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Treatment\tof\tthe\tprimary\tGI\tmanifestations\tappears\tto\tcorrect\tmost\tof\tthe\textraintestinal\tfeatures\tof\nthe\tdisease\tas\twell.\tThe\tmost\teffective\tmedical\tagents\tinclude\tcorticosteroids,\tantiinflammatory\nagents\t(aminosalicylates),\timmunosuppressive\tagents\t(cyclosporine,\tazathioprine,\n\tmercaptopurine),
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mercaptopurine),\nantibiotics\t(ciprofloxacin\tand\tmetronidazole),\tand\tmonoclonal\ttumor\tnecrosis\tfactor\tantagonists\n(anti-TNF),\tand\tinfliximab,\tadalimumab,\tcertolizumab,\tand\tnatalizumab,\tagents\tthat\tinactivate\tone\tof\nthe\tprimary\tinflammatory\tcytokines.\tAnti-TNF\thas\thistorically\tbeen\tused\tin\tsevere\tcases\tof\tCrohn’s
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disease\tand\tfistulas,\tbut\tmore\trecently\tit\thas\tshown\tpromise\tin\tUC\tas\twell\t(\nMao\tet\tal,\t2017\n).\nInvestigations\tof\tvarious\ttreatment\tmodalities\tfor\tthe\tacute\tand\tchronic\tstages\tof\tIBD\tare\tongoing\nand\tinclude\tnew\tforms\tof\texisting\tdrugs\tas\twell\tas\tnew\tagents\ttargeted\tto\tregulate\tproduction\tand
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] |
activity\tof\tcytokines,\teicosanoids,\tor\tother\tmediators\tof\tthe\tinflammatory\tand\tacute-phase\tresponse\n(\nMonteleone\tet\tal,\t2014\n).\nSurgical\tmanagement\nIn\tCrohn’s\tdisease,\tsurgery\tmay\tbe\tnecessary\tto\n\trepair\tstrictures\t(narrowing\tof\tthe\tGI\tlumen)\tor\nremove\tportions\tof\tthe\tbowel\twhen\tmedical\tmanagement\tfails.\tApproximately\t50%\tto\t70%\tof\tpersons
|
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] |
with\tCrohn’s\tdisease\tundergo\tsurgery\trelated\tto\tthe\tdisease.\tSurgery\tdoes\tnot\tcure\tCrohn’s\tdisease,\nand\trecurrence\toften\toccurs\twithin\t1\tto\t3\tyears\tof\tsurgery.\tThe\tchance\tof\tneeding\tsubsequent\nsurgery\tin\tthe\tpatient’s\tlife\tis\tabout\t30%\tto\t70%,\tdepending\n\ton\tthe\ttype\tof\tsurgery\tand\tthe\tage\tat
|
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] |
on\tthe\ttype\tof\tsurgery\tand\tthe\tage\tat\nthe\tfirst\toperation.\tMajor\tresections\tof\tthe\tintestine\tmay\tresult\tin\tvarying\tdegrees\tof\tmalabsorption\nof\tfluid\tand\tnutrients.\tIn\textreme\tcases\tpatients\tmay\thave\textensive\tor\tmultiple\tresections,\tresulting\nin\tshort-bowel\tsyndrome\t(SBS)\tand\tdependence\ton\tPN\tto\tmaintain\tadequate\tnutrient\tintake\tand
|
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] |
hydration\t(see\t\nChapter\t12\n).\nWith\tincreased\tefficacy\tof\tpharmaceutical\n\ttherapies\tfor\tUC,\tthe\tpercentage\tof\tpatients\twho\nundergo\ta\tcolectomy\tto\tremove\tthe\tcolon\tand\tresolve\tthe\tdisease\thas\tdecreased\tover\ttime\t(\nBarnes\tet\nal,\t2019\n).\tIf\tsurgery\tremains\tindicated,\tinflammation\tdoes\tnot\toccur\tin\tthe\tremaining\tGI\ttract.
|
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0.05852779373526573,
0.02150280773639679,
0.07038804143667221,
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] |
which\tspares\tthe\trectum,\tto\tserve\tas\ta\treservoir\tfor\tstool.\tThe\tinternal\tKoch\tpouch\talso\tmay\tbe\tused\n(see\tlater\tin\tthis\tchapter\tfor\tmore\tdetailed\tdescription).\nMedical\tnutrition\ttherapy\nPersons\twith\tIBD\tare\tat\tincreased\trisk\tof\tnutrition\tproblems\n\tfor\ta\thost\tof\treasons\trelated\tto\tthe
|
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] |
for\ta\thost\tof\treasons\trelated\tto\tthe\ndisease\tand\tits\ttreatment.\tThus\tthe\tprimary\tgoal\tis\tto\trestore\tand\tmaintain\tthe\tnutrition\tstatus\tof\tthe\nindividual.\tFoods,\tdietary\tand\tmicronutrient\tsupplements,\tand\tenteral\tand\tparenteral\tnutrition\tmay\nbe\tused\tto\taccomplish\tthat\tmission.\tOral\tdiet\tand\tthe\tother\tmeans\tof\tnutrition\tsupport\tmay\tchange
|
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during\tremissions\tand\texacerbations\tof\tthe\tdisease.\tDiet\tand\n\tspecific\tnutrients\tplay\ta\tsupportive\trole\nin\tmaintaining\tnutrition\tstatus\tand\tlimiting\tsymptom\texacerbations,\tas\twell\tas\tsupporting\tgrowth\tin\npediatric\tpatients.\nIn\tdaily\tlife\tpersons\twith\tIBD\tmay\thave\tintermittent\t“flares”\tof\tthe\tdisease\tcharacterized\tby\tpartial
|
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obstructions,\tnausea,\tabdominal\tpain,\tbloating,\tor\tdiarrhea.\tFoods\tthat\tare\tresponsible\tfor\tsome\tGI\nsymptoms\tin\ta\tnormal,\thealthy\tpopulation\n\t(gas,\tbloating,\tdiarrhea)\tare\tlikely\tto\tbe\ttriggers\tfor\tthe\nsame\tsymptoms\tin\tpatients\twith\tmild\tstages\tof\tIBD\tor\tthose\tin\tremission.\tMany\treport\tspecific,\nindividualized\tfood\tintolerances\t(\nHou\tet\tal,\t2014
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individualized\tfood\tintolerances\t(\nHou\tet\tal,\t2014\n)\tand\tare\tsometimes\tadvised\tto\teliminate\tfoods\tthey\nsuspect\tare\tresponsible\tfor\tthe\tintolerance.\tOften,\tthe\tpatient\tbecomes\tincreasingly\tfrustrated\tas\tthe\ndiet\tbecomes\tprogressively\tlimited\tand\n\tsymptoms\tstill\tdo\tnot\tresolve.\tSince\tmalnutrition\tis\ta
|
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] |
symptoms\tstill\tdo\tnot\tresolve.\tSince\tmalnutrition\tis\ta\nsignificant\trisk\tin\tpatients\twith\tIBD,\tan\toverly\trestrictive\tdiet\tonly\tincreases\tthe\tlikelihood\tof\nmalnutrition\tand\tweight\tloss.\nThere\tis\ta\tgreat\tdeficit\tof\tquality\tcontrolled\tdietary\tclinical\ttrials\tfor\tIBD.\tBecause\tof\tthis,\tno\tsingle
