Tag Archives: Intestinal

Celiac Disease

Definition:
Celiac disease, sometimes  called celiac sprue, is a digestive disorder that occurs when an individual’s immune system overreacts to the protein gluten, or other proteins within gluten such as gliadin, found in grains including wheat, rye, barley, and to some degree, oats. When a patient with the disease eats food that contains gluten, the immune system’s response damages the intestinal lining. This causes symptoms of abdominal pain and bloating after consuming gluten.

click & see the pictures

You may click to see the picture…> Coeliac disease :Classification and external resources

Diagram to show the different stages of Coeliac Disease

It  is an autoimmune disorder of the small intestine that occurs in genetically predisposed people of all ages from middle infancy onward. Symptoms include chronic diarrhoea, failure to thrive (in children), and fatigue, but these may be absent, and symptoms in other organ systems have been described. A growing portion of diagnoses are being made in asymptomatic persons as a result of increased screening. Coeliac disease is caused by a reaction to gliadin, a prolamin (gluten protein) found in wheat, and similar proteins found in the crops of the tribe Triticeae (which includes other cultivars such as barley and rye). Upon exposure to gliadin, and certain other prolamins, the enzyme tissue transglutaminase modifies the protein, and the immune system cross-reacts with the small-bowel tissue, causing an inflammatory reaction. That leads to a truncating of the villi lining the small intestine (called villous atrophy). This interferes with the absorption of nutrients, because the intestinal villi are responsible for absorption. The only known effective treatment is a lifelong gluten-free diet. While the disease is caused by a reaction to wheat proteins, it is not the same as wheat allergy.

This condition has several other names, including: cœliac disease (with œ ligature), c(o)eliac sprue, non-tropical sprue, endemic sprue, gluten enteropathy or gluten-sensitive enteropathy, and gluten intolerance. The term coeliac derives from the Greek  (koiliak?s, “abdominal”), and was introduced in the 19th century in a translation of what is generally regarded as an ancient Greek description of the disease by Aretaeus of Cappadocia.

No treatment can cure celiac disease. However, you can effectively manage celiac disease through changing your diet.


Symptoms :-

Severe coeliac disease leads to the characteristic symptoms of pale, loose and greasy stool (steatorrhoea), weight loss or failure to gain weight (in young children). People with milder coeliac disease may have symptoms that are much more subtle and occur in other organs rather than the bowel itself. Finally, it is possible to have coeliac disease without any symptoms whatsoever. Many adults with subtle disease only have fatigue or anaemia.

There are no typical signs and symptoms of celiac disease. Most people with the disease have general complaints, such as:
*Intermittent diarrhea
*Abdominal pain
*Bloating

Sometimes people with celiac disease may have no gastrointestinal symptoms at all. Celiac disease symptoms can also mimic those of other conditions, such as irritable bowel syndrome, gastric ulcers, Crohn’s disease, parasite infections, anemia, skin disorders or a nervous condition.

Celiac disease may also present itself in less obvious ways, including:

*Irritability or depression
*Anemia
*Stomach upset
*Joint pain
*Muscle cramps
*Skin rash
*Mouth sores
*Dental and bone disorders (such as osteoporosis)
*Tingling in the legs and feet (neuropathy)

Some indications of malabsorption that may result from celiac disease include:

*Weight loss
*Diarrhea
*Abdominal cramps, gas and bloating
*General weakness and fatigue
*Foul-smelling or grayish stools that may be fatty or oily
*Stunted growth (in children)
*Osteoporosis
*Anemia

Another gluten-related condition :-
Dermatitis herpetiformis is an itchy, blistering skin disease that also stems from gluten intolerance. The rash usually occurs on the elbows, knees and buttocks. Dermatitis herpetiformis can cause significant intestinal damage identical to that of celiac disease. However, it may not produce noticeable digestive symptoms. This disease is treated with a gluten-free diet, in addition to medication to control the rash.

When to see a doctor :-
If you notice or experience any of the signs or symptoms common to celiac disease, see your doctor. If someone in your family is known to have celiac disease, you may need to be tested.

Seek medical attention for a child who is pale, irritable, fails to grow, and who has a potbelly, flat buttocks and malodorous, bulky stools. Other conditions can cause these same signs and symptoms, so it’s important to talk to your doctor before trying a gluten-free diet.

Causes:-
General: When a celiac patient eats gluten, or other protein components of gluten, such as gliadin, the body’s immune system overreacts. Gluten is present in all types of wheat (including farina, graham flour, semolina, and durum), barley, rye, bulgur, Kamut, kasha, matzo meal, spelt, and triticale. The gluten is mistaken for a harmful invader, such as bacteria, and an attack is launched. Immune system cells flood to the stomach and intestine to destroy the gluten. However, among these immune cells are autoantibodies that attack the lining of the intestine by mistake. As a result, the intestinal lining becomes damaged.

