Current Concepts In Colonic Disorders

The 21st Century has seen a resurgence of research of the gastrointestinal tract, especially since it was established that it plays a central role as an immune system organ and consequentially has a huge impact on causation, impact and transmission of most human ailments. New diseases such as the Acquired Immunodeficiency Syndrome, hepatitis and tumours of the gastrointestinal tract have emerged and they are currently subjects of intensive research and topics of scientific papers published worldwide. Old diseases like diarrhea have become extremely complex to diagnose with new and old pathogens, drugs, tumours and malabsorptive disorders accounting for the confusion. This book has set out algorithms on how to approach such conditions in a systematic way both to reach a diagnosis and to make patient management cheaper and more efficient. "Current Concepts in Colonic Disorders" attempts to put all the new information into proper perspective with emphasis on aetiopathogenesis and providing rational approach to management of various old and new diseases. As the book editor, I have found this first edition extremely interesting and easy to understand. Comments on how to improve the content and manner of presentation for future editions are extremely welcome.

Three distinct types of contractions perform colonic motility functions. Rhythmic phasic contractions (RPCs) cause slow net distal propulsion with extensive mixing/turning over. Infrequently occurring giant migrating contractions (GMCs) produce mass movements. Tonic contractions aid RPCs in their motor function. The spatiotemporal patterns of these contractions differ markedly. The amplitude and distance of propagation of a GMC are several-fold larger than those of an RPC. The enteric neurons and smooth muscle cells are the core regulators of all three types of contractions. The regulation of contractions by these mechanisms is modifiable by extrinsic factors: CNS, autonomic neurons, hormones, inflammatory mediators, and stress mediators. Only the GMCs produce descending inhibition, which accommodates the large bolus being propelled without increasing muscle tone. The strong compression of the colon wall generates afferent signals that are below nociceptive threshold in healthy subjects. However, these signals become nociceptive; if the amplitudes of GMCs increase, afferent nerves become hypersensitive, or descending inhibition is impaired. The GMCs also provide the force for rapid propulsion of feces and descending inhibition to relax the internal anal sphincter during defecation. The dysregulation of GMCs is a major factor in colonic motility disorders: irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), and diverticular disease (DD). Frequent mass movements by GMCs cause diarrhea in diarrhea predominant IBS, IBD, and DD, while a decrease in the frequency of GMCs causes constipation. The GMCs generate the afferent signals for intermittent short-lived episodes of abdominal cramping in these disorders. Epigenetic dysregulation due to adverse events in early life is one of the major factors in generating the symptoms of IBS in adulthood.

The 21st Century has seen a resurgence of research of the gastrointestinal tract, especially since it was established that it plays a central role as an immune system organ and consequentially has a huge impact on causation, impact and transmission of most human ailments. New diseases such as the Acquired Immunodeficiency Syndrome, hepatitis and tumours of the gastrointestinal tract have emerged and they are currently subjects of intensive research and topics of scientific papers published worldwide. Old diseases like diarrhea have become extremely complex to diagnose with new and old pathogens, drugs, tumours and malabsorptive disorders accounting for the confusion. This book has set out algorithms on how to approach such conditions in a systematic way both to reach a diagnosis and to make patient management cheaper and more efficient. "Current Concepts in Colonic Disorders" attempts to put all the new information into proper perspective with emphasis on aetiopathogenesis and providing rational approach to management of various old and new diseases. As the book editor, I have found this first edition extremely interesting and easy to understand. Comments on how to improve the content and manner of presentation for future editions are extremely welcome.

This second edition, comprising 28 chapters, explains every aspect of the role of radiographers in performing CT colonography (CTC) and interpreting CTC images with the aim of enabling radiographers to extend the scope of their practice. It provides information required with respect to communication with the patient, procurement of informed consent, the principles of CT as well as dual-energy CT and photon counting CT, radiation dose, patient preparation and positioning, the use of contrast media, the performance of diagnostic and screening CTC studies, the interpretation and reporting of images, legal and professional requirements, and the importance of clinical audits. A wide range of CTC findings is described and depicted, covering normal anatomy, artefacts, haemorrhoids, polyps, colon cancer, diverticular disease, lipomas, extracolonic structures, opportunistic screening for osteoporosis and metabolic associated fatty disease, and CTC in incomplete or failed colonoscopy. The role of other modalities such as ultrasound, magnetic resonance imaging, and nuclear medicine in colorectal cancer patients is discussed. In addition, the text covers the role of artificial intelligence and machine learning in imaging of the colon for the detection of polyps, diagnosis and staging of colorectal cancer. Lastly, a chapter focusing on self-assessment of image interpretation will aid learning. This book provides the support that radiographers need in order to perform CTC studies to the standard required in terms of advances in imaging and interpretation of images.

