients who have moderate or severe symptoms after 3 to 6 months of medical care, and those whose symptoms are clearly exacerbated by stress or emotional symptoms. Effective psychological treatments, based on multiple randomized controlled trials, include cognitive behavioral therapy (CBT) and hypnosis for irritable bowel syndrome and pediatric functional abdominal pain; CBT for functional chest pain; and biofeedback for dyssynergic constipation in adults. Successful referral by the gastroenterologist for psychological treatment is facilitated by educating the patient about the rationale for such treatment, reassurance about the diagnosis and continuation of medical care, firm doctor-patient therapeutic alliance, and identification of, and communication with, an appropriate psychological services provider. PMID:23103907

Out-of-pocket Cost Burden in Pediatric Inflammatory Bowel Disease: A Cross-sectional Cohort Analysis.

PubMed

Sin, Aaron T; Damman, Jennifer L; Ziring, David A; Gleghorn, Elizabeth E; Garcia-Careaga, Manuel G; Gugig, Roberto R; Hunter, Anna K; Burgis, Jennifer C; Bass, Dorsey M; Park, K T

2015-06-01

Pediatric inflammatory bowel disease (IBD), consisting of Crohn's disease (CD) and ulcerative colitis (UC), can result in significant morbidity requiring frequent health care utilization. Although it is known that the overall financial impact of pediatric IBD is significant, the direct out-of-pocket (OOP) cost burden on the parents of children with IBD has not been explored. We hypothesized that affected children with a more relapsing disease course and families in lower income strata, ineligible for need-based assistance programs, disparately absorb ongoing financial stress. We completed a cross-sectional analysis among parents of children with IBD residing in California using an online HIPAA-secure Qualtrics survey. Multicenter recruitment occurred between December 4, 2013 and September 18, 2014 at the point-of-care from site investigators, informational flyers distributed at regional CCFA conferences, and social media campaigns equally targeting Northern, Central, and Southern California. IBD-, patient-, and family-specific information were collected from the parents of pediatric patients with IBD patients younger than 18 years of age at time of study, carry a confirmed diagnosis of CD or UC, reside in and receive pediatric gastroenterology care in California, and do not have other chronic diseases requiring ongoing medical care. We collected 150 unique surveys from parents of children with IBD (67 CD; 83 UC). The median patient age was 14 years for both CD and UC, with an overall 3.7 years (SD 2.8 yr) difference between survey completion and time of IBD diagnosis. Annually, 63.6%, 28.6%, and 5.3% of families had an OOP cost burden >$500, >$1000, and >5000, respectively. Approximately one-third (36.0%) of patients had emergency department (ED) visits over the past year, with 59.2% of these patients spending >$500 on emergency department copays, including 11.1% who spent >$5000. Although 43.3% contributed <$500 on procedure and test costs, 20.0% spent >$2000 in the past year. Families with household income between $50,000 and $100,000 had a statistically significant probability (80.6%) of higher annual OOP costs than families with lower income <$50,000 (20.0%; P < 0.0001) or higher income >$100,000 (64.6%; P < 0.05). Multivariate analysis revealed that clinical variables associated with uncontrolled IBD states correlated to higher OOP cost burden. Annual OOP costs were more likely to be >$500 among patients who had increased spending on procedures and tests (odds ratio [OR], 5.63; 95% confidence interval [CI], 2.73-11.63), prednisone course required over the past year (OR, 3.19; 95% CI, 1.02-9.92), at least 1 emergency department visit for IBD symptoms (OR, 2.84; 95% CI, 1.33-6.06), at least 4 or more outpatient primary medical doctor visits for IBD symptoms (OR, 2.82; 95% CI, 1.40-5.68), and history of 4 or more lifetime hospitalizations for acute IBD care (OR, 2.60; 95% CI, 1.13-5.96). Previously undocumented, a high proportion of pediatric IBD families incur substantial OOP cost burden. Patients who are frequently in relapsing and uncontrolled IBD states require more acute care services and sustain higher OOP cost burden. Lower middle income parents of children with IBD ineligible for need-based assistance may be particularly at risk for financial stress from OOP costs related to ongoing medical care.

Tumour necrosis factor-alpha (-308G/A) promoter polymorphism is associated with ulcerative colitis in Brazilian patients.

