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stringlengths 12
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listlengths 384
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however,\tmore\tthan\t30%\tof\tcases\tare\tidiopathic.\tNumerous\tclasses\tof\tclinical\tconditions\tare\nassociated\twith\tgastroparesis,\tincluding\tacid-peptic\tdiseases,\tgastritis,\tpostgastric\tsurgery,\tdisorder\nof\tgastric\tsmooth\tmuscle,\tpsychogenic\tdisorders,\tlong-term\tuncontrolled\tdiabetes,\tand\tneuropathic\ndisorders.\nPathophysiology
|
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disorders.\nPathophysiology\nClinical\tsymptoms\tmay\tinclude\tabdominal\tbloating,\tdecreased\tappetite\tand\tanorexia,\tnausea\tand\nvomiting,\tfullness,\tearly\tsatiety,\thalitosis,\tand\tpostprandial\thypoglycemia.\tThe\tgold-standard\nmeasure\tof\tgastric\temptying\trate\tis\t\nscintigraphy\n,\ta\tnuclear\ttest\tof\tgastric\temptying.\tThis\tconsists
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] |
scintigraphy\n,\ta\tnuclear\ttest\tof\tgastric\temptying.\tThis\tconsists\nof\tthe\tpatient\tingesting\ta\tradionucleotide-labeled\tmeal\t(such\tas\tan\tegg\tlabeled\t\n90m\ntechnetium),\tand\nscintigraphic\n\timages\tare\ttaken\tover\ttime\t(generally\t4\thours)\tto\tassess\tthe\trate\tof\tgastric\temptying.
|
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] |
Gastric\temptying\tis\tabnormal\twhen\tgreater\tthan\t50%\tof\tthe\tmeal\tis\tretained\tafter\t2\thours\tof\tstudy\nor\twhen\tgreater\tthan\t10%\tof\tthe\tmeal\tis\tretained\tafter\t4\thours.\nMedical\tmanagement\nNumerous\tsymptoms\tof\tgastroparesis\tcan\taffect\toral\tintake,\tand\tthe\tmanagement\tof\tthese\tsymptoms\ngenerally\timproves\tnutrition
|
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] |
generally\timproves\tnutrition\n\tstatus.\tTreatment\tof\tnausea\tand\tvomiting\tis\tperhaps\tthe\tmost\tvital,\tand\nprokinetics\tand\tantiemetics\tare\tthe\tprimary\tmedical\ttherapies\t(see\t\nTable\t26.3\n).\tMetoclopramide\tand\nerythromycin\tare\tmedications\tthat\tmay\tbe\tused\tto\tpromote\tgastric\tmotility.\tSIBO,\tappetite,\tileal
|
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brake\t(the\tslowing\teffect\tof\tintestinal\ttransit\tof\tundigested\tfood,\toften\tfat,\treaching\tthe\tileum),\tor\nformation\tof\ta\t\nbezoar\n\t(concentration\n\tof\tundigested\tmaterial\tin\tthe\tstomach)\tare\tother\tfactors\tthat\nmay\taffect\tnutritional\tstatus.\tIn\ta\tselect\tpatient\tpopulation,\timplantation\tof\tgastric\tpacemakers\tmay
|
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] |
be\tadvantageous\tto\timprove\tgastric\temptying\t(\nRoss\tet\tal,\t2014\n).\nBezoar\tformation\tmay\tbe\trelated\tto\tundigested\tfood\tsuch\tas\tcellulose,\themicellulose,\tlignin\tand\nfruit\ttannins\t(phytobezoars),\tor\tmedications\t(pharmacobezoars)\tsuch\tas\n\tcholestyramine,\tsucralfate,
|
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cholestyramine,\tsucralfate,\nenteric-coated\taspirin,\taluminum-containing\tantacids,\tand\tbulk-forming\tlaxatives.\tTreatment\tof\nbezoars\tincludes\tenzyme\ttherapy\t(such\tas\tpapain,\tbromelain,\tor\tcellulase),\tlavage,\tand\tsometimes\nendoscopic\ttherapy\tto\tmechanically\tbreak\tup\tthe\tbezoar.\tMost\tpatients\trespond\tto\tsome\tcombination
|
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of\tmedication\tand\tdietary\tintervention;\thowever,\tunresponsive\tand\tmore\tsevere\tcases\n\tmay\tbenefit\nfrom\tplacement\tof\tan\tenteral\ttube\tinto\tthe\tsmall\tintestine,\tsuch\tas\ta\tnasoenteric\tsmall\tbowel\tfeeding\ntube\t(for\tless\tthan\t4-week\tneed)\tor\tpercutaneous\tendoscopic\tgastrostomy\twith\tjejunal\textension
|
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(PEG/J)\t(for\tmore\tthan\t4-week\tneed).\tThe\tlatter\tallows\tfor\tnutrition\tto\tbypass\tthe\tstomach\twhile\nproviding\tan\talternative\troute\tfor\tventing\tof\tgastric\tsecretions,\twhich\tmay\trelieve\tnausea\tand\nvomiting.\nMedical\tnutrition\ttherapy\nThe\tprimary\tdietary\tfactors\tthat\taffect\tgastric\temptying\tinclude\tvolume,\tliquids\tversus\tsolids,
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] |
hyperglycemia,\tfiber,\tfat,\tand\tosmolality.\tGenerally,\tpatients\tbenefit\tfrom\tsmaller,\tmore\tfrequent\nmeals,\tas\tlarger\tvolumes\tof\tfood\tthat\tcreate\tstomach\tdistention\tcould\tdelay\tgastric\temptying\tand\nincrease\tsatiety.\tPatients\twith\tgastroparesis\toften\tcontinue\tto\n\tempty\tliquids,\tas\tthey\tempty,\tin\tpart,\nby\tgravity\tand\tdo\tnot\trequire\tantral\tcontraction.
