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Canadian Credentialing Guidelines for Flexible Sigmoidoscopy. Canadian Journal of Gastroenterology. 22(2): 115-119. February 2008.
Flexible sigmoidoscopy allows direct visualization of the colonic mucosa, from the rectum to the proximal sigmoid and descending colon. This article reviews the Canadian credentialing guidelines for flexible sigmoidoscopy and is designed to be read along with an accompanying article that outlines the principles of credentialing. The author notes that the credentialing guidelines have been set up by the Canadian Association of Gastroenterology (CAG) and are designed as general reference documents that should be considered during both endoscopic training and when individuals are applying for endoscopic privileges at an institution. The author stresses that the technical skills required to perform flexible sigmoidoscopy safely and effectively must be accompanied by a full understanding of the cognitive aspects of the procedure. The article covers the indications for flexible sigmoidoscopy and the need for training in adequate documentation; technical aspects, including the minimum number of procedures to be completed during training, depth of insertion, success rates, adenoma detection and referral for colonoscopy, therapeutic interventions, and complication rates; training issues, including the use of short courses and simulators; and the performance of flexible sigmoidoscopy by different types of health care professionals, including nurses, physician assistants, non-endoscopist physicians, surgeons, and gastroenterologists. The author concludes that because complications of flexible sigmoidoscopy are very rare, any complication merits investigation. The occurrence of two or more complications in one person’s sigmoidoscopy practice may prompt a review of competence, with the possibility that remedial training may be required. 2 tables. 43 references.
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Celiac Disease and the Colon. Practical Gastroenterology. 32(9): 40-45. September 2008.
This article explores the impact of celiac disease on the colon. The author defines celiac disease as an autoimmune enteropathy of the proximal small intestine, triggered by dietary exposure to gluten, a protein of wheat, barley, and rye. Serologic testing for celiac-related autoantibodies has facilitated diagnosis considerably, but diagnosis is still confirmed with intestinal biopsy. The author explores the associations between celiac disease and both inflammatory bowel disease (IBD) and microscopic colitis. One section reviews the likelihood of colon neoplasia in patients with celiac disease. Another section considers the use of diagnosing celiac disease during colonoscopy, determining that celiac disease cannot be excluded by ileal biopsy. One table helps physicians understand the significance of colon pathology, including microscopic colitis, inflammatory bowel disease, and colon neoplasia, in patients with celiac disease. The author recommends that physicians should consider additional pathology in patients who fail to respond to, or who later relapse despite, dietary gluten exclusion. Recurrent diarrhea and anemia in particular should prompt colonoscopy. 2 tables. 34 references.
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Colon Cancer Screening, Surveillance, Prevention, And Therapy Gastroenterology Clinics of North America. 37(1): 1-306. March 2008.
This issue of Gastroenterology Clinics of North America focuses on colon cancer screening, surveillance, prevention, and therapy. The issue includes 15 articles: pathophysiology, clinical presentation, and management of colon cancer; the classification, molecular genetics, natural history, and clinical management of sporadic and syndromic hyperplastic polyps and serrated adenomas of the colon; Lynch syndrome, a type of familial colon cancer syndrome, and familial adenomatous polyposis; the role of diet, chemoprevention, and lifestyle in the prevention of colorectal cancer; the techniques, costs, and barriers to implementation of colon cancer screening; screening for colorectal cancer; the implementation of colonoscopy for mass screening for colon cancer and colonic polyps; the use of mass screening and colonoscopic polypectomy to reduce the incidence and mortality of colon cancer; the current status and future promise of computed tomography (CT) colonography; the surveillance of patients at increased risk of colon cancer, including those with inflammatory bowel disease; the use of endoscopic ultrasound in the diagnosis, staging, and management of colorectal tumors; colonoscopic polypectomy; surgical therapy for colorectal adenocarcinoma; the role of radiation therapy for colorectal cancer; and systemic therapy for colon cancer. Each article is written by experts in the field and includes extensive references. The volume includes numerous full-color illustrations and concludes with a detailed subject index.
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Colon Polyps. JAMA: Journal of the American Medical Association. 300(12): 1480. September 2008.
This brief patient education fact sheet provides information about colon polyps, which are abnormal growths that can occur on the inner surface of the colon. Benign growths are called polyps or adenomas. Polyps can become cancerous, although not all will. Because colon polyps do not usually cause symptoms, people with polyps may not know they have them until they are found during colonoscopy. The fact sheet reviews risk factors, treatment, and prevention strategies for colon polyps. The author describes the use of colonoscopy for diagnosis and treatment—that is, removal—of polyps. Readers are referred to the National Cancer Institute at www.cancer.gov, the American Cancer Society at www.cancer.org, and the American Gastroenterological Association at www.gastro.org for more information. Readers are advised to find other patient education pages on the Journal of the American Medical Association’s website at www.jama.com. One illustration depicts the colonoscopy procedure. The fact sheet is also available in Spanish. 2 figures.
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Colonoscopy. Bethesda, MD: National Digestive Diseases Information Clearinghouse. 2008. 6 p.
This fact sheet describes colonoscopy, a procedure used to see inside the colon and rectum. Colonoscopy can detect inflamed tissue, ulcers, and abnormal growths. The procedure is used to look for early signs of colorectal cancer and can help doctors diagnose unexplained changes in bowel habits, abdominal pain, bleeding from the anus, and weight loss. The fact sheet answers common questions about colonoscopy, including the anatomy and function of the colon and rectum, how to prepare for a colonoscopy, what to expect during and after the procedure, and recommendations for routine screening colonoscopy. Preparation will include the emptying of all solids from the gastrointestinal tract by following a clear liquid diet for 1 to 3 days before colonoscopy. During colonoscopy, a sedative, and possibly pain medication, helps keep patients relaxed. A doctor can remove polyps and biopsy abnormal-looking tissues during colonoscopy. Driving is not permitted for 12 hours after colonoscopy to allow the sedative time to wear off. The fact sheet includes a brief description of current research in this area. Readers are referred to online publications and three resource organizations: the American College of Gastroenterology at 301–263–9000 or www.acg.gi.org, the American Society for Gastrointestinal Endoscopy at 1–866–353–2743 or www.asge.org, and the International Foundation for Functional Gastrointestinal Disorders at 1–888–964–2001 or www.iffgd.org. The document concludes with a summary of the activities of the National Digestive Diseases Information Clearinghouse (NDDIC), a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). 2 figures.
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Colorectal Cancer (CRC) Screening in the Geriatric Population: Factors in Risk Assessment And Outcome Benefits. Practical Gastroenterology. 32(2): 17-36. February 2008.
This article explores factors in risk assessment and outcome benefits associated with colorectal cancer screening (CRC) in the geriatric population. CRC screening is the search for polyps and cancer in individuals who have not been previously diagnosed with colonic neoplasms; surveillance refers to follow-up of patients who have already received a diagnosis of colonic neoplasms. The authors review the literature, report on the current status of CRC screening, and then analyze certain controversies in discontinuing screening colonoscopy after a certain age. Topics include the epidemiology of CRC in the United States, particularly in relation to age groups, racial factors, and ethnic groups; the prevalence of CRC in different groups; current recommendations for CRC screening, including risk stratification, recommendations for the average risk population and for those deemed at higher risk; the role of diagnostic tests, including fecal occult blood testing (FOBT), sigmoidoscopy, colonoscopy, and double contrast barium enema (DCBE); future alternatives to traditional colonoscopy, including virtual colonoscopy, stool DNA tests for colon cancer, and wireless capsule endoscopy; the effect of aging on the incidence of CRC; colonoscopy complications in older patients compared with those in younger patients; and cost factors. The authors note that many debates on screening colonoscopy in older adults are prompted by a desire to free up endoscopic resources to screen younger individuals with a longer life expectancy. The demand for screening colonoscopy continues to strain the U.S. health care system, despite overall low participation rates. The authors conclude that CRC screening should be individualized based on quality of life of the patient, comorbid situations, and a rough estimate of the individual’s life expectancy. 1 figure. 2 tables. 88 references.
