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Enjoying Travel While Protecting Your Vascular Access: And the PD Catheter. For Patients Only. 14(1): 21-23. January-February 2001.

This article reviews some of the trip planning that dialysis patients should consider before their vacation outings. The author reminds readers that once arrangements have been made for dialysis treatments during the travel experience, it is vital to get a copy of one's medical records to carry along. The author then offers tips that can help protect the vascular access (VA) during travel. These include not carrying too much luggage with the VA arm, moving around during airflight to minimize swelling (especially for those with a leg graft), taking extra precautions the first night in a new bed, and being extra careful with fluid intake. The author then shifts to a discussion of peritoneal dialysis (PD), focusing on leaks around the catheter and on outflow obstructions. Most leaks around the catheter occur either in the first few weeks or months after placement, or during a switch from continuous cycling PD (using a cycler at night) to continuous ambulatory PD (CAPD) which features several manual exchanges throughout the day. If leakage happens, the nephrologist or nurse may decrease the amount of fluid the patient is using for each exchange until the cuff has healed, have the patient lie down while filling or draining, or, possibly, put PD on hold until the healing has occurred. Outflow obstruction, on the other hand, can occur from kinking of the catheter, decreased bowel motion from constipation, or fibrin in the abdomen filling the catheter. The author concludes by encouraging readers to educate themselves and to work as an active member of their own health care team.

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Fecal Incontinence in Pediatric Urology. In: Gearhart, J.P.; Rink, R.C.; Mouriquand, P.D. Pediatric Urology. Philadelphia, PA: W.B. Saunders Company. 2001. p. 1015-1023.

Problems with the gastrointestinal and urinary tracts frequently coexist. They may be part of a complex congenital abnormality, they may share a common cause such as neuropathy, or an abnormality in one system may affect the other. This chapter on fecal incontinence is from a comprehensive textbook on pediatric urology that emphasizes the pathophysiology of various disorders. The authors stress that the pediatric urologist must be aware of these gastrointestinal anomalies and be conversant with their clinical presentation, management, and prognosis. The care of patients is usually shared with other specialists such as pediatric surgeons or pediatricians. However, the urologist should be able to initiate and supervise simple treatment. With the development of new surgical techniques, the operative management of fecal incontinence may also fall to the urologist, particularly during lower urinary tract reconstruction. Topics include pathology, clinical assessment, investigations, and treatment of fecal incontinence and constipation. 4 figures. 2 tables. 62 references.

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Functional Abdominal Disorders. In: Farthing, M.J.G.; Ballinger, A.B., eds. Drug Therapy for Gastrointestinal and Liver Diseases. Florence, KY: Martin Dunitz. 2001. p. 163-190.

This chapter on functional abdominal disorders is from a textbook that reviews the drug therapy for gastrointestinal and liver diseases. The authors review the evidence to support current therapies in nonulcer dyspepsia and irritable bowel syndrome (IBS), and introduce the reader to the novel therapeutic approaches that are on the threshold to clinical application. The chapter provides a brief summary of the pathophysiology of each disease, the rationale for drug intervention, and appropriate treatment regimens as indicated by current knowledge. Prokinetic and antisecretory agents are currently the mainstays of the initial treatment of non-ulcer dyspepsia. Eradication of Helicobacter pylori in non-ulcer dyspepsia remains controversial. In the treatment of IBS, therapeutic choices are based on the predominant symptoms: fiber for constipation; loperamide for diarrhea; smooth muscle relaxants for pain; psychotropic agents for depression, diarrhea and pain; and psychological treatments. The chapter concludes with a drug list that summarizes mode of action, and other aspects of clinical pharmacology where appropriate, drug doses, common adverse affects, and drug interactions. 4 figures. 5 tables. 187 references.

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Functional Abdominal Pain in the Elderly. Gastroenterology Clinics of North America. 30(2): 517-529. June 2001.