|
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] |
dietary\tregimen\tfor\treducing\tsymptoms\tor\tdecreasing\tflares\thas\tbeen\tfound\tto\tbe\tconclusively\neffective.\n\tThough\tlimited,\tcurrent\tdietary\tresearch\tis\texploring\tthe\tspecific\tcarbohydrate\tdiet,\nantiinflammatory\tdiet,\tlow\tFODMAPs\tdiet,\tand\tothers,\tand\tany\tpotential\tthey\tmay\thave\tto\thelp\npatients\twith\tIBD\t(\nKakodkar\tet\tal,\t2015\n;\t\nOlendzki\tet\tal,\t2014
|
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] |
patients\twith\tIBD\t(\nKakodkar\tet\tal,\t2015\n;\t\nOlendzki\tet\tal,\t2014\n;\t\nPrince\tet\tal,\t2016\n;\t\nBraly\tet\tal,\t2017\n;\nSuskind,\t2016\n).\tAn\timportant\taspect\tof\tdietary\tresearch\tis\tthe\timpact\tof\thow\tthe\tdiet\tacts\tas\tan\nenvironmental\tfactor\n\tthat\tcan\taffect\tthe\tmicrobiome\t(\nLee\tet\tal,\t2015\n;\t\nNishida\tet\tal,\t2018\n).\tFar\tmore
|
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] |
Lee\tet\tal,\t2015\n;\t\nNishida\tet\tal,\t2018\n).\tFar\tmore\ndietary\tresearch\tand\tclinical\ttrials\tare\tneeded\tto\tmake\tany\tspecific\tdietary\trecommendations\tfor\nIBD,\tbut\tthere\tis\tan\texciting\ttrend\tof\tinterest\tbrewing\tin\tthe\tscientific\tcommunity\t(\nLee\tet\tal,\t2016\n).
|
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] |
Lee\tet\tal,\t2016\n).\nThe\tability\tof\tnutrition\tsupport\tas\teither\tPN\tor\tenteral\tnutrition\t(EN)\tto\tinduce\tremission\tof\tIBD\nhas\tbeen\tdebated\n\tfor\tseveral\tyears.\tEvaluation\tis\tconfounded\tby\tthe\tnatural\tcourse\tof\tIBD\twith\nexacerbations\tand\tremissions\tand\tby\tthe\tgenetic\tdiversity\tof\tthe\tpatients.\tEN\tis\tnot\tas\teffective\tas
|
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] |
corticosteroid\ttherapy\tto\tinduce\tremission\tin\tadults\twith\tCrohn’s\tdisease.\tFor\tchildren,\thowever,\tEN\nis\tfar\tmore\teffective\tthan\tthe\tplacebo\tand\tshould\tbe\tconsidered\tas\ta\tprimary\ttherapy.\tEN\tcan\talso\tbe\nused\tto\treverse\tmalnutrition\n\tthat\tcan\toccur\twith\tCrohn’s,\tand\tto\tencourage\tgrowth\tin\tthe\tpediatric\npopulation\t(\nPalmer\tet\tal,\t2017
|
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] |
population\t(\nPalmer\tet\tal,\t2017\n).\tChildren\tcan\talso\tbenefit\tfrom\tEN,\teither\tas\tsole\tsource\tof\tnutrition\nor\tsupplemental\tto\tan\toral\tdiet,\tto\treduce\tdependence\ton\tsteroids\tthat\tmay\taffect\tgrowth\tand\tbone\ndisease.\tComplete\tbowel\trest\tusing\tPN\tis\tnot\tnecessarily\trequired\tbut\tmay\tbe\tused\tin\tthose\twith\ninadequate\tfunctioning\tbowel,
|
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inadequate\tfunctioning\tbowel,\n\tor\tfor\t1\tto\t2\tweeks\tbefore\tsurgery\tin\tmalnourished\tpatients\t(\nPalmer\net\tal,\t2017\n).\tEN\thas\tthe\tpotential\tto\tfeed\tthe\tintestinal\tepithelium\tand\talter\tGI\tflora\tand\tis\tthe\npreferred\troute\tof\tnutrition\tsupport\tin\tpatients\twith\tadequate\tbowel\tlength.\tEN\tmay\ttemper\tsome
|
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] |
elements\tof\tthe\tinflammatory\tprocess,\tserve\tas\ta\tvaluable\tsource\tof\tnutrients\tneeded\tfor\trestoration\nof\tGI\tdefects,\tand\tbe\tsteroid\tsparing\n\t(\nRichman\tand\tRhodes,\t2013\n).\tAvailable\tevidence\tdoes\tnot\nsupport\tthe\tuse\tof\tEN\tas\ta\tfirst-line\ttherapy\tin\tthose\twith\tUC,\tbut\ttolerance\thas\tbeen\tdemonstrated\nduring\tacute\tflares\t(\nPalmer\tet\tal,\t2017\n).
|
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] |
during\tacute\tflares\t(\nPalmer\tet\tal,\t2017\n).\nOverall,\tpatients\tand\tcaretakers\tmust\tbe\tvery\tcommitted\twhen\tusing\tEN\tformulas\tor\ttube\tfeeding\nbecause\tit\ttakes\t4\tto\t8\tweeks\tbefore\tone\tsees\tthe\tclinical\teffects.\tTimely\tnutritional\tsupport\tis\ta\tvital\ncomponent\tof\ttherapy\tto\trestore\tand\tmaintain\tnutritional\thealth.\tMalnutrition\tcompromises\tdigestive
|
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and\tabsorptive\tfunction\tby\tincreasing\tthe\tpermeability\tof\tthe\tGI\ttract\tto\tpotential\tinflammatory\nagents.\tEN\tis\talways\tthe\tpreferred\troute\tover\tPN\twhen\tnutrition\tsupport\tis\tmedically\tindicated\tin\nIBD.\tPN\tis\tnot\tas\tnutritionally\tcomplete,\thas\tincreased\trisk\tof\tinfectious\tcomplications,\tand\tis\tmore
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] |
expensive\tthan\tEN.\tHowever,\tPN\tmay\tbe\trequired\tin\tpatients\twith\tpersistent\tbowel\tobstruction,\nfistulas,\tand\tmajor\tGI\tresections\tthat\tresult\tin\tSBS\twhere\tEN\tis\tnot\tpossible.\nEnergy\tneeds\tof\tpatients\twith\tIBD\tare\tnot\tincreased\t(unless\tweight\tgain\tis\tdesired).\tGenerally,
|
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] |
when\tdisease\tactivity\tincreases\tbasal\tmetabolic\trate,\tphysical\tactivity\tis\tgreatly\tcurtailed,\tand\noverall\tenergy\tneeds,\tare\tnot\n\tsubstantially\tchanged.\tProtein\trequirements\tmay\tbe\tincreased,\ndepending\ton\tthe\tseverity\tand\tstage\tof\tthe\tdisease\tand\tthe\trestoration\trequirements.\tInflammation
|
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] |
and\ttreatment\twith\tcorticosteroids\tinduce\ta\tnegative\tnitrogen\tbalance\tand\tcause\ta\tloss\tof\tlean\nmuscle\tmass.\tProtein\tlosses\talso\toccur\tin\tareas\tof\tinflamed\tand\tulcerated\tintestinal\tmucosa\tvia\ndefects\tin\tepithelial\ttight\tjunctions\t(see\t\nChapter\t37\n).\tTo\tmaintain\tpositive\tnitrogen\tbalance,\t1.3\tto\n1.5\tg/kg/day\tof\tprotein\tis\trecommended.