PubMed

Tavares, M; de Lima, C; Fernandes, W; Martinelli, V; de Lucena, M; Lima, F; Telles, A; Brandão, L; de Melo Júnior, M

2016-12-01

Inflammatory bowel disease consists of multifactorial diseases whose common manifestation is inflammation of the gastrointestinal tract and their pathogenesis remains unknown. This study aimed to analyse the gene polymorphisms in Brazilian patients with inflammatory bowel disease. A total of 101 patients diagnosed with inflammatory bowel disease were analysed for the tumour necrosis factor-alpha (-308 G/A; rs1800629) and interleukin-10 (-1082 G/A; rs1800896) gene polymorphisms. Genotyping was performed through polymerase chain reaction-sequence-specific primer, then fractionated on 2% agarose gel and visualized after staining by ethidium bromide. The anatomic-clinical form of Crohn's disease (CD) predominant was the inflammatory (32.75%), followed by fistulizing (29.31%) and 27.58% stricturing. As control group, a total of 136 healthy subjects, from the same geographical region, were enrolled. The statistical analyses were performed using R program. The frequency of the A allele at tumour necrosis factor-alpha was high in ulcerative colitis (UC) patients (51%) than in controls (22%; P > 0.01). No statistical difference was found with the genotypic and allelic frequencies of CD patients compared to controls (P = 0.54). The polymorphism -1082G/A of interleukin-10 was not statistical different between the diseases compared to controls. Tumour necrosis factor-alpha (TNF-α) (-308G/A) is associated with UC onset, suggesting that the presence of -308A allele could confer a relative risk of 3.62 more to develop UC in general population. Further studies, increasing the number of individuals, should be performed to ratify the role of TNF-α in the inflammatory bowel disease pathogenesis. © 2016 John Wiley & Sons Ltd.

Bowel-associated dermatosis - arthritis syndrome in a patient with ulcerative colitis: an extraintestinal manifestation of inflammatory bowel disease.

PubMed

DeFilippis, Ersilia M; Magro, Cynthia; Jorizzo, Joseph L

2014-10-01

Bowel-associated dermatosis - arthritis syndrome (BADAS) is a neutrophilic dermatosis characterized by cutaneous lesions that begin as erythematous macules and progress to vesiculopustular eruptions. It has been described in patients with inflammatory bowel disease as well as those who have undergone various intestinal surgeries. Pathologically, the lesions show features of vasculitis without fibrinoid necrosis. In a patient with diagnosed inflammatory bowel disease, these neutrophilic dermatoses should be viewed as external signals of bowel inflammation. Management requires long-term treatment of the underlying disease. We report a case of BADAS in a patient with ulcerative colitis in which the skin lesions were associated with increased colonic inflammation.

Idiopathic small bowel diaphragm disease identified by laparoscopic-assisted double-balloon enteroscopy in a child: an integrated successful definitive therapeutic method.

PubMed

Soccorso, Giampiero; Sarkhy, Ahmed; Lindley, Richard M; Marven, Sean S; Thomson, Mike

2012-08-01

In adults, small bowel diaphragm disease is a rare complication of small bowel enteropathy secondary to the use of nonsteroidal antiinflammatory drugs. The main clinical manifestations are gastrointestinal bleeding and subacute obstruction, and management can be challenging. We present a case of a 5-year-old girl with small bowel diaphragm disease. To our knowledge, this is the first idiopathic case (no history of nonsteroidal antiinflammatory drug use) in the pediatric age group. This report describes an integrated successful definitive therapeutic method of double-balloon enteroscopy and minimal invasive bowel surgery for small bowel pathology. Copyright © 2012 Elsevier Inc. All rights reserved.

Inflammatory Bowel Disease in Primary Immunodeficiencies.

PubMed

Kelsen, Judith R; Sullivan, Kathleen E

2017-08-01

Inflammatory bowel disease is most often a polygenic disorder with contributions from the intestinal microbiome, defects in barrier function, and dysregulated host responses to microbial stimulation. There is, however, increasing recognition of single gene defects that underlie a subset of patients with inflammatory bowel disease, particularly those with early-onset disease, and this review focuses on the primary immunodeficiencies associated with early-onset inflammatory bowel disease. The advent of next-generation sequencing has led to an improved recognition of single gene defects underlying some cases of inflammatory bowel disease. Among single gene defects, immune response genes are the most frequent category identified. This is also true of common genetic variants associated with inflammatory bowel disease, supporting a pivotal role for host responses in the pathogenesis. This review focuses on practical aspects related to diagnosis and management of children with inflammatory bowel disease who have underlying primary immunodeficiencies.