 

click & see the pictures

Gliadin is a protein component of gluten, found in wheat and several other cereal grains of the genus Triticum. Patients with celiac disease are sensitive to the  and forms of gliadins. In response to gliadin, anti-gliadin IgA antibodies are produced, which are reportedly found in many patients with celiac disease.

Inherited: Researchers believe that many cases of celiac disease are inherited (passed down through families). Researchers estimate that if someone in a patient’s immediate family (parent or sibling) has celiac disease, the patient has a 5-15% chance of developing the disease as well.

Trauma: It also appears that many cases of celiac disease develop after trauma, such as an infection, stress, physical injury, surgery, or pregnancy.

Other disorders: Celiac disease is associated with autoimmune disorders. Autoimmune disorders occur when the immune system attacks the body by mistake. Autoantibodies in the blood bind to components of an individual’s own cells, triggering other cells to attack the body. The most common autoimmune disorders associated with celiac disease are lupus erythematosus, type I diabetes, rheumatoid arthritis, thyroid disease, and microscopic colitis (disorder that causes inflammation of the colon).

Risk factors:-
Although celiac disease can affect anyone, it tends to be more common in people who have:

*Type 1 diabetes
*Autoimmune thyroid disease
*Down syndrome
*Microscopic colitis, particularly collagenous colitis

Additionally, certain genes — HLA-DQ2 and DQ8 — are associated with an increased risk of celiac disease. But, experts also suspect that other, as yet unknown, genes also play a role in the development of celiac disease.

Complications:-
Left untreated, celiac disease can lead to several complications:

*Malnutrition. Untreated celiac disease can lead to malabsorption, which in turn can lead to malnutrition. This occurs in spite of what appears to be an adequate diet. Because vital nutrients are lost in the stool rather than absorbed in the bloodstream, malabsorption can cause a deficiency in vitamins and minerals, such as B-12, D, folate and iron, resulting in anemia and weight loss. Malnutrition can cause stunted growth in children and delay their development.

*Loss of calcium and bone density. With continued loss of fat in the stool, calcium and vitamin D may be lost in excessive amounts. This may result in a bone disorder called osteomalacia, a softening of the bone also known as rickets in children, and loss of bone density (osteoporosis), a condition that leaves your bones fragile and prone to fracture. In addition, lack of calcium absorption can lead to a certain type of kidney stone (oxalate stone).

*Lactose intolerance. Because of damage to your small intestine from gluten, foods that don’t contain gluten also may cause abdominal pain and diarrhea. Some people with celiac disease aren’t able to tolerate milk sugar (lactose) found in dairy products, a condition called lactose intolerance. If this is the case, you need to limit food and beverages containing lactose as well as those containing gluten. Once your intestine has healed, you may be able to tolerate dairy products again. However, some people may continue to experience lactose intolerance despite successful management of celiac disease.

*Cancer. People with celiac disease who don’t maintain a gluten-free diet also have a greater chance of getting one of several forms of cancer, especially intestinal lymphoma and bowel cancer.

*Neurological complications. Celiac disease has also been associated with disorders of the nervous system, including seizures (epilepsy) and nerve damage (peripheral neuropathy).

Diagnosis:
There are several tests that can be used to assist in diagnosis. The level of symptoms may determine the order of the tests, but all tests lose their usefulness if the patient is already taking a gluten-free diet. Intestinal damage begins to heal within weeks of gluten being removed from the diet, and antibody levels decline over months. For those who have already started on a gluten-free diet, it may be necessary to perform a re-challenge with some gluten-containing food in one meal a day over 2–6 weeks before repeating the investigations.

Combining findings into a prediction rule to guide use of endoscopy reported a sensitivity of 100% (it would identify all the cases) and specificity of 61% (it would be incorrectly positive in 39% of those without the disease, not a false positive rate of 39%). The prediction rule recommends that patients with high-risk symptoms or positive serology should undergo endoscopy. The study defined high-risk symptoms as weight loss, anaemia (haemoglobin less than 120 g/l in females or less than 130 g/l in males), or diarrhoea (more than three loose stools per day).

Blood tests:-
Serological blood tests are the first-line investigation required to make a diagnosis of coeliac disease. Serology for anti-tTG antibodies has superseded older serological tests and has a high sensitivity (99%) and specificity (>90%) for identifying coeliac disease. Modern anti-tTG assays rely on a human recombinant protein as an antigen. An equivocal result on tTG testing should be followed by antibodies to endomysium.

Because of the major implications of a diagnosis of coeliac disease, professional guidelines recommend that a positive blood test is still followed by an endoscopy/gastroscopy and biopsy. A negative serology test may still be followed by a recommendation for endoscopy and duodenal biopsy if clinical suspicion remains high due to the 1 in 100 “false-negative” result. As such, tissue biopsy is still considered the gold standard in the diagnosis of coeliac disease.

Historically three other antibodies were measured: anti-reticulin (ARA), anti-gliadin (AGA) and anti-endomysium (EMA) antibodies. Serology may be unreliable in young children, with anti-gliadin performing somewhat better than other tests in children under five. Serology tests are based on indirect immunofluorescence (reticulin, gliadin and endomysium) or ELISA (gliadin or tissue transglutaminase, tTG).