|
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] |
by\tgravity\tand\tdo\tnot\trequire\tantral\tcontraction.\nShifting\tthe\tdiet\tto\tmore\tpureed\tand\tliquefied\tfoods\tis\toften\tuseful.\tA\tnumber\tof\tmedications\t(such\nas\tnarcotics\tand\tanticholinergics)\tslow\tgastric\temptying\tand\tshould\tbe\tavoided\tif\tpossible.\tModerate\nto\tsevere\thyperglycemia\t(serum\tblood\tglucose\tmore\tthan\t200\tmg/dL)\tmay\tacutely\tslow\tgastric
|
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motility,\twith\n\tlong-term\tdetrimental\teffects\ton\tgastric\tnerves\tand\tmotility.\tLaboratory\tdata\nconsidered\tin\tinitial\tassessment\tinclude\tglycosylated\themoglobin\tA1C\t(if\tdiabetes\tis\tpresent),\nferritin,\tvitamin\tB\n12\n,\tand\t25-OH\tvitamin\tD\t(see\t\nChapter\t29\n).\nFiber,\tparticularly\tpectin,\tcan\tslow\tgastric\temptying\tand\tincrease\trisk\tof\tbezoar\tformation\tin
|
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patients\twho\tare\tsusceptible.\tIt\tis\tprudent\tto\tadvise\tpatients\tto\n\tavoid\thigh-fiber\tfoods\tand\tfiber\nsupplements.\tThe\tsize\tof\tthe\tfibrous\tparticles,\tnot\tthe\tamount\tof\tfiber,\tis\tmore\timportant\tin\tbezoar\nrisk\t(e.g.,\tpotato\tskins\tversus\tbran).\tThis\tand\tthe\tresistance\tto\tchewing\tare\tfactors\tin\tbezoar
|
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] |
formation.\tExamination\tof\tthe\tpatient’s\tdentition\tis\tvery\timportant\tbecause\tpatients\twho\thave
|
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missing\tteeth,\ta\tpoor\tbite,\tor\tare\tedentulous\tare\tat\tgreater\trisk.\tEven\tpeople\n\twith\tgood\tdentition\nhave\tswallowed\tand\tpassed\tfood\tparticles\tup\tto\t5\tto\t6\tcm\tin\tdiameter\t(potato\tskins,\tseeds,\ttomato\nskins,\tpeanuts).\nAlthough\tfat\tis\ta\tpowerful\tinhibitor\tof\tstomach\temptying\tprimarily\tmediated\tby\tcholecystokinin,
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0.07070163637399673,
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many\tpatients\ttolerate\tfat\twell\tin\tliquid\tform.\tFat\tshould\tnot\tbe\trestricted\tin\tpatients\twho\tare\nstruggling\tto\tmeet\ttheir\tdaily\tcaloric\tneeds.\n\t\nFocus\tOn\nNew\tGI\tDisorders\tClassified\tby\tRome\tIV\tCriteria\nWith\tthe\tupdated\tRome\tcriteria,\tsome\timportant\tadditions\thave\tbeen\tincluded,\tas\tthey\tfit\tthe\tnew
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definition\tof\tdisorders\tof\tgut-brain\tinteraction\t(DGBIs)\tdue\tto\ttheir\teffect\ton\tthe\tcentral\tnervous\nsystem\t(CNS).\tThese\tconditions\tare\tof\timportant\tnote\tgiven\tthe\tongoing\tuse\tof\topioids\tfor\tpain\nmanagement,\tand\talso\tgiven\tthe\tmore\trecent\tlegalization\n\tand\tincreased\tuse\tof\tmarijuana\tin\tsome\nstates.\tThe\tnew\tdiagnoses\tinclude:\n•
|
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] |
states.\tThe\tnew\tdiagnoses\tinclude:\n•\t\nNarcotic\tbowel\tsyndrome\t(NBS)\tor\topioid-induced\tgastrointestinal\t(GI)\thyperalgesia\tis\nclassified\tas\ta\tcentrally\tmediated\tdisorder\tof\tGI\tpain.\tIronically,\tnarcotics\tcan\tlead\tto\tmore\ndiscomfort\tin\tthose\twith\tfunctional\tGI\tdisorders,\twho\tpresent\twith\tchronic\tor\tfrequent\tpain
|
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] |
nausea,\tbloating,\tperiodic\tvomiting,\tabdominal\n\tdistention,\tand\tconstipation.\tOver\ttime,\tpain\ncan\tworsen\tor\tincompletely\tresolve\twith\tincreased\tdoses\tof\tnarcotics.\n•\t\nOpioid-induced\tconstipation\tis\tclassified\tas\ta\tbowel\tdisorder\tand\tconsidered\tthe\tmost\ncommon\tadverse\tside\teffect\tof\tchronic\topioid\tuse,\tand\tis\ttreated\twith\tmedications\twhen\nsevere.
|
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severe.\n•\t\nCannabinoid\thyperemesis\tsyndrome\n\tis\tclassified\tas\ta\tgastroduodenal\tdisorder\tand\nincluded\twith\n\tother\tnausea\tand\tvomiting\tdisorders.\tIt\tis\ta\tsyndrome\tof\tcyclic\tvomiting\nassociated\twith\tcannabis\tuse,\twith\ta\tcommon\treport\tof\tsymptom\timprovement\twith\thot\nbathing,\tand\trelief\tof\tsymptoms\twith\tcessation\tof\tcannabis\tuse.
