Cases reported "Irritable Bowel Syndrome"

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1/12. irritable bowel syndrome or endometriosis, or both?

    Both irritable bowel syndrome and endometriosis are common conditions, although symptomatic gastrointestinal endometriosis is extremely rare. We report the case of a patient initially thought to have irritable bowel syndrome, in whom the diagnosis of endometriosis only became clear following a laparotomy for small bowel obstruction. This case highlights the need to question the diagnosis in patients with irritable bowel syndrome when there is any uncertainty, and also to appreciate that other pathology can arise, even when the diagnosis is secure. ( info)

2/12. Does depression influence symptom severity in irritable bowel syndrome? Case study of a patient with irritable bowel syndrome and bipolar disorder.

    OBJECTIVE: irritable bowel syndrome (IBS) is frequently associated with mood disorder. However, it is typically difficult to distinguish between disturbed mood as a causal agent and disturbed mood as a consequence of the experience of IBS. This report considers the association between mood and symptom severity in a patient with diarrhea-predominant IBS and stable, rapid cycling bipolar disorder with a predominantly depressive course. Such a case provides an important opportunity to determine the direction of the relationship between mood and IBS symptom severity because the fluctuations of mood in bipolar disorder are assumed to be driven largely by biological, rather than psychosocial, processes. methods: The study was carried out prospectively, with ratings of mood and IBS symptom severity made daily by the patient for a period of almost 12 months. RESULTS: The patient experienced regular and substantial changes in mood as well as fluctuations in the level of IBS symptoms during the study period. Contrary to expectation, the correlation between mood and IBS symptom severity on the same day suggested that the patient experienced less severe IBS symptoms during periods of more severe depression. However, time series analysis revealed no significant association between these two processes when serial dependence within each series was controlled for. CONCLUSIONS: The unusual co-occurrence of IBS with bipolar disorder provides direct evidence to indicate that depression does not necessarily lead to an increase in the reported severity of IBS, at least in the context of bipolar disorder, and may under certain circumstances actually be associated with a reduction in the severity of IBS symptoms. Factors that might moderate the relationship between depression and symptom severity are discussed. ( info)

3/12. irritable bowel syndrome, functional dyspepsia, and functional abdominal pain syndrome.

    Recurrent or chronic abdominal pain is a description and not a diagnosis. The clinician should consider both disease and functional pain. In the absence of obvious disease, adolescents fulfilling symptom-based criteria for functional gastrointestinal disorders can be treated for their problems without initially performing extensive diagnostic studies. Most of these patients will have symptoms resembling IBS, functional dyspepsia, or functional abdominal pain syndrome. It is imperative that the clinician takes a biopsychosocial approach in dealing with these patients. Although the clinician still evaluates for biologic disease, he or she maintains an appreciation that psychosocial events may have a profound impact on physiology and symptom production. ( info)

4/12. intussusception caused by a heterotopic pancreas. Case report and literature review.

    CONTEXT: intussusception in adults is rare, accounting for 0.1% of adult hospital admissions. In contrast to this, it is the leading cause of obstruction in children. In up to 90% of adults a cause can usually be found, but in children this is rarely the case. CASE REPORT: We report the case of a 27-year-old lady with a subacute bowel obstruction caused by a jejunal heterotopic pancreas and describe its successful surgical management. CONCLUSION: The causes of intussusception in adults are discussed in the literature review. ( info)

5/12. Chronic pelvic pain in women: assessment and management.

    BACKGROUND: Chronic pelvic pain (CPP) is a common condition that poses diagnostic and management challenges for doctors and their patients. OBJECTIVE: This article outlines an approach to the diagnosis and management of CPP in women, lists a range of possible aetiologies, and provides additional information on three conditions commonly associated with CPP: endometriosis, pelvic inflammatory disease, and irritable bowel syndrome. DISCUSSION: Chronic pelvic pain may be due to one or several aetiologies, while in some women no specific cause is identified. All women should be advised that even though limited medical knowledge sometimes precludes the assignation of a definite cause and cure, the pain can be managed, and psychological support can be provided. A multidisciplinary approach can be beneficial. ( info)

6/12. Systemic lactose intolerance: a new perspective on an old problem.