Urinary excretion of orally ingested gastrografin on CT.

PubMed

Apter, S; Gayer, G; Amitai, M; Hertz, M

1998-01-01

Renal excretion of orally ingested gastrografin has rarely been reported on computed tomography (CT). We studied the unenhanced scans of 82 patients with bowel disorders or perforation to assess the prevalence of urinary contrast material (CM) in various bowel diseases. We also assessed the clinical significance of this sign. In addition, we reviewed the unenhanced CT scans of 100 randomly selected patients without bowel diseases as a control group. Twenty-nine of the 58 patients with bowel diseases, six of nine with free perforation, and one of 15 with covered perforation had CM in the urinary tract. None of the 100 without bowel disease showed urinary CM. Statistical analysis was done by using the Fisher's exact test. The prevalence of urinary CM was highest in inflammatory bowel disease, radiation enteritis, and free perforation (p < 0. 0001). This study shows that the CT finding of orally ingested gastrografin in the urinary tract differentiates patients with bowel disease from those without.

[A Feasibility Study of closing the small bowel with high-frequency welding device].

PubMed

Zhou, Huabin; Han, Shuai; Chen, Jun; Huang, Dequn; Peng, Liang; Ning, Jingxuan; Li, Zhou

2014-12-01

This study aimed to evaluate the feasibility and effectiveness of closing the small bowel in an ex vivo porcine model with high-frequency welding device. A total of 100 porcine small bowels were divided into two groups, and then were closed with two different methods. The fifty small bowels in experimental group were closed by the high-frequency welding device, and the other fifty small bowels in comparison group were hand-sutured. All the small bowels were subjected to leak pressure testing later on. The speed of closure and bursting pressure were compared. The 50 porcine small bowels closed by the high-frequency welding device showed a success rate of 100%. Compared with the hand-sutured group, the bursting pressures of the former were significantly lower (P<0.01) and the closing process was significantly shorter (P<0.01). The pathological changes of the closed ends mainly presented as acute thermal and pressure induced injury. Experimental results show that the high-frequency welding device has higher feasibility in closing the small bowel.

An unusual white blood cell scan in a child with inflammatory bowel disease: a case report.

PubMed

Porn, U; Howman-Giles, R; O'Loughlin, E; Uren, R; Chaitow, J

2000-10-01

Technetium-99m-labeled leukocyte (WBC) imaging is a valuable screening method for inflammatory bowel disease, especially in children, because of its high rate of sensitivity, low cost, and ease of preparation. A 14-year-old girl is described who had juvenile arthritis and iritis complicated by inflammatory bowel disease. She was examined for recurrent abdominal pain. A Tc-99m stannous colloid WBC scan was performed, and tracer accumulation was seen in the small bowel in the region of the distal ileum on the initial 1-hour image. Delayed imaging at 3 hours also revealed tracer accumulation in the cecum and ascending colon, which was not seen on the early image. A biopsy of the colon during endoscopy showed no evidence of active inflammation in the colon. The small bowel was not seen. Computed tomography revealed changes suggestive of inflammatory bowel disease in the distal ileum. The appearance on the WBC study was most likely a result of inflammatory bowel disease involving the distal ileum, with transit of luminal activity into the large bowel.

Efficacy of bowel cancer appeals for promoting physical activity.

PubMed

Jalleh, Geoffrey; Donovan, Robert J; Slevin, Terry; Dixon, Helen

2005-08-01

To investigate the potential efficacy of bowel cancer prevention messages in increasing intentions to be more physically active. A convenience sample of 281 physically inactive persons aged 30-60 years was recruited in the Perth city centre and randomly assigned to a bowel cancer and physical activity message or a heart disease and physical activity message. After reading a booklet containing information about physical activity and its link either to bowel cancer (n = 141) or cardiovascular disease (n = 140), respondents filled in a self-completion questionnaire. The main response measures were impact on intentions to be more physically active, and perceived believability and relevance of the message. Perceived believability of the message was high in both conditions. Perceived personal relevance of the message was substantially lower in the bowel cancer than the cardiovascular disease condition. Overall, the cardiovascular disease condition achieved somewhat higher behavioural intentions than the bowel cancer condition. The finding that two in three respondents in the bowel cancer condition had increased intention to increase their level of physical activity provides support for the potential efficacy of promoting physical activity in reducing the risk of bowel cancer.

