Irritable bowel syndrome (IBS) is a chronic relapsing disorder of gastrointestinal function, the main features of which are abdominal pain or discomfort and an alteration of the bowel habit. Rome Ⅱ criteria is the most recent international consensus definition for IBS. Rome Ⅱ consensus provides working definitions for constipation-(C-IBS) and diarrhea-predominant (D-IBS) subgroups. Initial management begins with a detailed history taking, including a careful dietary history. The presence of obvious causative factors of stress should be identified. Therapeutic trials may include those of dietary fiber supplementation for C-IBS, dietary manipulation and/or antidiarrheal agents for D-IBS, and antispasmodics for prominent pain. Reassurance of the patient is vital in the initial management. Current approaches to the long-term management of IBS include dietary measures, fiber and bulking agents, antispasmodic agents, antidiarrheal agents, laxatives, psychotroic drugs, and psychological and behavioral therapy. Medications should be prescribed as required, rather than on a regular basis. For moderate or severe abdominal pain, antispasmodics and certain smooth muscle relaxants may be used. These types of drugs are ideally used for a short term during an exacerbation of symptoms. In resistant cases, low-dose antidepressants have been used to treat the abdominal pain of IBS. For diarrhea, loperamide can be used effectively on a p.r.n. basis. For constipation, an increase in dietary fiber and/or dietary fiber supplements should be continued in a long-term basis. If symptoms continue, osmotic laxatives can be tried. Anthraquinone laxatives such as aloe or senna should be avoided in long-term treatment.
Abdominal Pain ; Aloe ; Antidepressive Agents ; Antidiarrheals ; Consensus ; Constipation ; Diarrhea ; Dietary Fiber ; Drug Therapy* ; Humans ; Irritable Bowel Syndrome* ; Laxatives ; Loperamide ; Muscle, Smooth ; Parasympatholytics

No abstract available.
Aged* ; Deglutition Disorders* ; Humans ; Male*

No abstract available.

No abstract available.
Drug Therapy* ; Humans ; Peptic Ulcer*

No abstract available.
Apoptosis* ; Epithelial Cells* ; Helicobacter pylori* ; Helicobacter*

Irritable bowel syndrome (IBS) is a complex disorder characterized by abdominal symptoms including chronic abdominal pain or discomfort and altered bowel habits. The etiology of IBS is multifactorial, as abnormal gut motility, visceral hypersensitivity, disturbed neural function of the brain-gut axis and an abnormal autonomic nervous system are all implicated in disease progression. Based on recent experimental and clinical studies, it has been suggested that additional etiological factors including low-grade inflammation, altered gut microbiota and alteration in the gut immune system play important roles in the pathogenesis of IBS. Therefore, therapeutic restoration of altered intestinal microbiota may be an ideal treatment for IBS. Probiotics are live organisms that are believed to cause no harm and result in health benefits for the host. Clinical efficacy of probiotics has been shown in the treatment or prevention of some gastrointestinal inflammation-associated disorders including traveler's diarrhea, antibiotics-associated diarrhea, pouchitis of the restorative ileal pouch and necrotizing enterocolitis. The molecular mechanisms, as cause of IBS pathogenesis, affected by altered gut microbiota and gut inflammation-immunity are reviewed. The effect of probiotics on the gut inflammation-immune systems and the results from clinical trials of probiotics for the treatment of IBS are also summarized.
Abdominal Pain ; Autonomic Nervous System ; Axis, Cervical Vertebra ; Diarrhea ; Disease Progression ; Enterocolitis, Necrotizing ; Hypersensitivity ; Immune System ; Inflammation ; Insurance Benefits ; Irritable Bowel Syndrome ; Metagenome ; Pouchitis ; Probiotics