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] |
bathing,\tand\trelief\tof\tsymptoms\twith\tcessation\tof\tcannabis\tuse.\nInternational\tFoundation\tfor\tFunctional\tGastrointestinal\tDisorders:\t\nNarcotic\tBowel\tSyndrome\n\t(website),\n2018.\t\nhttps://www.iffgd.org/other-disorders/narcotic-bowel-syndrome.html\n.\tSchmulson\tand\tDrossman,
|
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] |
.\tSchmulson\tand\tDrossman,\n2017;\tSorrenson\tCJ,\tDeSanto\tK\tet\tal:\tCannabinoid\tHyperemesis\tSyndrome:\tDiagnosis,\tPathophysiology,\nand\tTreatment\t–\ta\tSystematic\tReview,\tJ\t\nMed\tToxicol\n\t13(1):71-87,\t2017.\nCLINICAL\tCASE\tSTUDY\nSuzie\tis\ta\t55-year-old\tfemale\twho\tis\treferred\tto\tthe\toutpatient\tclinic\twith\tdumping\tsyndrome\tthat
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gastrointestinal\tdisorders\tis\trequested\tby\ther\tthoracic\tsurgeon\tto\thelp\twith\trelief\tof\tsymptoms.\nNutrition\tassessment\n•\t\nMedical\tHistory:\n\ta\tshort\tbout\twith\tdumping\tsyndrome\tin\t2014\tafter\n\ta\tNissen\tfundoplication\nfor\ta\thiatal\thernia\tthat\tresolved\ta\tshort\tperiod\tafter\tsurgery.\tAfter\ta\tminor\thernia\trepair
|
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] |
surgery\tto\tredo\tthe\tfundoplication\tin\tearly\t2018,\tshe\tbegan\texperiencing\tit\tagain\tbut\twith\nmore\tseverity.\tSymptoms\tinclude\tsudden\tweakness,\tshakiness,\tand\thunger.\tShe\thas\noccasional\tnausea\tduring\tepisodes,\tbut\tno\tvomiting.\tSuzie\talso\thas\ta\tnew\tdiagnosis\tof\ngastroparesis,\tdiscovered\n\tbefore\ther\tsecond\tfundoplication.\tUpon\tdiscovering\tthis,\ther
|
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] |
before\ther\tsecond\tfundoplication.\tUpon\tdiscovering\tthis,\ther\nsurgeon\talso\tdid\ta\tpyloroplasty\tduring\ther\tsecond\tfundoplication\tsurgery\tto\ttry\tand\thelp\nwith\tgastroparesis,\tand\tshe\twill\thave\tanother\tgastric\temptying\tstudy\tin\t3\tmonths.\tOther\nhistory\tincludes\televated\tblood\tpressure\tthat\tshe\treports\tcontrolling\twith\tdiet,\theartburn,
|
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] |
and\tblood\tglucose\tlevels\twithin\tnormal\tlimits\tunless\tshe\tis\thaving\ta\tdumping\n\tepisode,\twhen\nit\tdips\tas\tlow\tas\t30\tmg/dL.\tShe\talso\treports\toccasional\tnumbness\tand\ttingling\tin\ther\thands\nand\tfeet.\n•\t\nMedications:\n\tReglan,\tTums,\tand\tOmeprazole.\n•\t\nNutrition\tHistory:\n\tSuzie\ttravels\tfor\twork\tas\ta\tsales\tmanager\tand\tis\ton\tthe\troad\tconstantly,
|
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chicken.\tShe\tsays\tshe\tis\tnot\topposed\tto\teating\tmeat\tbut\tmostly\tavoids\tcooking\tit.\tShe\tis\topen\nto\tnutrition\trecommendations\n\tand\tarrives\tat\tthe\tappointment\tready\tto\tlearn.\n•\t\nDietary\trecall:\n•\t\nBreakfast:\tShe\thas\tcoffee\twith\tcream\tand\tone\tslice\tof\ttoast\twith\tbutter\tor\tjam\tbefore\nleaving\tto\tdrive\tto\tan\tadjacent\tcity\tfor\ta\tfew\thours\tfor\tmeetings.\n•
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leaving\tto\tdrive\tto\tan\tadjacent\tcity\tfor\ta\tfew\thours\tfor\tmeetings.\n•\t\nSnack:\tIn\tthe\tcar,\tshe\thas\ta\tcooler\tpacked\twith\tapplesauce,\tpeach\tcups,\tor\ta\tbanana,\tof
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27\nMedical\tnutrition\ttherapy\tfor\nlower\tgastrointestinal\ttract\ndisorders\nDeeAnna\tWales\tVanReken,\tMS,\tRDN,\tCD,\tIFNCP,\tRachel\tE.\tKay,\tMS,\tRDN,\tCD,\tCNSC,\tCarol\tS.\tIreton-\nJones,\tPhD,\tRDN,\tLD,\tCNSC,\tFASPEN,\tFAND\nKEY\tTERMS\naerophagia\nantibiotic-associated\tdiarrhea\t(AAD)\nClostridium\tdifficile\t(C.\tdifficile)\n\tinfection\t(CDI)\nceliac\tdisease\t(CD)
|
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] |
infection\t(CDI)\nceliac\tdisease\t(CD)\ncolitis,\tcollagenous\ncolitis,\tlymphocytic\ncolitis,\tmicroscopic\ncolostomy\nconstipation\nCrohn’s\tdisease\ndermatitis\therpetiformis\ndiarrhea\ndietary\tfiber\ndiverticulitis\ndiverticulosis\nenterocutaneous\tfistula\t(ECF)\neructation\nfecal\tmicrobiota\ttransplant\t(FMT)\nfistula\nflatulence\nflatus\nFODMAPs\nfructose\tmalabsorption
|
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] |
fistula\nflatulence\nflatus\nFODMAPs\nfructose\tmalabsorption\nglutamine\ngluten\ngluten\tintolerance\ngluten-sensitive\tenteropathy\ngluten\tsensitivity\nhigh-fiber\tdiet\nhigh-output\n\tstoma\t(HOS)\nhypolactasia\nileal\tJ-pouch\nileal\tpouch\tanal\tanastomosis\t(IPAA)\nileostomy\ninflammatory\tbowel\tdisease\t(IBD)\ninsoluble\tfiber\nintestinal\tostomy
|
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irritable\tbowel\tsyndrome\t(IBS)\nKoch\tpouch\nlactose\tintolerance\nmedium-chain\ttriglycerides\t(MCTs)\nmicrobiota\nneurogenic\tbowel\noral\trehydration\tsolution\t(ORS)\nosmotic\tagents\nostomy\nostomy,\tend\nostomy,\tloop\npolyp\npouchitis\nprebiotic\nprimary\tconstipation\nprobiotic\nproctocolectomy\nrefractory\tceliac\tdisease\nRome\tIV\tcriteria\nshort-bowel\tsyndrome\t(SBS)
|
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refractory\tceliac\tdisease\nRome\tIV\tcriteria\nshort-bowel\tsyndrome\t(SBS)\nshort-chain\tfatty\tacids\t(SCFAs)\nsmall\tintestinal\tbacterial\tovergrowth\t(SIBO)\nsoluble\tfiber\nS-pouch\nsteatorrhea\nstimulant\tlaxatives\nstool\tsofteners\nsynbiotics\ntropical\tsprue\nulcerative\tcolitis\t(UC)\nW-pouch\nThe\tlower\tgastrointestinal\t(GI)\ttract\tis\tdefined\tas\tthe