Women's experiences and health care-seeking practices in relation to uterine prolapse in a hill district of Nepal.

PubMed

Shrestha, Binjwala; Onta, Sharad; Choulagai, Bishnu; Poudyal, Amod; Pahari, Durga Prasad; Uprety, Aruna; Petzold, Max; Krettek, Alexandra

2014-02-03

Although uterine prolapse (UP) occurs commonly in Nepal, little is known about the physical health and care-seeking practices of women with UP. This study aimed to explore women's experiences of UP and its effect on daily life, its perceived causes, and health care-seeking practices. Using a convenience sampling method, we conducted 115 semi-structured and 16 in-depth interviews with UP-affected women during September-December 2012. All interviews occurred in outreach clinics in villages of the Dhading district. Study participants were 23-82 years of age. Twenty-four percent were literate, 47.2% had experienced a teenage pregnancy, and 29% had autonomy to make healthcare decisions. Most participants (>85%) described the major physical discomforts of UP as difficulty with walking, standing, working, sitting, and lifting. They also reported urinary incontinence (68%) bowel symptoms (42%), and difficulty with sexual activity (73.9%). Due to inability to perform household chores or fulfill their husband's sexual desires, participants endured humiliation, harassment, and torture by their husbands and other family members, causing severe emotional stress. Following disclosure of UP, 24% of spouses remarried and 6% separated from the marital relationship. Women perceived the causes of UP as unsafe childbirth, heavy work during the postpartum period, and gender discrimination. Prior to visiting these camps some women (42%) hid UP for more than 10 years. Almost half (48%) of participants sought no health care; 42% ingested a herb and ate nutritious food. Perceived barriers to accessing health care included shame (48%) and feeling that care was unnecessary (12.5%). Multiple responses (29%) included shame, inability to share, male service provider, fear of stigma and discrimination, and perceiving UP as normal for childbearing women. UP adversely affects women's daily life and negatively influences their physical, mental, and social well-being. The results of our study are useful to generate information on UP symptoms and female health care seeking practices. Our findings can be helpful for effective development of UP awareness programs to increase service utilization at early stages of UP and thereby might contribute to both primary and secondary prevention of UP.

Recurrent intestinal volvulus in midgut malrotation causing acute bowel obstruction: A case report

PubMed Central

Sheikh, Fayed; Balarajah, Vickna; Ayantunde, Abraham Abiodun

2013-01-01

Intestinal malrotation occurs when there is a disruption in the normal embryological development of the bowel. The majority of patients present with clinical features in childhood, though rarely a first presentation can take place in adulthood. Recurrent bowel obstruction in patients with previous abdominal operation for midgut malrotation is mostly due to adhesions but very few reported cases have been due to recurrent volvulus. We present the case of a 22-year-old gentleman who had laparotomy in childhood for small bowel volvulus and then presented with acute bowel obstruction. Preoperative computerised tomography scan showed small bowel obstruction and features in keeping with midgut malrotation. Emergency laparotomy findings confirmed midgut malrotation with absent appendix, abnormal location of caecum, ascending colon and small bowel. In addition, there were small bowel volvulus and a segment of terminal ileal stricture. Limited right hemicolectomy was performed with excellent postoperative recovery. This case is presented to illustrate a rare occurrence and raise an awareness of the possibility of dreadful recurrent volvulus even several years following an initial Ladd’s procedure for midgut malrotation. Therefore, one will need to exercise a high index of suspicion and this becomes very crucial in order to ensure prompt surgical intervention and thereby preventing an attendant bowel ischaemia with its associated high fatality. PMID:23556060

Recurrent intestinal volvulus in midgut malrotation causing acute bowel obstruction: A case report.

