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Latest on Complementary and Alternative Medicine for GI Disorders. Digestive Health and Nutrition. 8(1): 22-25. March- April 2006.

Many people with digestive disorders are frustrated by the options that traditional medicine offers and may turn to alternatives to cope with their symptoms. Up to 62 percent of Americans use some form of complementary and alternative medicine (CAM) in their lives. However, most forms of CAM still need well-designed studies to confirm their success and safety. This article is designed to help readers with chronic gastrointestinal (GI) disorders who are seeking forms of CAM to help manage their discomfort. The author outlines mind-body medicine (hypnotherapy, relaxation), which is often used for patients with functional GI disorders such as irritable bowel syndrome (IBS) and dyspepsia, constipation, vomiting, nausea, or abdominal pain; biologically-based therapies, including botanicals, vitamins and minerals, probiotics, and which are often used for the treatment of Crohn’s disease, ulcerative colitis, and dyspepsia; and energy-based therapies such as healing touch and acupuncture, which are often used for nausea and vomiting, IBS, dysphagia, gastric dysmotility, and acid reflux. Readers are encouraged to educate themselves about any CAM therapy they are considering and to work in tandem with their traditional health care providers. 3 figures. 1 reference.

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Non-Surgical Treatments for POP. Quality Care. 24(2): 8. 1st Quarter 2006.

This brief article, from a newsletter for people with urinary incontinence, reviews the non-surgical treatments that can be used to manage pelvic organ prolapse (POP). POP is a condition unique to females in which the genitourinary internal organs (bladder, urethra, cervix, uterus, bowel, rectum) descend within the pelvis, distort the vaginal wall and, in some patients, bulge outside the vagina. POP is also known as vaginal prolapse. The author first reviews the risk factors for POP, which include pregnancy, childbirth, weak pelvic floor muscles, white race, aging, and activities like heavy lifting. After a short summary of the surgery used for POP, the author focuses on non-surgical treatments including pessaries, pelvic floor exercises (Kegel exercises), and behavioral changes such as weight loss, avoiding heavy lifting, and preventing constipation. One sidebar illustrates the different types of pessaries currently available. 1 figure.

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Preventative Strategies to Keep POP from Advancing. Quality Care. 24(2): 7. 1st Quarter 2006.

This brief article, from a newsletter for people with urinary incontinence, reviews the problem of pelvic organ prolapse (POP). POP is a condition unique to females in which the genitourinary internal organs (bladder, urethra, cervix, uterus, bowel, rectum) descend within the pelvis, distort the vaginal wall and, in some patients, bulge outside the vagina. POP is also known as vaginal prolapse. The author focuses on preventive strategies that can keep POP from advancing. Readers are encouraged to stay active with exercise such as swimming or bicycling, but to avoid activities that involve straining (such as heavy lifting, running or aerobics). Constipation should be prevented in order to avoid the straining during bowel movements that could make the prolapse worse. Another section of the article reviews pelvic muscle exercises (Kegel exercises), including the benefits they can provide and how to exercise these muscles appropriately. A final section briefly discusses the use of Cesarean section as a way to prevent prolapse; the author explains why this is not a good approach (the risk of prolapse is relatively small and there are good treatments for it).

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Prebiotics, Probiotics, and Dietary Fiber. IN: Buchman, A., ed. Clinical Nutrition in Gastrointestinal Disease. Thorofare, NJ: Slack Incorporated. 2006. pp 123-138.