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symptoms\tand\tto\tcorrect\tnutrient\tdeficiencies.\tA\tcomprehensive\tnutritional\tassessment\tshould\tbe\nperformed\tto\tdetermine\tthe\tnature\tand\tseverity\tof\n\tthe\tGI\tproblem\tto\tdetermine\tthe\tbest\tapproach\nfor\teach\tindividual.\tInformation\tobtained\tshould\tinclude\ta\thistory\tof\tweight\ttrends,\tmedications\tand
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supplements,\tpresence\tof\tGI\tand\tother\tsymptoms\tthat\tmay\taffect\toral\tintake\tor\tfluid\tloss,\tand\npotential\tsigns\tand\tsymptoms\tof\tmicronutrient\tdeficiencies.\nCommon\tintestinal\tproblems\nIt\tis\timportant\tto\tunderstand\tsome\tof\tthe\tcommon\tGI\tprocesses\tthat\n\toccur\tin\thealthy\tpeople\tbefore
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] |
disorders.\nIntestinal\tgas\tand\tflatulence\nPathophysiology\nThe\tdaily\tvolume\tof\thuman\tintestinal\tgas\tis\tabout\t200\tmL,\tand\tit\tis\tderived\tfrom\tcomplex\tphysiologic\nprocesses,\n\tincluding\t\naerophagia\n\t(swallowed\tair)\tand\tbacterial\tfermentation\tby\tthe\tintestinal\ttract.\nIntestinal\tgases\tinclude\tcarbon\tdioxide\t(CO\n2\n),\toxygen\t(O\n2\n),\tnitrogen\t(N\n2
|
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] |
2\n),\toxygen\t(O\n2\n),\tnitrogen\t(N\n2\n),\thydrogen\t(H\n2\n),\tand\nsometimes\tmethane\t(CH\n4\n),\tand\tare\teither\texpelled\tthrough\t\neructation\n\t(belching)\tor\tpassed\trectally\nas\t\nflatus\n.\tDetectable\tlevels\tof\tCH\n4\n\tproduced\tvia\tanaerobic\tfermentation\tby\thuman\tenteric\nmicroflora\tof\tboth\tendogenous\n\tand\texogenous\tcarbohydrates\thave\tbeen\tfound\tin\t30%\tto\t62%\tof
|
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] |
and\texogenous\tcarbohydrates\thave\tbeen\tfound\tin\t30%\tto\t62%\tof\nhealthy\tadult\tindividuals\t(\nSahakian\tet\tal,\t2010\n).\tThis\tremains\tcompelling,\tas\tabnormal\tCH\n4\nproduction\thas\tbeen\tconsidered\tin\tthe\tpathogenesis\tof\tseveral\tintestinal\tdisorders,\tincluding\tcolon\ncancer,\tinflammatory\tbowel\tdisease\t(IBD),\tirritable\tbowel\tsyndrome\t(IBS),\tand\tdiverticulosis
|
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(\nTriantafyllou\tet\tal,\t2014\n).\nWhen\tpatients\tcomplain\n\tabout\t“excessive\tgas”\tor\t\nflatulence\n,\tthey\tmay\tbe\treferring\tto\tincreased\nvolume\tor\tfrequency\tof\tbelching\tor\tpassage\tof\trectal\tgas.\tThey\tmay\talso\tcomplain\tof\tabdominal
|
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distention\tor\tcramping\tassociated\twith\tthe\taccumulation\tof\tgases\tin\tthe\tupper\tor\tlower\tGI\ttract.\tThe\namount\tof\tair\tswallowed\tincreases\twith\teating\tor\tdrinking\ttoo\tfast,\tsmoking,\tchewing\tgum,\tsucking\non\thard\tcandy,\tusing\ta\tstraw,\tdrinking\n\tcarbonated\tdrinks,\tand\twearing\tloose-fitting\tdentures.\tFoods
|
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carbonated\tdrinks,\tand\twearing\tloose-fitting\tdentures.\tFoods\nthat\tproduce\tgas\tin\tone\tperson\tmay\tnot\tcause\tgas\tin\tsomeone\telse,\tdepending\ton\tthe\tmix\tof\nmicroorganisms\tin\tthe\tindividual’s\tcolon.\tInactivity,\tdecreased\tmotility,\taerophagia,\tdietary\ncomponents,\tand\tcertain\tGI\tdisorders\tcan\talter\tthe\tamount\tof\tintestinal\tgas\tand\tindividual\nsymptoms.
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0.054199084639549255,
0.005671781022101641,
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0.0762096419930458,
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0.03250429034233093,
0.03391728922724724,
0.08477873355150223,
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] |
symptoms.\nNormally,\tthe\tconcentration\tof\tbacteria\tin\tthe\tsmall\n\tintestine\tis\tsignificantly\tlower\tthan\tthat\tfound\nin\tthe\tcolon.\tVarious\tconditions\tcan\tlead\tto\tovergrowth\tof\tbacteria\tin\tthe\tsmall\tintestine,\tcausing\nbloating,\tdistention,\tnausea,\tdiarrhea,\tor\tother\tsymptoms.\tIn\ta\tnormally\tfunctioning\tbowel,\tfactors
|
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0.04312527924776077
] |
such\tas\tgastric\tacid,\tintestinal\tperistalsis,\tthe\tileocecal\tvalve,\tbile\tacids,\tthe\tenteric\timmune\tsystem,\nand\tpancreatic\tenzyme\tsecretion\tall\twork\n\tin\tconcert\tto\tprevent\tthe\tovergrowth\tof\tbacteria\twithin\tthe\nsmall\tintestine.\nMedical\tnutrition\ttherapy\nWhen\tevaluating\ta\tpatient,\tclinicians\tmust\tinvestigate\tand\tdifferentiate\tbetween\tincreased
|
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production\tof\tgas\tand\tgas\tthat\tis\tnot\tbeing\tpassed.\tIt\tis\talso\timportant\tto\tconsider\twhy\ta\tpatient\tmay\nhave\tnew\tor\tincreased\tsymptoms\tor\tif\tgas\tis\taccompanied\tby\tother\tsymptoms\tsuch\tas\tconstipation,\ndiarrhea,\tor\tweight\tloss.\tKeeping\ta\tfood\tdiary\tto\ttrack\teating\thabits\tand\tsymptoms\tmay\thelp\tidentify
|
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food\n\twell,\teating\tslowly\tor\tunder\tstressful\tconditions,\tand\teating\tlarge\tamounts\tof\traw\tfoods\tthat\ncould\tbe\tcontributing\tto\texcess\tgas.\nIf\tmilk\tor\tmilk\tproducts\tare\tcausing\tgas,\ta\tpatient\tis\tevaluated\tfor\tlactose\tintolerance\t(see\tdetailed\ndiscussion\tlater\tin\tthis\tchapter\tfor\tmore\tin-depth\tdiscussion\ton\tthis\tcondition)\tand\tadvised\tto\tavoid
|
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milk\tproducts\tfor\ta\tshort\ttime\tto\tsee\tif\tsymptoms\timprove.\n\tRecent\tviral\tor\tGI\tinfection\tmay\tinduce\ntemporary\tor\teven\tpermanent\timpairment\tin\tthe\tability\tto\tdigest\tlactose.\tIf\tintake\tis\tdesired\tor\ndifficult\tto\tavoid\tfor\tsome\treason,\tlactase\ttablets,\tdrops,\tand\tlactose-free\tmilk\tproducts\tare\tavailable\nto\thelp\tdigest\tlactose\tand\treduce\tgas.