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Delayed Presentation of Traumatic Diaphragmatic Hernia Due to Stab Wound: Still Missing the Diagnosis. Practical Gastroenterology. 32(1): 42-44, 46. January 2008.
This article reviews some of the difficulties in diagnosing diaphragmatic hernia (DH) due to trauma. The authors use a case report on delayed presentation of DH due to a stab wound 2 years after the initial trauma. The 20-year-old male presented with constipation for 3 days and vomiting for 1 day; his past medical history included left-sided pneumothorax due to a stab wound 2 years prior to current admission. Barium enema and colonoscopy showed a narrowing of the proximal descending colon and splenic flexure area. Laparoscopy revealed a small loop of the colon that was clearly herniating through the diaphragm into the left chest. After reducing the loop and debridement of the area, a 3-centimeter oval deficit was seen and subsequently repaired with mesh. The patient recovered uneventfully. The authors discuss the various types of blunt trauma that may result in acquired DH and why it often goes undetected at the time of original injury. They briefly suggest appropriate surgical repair techniques, mortality rates, and other complications. The authors stress that the best way to initially screen for the possibility of DH is to complete a comprehensive history with the patient, including any traumas to the area, even if minor. They recommend laparoscopy at the time of a trauma as vital in detecting DH. 4 figures. 7 references.
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Flexible Sigmoidoscopy. Bethesda, MD: National Digestive Diseases Information Clearinghouse. 2008. 6 p.
This fact sheet describes flexible sigmoidoscopy, a procedure used to see inside the sigmoid colon and rectum. Flexible sigmoidoscopy can detect inflamed tissue, abnormal growths, and ulcers. The procedure is used to look for early signs of cancer and can help doctors diagnose unexplained changes in bowel habits, abdominal pain, bleeding from the anus, and weight loss. The fact sheet answers common questions about flexible sigmoidoscopy, including the anatomy and function of the sigmoid colon and rectum, the differences between flexible sigmoidoscopy and colonoscopy, how to prepare for a flexible sigmoidoscopy procedure, and what to expect during and after the procedure. Preparations include one or more enemas that are performed about 2 hours before the procedure to remove all solids from the sigmoid colon. In some cases, the entire gastrointestinal tract must be emptied—similar to the preparation for colonoscopy. A sigmoidoscope transmits a video image from inside the colon to a computer screen. A doctor can biopsy abnormal-looking tissues during a flexible sigmoidoscopy. Polyps can be removed using special tools passed through the sigmoidoscope. If polyps or other abnormal tissues are found, the doctor may suggest examining the rest of the colon with a colonoscopy. A flexible sigmoidoscopy takes about 20 minutes. The fact sheet includes a brief description of current research in this area. Readers are referred to online publications and three resource organizations: the American College of Gastroenterology at 301–263–9000 or www.acg.gi.org, the American Society for Gastrointestinal Endoscopy at 1–866–353–2743 or www.asge.org, and the International Foundation for Functional Gastrointestinal Disorders at 1–888–964–2001 or www.iffgd.org. The document concludes with a summary of the activities of the National Digestive Diseases Information Clearinghouse (NDDIC), a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). 1 figure.
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Inflammatory Bowel Disease: Extraintestinal Manifestations and Cancer IN: Hauser, S., ed. Mayo Clinic Gastroenterology and Hepatology Board Review. 3rd ed. New York, NY: Informa Healthcare USA. 2008. pp 215-222.
This chapter on inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn’s disease, is from a comprehensive textbook that provides an in-depth examination of essential knowledge in gastroenterology, hepatology, and the related areas of pathology, endoscopy, nutrition, and radiology. The author focuses on the extraintestinal manifestations of these conditions, as well as the relationship between IBD and colorectal cancer. Such extraintestinal manifestations are classically considered to be immune-mediated phenomena that affect the joints, eye, skin, or hepatobiliary tract, but they can be defined more broadly to include complications in other organ systems, as well as complications that arise as a direct pathophysiologic consequence of extensive bowel inflammation or resection. Extraintestinal manifestations of IBD covered in this chapter include arthritis, ocular manifestations, dermatologic manifestations, hepatobiliary manifestations, osteopenia and osteoporosis, kidney complications, and hematologic complications. The latter part of the article reviews the risk factors for colorectal cancer and provides an algorithm for surveillance colonoscopy in patients with IBD. 5 tables. 14 references.
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Preparing for a Colonoscopy. Baltimore, MD: AGA Institute. 2007. 4 p.
This brochure from the American Gastroenterological Association (AGA) familiarizes readers with colonoscopy, a procedure in which a long flexible tube is used to check for colon cancer and to treat colon polyps. The brochure outlines the reasons for having a colonoscopy and helps readers know what to expect before, during, and after the colonoscopy. Topics include preparing the colon for the test, the equipment used, and possible complications. In addition to its role as a screening tool, colonoscopy can be used to evaluate blood loss, abdominal or rectal pain, changes in bowel habits, abnormalities that may have first been detected by other diagnostic studies, and active bleeding from the large bowel. Colonoscopy may be performed in a hospital, special outpatient surgical center, or a physician’s office. The brochure emphasizes that colorectal cancer can be cured, especially when detected early through tests such as the colonoscopy. A final section reiterates the basic information presented in the brochure. One illustration presents the organs of the digestive system labeled in a simple line drawing. Readers are referred to the AGA website at www.gastro.org/patient for more information about digestive health and to find a local AGA member physician. 4 figures.
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Suspected Asymptomatic Large Colon Lipoma: Biopsy?. Practical Gastroenterology. 32(3): 35-40. March 2008.
This article presents a case report of a suspected large colon lipoma. The authors note that lipomas are the second most common benign tumors of the colon, after adenomatous polyps. When symptomatic, colon lipomas present with abdominal pain, rectal bleeding, and changes in bowel habits. The authors report the case of a 59-year-old female with a history of hypertension and hyperlipidemia who underwent a routine colonoscopy that showed a 3.5-centimeter lipomatous-appearing polyp in the sigmoid colon. Referral to the gastroenterology clinic resulted in no further treatment until 1 year later when repeat colonoscopy showed the same sized mass. The mass was biopsied and histopathology revealed smooth muscle prominence and fibrovascular tissue. One week later, the patient presented with bright red blood per rectal and mild, crampy abdominal pain; flexible sigmoidoscopy showed a completely obstructing purplish mass in the sigmoid colon with an overlying clot. A computerized tomography (CT) scan of the abdomen showed a pendunculated soft tissue density consistent with lipoma and a 2.9-centimeter mass in the lumen of the sigmoid colon consistent with hematoma. Conservative management resulted in spontaneous resolution of the bleeding and no symptoms at 1-year follow-up. The authors conclude by reminding readers of the characteristic features of lipoma and by cautioning that biopsy can result in no additional diagnostic hints and may even cause complications such as bleeding or obstruction. 5 figures. 14 references.
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Understanding Colonoscopy. Oak Brook, IL: American Society for Gastrointestinal Endoscopy. 2008. 2 p.
This brochure from the American Society for Gastrointestinal Endoscopy (ASGE) familiarizes readers with colonoscopy, a diagnostic test that examines the lining of the colon for abnormalities. After defining the test, the brochure reviews the preparations that a person should undergo before the test, whether current medications can be continued, what to expect during the test, how long the test will last, what to expect after the test, the possible complications, and the use of biopsy in conjunction with colonoscopy. An additional section describes colonic polyps, why they need to be removed, and how they are usually removed. The brochure reminds readers of the importance of colonoscopy and the fact that most people tolerate colonoscopy without pain or complications. The brochure concludes with a brief description of the work of and contact information for the ASGE.
