This book provides a practical overview of the treatment and management of celiac disease. It examines new data which can be merged with clinical aspects to provide a global perspective for the busy clinician. The disease represents 1% of the population and often goes unnoticed for a long time; however, this book aims to reduce the instance of misdiagnoses of symptoms by providing clear guidance in a single book, with contributions from esteemed experts in the field. Advances in Celiac Disease - Improving Paediatric and Adult Care addresses the clinical characterisation of the disease, in both paediatric and adult populations. The clinical symptoms are clearly defined as well as treatment options and follow-up. This book will be an essential resource for clinicians seeking a clear, concise resource to identifying, treating, and managing celiac disease in both adults and children.

The Anglo-Swiss Colo-Proctology Meeting, held at Lausanne in May 1983, enabled numerous specialists to share their experiences of lower gastrointestinal tract pathology. The focus was on ischae mic disease and tumours of the colon, rectum and anus. By featuring ischaemic disease in our programme we hoped to give this too often underestimated process a fair hearing. Ischaemic lesions are far more common than is recognised on clinical grounds alone, particularly in the gastrointestinal tract. Large intestine is chaemia is often confused with other syndromes, especially since the clinical features evoked are, in most cases, atypical. Thus diag nosis is frequently late, with dramatic consequences. The oncology section basically discusses the early diagnosis of gastrointestinal tumours, a prerequisite for improving survival in af fected patients, and also presentation and treatment of certain rare tumours. The third section of this volume covers various diverse subjects including surgical technique, functional disorders of the large intes tine, inflammatory bowel disease, haemorrhoids and investigatory procedures. Several of the articles come from international authorities in their field. Some communications contain unpublished results, and others may lead to new diagnostic and therapeutic methods. We feel that the quality and variety of the texts from the Anglo-Swiss Colo Proctology Meeting merit wide appreciation. We are grateful to Springer-Verlag for accepting these proceed ings for publication."

"Gastrointestinal Disease" is the first monograph in a new series on management and treatment in major clinical subspecialties and patient groups. Further volumes will be published over the next few years. Each book is complete in its own right. The whole series, however, has been prepared to fill a gap, perceived by the publisher, myself and the volume authors, between standard textbooks of medicine and therapeutics and research reviews, symposia and original articles in specialist fields. Each volume aims to provide a concise, up to date account of treatment in its subject area with particular reference to drug therapy. Traditional clinical and therapeutic approaches have been presented in the context of developments in clinical pharmacology. Wherever possible, authorship has been under taken by practising clinicians who themselves have training and experience in clinical pharmacology. The volumes are intended to be guides to treatment, to assist in the choice of drug and other treatment and to provide easy references to drug interactions and adverse reactions. It is expected that these monographs will be particularly useful for the young hospital doctor in training for higher qualifications. However, they should also be valuable to or senior medical students and to those in established hospital general practice who are seeking to update their knowledge and to view recent developments in other fields in a balanced context. The aims of the series should be upheld by this volume on "Gastrointestinal Disease.""

This book of diagnostic exercises cannot be used to good advantage without a good grasp of elementary sonoanatomy and the most common pathologic l images . We have tried to follow a pedagogical progression from the simple to the complicated for each group of clinical situations. We recommend that the sonograms at the beginning of each case study be thoroughly analysed before proceeding to the commentaries which explain the grounds for the final diagnosis. These explanatory remarks are accompanied by the same sonograms, but with arrows and letters added so as to pinpoint the details referred to as the diagnosis progresses. In reading the commentaries it will therefore be a good idea to cover over the figures in which the details are picked out for you, uncovering them one by one as required. 1 Which the reader may obtain from our previous books: Ed., 1982) Ultrasonography of Digestive Diseases (Mosby Publ., 2nd Renal Sonography (Springer Verlag, 1981) 1 Chapter 1 In Which the Reader is Invited to Clean His Glasses 1.1. Mrs. Beech, 75 years, has the complexion of a young girl, but she is losing weight and complains of epigastric pain. She has undergone a whole series of conventional radiological procedures; this may be good news for the film manufacturers, but it has not aided in the diagnosis. Finally, she is referred for an ultrasound examination. Look first at ultrasonic cuts 1.1a, b (transverse), then LId (sagittal).