|
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to\thelp\tdigest\tlactose\tand\treduce\tgas.\nInactivity,\tconstipation,\tintestinal\tdysmotility,\tor\tpartial\tbowel\tobstruction\tmay\tcontribute\tto\tthe\ninability\tto\n\tmove\tnormal\tamounts\tof\tgas\tproduced.\tFurther,\ta\tsudden\tchange\tin\tdiet,\tsuch\tas\ta\ndrastic\tincrease\tin\tfiber\tintake,\talso\tcan\talter\tgas\tproduction.\tSpecific\tfoods\tthat\tcontain\traffinose\t(a
|
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] |
complex\tsugar\tresistant\tto\tdigestion),\tsuch\tas\tbeans,\tcabbage,\tbroccoli,\tBrussels\tsprouts,\tasparagus,\nand\tsome\twhole\tgrains\tcan\tincrease\tgas\tproduction.\tChanges\tin\tthe\tintestinal\tflora\toccur\tover\ttime\nafter\tan\tincrease\n\tin\tdietary\tfiber.\tA\tgradual\tintroduction\tof\tfiber\twith\tadequate\tfluid\tconsumption\nappears\tto\treduce\tcomplaints\tof\tgas.\t\nBox\t27.1
|
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0.08840548992156982,
0.1122983992099762,
0.0782725140452385,
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] |
appears\tto\treduce\tcomplaints\tof\tgas.\t\nBox\t27.1\n\toutlines\tfoods\tthat\tmay\tcause\tincrease\tin\tgas\nproduction.\nBOX\t27.1\nFoods\tThat\tMay\tIncrease\tIntestinal\tGas\tProduction\n1.\t\nBeans\t(legumes)\n2.\t\nVegetables\tsuch\tas\tbroccoli,\tcauliflower,\tcabbage,\tBrussels\tsprouts,\tonions,\tmushrooms,\nartichokes,\tand\tasparagus\n3.\t\nFruits\tsuch\tas\tpears,\tapples,\tand\tpeaches
|
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] |
3.\t\nFruits\tsuch\tas\tpears,\tapples,\tand\tpeaches\n4.\t\nWhole\tgrains\tsuch\tas\twhole\twheat\tand\tbran\n5.\t\nSodas:\tfruit\tdrinks\tespecially\tapple\tjuice\tand\tpear\tjuice;\tand\tother\tdrinks\tthat\tcontain\thigh-\nfructose\tcorn\tsyrup,\ta\tsweetener\tmade\tfrom\tcorn\n6.\t\nMilk\tand\tmilk\tproducts\tas\twell\tas\tsoft\tcheese,\tice\tcream,\tand\tyogurt\n7.
|
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7.\t\nPackaged\tfoods\tsuch\tas\tbread,\tcereal,\tand\tsalad\tdressing\tthat\tcontain\tsmall\tamounts\tof\nlactose\t(milk\tsugar).\n8.\t\nSugar-free\tcandies\tand\tgums\tthat\tcontain\tsugar\talcohols\tsuch\tas\tsorbitol,\tmannitol,\nerythritol,\tand\txylitol\nFrom\tNational\tInstitute\tof\tDiabetes\tand\tDigestive\tand\tKidney\tDiseases:\t\nDigestive\tDiseases\tA-Z\n\t(website):
|
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] |
Digestive\tDiseases\tA-Z\n\t(website):\nhttp://digestive.niddk.nih.gov/\n.\nConstipation\nConstipation\tis\ta\tmajor\tproblem\tworldwide.\tIn\tthe\tUnited\tStates,\tchronic\tconstipation\tleads\tto\t8\nmillion\n\tvisits\tto\tmedical\tproviders\tper\tyear\t(\nWald,\t2016\n).\tIts\texact\tprevalence\tis\tdifficult\tto\tascertain
|
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] |
Wald,\t2016\n).\tIts\texact\tprevalence\tis\tdifficult\tto\tascertain\nbecause\tonly\ta\tminority\tof\tpatients\tsuffering\tfrom\tconstipation\tseek\thealth\tcare.\tReports\tof\tits\nprevalence\thave\tvaried\twidely,\tranging\tfrom\t0.7%\tto\t29%\tin\tchildren\tand\tfrom\t2.5%\tto\t79%\tin\tadults\n(\nForootan\tet\tal,\t2018\n;\t\nRajindrajith\tet\tal,\t2016
|
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] |
(\nForootan\tet\tal,\t2018\n;\t\nRajindrajith\tet\tal,\t2016\n).\tThis\tworldwide\tvariation\tin\tprevalence\trates\tarises\nfrom\tfactors\tsuch\tas\tcultural\tdiversity;\tgenetic,\tenvironmental,\tand\tsocioeconomic\tconditions;\tand\ndifferent\thealth\tcare\tsystems.\tConstipation\thas\ta\tsignificant\timpact\ton\tquality\tof\tlife,\tand\tit
|
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] |
contributes\tto\thealth\tcare\tfinancial\tburden.\tFemale\tgender\tin\tadults,\tadvancing\tage,\thigh\tbody\tmass\nindex,\tand\tlow\tsocioeconomic\tstatus\tseem\tto\tbe\tassociated\twith\ta\thigher\tprevalence\tof\tconstipation\n(\nForootan\tet\tal,\t2018\n).\nEtiology
|
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Constipation\n\tis\tdefined\tas\tdifficulty\twith\tdefecation\tcharacterized\tby\tinfrequent\tbowel\tmovements\nor\tdyschezia\t(painful,\thard,\tor\tincomplete\tevacuations).\tNormal\tbowel\tmovement\tfrequency\tcan\nrange\tfrom\tthree\ttimes\tper\tday\tto\tthree\ttimes\tper\tweek.\tStool\tweight\tis\tused\tmost\tfrequently\tin
|
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] |
medical\tpractice\tand\tclinical\tdescriptions\tas\tan\tobjective\tmeasure\tof\tthe\tamount\tor\tvolume\tof\tstool.\nA\tvolume\tof\tas\tlittle\tas\t200\tg\tdaily\tis\tconsidered\tnormal\tin\thealthy\tchildren\tand\tadults.\tThe\tBristol\nStool\tScale\t(\nFig.\t27.1\n)\twas\tfirst\tdeveloped\tin\tBristol,\tEngland,\tin\tthe\t1990s\tand\thas\tbeen\tmodified
|
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] |
over\ttime\tbut\tremains\ta\tuseful\treference\tfor\tclinicians\tand\tpatients\tto\tidentify\tstool\tform\tor\nconsistency\t(\nLewis\tand\tHeaton,\t1997\n).\nFIG.\t27.1\nBristol\tStool\tScale\t(Wikimedia\tCommons:\tFile:\tBristolStoolChart.png\t(website),\n\t\nhttps://commons.wikimedia.org/wiki/File:BristolStoolChart.png\n,\tUpdated\tJune\t18,\t2018).