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Use of Colorectal Cancer Tests: United States, 2002, 2004, and 2006. Morbidity and Mortality Weekly Report. 57(10): 253-258. March 2008.
Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States among cancers that affect both men and women. People who are older than 50 and are at average risk, should be screened for CRC using one or more of the following methods: fecal occult blood testing (FOBT) every year, sigmoidoscopy or double-contrast barium enema every 5 years, or colonoscopy every 10 years. This article presents information from the Centers for Disease Control and Prevention (CDC) on rates of the use of colorectal cancer tests, as well as how those rates changed over time. The authors compared data from the 2002, 2004, and 2006 Behavioral Risk Factor Surveillance System (BRFSS) surveys. This report describes the results of that comparison, which indicated that the proportion of respondents older than 50 who reported use of FOBT and/or sigmoidoscopy or colonoscopy increased overall from 2002 to 2006. Certain populations, such as racial or ethnic minorities and those who reported no health insurance coverage had lower prevalence of testing. The authors conclude by emphasizing that specific measures to increase colorectal cancer screening and to address these disparities in screening are needed. 1 figure. 2 tables. 9 references.
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Virtual Colonoscopy. Bethesda, MD: National Digestive Diseases Information Clearinghouse. 2008. 6 p.
This fact sheet describes virtual colonoscopy, a procedure used to look for signs of precancerous growths, called polyps; cancer; and other diseases of the large intestine. In virtual colonoscopy, images of the large intestine are taken using computerized tomography (CT) or, less often, magnetic resonance imaging (MRI). A computer puts the images together to create an animated, three-dimensional view of the inside of the large intestine. The fact sheet answers common questions about virtual colonoscopy, including the anatomy and function of the colon and rectum, the roles of CT and MRI, how to prepare for a virtual colonoscopy procedure, what to expect during the procedure, and the differences between virtual colonoscopy and conventional colonoscopy, including the advantages and disadvantages of virtual colonoscopy. Readers are reminded that all solids must be emptied from the gastrointestinal (GI) tract by following a clear liquid diet for 1 to 3 days before virtual colonoscopy. Virtual colonoscopy does not require insertion of a colonoscope or sedation. However, during virtual colonoscopy, a tube is inserted into the rectum to expand the large intestine with gas or liquid. Virtual colonoscopy does not allow the doctor to remove tissue samples or polyps. The fact sheet includes a brief description of current research in this area. Readers are referred to online publications and two resource organizations: the American College of Gastroenterology at 301–263–9000 or www.acg.gi.org and the International Foundation for Functional Gastrointestinal Disorders at 1–888–964–2001 or www.iffgd.org. The document concludes with a summary of the activities of the National Digestive Diseases Information Clearinghouse (NDDIC), a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). 1 figure.
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American Gastroenterological Association (AGA) Institute Medical Position Statement on Obscure Gastrointestinal Bleeding. Gastroenterology. 133: 1694-1696. November 2007.
This article presents the official recommendations of the American Gastroenterological Association (AGA) Institute, approved in 2007, about the evaluation and management of occult and obscure gastrointestinal (GI) bleeding. These recommendations update the prior technical review on obscure GI bleeding, which was published in 2000. The authors define obscure GI bleeding as bleeding from the GI tract that persists or recurs without an obvious cause after esophagogastroduodenoscopy (EGD), colonoscopy, and radiologic evaluation of the small bowel. Determining the cause of some GI bleeding is difficult, particularly when it is due to bleeding lesions that are overlooked in the esophagus, stomach, and colon during initial workup or to lesions in the small intestine that are difficult to visualize with conventional endoscopy or radiologic imaging. The guidelines review etiology and definitions, along with patient evaluation and management. The authors focus on specific steps to determining the cause of occult GI bleeding, starting with a comprehensive workup, a repeat of the endoscopic examinations, and then the use of capsule endoscopy. The authors conclude that endoscopic or surgical therapy should be considered due to its ease, relatively good long-term results, and the lack of a clearly effective, well-tolerated medical therapy. They propose that the earlier use of capsule endoscopy may allow more rapid diagnosis and thus improved patient care, as well as reduce costs for managing occult bleeding. 1 reference.
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Canadian Credentialing Guidelines for Endoscopic Privileges: An Overview. Canadian Journal of Gastroenterology. 21(12): 797-801. December 2007.
This article reviews the Canadian credentialing guidelines for upper gastrointestinal (GI) endoscopy, flexible sigmoidoscopy, colonoscopy, endoscopic retrograde cholangiopancreatography (ERCP), and endoscopic ultrasound (EUS), with reference to diagnostic procedures as well as interventional or therapeutic maneuvers such as polypectomy, dilation, hemostasis, and endoscopic mucosal resection. The authors focus on the issues that are common to all types of endoscopic procedures. The authors note that the credentialing guidelines, set up by the Canadian Association of Gastroenterology (CAG), are designed as general reference documents that should be considered during both endoscopic training and when individuals are applying for endoscopic privileges at an institution. The article includes a definition of terms, the Canadian credentialing process, appropriate training, proctoring, medicolegal issues, and the responsibilities of the institution. The guidelines are similar to those developed by other national professional bodies and, as such, are based primarily on the application of expert opinion regarding the numbers of procedures required to achieve competence. The authors conclude by reminding readers that the guidelines are not all-encompassing and that some deficiencies in the current process still exist. However, these guidelines may help lead to a greater degree of uniformity in evaluating credentials and granting privileges. 15 references.
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Colonic Histoplasmosis. Gastroenterology and Hepatology. 3(6): 459-463. June 2007.
This article reports the case of a renal transplant recipient who presented with chronic diarrhea and was diagnosed with colonic histoplasmosis, a fungal infection endemic to the Ohio and Mississippi River valleys in the United States. The authors note that this is the first reported case of colonic histoplasmosis in a renal transplant recipient from a nonendemic region. The patient, a 42-year-old woman, presented with 4 weeks of watery diarrhea, intermittent fevers, and weight loss. She had undergone renal transplantation 3 years prior and was on immunosuppressants––tacrolimus and mycophenolate. Colonoscopy revealed multiple scattered ulcers throughout the colon; histological examination resulted in the diagnosis of histoplasmosis. Subsequently, intravenous amphotericin B was initiated, and the symptoms resolved within 1 week. Her medication was then switched to oral itraconazole. The authors discuss the symptoms of gastrointestinal histoplasmosis, the problem of histoplasmosis in immunocompromised patients, typical diagnostic findings, and the initial treatment of severely ill patients. The authors conclude that gastroenterologists caring for transplant recipients should be aware of the varied presentations of infectious diseases in immunosuppressed individuals and should consider uncommon etiologies in this population, even from nonendemic geographic regions. Appended to the article is a commentary by Psarros and Kauffman, who review guidelines for the diagnosis and treatment of histoplasmosis. 3 figures. 32 references.
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Colonoscopy Withdrawal Times and Adenoma Detection Rates. Gastroenterology and Hepatology. 3(8): 609-610. August 2007.
This article from a series on advances in endoscopy answers common clinical questions about colonoscopy withdrawal times and adenoma detection rates. The author discusses the main quality indicators for colonoscopy, recommendations for adenoma detection rates, the relationship between withdrawal times and adenoma detection rates, the role of other factors such as bowel preparation or the presence of advanced neoplasia in this context, and areas needing additional research. Research studies have shown that adenoma detection was strongly associated with longer withdrawal times: Endoscopists whose withdrawal times were more than 6 minutes detected more than twice as many patients with adenomas that were 1 centimeter or larger in size. The author reminds readers that withdrawal time is not the only factor involved, and improved research on other aspects, such as how well endoscopists are looking behind folds, how well they clean up, and the general quality of their bowel preparations, is needed. 5 references.
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Colonoscopy. IN: Wexner, S.; Stollman, N., eds. Diseases of the Colon. . New York, NY: Informa Healthcare USA. 2007. pp 137-162.
