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  1. Fact Sheet: Evaluation and Treatment of Constipation

    118

    By: M. Scott Harris, MD

    Constipation is one of the most common gastrointestinal complaints in the United States. It afflicts approximately 1 in 6 individuals and is responsible for approximately 2.5 million physician visits each year. More than $400 million is spent annually on over-the-counter laxatives; at least 120 of these products are available. The management of constipation includes patient education about bowel function and diet, behavior modification, drug therapy, and infrequently, surgery. Revised 1/2012

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  2. Fact Sheet: Malabsorption

    119

    By: Nimish Vakil, MD, FACP, FACG; Carol Jorgensen-Vakil, MS, RD, CNSD, Registered Dietician

    The gastrointestinal tract and liver play key roles in the digestion, absorption and metabolism of nutrients. Diseases of the gastrointestinal tract and liver may profoundly disturb normal nutrition. Malabsorption refers to decreased intestinal absorption of carbohydrate, protein, fat, minerals or vitamins. There are many symptoms associated with malabsorption. Weight loss, diarrhea, greasy stools (due to high fat content), abdominal bloating and gas are suggestive of malabsorption.

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  3. Fact Sheet: Gut Motility: In Health and Irritable Bowel Syndrome

    121

    By: John E. Kellow, MD

    What are normal movements (motility) of the digestive tract? How may altered motility lead to symptoms? Disorders affecting the motility of the digestive tract may be self-limiting, occurring only for a brief period as in acute infection of the digestive tract causing diarrhea. They can also be more longstanding and persistent as in irritable bowel syndrome (IBS). IBS is associated with a variety of symptoms, particularly abdominal pain and an irregular bowel habit.

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  4. Fact Sheet: Lactose Intolerance: Definition, Symptoms and Treatment

    122

    By: Eli D. Ehrenpreis, MD; Benjamin Z. Ehrenpreis

    The term lactose intolerance refers to the development of gastrointestinal symptoms following the ingestion of milk or dairy products. Lactose intolerance is caused by a shortage of a digestive enzyme called lactase, which is produced within the lining of the small intestine, although not all people with lactase deficiency develop symptoms. Lactose intolerance is an extremely common disorder and may have a prevalence of up to 100% in some populations. The following brief review of lactose intolerance will provide a summary of the populations most affected, symptoms, diagnosis, and treatment. Revised 2007.

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  5. Fact Sheet: Gynecological Aspects of Irritable Bowel Syndrome

    123

    By: Margaret M. Heitkemper, RN, PhD; Monica Jarett

    Over a decade ago, investigators noted that approximately half of the women attending a gynecology clinic had symptoms (e.g., abdominal pain, change in bowel pattern) compatible with a diagnosis of irritable bowel syndrome (IBS). Since that study, a number of other studies have demonstrated a higher prevalence of gynecologic disorders, such as pain associated with menstruation (dysmenorrhea) and premenstrual distress syndrome in women with IBS as compared to those without IBS.

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  6. Fact Sheet: Irritable Bowel Syndrome: The Pathophysiologic Links to More Effective Future Therapy

    124

    By: Michael Camilleri, MD

    Several investigators as well as an NIH consensus conference on the "irritable bowel syndrome" (IBS) have stressed the importance of the biopsychosocial model in the etiopathogenesis (origin and development) of this syndrome. In this short article, the pathophysiologic (disease process) links between big brain, little brain, motility and sensation are explored based on currently available data. These data suggest that investigators and clinicians need to be dissuaded from approaching IBS as though it was a single disorder in all patients, or as though only one mechanism is responsible for development of symptoms. In essence, this is a plea for the importance of integrated rather than reductionist approaches to research, diagnosis, and management of IBS. Revised and updated 2009.

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  7. Fact Sheet: Report on the 4th International Symposium on Functional Gastrointestinal Disorders

    125

    By: Douglas A. Drossman, MD; William F. Norton, Communications Director, IFFGD

    There is a growing understanding of the multi-faceted nature of functional gastrointestinal disorders. Symptoms, behaviors, and treatment outcomes for individuals with these disorders relate to disturbances in gastrointestinal motility and sensation that is effected by interactions that take place via the brain-gut axis. To understand and study these conditions, physicians and researchers must become familiar with evolving knowledge that integrates basic science, physiology, clinical medicine, psychology, and psychiatry. Indicated below are some of the highlights of the presentations at the 4th International Symposium for Functional Gastrointestinal Disorders, which we believe truly reflect the developing areas of research in irritable bowel syndrome (IBS) and the functional gastrointestinal (GI) disorders.

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  8. Fact Sheet: Clinical Features and Treatments of Inflammatory Bowel Disease (IBD) - An Update

    126

    By: Barry W. Jaffin, MD; Vera Kandror Denmark, MD

    Nearly two million people are affected with IBD [e.g., Crohn's disease and ulcerative colitis] in the U.S. These inflammatory conditions are a group of several distinct disorders which probably explains the diversity of extent and activity of inflammation within the gastrointestinal (GI) tract. The age of onset is usually in the 20s and 30s, although there is a slight second peak in incidence in the 50s to 60s. Men and women are equally affected in IBD as opposed to IBS, which is female predominant. Revised and updated 2009.

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  9. Fact Sheet: Visceral Sensations and Brain-Gut Mechanisms

    127

    By: Emeran A. Mayer, MD

    Over the past several years, different mechanisms located within the gut, or gut wall have been implicated as possible pathophysiologic mechanisms underlying the characteristic IBS symptoms of abdominal pain and discomfort. The list ranges from altered transit of intestinal gas, alterations in the colonic flora, immune cell activation in the gut mucosa, and alterations in serotonin containing enterochromaffin cells lining the gut. For those investigators with a good memory, these novel mechanisms can be added to an older list of proposed pathomechanisms, including altered gut motility ("spastic colitis") and alterations in mucus secretion.

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  10. Fact Sheet: Quality of Life Assessment

    130

    By: Ivan Barofsky, PhD

    In general, a quality of life assessment is one of the most important ways that a patient has to have his or her interest expressed in the design and selection of treatments. You should be aware of this and ask your doctor about what he or she knows about the qualitative, or quality of life, consequence of any new treatment you are being asked to take. In this way you can become a powerful force in keeping the quality of life issues as a visible part of medical practice

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