|
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] |
1.5\tg/kg/day\tof\tprotein\tis\trecommended.\nSupplemental\tvitamins,\tespecially\tfolate,\tB\n6\n,\tand\tB\n12\n,\tmay\tbe\tneeded,\tas\twell\tas\tminerals\tsuch\tas
|
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iron\tand\ttrace\telements\tto\treplace\tstores\tor\tfor\tmaintenance\tbecause\tof\tmaldigestion,\nmalabsorption,\tdrug-nutrient\tinteractions,\tor\tinadequate\tintake\t(\nOwczarek\tet\tal,\t2016\n).\tDiarrhea\tcan\naggravate\tlosses\tof\tzinc,\n\tpotassium,\tand\tselenium.\tPatients\twho\treceive\tintermittent\tcorticosteroids
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may\tneed\tsupplemental\tcalcium\tand\tvitamin\tD.\tPatients\twith\tIBD\tare\tat\tincreased\trisk\tof\tosteopenia\nand\tosteoporosis;\t25-OH\tvitamin\tD\tlevels\tand\tbone\tdensity\tshould\tbe\tmonitored\troutinely\tand\nvitamin\tD\tsupplemented\tappropriately\t(\nHlavaty\tet\tal,\t2015\n).\tOmega-3\tfatty\tacid\tsupplements\tin\nCrohn’s\tdisease\tsignificantly\treduce
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Crohn’s\tdisease\tsignificantly\treduce\n\tdisease\tactivity.\tUse\tof\tomega-3\tfatty\tacids\tor\tfish\toil\nsupplements\tin\tUC\tappears\tto\tresult\tin\ta\tsignificant\tmedication-sparing\teffect,\twith\treductions\tin\ndisease\tactivity\tand\tincreased\ttime\tin\tremission\treported\t(\nFarrukh\tand\tMayberry,\t2014\n).\tUse\tof
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] |
Farrukh\tand\tMayberry,\t2014\n).\tUse\tof\nfoods\tand\tsupplements\tcontaining\tprebiotics\tand\tprobiotic\tsupplements\tcontinues\tto\tbe\tinvestigated\nfor\ttheir\tpotential\tto\talter\tthe\tgut\tmicrobiota;\n\tand\tfurther\tresearch\tis\tindicated\t(\nSinagra\tet\tal,\t2013\n;\nNishida\tet\tal,\t2018\n).
|
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0.03332319110631943,
0.09146244823932648,
0.001565894577652216
] |
Sinagra\tet\tal,\t2013\n;\nNishida\tet\tal,\t2018\n).\nDuring\tacute\tand\tsevere\texacerbations\tof\tthe\tdisease,\tthe\tdiet\tis\ttailored\tto\tthe\tindividual\tbut\nusually\tincludes\treduced\tfiber\tintake\tand\tdecaffeinated,\tlow-sugar\tbeverages\tfor\tadequate\thydration\n(\nAcademy\tof\tNutrition\tand\tDietetics\t[AND],\t2019\n).\tIn\tpeople\twith\trapid\tintestinal\ttransit,\textensive
|
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] |
).\tIn\tpeople\twith\trapid\tintestinal\ttransit,\textensive\nbowel\tresections,\tor\n\textensive\tsmall\tbowel\tdisease,\tabsorption\tmay\tbe\tcompromised.\tHere,\texcessive\nintake\tof\tlactose,\tfructose,\tor\tsorbitol\tmay\tcontribute\tto\tabdominal\tcramping,\tgas,\tand\tdiarrhea;\tand
|
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] |
high\tfat\tintake\tmay\tresult\tin\tsteatorrhea.\tHowever,\tthe\tincidence\tof\tlactose\tintolerance\tis\tno\tgreater\nin\tpatients\twith\tIBD\tthan\tin\tthe\tgeneral\tpopulation.\tPatients\twith\tIBD\twho\ttolerate\tlactose\tshould\nnot\tnecessarily\n\trestrict\tlactose-containing\tfoods\tbecause\tthey\tcan\tbe\ta\tvaluable\tsource\tof\thigh-\nquality\tprotein,\tcalcium,\tand\tvitamin\tD.