This chapter about colonoscopy is from a comprehensive text that offers chapters about each of the major colonic disorders. Each chapter is coauthored by at least one surgeon and one gastroenterologist to reflect the in-depth collaboration between these fields that is required for managing diseases of the colon. In this chapter, the authors describe the diagnostics, imaging, and therapeutic techniques for colonic evaluation and intervention. They note that the development of a means to accurately and safely visualize the entire colon endoscopically has revolutionized the diagnosis and management of colonic diseases and the clinical practice of gastroenterologists and colorectal surgeons. The authors discuss colon embryology and endoscopic anatomy, the role of sigmoidoscopy, professional training and competence in colonoscopy, patient preparation, bowel preparation, antibiotic prophylaxis, anticoagulant and antiplatelet medication use, the equipment used for colonoscopy, the role of the colonoscopy assistant, sedation and analgesia during colonoscopy, infection control and colonoscope disinfection, contraindications and limitations of colonoscopy, and the use of air-contrast barium enema and virtual colonoscopy. The chapter includes black-and-white photographs and illustrations and concludes with an extensive list of references. 7 figures. 2 tables. 154 references.
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Constipation. Bethesda, MD: National Digestive Diseases Information Clearinghouse. 2007. 12 p.
This fact sheet describes constipation, defined as having a bowel movement fewer than three times a week. People who are constipated may have stools that are hard, dry, small in size, and difficult and painful to eliminate. Other symptoms of constipation include feeling bloated, uncomfortable, and sluggish. Written in a question-and-answer format, the fact sheet covers a definition of constipation, the incidence of constipation, causes of the condition, the diagnostic tests to confirm problems of constipation, treatment options, and complications. Common causes of constipation are: not enough fiber in the diet; not enough liquids; lack of exercise; medications; irritable bowel syndrome (IBS); lifestyle changes such as pregnancy, older age, or travel; abuse of laxatives; ignoring the urge to have a bowel movement; specific diseases such as stroke; problems with the colon and rectum; and problems with intestinal function, including chronic idiopathic constipation or functional constipation. Diagnostic tests used to confirm the presence of constipation and to determine its causes include colorectal transit study, anorectal function tests, defecography, barium enema x ray, and sigmoidoscopy or colonoscopy. Each of these tests are briefly described. Treatment strategies can include dietary changes, lifestyle changes, and different types of laxatives, including bulk-forming laxatives, stimulants, osmotics, stool softeners, lubricants, saline laxatives, and chloride channel activators. Readers are referred to the International Foundation for Functional Gastrointestinal Disorders at www.iffgd.org or 1–888–964–2001 and the American Gastroenterological Association at www.gastro.org or 301–654–2055 for more information. A final section outlines the goals and work of the National Digestive Diseases Information Clearinghouse. 1 figure.
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Diseases of the Colon. New York, NY: Informa Healthcare USA. 2007. 809 p.
This comprehensive text offers chapters about each of the major colonic disorders. Each chapter is coauthored by at least one surgeon and one gastroenterologist to reflect the in-depth collaboration between these fields that is required for managing diseases of the colon. The book is designed as a useful, definitive, and concise reference source for internists, gastroenterologists, and general and colorectal surgeons, as well as residents and fellows in these fields. The book includes 36 chapters in eight sections: colonic development; disorders of function; diagnostics, imaging, and therapeutic techniques for colonic evaluation and intervention; infectious disorders; vascular disorders; motor disorders; neoplastic disorders of the colon; inflammatory—noninfectious—bowel disorders; anorectal disorders; and miscellaneous colonic disorders. Specific topics covered include embryology, colonic and rectal obstruction, fecal incontinence, rectal prolapse, constipation, colonoscopy, radiology of the colon, laparoscopic surgery of the colon, anorectal physiology testing, ultrasound, biofeedback for pelvic floor disorders, infectious colitis, pseudomembranous colitis, colon ischemia, radiation injury, acute lower gastrointestinal (GI) tract bleeding, vascular disorders of the colon, irritable bowel syndrome, diverticular disease, megacolon, pseudo-obstruction, volvulus, adenocarcinoma, benign and malignant colonic tumors, intestinal polyposis, ulcerative colitis, Crohn’s disease, diversion colitis and pouchitis, hemorrhoids, anal fissures, anorectal neoplastic disorders, the colon and systemic disease, and medications, toxins, and the colon. Each chapter includes black-and-white photographs and illustrations and concludes with an extensive list of references. A detailed subject index concludes the volume.
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Diverticular Disease. IN: Wexner, S.; Stollman, N., eds. Diseases of the Colon. . New York, NY: Informa Healthcare USA. 2007. pp 399-434.
This chapter about diverticular disease is from a comprehensive text that offers chapters about each of the major colonic disorders. Each chapter is coauthored by at least one surgeon and one gastroenterologist to reflect the in-depth collaboration between these fields that is required for managing diseases of the colon. In this chapter, the authors cover historical aspects, epidemiology, natural history, pathologic anatomy, etiology and pathogenesis, uncomplicated diverticulosis, complicated diverticular disease, and hemorrhage associated with diverticular disease. They note that most people with diverticulosis are asymptomatic, which makes the pathogenesis and natural history of diverticular disease somewhat difficult to study. Particular emphasis is placed on the role of colonoscopy in the diagnosis and management of diverticular disease and on the emerging role of minimally invasive surgical management of diverticular complications. Dietary fiber may play a preventive role and should be recommended to those patients with asymptomatic or mild disease. Medical management of diverticulitis involves a combination of antibiotics and, when necessary, percutaneous drainage. Surgery is used electively after multiple attacks of diverticulitis and more urgently for complications such as abscess, free perforation, fistula, or obstruction. A patient care algorithm is provided. The chapter includes black-and-white photographs and illustrations and concludes with an extensive list of references. 11 figures. 3 tables. 211 references.
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Endoscopy in Pregnancy. IN: Pregnancy in Gastrointestinal Disorders. 2nd ed. Bethesda, MD: American College of Gastroenterology. 2007. pp 10-17.
This chapter about endoscopy in pregnancy is from a monograph that presents updated information about pregnancy in women with gastrointestinal disorders. The authors stress that the spectrum of gastrointestinal diseases in the pregnant patient is virtually identical to that in nonpregnant women. However, options for evaluating pregnant patients are somewhat limited because barium studies and other radiographic techniques subject the fetus to the risks of radiation. However, endoscopy can play a crucial role in the diagnosis and treatment of various disorders in the pregnant patient. The chapter focuses on bringing readers up to date on the research in the area covered, the recommended treatments, and patient management concerns, notably issues of maternal and fetal safety. Topics include the use of upper endoscopy for diagnosing nausea, vomiting, esophagitis, ulcers, and gastritis; the use of lower endoscopy to evaluate rectal bleeding and inflammatory bowel disease (IBD); sigmoidoscopy and colonoscopy; endoscopic retrograde cholangiopancreatography (ERCP) used to evaluate gallstones; percutaneous endoscopic gastrostomy (PEG) placement to assist patients who cannot sustain adequate nutritional intake; and the use of sedation for endoscopic tests in women who are pregnant. The authors conclude that endoscopy appears to be safe in pregnancy. They recommend that procedures be performed after the first trimester if possible, following guidelines to minimize radiation and excessive sedation. Endoscopists are encouraged to consult with an obstetrician in challenging, complicated cases. 1 table. 17 references.
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Gourmet Colon Prep. Practical Gastroenterology. 31(11): 41-42, 47-57. November 2007.
This article reviews the current diet regimens used during bowel preparation for colonoscopy and offers suggestions for dietary measures that may make the bowel preparation more tolerable and thus ultimately more successful. The authors summarize selected commercially available colonoscopy preparations and their accompanying manufacturer diet and liquid recommendations. The authors review clinical trials addressing some alternative regimens for bowel preparation. Specific topics include the clear liquid diet, the use of lactose-free, fiber-free nutritional supplements, low-residue diet options, sample menus, preparations for patients who have an ileostomy or jejunostomy, and tips for improving acceptability. The authors conclude that liberalizing the preprocedure diet may not only decrease hunger during the preparation period but can also decrease the patient’s dread of such a long period without food. Emphasizing the importance of adequate fluid intake to prevent dehydration is valuable, and providing a variety of options for the liquid diet may be helpful. 11 tables. 13 references.