    Intolerance to certain foods can cause a range of gut and systemic symptoms. The possibility that these can be caused by lactose has been missed because of "hidden" lactose added to many foods and drinks inadequately labelled, confusing diagnosis based on dietary removal of dairy foods. Two polymorphisms, C/T13910 and G/A22018, linked to hypolactasia, correlate with breath hydrogen and symptoms after lactose. This, with a 48 hour record of gut and systemic symptoms and a six hour breath hydrogen test, provides a new approach to the clinical management of lactose intolerance. The key is the prolonged effect of dietary removal of lactose. patients diagnosed as lactose intolerant must be advised of "risk" foods, inadequately labelled, including processed meats, bread, cake mixes, soft drinks, and lagers. This review highlights the wide range of systemic symptoms caused by lactose intolerance. This has important implications for the management of irritable bowel syndrome, and for doctors of many specialties. ( info)

7/12. serotonin mechanisms in pain and functional syndromes: management implications in comorbid fibromyalgia, headache, and irritable bowl syndrome - case study and discussion.

    A young woman presented with multiple central hypersensitivity disorders, including fibromyalgia, headache, pelvic pain and several smooth muscle spasm disorders, including irritable bowel syndrome, irritable bladder and Raynaud's phenomenon. She also had significant fatigue and sleep problems. Her case illustrates the importance and surprising frequency of atypical bipolar mood disorders in people with multiple central hypersensitivity pain disorders, especially with depression and anxiety resistant to antidepressant treatment. Considering neurological mechanisms common to her overlapping disorders was very helpful in guiding treatment choices. This experience illustrates the value of serotonin receptor type 2 (5HT2) inhibition with atypical neuroleptics, of neural cation channel and glutamate inhibition with anticonvulsants, and the potential usefulness of antidepressants after establishing 5HT2 control to enhance downward inhibitory tracts. Medications with combined usefulness for both bipolar mood and pain disorders were highly effective for her multiple hypersensitivity problems. ( info)

8/12. Are cardiac syndrome X, irritable bowel syndrome and reflex sympathetic dystrophy examples of lateral medullary ischaemic syndromes?

    Altered pain appreciation and autonomic function are hallmarks of Cardiac syndrome X, irritable bowel syndrome and reflex sympathetic dystrophy. Both pain appreciation and autonomic function are controlled by the lateral medulla. This hypothesis proposes that lateral medullary ischaemia at a microvascular level is responsible for these syndromes and could also be linked to other conditions where autonomic dysfunction is a major feature such as late-onset asthma, type 2 diabetes and essential hypertension. Autonomic function is controlled by the nucleus tractus solitarius, which acts as the main viscero-afferent nucleus in the brain stem regulating vagal tone. It is particularly susceptible to ischaemia since it is highly metabolically active and lies in a medullary arterial watershed zone. The anatomical route of the vertebral artery through cervical vertebra makes it vulnerable to injury from whiplash with or without any genetic predisposition to atheroma formation. This could make microvascular occlusion commonplace and a plausible explanation for the above syndromes. Ischaemia rather than infarction occurs because of the excellent collateral blood supply in the brainstem. In support of this hypothesis, a new Transcranial doppler ultrasonography arterial signal has been described called small vessel knock, the ultrasound signal of small vessel occlusion. Recent evidence has shown that ultrasound targeting of this signal in the vertebral artery improves clinical symptoms in these syndromes which supports this hypothesis. Two such cases are discussed. ( info)

9/12. Tegaserod-associated ischemic colitis.

    Tegaserod, a potent partial agonist of the serotonin 5-HT4 receptor, is used to treat women with constipation-predominant irritable bowel syndrome. Since the drug's approval, the manufacturer has received infrequent although serious reports of diarrhea and ischemic colitis in patients taking the drug. These instances have led to a recent warning letter to physicians and a change in the prescription labeling of tegaserod. We describe the development of ischemic colitis in a woman who was treated with tegaserod and review the relationship among ischemic colitis, tegaserod use, and irritable bowel syndrome. Potential mechanisms involved in the occurrence of ischemic colitis in patients receiving tegaserod are also discussed. ( info)

10/12. An unexpected cause of macroscopic haematuria.

    A 25-year-old man presented with macroscopic haematuria associated with a body mass index of 20 kg/m and a severe coagulopathy consistent with vitamin k deficiency. The diagnosis of a profound malabsorption syndrome secondary to coeliac disease was confirmed by small bowel histology and positive coeliac serology. ( info)
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