IBS. TomSult Sult, MD Patrick Hanaway, MD. Post Webinar Sept 21, 2011
|
|
- Ethelbert Douglas
- 7 years ago
- Views:
Transcription
1 Case Studies Differentiating IBD from IBS TomSult Sult, MD Patrick Hanaway, MD ApplyingFunctional Medicine inclinical Practice Post Webinar Sept 21, 2011
2 Tom Sult, MD Patrick Hanaway, MD
3 Inside the Presentation If you have a technical issue, type your question in this box and select send to : Host, then click send If you have a question or comment for the Presenters, type it here and then click send In full screen mode, click the? icon to ask a question
4 Case Studies Differentiating IBD from IBS Patrick Hanaway, MD Patrick Hanaway, MD Tom Sult, MD
5 IS IT?: Irritable Bowel Syndrome (IBS) OR Inflammatory Bowel Disease (IBD) OR Celiac Disease
6 The BIG Picture Many conditions start with imbalances in Digestion & Absorption Inflammation & Immune dys-regulation Gut microbiology (bacteria, parasites, fungus) An excellent starting point for clinicians interested in getting to the root and IBS and GI symptoms, found in nearly 80% of all patients seen!
7 Management of IBS Digestion/ Absorption Inflammation/ Immune/ Infection Gut Bacterial Flora/ Dysbiosis Intestinal Permeability enteric Nervous System
8 IBS Epidemiology Up to 20% of population Females > males Younger > older 3.6 million visits/ year Sociocultural factors affect M.D. visits 12% primary care practice, 28% GI practice >3x work loss, M.D. visits Drossman DA et al. Gastroenterology 1997;112:2137b
9 Irritable Bowel Syndrome ROME III Criteria For at least 3 months, with onset at least 6 months previously, of recurrent abdominal pain or discomfort* >2d/month associated with 2 or more of the following symptoms: Improvement with defecation; and/ or Onset associated with a change in frequency of stool; and/or Onset associated with a change in form (appearance) of stool * Discomfort means an uncomfortable sensation not described as pain.
10 Cash BD, Chey WD. Gastroenterol Clin North Am. 2005;34:
11 Case Study Irritable Bowel Syndrome Challenges in Diagnosis Diagnosis of Exclusion Physicians rule out Inflammatory Bowel Disease (Crohns Disease, Ulcerative Colitis) and categorize all other conditions as IBS Challenges in Treatment IBS can actually be many different things, including: bacterial infection, food allergy, parasitic infection, pancreatic insufficiency, i dysbiosis. i One particular treatment will not work for all situations.
12 IBS Case #1 32 yo Male, recently returned from traveling in Asia. Had occasional abdominal discomfort before traveling, now present 2-4x/ month over 3 months. DIG Digestion/ Absorption Hypochlorhydria y Food Intolerance Villous Atrophy Pancreatic Insufficiency Small Intestinal Bowel Overgrowth (SIBO)
13 IBS Case #1 32 yo Male, recently returned from traveling in Asia. Had occasional abdominal discomfort before traveling, now present 2-4x/ month over 3 months. DIG Immune Regulation/ Inflammation Food Sensitivity y(g (IgG) and Allergy (IgE) Neutrophilic inflammation (Infection, IBD, CA) Eosinophilic Inflammation Infection (bacterial, viral, parasitic) Gluten Sensitive Enteropathy (Celiac)
14 IBS Case #1 32 yo Male, recently returned from traveling in Asia. Had occasional abdominal discomfort before traveling, now present 2-4x/ month over 3 months. DIG Gut Microflora Dysbiosis Beneficial bacteria Other bacteria Infection SIBO Candidiasis
15 Management of IBS Digestion/ Absorption Inflammation/ Immune/ Infection Gut Bacterial Flora/ Dysbiosis Intestinal Permeability enteric Nervous System
16 Conclusions There is no single IBS When we observe the relationships between: Digestion & Absorption Immune/ Inflammation Gut Microflora... we move beyond symptom suppression to a level of personalized diagnosis and treatment.
17 Maldigestion Inadequate mastication Hypochlorhydria Pancreatic insufficiency* Bile insufficiency* Villous atrophy brush border enzyme destruction*
18 IBS Evaluation
19 Pancreatic Elastase Proteolytic enzyme secreted exclusively by the human pancreas Reflects overall enzyme production (amylase, lipase and protease) Simple, non-invasive marker for evaluating exocrine pancreatic function 1,2 Sensitivity = % Specificity = 93-98% Stein J, et al. Clin Chem 1996 Feb;42(2):222 6 Loser C, Mollgaard A, Folsch UR. Gut 1996;39(4):580 6.