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How to Prepare for Tests. Digestive Health Matters. 16(2): 15-17. Summer 2007.
The diagnosis of a functional gastrointestinal disorder can often be made without the assistance of laboratory testing. However, a structural disease must often be excluded by tests that probe the gastrointestinal tract. This article helps readers prepare for gastrointestinal diagnostic tests. The author stresses that correct preparation for a test helps make that test itself easier and the results more useful; in addition, patients may feel some relief at understanding what to expect before, during, and after a particular test. The author first reviews general principles, including the use of sedation, local anesthesia, and informed consent. Specific tests are then described, including sigmoidoscopy, colonoscopy, other colonic procedures such as a barium enema, upper gastrointestinal endoscopy, and other upper gut examinations. When the gut interior is to be visualized by an endoscope or barium x ray, a clean and empty interior is required for a successful examination. In some tests of gut function, as little as possible should be done to interfere with the gut’s natural performance. Sometimes fasting is necessary, but during such tests, eating and activity should be normal and drugs that might alter gut performance should be withdrawn. 5 references.
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Improvements in Ulcerative Colitis Symptoms After Use of Fish Oil Enemas. Gastroenterology and Hepatology. 3(10): 786-788. October 2007.
This article presents a case report of improvement in ulcerative colitis symptoms after use of fish oil enemas. The authors report a case of a 75-year-old woman with active colitis who experiences improvement in her symptoms after adding to her treatment omega-3 (n-3) fatty acid supplements delivered via rectal enema. The authors describe the patient’s symptoms of bloody, loose stools that had recently worsened, recommended changes in her maintenance medications of oral mesalamine and mesalamine enemas, and her colonoscopy findings. Remaining on her treatment regimen, the patient self-administered an additional enema daily of 3 grams of of fish oil. The over-the-counter preparation of fish oil she used was an oral gel-cap liquid supplement with eicosapentaenoic acid (EPA) 540 milligrams (mg), docosahexaenoic acid (DHA) 360 mg, and vitamin E 3.3 IU. The liquid portion was separated from the gel cap and administered locally by the patient. The patient’s symptoms resolved within 3 weeks of starting this supplemental therapy. Subsequent colonoscopy demonstrated vast improvements in the colonic mucosa. The authors discuss the case, as does author A. Brzezinski in an appended commentary and review. 18 references.
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New Post-Polypectomy Surveillance Guidelines. Practical Gastroenterology. 31(8): 30, 35-42. August 2007.
People found to have adenomatous polyps usually undergo polypectomy and then are placed into a surveillance program of periodic colonoscopy to remove missed synchronous and new metachronous adenomas and cancers. This article reviews new postpolypectomy surveillance guidelines issued by the United States Multi-Society Task Force on Colorectal Cancer and the American Cancer Society (USM-STF/ACS). The author outlines how this set of guidelines differs from earlier guidelines: They offer a consensus statement that strengthens the guidelines, they specifically examine predictors of advanced adenomas and incorporate them into the guidelines, and they emphasize the quality of baseline colonoscopy and its impact on detection of postpolypectomy colorectal cancer. The author maintains that risk stratification can reduce the intensity of follow-up evaluation in a substantial proportion of these patients, so limited colonoscopy resources could be shifted from surveillance to screening and diagnosis. The article includes the recommendations, addition surveillance considerations, and a discussion of their implications for clinical practice. 8 tables. 67 references.
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Post-Polypectomy Surveillance: Who and How. Practical Gastroenterology. 31(7): 19-25. July 2007.
The most common neoplastic lesions found during screening tests are colorectal adenomas; their presence indicates a possible increased risk for future colorectal neoplasia. This article considers the guidelines for postpolypectomy surveillance of these patients. The author notes that high-quality baseline colonoscopy with excellent preparation, adequate examination, and complete polypectomy will reduce miss rates and should be the basis of any program of follow-up. Findings at baseline colonoscopy can be used to predict future risk and thus recommended surveillance intervals. High-risk adenomas justify a surveillance interval of 3 years; for those with one or two tubular adenomas, an interval of 5 to 10 years is adequate. Hyperplastic polyps warrant only an average-risk screening program. The author concludes that the implementation of these guidelines could free up procedures to support screening programs. 1 figure. 1 table. 11 references.
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Pseudo-Obstruction (Ogilvie’s), Cathartic Colon-Laxative Abuse, and Melanosis IN: Wexner, S.; Stollman, N., eds. Diseases of the Colon. . New York, NY: Informa Healthcare USA. 2007. pp 449-462.
This chapter about pseudo-obstruction, cathartic colon due to laxative abuse, and melanosis is from a comprehensive text that offers chapters about each of the major colonic disorders. Each chapter is coauthored by at least one surgeon and one gastroenterologist to reflect the in-depth collaboration between these fields that is required for managing diseases of the colon. In this chapter, the authors first discuss acute colonic pseudo-obstruction (ACPO), covering presentation and etiology, pathophysiology, diagnosis, conservative management, endoscopic management, drug therapy, and surgical options. They note that drug therapy with neostigmine has become an accepted, safe means of decompression that requires fewer repeat procedures than colonoscopy and carries a lower complication and mortality rate. The second section considers laxative abuse and melanosis. The authors describe the five categories of laxatives in current use and consider whether laxative abuse syndrome could be considered a type of Munchausen syndrome. Melanosis coli is a nonspecific marker of increased apoptosis in the colon, which may result from laxative abuse or may be from numerous other etiologies. The authors caution that the treatment of laxative abuse is extremely difficult and recommend a team approach that includes psychiatric input and support from the patient’s family. The chapter includes black-and-white photographs and illustrations and concludes with an extensive list of references. 6 figures. 2 tables. 50 references.
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Recto-Sigmoid Perforation During Retroflexion: Is There a Relationship to Rectal Prolapse?. Practical Gastroenterology. 31(7): 37-38, 43. July 2007.
Although colonic perforation is a known complication of colonoscopy, the rectum is generally considered to be an area of low risk for perforation. This article presents the case of a 70-year-old man with rectosigmoid colon perforation occurring upon retroflexion in the rectum during colonoscopy. This patient had prolapse of the rectal mucosa identified on digital rectal examination (DRE) prior to insertion of the colonoscopy. The authors present the case details, including confirmation of the perforation and the laparotomy repair of the 1 to 2 centimeter colon perforation just above the peritoneal reflexion. The patient was discharged from the hospital 2 days later with no further complications. The authors conclude that rectal prolapse may increase the risk of perforation during retroflexion. Thus, endoscopists should use caution when performing this maneuver in patients with rectal prolapse. 17 references.
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Role of Fecal Occult Blood Testing in Screening for Colorectal Cancer. Practical Gastroenterology. 31(6): 20-32. June 2007.
This review article considers the role of fecal occult blood testing (FOBT) in screening for colorectal cancer (CRC). The author notes that all of the most recent guidelines for CRC screening recommend a group of screening options. However, the popular press and many gastroenterology opinion leaders focus on only one test: colonoscopy. This article discusses the various FOBTs available. The author makes the argument that FOBT screening is still relevant and important in population screening efforts. The author discusses the details of both the guaiac tests and the immunochemical tests, explaining the similarities and differences between them; reviews the practicalities of screening with colonoscopy in both the United States and the United Kingdom; and emphasizes that the best screening test is the one that actually gets performed. 5 figures. 3 tables. 52 references.
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Standards for Gastroenterologists for Performing And Interpreting Diagnostic Computed Tomographic Colonography. Gastroenterology. 133(3): 1005-1024. 2007.
