Microsoft word - ibs_info.doc
How do functional bowel disorders differ
from other bowel diseases?
PATIENT GUIDE TO
With functional bowel disorders the bowels look normal - it's the way they work which is disordered.
THE IRRITABLE BOWEL
With other bowel diseases there is usually
something abnormal to see - an ulcer, for example. These are termed 'organic bowel disorders'.
Does 'functional' mean it's all in the
What is the irritable bowel syndrome?
No, but many bowel symptoms are made worse by
stress - this is true of both functional and organic
Irritable Bowel Syndrome (IBS) is the term use to
bowel disorders. Some people only get symptoms
describe a collection of bowel symptoms which are
when they are under stress. On the other hand,
believed to be due to disordered activity of the
others are psychologically well adjusted and have
bowel muscle. It is what is known as a functional
no stress in their lives but can be plagued by
What is a functional bowel disorder?
Is it the same as 'colitis'?
The bowel is like a muscular tube which propels
Although once called mucus or membranous
food from mouth to anus allowing nutrients to be
colitis, this disorder is quite different from ulcerative
digested and absorbed on the way. The colon or
colitis. In the irritable bowel syndrome, muscle
large bowel is largely responsible for the absorption
spasm seems to be the main problem, while in
of fluid from the faeces, and for storing them ready
ulcerative colitis there is inflammation of the large
for evacuation. IBS is mostly a problem with the
How common is it and who is affected?
IBS is extremely common in developed countries but may be less common in other countries, such as Africa and Asia. Probably one third of the people in Britain have occasional symptoms and 1 in 10 have symptoms bad enough to require medical attention. It commonly starts between 15 and 40 years of age and is more common in women. However, it may affect any age. 7.
What are the main symptoms?
These may vary from patient to patient, but all will have at least some of the following:
Abdominal pain. Most often it is colicky (gripey) in nature. It may be felt anywhere in the abdomen, but often low down on the left. The pain is often relieved by passing flatus (wind from the back passage) or by bowel
A functional bowel disorder occurs if this normal
function of the gut is not working correctly. For
Irregular bowels varying between diarrhoea,
example, if the muscle propels bowel contents too
fast the patient gets diarrhoea, if it works too slowly
constipation. Many patients find their pain is
constipation occurs. If the muscle goes into spasm
it can cause pain rather like muscular leg cramps.
Small, hard, pelletty stools which may be
covered in mucus. It is also quite common
What other symptoms may occur?
Some patients get spasm in particular areas. The
Urgency - a need to rush to open the bowels.
splenic flexure syndrome (pain in the upper left
This can lead to incontinence if a toilet is not
abdomen) and 'proctalgia fugax' (a spasm in the
lower bowel which causes a brief sharp pain in the
Are any investigations necessary?
Investigations are usually arranged to exclude
other bowel disorders that produce the same
A brief, sharp spasm of pain felt low down
symptoms as the irritable bowel syndrome. In
many young patients, the doctor may diagnose and
treat the disorder without investigation. In older
Nausea, especially in the morning, belching,
patients, the doctor may do investigations to
exclude other possible bowel disorders. Some
doctors may only investigate those who do not
Are other organs affected?
respond to a trial of treatment. If some of the
symptoms are not typical, such as weight loss or
Some patients with IBS may also have an irritable
blood in the motions, investigations are necessary.
bladder causing frequency of passing urine, others
may have indigestion and some women may find
What investigations are helpful?
The main aim of tests is to exclude other bowel
What is the cause of this disorder?
IBS is an exaggerated response by the bowels to
situations of tension associated with normal daily
living, leading to abnormal contractions or
particularly likely to occur in an individual who eats
an irregular diet, or one which is deficient in dietary
fibre (roughage). The breakfast meal is particularly
important in this respect: an input of roughage first
thing in the morning before the stresses and
tensions of daily living start seems to 'kick start'
normal in IBS although spasm is sometimes seen.
What treatment is available?