Guidelines recommend that a total serum IgA level is checked in parallel, as coeliac patients with IgA deficiency may be unable to produce the antibodies on which these tests depend (“false negative”). In those patients, IgG antibodies against transglutaminase (IgG-tTG) may be diagnostic.

Antibody testing and HLA testing have similar accuracies. However, widespread use of HLA typing to rule out coeliac disease is not currently recommended.

Endoscopy:-Click to see the picture
An upper endoscopy with biopsy of the duodenum (beyond the duodenal bulb) or jejunum is performed. It is important for the physician to obtain multiple samples (four to eight) from the duodenum. Not all areas may be equally affected; if biopsies are taken from healthy bowel tissue, the result would be a false negative.

Most patients with coeliac disease have a small bowel that appears normal on endoscopy; however, five concurrent endoscopic findings have been associated with a high specificity for coeliac disease: scalloping of the small bowel folds (pictured), paucity in the folds, a mosaic pattern to the mucosa (described as a “cracked-mud” appearance), prominence of the submucosa blood vessels, and a nodular pattern to the mucosa.

Until the 1970s, biopsies were obtained using metal capsules attached to a suction device. The capsule was swallowed and allowed to pass into the small intestine. After x-ray verification of its position, suction was applied to collect part of the intestinal wall inside the capsule. One often-utilised capsule system is the Watson capsule. This method has now been largely replaced by fibre-optic endoscopy, which carries a higher sensitivity and a lower frequency of errors.


Pathology
:-
The classic pathology changes of coeliac disease in the small bowel are categorised by the “Marsh classification”

*Marsh stage 0: normal mucosa
*Marsh stage 1: increased number of intra-epithelial lymphocytes, usually exceeding 20 per 100 enterocytes
*Marsh stage 2: proliferation of the crypts of Lieberkuhn
*Marsh stage 3: partial or complete villous atrophy
*Marsh stage 4: hypoplasia of the small bowel architecture

Marsh’s classification, introduced in 1992, was subsequently modified in 1999 to six stages, where the previous stage 3 was split in three substages. Further studies demonstrated that this system was not always reliable and that the changes observed in coeliac disease could be described in one of three stages—A, B1 and B2—with A representing lymphocytic infiltration with normal villous appearance and B1 and B2 describing partial and complete villous atrophy.

The changes classically improve or reverse after gluten is removed from the diet. However, most guidelines don’t recommend a repeat biopsy unless there is no improvement in the symptoms on diet. In some cases, a deliberate gluten challenge, followed by biopsy, may be conducted to confirm or refute the diagnosis. A normal biopsy and normal serology after challenge indicates the diagnosis may have been incorrect.

Other diagnostic tests:-
At the time of diagnosis, further investigations may be performed to identify complications, such as iron deficiency (by full blood count and iron studies), folic acid and vitamin B12 deficiency and hypocalcaemia (low calcium levels, often due to decreased vitamin D levels). Thyroid function tests may be requested during blood tests to identify hypothyroidism, which is more common in people with coeliac disease.

Osteopenia and osteoporosis, mildly and severely reduced bone mineral density, are often present in people with coeliac disease, and investigations to measure bone density may be performed at diagnosis, such as dual energy X-ray absorptiometry (DXA) scanning, to identify risk of fracture and need for bone protection medication.

Screening:-
Due to its high sensitivity, serology has been proposed as a screening measure, because the presence of antibodies would detect previously undiagnosed cases of coeliac disease and prevent its complications in those patients. There is significant debate as to the benefits of screening. Some studies suggest that early detection would decrease the risk of osteoporosis and anaemia. In contrast, a cohort study in Cambridge suggested that people with undetected coeliac disease had a beneficial risk profile for cardiovascular disease (less overweight, lower cholesterol levels). There is limited evidence that screen-detected cases benefit from a diagnosis in terms of morbidity and mortality; hence, population-level screening is not presently thought to be beneficial.

In the United Kingdom, the National Institute for Health and Clinical Excellence (NICE) recommends screening for coeliac disease in patients with newly diagnosed chronic fatigue syndrome  and irritable bowel syndrome, as well as in type 1 diabetics, especially those with insufficient weight gain or unexplained weight loss. It is also recommended in autoimmune thyroid disease, dermatitis herpetiformis, and in the first-degree relatives of those with confirmed coeliac disease.

There is a large number of scenarios where testing for coeliac disease may be offered given previously described associations, such as the conditions mentioned above in “miscelaneous”.

Treatment:-
General: Although there is currently no cure for celiac disease, the condition can be managed with diet. Symptoms will subside within several weeks and patients will be able to absorb food normally once they avoid eating gluten. However, it may take several months in children and two to three years in elderly patients for the intestine to fully recover.