Are you suffering from Irritable Bowel Syndrome? Do you have episodes of wind, bloating, constipation and diarrhoea? If so, this probably means that your digestive system is not functioning properly and you need to find out why. Based on proven methods applied in her own practice, Hilda Glickman discusses the symptoms of IBS, shows you how to test at home for the possible causes and looks at how you can improve your overall health through simple changes to your diet. Written in a clear, accessible style, this book offers a five-step plan that will enable you to *Find out and eliminate what should not be in your digestive tract *Add in what should be in the digestive tract *Facilitate the reintroduction of beneficial bacteria *Heal and strengthen your digestive tract *Learn how you should eat in order to maintain a healthy digestion Your digestive system doesn't exist on its own. If it is not functioning correctly your overall health will be adversely affected. This book will show you how to heal your gut, improve your health, and prevent further problems.

'I deeply respect and honour the work of Ann Louise Gittleman, whom I consider as a teacher, as well as what she has done to bring intelligence to the world of nutrition.' Dr Mark Hyman Eat your way to a faster metabolism, easier weight loss and better health - from New York Times bestselling author and health pioneer Ann Louise Gittleman. One reason many diets fail is that they don't correct the shutdown of key fat-burning tissues in the body: brown fat, muscle and the microbiome. Each of these prefers a specific type of food for optimal function and this expert book tells you exactly how to fuel them. Radical Metabolism will shake up your long-held beliefs and assumptions about what is healthy, especially when it comes to diet. However, this isn't just about weight loss - this is about putting the brakes on ageing, gaining the tools necessary to dodge age-related illness and staying energised for life. The book is divided into three sections: The first section lays out the scientific basis for the Radical Metabolism plan so that you can understand the rationale behind the programme. Discover the five radical rules for rescuing your metabolism, the forgotten but powerful role bile plays in the body's slimming systems and the hero ingredients that are key to lasting weight loss. The second section is the eating diet plan. It starts off with the 4-Day Radical Intensive Cleanse, a simple juicing-and-souping detox plan designed to give your liver and gallbladder a rest before the main programme. The 21-Day Radical Reboot will teach you how to reawaken and retrain your metabolism to build a lasting and lean body. The third section expands the menu with a collection of 49 recipes (anglicised for UK readers) and provides a maintenance plan and additional guidance for staying on track for life. An easy-to-follow programme with the nutritional and scientific research to back it up, this book offers simple strategies that produce radical results. REAP THE BENEFITS OF A RADICAL METABOLISM: - Lasting weight loss - Greater energy - Balanced mood - Healthier skin - Protection against health problems, such as type II diabetes and gallbladder issues

Ever since the invention of the fiberoptic endoscope in 1888, gastrointestinal endoscopy has grown increasingly popular in day-to-day patient management. Most recently, a variety of therapeutic procedures are also being performed through the endoscope. With increasing technological advances, new endo scopic procedures will be appearing on the horizon. It, therefore, becomes extremely relevant for the gastrointestinal nurse or assistant to be familiar with various endoscopic procedures. Gastrointestinal Endoscopy and Related Procedures will be a useful and practical guide in the making of a qualified gastrointestinal assistant. This book is notable for its elegant style, illustrations, detailed account of procedures, and especially the instructions on patient care. Discussions on physical preparation of gastrointestinal procedures, helpful hints and instrument care add to the value of this book. The psychological impact on the patient undergoing endo scopic procedures and the nurse's role in alleviating 'the fear of the unknown' also is properly covered in the text. It is refreshing to see a nursing perspective in the writing of this text. Throughout the whole book, one can feel a warm and humane approach towards patients with gastrointestinal disease. All these and more are, of course, a result of Sister Morag Ravenscroft's vast experience along with the guidance of Dr Charles Swan. It is a textbook worth reading and relishing. Marcia Pfeifer R.N."

Howard C. Thomas In normal subjects the regulatory apparatus of the immune system permits responses to foreign antigens but suppresses those directed to "self' components. Autoimmune disease occurs as a failure ofthis system either as a result of a primary defect in the regulatory apparatus (primary autoimmunization) or because of a change in the antigenicity of the tissues (secondary autoimmunization). Autoaggressive reactions are characterised by the presence of autoantibodies. When these are directed to membrane displayed antigens (Fig. 1) they are probably of importance in the lysis of hepatocytes. Those directed to cytoplasmic antigens may be useful diagnostically but are of unknown pathogenic significance. When no extrinsic aetiological factor can be identified, the process is assumed to be the result of a failure ofthe regulatory system, allowing the spontaneous expansion of a clone of autoreactive lymphocytes. The defect may be generalised or specific to certain groups of self-antigens and thus the autoimmune disease may be either multi- or unisystemic. The recent development of techniques to enumerate and measure the functional activity of the suppressor lymphocytes which control the effector limbs of the immune system has enabled investigators to test whether the various purported autoimmune diseases do have as their basis a generalised defect in immunoregu lation. Assessment of antigen-specific immunoregulatory function is, however, not yet readily available. liver Membrane I Antigen (LIM) I Liver I HLA, A, B, C, Sensitisation to Specific -;::!IIIL. .