This chapter about prebiotics, probiotics, and dietary fiber is from a comprehensive textbook that compiles available data, clinical experience, and research on the role of nutrition in the management of patients with disorders that affect the gastrointestinal (GI) tract. The author emphasizes that the intestinal microflora is essential in maintaining health and that understanding the role of prebiotics, probiotics, and dietary fiber in the physiology of the GI tract is vital. Prebiotics are defined as food substances that are not absorbed in the small intestine, so they reach the large intestine. The section on prebiotics covers prebiotic substances used and available, the effect of prebiotics on intestinal flora, and clinical use. Probiotics are live microbial organisms obtained from humans and used in supplements. The section on probiotics discusses the organisms that are used, the physiologic effects resulting in benefit to the host, the immune process, barrier protection, the importance of fermentation, and clinical use for infections, inflammatory bowel disease (IBD) including ulcerative colitis and Crohn’s disease, pouchitis, and irritable bowel syndrome (IBS). Dietary fiber is defined as nonstarch polysaccharide in plant food that is poorly digested by human enzymes. The section on dietary fiber covers the chemical and physical properties of the fiber component of plant foods, mechanisms resulting in benefit, the effect on GI function, fermentation and short-chain fatty acids, dietary fiber intake and recommendations, the fiber contents of foods, and clinical use including the prevention of coronary heart disease and lipid control, diabetes mellitus, constipation and bowel movement regulation, diverticular disease, IBS, colon neoplasia, and IBD. The author concludes that dietary fiber is probably the best prebiotic. The intestinal microecology depends on a matrix within the colon, and the matrix depends on food to maintain a health bacterial flora. 153 references.

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Principles of Applied Neurogastroenterology: Physiology-Motility-Sensation. IN: Drossman, D.A., ed. Rome III: The Functional Gastrointestinal Disorders. 3rd ed. McLean, VA: Degnon Associates, Inc. 2006. pp. 89-160.

This chapter on the principles of applied neurogastroenterology is from a lengthy reference book that presents the Rome III criteria for functional gastrointestinal disorders (FGIDs), a classification system based on the assumption and premise that for each disorder there are identifiable symptom clusters that emerge across clinical and population groups. The chapter focuses on the physiology and motility of sensory dysfunction. The authors note that patients with FGIDs often exhibit sensory afferent dysfunction of the digestive tract that is characterized by altered sensitivity to luminal distension or other stimuli and that selectively affects the visceral territory; this condition is termed visceral sensitivity and is regarded as an important pathophysiologic mechanism in the FGIDs. Visceral sensitivity may underlie common symptoms in FGIDs such as chest pain, abdominal discomfort, abdominal bloating, and urgency of defecation. Other symptoms of FGIDs, such as constipation and diarrhea, are consistent with altered gut motility that may include alterations in contractile activity, tone, compliance, and transit in various regions of the digestive tract. The authors provide an overview of the fundamental concepts and terminology of human digestive tract sensorimotor physiology and pathophysiology relevant to the FGIDs, an outline of normal regional sensorimotor physiology along the human digestive tract, a review of currently available techniques for testing sensorimotor function in the FGIDs, a discussion of the putative origins of visceral hypersensitivity and dysmotility in the FGIDs, some examples of the specific symptom correlates of sensorimotor dysfunction in the FGIDs, a description of the current role of sensorimotor testing in the clinical evaluation of patients with FGIDs, and recommendations for future research in this area. 11 figures. 1 table. 318 references.

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Anatomic Problems of the Colon. Bethesda, MD: National Digestive Diseases Information Clearinghouse. 2005. 8 p.

The colon, or large intestine, is part of the digestive system, which is a series of organs from the mouth to the anus. When the shape of the colon or the way it connects to other organs is abnormal, digestive problems result. Some of these anatomic problems can occur during embryonic development of the fetus and[m1] are known as congenital anomalies; other problems develop with age. This fact sheet describes anatomic problems of the colon, including malrotation, small bowel and colonic intussusception, fistulas, colonic atresia, volvulus, and imperforate anus. The fact sheet begins with a review of normal colon anatomy and development. For each condition, the fact sheet covers symptoms, diagnosis, and treatment, which often entails surgery. Symptoms of anatomic problems include abdominal pain, abdominal distension, vomiting, and diarrhea or constipation. Some anatomic problems may resolve over time; others will need surgical correction. A final section describes the goals and work of the National Digestive Diseases Information Clearinghouse. 4 figures.

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Bladder Health: Patient Fact Sheet. Pitman, NJ: Society of Urologic Nurses and Associates. 2005. 2 p.