This article provides standards for gastroenterologists for performing and interpreting diagnostic computed tomography (CT) colonography, a relatively new technique used to image the colon. The article provides a brief background section and an executive summary of the recommendations before presenting the full task force review and recommendations. Topics include the current status of CT colonography; current indications for CT colonography, including failed colonoscopy, evaluation of the colon proximal to an obstructing lesion, evaluation of patients with contraindications to colonoscopy, and as screening for asymptomatic normal-risk adults; qualifications and training of personnel; examination and equipment specifications, including colonic preparation, the CT acquisition technique, and CT interpretation; reading and reporting the results; quality control and safety; and regulatory issues, including the implications of the Stark laws, referrals, split interpretation and billing for services, oversight, and risk management issues. In each topic area, the authors provide specific task force recommendations. 1 figure. 2 tables. 115 references.
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Volvulus. IN: Wexner, S.; Stollman, N., eds. Diseases of the Colon. . New York, NY: Informa Healthcare USA. 2007. pp 463-476.
This chapter about volvulus is from a comprehensive text that offers chapters about each of the major colonic disorders. Volvulus refers to a torsion or twist of an organ on a stalk or stem of tissue. Each chapter is coauthored by at least one surgeon and one gastroenterologist to reflect the in-depth collaboration between these fields that is required for managing diseases of the colon. In this chapter, the authors cover definition, historical background, classification, and epidemiology of volvulus. They discuss specific types including sigmoid volvulus, cecal volvulus, transverse volvulus, and splenic flexure volvulus. The authors note that there are clinical differences in the presentation and treatment of volvulus, depending on grade of obstruction and the segment involved. The treatment of sigmoid volvulus has changed from an immediate surgical correction with a high mortality rate to a more conservative approach with immediate decompression of the volvulus followed by electric surgery. However, conservative treatment of cecal volvulus with colonoscopy is often unsuccessful, so treatment ranges from nonresectional procedures in viable bowels to resection in gangrenous bowels. The different types of volvulus are typically diagnosed with plain abdominal x rays. The chapter includes black-and-white photographs and illustrations and concludes with an extensive list of references. 2 figures. 7 tables. 100 references.
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Biomarkers for IBD-Related Colon Cancer: CCFA Researchers Seek Better Ways to Detect Risk and Prevent Disease. Take Charge. p. 32-35. Winter 2006.
One of the complications of inflammatory bowel disease (IBD, including Crohn's disease and ulcerative colitis) is an increased risk for colon cancer, a risk that rises even more after people have had colitis or Crohn's of the colon for more than 8 to 10 years. This article discusses the biomarkers used to detect IBD-related colon cancer. Gastroenterologists urge people with IBD to have a colonoscopy every one to two years after they have had IBD for more than 8 years. The author considers the increased cancer risk (which actually applies to a minority of IBD patients, approximately 10 percent) and diagnostic or screening strategies that can distinguish between inflammatory changes in the colon and precancerous ones. The author outlines the problems with colonoscopy in this patient population and makes the case for a quick, non-invasive test for colon cancer based on a biomarker, comparable to the Prostate Specific Antigen (PSA) which is used to screen for prostate cancer. The Crohn's and Colitis Foundation of America (CCFA) is currently supporting three research projects concerning the identification and testing of genetic markers for colon cancer. The author concludes that soon some of the genetic and other tests under study will be moved from the lab to clinical use, where they will complement colonoscopy in screening people with IBD for colon cancer. The article includes quotes from and photographs from three researchers in the area of biomarkers. 3 figures.
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Cancer: New Colonoscopic Techniques. IN: Jewell, D.P., et al, eds. Challenges in Inflammatory Bowel Disease: Management of Crohn's Disease. Malden, MA: Blackwell Publishing Inc. pp. 293-302.
Patients with longstanding, extensive ulcerative colitis (UC) are at increased risk of developing colorectal cancer. Colonoscopic surveillance is recommended to reduce associated mortality. This chapter on new colonoscopic techniques is from a textbook that addresses some of the challenges in the understanding of UC and Crohn’s disease (CD), collectively known as inflammatory bowel disease (IBD). In this chapter, the authors discuss detection of premalignant lesions in UC, chromoendoscopy, the efficiency of chromoendoscopy, and future trends, including confocal laser endomicroscopy. The authors conclude that the newly developed high-resolution and magnification endoscopes offer features that allow more and new mucosal details to be seen. These techniques are commonly used in conjunction with chromoendoscopy. Endoscopic prediction of neoplastic and non-neoplastic tissue is possible by analysis of the surface architecture of the mucosa, which influences the endoscopic management. 5 figures. 1 table. 19 references.
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Colonoscopic Surveillance: If and When?. IN: Jewell, D.P., et al, eds. Challenges in Inflammatory Bowel Disease: Management of Crohn's Disease. Malden, MA: Blackwell Publishing Inc. pp. 281-292.
The increased risk of intestinal cancer is one of the major problems in the long-term management of patients with inflammatory bowel disease (IBD). This chapter on colonoscopic surveillance is from a textbook that addresses some of the challenges in the understanding of ulcerative colitis (UC) and Crohn’s disease (CD), collectively known as IBD. In this chapter, the authors discuss overall cancer risk, small bowel carcinoma in CD, colorectal cancer risk in UC, colorectal cancer risk in CD, clinical risk factors, protective factors for colorectal cancer in IBD, management strategies for colorectal surveillance in patients with IBD, screening colonoscopy, and surveillance colonoscopy. The understanding that widespread dysplastic lesions in the colorectal mucosa precede the development of invasive carcinoma forms the mainstay for colonoscopic surveillance. The authors conclude that examinations with multiple biopsies, at regular intervals, can be used as an instrument to select high-risk patients for prophylactic colectomy before cancer occurs or, if cancer is detected, at a potentially curable stage. 101 references.
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Colonoscopies 101: Everything You've Always Wanted to Know But Were Afraid to Ask. Digestive Health and Nutrition. 8(1): 18-20. March- April 2006.
Colorectal cancer is the third most common cancer in both men and women in the United States. A colonoscopy is used to find and remove fleshy growths in the colon (polyps) before they become cancerous. This article answers common questions about colonoscopy, including the procedure itself, why it may be used, and alternatives. The author notes that, in order for the gastroenterologist to complete the test, the patient’s colon must be entirely empty of stool. Emptying the bowel requires fasting, laxatives, and increased drinking the day before the test. A colonoscopy is typically an outpatient procedure performed under sedation. Patients must arrange transportation after the procedure. The author walks patients through each step of the procedure. A final section describes some alternative screening methods, including virtual colonoscopy, digital rectal exam (DRE), stool blood test, flexible sigmoidoscopy, and barium enema with contrast. One sidebar outlines six steps to colorectal cancer prevention; another summarizes the guidelines for colon cancer screening using colonoscopy. 3 references.
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Irritable Bowel Syndrome (IBS): Answers to Common Questions. Digestive Health Matters. 15(1): 4-8. Spring 2006.
This article provides information on the symptoms of irritable bowel syndrome (IBS), and the factors and mechanisms that are thought to be associated with their occurrence. IBS is defined as a long-term or recurrent disorder of gastrointestinal functioning that is characterized by abdominal pain or discomfort, bloating or a sense of gaseousness, and altered bowel habits, such as diarrhea and constipation. Diagnosis is usually determined by the patient's symptoms and is also dependent on the absence of alarm signs that may suggest a condition other than IBS, such as inflammatory bowel disease or colon cancer. Some diagnostic tests may be used to help in the diagnosis, including laboratory blood and stool tests, colonoscopy, and tests for celiac sprue. The authors also discuss the causes of IBS, how serious the disease is considered to be, the difference between IBS and colitis, the causes of bloating and gas, how the menstrual cycle affects IBS symptoms, the relationship between stress and IBS, the effect of diet on IBS, and treatment options. The authors conclude that individuals who have not responded to lifestyle changes and careful use of medications should consider being evaluated by a physician who specializes in motility or stress-related gastrointestinal disorders. The article concludes with a list of seven simple guidelines to help readers cope with IBS. 1 figure.