Functional abdominal pain is a common and distressing symptom in the elderly. This article, from a special issue on gastrointestinal (GI) disorders in the elderly, addresses functional abdominal pain in this population. The possibility of organic diseases causing pain (such as cancer and chronic mesenteric ischemia, or lack of blood flow) must be excluded before this diagnosis can be made with confidence. Although aging affects gastrointestinal motor and sensory function in several ways, particularly after age 70, the observed changes are relatively modest and often asymptomatic, perhaps because of the vast reserve of neuromuscular functional elements in the gut. The proximal esophagus, anus, and pelvic floor are possible exceptions to this generalization, and the combination of aging and factors such as minor strokes or obstetric damage often results in dysphagia (swallowing disorders), constipation, or fecal incontinence (involuntary loss of stool). Unfortunately, the pathophysiology of functional pain in the elderly is incompletely understood. Psychological factors may also play a role and should be carefully assessed and considered in management strategies. Judicious pharmacological (drug) therapy is often effective for pain and other symptoms. Nonpharmacologic measures that may supplement drug therapy for alleviating abdominal pain have not been studied in the elderly. These modalities include exercise and cognitive or cognitive behavioral approaches. The authors stress that managing elderly patients with functional abdominal pain demands clinical acumen, tact, understanding, and patience. 1 figure. 1 table. 76 references.

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Gastrointestinal Motility Disorders of the Colon, Rectum, and Pelvic Floor. Participate. 10(1): 3-5. Spring 2001.

Motility is a term used to describe the contraction of the muscles in the gastrointestinal tract. This article, the second in a two part series, reviews gastrointestinal (GI) motility disorders of the colon, rectum, and pelvic flood. The four parts of the GI tract (esophagus, stomach, small intestine and large intestine or colon) are separated from each other by special muscles called sphincters, which normally stay tightly closed and which regulate the movement of food and food residues from one part to another. Each part of the GI tract has a unique function in digestion, and each part has a distinct type of motility and sensation. Motility problems can cause symptoms such as pain, bloating, fullness, and urgency to have a bowel movement. The author describes the normal patterns of large intestine motility and sensation, along with the symptoms that can result from abnormal motility or sensations. Symptoms of motility problems in the large intestine include constipation, diarrhea, fecal incontinence, Hirschsprung's disease, and outlet obstruction type constipation (pelvic floor dyssynergia). For each, the author describes the diagnostic tests that may be used to establish an appropriate diagnosis.

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Health Benefits of Dietary Fiber for People with Diabetes. Diabetes Educator. 27(4): 511-514. July-August 2001.

Dietary fiber has long been known to provide many health benefits. However, most people fall exceedingly short of approaching the daily recommended amount of 20 to 35 grams. This article describes the importance of educating people with diabetes about the importance of a high fiber diet. The author first describes the different types of fiber (insoluble and soluble) and the impact of each on the gastrointestinal tract and on nutrition. The author considers the role of fiber and colon cancer, fiber and heart disease, and fiber and diabetes. The author notes that the role of dietary fiber in managing diabetes has been somewhat controversial. Eating a fiber risk diet may actually help to prevent diabetes. Soluble fiber, in addition to delaying gastric (stomach) emptying and binding to bile acids, can delay the absorption of glucose from the intestine into the blood. Recent research demonstrated a lowering of blood glucose in participants who were on a 50 gram fiber diet, compared to those on a 24 gram fiber diet. The average daily fiber intake for most Americans is 17 grams, while the recommended daily intake is between 20 and 35 grams. The author offers suggestions for ways to help patients increase their fiber intake. Patients should also be advised to gradually increase their fiber intake over time to help avoid gastrointestinal discomfort and to increase their fluid intake at the same time (to prevent constipation). In addition, it is preferable for people to obtain fiber from food sources rather than from supplements. 3 tables. 5 references.

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HEN Complication Chart. Albany, NY: The Oley Foundation. 2001. (chart).

This chart helps nurses and other care providers quickly understand the complications of home enteral nutrition (HEN, which uses feeding tubes directly into the gastrointestinal tract) and how to prevent and treat those complications. Each of the complications are contained in a separate section: nausea, diarrhea, tube obstruction or blockage, tube displacement, skin or site irritation or tube leaking, aspiration, constipation, gastrointestinal bleeding, pump or power failure, and rare complications (hyperglycemia, hypoglycemia, and fluid or electrolyte imbalances). Each section lists the symptoms, immediate action to take, causes, and prevention strategies. Prevention steps are numbered to correspond with the causes listed in each section. Readers are advised to review this chart with their supervising MD, noting any differences in protocols or procedures prior to taking any actions recommended in the chart.