This brief fact sheet provides an overview of bladder health and bladder problems. It first reviews the anatomy and physiology of the bladder, then lists signs or symptoms to watch for that may indicate a problem for which one should seek medical attention. It then offers suggestions about keeping one’s bladder healthy, including stopping smoking (smoking is the main cause of bladder cancer), achieve and maintain proper body weight, exercise, eat a healthy diet, avoid constipation, and stay well-hydrated. Readers are encouraged to consult a health care provider whenever a change in bladder or bowel habits is noticed.

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Refractory Distal Colitis. IN: Jewell, D.P., et al, eds. Inflammatory Bowel Disease: Management of Ulcerative Colitis. Malden, MA: Blackwell Publishing Inc. pp. 124-143.

This chapter on refractory distal colitis is from a textbook that addresses some of the challenges in the understanding of ulcerative colitis (UC) and Crohn’s disease (CD), collectively known as IBD. In this chapter, the author reviews the controversies of management in patients whose disease is refractory to conventional treatment. The author notes there is very little data on this topic and thus the management approach presented is based on opinion and observation as well as on scientific evidence. The chapter defines refractoriness and its prevalence, pathophysiology, the conventional treatment of active distal colitis, the use of oral aminosalicylates and rectal steroids, combination treatment with oral and rectal steroids, differential diagnosis, the use of topical salicylates, problems with proximal constipation, indications for intensive treatment, strategies to maintain remission, alternative therapies, and the use of surgery. The author concludes that combining oral and topical therapy, using salicylate suppositories as an adjunct to enemas, hospital admission for intensive treatment, and maintaining remission with immunosuppression should be effective in the vast majority, without resorting to alternative therapies or surgery. Only patients with chronically active disease affecting their quality of life or employment who have not responded to intensive treatment or cannot tolerate immunosuppression are candidates for surgery. 2 figures. 2 tables. 122 references.

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Role of Fiber in the Treatment of Irritable Bowel Syndrome: Therapeutic Recommendations. Journal of Clinical Gastroenterology. 40(2): 104-108. February 2006.

This article reviews the role of fiber in the treatment of irritable bowel syndrome (IBS), a group of functional bowel disorders in which abdominal discomfort or pain is associated with defecation of a change in bowel habit. Symptoms can include constipation, diarrhea, bloating, straining, urgency, feeling of incomplete evacuation, and passage of mucus. The author summarizes the current literature on the use of fiber in IBS and provides some specific recommendations for patient care management. Systematic reviews of the research studies have generally not found fiber to be significantly more effective than placebo at relieving global IBS symptoms. There may be differences between results obtained with soluble and insoluble fiber. Adverse effects of fiber use may include abdominal discomfort and bloating. The author notes that although dietary fiber or bulking agents do not appear to be useful as sole treatment of IBS, they may have a limited role in empiric therapy depending upon the patient’s symptom complex, especially if constipation is the most significant symptom. The basic principles for fiber therapy are to start with a low dose and to increase slowly, to give an adequate trial, and to evaluate the results early and regularly. 2 tables. 65 references.

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Stress and Irritable Bowel Syndrome: Unraveling the Code. Digestive Health Matters. 15(4): 24-25. Winter 2006.

This article describes the interrelationship between stress and irritable bowel syndrome (IBS), a condition characterized by abdominal pain and discomfort associated with changes in bowel habits, namely constipation and diarrhea. The author notes the expression of IBS reflects a disorder in which various factors interact. Among these factors, psychosocial trauma and a high rate of stressful life events have been identified as important risk factors. The author describes the physiology of the stress response, then explains the role of corticotropin-releasing factor (CRF1) receptors in IBS symptoms. The CRF1 receptors are structures on cells that receive a stimulus or message and, in turn, induce a physiological response in the body. CRF1 receptors play a key role in the endocrine, behavioral, and gut responses to stress. The author briefly reviews some medications that are being studied that blockade the CRF1 receptors. 1 reference.

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