20 Pancreatic Elastase Treatment > 350 μg/g Normal pancreatic function μg/g Declining pancreatic function Consider supplement with pancreatic enzymes μg/g Moderate pancreatic insufficiency Supplement with broad array of pancreatic enzymes <100 μg/g Severe pancreatic insufficiency Supplement with broad array of pancreatic enzymes
21 IBS Evaluation
22
23 Calprotectin Predominately found in extra lysosomal cytosol of the neutrophil Accounts for ~ 60% of the cytosolic protein Inhibitory effect on zinc dependent enzymes Bacteriostatic activity Dale I, et al. Am J Clin Pathol 1985;84:24 34 Brun JG, et al. Scand J Immuno, 1994;40:
24
25 Calprotectin Elevated in: Inflammatory Bowel Disease Post-Infectious Irritable Bowel Syndrome Cancer of the GI Certain GI infections NSAID enteropathy Food allergy Chronic Pancreatitis Poullis A et al. J Gastroenterol Hepatol 2003;18:
26 Interpreting Calprotectin: Know when it s SERIOUS < 50 μg/g No significant inflammation μg/g Indicates some GI inflammation: IBD, infection, polyps, neoplasia, NSAIDS > 120 μg/g Significant inflammation; referral may be indicated to determine pathology > 250 μg/g Active disease present; predicts imminent relapse in treated patients Tibble J, Teahon K, Thjodleifsson B, et al. Gut 2000;47:
27 Colonoscopies Deemed Unnecessary For Most IBS Patients 3/17/2010 American Journal of Gastroenterology, "people with irritable bowel syndrome (IBS) are not at increased risk for polyps, colon cancer or inflammatory bowel diseases, such as Crohn's disease and, in most cases, don't require a colonoscopy." Lead investigator Dr. William D. Chey, of the University of Michigan, said, unless there is a family history of colorectal cancer or the patient has alarming symptoms such as unexplained weight loss or anemia, or bleeding from the gastrointestinal tract," there is no need for the procedure.
28 Eosinophilic Protein X
29 Eosinophil Protein X (EPX) Released in eosinophil degranulation Sensitive marker of GI inflammation Levels correlate well with clinical course and can predict relapse in IBD Superior to lactoferrin and siga Stable in transport up to 7 days Less intra-individual variability Much more sensitive marker for low-level inflammation 3,4
30 Celiac vs. Gluten Sensitivity
31 Am J Gastro March, ac 2011 IBS Rome III Celiac negative Randomized Trial +/ gluten
32 Am J Gastro March, 2011 Symptoms worsened No change in Ab: ttg IgA AGA IgA AGA IgG No change hs-crp No change L/M ratio
33 The Gut Flora Our intestinal flora has a massive amount of influence the on our metabolism! 10x the number of cells 100x the genomic material Metabolic activity > liver 3# of body mass THE HIDDEN ORGAN!
34 Metabolic Functions of Bacteria Mucous production Short Chain Fatty Acids Metabolism Pi Primary Bile Acid Deconjugation Vitamin absorption Fats, TG, Cholesterol regulation Undigested dietary fiber breakdown Gas production Fermentation ti Production of Phenols Breakdown of oligo-saccharides Detoxification
35 Microbiota At birth - digestive tract of humans is sterile. Colonised by microbes within the first few days of life At first, predominantly bifidobacteria (breast fed infants) With the introduction of other foods, a diverse microbial population develops in the gastrointestinal tract. As adults, of all the cells in a human body, the overwhelming majority are non-human.
36 Bacteroides, Lactobacillus, Clostridium, Fusobacterium, Bifidobacterium, Eubacterium, Peptococcus, Peptostreptococcus, Escherichia, and Veillonella. Bacterial count 100,000/ml /ml >400 different microbial species
37 Bacteroides, Lactobacillus, Clostridium, Fusobacterium, Bifidobacterium, Eubacterium, Peptococcus, Peptostreptococcus, Escherichia,, and Veillonella. Bacterial count 100,000/ml /ml >400 different microbial species
38 Dysbiosis CDSA 2.0 < 6+
39 Dysbiosis CDSA 2.0 > 12+
40 Treating Dysbiosis Stool culture Microbiology Additional Bacteria: LOW to MODERATE Additional Bacteria: EXCESSIVE Beneficial Bacteria: No need Treat with anti- ADEQUATE to treat microbial herbs Beneficial Bacteria: Treat with ProBiotics Treat with Probiotics INSUFFICIENT billion cfu qd billion cfu qd + antibiotics If patient is ILL add ~50 billion cfu qd & advance to antibiotics more quickly
41 Probiotics: History
42 Common Parasites A recent Genova study revealed 23.5 % of submitted clinical samples tested positive for at least one parasite (3,223/ 13,857) Blastocystis hominis (12.5%) Dientamoeba fragilis (3.8%) Entamoeba spp. (3.4%) Endolimax nana (2.2%) Giardia lamblia (0.7%)
43 Conclusions There is no single IBS When we observe the relationships between: Digestion & Absorption Immune/ Inflammation Gut Microflora... we move beyond symptom suppression to a level of personalized diagnosis and treatment.
44 IBS Case #2 24 yo Female with intermittent recurrent abdominal pain/ discomfort x5 years. Also with depression and fatigue. Currently being treated with tri-cyclic anti-depressants. DIG Digestion/ Absorption food not completely digested, exocrine pancreatic function decreased Immune Regulation/ Inflammation serum ttg +, DGP +, and confirmed with endomysial IgA + Gut Microflora normal
45 IBS Case #2 24 yo Female, newly diagnosed with Celiac disease & pancreatic insufficiency i TREATMENT Remove Gluten Replace enzymes 10x USP Pancreatin, take before each meal Repair gut lining L-Glutamine 1000mg TID, increasing to 3000mg TID for 4 weeks.