PubMed

Sheikh, Fayed; Balarajah, Vickna; Ayantunde, Abraham Abiodun

2013-03-27

Intestinal malrotation occurs when there is a disruption in the normal embryological development of the bowel. The majority of patients present with clinical features in childhood, though rarely a first presentation can take place in adulthood. Recurrent bowel obstruction in patients with previous abdominal operation for midgut malrotation is mostly due to adhesions but very few reported cases have been due to recurrent volvulus. We present the case of a 22-year-old gentleman who had laparotomy in childhood for small bowel volvulus and then presented with acute bowel obstruction. Preoperative computerised tomography scan showed small bowel obstruction and features in keeping with midgut malrotation. Emergency laparotomy findings confirmed midgut malrotation with absent appendix, abnormal location of caecum, ascending colon and small bowel. In addition, there were small bowel volvulus and a segment of terminal ileal stricture. Limited right hemicolectomy was performed with excellent postoperative recovery. This case is presented to illustrate a rare occurrence and raise an awareness of the possibility of dreadful recurrent volvulus even several years following an initial Ladd's procedure for midgut malrotation. Therefore, one will need to exercise a high index of suspicion and this becomes very crucial in order to ensure prompt surgical intervention and thereby preventing an attendant bowel ischaemia with its associated high fatality.

The value of X-ray digital tomosynthesis in the diagnosis of urinary calculi

PubMed Central

Liu, Shifeng; Wang, Hong; Feng, Weihua; Hu, Xiaokun; Guo, Jian; Shang, Qingjun; Li, Zixiang; Yu, Hongsheng

2018-01-01

Urinary calculus is a common and recurrent condition that affects kidney function. The present study evaluated the use of digital tomosynthesis (DTS) and Kidneys-Ureters-Bladder (KUB) radiography as methods of diagnosing urinary calculi. Unenhanced multidetector computed tomography (UMDCT) was used in the diagnosis of calculi. KUB radiography and DTS procedures were conducted on patients prior to and following bowel preparation to detect kidney, ureteral and bladder calculi. Differences in diagnostic performance of KUB radiography and DTS imaging on prepared and unprepared bowel were evaluated using the χ2 test. The consistency of diagnostic results between two examining physicians was analyzed using the κ test. A total of 138 calculi from 80 patients were detected via UMDCT. The calculi detection rates of KUB prior to and following bowel preparation were 47.8 and 66.7% respectively, and the calculi detection rate of DTS prior to and following bowel preparation were 94.2 and 96.4%, respectively. The detection rates of calculi >5 mm via KUB prior to and following bowel preparation were 56.6 and 73.5% respectively, and in DTS they were 100% prior to and following bowel preparation. Economically, DTS performed on the unprepared bowel was the most cost effective, followed by DTS on the prepared bowel, KUB on the unprepared bowel and KUB on the prepared bowel. Therefore, the current study concluded that DTS may be an appropriate first-line imaging technique in patients with urinary calculi. PMID:29434761

The value of X-ray digital tomosynthesis in the diagnosis of urinary calculi.

PubMed

Liu, Shifeng; Wang, Hong; Feng, Weihua; Hu, Xiaokun; Guo, Jian; Shang, Qingjun; Li, Zixiang; Yu, Hongsheng

2018-02-01

Urinary calculus is a common and recurrent condition that affects kidney function. The present study evaluated the use of digital tomosynthesis (DTS) and Kidneys-Ureters-Bladder (KUB) radiography as methods of diagnosing urinary calculi. Unenhanced multidetector computed tomography (UMDCT) was used in the diagnosis of calculi. KUB radiography and DTS procedures were conducted on patients prior to and following bowel preparation to detect kidney, ureteral and bladder calculi. Differences in diagnostic performance of KUB radiography and DTS imaging on prepared and unprepared bowel were evaluated using the χ 2 test. The consistency of diagnostic results between two examining physicians was analyzed using the κ test. A total of 138 calculi from 80 patients were detected via UMDCT. The calculi detection rates of KUB prior to and following bowel preparation were 47.8 and 66.7% respectively, and the calculi detection rate of DTS prior to and following bowel preparation were 94.2 and 96.4%, respectively. The detection rates of calculi >5 mm via KUB prior to and following bowel preparation were 56.6 and 73.5% respectively, and in DTS they were 100% prior to and following bowel preparation. Economically, DTS performed on the unprepared bowel was the most cost effective, followed by DTS on the prepared bowel, KUB on the unprepared bowel and KUB on the prepared bowel. Therefore, the current study concluded that DTS may be an appropriate first-line imaging technique in patients with urinary calculi.

MRI of the small bowel: can sufficient bowel distension be achieved with small volumes of oral contrast?