|
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] |
quality\tprotein,\tcalcium,\tand\tvitamin\tD.\nPatients\twith\tstrictures\tor\tpartial\tbowel\tobstruction\tbenefit\tfrom\ta\treduction\tin\tdietary\tfiber\tor\nlimited\tfood\tparticle\tsize.\tSmall,\tfrequent\tfeedings\tmay\tbe\ttolerated\tbetter\tthan\tlarge\tmeals.\tSmall\namounts\tof\tisotonic\t(having\tthe\tsame\tsolute\tconcentration\tas\tbodily\tfluids),\n\tliquid\toral\tsupplements,
|
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] |
be\tintroduced\tslowly\tto\tavoid\tGI\tdistress.\tHowever,\tthese\tproducts\tare\texpensive\tand\tmay\tbe\tless\neffective\tthan\tmore\tbasic\ttreatments.\nThe\tinformation\ton\tIBD\tavailble\tto\tthe\tgeneral\tpublic\tis\tsometimes\tinaccurate\tor\texaggerated,\tor\tit\nmay\tpertain\tonly\tto\tone\tindividual’s\tsituation\tand\tnot\tto\tanother’s.\tA\tcritical\tcomponent\tof\tpatient
|
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] |
education\tfor\tIBD\tpertains\tto\thelping\twith\tthe\tevaluation\tof\tnutrition\tinformation.\tPatients’\nparticipation\tin\tthe\tmanagement\tof\ttheir\tdisease\tmay\thelp\tto\treduce\n\tnot\tonly\tthe\tsymptoms\tof\tthe\ndisease\tbut\talso\tthe\tassociated\tanxiety\tlevel.\nMicrobiota.\nProbiotic\tfoods\tand\tsupplements\thave\tbeen\tinvestigated\tas\tpotential\ttherapeutic\tagents\tfor\tIBD
|
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because\tof\ttheir\tability\tto\tmodify\tthe\tgut\tmicrobiota\tand\tpotentially\tmodulate\tgut\tinflammatory\nresponse.\tMultistrain\tprobiotic\tsupplements\t(e.g.,\tVSL#3)\thave\tbeen\tshown\tto\tbe\tbeneficial\tin\nmaintaining\tdisease\n\tremission\tin\tpatients\twith\tUC\twho\thad\t\npouchitis\n,\tinflammation\tin\tthe\tileal\npouch\tsurgically\tformed\tafter\tcolectomy\t(\nShen\tet\tal,\t2014
|
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] |
pouch\tsurgically\tformed\tafter\tcolectomy\t(\nShen\tet\tal,\t2014\n).\tSpecific\tprobiotic\tsupplements\tappear\tto\nbe\tuseful\tfor\tinduction\tand\textension\tof\tremissions\tin\tpediatric\tand\tadult\tUC\t(\nGhouri\tet\tal,\t2014\n;\nShen\tet\tal,\t2014\n).\nAlthough\tprobiotics\tappear\tuseful\tin\tUC,\tprobiotic\tstudies\thave\tnot\tdemonstrated\tsignificant\nimprovement
|
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] |
improvement\n\tin\tCrohn’s\tdisease\tactivity\tin\tadults\tor\tpediatric\tpatients,\tnor\tdo\tprobiotic\tsupplements\nappear\tto\tprolong\tremission\tin\tCrohn’s\tdisease\t(\nGhouri\tet\tal,\t2014\n).\tDue\tto\tmany\tconfounding\nfactors\tto\tresearch\tincluding,\tbut\tnot\tlimited\tto,\tmedication\tuse\t(antibiotics,\tproton-pump\tinhibitors,
|
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antidiarrheals),\tvariability\tin\tprobiotic\tquality,\tand\tdifferences\tin\tdietary\tintake\tamong\tparticipants,\nit\thas\n\tyet\tto\tbe\testablished\twhether\tprobiotics\tcould\tbe\tof\tbenefit\tas\tpart\tof\tthe\troutine\ttreatment\tin\nIBD\t(\nAbraham\tand\tQuigley,\t2017\n).\nRegular\tintake\tof\tprebiotic\tfoods\tsuch\tas\toligosaccharides,\tfermentable\tfibers,\tand\tresistant
|
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] |
starches\tcan\tbeneficially\taffect\tthe\tgut\tmicrobiota,\tfeeding\t\nLactobacillus\n\tand\t\nBifidobacteria\n,\tthus\nproviding\tcompetition\tto\tand\ttheoretically\tsuppression\tof\tpathogenic\tor\n\topportunistic\tmicrobiota.\tIn\naddition,\tfermentation\tof\tprebiotics\tleads\tto\tincreased\tproduction\tof\tSCFAs,\ttheoretically\tcreating\ta
|
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more\tacidic\tand\tless\tfavorable\tenvironment\tfor\topportunistic\tbacteria.\nUse\tof\tprobiotics\tand\tprebiotics\tmay\tprevent\tSIBO\tin\tpredisposed\tindividuals\tand\tmay\tbe\tused\tto\ntreat\tdiarrhea.\tAdditional\tstudy\tis\tneeded\tto\tidentify\tthe\tdose,\tthe\tmost\teffective\tprebiotic\tand
|
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] |
probiotic\tfoods,\tthe\tform\tin\twhich\tthey\tcan\tbe\tused\tfor\ttherapeutic\tand\tmaintenance\tpurposes,\tand\ntheir\trelative\tvalue\tcompared\twith\tother\ttherapies\t(\nGhouri\tet\tal,\t2014\n).\nMicroscopic\tcolitis\nInjury\tof\tthe\tcolon\tcaused\tby\tUC,\tCrohn’s\tdisease,\tinfections,\tradiation\tinjury,\tand\tischemic\tinsult\tto
|
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] |
the\tcolon\tpresents\twith\tabnormalities\tsuch\tas\tedema,\tredness,\tbleeding,\tor\tulcerations\tthat\tare\nvisible\ton\tcolonoscopy\texamination.\tUnlike\tthe\tcolitis\tof\tIBD,\t\nmicroscopic\tcolitis\n\tis\tcharacterized\nby\tinflammation\tthat\tis\tnot\tvisible\tby\tinspection\tof\tthe\tcolon\tduring\tcolonoscopy\tand\tis\tapparent\tonly
|
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when\tthe\tcolon’s\tlining\tis\tbiopsied\tand\tthen\texamined\tunder\ta\tmicroscope.\tPatients\twith\tmicroscopic\ncolitis\tcan\thave\tdiarrhea\tfor\tmonths\tor\tyears\tbefore\tthe\tdiagnosis\tis\tmade.\tThe\tcause\tof\tmicroscopic\ncolitis\tis\tunknown.\nPathophysiology\nThere\tare\ttwo\ttypes\tof\tmicroscopic\tcolitis.\tIn\t\nlymphocytic\tcolitis\n,\tthere\tis\tan\taccumulation\tof
|
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] |
lymphocytic\tcolitis\n,\tthere\tis\tan\taccumulation\tof\nlymphocytes\twithin\tthe\tlining\tof\tthe\tcolon.\tIn\t\ncollagenous\tcolitis\n,\tthere\tis\talso\ta\tlayer\tof\tcollagen\n(like\tscar\ttissue)\tjust\tbelow\tthe\tlining.\tSome\texperts\tbelieve\tthat\tlymphocytic\tcolitis\tand\tcollagenous\ncolitis\trepresent\tdifferent\tstages\tof\tthe\tsame\tdisease.