46 IBS Case #2 24 yo Female, newly diagnosed with Celiac disease & pancreatic insufficiency TREATMENT Pancreatic supplementation until villous atropy (2 o celiac disease) resolves Repair of leaky gut Totally, gluten-free diet lifetime! 6 & 12 weeks Symptoms significantly improved Intermittent dietary 1 year Screen for auto-immune diseases
47 IBS Case #3 48yo Female with a history of depression and intermittent abdominal pain with cramping over the past 6 months. DIG Digestion/ Absorption no problems Immune Regulation/ Inflammation significant elevation in neutrophilic markers of inflammation, Calprotectin = 378! Gut Microflora no alterations in bacteria, no parasites present, no C. difficile
48 IBS Case #3 48yo Female with a history of depression and dintermittent itt tabdominal pain with cramping over the past 6 months. TREATMENT Referred for colonoscopy must determine source of significantly elevated inflammation: Inflammatory Bowel Disease ColoRectal Carcinoma
49 IBS Case #3 48yo Female with a history of depression and intermittent abdominal pain with cramping over the past 6 months. TREATMENT Referred for colonoscopy FOLLOW-UP Ulcerative Colitis noted on colonoscopy 5-ASA begun, attempt to spare steroids Hi-dose probiotics to induce remission i
50 Historical 31% Tx 13% Tx 3% Referral 25% Tx 47% Tx 19% Tx
51 The BIG Picture Many conditions start with imbalances in Digestion & Absorption Inflammation & Immune dys-regulation Calprotectin need for referral? Celiac Disease and non-cd gluten sensitivity Gut microbiology (bacteria, parasites, fungus) An excellent starting gpoint for clinicians interested in getting to the root and IBS and GI symptoms, found in nearly 80% of all patients seen!
52
53 Next Two Webinars with Drs. Hanaway and Sult: Wednesday, September 28 th, 4 pm: Systemic disease and increased intestinal permeability-eczema and the 5R program Wednesday, October 5. th, 4 pm: Case Evaluations The last webinar will be a discussion of cases that participants submit. Cases must be submitted to Dan Lukaczer (danlukaczer@fxmed.com) in electronic form using the template no later than Monday, October 3 rd. The template can be found under Dr. Sult s presentation on the CD or on the Course Materials page
Probiotics for the Treatment of Adult Gastrointestinal Disorders
Probiotics for the Treatment of Adult Gastrointestinal Disorders Darren M. Brenner, M.D. Division of Gastroenterology Northwestern University, Feinberg School of Medicine Chicago, Illinois What are Probiotics?
More informationCOMPLETE DIGESTIVE STOOL ANALYSIS - Level 4+
COMPLETE DIGESTIVE STOOL ANALYSIS - Level 4+ MACROSCOPIC DESCRIPTION Result Stool Colour TAN Brown Colour - Brown is the colour of normal stool. Other colours may indicate abnormal GIT conditions. Stool
More informationBacteriology. Mycology. Order Number: DOE DOB: July 17, 2006 Sex: M MRN: None. Rare. Negative. Brown. Negative *NG. Negative
Patient: JOHN DOE DOB: July 17, 2006 ex: M MN: Order Number: Completed: October 26, 2011 eceived: October 14, 2011 Collected: October 12, 2011 5.3 0.9-26.8 U/g 0.3 0.2-3.3 mg/g 0.9 1.3-8.6 micromol/g 12.4
More information7 Reasons You Can t Eat the Foods You Love!
Dr. Susan Plank s Report: 7 Reasons You Can t Eat the Foods You Love! Betsy Coltrain sat feeling miserable on the couch. She had just finished eating dinner and began to feel the uncomfortable fullness,
More informationIt s A Gut Feeling: Abdominal Pain in Children. David Deutsch, MD Pediatric Gastroenterology Rockford Health Physicians
It s A Gut Feeling: Abdominal Pain in Children David Deutsch, MD Pediatric Gastroenterology Rockford Health Physicians Introduction Common Symptom Affects 10-15% of school-aged children Definition (Dr.
More informationSupport Guide. Introduction
Support Guide Introduction This Support Guide is intended to help clinicians understand and use the GI Effects Comprehensive Profile, a select set of fecal biomarkers aimed at identifying key processes
More informationQS114. NICE quality standard for irritable bowel syndrome in adults (QS114)
NICE quality standard for irritable bowel syndrome in adults (QS114) QS114 NICE approved the reproduction of its content for this booklet. The production of this booklet is sponsored by Thermo Fisher Scientific,
More informationPROBIOTICS. what they are and what they can do for you. A patient s guide from your doctor and
PROBIOTICS what they are and what they can do for you A patient s guide from your doctor and Probiotics Products containing probiotics have flooded the market in recent years. As more people seek natural
More informationChronic Diarrhea in Children
Chronic Diarrhea in Children National Digestive Diseases Information Clearinghouse What is chronic diarrhea? Diarrhea is loose, watery stools. Chronic, or long lasting, diarrhea typically lasts for more
More informationCeliac Disease. Donald Schoch, M.D. Ohio ACP Meeting October 17, 2014
Celiac Disease Donald Schoch, M.D. Ohio ACP Meeting October 17, 2014 None to disclose Conflicts of Interest Format Present a case Do a pretest about the evaluation Review case Discuss the questions & answers
More informationDiet and Pancreatic Enzyme Replacement Therapy. Anna Burton Specialist Pancreatic Dietitian Leeds Teaching Hospital NHS Trust
Diet and Pancreatic Enzyme Replacement Therapy Anna Burton Specialist Pancreatic Dietitian Leeds Teaching Hospital NHS Trust Pancreatic cancer Symptoms which affect nutritional status Patient and carers
More informationBile Duct Diseases and Problems
Bile Duct Diseases and Problems Introduction A bile duct is a tube that carries bile between the liver and gallbladder and the intestine. Bile is a substance made by the liver that helps with digestion.