The acute abdomen often perplexes the expert as well as the young physician. There are few areas in medicine in which Hippocrates' aphorism-the art is long, life is short, decision difficult, and delay perilous-is more applicable than here. Too often the harried physician fails to listen to the patient who is trying desperately to suggest the diagnosis. The significance of various types and location of pain often are neglected by the doctor. Physical findings are influenced by experience; the presence or absence of tenderness or a mass may be answered in entirely different ways by various observers. Because solid facts frequently are lacking, attempts to resolve diagnostic dilemmas by computer analysis or by algorithms are not likely to be successful. Fortunately, in the great majority of cases, unusual and difficult diagnostic procedures are not necessary for the identification of the acute abdomen and of the major disease. Astute clinical judgment must be based primarily upon careful attention to the pa tient's words and detailed observation."

Dieses Buch ist nach der "Ulcus-Therapie" und den "Postoperativen Syndromen" der dritte Folgeband der Reihe "Interdisziplinare Gastro- enterologie". Die Reflux-Therapie erschien uns als interdisziplinares Thema besonders geeignet. Mehr noch als bei der Ulcus-Therapie ist die Grenzlinie zwischen konservativer und operativer Therapie verwaschen. Wahrend bei der Ulcuskrankheit zumindestens gewisse Vorstellungen uber die Definition des Krankheitsbildes und die Haufigkeit der Er- krankungen bestehen, besteht hieruber - auch heute noch - bei der Refluxkrankheit Unklarheit. Viele Arzte arbeiten nicht mit dem Begriff "Refluxkrankheit" , sondern sehen des Problem einzig im Zusammenhang mit der Hiatushernie. Andere fuhren Refluxbeschwerden automatisch auf eine "Gastritis" zuruck. Dementsprechend herrschen auch uber die therapeutischen Moglichkeiten Unklarheiten. Wahrend die einen auto- matisch beim Vorliegen einer Hiatushernie eine chirurgische Therapie anstreben, beginnen die anderen beim Vorliegen von "Hyperaziditats- beschwerden" nicht einmal mit einer Diagnostik, sondern begnugen sich mit halbherzigen palliativen Massnahmen. Es schien uns deshalb angezeigt, eine Gruppe von Sachkennern dieser Materie zusammenzurufen, eine Bestandsaufnahme vorzunehmen und therapeutische Richtlinien zu erarbeiten. Solche Bemuhungen sind bedeutungsvoll, da die Refluxkrankheit bei ahnlicher Symptomatologie im einen Fall eine harmlose, fast zu vernachlassigende Storung dar- stellt, im anderen Fall aber zu einer bedrohlichen Erkrankung fort- schreiten und im schlimmsten Fall sogar der Schrittmacher eines malignen Tumors sein kann.

IBS, which affects almost one in six Americans, is characterized by abdominal pain, bloating, gas, and diarrhea or constipation. Today more than ever before, physicians are able to diagnose this complex disorder, understand and explain its origins, and develop a treatment plan that effectively meets the individual needs of a patient. Drawing on his many years of experience treating people who have symptoms of IBS, Dr. Brian E. Lacy explains normal digestion, the causes of IBS, how IBS is diagnosed, and what to expect with treatment. He also explores special topics such as IBS in children and psychological, hypnotherapeutic, and psychiatric therapies. Important new information in the second edition includes: the roles of fiber, gluten, lactose, and fructose in the development and treatment of IBS; the use of probiotics and antibiotics to treat IBS; similarities and differences between IBS and inflammatory bowel disease (IBD); the relationship between small intestine bacterial overgrowth and IBS; how to make the most of your visits to a gastroenterologist; and lifestyle modifications that can improve symptoms of IBS. Making Sense of IBS is an essential resource for anyone who has symptoms or a diagnosis of IBS as well as for health professionals who treat people with this complex disorder.

GI Emergencies: A Quick Reference Guide contains practical information regarding the diagnosis and management of common gastrointestinal emergencies. Each chapter is written by a fellow or resident with an experienced clinician. This offers the perspective of a trainee, who has many basic questions about how to handle a given situation, combined with the experience of a seasoned practitioner who can guide the work-up and treatment of each clinical case. The result is a reference that provides the clinical acumen of a trained gastroenterologist in an easy-to-use format for physicians to approach GI emergencies efficiently and thoroughly. The dual-perspectives blend perfectly together to create a practical, evidence-based read for the learning physician. In GI Emergencies: A Quick Reference Guide, Dr. Robert C. Lowe and Dr. Francis A. Farraye, along with 20 contributors, help physicians deal with problems as they occur in a "real-time" format. Some Topics Include: * Evaluation and management of acute liver failure * Caustic ingestions, foreign bodies, and food impaction * Nonvariceal upper GI hemorrhage * Acute pancreatitis * Complications of endoscopy The case-based format is less formal than that of a typical textbook, making it enjoyable without losing the educational value and evidence-based recommendations needed to provide excellent patient care. With succinct key teaching points, GI Emergencies: A Quick Reference Guide assists physicians who are training interns, residents, and medical students in training, making it an all-around reference for those in the gastroenterology field.