Support: Healthcare providers may recommend a dietitian or nutritionist who can help a patient plan an appropriate gluten-free diet. These professionals can also help patients determine whether or not supplementation with vitamins and minerals is necessary.

Diet:
Gluten-free diet
At present, the only effective treatment is a life-long gluten-free diet. No medication exists that will prevent damage or prevent the body from attacking the gut when gluten is present. Strict adherence to the diet allows the intestines to heal, leading to resolution of all symptoms in most cases and, depending on how soon the diet is begun, can also eliminate the heightened risk of osteoporosis and intestinal cancer. Dietician input is generally requested to ensure the patient is aware which foods contain gluten, which foods are safe, and how to have a balanced diet despite the limitations. In many countries, gluten-free products are available on prescription and may be reimbursed by health insurance plans.

The diet can be cumbersome; failure to comply with the diet may cause relapse. The term gluten-free is generally used to indicate a supposed harmless level of gluten rather than a complete absence. The exact level at which gluten is harmless is uncertain and controversial. A recent systematic review tentatively concluded that consumption of less than 10 mg of gluten per day is unlikely to cause histological abnormalities, although it noted that few reliable studies had been done. Regulation of the label gluten-free varies widely by country. For example, in the United States, the term gluten-free is not yet regulated. The current international Codex Alimentarius standard, established in 1981, allows for 50 mg N/100 g on dry matter, although a proposal for a revised standard of 20 ppm in naturally gluten-free products and 200 ppm in products rendered gluten-free has been accepted. Gluten-free products are usually more expensive and harder to find than common gluten-containing foods. Since ready-made products often contain traces of gluten, some coeliacs may find it necessary to cook from scratch.

Even while on a diet, health-related quality of life (HRQOL) may be lower in people with coeliac disease. Studies in the United States have found that quality of life becomes comparable to the general population after staying on the diet, while studies in Europe have found that quality of life remains lower, although the surveys are not quite the same. Men tend to report more improvement than women. Some have persisting digestive symptoms or dermatitis herpetiformis, mouth ulcers, osteoporosis and resultant fractures. Symptoms suggestive of irritable bowel syndrome may be present, and there is an increased rate of anxiety, fatigue, dyspepsia and musculoskeletal pain.

Everyone is different, but many people with coeliac disease also have one or more additional food allergies or food intolerances, which may include milk protein (casein), corn (maize), soy, amines, or salicylates.

What if you eat gluten?
If you accidentally eat a product that contains gluten, you may experience abdominal pain and diarrhea. Some people experience no signs or symptoms after eating gluten, but this doesn’t mean it’s not hurting them. Even trace amounts of gluten in your diet can be damaging, whether or not they cause signs or symptoms.

Most people with celiac disease who follow a gluten-free diet have a complete recovery. Rarely, people with severely damaged small intestines don’t improve with a gluten-free diet. When diet isn’t effective, treatment often includes medications to help control intestinal inflammation and other conditions resulting from malabsorption.

Because celiac disease can lead to many complications, people who don’t respond to dietary changes need frequent monitoring for other health conditions.

Lifestyle and home remedies:-

Following a gluten-free diet may leave you angry and frustrated, understandably so. But with time, patience and a little creativity, you’ll find there are many foods that you can still eat and enjoy. Following are some tips to help you on your way to a safe and healthy diet.

Read food labels
Food labels are your lifeline to better health. Always read the food label before you purchase any product. Some foods that may appear acceptable, such as rice or corn cereals, may contain gluten. What’s more, a manufacturer may change a product’s ingredients at any time. A food that was once gluten-free no longer may be. Unless you read the label every time you shop, you won’t know this.

Call the manufacturer
If you can’t tell by the label if a food contains gluten, don’t eat it until you check with the product’s manufacturer. Some support groups produce a gluten-free shopper’s guide that can save you time at the market, although it may not be as current as that obtained from the manufacturer.

Don’t be afraid to eat out

Though preparing your own meals is the easiest way to monitor your diet, this doesn’t mean you can’t eat out. For an enjoyable dining experience, remember the following advice:

*Select places that specialize in the kinds of foods you can eat. You may want to call the restaurant in advance and discuss the menu options and your dietary needs.
*Be a repeat customer. Visit the same restaurants so that you become familiar with their menus and the personnel get to know your needs.
*Seek and share ideas. Ask members of your support group for suggestions on restaurants that serve gluten-free food. If there are enough gluten-sensitive people in your community, it’s likely that restaurant owners will try to satisfy your needs. Continue to share with the support group the names of any restaurants that add gluten-free foods to their menus.
*Follow the same practices you do at home. Select simply prepared or fresh foods and avoid all breaded or batter-coated foods, gravies and other foods with obvious or questionable ingredients.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Coeliac_disease
http://www.mayoclinic.com/health/celiac-disease/DS00319
http://www.righthealth.com/topic/Celiac_Disease_Symptoms/overview/NaturalStandard20?fdid=NaturalStandard_5ba0efa8e0040c39deb1cd99a1446453&section=Full_Article

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Belly Bulges

A protruding belly button is commoner in boys and may run in families   Everyone would love an eight pack abdomen, but for some it may remain just a dream. Their abdominal wall has unsightly bulges and protuberances, which may be a well rounded paunch or even hernia.

