Archive for 'Gastrointestinal'
Q. Whilst we are discussing bowel disorders, what is irritable bowel syndrome?
A. This is a common bowel problem in which no organic disease can be found. It is probably nervous or psychogenic in nature, although certain dietetic factors (such as inadequate fibre) may play a part.
Q. What are the symptoms?
A. They are fairly constant and consist of long bouts of diarrhoea, which is worse when under stress and anxiety, does not involve the passing of blood, constipation or abdominal pain. Pain is eased by a bowel action or the passage of wind. These symptoms may occur separately, or in succession, or together. The patient’s general health is usually good. Often a lot of mucus is passed but not blood.
Q. What about diagnosis and treatment?
A. Symptoms of this nature always require a full bowel check to exclude a serious disease. X-rays and endoscopic examinations may take place. Treatment includes a high fibre diet, rich in unprocessed bran and fibre foods. Foods which obviously upset should be excluded. Medical hypnotherapy by an experienced doctor often produces excellent results.
Q. What is aerophagy?
A. This means swallowing air but usually means the symptoms that occur when there is too much gas or air in the G.I. system and when there is no organic disease.
Q. Where does intestinal gas come from?
A. It may only come from a few sources. These are air that is swallowed or gas produced within the intestinal system itself. It is easy to unconsciously swallow air, specially at times of emotional stress, when chewing gum, smoking, with excessive salivation or with a dry throat. Many who like to belch often take in more air than they eliminate. Many foods, specially fizzy drinks and various sugary fruit juices and carbohydrates are notorious for increasing gas in the bowel system.
Q. What are the symptoms and how is it treated?
A. There is a feeling of fullness, maybe nausea. Belching, dyspepsia and “indigestion” are common. Much wind is passed by the bowel, a condition called flatulence. Treatment consists in avoiding the causes. Eat in a peaceful environment. Avoid fizzy drinks and alcohol with meals. Avoid gum chewing, smoking, or foods or vegetables that knowingly cause distress. Apples, grapes, raisins, bananas, leafy greens, onions, lentils, legumes and fried foods are best avoided. Experience is the best teacher. Drug therapy is not necessary. Fibre often helps, such as bran for breakfast each day.
Q. What about worms? Are these very common?
A. Indeed they are and I guess nearly every child in Australia has suffered from worms. The most common kind here is the threadworm, also called the pin worm. It commonly affects children of school age, for eggs are readily transmitted on fingers and hands, school implements, toys and play things.
The eggs quickly hatch out in the bowel and adult worms leave the anus to deposit eggs around the anal margin at night. This causes irritation and the desire to scratch, which in turn transmits more eggs to the fingers and under the nails and so they are spread to others, either members of the family or school chums. Apart from irritation there are rarely any severe effects.
Q. What is the best treatment?
A. Ideally the whole family or the whole class or school should be treated at the same time. A variety of medications is used, Mebendazole (Vermox) is very satisfactory. One tablet, or 5 ml of liquid, is all that is required irrespective of age. If the worms recur, which is common, a further dose or two at weekly intervals will again have a beneficial effect. Other worm killers are also used with good effect.
Q. What about other worm infestations. Are these common?
A. In certain under-developed countries they are notoriously common. In Australia, in the main, they are not commonly seen. Round worm (ascariasis) sometimes occurs. There may be no symptoms, although nausea, vomiting and colic may be present. Piperazine citrate is effective treatment. Hookworm, strongyloides and tape worm are occasionally seen.
Q. What about giardiasis? This seems to have suddenly taken off in Australia in recent years.
A. True, and the parasite called giardia lamblia which came here from the Mediterranean area is now very common all around Australia, especially along the eastern seaboard. It usually comes from infected water, maybe swimming pools, is swallowed, multiplies in the duodenum and causes ongoing diarrhoea with frothy stools. The organism may be identified by material taken from the duodenum or from the contaminated stools.
Q. What about treatment?
A. This is excellent. Metronidazole (Flagyl) given three times a day for a week is curative. A simpler method is taking tinidazole (Fasigyn), four tablets of 500 mg as a single dose. These drugs should be taken under medical supervision after the diagnosis has been confirmed.
Q. What is the most widely used form of treatment at present?
A. Just now, probably the most popular form of therapy is the use of a family of drugs called the histamine IT receptor antagonists. The most widely used one is called cimetidine, although the doctor will probably give you a prescription using the trade name, ‘Tagamet’. These are tablets taken orally which act on the acid producing cells of the stomach wall, and prevent acid production. In turn, this inhibits the production of the other important stomach chemical, pepsin. Therefore, with no acid and pepsin present, the cause of the ulcer vanishes, and symptoms vanish as the ulcer gradually heals.
Q. How long does it take for symptoms to disappear?
A. Many patients report that symptoms, especially abdominal pain, disappear within a few days! This seems remarkable, especially with those in whom pain had been intermittently present for months or even years. It may be dramatic.
Q. Does cessation of pain mean the ulcer has healed completely?
A. Certainly not. It means acid production is stemmed, and the pain from acid irritation on the exposed nerves has stopped. It takes at least from four to six weeks for the stomach lining to grow over the ulcer site.
Unfortunately, many patients thinking that pain cessation means ulcer healing, foolishly stop medication. The results are then bad, for often within a few more days, the pain naturally recommences as acid production starts up again. Once the physician has ordered a course of treatment it is imperative that it be taken exactly as prescribed, and for the total number of tablets.
Q. What is the usual dosage?
A. Generally, 400 mg is taken morning and night. Many doctors now find that one single evening dose of 800 mg is preferable. It is easier to remember, and seems to give very satisfactory results. The aim is to keep acid at a low level during the day, and the higher bedtime dose is aimed at keeping it low throughout the night. Remember, nocturnal pain due to acid build up is the hallmark of the ulcer patient — and a very disturbing symptom. This dosage method is different to multiple doses which were originally recommended.
Q. What is the value of this altered dose routine?
A. First of all, doctors have found that the results are often as good or better with this system. Also, by making the tablet swallowing routine less frequent, a strange phenomenon called ‘patient compliance’ is far higher.