More informationIdentifying Celiac Disease and Gluten Sensitivity with Minimally Invasive Testing
Identifying Celiac Disease and Gluten Sensitivity with Minimally Invasive Testing Enjoy this white paper by Jack A. Maggiore, PhD, MT(ASCP), Assistant Director, Chemistry Laboratory and R&D at Doctor s
More informationProblems of the Digestive System
The American College of Obstetricians and Gynecologists f AQ FREQUENTLY ASKED QUESTIONS FAQ120 WOMEN S HEALTH Problems of the Digestive System What are some common digestive problems? What is constipation?
More informationIRRITABLE BOWEL SYNDROME (IBS)
IRRITABLE BOWEL SYNDROME (IBS) INTRODUCTION IBS is the most commonly diagnosed gastrointestinal condition and is second only to the common cold as a cause of absence from work. An estimated 10 to 20 percent
More informationRespect It. Protect It. Learn More About It.
YOUR DIGESTIVE SYSTEM FUELS YOUR LIFE. Respect It. Protect It. Learn More About It. Digestive disorders can happen to anyone, at any age. The Canadian Digestive Health Foundation (CDHF) estimates 20 million
More informationChronic abdominal pain of childhood
Chronic abdominal pain of childhood Sandra I. Escalera, M.D. ProHealth Physicians Associate Clinical Professor Department of Pediatrics Yale University School of Medicine Objectives Brief overview of approach
More informationIrritable Bowel Syndrome
Irritable Bowel Syndrome National Digestive Diseases Information Clearinghouse National Institute of Diabetes and Digestive and Kidney Diseases NATIONAL INSTITUTES OF HEALTH U.S. Department of Health and
More informationWhat Is Clostridium Difficile (C. Diff)? CLOSTRIDIUM DIFFICILE (C. DIFF)
What Is Clostridium Difficile (C. Diff)? Clostridium difficile, or C. diff for short, is an infection from a bacterium, or bug, that can grow in your intestines and cause bad GI symptoms. The main risk
More informationSCHHS Referral Guidelines. Gastroenterology. February 2015
SCHHS Referral Guidelines Gastroenterology February 2015 Referral Guidelines Gastroenterology Published by SCHHS, February 2015 An electronic version of this document is available at: www.health.qld.gov.au/sunshinecoast
More informationMillions of Americans suffer from abdominal pain, bloating, constipation and diarrhea. Now new treatments can relieve your pain and discomfort.
3888-IBS Consumer Bro 5/8/03 10:38 AM Page 1 TAKE THE IBS TEST Do you have recurrent abdominal pain or discomfort? YES NO UNDERSTANDING IRRITABLE BOWEL SYNDROME A Consumer Education Brochure Do you often
More informationLearning Objectives. Introduction to Medical Careers. Vocabulary: Chapter 16 FACTS. Functions. Organs. Digestive System Chapter 16
Learning Objectives Introduction to Medical Careers Digestive System Chapter 16 Define at least 10 terms relating to the digestive Describe the four functions of the digestive Identify different structures
More informationProposal to Establish the Crohn s and Colitis Center at the University of Miami Miller School of Medicine
Proposal to Establish the Crohn s and Colitis Center at the University of Miami Miller School of Medicine Contents Mission... 1 Background... 2 Services and Programs... 2 Clinical Care... 2 IBD Specialists...
More informationAdams Memorial Hospital Decatur, Indiana EXPLANATION OF LABORATORY TESTS
Adams Memorial Hospital Decatur, Indiana EXPLANATION OF LABORATORY TESTS Your health is important to us! The test descriptions listed below are for educational purposes only. Laboratory test interpretation
More informationEVIDENCE BASED TREATMENT OF CROHN S DISEASE. Dr E Ndabaneze
EVIDENCE BASED TREATMENT OF CROHN S DISEASE Dr E Ndabaneze PLAN 1. Case presentation 2. Topic on Evidence based Treatment of Crohn s disease - Introduction pathology aetiology - Treatment - concept of
More informationIBS. A patient s guide to living with irritable bowel syndrome. a program of the aga institute
IBS A patient s guide to living with irritable bowel syndrome a program of the aga institute IBS Basics Irritable bowel syndrome (IBS) is a common disorder of the intestines with symptoms that include
More informationPathophysiology of Diarrhea
1. Pathophysiology of Diarrhea 2. Case Presentation Page - 1 3. Diarrhea is the too rapid evacuation of too fluid sto... 4. The Amazing Intestines helsenet.info Page - 2 5. : Slide 5 6. Diarrhea helsenet.info
More informationCLINICAL UPDATE. Irritable Bowel Syndrome IBS
CLINICAL UPDATE Irritable Bowel Syndrome IBS 2nd Edition 2003, Reprinted 2006 Digestive Health Foundation 2006 Table of Contents 1 Digestive Health Foundation 2 What Is Irritable Bowel Syndrome? 2 How
More informationMigrene og mikroflora. Linda Mulder, MSc. Vårseminaret 2014
Migrene og mikroflora Linda Mulder, MSc. Vårseminaret 2014 Contents Introduction to migraine Introduction to intestinal barrier The role of the intestine & microbiota in migraine Finding the best probiotic
More informationRheumatoid Arthritis. Treating Inflammation. Sequoia Education Systems, Inc http://www.functionalmedicineuniversity.com 1. How is RA Diagnosed?