Some children have a protruding navel or belly button, which is noticed soon after the remnant of the umbilical cord falls off. When the baby cries or strains, the tummy bulges at the umbilicus. The swelling is called an umbilical hernia. It is commoner in boys. It may run in families and be associated with other diseases like thyroid deficiency or inborn errors of metabolism.

The foetus receives its nutrition through umbilical blood vessels that are attached to the navel. The abdominal muscles also fuse at that point. There is an area of weakness there which can cause a defect in the abdominal wall muscles. The intestines may protrude through this. Usually, the intestines can be pushed back when the child is quiet and lying down.

By the age of three or four years, the abdominal musculature develops and the hernia disappears on its own. It usually does not cause any symptoms till that time. If the skin over the hernia changes colour, or if the child starts to cry incessantly, consult a doctor. It may mean the intestine has got trapped in the hernia and its blood supply is being compromised, strangling the bowel.

Strapping the bulging belly button with plaster, tying it with a bandage or fixing a coin over it won’t help. On the contrary, it may be harmful as a piece of intestine may get caught in the bandage and stop the blood supply. This then becomes a medical emergency. If the hernia persists after the age of three, it needs to be surgically repaired.

Hernias can also suddenly appear near the umbilicus in adults. This “paraumbilical hernia” is situated just above the navel and occurs through a weakness in the abdominal wall muscles. It may be due to pregnancy, obesity or poor abdominal muscle tone. It may also appear if fluid accumulates in the abdomen as a result of kidney or liver disease. The hernia may contain fat or intestines.

Paraumbilical hernias that appear during pregnancy may disappear on their own. In others, they need to be surgically corrected, even if they are painless. Bits of bowel or other intestinal content can suddenly become trapped in them, precipitating an emergency. There is a band of fibrous tissue connecting and holding together the musculature of the two halves of the abdomen. If this is weak and separates out, it may cause a condition called “divarication of the rectus abdominus”. It is common in obesity. The affected area is usually long and stretches over the abdomen from the umbilicus to the rib cage. As the defect is large, the intestine does not become trapped inside. If there is no umbilical hernia, it can be left alone. Surgical repair is a variation of a “tummy tuck” and is done purely for cosmetic reasons.

If there is a small defect in the linea alba (fibrous structure running down the midline of the abdomen), a ping-pong ball sized bulge can occur at the spot. This is called an “epigastric hernia”. It needs to corrected.

About 75 per cent of hernias occur lower down in the groin area and are called “inguinal hernias”. They are commoner in men. They can extend from the lower part of the abdomen to the scrotum in men and to the labia in women. They are caused by a congenital defect in the abdominal wall. Some men push the contents of the hernia back into the abdomen and then use a “surgical truss” to hold it there.

The surgical treatment of hernias has changed over the years. Traditional techniques involved opening the abdomen and suturing the muscle layers. Hospital stays were prolonged and recovery slow. Now, laparoscopic repairs can be done, reducing the hospital stay to two or three days. Fine sterile surgical mesh can be used to cover the defect. The hernia is then less likely to recur as there is no tension on the layers of the abdominal muscles.

Some hernias can’t be prevented. Congenital abdominal wall defects are less likely to manifest as hernias if

• The BMI (body weight divided by height in metre squared) is 23

• Core strengthening exercises (oblique sit ups, plank position) are done daily

• Lifting heavy weights is avoided

• Weight-lifting exercises are done after proper training and conditioning.

Source: The Telegraph (Kolkata, India)

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Roughage not so Good for Bowels

Grandma was wrong: wheat bran and other fibrous foods that do not dissolve easily in water not only fail to soothe irritable bowels, but may  actually make things worse, a study reported Friday.
………………FOOD WITH ROUGHAGE

While soluble types of bran, such as psyllium, appear to ease inflamed bowels, the insoluble varieties that have long been a staple for people in search of regularity don’t work as advertised, the study found.

Bran is the hard outer layer of grains. Psyllium, also referred to as isphagula, is derived from the seed husks of the Plantago ovata plant, and is the chief ingredient in many over-the-counter laxatives.

The signature symptoms of irritable bowel syndrome (IBS), which affects about 10 percent of the population, are abdominal pain and an irregular bowel habit.

In many countries, doctors recommend daily doses of fibre in the form of insoluble bran, but there have been very few rigorous studies to see whether boosting intake of this type of fibre actually works.

A team of researchers from the Netherlands led by Rene Bijkerk of the University Medical Centre set up clinical trials to find out.

They divided 275 patients into three groups, and gave each a different 12-week treatment regimen.

One group ate 10-grams of bran twice a day, and a second ate the same quantities of psyllium, which forms a gel-like substance when mixed with water.

A third group ate a neutral placebo made out of rice flour, which contains no fibre at all.