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Hirschsprung's Disease: An Overview. Milwaukee, WI: International Foundation for Functional Gastrointestinal Disorders (IFFGD). 2001. [2 p.].

This fact sheet offers an overview of Hirschsprung's disease, a genetic disorder that results in the absence of nerve cells in the wall of the bowel. Collections of nerve cells (ganglia) control the coordinate contraction and relaxation of the bowel wall, called peristalsis, that is necessary for bowel contents to advance. Without this action, the bowel remains collapsed and stools cannot pass. Bowel contents build up behind the obstruction, resulting in constipation. The fact sheet describes the condition in infants and very young children, the emergency conditions that can accompany Hirschsprung's disease, diagnostic strategies, and treatment options. To diagnose Hirschsprung's disease, a barium enema x ray tests is used to identify the narrow collapsed segment of bowel as well as the dilated bowel in front of the affected regions. Treating Hirschsprung's disease requires surgery to remove the affected bowel and then to join the healthy bowel segments. There are several different surgical approaches, each with a high rate of success. The fact sheet includes the contact information for the International Foundation for Functional Gastrointestinal Disorders (IFFGD, www.iffgd.org).

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Irritable Bowel Syndrome in Twins: Heredity and Social Learning Both Contribute to Etiology. Gastroenterology 121(4): 799-804. October 2001.

The irritable bowel syndrome is a chronic functional gastrointestinal disorder characterized by abdominal discomfort or pain that beings with a change in the frequency or consistency of stool (diarrhea or constipation), that is relieved by defecation, and that is present in the absence of other diseases that could explain the symptoms. Heredity has been suggested to explain the finding that irritable bowel syndrome (IBS) tends to run in families. This article reports on a study undertaken to assess the relative contribution of genetic and environmental (social learning) influences on the development of IBS by comparing concordance rates in monozygotic (identical) and dizygotic (fraternal) twins to concordance between mothers and their children. Questionnaires soliciting information on the occurrence of more than 80 health problems, including IBS, in self and other family members were sent to both members of 11,986 twin pairs. The authors' analysis is based on 10,699 respondents representing 6,060 twin pairs. Concordance for IBS was significantly greater in monozygotic (17.2 percent) than in dizygotic (8.4 percent) twins, supporting a genetic contribution to IBS. However, the proportion of dizygotic twins with IBS who have mothers with IBS (15.2 percent) was greater than the proportion of dizygotic twins with IBS who have co-twins with IBS (6.7 percent). Logistic regression analysis showed that having a mother with IBS and having a father with IBS are independent predictors of irritable bowel status; both are stronger predictors than having a twin with IBS. Addition of information about the other twin accounted for little additional predictive power. The authors conclude that heredity contributes to development of IBS, but social learning (what an individual learns from those in his or her environment) has an equal or greater influence. 1 figure. 2 tables. 18 references.

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Irritable Bowel Syndrome. New England Journal of Medicine. 344(24): 1846-1850.

This article reviews the epidemiology, pathophysiology, diagnosis, and therapy of the irritable bowel syndrome (IBS). The syndrome of IBS is divided into four subcategories according to whether the predominant symptom is abdominal pain, diarrhea, constipation, or constipation alternating with diarrhea. Altered bowel motility (movement within the gastrointestinal tract), visceral hypersensitivity, psychosocial factors, an imbalance in neurotransmitters, and infection or inflammation have all been proposed as playing a part in the development of the IBS. After a complete history has been obtained, all patients with lower GI tract symptoms should undergo a complete physical examination and laboratory testing, including a complete blood count, blood chemistry tests, liver function tests, and measurement of thyrotropin. Diagnosis of IBS is suggested based on the Rome criteria. In the majority of cases, there are no abnormalities oh physical examination or laboratory testing and there are no finding suggestive of a structural disorder. Treatment begins with the establishment of a positive physician-patient relationship and the use of a diary of food intake and symptoms. Additional treatment is based on the subcategory of IBS that the patient manifests. Common pitfalls in diagnosing and treating this disorder include unnecessary repetition of tests, failure to establish trust in the physician-patient relationship, and failure to provide the patient with realistic expectations regarding the efficacy of medications. 1 figure. 2 tables. 50 references.

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