PubMed

Kinner, Sonja; Kuehle, Christiane A; Herbig, Sebastian; Haag, Sebastian; Ladd, Susanne C; Barkhausen, Joerg; Lauenstein, Thomas C

2008-11-01

Sufficient luminal distension is mandatory for small bowel imaging. However, patients often are unable to ingest volumes of currently applied oral contrast compounds. The aim of this study was to evaluate if administration of low doses of an oral contrast agent with high-osmolarity leads to sufficient and diagnostic bowel distension. Six healthy volunteers ingested at different occasions 150, 300 and 450 ml of a commercially available oral contrast agent (Banana Smoothie Readi-Cat, E-Z-EM; 194 mOsmol/l). Two-dimensional TrueFISP data sets were acquired in 5-min intervals up to 45 min after contrast ingestion. Small bowel distension was quantified using a visual five-grade ranking (5 = very good distension, 1 = collapsed bowel). Results were statistically compared using a Wilcoxon-Rank test. Ingestion of 450 ml and 300 ml resulted in a significantly better distension than 150 ml. The all-over average distension value for 450 ml amounted to 3.4 (300 ml: 3.0, 150 ml: 2.3) and diagnostic bowel distension could be found throughout the small intestine. Even 45 min after ingestion of 450 ml the jejunum and ileum could be reliably analyzed. Small bowel imaging with low doses of contrast leads to diagnostic distension values in healthy subjects when a high-osmolarity substance is applied. These findings may help to further refine small bowel MRI techniques, but need to be confirmed in patients with small bowel disorders.

Small bowel preparations for capsule endoscopy with mannitol and simethicone: a prospective, randomized, clinical trial.

PubMed

Chen, Hong-bin; Huang, Yue; Chen, Su-yu; Song, Hui-wen; Li, Xiao-lin; Dai, Dong-lin; Xie, Jia-tia; He, Song; Zhao, Yuan-yuan; Huang, Chun; Zhang, Sheng-jun; Yang, Lin-na

2011-04-01

There is no consensus concerning small bowel preparation before capsule endoscopy (CE). This study evaluated the effects of 4 regimens on small bowel cleansing and diagnostic yield. Patients were randomly divided into 4 groups. Group A consumed a clear liquid diet after lunch on the day before CE, followed by overnight fasting. Group B took 250 mL 20% mannitol and 1 L 0.9% saline orally at 05:00 hours on the day of the procedure. In group C, the same regimen was taken at 20:00 hours on the day before and at 05:00 hours on the day of CE. In group D, in addition to the group C regimen, 20 mL oral simethicone was taken 30 minutes before CE. Two hundred patients were prospectively enrolled, and 7 were excluded from the final analysis because of incomplete small bowel transit. No significant difference was noted among the 4 groups for small bowel transit time. Bowel preparation in group D was significantly better than for the other regimens for overall cleansing of the proximal small bowel, and showed improved overall cleansing of the distal small bowel when compared with 10-hours overnight fasting. Pathological lesions of the proximal and distal small bowel were, respectively, achieved in 82 and 74 patients, mostly distributed in group D. Small bowel preparation that involves split-dose oral mannitol plus single-dose simethicone for CE can improve mucosal visualization and subsequent diagnostic yield when compared with 10-hours overnight fasting.

Impact of mechanical bowel preparation in elective colorectal surgery: A meta-analysis.