All but six percent of the participants were Caucasian, and more than three-quarters were women, who suffer from IBS more than men.

The patients had either been diagnosed as having the syndrome within the last two years, or fulfilled other criteria for chronic bowel-related problems.

A standardised scale measuring the severity of symptoms showed that psyllium was the most effective treatment, even after only one month.

After three months, the severity was reduced by 90 points in the psyllium group, 49 points in the placebo group, and 58 points in the bran group.

The slight difference between the bran and the rice gruel placebo was judged statistically insignificant.

“Bran showed no clinically relevant benefits, and many patients seemed not to tolerate bran,” the researchers reported in the British Medical Journal.

“Indeed, bran may worsen symptoms of irritable bowel syndrome and should be advised only with caution.”

Previous studies have linked soluble fibres to healthy blood cholesterol levels and a better regulation of blood sugar levels.

Food sources that contain soluble fibre include psyllium, barley, oatmeal, lentils, fruit and vegetables.

You may also click to see:-
>Soluble fibre helpful in bowel movement
>Gut bacteria may help treat bowel disease
>’Healthy’ fat could lead to bowel disease
>Bowel cancer risk factor found
>Alcohol, cigarettes cause bowel cancer

Hypnosis ‘can ease bowel illness’
‘Perfectionism’ bowel pain link
Food allergy ‘link’ to bowel pain

‘Imagine your gut as a river…’
People ‘ignoring’ gut illnesses
IBS linked to low birth weights

Source: TheTimes Of India

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Mare’s Milk to Ease Gut Ache

Mare’s milk is being tested as a treatment for inflammatory bowel problems, such as ulcerative colitis.  …..CLICK & SEE

CLICK TO SEE
This follows an earlier study which showed that the milk from horses reduced eczema symptoms by an average of 30 per cent.
The same study found that the patients also had higher levels of ‘good’ bacteria after treatment. Good bacteria are thought to have an antiinflammatory effect, as well as boosting the immune system.
In the latest German trial, conducted at the University of Jena, patients were given either 250ml of mare’s milk or a placebo daily for two months. Those who had the milk suffered less abdominal pain and needed less medication.
It’s not clear what is in the milk that is beneficial, but the researchers believe it ‘could improve the well-being of patients with Crohn’s disease and ulcerative colitis’.

Other Health Benefits:

Toward the end of the 19th century, kumis had a strong enough reputation as a cure-all to support a small industry of “kumis cure” resorts, mostly in southeastern Russia, where patients were “furnished with suitable light and varied amusement” during their treatment, which consisted of drinking large quantities of kumis. W. Gilman Thompson’s 1906 Practical Diatetics reports that kumis has been cited as beneficial for a range of chronic diseases, including tuberculosis, bronchitis, catarrh, and anemia. Gilman also says that a large part of the credit for the successes of the “kumis cure” is due not to the beverage, but to favorable summer climates at the resorts. Among notables to try the kumis cure were writers Leo Tolstoy and Anton Chekhov. Chekhov, long-suffering from tuberculosis, checked into a kumis cure resort in 1901. Drinking four bottles a day for two weeks, he gained 12 pounds but no cure.

 

Nutritional properties of mare’s milk
87.9% of Inner Mongolians are lactose intolerant. During fermentation, the lactose in mare’s milk is converted into lactic acid, ethanol, and carbon dioxide, and the milk becomes an accessible source of nutrition for people who are lactose intolerant.

Before fermentation, mare’s milk has almost 40% more lactose than cow’s milk According to one modern source, “unfermented mare’s milk is generally not drunk”, because it is a strong laxative.    Varro’s On Agriculture, from the 1st century BC, also mentions this: “as a laxative the best is mare’s milk, then donkey’s milk, cow’s milk, and finally goat’s milk…”; drinking six ounces (190 ml) a day would be enough to give a lactose-intolerant person severe intestinal symptoms.

You may click to learn more about  Mare’s milk……(1)…….(2)……(3)


Resources:

Mail Online. Aug.21.2009
http://en.wikipedia.org/wiki/Kumis

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Peritonitis

Alternative Name: Abdominal wall inflammation

Definition:
Peritonitis is defined as inflammation of the peritoneum (the serous membrane which lines part of the abdominal cavity and some of the viscera it contains). It may be localised or generalised, generally has an acute course, and may depend on either infection (often due to rupture of a hollow organ as may occur in abdominal trauma) or on a non-infectious process.