Rheumatoid Arthritis Causes, Assessment and Treatment How is RA Diagnosed? The following labs make up the basics of ruling in or out RA. Citrullinated Peptide (anti-ccp) Antibodies Rheumatoid factor Erythrocyte
More informationChoosing the right foods can have a profound impact on your
3 As a result of your program, my blood pressure fell in 6 months from 135/82 to 110/62, my asthma of 30 years totally disappeared, my sinuses cleared up for the first time in my life, my edema went away,
More informationIBS TREATMENT CENTER
IBS TREATMENT CENTER NEWSLETTER JUNE 2010 IN THIS ISSUE 1...Treating Ulcerative Colitis and Crohn s Diseaase 2...Treating UC and Crohn s continued 2...Announcements 3...Annoucements 4...Dr. Wangen s Scheduled
More informationThe Digestive System
School of Social Work The Digestive System Undergraduate researcher: Nancy D. Bergerson (2010). 1 The Digestive System breaks down and absorbs food. When food is eaten, it is not in a form the body can
More informationProbiotics for Gut Health
Probiotics for Gut Health Peter Cartwright MSc MA Human Microbiota Specialist, Probiotics International Ltd. It is widely accepted that probiotics (beneficial microbes) improve the health of the intestine,
More informationFrequently Asked Questions: Ai-Detox
What is Ai-Detox? Frequently Asked Questions: Ai-Detox Ai-Detox is a Chinese herbal medicinal formula, produced using state of the art biotechnology, which ensures the utmost standards in quality and safety.
More informationNICE guideline Published: 2 September 2015 nice.org.uk/guidance/ng20
Coeliac disease: recognition, assessment and management NICE guideline Published: 2 September 2015 nice.org.uk/guidance/ng20 NICE 2015. All rights reserved. Contents Key priorities for implementation...
More informationIrritable Bowel Syndrome
Irritable Bowel Syndrome National Digestive Diseases Information Clearinghouse U.S. Department of Health and Human Services NATIONAL INSTITUTES OF HEALTH What is irritable bowel syndrome (IBS)? Irritable
More informationBlood Testing Protocols. Disclaimer
Blood Testing Protocols / Page 2 Blood Testing Protocols Here are the specific test protocols recommend by Dr. J.E. Williams. You may request these from your doctor or visit www.readyourbloodtest.com to
More informationAntibiotic-Associated Diarrhea, Clostridium difficile- Associated Diarrhea and Colitis
Antibiotic-Associated Diarrhea, Clostridium difficile- Associated Diarrhea and Colitis ANTIBIOTIC-ASSOCIATED DIARRHEA Disturbance of the normal colonic microflora Leading to alterations in bacterial degradation
More informationCOLORECTAL CANCER SCREENING
COLORECTAL CANCER SCREENING By Douglas K. Rex, M.D., FACG & Suthat Liangpunsakul, M.D. Division of Gastroenterology and Hepatology, Department of Medicine Indiana University School of Medicine Indianapolis,
More informationInflammatory Bowel Disease
Inflammatory Bowel Disease Laboratory Support of Diagnosis and Management CLINICAL BACKGROUND Inflammatory bowel disease (IBD), which includes Crohn disease (CD) and ulcerative colitis (UC), is characterized
More informationAmylase and Lipase Tests
Amylase and Lipase Tests Also known as: Amy Formal name: Amylase Related tests: Lipase The Test The blood amylase test is ordered, often along with a lipase test, to help diagnose and monitor acute or
More informationIRRITABLE BOWEL SYNDROME
IRRITABLE BOWEL SYNDROME CONTENTS Digestive Health Foundation What Is? How Big is the Problem? What Causes? Diagnosis of Other Gut Symptoms in Non Gut Symptoms in Differential Diagnosis of How To Manage
More informationNational Digestive Diseases Information Clearinghouse
Diarrhea National Digestive Diseases Information Clearinghouse National Institute of Diabetes and Digestive and Kidney Diseases NATIONAL INSTITUTES OF HEALTH U.S. Department of Health and Human Services
More informationLong Term Use of Antacid Medications Can Cause an Increased Risk for Osteoporosis and Much More
Long Term Use of Antacid Medications Can Cause an Increased Risk for Osteoporosis and Much More By: Jeremie Pederson D.C., C.S.C.S. Many people are concerned about the FDA news release dated May 25, 2010
More informationFirst Name. Profession. Weight lbs. Weight 1 year ago lbs. Min. Adult Weight lbs. at age Maximum Weight lbs. at age
Date Time Dietary consultation involves a health profile whose purpose is not to establish a diagnosis, but rather to determine a client's health status in order to guide his or her weight loss plan. A
More informationNutritional Challenges Unique to Pancreatic Cancer
Nutritional Challenges Unique to Pancreatic Cancer Dena McDowell, MS, RD, CD Registered Dietitian Pancreatic Cancer Program Froedtert & Medical College of Wisconsin Pancreas Endocrine Function Exocrine