|
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] |
,\tUpdated\tJune\t18,\t2018).\nThe\tcauses\tof\tconstipation\tare\tvaried\tand\tmay\tbe\tmultifactorial.\tInadequate\tfiber\tintake\thas\tbeen\ncited\tas\tthe\tprimary\tculprit\tsince\tthe\tearly\t1970s,\tbut\ttreatment\tof\tthe\tunderlying\tdisorder\tshould\nalways\tbe\tthe\tprimary\n\tcourse\tof\taction.\tIt\tis\talso\timportant\tto\tunderstand\tsymptom\tpatterns\tand
|
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0.02935340441763401,
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] |
classification\tof\tconstipation\tto\ttailor\ttherapy\tbased\ton\tthe\tunderlying\tpathophysiology.\t\nBox\t27.2\noutlines\tfactors\tand\tconditions\tknown\tto\tcause\tconstipation.\nBOX\t27.2\nCauses\tof\tConstipation\nLifestyle\tand\tdiet\nLack\tof\tfiber\tin\tdiet\nLow\ttotal\tcalorie\tand\tfluid\tintake\nIron\tand\tcalcium\tsupplements\nLack\tof\texercise\nImmobility\nLaxative\tabuse
|
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Lack\tof\texercise\nImmobility\nLaxative\tabuse\nPostponing\turge\tto\tdefecate\nDysmotility\tdisorders\nChronic\tintestinal\tpseudoobstruction\nHypothyroidism\nColonic\tinertia\nGastroparesis\nHirschsprung\tdisease\nChagas\tdisease\nMetabolic\tand\tendocrine\tabnormalities\tsuch\tas\tdiabetes
|
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] |
Neurologic\tdiseases\nAmyotrophic\tlateral\tsclerosis\nMultiple\tsclerosis\nMuscular\tdystrophy\nParkinson’s\tdisease\nFriedrich\tataxia\nCerebral\tpalsy\nPara-\tor\tquadriplegia\nSpinal\tcord\tinjury\nCerebrovascular\tdisease\nBrain\ttrauma\nPelvic\tfloor\tdisorders\nPregnancy\nDyssynergic\tdefecation\nChronic\tuse\tof\topiates\nOncology\tpatients\nChronic\tpain\tpatients
|
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] |
Chronic\tuse\tof\topiates\nOncology\tpatients\nChronic\tpain\tpatients\nNarcotic\tbowel\tsyndrome\nOther\tgastrointestinal\tdisorders\nDiseases\tof\tthe\tupper\tgastrointestinal\ttract\nDiseases\tof\tthe\tlarge\tbowel\tresulting\tin:\nFailure\n\tof\tpropulsion\talong\tthe\tcolon\t(colonic\tinertia)\nAnorectal\tmalformations\tor\toutlet\tobstruction
|
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Anorectal\tmalformations\tor\toutlet\tobstruction\nIrritable\tbowel\tsyndrome\t(IBS)\tSmall\tIntestinal\tBacteria\tOvergrowth\t(SIBO)\nAnal\tfissure\nData\tfrom\tAndrews\tCN,\tStorr\tM,\t2011;\tLongstreth\tGF\tet\tal,\t2006;\tSchiller\tLR:\tNutrients\tand\tconstipation:\ncause\tor\tcure?\t\nPract\tGastroenterol\n\t32:4,\t2008.\nPathophysiology\nConstipation\tis\tcategorized
|
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] |
32:4,\t2008.\nPathophysiology\nConstipation\tis\tcategorized\n\tas\teither\tprimary\tor\tsecondary.\t\nPrimary\tconstipation\n,\talso\tknown\tas\nidiopathic\tor\tfunctional\tconstipation,\tis\tcaused\tby\tphysical\tor\tfunctional\tproblems\twhen\tno\nunderlying\tdisorder\tcan\tbe\tidentified\t(\nBarco\tet\tal,\t2015\n).\tThe\tdifferent\tsubtypes\tof\tprimary
|
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] |
Barco\tet\tal,\t2015\n).\tThe\tdifferent\tsubtypes\tof\tprimary\nconstipation\tcan\tbe\tcategorized\tas\tfollows\t(\nAndrews\tand\tStorr,\t2011\n):\n•\t\nNormal-transit\tconstipation:\tThis\tis\tmost\tcommon\tform\tof\tchronic\tconstipation\n\tseen\tby\nclinicians\tand\tis\talso\tknown\tas\tfunctional\tconstipation.\tStool\tpasses\tthrough\tthe\tcolon\tat\ta
|
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rate\tof\tabout\t5\tdays\tin\tpersons\twith\tnormal-transit\tconstipation.\tIn\tfunctional\tconstipation,\npatients\treport\tsymptoms\tthey\tbelieve\tto\tbe\tconsistent\twith\tconstipation\tsuch\tas\tthe\npresence\tof\thard\tstools\tor\ta\tperceived\tdifficulty\twith\tdefecation.\tHowever,\ton\ttesting,\tstool\ntransit\tis\tnot