|
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] |
colitis\trepresent\tdifferent\tstages\tof\tthe\tsame\tdisease.\n\tSymptoms\tinclude\tchronic,\twatery\tdiarrhea,\nmild\tabdominal\tcramps,\tand\tpain.\tMore\tthan\t30%\tof\tpatients\treport\tweight\tloss.\tMicroscopic\tcolitis
|
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] |
appears\tmore\tfrequently\tin\tpatients\taged\t60\tto\t70\tyears,\tand\tcollagenous\tcolitis\toccurs\tmore\nfrequently\tin\tfemales\t(\nOhlsson,\t2015\n).\nMedical\tnutrition\ttherapy\nResearch\tis\tunderway\tto\tdetermine\tpossible\teffective\ttreatments\tfor\tmicroscopic\tcolitis,\tincluding
|
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] |
corticosteroids\tand\timmunosuppressive\tagents.\tMedical\tnutrition\ttherapy\tis\tsupportive\twith\tefforts\nto\tmaintain\tweight\tand\tnutrition\tstatus,\tavoid\tsymptom\texacerbation,\tand\tmaintain\thydration,\nsimilar\tto\tthat\tfor\tIBD.\nIrritable\tbowel\tsyndrome\nIrritable\tbowel\tsyndrome\t(IBS)\n\tis\ta\tfunctional\tgastrointestinal\tdisorder\tdefined\tby\tthe\tAmerican
|
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is\ta\tfunctional\tgastrointestinal\tdisorder\tdefined\tby\tthe\tAmerican\nCollege\tof\tGastroenterology\t(ACG)\tIBS\tTask\tForce\tas\t“abdominal\n\tdiscomfort\tassociated\twith\taltered\nbowel\thabits”\t(\nFord\tet\tal,\t2014\n).\tThe\t\nRome\tIV\tcriteria\n\tfor\tIBS\tand\tits\tsubtypes\tare\tused\tto\tdefine\nthe\tdiagnosis\tbased\ton\tthe\tpresence\tof\tGI\tsymptoms\t(\nBox\t27.10
|
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] |
the\tdiagnosis\tbased\ton\tthe\tpresence\tof\tGI\tsymptoms\t(\nBox\t27.10\n).\tIBS\tis\ta\tcondition\tcharacterized\tby\nunexplained\tabdominal\tdiscomfort\tor\tpain\tthat\tis\tassociated\twith\tchanges\tin\tbowel\thabits\n(\nSchoenfeld,\t2016\n).\tOther\tcommon\tsymptoms\tinclude\tgas,\tbloating,\tdiarrhea\n\tand\tconstipation,\tand
|
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] |
and\tconstipation,\tand\nincreased\tGI\tdistress\tassociated\twith\tpsychosocial\tdistress.\tThese\tsymptoms\tmay\tbe\tvague\tand\ntransient,\tmaking\tIBS\ta\tdiagnosis\tof\texclusion.\tIt\tis\tclassified\tas\ta\tfunctional\tdisorder\tbecause\ttests\nshow\tno\thistologic\tabnormalities\tand,\ttherefore,\tdiagnosis\tdepends\ton\tsymptoms.\tThe\tdiagnostic
|
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] |
criteria\talso\tinclude\ta\trefining\tof\tsubtypes\tof\tIBS\tbased\ton\tpredominant\tstool\tpatterns\n\t(\nTable\t27.5\n).\nTABLE\t27.5\nSubtypes\tof\tIrritable\tBowel\tSyndrome\t(IBS)\tBased\ton\tStool\tPatterns\nType\nSymptoms\nIBS\twith\tpredominant\nconstipation\t(IBS-C)\nStool\ttype\t1\tand\t2\tmore\tthan\t25%\nStool\ttype\t6\tand\t7\tless\tthan\t25%\nIBS\twith\tpredominant\tdiarrhea\n(IBS-D)
|
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] |
IBS\twith\tpredominant\tdiarrhea\n(IBS-D)\nStool\ttype\t1\tand\t2\tless\tthan\t25%\nStool\ttype\t6\tand\t7\tmore\tthan\t25%\nIBS\twith\tmixed\tbowel\thabits\t(IBS-\nM)\nStool\ttype\t1\tand\t2\tmore\n\tthan\t25%\nStool\ttype\t6\tand\t7\tmore\tthan\t25%\nUnsubtyped\tIBS\nMeet\tcriteria\tfor\tIBS\tbut\tbowel\thabits\tcannot\tbe\tcategorized\tinto\nIBS-C,\tD,\tor\tM\nData\tfrom\tLacy\tBE,\tet\tal.\tBowel\tDisorders,
|
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] |
IBS-C,\tD,\tor\tM\nData\tfrom\tLacy\tBE,\tet\tal.\tBowel\tDisorders,\t\nGastroenterology\n\t150:1393-1407,\t2016.\nBOX\t27.10\nRome\tIV\tCriteria\tfor\tDiagnosing\tIrritable\tBowel\tSyndrome\n(IBS)\nRome\tIV\tcriteria\tfor\tdiagnosing\tIBS\n*\n:\nRecurrent\tabdominal\tpain,\ton\taverage,\tat\tleast\t1\n\tday/week\tin\tthe\tlast\t3\tmonths,\tassociated\twith\ntwo\tor\tmore\tof\tthe\tfollowing\tcriteria:\n•
|
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] |
two\tor\tmore\tof\tthe\tfollowing\tcriteria:\n•\t\nRelated\tto\tdefecation\n•\t\nAssociated\twith\ta\tchange\tin\tfrequency\tof\tstool\n•\t\nAssociated\twith\ta\tchange\tin\tform\t(appearance)\tof\tstool\n*Criteria\tfulfilled\tfor\tthe\tlast\t3\tmonths\twith\tsymptom\tonset\tat\tleast\t6\tmonths\tbefore\tdiagnosis.\t\nData\tfrom:\tLacy\tBE,\tet\tal.\tBowel\tDisorders.\t\nGastroenterology
|
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] |
Data\tfrom:\tLacy\tBE,\tet\tal.\tBowel\tDisorders.\t\nGastroenterology\n.\t2016;150:1393-1407;\n\tRome\tIII\tDiagnostic\nCriteria\tfor\tFunctional\tGastrointestinal\tDisorders.\nhttp://www.romecriteria.org/assets/pdf/19_RomeIII_apA_885-898.pdf\n;\nhttps://irritablebowelsyndrome.net/clinical/new-rome-iv-diagnostic-criteria/\n.