.click to see

There are three types of Peritonitis:

click to see

1.primary (spontaneous)
2.secondary (anatomic)………click to see
3.tertiary (peritoneal dialysis related)

Primary peritonitis is caused by the spread of an infection from the blood and lymph nodes to the peritoneum. This type of peritonitis is rare — less than 1% of all cases of peritonitis are primary. The more common type of peritonitis, called secondary peritonitis, is caused when the infection comes into the peritoneum from the gastrointestinal or biliary tract. Both cases of peritonitis are very serious and can be life threatening if not treated quickly

Signs and Symptoms:
The signs and symptoms of peritonitis include:

•Swelling and tenderness in the abdomen with pain ranging from dull aches to severe, sharp pain
•Fever and chills
•Loss of appetite
•Thirst
•Nausea and vomiting
•Limited urine output
•Inability to pass gas or stool

Risk Factors:
The following factors may increase the risk for primary peritonitis:

•Liver disease (cirrhosis)
•Fluid in the abdomen
•Weakened immune system
•Pelvic inflammatory disease
Risk factors for secondary peritonitis include:

•Appendicitis (inflammation of the appendix)
•Stomach ulcers
•Torn or twisted intestine
•Pancreatitis
•Inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis
•Injury caused by an operation
•Peritoneal dialysis
•Trauma

Diagnosis and investigations
Diagnosing peritonitis is accomplished through a medical procedure often colloquially referred to as a “cough test“.

Patient is asked to lie flat (in position for undertaking abdominal examination) and to give a deep cough.
Sometimes the patient is asked to stand, and then asked to turn their head and cough.
If this produces pain/tenderness/obvious discomfort, peritonitis can be considered as a differential diagnosis.
Obviously this is not a particularly specific or sensitive test, but may be highly suggestive when combined with other physical signs of peritonitis such as absent bowel sounds.
It is important to look at the patient’s face when carrying out this test, as they may later deny that they experienced pain.

A diagnosis of peritonitis is based primarily on clinical grounds, that is on the clinical manifestations described above; if they support a strong suspicion of peritonitis, surgery is performed without further delay from other investigations. Leukocytosis, hypokalemia, hypernatremia and acidosis may be present, but they are not specific findings. Plain abdominal X-rays may reveal dilated, edematous intestines, although it is mainly useful to look for pneumoperitoneum (free air in the peritoneal cavity), which may also be visible on chest X-rays.

Definitive diagnosis of peritonitis is achieved via paracentesis (abdominal tap). More than 250 polymorphonuclear cells per ?L is considered diagnostic. In addition, gram stain, and culture with sensitivity of the peritoneal fluid can determine the underlying etiologic organism.

Causes

Infected peritonitis:-
*Perforation of a hollow viscus is the most common cause of peritonitis. Examples include perforation of the distal oesophagus (Boerhaave syndrome), of the stomach (peptic ulcer, gastric carcinoma), of the duodenum (peptic ulcer), of the remaining intestine (e.g. appendicitis, diverticulitis, Meckel diverticulum, inflammatory bowel disease (IBD), intestinal infarction, intestinal strangulation, colorectal carcinoma, meconium peritonitis), or of the gallbladder (cholecystitis). Other possible reasons for perforation include abdominal trauma, ingestion of a sharp foreign body (such as a fish bone, toothpick or glass shard), perforation by an endoscope or catheter, and anastomotic leakage. The latter occurrence is particularly difficult to diagnose early, as abdominal pain and ileus paralyticus are considered normal in patients who just underwent abdominal surgery. In most cases of perforation of a hollow viscus, mixed bacteria are isolated; the most common agents include Gram-negative bacilli (e.g. Escherichia coli) and anaerobic bacteria (e.g. Bacteroides fragilis). Fecal peritonitis results from the presence of faeces in the peritoneal cavity. It can result from abdominal trauma and occurs if the large bowel is perforated during surgery.

*Disruption of the peritoneum, even in the absence of perforation of a hollow viscus, may also cause infection simply by letting micro-organisms into the peritoneal cavity. Examples include trauma, surgical wound, continuous ambulatory peritoneal dialysis, intra-peritoneal chemotherapy. Again, in most cases mixed bacteria are isolated; the most common agents include cutaneous species such as Staphylococcus aureus, and coagulase-negative staphylococci, but many others are possible, including fungi such as Candida.

*Spontaneous bacterial peritonitis (SBP) is a peculiar form of peritonitis occurring in the absence of an obvious source of contamination. It occurs either in children, or in patients with ascites. See the article on spontaneous bacterial peritonitis for more information.

*Systemic infections (such as tuberculosis) may rarely have a peritoneal localisation.

Non-infected peritonitis:-
*Leakage of sterile body fluids into the peritoneum, such as blood (e.g. endometriosis, blunt abdominal trauma), gastric juice (e.g. peptic ulcer, gastric carcinoma), bile (e.g. liver biopsy), urine (pelvic trauma), menstruum (e.g. salpingitis), pancreatic juice (pancreatitis), or even the contents of a ruptured dermoid cyst. It is important to note that, while these body fluids are sterile at first, they frequently become infected once they leak out of their organ, leading to infectious peritonitis within 24-48h.

*Sterile abdominal surgery normally causes localised or minimal generalised peritonitis, which may leave behind a foreign body reaction and/or fibrotic adhesions. Obviously, peritonitis may also be caused by the rare, unfortunate case of a sterile foreign body inadvertently left in the abdomen after surgery (e.g. gauze, sponge).