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transit\tis\tnot\n\tdelayed,\tand\tthe\tstool\tfrequency\tis\toften\twithin\tthe\tnormal\trange.\tPatients\tmay\nexperience\tbloating\tand\tabdominal\tpain\tor\tdiscomfort.\tSymptoms\tof\tfunctional\tconstipation\ntypically\trespond\twith\tdietary\tfiber\talone\tor\twith\tthe\taddition\tof\tan\tosmotic\tagent.\tThe
|
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] |
Rome\tIV\tcriteria\tfor\tthe\tdiagnosis\tof\tfunctional\tconstipation\tis\toutlined\tin\t\nBox\t27.3\n\t(\nSood\nand\tFord,\t2016\n).\n•\t\nSlow\ttransit\tconstipation:\n\tThis\tsubtype\tcauses\tinfrequent\tbowel\tmovements\t(typically\tless\nthan\tonce\tper\tweek).\tOften\tpatients\tdo\tnot\tfeel\tthe\turge\tto\tdefecate\tbut\tmay\tcomplain\tof
|
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associated\tbloating\tand\tabdominal\tdiscomfort.\tSlowing\tof\tintestinal\tcontents\toccurs\tmore\ncommonly\tin\tthe\trectosigmoid\tcolon\tand\tresults\tin\tdecreased\twater\tcontent\tin\tthe\tstool\tand\nreduced\tpropulsive\taction.\tTreatment\ttypically\tuses\tan\taggressive\n\tlaxative\tregimen.\tWhen
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laxative\tregimen.\tWhen\nsevere\tand\tnot\tresolved\tby\tother\tless\tinvasive\ttreatment\toptions,\tselect\tpatients\twith\tslow\ntransit\tconstipation\tmay\talso\tbe\tconsidered\tfor\tsurgical\tprocedures\tsuch\tas\tsubtotal\ncolectomy\tand\tileorectal\tanastomosis.\n•\t\nAnorectal\tdysfunction:\tThis\tsubtype\tis\ta\tresult\tof\tpelvic\tfloor\tmuscle\tlaxity,\timpaired\trectal
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sensation,\tand\tdecreased\tluminal\tpressure\tin\tthe\tanal\tcanal.\n\tFrequently,\tlaxatives\tare\thighly\nineffective\tin\tanorectal\tdysfunction.\tThe\tuse\tof\tbiofeedback\ttherapy\tto\tretrain\tthe\tmuscles\ncan\tbe\tused\tby\tpatients\twith\tconstipation\tcaused\tby\tproblems\tin\tthe\tanorectal\tmuscles.\tIt
|
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uses\ta\tcombination\tof\tdiaphragmatic\tmuscle\ttraining,\tsimulated\tdefecation,\tand\tmanometric\nor\telectromyogram\t(EMG)\tguided\tanal\tsphincter\tand\tpelvic\tmuscle\trelaxation,\twith\ta\tgoal\tof\nimproving\n\trecto-anal\tcoordination\tand\tsensory\tawareness\t(\nLee\tet\tal,\t2014\n).\tThe
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Lee\tet\tal,\t2014\n).\tThe\nmeasurements\tare\tdisplayed\ton\ta\tvideo\tscreen\tas\tline\tgraphs,\tand\tsounds\tindicate\twhen\tthe\npatient\tis\tusing\tthe\tcorrect\tmuscles.
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] |
BOX\t27.3\nRome\tIV\tDiagnostic\tCriteria\tfor\tFunctional\tConstipation\nCriteria\tfulfilled\tfor\tthe\tlast\t3\tmonths,\twith\tsymptom\tonset\tat\tleast\t6\tmonths\tbefore\tdiagnosis\n1.\t\nMust\tinclude\ttwo\tor\tmore\n\tof\tthe\tfollowing:\na.\n\tStraining\tduring\tmore\tthan\t25%\tof\tdefecations\nb.\n\tLumpy\tor\thard\tstools\t(Bristol\tstool\tscale\t1\tto\t2)\tin\tmore\tthan\t25%\tof\tdefecations\nc.
|
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] |
c.\n\tSensation\tof\tincomplete\tevacuation\tfor\tmore\tthan\t25%\tof\tdefecations\nd.\n\tSensation\tof\tanorectal\tobstruction/blockage\tfor\tmore\tthan\t25%\tof\tdefecations\ne.\n\tManual\tmaneuvers\tto\tfacilitate\tmore\tthan\t25%\tof\tdefecations\t(i.e.,\tdigital\tevacuation,\nsupport\n\tof\tthe\tpelvic\tfloor)\nf.\n\tFewer\tthan\tthree\tdefecations\tper\tweek\n2.
|
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] |
of\tthe\tpelvic\tfloor)\nf.\n\tFewer\tthan\tthree\tdefecations\tper\tweek\n2.\t\nLoose\tstools\tare\trarely\tpresent\twithout\tthe\tuse\tof\tlaxatives.\n3.\t\nThere\tare\tinsufficient\tcriteria\tfor\tirritable\tbowel\tsyndrome.\nSood\tR,\tFord\tAC:\tDiagnosis:\trome\tIV\tcriteria\tfor\tFGID’s\t–\tan\timprovement\tor\tmore\tof\tthe\tsame?\t\nNat\tRev\nGastroenterol\tHepatol\n\t13:501–502,\t2016.