|
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] |
.\nResearch\tis\tunderway\tto\tbetter\tdefine\tIBS,\twhich\tmay\tbe\treflected\tin\ta\tnew\tname\tfor\tthis\nchallenging\tdisease\tprocess.\nAn\testimated\t10%\tto\t20%\tof\tthe\tUnited\tStates\tpopulation\n\thas\tIBS,\twith\ttwice\tas\tmany\twomen\tas\nmen\tbeing\taffected,\talthough\tthis\tmay\tbe\ta\tfactor\tof\treporting\t(\nKoff\tand\tMullin,\t2012\n).\tThere\tare
|
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] |
Koff\tand\tMullin,\t2012\n).\tThere\tare\nbetween\t2.4\tand\t3.5\tmillion\tannual\tphysician\tvisits\tfor\tIBS\tin\tthe\tUnited\tStates\talone.\tIBS\tis\tthe\nmost\tcommon\tdisorder\tdiagnosed\tby\tgastroenterologists\tand\taccounts\tfor\t20%\tto\t40%\tof\tvisits\n(\nInternational\tFoundation\tfor\tFunctional\tGastrointestinal\tDisorders\t[IFFGD],\t2014\n).\tPatients\twith
|
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] |
).\tPatients\twith\nIBS\toften\tmiss\tschool\tand\twork\tdays,\tresulting\tin\tdecreased\tproductivity,\tincreased\thealth\tcare\ncosts,\tand\tdecreased\tquality\tof\tlife\tas\ta\tresult\tof\ttheir\tsymptoms.\nEtiology\nNo\tspecific\tmarker\tor\ttest\tis\tdiagnostic\tfor\tIBS.\tLactulose\tbreath\ttesting\thas\tbeen\tused\tto\tmeasure
|
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breath\thydrogen\tand\tmethane\tlevels\tresulting\tfrom\tan\tovergrowth\tof\tbacteria\tin\tthe\tsmall\tintestine,\nand\n\tthis\thas\tbeen\tcorrelated\twith\tsome\tcases\tof\tIBS\t(\nRezaie\tet\tal,\t2017\n).\tWhen\tassessing\ta\tpatient\nfor\tIBS,\tthe\tclinician\tmust\tcarefully\treview\tmedication\trecords\tbecause\tnumerous\tover-the-counter
|
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] |
and\tprescribed\tmedications\tcan\tcause\tabdominal\tsymptoms\tsuch\tas\tpain\tand\tchanges\tin\tbowel\nhabits.\tIn\taddition,\tthe\tsymptoms\tof\tIBS\toverlap\twith\tor\tare\tsimilar\tto\tother\tGI\tdiseases\tsuch\tas\tCD,\nIBD,\tfunctional\n\tdyspepsia,\tand\tfunctional\tconstipation.\tIBS\tmay\tbe\tpresent\twith\tCD\tand\tIBD.\tRectal
|
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bleeding,\tiron\tdeficiency\tanemia,\tunintentional\tweight\tloss,\tand\tfamily\thistory\tshould\talso\tbe\nconsidered\twhen\tassessing\tsymptoms\tas\tthey\tare\tnot\tcommon\tfor\tpatients\twith\tIBS\t(\nIreton-Jones,\n2017\n;\t\nChey\tet\tal,\t2015\n).\nPathophysiology\nThe\tpathophysiology\tof\tIBS\tis\tnot\tcompletely\tunderstood.\tSeveral\tfactors\tare\tpresumed\n\tto\tplay\ta
|
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to\tplay\ta\nrole\tin\tthe\tetiology\tof\tIBS,\tincluding\tnervous\tsystem\talterations\t(abnormal\tGI\tmotility\tand\tvisceral\nhypersensitivity),\tgut\tflora\talterations,\tgenetics,\tand\tpsychosocial\tstress\t(\nChey\tet\tal,\t2015\n).\tResearch\ntraditionally\thas\tfocused\ton\tintestinal\tmotility;\thowever,\tstudies\tof\tsmall-bowel\tand\tcolonic\tmotility
|
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show\tinconsistent\tresults\twith\tchanges\tin\tthe\tintestinal\tmicrobiome\tplaying\ta\n\tlarge\trole\tin\tthe\ndevelopment\tof\tIBS\t(\nDupont,\t2014\n).\nSensation\tin\tthe\tGI\ttract\tresults\tfrom\tstimulation\tof\tvarious\treceptors\tand\tsensory\tnerves\tin\tthe\ngut\twall,\twhich\ttransmit\tsignals\tto\tthe\tspinal\tcord\tand\tbrain.\tAlterations\tin\tareas\tof\tthe\tbrain
|
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] |
involved\tin\tpain\tmodulation,\tautonomic\tnervous\tsystem\tdysregulation,\tand\timpaired\tbrain-gut\ncommunication\tresult\tin\thyperalgesia\t(increased\tsensation\n\tto\tpain\tin\tthe\tgut),\tvisceral\nhypersensitivity,\tand\taltered\tmotility\t(\nChey\tet\tal,\t2015\n;\t\nAnastasi\tet\tal,\t2013\n).\tDysregulation\tof
|
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] |
Chey\tet\tal,\t2015\n;\t\nAnastasi\tet\tal,\t2013\n).\tDysregulation\tof\nserotonin\tconcentrations\tin\tthe\tGI\ttract\thas\tbeen\tcorrelated\twith\tthe\ttype\tof\tIBS\ta\tpatient\nexperiences;\tlow\tserotonin\tconcentrations\tare\tassociated\twith\tconstipation\tor\ta\tsluggish\tgut\tand\nhigher\tserotonin\tconcentrations\tare\tassociated\twith\tdiarrhea\tor\tincreased\tperistalsis
|
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] |
in\tthe\tintestine\n(\nKanazawa\tet\tal,\t2011\n;\t\nStasi\tet\tal,\t2014\n).\nOften\tSIBO\tis\tseen\twith\tIBS;\thowever,\tadditional\tstudies\tare\tneeded\tto\tunderstand\twhether\tSIBO\nis\tdirectly\tconnected\tto\tIBS\tor\tis\ta\tseparate\tentity.\tAlthough\ttreatment\tof\tSIBO\tusually\tincludes\nantibiotic\tand\tor\therbal\ttherapy,\tthe\tlow\tFODMAP\tdiet\tis\talso\trecommended\tconcomitantly.
|
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Psychological\tconditions,\tsuch\tas\tdepression\tand\tanxiety,\n\toften\tare\tobserved\tin\tpatients\twith\tIBS.\nAlthough\tit\tis\tunclear\twhether\tstress\tis\ta\tcause\tof\tIBS,\tit\tis\tknown\tto\ttrigger\tand\texacerbate\nsymptoms\t(\nStaudacher,\t2017\n).\tIt\tis\tnot\tunusual\tfor\tpatients\twith\tIBS\tto\tlink\ttheir\tsymptoms\twith\nlifetime\tor\tdaily\tstress\t(
|
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should\tbe\ttailored\tto\thelp\tthe\tpatient\tmanage\tthe\tsymptoms\tand\tthe\tfactors\tthat\tmay\ttrigger\tthem.\nNutrition\ttherapy\tusing\tthe\tFODMAP\telimination\tdiet\tshould\tbe\ta\tprimary\tconsideration\tfor\tIBS.\nGibson\tnoted\tthat\tthe\thigh\tquality\tof\tevidence\tfor\tthe\tFODMAP\telimination\tdiet\tsupports\n\tits\tuse\tas\nfirst-line\ttherapy\t(\nGibson,\t2017b
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its\tuse\tas\nfirst-line\ttherapy\t(\nGibson,\t2017b\n).\tDrug\ttherapy\tis\taimed\tat\tmanagement\tof\tsymptoms\tassociated\nwith\tGI\tmotility,\tvisceral\thypersensitivity,\tor\tpsychological\tissues.\tCombination\therbal\tremedies\tmay\nbe\temployed\tas\twell\tand\thave\tbeen\tfound\tto\tbe\tas\teffective\tas\tantibiotic\ttreatment\t(\nMullin\tet\tal,\n2014
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0.07916989922523499,
0.02713046409189701,
-0.0013848699163645506,
-0.01041567325592041,
0.067141592502594,
0.0932580754160881,
0.10438983887434006,
-0.025315143167972565
] |