IBS sometimes follows an attack of viral or
bacterial gastroenteritis/diarrhoea, particularly in a
Although the irritable bowel syndrome may produce
susceptible individual whose diet lacks dietary
troublesome symptoms, it does not lead to serious
There is no
evidence that IBS is a bowel
i) an explanation of the disorder and how
inflammation (like ulcerative colitis or Crohn's
symptoms are produced helps to relieve anxiety
disease), hereditary (although other members of
and allow the patient to cope with infrequent
the family may also suffer from it), or a food allergy
episodes of symptoms, and reassurance that more
(although some patients find they are intolerant of
ii) increasing the fibre content of the diet
How do symptoms develop?
particularly at breakfast time, encouraging the
intake of foods such as high fibre breakfast cereals
In general, muscle changes cause many of the
(e.g. Weetabix, Shredded Wheat etc.), whole
wheat bread, fruit, vegetable and berries, instead of
refined foods such as white bread and desserts -
see section 16 for a dietician's advice.
Sometimes it may be necessary or convenient to
take fibre supplements in addition, although raw
bran generally tends to make diarrhoea and
Eat plenty of fruit
, 2 or 3 pieces daily at
wind/bloating worse. In this situation it is usually
least, preferably without peeling them first (except
better to take such medications as Fybogel or
citrus fruits!). Dried fruit can be used to sweeten
cereal or puddings in place of sugar and is useful
Severe spasm or colic pains may respond to an
antispasmodic although in general, drug treatment
contraction, so reducing fat intake may help to
alleviate some of the colicky pains of IBS. A lower
Diarrhoea may sometimes need treatment with
fat diet is also likely to benefit general health.
drugs such as Loperamide (Imodium) especially at
Avoid fried foods: grill, bake, boil, steam or
Can IBS be cured?
Having made the necessary adjustments to diet
with vegetables and pulses. Chicken and fish can
and lifestyle, there is a good chance that the
symptoms will gradually subside and become
bearable over the course of several weeks or
months. The IBS may well recur from time to time,
skimmed or skimmed milk, low fat yoghurts and
particularly at times of stress or following a bout of
diarrhoea, for instance due to food poisoning.
Beware of "hidden" fats in cakes, pastries,
Look out for other lower fat products: low fat
bowel function and can ease both constipation and
spreads, crisps, sausages, etc. to replace the
diarrhoea. It is found in many different foods,
mainly cereal products, vegetables and fruit.
Increase the amount gradually and always take
plenty of fluids throughout the day to achieve the
consumption of tea and coffee as caffeine can
Use wholemeal bread
in preference to
Some people find that certain
white or brown bread. There are many different
foods are associated with the symptoms of IBS. If
you suspect this, record which foods are concerned
and discuss them with your doctor before
Choose cereals high in soluble fibre, e.g.
eliminating them from your diet. Any food
Weetabix, Shredded Wheat
, Porridge Oats.
intolerance should be investigated properly with
These are higher than Cornflakes and Crisped
medical and dietetic care to avoid unnecessary
restrictions and a diet that may be deficient.
Wholemeal flour can replace white flour in
cooking. Try half of each to begin with.
There are many choices of high fibre biscuits
now. Digestives, Oat Biscuits, Ryvita, Bran biscuits
and whole-wheat crackers are better choices than arrowroot biscuits, shortcake and custard creams.
Replace white pasta and rice with wholemeal
Use "pulse" vegetables: lentils and beans in
soups, casseroles and on toast. These can replace some of the meat, fish, cheese and eggs in your diet, as they are also rich in protein.
contain fibre so try to include
at least 2 servings each meal. Always eat the skins where appropriate, e.g. jacket potatoes.
Revista del Hospital Privado de Comunidad PENFIGOIDE CICATRIZAL DE MUCOSAS Dres. Gerónimo Alazard1, Andrés Alza1, Hernán Cantú1, Marcelo Guagnini2 INTRODUCCIÓN para descartar lupus eritematoso (anticuerposEl penfigoide cicatrizal de mucosas (PC) es una en-antinucleares (ANA), anticuerpos anti-ADN, célulasfermedad ampollosa crónica autoinmune que afecta pre-LE). Todos los valor
Biliary and Gastrointestinal Manifestations of the Herpes Simplex Virus, Type I (HSV-I) William L. Pridgen, M.D., F.A.C.S., Erin Haggard, PA-C Biliary and Gastrointestinal Manifestations of the Herpes Simplex Virus, Type I (HSV-I) William L. Pridgen, M.D., F.A.C.S., Erin Haggard, PA-C Abstract Objective : To analyze 421 surgical patients exhibiting biliary and gastrointestinal dysfun