|
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] |
Nat\tRev\nGastroenterol\tHepatol\n\t13:501–502,\t2016.\nSecondary\tconstipation\tcan\tresult\tfrom\ta\twide\tvariety\n\tof\tfactors.\tThe\tmost\tcommon\tof\tthese\tare\nlack\tof\tdietary\tfiber,\tinactivity,\tor\tlow\tfluid\tintake.\tOther\tcauses\tcan\tinclude\tbut\tare\tnot\tlimited\tto\nmedications,\tlifestyle,\tmechanical\tblockages\tcaused\tby\tcancers,\tadhesions,\tand\tstrictures,
|
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] |
psychogenic\tfactors\tsuch\tas\tanxiety,\tdepression,\tdementia,\tor\teating\tdisorders,\tor\tmetabolic\nabnormalities\tsuch\tas\telectrolyte\timbalance\tand\tdiabetes.\tConditions\n\tsuch\tas\tobesity,\tpregnancy,\nirritable\tbowel\tsyndrome\t(IBS),\tsmall\tintestinal\tbacteria\tovergrowth\t(SIBO),\tor\tceliac\tdisease\tcan
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also\tcontribute\tto\tsecondary\tconstipation\tand\tshould\tbe\tconsidered\tin\tclinicians\taddressing\tthe\nproblem\t(\nBarco\tet\tal,\t2015\n).\t\nNeurogenic\tbowel\n\tis\ta\ttype\tof\tbowel\tdysfunction\tcaused\tby\tnerve\nmalfunction\tafter\tspinal\tcord\tinjury\tor\tnerve\tdiseases\tincluding\tbut\tnot\tlimited\n\tto\tmultiple\tsclerosis
|
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] |
to\tmultiple\tsclerosis\n(MS)\tor\tamyotrophic\tlateral\tsclerosis\t(ALS)\tthat\tdamages\tnerves\tassociated\twith\tcontrolling\tthe\nlower\tcolon.\tThe\ttwo\tmain\ttypes\tof\tneurogenic\tbowel\tinclude\treflex\t(spastic)\tbowel\tor\tflaccid\tbowel,\nwhich\tboth\tlead\tto\tconstipation\tfor\tvarious\treasons\t(\nCedars\tSinai,\t2018\n)
|
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] |
Cedars\tSinai,\t2018\n)\nIBS\tmay\talso\tbe\tassociated\twith\tchronic\tconstipation.\tA\tlow\tFODMAP\tdiet\tis\toften\thelpful.\tMore\ninformation\n\ton\tIBS\tand\ta\tlow\tFODMAP\tdiet\tis\tfound\tlater\tin\tthis\tchapter.\nMedical\tmanagement\tfor\tadults\nA\tthorough\tand\tmeticulous\thistory\tis\tmost\thelpful\tin\truling\tout\tconstipation\tsecondary\tto
|
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medical\tprofessional\tand\tconsider\ta\ttransition\tto\tsomething\tmilder\tsuch\tas\tmagnesium\tcitrate\twhen\nmedically\tappropriate\tand\treducing\tthe\tlaxative\tdose\tuntil\twithdrawal\tis\tcomplete.\nWhen\tconstipation\tpersists\tdespite\tlifestyle\tand\tdietary\tmodifications,\tmedications\tthat\tpromote\nregular\tbowel\tmovements\tmay\tbe\tprescribed.
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regular\tbowel\tmovements\tmay\tbe\tprescribed.\n\tAgents\tused\tin\tthe\ttreatment\tof\tconstipation\tare\ncategorized\tbroadly\tas\teither\tstool\tsofteners\tor\tstimulants.\n•\t\nStool\tsofteners\n\t(i.e.,\tdocusate\tsodium)\tare\tanionic\tsurfactants\twith\tan\temulsifying\ndetergent-like\tproperty\tthat\tincreases\tthe\twater\tcontent\tin\tstool\tto\tmake\tbowel\tmovements\neasier\tto\tpass.
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easier\tto\tpass.\n•\t\nOsmotic\tagents\n\tsuch\tas\tmagnesium\thydroxide,\tsorbitol,\tlactulose,\tand\tpolyethylene\tglycol\ncontain\tpoorly\tabsorbed\tor\tnonabsorbable\tsugars\tand\twork\tby\tpulling\tfluid\tinto\tthe\nintestinal\tlumen.\n•\t\nStimulant\tlaxatives\n\tsuch\tas\tbisacodyl\tand\tsenna\tincrease\tperistaltic\tcontraction\tand\tbowel
|
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motility\tand\tact\tto\tprevent\twater\tabsorption.\tChronic\tuse\tof\tlaxatives\tis\tassociated\twith\nabdominal\tcramping\tand\tfluid\timbalance.\nLubiprostone\t(Amitiza)\tis\ta\tmedication\tthat\thas\tbeen\tapproved\tby\tthe\n\tFDA\tfor\tidiopathic\nconstipation\tand\tto\ttreat\tIBS\twith\tconstipation\tin\tadults.\tThe\tdrug\tis\ta\tchloride\tchannel\tactivator
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] |
that\tincreases\tintestinal\tfluid\tsecretion\tand\tmobility\twithout\taltering\tsodium\tor\tpotassium\nelectrolytes\t(\nBailes\tand\tReeve,\t2013\n).\tIt\tincreases\tspontaneous\tbowel\tmovements\tbut\tis\ncontraindicated\tin\tpatients\twith\tsuspected\tor\tknown\tmechanical\tGI\tobstruction.\tIt\tis\trecommended\nthat
|
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0.04571748897433281,
0.06831926852464676,
0.08599280565977097,
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] |
that\n\tpatients\ttake\t1500\tto\t2000\tmL\tof\tfluids\tper\tday\tand\ta\thigh-fiber\tdiet\tin\taddition\tto\tthe\nmedication\t(\nPronsky\tet\tal,\t2015\n).\tFurther\tdata\ton\tefficacy\tof\tany\tmedication\tshould\tbe\tevaluated\tas\nnutrition\tintervention,\tpositioning\tfor\tdefecation,\tand\tphysical\ttherapy\tmay\tbe\tequally\tas\teffective.\nMedical\tmanagement\tfor\tinfants\tand\tchildren
|
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] |
Medical\tmanagement\tfor\tinfants\tand\tchildren\nConstipation\tis\toften\tespecially\ttroubling\tin\tinfants\tand\n\tyoung\tchildren.\tApproximately\t3%\tto\t5%\tof\nall\tpediatric\tvisits\tare\trelated\tto\tchronic\tconstipation.\tSome\tpatients\thave\tsymptoms\tthat\tpersist\tfor
|
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] |
6\tmonths\tor\tmore.\tConstipation\tin\tthis\tlife\tstage\tmay\tbe\trelated\tto\tinadequate\tintake\tof\tfiber\tor\tfluid,\nside\teffects\tof\tmedication,\tinactivity,\tor\tdisordered\tbowel\tmotility.\tHistorically,\ta\thigh-fiber\tdiet\thas\nbeen\trecommended\tfor\tchildren\twith\tconstipation,\n\tbut\tfew\tstudies\tdocument\tbenefit\t(\nKranz\tet\tal,\n2012
|
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] |
but\tfew\tstudies\tdocument\tbenefit\t(\nKranz\tet\tal,\n2012\n).\tA\tthorough\thistory\tand\tphysical\texamination,\tparent-child\teducation,\tbehavioral\tand\nnutritional\tintervention,\tand\tappropriate\tuse\tof\tlaxatives\toften\tlead\tto\tdramatic\timprovement.
|
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] |
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