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Preventing Colorectal Cancer. Diabetes Self-Management. 23(2): 29-36. March April 2006.
Colorectal cancer is a common type of cancer in both men and women. This article helps readers with diabetes understand the strategies they can take to help prevent the likelihood of developing colorectal cancer. Symptoms of colorectal cancer can include a change in bowel habits, blood in the stool, lower abdominal pain or cramping, fatigue, and vomiting. However, there are no symptoms in the earliest and most treatable stages of colorectal cancer, which is why screening is so important. The author outlines the risk factors for colorectal cancer, including age factors, family history, obesity, and having type 2 diabetes. There is some evidence that high levels of circulating insulin increase the risk of colon cancer. The author considers the influence of diet, noting that although there is much conflicting information, it is clear that following a nutritious diet high in fruits and vegetables and low in red and processed meats and saturated fat is likely to be beneficial. Other lifestyle changes that can have a positive impact include stopping smoking and avoiding a sedentary lifestyle. One sidebar explains the tests that are used to screen for colorectal cancer, including the fecal occult blood test, flexible sigmoidoscopy, barium enemas, and colonoscopy. Another sidebar lists resource organizations through which readers can obtain additional information.
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Preventing Colorectal Cancer. Diabetes Self-Management. 23(2): 29-36. March April 2006.
Colorectal cancer is a common type of cancer in both men and women. This article helps readers with diabetes understand the strategies they can take to help prevent the likelihood of developing colorectal cancer. Symptoms of colorectal cancer can include a change in bowel habits, blood in the stool, lower abdominal pain or cramping, fatigue, and vomiting. However, there are no symptoms in the earliest and most treatable stages of colorectal cancer, which is why screening is so important. The author outlines the risk factors for colorectal cancer, including age factors, family history, obesity, and having type 2 diabetes. There is some evidence that high levels of circulating insulin increase the risk of colon cancer. The author considers the influence of diet, noting that although there is much conflicting information, it is clear that following a nutritious diet high in fruits and vegetables and low in red and processed meats and saturated fat is likely to be beneficial. Other lifestyle changes that can have a positive impact include stopping smoking and avoiding a sedentary lifestyle. One sidebar explains the tests that are used to screen for colorectal cancer, including the fecal occult blood test, flexible sigmoidoscopy, barium enemas, and colonoscopy. Another sidebar lists resource organizations through which readers can obtain additional information.
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Role of Capsule Endoscopy in IBD. Gastroenterology and Hepatology. 2(2): 97-99. February 2006.
This article offers the answers to clinical questions about the role of capsule endoscopy in inflammatory bowel disease (IBD). Topics include the challenges in diagnosing IBD that may be addressed by capsule endoscopy, the research studies that have evaluated the use of capsule endoscopy in Crohn’s disease (CD, a type of IBD), the risks of capsule endoscopy (predominantly capsule retention, which can happen when a stricture is present), and conclusions that can be made when capsule endoscopy identifies lesions. If CD is suspected but not found on upper endoscopy or colonoscopy, a capsule endoscopy may be the next logical step. The author concludes that efforts to improve biopsy capabilities and remote control capabilities with the capsule are ongoing. It may prove possible to complement capsule endoscopy with enteroscopy, such as the double-balloon technique, enabling a larger part of the bowel to be seen. 4 references.
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Simulators for Training in Endoscopy. Gastroenterology and Hepatology. 2(1): 13-14. January 2006.
This article, written in a question-and-answer format, addresses the use of simulators for training in endoscopy. Beginning in the mid-1990s, computer simulators were able to create a realistic, visual representation of the colonoscopy, esophagogastroduodenoscopy, or other technique being performed. The simulators are designed to provide not only a visually realistic simulation of the lumen of the gastrointestinal tract, but also the feel and resistance of inserting and advancing a scope, loop formation, etc. The author describes current research studies on the effectiveness of simulation training, the goals of using this kind of training to accelerate skill acquisition, the need for achieving competence quickly, the use of simulators to assess competence, the recommended stages of training that are most appropriate for simulator program use, and advances in simulator training that would be useful. A final section considers the costs of simulator training. 5 references.
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Bringing to Light the Risk of Colorectal Cancer among Crohn's & Ulcerative Colitis Patients. New York, NY: Crohn's and Colitis Foundation of America. 2005. 2 p.
Crohn’s disease (CD) and ulcerative colitis (UC), collectively known as inflammatory bowel disease (IBD), are chronic diseases that inflame the digestive or gastrointestinal (GI) system. This brochure helps readers with IBD understand their risk factors for colorectal cancer (CRC). The two factors that are associated with increased cancer risk in this population are disease duration and the extent of the colon involved. Written in a question-and-answer format, the brochure covers the common signs and symptoms of CRC, diagnostic approaches, recommendations for screening (including with colonoscopy), the risk factors for CRC, and how to decrease the risks for developing CRC. The brochure stresses that knowledge of the connection between CRC and IBD, along with annual screenings, can lead to early treatment of CRC, which can help reduce the potential life-threatening consequences of CRC. The back cover of the brochure describes an educational campaign, sponsored by the Crohn’s and Colitis Foundation of America (CCFA), that is designed to raise awareness about the increased risk for colorectal cancer among patients with CD and UC. Readers are referred to the CCFA website for additional educational materials.
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Chronic Constipation : From Evaluation to Treatment. Digestive Health Matters. 14(4): 4-9. Winter 2005.
This article brings readers up-to-date on the evaluation and treatment of chronic constipation. The author begins by defining constipation and differentiating chronic constipation from irritable bowel syndrome (IBS), a condition that can be characterized by constipation as one of its features. The term constipation includes a complex group of symptoms related to slow, impaired, difficult, or painful defecation. The article then addresses the major identifiable causes of constipation, when to consult a doctor for evaluation, the role of colonoscopy in diagnosis, the indications for specialized testing, including anorectal manometry and defecography, and treatment strategies, which are dependent upon diagnosis. The author discusses the use of drug therapies, biofeedback therapy, dietary fiber and fluids, and surgical options. The author concludes that most people with constipation can be successfully treated when a complete evaluation is performed and a rational treatment plan is pursued in partnership with their health care provider. 2 figures. 3 tables. 3 references.
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Living with Crohn's Disease. New York, NY: Crohn's & Colitis Foundation of America. 2005. 12 p.
Crohn’s disease (CD), one of two diseases collectively known as inflammatory bowel disease (IBD), is a chronic disease that inflames the digestive or gastrointestinal (GI) system. This brochure helps readers newly diagnosed with CD to understand the basics of their disease and what to expect. Written in a question-and-answer format, the brochure covers the definition of the disease, the anatomy and physiology of the normal GI tract, risk factors for CD (including genetics), the different types of CD, the causes of CD, the signs and symptoms of the disease, extra-intestinal problems associated with CD, diagnostic tests that are used to confirm the presence of CD (including sigmoidoscopy and colonoscopy), treatment options (drug therapy and surgery), the role of nutrition, the role of stress and emotional factors, and coping strategies for living a healthy active life with CD. A final section describes the Crohn’s and Colitis Foundation of America (CCFA), a non-profit organization that funds research on IBD, provides educational resources for patients and their families, medical professionals, and the public, and offers support services for people with IBD. Readers are encouraged to join the CCFA and are referred to the CCFA website for additional educational materials; a membership application form is also included in the brochure. 1 figure.
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Living with Ulcerative Colitis. New York, NY: Crohn's and Colitis Foundation of America. 2005. 12 p.