More informationTHE DIGESTIVE SYSTEM
THE DIGESTIVE SYSTEM What is digestion? Digestion is the process of breaking down food so that it's small enough to be absorbed and used by the body for energy or in other bodily functions. Digestion involves
More informationLe spectrum des entéropathies
Le spectrum des entéropathies 14:30 Enteropathies Celiac disease GI manifestations of food allergy Eosinophilic gastro-enteropathies Inflammatory Bowel Disease (IBD) Crohn s disease, Ulcerative colitis,
More informationIRRITABLE BOWEL SYNDROME
IRRITABLE BOWEL SYNDROME What is Irritable Bowel Syndrome (IBS)? IBS is one of more than twenty functional gastrointestinal disorders (FGID). These are disorders in which the gastrointestinal (GI) tract
More informationHomeostatic Imbalances of the Digestive System
Homeostatic Imbalances of the Digestive System Sign or Disease Description, Causes, Etc. 1 Abdominal Adhesions Fibrous bands that form between tissues and organs, often as a result of injury during surgery;
More informationDigestive System. About the Digestive System. How Digestion Works
Digestive System The first step in the digestive process happens before we even taste food. Just by smelling that homemade apple pie or thinking about how delicious that ripe tomato is going to be, you
More informationDietary emulsifiers impact the mouse gut microbiota promoting colitis and metabolic syndrome
Dietary emulsifiers impact the mouse gut microbiota promoting colitis and metabolic syndrome Andrew T. Gewirtz et al N A T U R E VOL 519 5 M A R C H 2 0 1 5 Background Incidence of IBD Fact 1: increasing
More informationPeptic Ulcer Disease and Dyspepsia. John M. Inadomi, MD Professor of Medicine UCSF Chief, Clinical Gastroenterology San Francisco General Hospital
Peptic Ulcer Disease and Dyspepsia John M. Inadomi, MD Professor of Medicine UCSF Chief, Clinical Gastroenterology San Francisco General Hospital Case History 49 y/o woman complains of several months of
More informationH. Pylori and Other GI Pathogens
Thank you for joining us for H. Pylori and Other GI Pathogens We will start promptly at 12 noon EST. Please note that until that time, the line will be silent. Thank you! Proudly Hosted by 1. All attendees
More informationMicroscopic Colitis: Collagenous Colitis and Lymphocytic Colitis
Microscopic Colitis: Collagenous Colitis and Lymphocytic Colitis National Digestive Diseases Information Clearinghouse U.S. Department of Health and Human Services NATIONAL INSTITUTES OF HEALTH What is
More informationSymptomspesifikke probiotikum. Linda Mulder, MSc. Vårseminaret 2014
Linda Mulder, MSc. Vårseminaret 2014 Content Background on probiotics Intestinal microbiota & health on 3 levels Indication-specific probiotics Strain-specific characteristics Monostrain vs. multispecies
More informationPHYSIOLOGY AND MAINTENANCE Vol. II Intestinal Microflora - Erkki Eerola, Wen Hua Ling
INTESTINAL MICROFLORA Erkki Eerola Turku University. Department of Medical Microbiology, Turku, Finland. Wen Hua Ling Zhongshan University. Department of Clinical Nutrition, Guangzhou, PRChina Keywords:
More informationAbout Celiac Disease. A document providing answers and references to the most frequently asked questions about Celiac Disease
About Celiac Disease A document providing answers and references to the most frequently asked questions about Celiac Disease FAQ AboutCeliacDisease rev1 Basics What is Celiac Disease? Celiac Disease is
More informationTREATING INFLAMMATORY BOWEL DISEASE (IBD) BACKGROUNDER
Press information for journalists only TREATING INFLAMMATORY BOWEL DISEASE (IBD) BACKGROUNDER Why treat IBD? IBD describes a range of chronic diseases of the gastrointestinal system, encompassing Ulcerative
More informationOverview. Nutritional Aspects of Primary Biliary Cirrhosis. How does the liver affect nutritional status?
Overview Nutritional Aspects of Primary Biliary Cirrhosis Tracy Burch, RD, CNSD Kovler Organ Transplant Center Northwestern Memorial Hospital Importance of nutrition therapy in PBC Incidence and pertinence
More informationDiarrhea National Digestive Diseases Information Clearinghouse
Diarrhea National Digestive Diseases Information Clearinghouse National Institute of Diabetes and Digestive and Kidney Diseases NATIONAL INSTITUTES OF HEALTH Diarrhea Diarrhea loose, watery stools occurring
More informationOmega-3 fatty acids improve the diagnosis-related clinical outcome. Critical Care Medicine April 2006;34(4):972-9
Omega-3 fatty acids improve the diagnosis-related clinical outcome 1 Critical Care Medicine April 2006;34(4):972-9 Volume 34(4), April 2006, pp 972-979 Heller, Axel R. MD, PhD; Rössler, Susann; Litz, Rainer
More informationMedical Nutrition Therapy for Upper Gastrointestinal Tract Disorders. By: Jalal Hejazi PhD, MSc.