Gastroenterologic endoscopy has made important progress in the past decade. New techniques and ideas have given it new life. The end of this evolution is not yet in sight. FuIly flexible fiberoptic instruments have eliminated all blank areas from the map of the gastrointestinal tract. Retro- grade visualization of the pancreatic and biliary system has been achieved in conjunction with radiologic methods. Operative endoscopy has de- veloped beyond the removal of foreign bodies, to a stage where laparotomy can be avoided in a number of situations. Hemostasis by laser coagulation and crushing of concrements by ultrasound and electric energy have reached the threshold of clinical applicability. With all these spectacular develop- ments, however, it is important to maintain a firm grasp of the fundamentals of endoscopy. This is the basis of day-to-day success and includes knowl- edge of the proper indications, the ability to manage complications, famil- iarity with the technical properties of the instruments, their skillful handling, and experience in organizing an endoscopy section. Endoscopists, particu- larly members of the Erlangen group, have undertaken the task of charting these fundamentals and of compiling them into a working manual for those already practicing endoscopy or intending to do so. They have been sup- ported in this effort by colleagues from other parts of the Federal Republic of Germany and from Italy.

For at least three centuries, Holland has been at the centre of research on intestinal malabsorption. In the 17th and 18th centuries, early descriptions of coeliac disease and tropical sprue were published by physicians trained in Holland, and it was in 1950 that Dicke published his painstaking and vital observations that coeliac disease in children was caused by the inges tion of wheat flour. Subsequent careful work with van de Kamer and Weijers showed that the harmful agent was gluten. Since these discoveries were made, research in intestinal malabsorption, particularly in the adult, has continued in several centres in Holland. At Nijmegen, for example, dr. Cluysenaer, dr. van Tongeren and their as sociates have been involved in long-term studies of patients with intestinal disease for the past fifteen years. In this book they describe their experience of the investigation and treatment of fifty patients with the adult form of coeliac disease. Their monograph gives an account of the history, definition and incidence of the disorder, and then goes on to undertake a critical review of the pathogenesis of the coeliac lesion. Before embarking on the different patterns of malabsorption seen in adult coeliac disease, the authors describe the normal small intestine, its morphology and function."

Gastroenterologists require detailed knowledge regarding the anatomy of the GI system in order to understand the disturbances caused by diseases they diagnose and treat. Gastrointestinal Anatomy and Physiology will bring together the world s leading names to present a comprehensive overview of the anatomical and physiological features of the gastrointestinal tract. Full colour and with excellent anatomical and clinical figures throughout, it will provide succinct, authoritative and didactic anatomic and physiologic information on all the key areas, including GI motility, hepatic structure, GI hormones, gastric secretion and absorption of nutrients. GI trainees will enjoy the self-assessment MCQs, written to the level they will encounter during their Board exams, and the seasoned gastroenterologist will value it as a handy reference book and refresher for re-certification exams

VI J. R. VON RONNEN PREFACE This atlas is a selection of the roentgenograms of patients who visited the Radiology Department at the University Hospital in Leiden between 1970 and 1974. The heads of this department are Prof. J. R. von Ronnen and Prof. A. E. van Voorthuisen. In this atlas, the most frequently occurring radiological abnormalities of the small intestine are illustrated as clearly as possible - without the shadows caused by flocculation or segmentation of the contrast fluid. The author hopes it will be a positive contribution towards the attainment of the highest possible diagnostic score. It should be remembered that the key to good diagnostics is not only a perfect examination technique, but also the knowledge and character of the physician. If these factors are optimal, then the best possible series of roentgenograms will be obtained, at least as far as technique is concerned. All patients were examined by the enteroclysis technique. With this method of examination of the small intestine, the contrast fluid is administered via an infusion directly into the duodenum instead of orally. The infusion method has added a new dimension to the radiological examination of the small intestine. This method has turned out to be especially suitable for the comparative evaluation of motility, and also for the study of disturbed motility.