Ulcerative colitis (UC), one of two diseases collectively known as inflammatory bowel disease (IBD), is a chronic disease that inflames the digestive or gastrointestinal (GI) system. This brochure helps readers newly diagnosed with UC to understand the basics of their disease and what to expect. Written in a question-and-answer format, the brochure covers the definition of the disease, the anatomy and physiology of the normal GI tract, risk factors for UC (including genetics), the causes of UC, the signs and symptoms of the disease, extra-intestinal problems associated with UC, diagnostic tests that are used to confirm the presence of UC (including sigmoidoscopy and colonoscopy), treatment options (drug therapy and surgery), the role of nutrition, the use of probiotics and prebiotics, the role of stress and emotional factors, and coping strategies for living a healthy active life with UC. A final section describes the Crohn’s and Colitis Foundation of America (CCFA), a non-profit organization that funds research on IBD, provides educational resources for patients and their families, medical professionals, and the public, and offers support services for people with IBD. Readers are encouraged to join the CCFA and are referred to the CCFA website for additional educational materials; a membership application form is also included in the brochure. 1 figure.
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Small and Large Intestines. IN: Digestive Disorders 2005. Palm Coast, FL: Medletter Associated. pp 24-29. 2005.
This lengthy section on the small and large intestines is from a White Paper on digestive disorders, including conditions that affect the esophagus, stomach, gallbladder, bile ducts, small intestine, and large intestine. This chapter covers normal anatomy of the small and large intestines; the examination of the colon and rectum, including barium enema, sigmoidoscopy, colonoscopy, virtual colonoscopy, and capsule endoscopy; and the causes, symptoms, diagnosis, and treatment of constipation, diverticulosis and diverticulitis, diarrhea, celiac disease (gluten intolerance), Crohn's disease, ulcerative colitis, irritable bowel syndrome, hemorrhoids, anal fissure, and colorectal cancer. Numerous sidebars cover some topics in greater detail: research on the clinical utility of virtual colonoscopy, specific foods and a suggested menu for people on a clear liquid diet, strategies for living with lactose intolerance, understanding changes in color of the feces (stool), the interrelationship between appendectomy and the risk of ulcerative colitis, the grains that are safe for people on a gluten-free diet (for celiac disease), a drug used in Crohn's disease that may reverse or delay the formation of fistulas, travel tips for people with inflammatory bowel disease (IBD), the risks associated with eating red meat and drinking alcohol for people with colitis, the impact of depression on IBD flare-ups, quality of life issues in irritable bowel syndrome (IBS), coping with pruritus ani (anal itching), the risks of colorectal cancer associated with a high-glycemic diet (one that includes a lot of simple and complex sugars), how high doses of aspirin may fight colon polyps, a new anticancer drug (Avastin, bevacizumab) used for metastatic colorectal cancer, laparoscopic surgery for colon cancer, and how colon cancer is staged. One illustration outlines the parts of the lower digestive system and the diseases or conditions that can affect each part. One chart summarizes the drugs used for IBD.
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Straight Talk on Colorectal Cancer. Digestive Health and Nutrition. 7(2): 16-18. March-April 2005.
This article discusses colorectal cancer, emphasizing the importance of early detection for best treatment results. The author cautions that because colorectal cancer does not often have symptoms in its earlier stages, screening and removal of polyps (growths on the inner wall of the large intestine) are vital. Removing a polyp eliminates the chance of it changing to a cancerous growth. The author considers some of the reasons why there are low screening rates, including people being unaware of the need for or the benefits of screening, and clinicians not recommending screening. The author also discusses the colonoscopy procedure, preparation for colonoscopy, fecal occult blood testing, recommendations for how often to have these screening tests, new testing methods that are under development (including virtual colonoscopy), risk factors for colorectal cancer, lifestyle factors that may play a role in the development of colorectal cancer, and the role of genetics in colorectal cancer. One sidebar summarizes colorectal cancer screening guidelines; another sidebar lists the different methods currently available to screen for colorectal cancer. 1 figure. 6 references.
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Adenomatous Polyps. Riviera Beach, FL: AmeriPath, Inc. 2004. 2 p.
This fact sheet helps readers understand adenomatous polyps, abnormal noncancerous (benign) growths that may be precursor lesions to colorectal cancer. The fact sheet reviews the risk factors for adenomatous polyps; the types of diagnostic tests that may be used to diagnose polyps; the treatment options, notably colonoscopy; methods to help prevent colon cancer, including monitoring one's bowel habits and including dietary fiber in one's regular plan of eating; and recommended questions to ask of one's physician. The fact sheet concludes with a list of sources of additional information, primarily the web site addresses of professional and voluntary organizations. 1 figure.
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Colorectal Carcinoma and Inflammatory Bowel Disease. Alimentary Pharmacology and Therapeutics. 20 (Suppl 4): 24-30. October 2004.
This review article considers the interplay between colorectal carcinoma and inflammatory bowel disease (IBD, which includes ulcerative colitis and Crohn's disease). The risk of colorectal cancer for any patient with ulcerative colitis is estimated to be 2 percent after 10 years, 8 percent after 20 years and 18 percent after 30 years of disease. The relative risk of colorectal cancer in Crohn's colitis is approximately 5.6 and should raise the same concerns as in ulcerative colitis. Risk factors for colorectal cancer include disease duration, early onset, extensive disease, primary sclerosing cholangitis (PSC), and a family history of sporadic colorectal cancer. The author recommends that all patients have a review colonoscopy 8 to 10 years after their diagnosis to establish the extent of their disease. Regular surveillance is recommended, with a screening interval every 3 years in the second decade of disease and annually by the fourth decade. Dysplasia (differences in cell growth and structure) is recognized as a premalignant condition, but the likelihood of progression to cancer is difficult to predict. The author concludes with a brief discussion of the socioeconomic implications of surveillance programs, notably cost-effectiveness issues. 58 references.
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Hyperplastic Polyps. Riviera Beach, FL: AmeriPath, Inc. 2004. 2 p.
This fact sheet helps readers understand hyperplastic polyps, abnormal growths rising from the lining of the large intestine (colon) and protruding into the intestinal canal (lumen). Polyps are usually classified into two types: adenomatous polyps (adenomas) and hyperplastic polyps. Adenomas are the precursor lesions for colorectal carcinoma (colon cancer). The more common hyperplastic polyps are benign and, in most cases, not considered to be premalignant. The fact sheet reviews the types of diagnostic tests that may be used to diagnose polyps; the treatment options, notably colonoscopy; methods to help prevent colon cancer, including monitoring one's bowel habits and including dietary fiber in one's regular plan of eating; and recommended questions to ask of one's physician. The fact sheet concludes with a list of sources of additional information, primarily the web site addresses of professional and voluntary organizations. 1 figure.
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Ischemic Colitis. In: Kelly, K.A.; Sarr, M.G.; Hinder, R.A., eds. Mayo Clinic Gastrointestinal Surgery. St. Louis, MO: Elsevier Science. 2004. p. 519-524.
Ischemic colitis (lack of or reduced blood flow to the colon) has a number of causes and treatments. This chapter on ischemic colitis is from a book that focuses on the major diseases treated by gastrointestinal surgeons, from the esophagus to the anal canal. The presentation has a definite clinical orientation and a major emphasis on practical applications as they are applied at the Mayo Clinic. The author of this chapter reviews colonic vascular (blood vessel) anatomy and variations, pathologic conditions, etiologic factors and patient groups, clinical presentation and diagnosis, indications for operation, conduct of operation, surgical outcomes, and long-term follow-up. The typical patient, whose diagnosis is confirmed with colonoscopy, usually responds well to treatment with intravenous fluids, antibiotics, and bowel rest. Transmural necrosis, which requires urgent surgical intervention, should be suspected in patients who have signs of peritonitis or sepsis. A surgical approach also may be indicated for complications of ischemic colitis, such as perforation, recurrence, or strictures. The chapter is illustrated with full-color photographs. 2 figures. 1 table. 30 references.
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