PubMed

Rollins, Katie E; Javanmard-Emamghissi, Hannah; Lobo, Dileep N

2018-01-28

To analyse the effect of mechanical bowel preparation vs no mechanical bowel preparation on outcome in patients undergoing elective colorectal surgery. Meta-analysis of randomised controlled trials and observational studies comparing adult patients receiving mechanical bowel preparation with those receiving no mechanical bowel preparation, subdivided into those receiving a single rectal enema and those who received no preparation at all prior to elective colorectal surgery. A total of 36 studies (23 randomised controlled trials and 13 observational studies) including 21568 patients undergoing elective colorectal surgery were included. When all studies were considered, mechanical bowel preparation was not associated with any significant difference in anastomotic leak rates (OR = 0.90, 95%CI: 0.74 to 1.10, P = 0.32), surgical site infection (OR = 0.99, 95%CI: 0.80 to 1.24, P = 0.96), intra-abdominal collection (OR = 0.86, 95%CI: 0.63 to 1.17, P = 0.34), mortality (OR = 0.85, 95%CI: 0.57 to 1.27, P = 0.43), reoperation (OR = 0.91, 95%CI: 0.75 to 1.12, P = 0.38) or hospital length of stay (overall mean difference 0.11 d, 95%CI: -0.51 to 0.73, P = 0.72), when compared with no mechanical bowel preparation, nor when evidence from just randomized controlled trials was analysed. A sub-analysis of mechanical bowel preparation vs absolutely no preparation or a single rectal enema similarly revealed no differences in clinical outcome measures. In the most comprehensive meta-analysis of mechanical bowel preparation in elective colorectal surgery to date, this study has suggested that the use of mechanical bowel preparation does not affect the incidence of postoperative complications when compared with no preparation. Hence, mechanical bowel preparation should not be administered routinely prior to elective colorectal surgery.

Patients' experiences of healthcare encounters in severe irritable bowel syndrome: an analysis based on narrative and feminist theory.

PubMed

Björkman, Ida; Simrén, Magnus; Ringström, Gisela; Jakobsson Ung, Eva

2016-10-01

This study aimed to explore patients' experiences of healthcare encounters in severe irritable bowel syndrome. Irritable bowel syndrome is a common functional disorder with symptoms such as abdominal pain and disturbed bowel habits, the cause of which is not completely known. Treatments options are limited, and healthcare encounters in irritable bowel syndrome have been described as unsatisfying and frustrating for both patients and professional healthcare providers. Furthermore, the influence of power on healthcare encounters has long been recognised, especially regarding the disadvantaged position of those suffering from functional illness which cannot be identified by commonly used tests or investigations. We interviewed 10 patients during 2014, all attending an outpatient clinic and suffering from severe irritable bowel syndrome. Relying on narrative and feminist theory, we explored how they actively negotiate professional discourse communicated to them in the clinical encounter. The patients' experiences of healthcare encounters in irritable bowel syndrome were mostly described as negative, and often induced feelings of confusion and self-doubt. Positive encounters were described as being listened to, believed and taken seriously. Narrators found it especially problematic when healthcare professionals described irritable bowel syndrome as a minor disorder with primarily stress or psychological aetiology and put the responsibility for recovery onto the patient. Patients' actively negotiated such professional discourse by presenting a counternarrative describing their own suffering and strengths, experienced healthcare shortcomings and possible organic aetiology of irritable bowel syndrome. Patients suffering from severe irritable bowel syndrome described how they often felt a need to protect their positive identities in the face of trivialisation and disbelief by healthcare professionals. A deepened understanding of patients' experiences of healthcare encounters in irritable bowel syndrome could enable more helpful and supporting interventions by healthcare professionals. © 2016 John Wiley & Sons Ltd.

Small Bowel Dose Parameters Predicting Grade ≥3 Acute Toxicity in Rectal Cancer Patients Treated With Neoadjuvant Chemoradiation: An Independent Validation Study Comparing Peritoneal Space Versus Small Bowel Loop Contouring Techniques

DOE Office of Scientific and Technical Information (OSTI.GOV)

Banerjee, Robyn, E-mail: robynbanerjee@gmail.com; Chakraborty, Santam; Nygren, Ian

Purpose: To determine whether volumes based on contours of the peritoneal space can be used instead of individual small bowel loops to predict for grade ≥3 acute small bowel toxicity in patients with rectal cancer treated with neoadjuvant chemoradiation therapy. Methods and Materials: A standardized contouring method was developed for the peritoneal space and retrospectively applied to the radiation treatment plans of 67 patients treated with neoadjuvant chemoradiation therapy for rectal cancer. Dose-volume histogram (DVH) data were extracted and analyzed against patient toxicity. Receiver operating characteristic analysis and logistic regression were carried out for both contouring methods. Results: Grade ≥3more » small bowel toxicity occurred in 16% (11/67) of patients in the study. A highly significant dose-volume relationship between small bowel irradiation and acute small bowel toxicity was supported by the use of both small bowel loop and peritoneal space contouring techniques. Receiver operating characteristic analysis demonstrated that, for both contouring methods, the greatest sensitivity for predicting toxicity was associated with the volume receiving between 15 and 25 Gy. Conclusion: DVH analysis of peritoneal space volumes accurately predicts grade ≥3 small bowel toxicity in patients with rectal cancer receiving neoadjuvant chemoradiation therapy, suggesting that the contours of the peritoneal space provide a reasonable surrogate for the contours of individual small bowel loops. The study finds that a small bowel V15 less than 275 cc and a peritoneal space V15 less than 830 cc are associated with a less than 10% risk of grade ≥3 acute toxicity.« less

Predictors of Bowel Function in Long-term Rectal Cancer Survivors with Anastomosis.