Jeder fA1/4nfte Deutsche leidet unter Reizdarmbeschwerden. Vielleicht auch Sie? Dieses Buch verspricht Linderung bei Durchfall oder Verstopfungen, BlAhungen und Schmerzen. Der Internist und ErnAhrungsmediziner Dr. Matthias Robert beschreibt, was sich hinter dem Reizdarmsyndrom verbirgt, welche so gar nicht reizenden Symptome es mit sich bringt und welche Untersuchungen Ihr Arzt bei Ihnen durchfA1/4hrt, um die Diagnose stellen und andere Erkrankungen ausschlieA en zu kAnnen. Er erklArt, wie das komplexe Organ Darm funktioniert, wie eng Bauch und Hirn verbunden sind und warum deshalb Psyche und Stress eine so groA e Rolle beim Reizdarmsyndrom spielen. Vor allem aber setzt er sich mit den verschiedenen MAglichkeiten der Therapie auseinander und stellt eine ganze Reihe von MAglichkeiten vor, wie Sie Ihre Beschwerden lindern kAnnen: ErnAhrungsumstellung und Entspannung, Medikamente und alternative Heilmethoden. Damit endlich Ruhe in Ihrem Bauch einkehrt.

Practising evidence-based medicine necessarily depends on the clinician having access to the best evidence available, but in a fast-moving field, keeping up to date with the latest developments is a challenging prospect. In this new volume, leading experts focus on the most important clinical issues associated with the management of Lipid Disorders, evaluating and interpreting the evidence available to provide the reader with a reliable summary of our current knowledge. Topics covered include therapeutic strategies for managing hereditary lipid disorders, including familial hypercholesterolaemia, both in adults and children, and familial combined hypercholesterolaemia. The authors also evaluate the evidence for a link between inflammatory disease and cardiovascular risk; the metabolic syndrome and the interconnections between dyslipidaemias and diabetes. They also look at therapeutic challenges such as the management of patients who are statin resistant, and the control of lipid levels in those suffering renal insufficiency. Tables highlight important data, evidence from trial results and expert reports, and each section concludes with a series of Key Points that present a summary of evidence-based recommendations for best practice, graded according to the quality of that evidence. The book provides the busy clinician with a unique analysis of the data supporting current therapies and will help the reader formulate effective strategies for treating their own patients.

Our knowledge of the diseases of the small intestine has increased greatly since the second world war. The advances made in the auxiliary sciences, in particular biochemistry and histology, are mainly responsible and have led to their increased importance in this field. It is unfortunate that although radiology also contributed new understanding, it has not been able to match the progress of the other sciences. In spite of the advancements made in, for instance, vascular examination, radiology has experienced a relative decrease in its importance to the differential diagnosis of the diseases of the small intestine. The main reason for this is that radiology can only offer an extremely modest contribution to the differentiation between the many diseases with the malabsorption syndrome. In a number of cases, radiological differential diagnosis is in principle not possible because there are only histological and biochemical abnormalities of the mucous membrane of the small intestine without macroscopic abnormalities. There remain however many diseases with malabsorption for which a morphological examination can be highly valuable. This applies for: 1. diseases with gross anatomical abnormalities: anastomoses, fistulae, blind loops; strictures, adhesions; diverticula. 2. diseases with local, usually rather gross mucosal abnormalities: leukemia, Hodgkin's disease, lymphosarcoma; intra-mural bleeding; local edema due to venous congestion (e. g. thrombosis) or lymphatic obstruction (irradiation treatment). 3. diseases with more general mucosal abnormalities: edema due to: lymphangiectasis, allergic reactions, protein-losing enteropathy; amyloidosis, Whipple's disease, scleroderma.

A practical, portable handbook, newly updated with nearly 100 color images and figures, The Little GI Book: An Easily Digestible Guide to Understanding Gastroenterology, Second Edition is an invaluable resource for anyone new to the world of gastroenterology and hepatology. Featuring new information on the latest advancements in gastroenterology and hepatology and written in a friendly, conversational style, The Little GI Book will help readers learn the core concepts of digestive health and disease and absorb important information without a hiccup. Author Dr. Douglas G. Adler provides a comprehensive, soup-to-nuts guide to gastrointestinal anatomy, physiology, disease states, and treatment. With new color images throughout, The Little GI Book guides the reader through the entire gastrointestinal tract, starting at the top with the esophagus, ending at the bottom with the colon and rectum, and covering everything in between: the stomach, small intestine, liver, pancreas, bile ducts, and gallbladder. The Little GI Book is an indispensable pocket guide for residents, students, nurse practitioners, office staff, industry sales force, and anyone who works in the GI industry but isn't a gastroenterologist.