Medical Nutrition Therapy for Upper Gastrointestinal Tract Disorders By: Jalal Hejazi PhD, MSc. Digestive Disorders Common problem; more than 50 million outpatient visits per year Dietary habits and nutrition
More informationChronic Diarrhea. Information and Practical Approaches for Management
Chronic Diarrhea Information and Practical Approaches for Management Chronic diarrhea is a debilitating condition. Many sufferers are homebound, isolated. If you and your physician have run-out of things
More informationCOMMITTEE FOR PROPRIETARY MEDICINAL PRODUCTS (CPMP)
The European Agency for the Evaluation of Medicinal Products Evaluation of Medicines for Human Use London, 19 March 2003 CPMP/EWP/785/97 COMMITTEE FOR PROPRIETARY MEDICINAL PRODUCTS (CPMP) POINTS TO CONSIDER
More informationControlling intestinal microflora with BioHealth, MicroHealth and LactoHealth. Below illustration shows clearly the effects of unbalanced microflora
Controlling intestinal microflora with BioHealth, MicroHealth and LactoHealth Probiotics are products aimed at delivering living bacterial cells to the guts ecosystem of humans and other animals, whereas
More informationNutritional Challenges After Surgery
Nutritional Challenges After Surgery L I N D A P A T A K I M S R D C S O L D C N S C M D A N D E R S O N C A N C E R C E N T E R H O U S T O N, T E X A S Objectives Identify the reasons that GIST and its
More informationENZAR FORTE TABLETS. (derived from Pancreatin USP) Sodium tauroglycocholate BPC 65mg (with sugar coating containing essential carminative oils)
ENZAR FORTE TABLETS COMPOSITION Each enteric-coated tablet contains: Amylase activity -15,000 USP units Lipase activity -4,000 USP units Protease activity -15,000 USP units of (derived from Pancreatin
More informationHealing the Gut and Working with Food Allergies Compiled by Peter Brodhead CN From the Book Is your child s brain starving? By Dr. Michael R.
Healing the Gut and Working with Food Allergies Compiled by Peter Brodhead CN From the Book Is your child s brain starving? By Dr. Michael R. Lyon, MD The GI tract has an enormous influence over both the
More informationBSc in Medical Sciences with GASTROENTEROLOGY AND HEPATOLOGY
BSc in Medical Sciences with GASTROENTEROLOGY AND HEPATOLOGY Introduction The BSc in Gastroenterology and Hepatology allows a science-based study of the physiology, cell biology, pathology and pharmacology
More informationStudy of Effects of Probiotic Lactobacilli in Preventing Major Complications in Patients of Liver Cirrhosis
Research Article Study of Effects of Probiotic Lactobacilli in Preventing Major Complications in Patients of Liver Cirrhosis RR. Pawar*, ML. Pardeshi and BB. Ghongane Department of Pharmacology, B.J. Medical
More informationClinical Indicator Ages 19-29 Ages 30-39 Ages 40-49 Ages 50-64 Ages 65+ Frequency of visit as recommended by PCP
SCREENING EXAMINATION & COUNSELING UPMC Health Plan Clinical Indicator Ages 19-29 Ages 30-39 Ages 40-49 Ages 50-64 Ages 65+ Annually Physical Exam and Counseling 1 Blood Pressure 2 At each visit. At least
More informationCrohn's disease and ulcerative colitis
Crohn's disease and ulcerative colitis Summary Crohn s disease and ulcerative colitis are collectively known as inflammatory bowel disease (IBD). Crohn s disease can appear in any part of a person s digestive
More informationGuide To Intestinal Health In Autism Spectrum Disorder
Guide To Intestinal Health In Autism Spectrum Disorder A comprehensive review of intestinal health issues in Autism Spectrum Disorders and the options available for treating them. Authored By Kirkman Labs
More informationCandida and Autism. Healthy Intestinal Flora
of Candida Elimination An effective Candida treatment program ensures that the Candida is not just eliminated, but also corrects underlying imbalances, deficiencies and toxicities that could allow the
More informationIrritable Bowel Syndrome
Irritable Bowel Syndrome National Digestive Diseases Information Clearinghouse U.S. Department of Health and Human Services NATIONAL INSTITUTES OF HEALTH What is irritable bowel syndrome (IBS)? Irritable
More informationCancer Expert Working Group on Cancer Prevention and Screening. Prevention and Screening for Colorectal Cancer
Cancer Expert Working Group on Cancer Prevention and Screening Prevention and Screening for Colorectal Cancer 1 What is colorectal cancer? Colorectum (colon and rectum, or the large bowel or large intestine)
More informationSelective IgA deficiency (slgad) hello@piduk.org 0800 987 8986 www.piduk.org
Selective IgA deficiency (slgad) hello@piduk.org 0800 987 8986 www.piduk.org About this booklet This booklet provides information on selective IgA deficiency (sigad). It has been produced by the PID UK
More informationArthritis and Rheumatology Clinics of Kansas Patient Education. Reactive Arthritis (ReA) / Inflammatory Bowel Disease (IBD) Arthritis
Arthritis and Rheumatology Clinics of Kansas Patient Education Reactive Arthritis (ReA) / Inflammatory Bowel Disease (IBD) Arthritis Introduction: For as long as scientists have studied rheumatic disease,
More informationIrritable Bowel Syndrome
What I need to know about Irritable Bowel Syndrome NATIONAL INSTITUTES OF HEALTH National Digestive Diseases Information Clearinghouse U.S. Department of Health and Human Services What I need to know
More informationLeukapheresis for inflammatory bowel disease
Issue date: June 2005 Leukapheresis for inflammatory bowel disease Understanding NICE guidance information for people considering the procedure, and for the public Information about NICE Interventional
More informationSeriously, talk. tell. test. Celiac Disease.