*Much rarer non-infectious causes may include familial Mediterranean fever, porphyria, and systemic lupus erythematosus.

Pathology:-
The peritoneum normally appears greyish and glistening; it becomes dull 2–4 hours after the onset of peritonitis, initially with scarce serous or slightly turbid fluid. Later on, the exudate becomes creamy and evidently suppurative; in dehydrated patients, it also becomes very inspissated. The quantity of accumulated exudate varies widely. It may be spread to the whole peritoneum, or be walled off by the omentum and viscera. Inflammation features infiltration by neutrophils with fibrino-purulent exudation.

Treatment:-
Depending on the severity of the patient’s state, the management of peritonitis should be done.

Peritonitis is a potentially life-threatening condition, and you should see immediate emergency medical attention when symptoms occur. You will likely need to be hospitalized for treatment. You may need surgery to remove the source of infection, such as an inflamed appendix, or to repair a tear in the walls of the gastrointestinal or biliary tract. Antibiotics are used to control infection. Integrative therapies may also be used for supportive care when recovering from peritonitis.

Medications
Your doctor will prescribe antibiotics to kill bacteria and prevent the infection from spreading. The antibiotics prescribed vary, depending on the type of peritonitis and the organism causing the condition.

Surgery and Other Procedures
People with peritonitis often need surgery to remove infected tissue and repair damaged organs.

Nutrition and Dietary Supplements
Peritonitis is a medical emergency and should be treated by a medical doctor. Do not try to treat peritonitis with herbs or supplements. However, a comprehensive treatment plan for recovering from peritonitis may include a range of complementary and alternative therapies. Ask your team of health care providers about the best ways to incorporate these therapies into your overall treatment plan. Always tell your health care provider about the herbs and supplements you are using or considering using.

When recovering from any serious illness, it is important to follow good nutrition habits:

•Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes) and vegetables (such as squash and bell peppers).
•Eat foods high in B-vitamins and calcium, such as almonds, beans, whole grains (if no allergy), dark leafy greens (such as spinach and kale), and sea vegetables.
•Avoid refined foods, such as white breads, pastas, and especially sugar.
•Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy), or beans for protein.
•Use healthy oils in foods, such as olive oil or vegetable oil.
•Avoid caffeine and other stimulants, alcohol, and tobacco.
•Drink 6 – 8 glasses of filtered water daily.
•Ask your doctor about taking a multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals such as magnesium, calcium, zinc, and selenium.
•Probiotic supplement (containing Lactobacillus acidophilus among other species), 5 – 10 billion CFUs (colony forming units) a day, for gastrointestinal and immune health. Probiotics can be especially helpful when taking antibiotics, because probiotics can help restore the balance of “good” bacteria in the intestines.

Herbs
Herbs are generally a safe way to strengthen and tone the body’s systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 – 10 minutes for leaf or flowers, and 10 – 20 minutes for roots. Drink 2 – 4 cups per day. You may use tinctures alone or in combination as noted.

Herbs can be used as a supportive therapy when you are recovering from peritonitis, but do not use herbs alone to treat peritonitis. Ask your doctor before taking any of the herbs listed below.

•Green tea (Camellia sinensis) standardized extract, 250 – 500 mg daily, for antioxidant, anti-inflammatory, and heart health effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.
•Cat’s claw (Uncaria tomentosa) standardized extract, 20 mg three times a day, to reduce inflammation. Cat’s claw also has antibacterial and antifungal effects.
Olive leaf (Olea europaea) standardized extract, 250 – 500 mg one to three times daily, for antibacterial and antifungal effects. You may also prepare teas from the leaf of this herb.
•Milk thistle (Silybum marianum) seed standardized extract, 80 – 160 mg two to three times daily, for liver health.

Homeopathy

Few studies have examined the effectiveness of specific homeopathic remedies. A professional homeopath, however, may recommend one or more of the following treatments for peritonitis based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person’s constitutional type — your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

•Belladonna — for people who are hypersensitive to touch, have sudden attacks of pain that come and go, and have a high fever
•Arsenicum album — for people with a swollen abdomen, unquenchable thirst, extreme chills, and symptoms that worsen at night

Other Considerations:
Prognosis and Complications:-

Complications from peritonitis can include:

•Sepsis — an infection throughout the blood and body that can cause shock and multiple organ failure
•Abnormal clotting of the blood (generally due to significant spread of infection)
•Formation of fibrous tissue in the peritoneum
•Adult respiratory distress syndrome
— a severe infection of the lungs
The prognosis for peritonitis depends on the type of the condition. For example, the outlook for people with secondary peritonitis tends to be poor, especially among the elderly, people with compromised immune systems, and those who have had symptoms for longer than 48 hours before treatment. The long-term outlook for people with primary peritonitis due to liver disease also tends to be poor. However, the prognosis for primary peritonitis among children is generally very good after treatment with antibiotics.
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Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Peritonitis
http://www.umm.edu/altmed/articles/peritonitis-000127.htm

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