According to Rome II criteria, irritable bowel syndrome is defined as a group of functional bowel disorders in which abdominal discomfort or pain is associated with defecation or change in bowel habit and is associated with features of disordered defecation. A diagnosis is based on identifying the consistent symptoms with the exclusion of other organic or functional disorders having similar clinical presentations in a cost-effective manner. A physical examination should be performed on the first visit and on subsequent visits as needed. Two algorithms for the evaluation of patients seen in primary care settings and two other algorithms for patients presenting to gastroenterologists are presented. In general, if Rome II criteria are fulfilled, alarm features are not present, and screening studies from the referring physician are negative, further testing is not needed. Screening studies are recommended when certain historical information is present. In many cases, the therapeutic trial can be undertaken before further diagnostic studies are done and will depend on the symptom subtype and its severity. It needs to be emphasized that patients presenting with typical symptoms and no alarm signs are rarely found to have another diagnosis, supporting the benefit of ongoing care and symptomatic management rather than continued diagnostic evaluation. If initial treatment fails, or certain clinical features emerge requiring further evaluation, studies may be performed by gastroenterologists in specialty centers.
Humans ; Irritable Bowel Syndrome/*diagnosis

The relationship between hiatal hernias and gastroesophageal reflux disease (GERD) has been greatly debated over the past decades, with the importance of hiatal hernias first being overemphasized and then later being nearly neglected. It is now understood that both the anatomical (hiatal hernia) and the physiological (lower esophageal sphincter) features of the gastroesophageal junction play important, but independent, roles in the pathogenesis of GERD, constituting the widely accepted "two-sphincter hypothesis." The gastroesophageal junction is an anatomically complex area with an inherent antireflux barrier function. However, the gastroesophageal junction becomes incompetent and esophageal acid clearance is compromised in patients with hiatal hernia, which facilitates the development of GERD. Of the different types of hiatal hernias (types I, II, III, and IV), type I (sliding) hiatal hernias are closely associated with GERD. Because GERD may lead to reflux esophagitis, Barrett's esophagus and esophageal adenocarcinoma, a better understanding of this association is warranted. Hiatal hernias can be diagnosed radiographically, endoscopically or manometrically, with each modality having its own limitations, especially in the diagnosis of hiatal hernias less than 2 cm in length. In the future, high resolution manometry should be a promising method for accurately assessing the association between hiatal hernias and GERD. The treatment of a hiatal hernia is similar to the management of GERD and should be reserved for those with symptoms attributable to this condition. Surgery should be considered for those patients with refractory symptoms and for those who develop complications, such as recurrent bleeding, ulcerations or strictures.
Adenocarcinoma ; Barrett Esophagus ; Constriction, Pathologic ; Esophageal Sphincter, Lower ; Esophagitis, Peptic ; Esophagogastric Junction ; Gastroesophageal Reflux ; Hemorrhage ; Hernia, Hiatal ; Humans ; Manometry ; Ulcer

No abstract available.
Autonomic Pathways ; Diabetes Mellitus ; Gastroesophageal Reflux

We had experienced 2 cases of acute phlegmonous gastritis confirmed by endoscopy, microbiological study and surgical pathologic findings. The first was a 61- year-old female who had been diagnosed as the communicating hydrocephalus and the other was a healthy 60-year-old female. Enterococcus fecalis & Klebsiella pneumoniae, Enterococcus fecalis & E.coli were cultured from the gastric tissue and juice obtained by endoscopy in each patient. In both patients, endoscopic findings showed numerous large ulcers and edema with necrotic material and exudate over the whole stomach. Operation findings were markedly edematous and overall ulcerative mucosa in one patient, and hyperemic outlet stricture in the other. Pathologic findings were acute necrotizing inflammation, involving the mucosa and submucosal layer, consistent with acute phlegmonous gastritis. After operation and antibiotics therapy, the patients were rapidly improved. We reported 2 cases of acute phlegmonous gastritis with the review of literature.
Anti-Bacterial Agents ; Cellulitis* ; Constriction, Pathologic ; Edema ; Endoscopy ; Enterococcus ; Exudates and Transudates ; Female ; Gastritis* ; Humans ; Hydrocephalus ; Inflammation ; Klebsiella pneumoniae ; Middle Aged ; Mucous Membrane ; Stomach ; Ulcer