1 2 MARCEL B. ROBERFROID AND GLENN R. GIBSON 1 Universite Catholique de Louvain, Department of Pharmaceutical Sciences, Avenue Mounier 73, B-1200 Brussels, BELGIUM 2 Food Microbial Sciences Unit, Department of Food Science and Technology, The University of Reading, Reading, UK It is clear that diet fulfils a number of important human requirements. These include the provision of sufficient nutrients to meet the requirements of essential metabolic pathways, as well as the sensory (and social) values associated with eating. It is also evident that diet may control and modulate various body functions in a manner that can reduce the risk of certain diseases. This very broad view of nutrition has led to the development of foodstuffs with added "functionality". Many different definitions of functional foods have arisen. Most of these complicate the simple issue that a functional food is merely a dietary ingredient(s) that can have positive properties above its normal nutritional value. Other terms used to describe such foods include vitafoods, nutraceuticals, pharmafoods, foods for specified health use, health foods, designer foods, etc. Despite some trepidation, the concept has recently attracted much interest through a vast number of articles in both the popular and scientific media.

This book answers key questions asked by emergency clinicians faced with complex gastrointestinal and abdominal pain presentations. Instead of a traditional format that includes epidemiology, pathophysiology, diagnosis, and treatment options, this book takes an approach that mirrors the way clinicians interact with patients – by asking and answering specific clinical care questions. The book is organized into sections by presentation – gastrointestinal bleeding, for example – each of which contains chapters on specific questions, such as “What is the best clinical risk score for low risk GIB patients?” Each clinical question comes with a detailed, evidence-based response and a summary that gives best practices, recommendations, and references. Additionally, at the end of each section is a chapter titled “Expert Corner,” which asks the same clinical questions to a surgical or gastrointestinal specialist and includes key pearls these experts have for emergency medicine practitioners. Gastrointestinal Emergencies: Evidence-Based Answers to Key Clinical Questions is an essential guide for emergency medicine physicians, residents, and medical students who want to review and improve their care of acute gastrointestinal emergencies.

The Scientification of Gastroenterology During the 20th Century * Science contributes to medicine in three ways: It provides a body of relatively secure knowl edge. Some of that knowledge has been applied to develop technologies which have had a major impact upon the practice and effectiveness of medicine. Last, science offers to medicine a way of thinking. - 1. McCormick [(1993) The Contribution of Science to Medicine. Perspect. Bioi. Med. 16,315.] Awareness of the digestive system began with the dawn of civilization, when man, observing the feeding habits of animals in the surrounding environment, experimented with foods, edible and inedible. Identity came with discoveries of the digestive organs during the 16th and 17th centuries. Function was revealed by physiologic studies of digestion, absorp tion and secretion, metabolism, and motility during the 18th and 19th centuries. Diagnostic access improved with the technological advances of the 20th century. Understanding of gas trointestinal (GI) disease followed the growth of the basic sciences and gastroenterology's involvement in scientific research during the latter half of the 20th century. Early in the 20th century, gastroenterology was yet an undefined activity without clinical or scientific guidelines. Diagnostic approach to the digestive tract was minimal. Valid con cepts of disease were lacking. Visceroptosis, sitophobia, and "colonic autointoxication" were common "diagnoses." Therapeutic resources were scarce.

The ASCRS Textbook of Surgery of the Colon and Rectum offers a comprehensive textbook designed to provide state of the art information to residents in training and fully trained surgeons seeking recertification. The textbook also supports the mission of the ASCRS to be the world’s authority on colon and rectal disease. The combination of junior and senior authors selected from the membership of the ASCRS for each chapter will provide a comprehensive summary of each topic and allow the touch of experience to focus and temper the material. This approach should provide the reader with a very open minded, evidence based approach to all aspects of colorectal disease. Derived from the textbook, The ASCRS Manual of Surgery of the Colon and Rectum offers a “hands on” version of the textbook, written with the same comprehensive, evidence-based approach but distilled to the clinical essentials. In a handy pocket format, readers will find the bread and butter information for the broad spectrum of practice. In a consistent style, each chapter outlines the condition or procedure being discussed in a concise outline format – easy to read, appropriately illustrated and referenced.

This book conjoins the latest advances on the use of endoscopy to diagnose, monitor, and treat patients with inflammatory bowel disease. Chapters include the historical use of rigid sigmoidoscopy, non-interventional imaging procedures, and the correlation of pathology and endoscopic visualization. This is the first book to include individual chapters in gastroenterology, colorectal surgery, and IBD texts, the preeminent role of endoscopic imaging in the management of chronic ulcerative colitis, and Crohn's disease. It also includes chapters on capsule endoscopy and balloon and overtube-assisted enteroscopy to define the presence and activity of Crohn's enteritis and additional chapters defining the use of random biopsies versus chromoendoscopy, and computer enhanced imaging to define possible dysplasia development. The book also includes access to online videos, making it the ultimate verbal and visual tool for all medical professionals interested in the advances in the field over the last several decades. Endoscopy in Inflammatory Bowel Disease is a concise text that is of great value to practicing endoscopists, gastroenterologists, general or colorectal surgeons, physicians in training, and all medical professionals caring for patients with inflammatory bowel disease.