Mullin\tet\tal,\n2014\n).\tThe\ttreatment\toption\tis\tusually\tdetermined\tby\tthe\tpredominant\tbowel\tpattern\tand\tthe\nsymptoms\tthat\tmost\tdisrupt\tthe\tpatient’s\tquality\tof\tlife\t(\nTable\t27.6\n).\nTABLE\t27.6\nMedical\tand\tHerbal\tTreatment\tOptions\tfor\tIrritable\tBowel\tSyndrome\t(IBS)\tSymptoms\nSymptom\nTreatment\nAbdominal\tpain\tand\ndiscomfort\nAntispasmodic\tagents
|
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0.05885758996009827,
0.002283352892845869
] |
Symptom\nTreatment\nAbdominal\tpain\tand\ndiscomfort\nAntispasmodic\tagents\nTricyclic\tantidepressants\nSerotonin-directed\tagents\t(selective\tserotonin\treuptake\tinhibitors,\nserotonin-3\treceptor\tantagonists,\tor\tserotonin-4\treceptor\n\tagonists)\nDigestive\tenzymes\nPeppermint\toil\nMelatonin\nConstipation\nFiber\tsupplements:\tpsyllium\thusk,\tsoluble,\tnonfermentable
|
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] |
Fiber\tsupplements:\tpsyllium\thusk,\tsoluble,\tnonfermentable\nStool\tsofteners\nLaxatives\t(osmotic,\ti.e.,\tMg;\tstimulant,\ti.e.,\tsenna)\nDiarrhea\nAntidiarrheal\tagents\t(loperamide,\tdiphenoxylate\twith\tatropine)\nSoluble\tfiber\tsupplements\nSmall\tintestinal\tbacterial\novergrowth\t(SIBO)\nAntibiotics\nHerbal\ttreatments\tincluding\tberberine\n\tand\toregano
|
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] |
Antibiotics\nHerbal\ttreatments\tincluding\tberberine\n\tand\toregano\nElemental\tdiet\t(2-week\ttherapy)\nDigestive\tenzymes\nGlobal\tsymptoms\tand/or\noverall\twell-being\nPsychotherapy\t(cognitive\tbehavioral\ttherapy,\trelaxation\ttherapy,\tgut-directed\nhypnotherapy)\nComplementary\tand\tintegrative\tmedicine\t(acupuncture,\tmeditation,\tstress\nreduction)\nProbiotics
|
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] |
reduction)\nProbiotics\nPrebiotics\t(use\twith\tcaution\tif\tbloating\tis\tpresent)\nData\tfrom\tChey\tW,\tKurlander\tJ,\tEswaran\tS:\n\tIrritable\tbowel\tsyndrome:\ta\tclinical\treview,\t\nJAMA\n\t313(9):949–958,\t2015;\tMullin\tG,\tShepherd\tSJ,\nRoland\tCB,\tet\tal:\tIrritable\tbowel\tsyndrome:\tcontemporary\tnutrition\tmanagement\tstrategies,\t\nJPEN\tJ\tParenter\tEnteral\tNutr
|
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JPEN\tJ\tParenter\tEnteral\tNutr\n\t38(7):781–799,\t2014.
|
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Medical\tnutrition\ttherapy\nThe\tgoals\tof\tnutrition\ttherapy\tfor\tIBS\tare\tto\tensure\tadequate\tnutrient\tintake\tand\texplain\tthe\npotential\troles\tof\tfoods\tin\tthe\tmanagement\n\tof\tsymptoms.\tFirst-line\ttherapy\tto\ttreat\tIBS\tis\tthe\nimplementation\tof\tthe\tFODMAP\telimination\tdiet\tor\tlow\tFOODMAP\tdiet,\twhich\tis\tdefined\tlater\tin\tthis
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] |
chapter.\tBecause\tthe\tsymptoms\tmay\thave\tbeen\tongoing\tfor\ta\tperiod\tof\ttime,\ta\tthorough\tnutrition\nassessment\tshould\tbe\tcompleted\tinitially.\tThis\tshould\tinclude\t(1)\tassessment\tof\tnutritional\tstatus-\nbody\tweight\tstatus,\tloss\tor\tgain,\tand\tfood\tintake;\n\t(2)\treview\tof\tcurrent\tmedications\tfor\tIBS\tand\tother
|
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(2)\treview\tof\tcurrent\tmedications\tfor\tIBS\tand\tother\nmedications;\t(3)\treview\tof\tGI\tsymptoms\t(duration,\tseverity,\tfrequency);\t(4)\treview\tof\tsupplement\nintake\t(vitamins,\tminerals,\tfats,\tpre-\tand\tprobiotics,\therbals);\tand\t(5)\treview\tof\tuse\tof\tmind-body\ntherapies\tand\tthe\tresults\tachieved\t(\nIreton-Jones,\t2017\n;\t\nMullin\tet\tal,\t2014
|
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Ireton-Jones,\t2017\n;\t\nMullin\tet\tal,\t2014\n).\tPresence\tof\tCD\tshould\tbe\nruled\tout\tas\twell\tas\tany\tdisease\tassociated\twith\n\tsymptoms\tsuch\tas\tdelayed\tgastric\temptying\tor\nbleeding,\twhich\tare\tnot\tkey\tsigns\tof\tIBS.\nThe\tFODMAPs\telimination\tdiet\nA\tdiet\tlow\tin\t\nf\nermentable\t\no\nligo,\t\nd\ni,\t&\t\nm\nonosaccharides\tand\t\np\nolyols\t(FODMAP)\thas\tbeen\tshown\tto\tbe
|
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] |
d\ni,\t&\t\nm\nonosaccharides\tand\t\np\nolyols\t(FODMAP)\thas\tbeen\tshown\tto\tbe\nan\teffective\ttherapy\tin\tthe\tmanagement\tof\tGI\tsymptoms\tin\tpatients\twith\tIBS.\tFODMAPs\tare\tmade\tup\nof\tthe\tfermentable\tcarbohydrate\tportion\tof\tplant\tbased\tfoods.\tWhen\tmetabolized\tby\n\tgut\tbacteria,\nFODMAPs\tincrease\tgas\tproduction\tand\tand\tcause\tintestinal\tdysmotility\t(
|
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Ireton-Jones,\t2017\n;\t\nChey\tet\nal,\t2015\n;\t\nMullin,\t2014\n;\t\nShepherd\tand\tGibson,\t2006\n).\tIn\taddition,\tthese\tfoods\tincrease\tluminal\twater\ncontent\tand\tfluid\tstatus\tin\tthe\tGI\ttract.\tWhen\tthese\tare\tlimited\tor\teliminated,\tsymptoms\tare\talso\nreduced\tor\teliminated\tin\tup\tto\t70%\tof\tpeople\twith\tIBS\t(\nGibson,\t2017a\n).\tThis\thas\tbeen\tdemonstrated
|
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] |
Gibson,\t2017a\n).\tThis\thas\tbeen\tdemonstrated\nin\tchildren\tas\twell\t(\nChumpitazi\tet\tal,\t2015\n).\nThe\tlow\t\nFODMAPs\n\tdiet\tlimits\tfoods\tthat\tcontain\tlactose,\tfructose,\tfructo-oligosaccharides\n(fructans),\tgalacto-oligosaccharides\t(galactans),\tand\tpolyols\tor\tsugar\talcohols\t(sorbitol,\txylitol,
|
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] |
mannitol,\tisomaltase,\tand\tmaltitol).\tThese\tshort-chain\tcarbohydrates\tare\tpoorly\tabsorbed\tin\tthe\nsmall\tintestine,\tare\thighly\tosmotic,\tand\tare\trapidly\tfermented\n\tby\tbacteria\tin\tthe\tsmall\tand\tlarge\nintestine,\tresulting\tin\tgas,\tpain,\tand\tdiarrhea\tin\tsensitive\tindividuals.\tFODMAPs\thave\ta\tcumulative
|
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] |
impact\ton\tGI\tsymptoms.\tA\tthreshhold\tlevel\tfor\tacceptable\tamounts\tof\tFODMAPs\thas\tnot\tbeen\twell\ndefined\tand\tis\tlikely\tpatient\tspecific.\tPatients\tmay\ttolerate\tsmall\tamounts,\tbut\tsymptoms\tcan\tdevelop\nif\tthey\tconsume\tquantities\tthat\tsurpass\ttheir\tthreshold.\tLactulose\tbreath\n\ttesting,\tordered\tby\ta
|
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] |
testing,\tordered\tby\ta\nphysician,\tcan\tbe\tuseful\tto\tdemonstrate\tthe\tpresence\tof\tSIBO\tby\tmeasuring\tincreases\tin\tbreath\nhydrogen\tand\tmethane\t(\nRezaie\tet\tal,\t2017\n).\tThese\tgases\tare\tincreased\twhen\tgut\tbacteria\tmetabolize\nFODMAPs,\tespecially\tin\tthe\tsmall\tintestine.