PubMed

Alavi, Mubarika; Wendel, Christopher S; Krouse, Robert S; Temple, Larissa; Hornbrook, Mark C; Bulkley, Joanna E; McMullen, Carmit K; Grant, Marcia; Herrinton, Lisa J

2017-11-01

Bowel function in long-term rectal cancer survivors with anastomosis has not been characterized adequately. We hypothesized that bowel function is associated with patient, disease, and treatment characteristics. The cohort study included Kaiser Permanente members who were long-term (≥5 years) rectal cancer survivors with anastomosis. Bowel function was scored using the self-administered, 14-item Memorial Sloan-Kettering Cancer Center Bowel Function Index. Patient, cancer, and treatment variables were collected from the electronic medical chart. We used multiple regression to assess the relationship of patient- and treatment-related variables with the bowel function score. The study included 381 anastomosis patients surveyed an average 12 years after their rectal cancer surgeries. The total bowel function score averaged 53 (standard deviation, 9; range, 31-70, higher scores represent better function). Independent factors associated with worse total bowel function score included receipt of radiation therapy (yes vs. no: 5.3-unit decrement, p < 0.0001), tumor distance from the anal verge (≤6 cm vs. >6 cm: 3.2-unit decrement, p < 0.01), and history of a temporary ostomy (yes vs. no: 4.0-unit decrement, p < 0.01). One factor measured at time of survey was also associated with worse total bowel function score: ever smoking (2.3-unit decrement, p < 0.05). The regression model explained 20% of the variation in the total bowel function score. Low tumor location, radiation therapy, temporary ostomy during initial treatment, and history of smoking were linked with decreased long-term bowel function following an anastomosis. These results should improve decision-making about surgical options.

Interdisciplinary rehabilitation for a patient with incomplete cervical spinal cord injury and multimorbidity: A case report.

PubMed

Vining, Robert D; Gosselin, Donna M; Thurmond, Jeb; Case, Kimberlee; Bruch, Frederick R

2017-08-01

This report describes interdisciplinary rehabilitation for a 51-year-old male recovering from incomplete cervical spinal cord injury (SCI) and multiple comorbidities following an automobile accident. The patient was admitted to a rehabilitation specialty hospital approximately 2 months post SCI and 2 separate surgical fusion procedures (C3-C6). Clinical presentation at the rehabilitation hospital included moderate to severe motor strength loss in both upper and lower extremities, a percutaneous endoscopic gastronomy tube (PEG), dysphagia, bowel/bladder incontinence, dependence on a mechanical lift and tilting wheelchair due to severe orthostatic hypotension, and pre-existing shoulder pain from bilateral joint degeneration. The interdisciplinary team formally coordinated rehabilitative care from multiple disciplines. Internal medicine managed medications, determined PEG removal, monitored co-morbid conditions, and overall progress. Chiropractic care focused on alleviating shoulder and thoracic pain and improving spinal and extremity mobility. Physical therapy addressed upright tolerance, transfer, gait, and strength training. Occupational therapy focused on hand coordination and feeding/dressing activities. Psychology assisted with coping strategies. Nursing ensured medication adherence, nutrient intake, wound prevention, and incontinence management, whereas physiatry addressed abnormal muscle tone. Eleven months post-admission the patient's progress allowed discharge to a long-term care facility. At this time he was without dysphagia or need for a PEG. Orthostatic hypotension and bilateral shoulder pain symptoms were also resolved while bowel/bladder incontinence and upper and lower extremity motor strength loss remained. He was largely independent in transferring from bed to wheelchair and in upper body dressing. Lower body dressing/bathing required maximal assistance. Gait with a 2-wheeled walker was possible up to 150 feet with verbal cues and occasional stabilizing assistance. Several specialties functioning within an interdisciplinary team fulfilled complementary roles to support rehabilitation for a patient with SCI.