Seriously, Celiac Disease. talk. If you have celiac disease, your family members might have it too. Talk to them about your experience and how celiac disease runs in families. Tell them the facts. Urge
More informationLaparoscopic Surgery of the Colon and Rectum (Large Intestine) A Simple Guide to Help Answer Your Questions
Laparoscopic Surgery of the Colon and Rectum (Large Intestine) A Simple Guide to Help Answer Your Questions What are the Colon and Rectum? The colon and rectum together make up the large intestine. After
More informationAn Essential Guide to Recovery. Dr. Peter Osborne, D.C., D.A.C.B.N., PSc.D.
An Essential Guide to Recovery Dr. Peter Osborne, D.C., D.A.C.B.N., PSc.D. www.glutenfreesociety.org www.drpeterosborne.com Celiac Disease Rheumatoid Arthritis Bone Loss Osteoporosis Cancer (Lymphoma)
More informationUnderactive Thyroid. What is Hypothyroidism? Symptoms. Causes / Triggers
Hypothyroidism Underactive Thyroid Underactive thyroid, more commonly known as Hypothyroidism, generally develops gradually and many of the symptoms are sufficiently vague, so that many do not even know
More informationResearch in IBD at University of Colorado Denver
Research in IBD at University of Colorado Denver Blair Fennimore, MD Assistant Professor of Medicine Division of Gastroenterology and Hepatology UCH Crohn s and Colitis Center Mucosal Inflammation Program
More informationGastrointestinal Bleeding
Gastrointestinal Bleeding Introduction Gastrointestinal bleeding is a symptom of many diseases rather than a disease itself. A number of different conditions can cause gastrointestinal bleeding. Some causes
More informationFUNCTIONAL BOWEL DISORDERS
FUNCTIONAL BOWEL DISORDERS Contributed by the International Foundation for Functional Gastrointestinal Disorders (IFFGD) and edited by the Patient Care Committee of the ACG. INTRODUCTION Doctors use the
More informationThe Use of Enzymes in Dietary Supplements USP Enzyme Workshop July 8, 2009
The Use of Enzymes in Dietary Supplements USP Enzyme Workshop July 8, 2009 Nena Dockery Introduction and History of Use Commercial production of enzymes for use as digestive aids has an extensive history
More informationLiver, Gallbladder, Exocrine Pancreas KNH 406
Liver, Gallbladder, Exocrine Pancreas KNH 406 2007 Thomson - Wadsworth LIVER Anatomy - functions With disease blood flow becomes obstructed Bile All bile drains into common hepatic duct Liver Bile complex
More informationThe Case of the Concentration Camp Survivor with Diarrhea
The Case of the Concentration Camp Survivor with Diarrhea Ruth DeBusk, PhD, RD Michael Stone, MD, MS Functional Nutrition Course Hollywood, Florida December 2010 Disclosures RUTH DEBUSK, PHD, RD is an
More informationDigestive System Why is digestion important? How is food digested? Physical Digestion and Movement
Digestive System The digestive system is made up of the digestive tract a series of hollow organs joined in a long, twisting tube from the mouth to the anus and other organs that help the body break down
More informationRestore and Maintain treatment protocol
Restore and Maintain treatment protocol Combating inflammation through the modulation of eicosanoids Inflammation Inflammation is the normal response of a tissue to injury and can be triggered by a number
More informationBreath Hydrogen Tests
Breath Hydrogen Tests Breath hydrogen tests are very useful to help plan a low FODMAP diet. The tests have been around for many years - decades, in fact. However they were not regularly used in routine
More informationNon-alcoholic fatty liver disease: Prognosis and Treatment
Non-alcoholic fatty liver disease: Prognosis and Treatment Zachary Henry, M.D. Assistant Professor UVA Gastroenterology & Hepatology October 28, 2015 Overview Case Presentation Prognosis Effects of fibrosis
More informationIrritable bowel syndrome (IBS)
Irritable bowel syndrome (IBS) Kok-Ann Gwee, Uday C Ghoshal* Associate Professor, National University of Singapore, and *Associate Professor, Dept. of Gastroenterology, SGPGI, Lucknow, India Story of a
More information