|
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FODMAPs,\tespecially\tin\tthe\tsmall\tintestine.\nNutrition\tintervention\tbegins\twith\telimination\tof\tall\thigh\tFODMAPs\tfoods\tfrom\tthe\tdiet\tfor\ta\ttrial\nperiod\tof\tapproximately\t6\tweeks\talthough\n\tsymptoms\tmay\timprove\twithin\t2\tweeks\t(\nIreton-Jones,\n2017\n;\t\nBarrett,\t2017\n;\t\nCatsos,\t2017\n;\t\nGibson,\t2011\n).\tThe\tchallenge\tor\treintroduction\tphase\tbegins\tafter
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;\t\nGibson,\t2011\n).\tThe\tchallenge\tor\treintroduction\tphase\tbegins\tafter\nthe\telimination\tphase\twith\ta\tslow,\tmethodical,\tor\tcontrolled\treintroduction\tof\tone\tFODMAPs\ncategory\tat\ta\ttime\tto\tobserve\tfor\tsymptoms\tand\tidentify\tthe\tmost\tchallenging\tfoods\t(\nVakil,\t2018\n).\nThe\tgoal\tis\tto\teventually\treduce\tor\teliminate\tGI\tsymptoms
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] |
).\nThe\tgoal\tis\tto\teventually\treduce\tor\teliminate\tGI\tsymptoms\n\tby\tcreating\ta\tdiet\tthat\tincludes\tFODMAPs\nat\tthe\tmost\ttolerable\tintake\tlevel,\tand\twith\tuse\tof\talternative\tfoods.\tIt\tdoes\tnot\tpresent\ta\tcure\tbut\ta\ndietary\tapproach\tto\timprove\tsymptoms\tand\tquality\tof\tlife.\nThe\tkey\tto\tthe\tsuccessful\tFODMAP\telimination\tdiet\tis\tto\twork\twith\tan\tRDN\twho\tis\tvery
|
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] |
knowledgeable\tof\tthe\tdiet\tprinciples.\tThere\tare\tmany\t“lists”\tof\tlow\tFODMAP\tfoods\tavailable,\tand\nthey\tcan\tbe\n\tconfusing\tand\tchallenging\tfor\tthe\tpatient\twho\tis\ttrying\tto\tfollow\tthe\tlow\tFODMAP\tdiet\non\ttheir\town.\tFor\tthis\treason,\tno\tspecific\tlist\tof\tlow\tFODMAP\tfoods\tis\tprovided\tin\tthis\tchapter.
|
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Monash\tUniversity\tis\ta\treliable\tsource\tfor\tFODMAP\tcontent\tof\tfoods\t(\nGibson,\t2017b\n).\tThe\tMonash\nFODMAPs\tapp,\tavailable\ton\tboth\tiPhone\tand\tAndroid,\tis\tconstantly\tbeing\tupdated\tand\tan\texcellent\nresource\tfor\tclinicians\n\tand\tclients.\tMonash\tUniversity\thas\tother\tresources\ton\tthe\tlow\tFODMAP\tdiet\nas\twell.
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as\twell.\nNutritional\tdeficiencies\tthat\tcan\tarise\twith\tthe\tlow\tFODMAPs\tdiet\tinclude\tfolate,\tthiamin,\tvitamin\nB\n6\n,\tand\tfiber\t(from\tlimiting\tcereals\tand\tbreads),\tas\twell\tas\tcalcium\tand\tvitamin\tD\t(if\tavoiding\tall\ndairy\tproducts\tin\taddition\tto\tlactose).\tAn\tRDN\tcan\tprovide\tappropriate\tfood\tsubstitutions\tto\tensure\nan\tadequate\tdiet.
|
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] |
an\tadequate\tdiet.\n\tPatients\tmay\twish\tto\tstay\ton\ta\tlow\tFODMAP\tdiet\tto\tmanage\ttheir\tsymptoms;\nhowever,\tit\tis\timportant\tto\tadd\tother\tfoods\tin\tthe\treintroduction\tphase,\tas\tthese\tmay\thave\tfibers\tand\nother\tkey\tnutrients\twhich\twill\tenhance\toverall\thealth.\nSeveral\tqualified\tdietitians\thave\twritten\tcookbooks\tand\thave\twebsites\tdedicated\tto\tassisting
|
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] |
clients\twith\tthe\tlow\tFODMAP\tdiet.\tTwo\tof\tthese\tare\tPatsy\tCatsos,\tMS,\tRDN\n\tand\tKate\tScarlata,\tRDN.\nA\ttraining\tcourse\thas\tbeen\testablished\tat\tthe\tUniversity\tof\tMichigan\tcalled\tFOOD:\tThe\tMain\tCourse\nto\tDigestive\tHealth,\tand\talso\tat\tMonash\tUniversity\t(available\tonline).\nDiverticular\tdisease
|
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] |
Diverticular\tdisease\nDiverticular\tdisease\tis\tone\tof\tthe\tmost\tcommon\tmedical\tconditions\tamong\tindustrialized\tsocieties.\nDiverticulosis\n\tis\tcharacterized\tby\tthe\tformation\tof\tsac-like\toutpouchings\tor\tpockets\n\t(diverticula)\nwithin\tthe\tcolon\tthat\tform\twhen\tcolonic\tmucosa\tand\tsubmucosa\therniate\tthrough\tweakened\tareas\tin
|
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] |
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