This book provides up to date information about IBS and its developments in the last decade and provides ways of controlling IBS based on the authors' long experience in treating IBS patients. Although IBS is a tortuous disorder and interferes with the patients' daily activities, it does not develop into a serious disease or kill its sufferer. Understanding and learning ways of controlling IBS does not only help patients to lead normal lives, but also enables them to help their children and closest relatives.

This text provides a comprehensive review of the cytology of disease processes of the mediastinum and mediastinal lymph nodes with emphasis in lung and gut nodal cancer staging in specimens obtained by EUS-FNA. This book also reviews the cytology of intramural masses of the gastrointestinal tract using a pattern-based diagnostic approach. The cytomorphology of lesions obtained by EUS-FNA is peculiar by the common presence in the obtained sample of normal luminal gastrointestinal contents, and the cytopathologist should be familiar with this pattern not often seen when the sampling is done by percutaneous approach. Technical considerations pertaining to the operator performing the procedure as well as to the cytopathologist, with emphasis on rapid on-site interpretation are also covered. Most lesions described in the book also have endoscopic US image correlation. Cytology of the Mediastinum and Gut is a useful and practical guide for cytological interpretation and differential diagnosis of lesions obtained by EUS-FNA of mediastinum and gut. All chapters are written by experts with many years of experience in the field and contain the cytology, immuno-profile, molecular profile, and ultrasound features of the masses described.

Pediatric Inflammatory Bowel Disease, Second Edition provides an essential reference with an emphasis on the unique pediatric issues of IBD. Chapters focus on complications of IBD specific to children and adolescents. Treatment recommendations are based on the latest clinical research available. The textbook also presents sections dedicated to the aspects of participation in clinical research unique to children and adolescents and the complicated yet vital process of successfully transitioning a patient from a pediatric to adult specialist. Controversies in pediatric IBD care such as the off-label use of medications are also covered. The format incorporates multiple tables, graphs, and figures to improve readability and make for an efficient reference for clinicians to use. Thoroughly revised and updated from the first edition, the volumes includes new therapies that are currently being used or tested for treatment of IBD, important areas regarding incidence and prevalence, immunization and response to vaccine administration as well as advancements in our understanding of growth and development with particular to the use of growth hormone therapy. Other new areas covered include important topics of complementary and alternative medicine use in IBD, immunization, and liver disease in IBD. Pediatric Inflammatory Bowel Disease, Second Edition is a valuable resource for pediatric gastroenterologists as well as adult gastroenterologists.

Originally published in 1937, this book provides a brief clinical study of appendicitis and its common varieties. Bowen deals with topics such as the etiology and treatment of appendicitis as well as potential complications following the operation, such as fistula and jaundice. This book will be of value to anyone with an interest in the history of medicine.

Originally published in 1915, this book presents the findings of an investigation into outbreaks of tropical sprue, an intestinal inflammation, on the island of Sri Lanka. Bahr analyses the various symptoms of the disease, which appeared to affect predominantly non-native inhabitants of Sri Lanka, as well as suggesting possible solutions and treatments. The text is illustrated with a number of diagrams, drawings and photographs of sprue symptoms and the microscopic organisms found in connection with the disease. This book will be of value to anyone with an interest in medical history or the history of tropical medicine.

Candida albicans is an opportunistic pathogenic yeast and it is a common member of the human gut flora. It does not proliferate outside the human body. It is detected in the gastrointestinal tract and mouth in 40a60% of healthy adults. It is usually a commensal organism but can become pathogenic in immunocompromised individuals under a variety of conditions. Yeast infection is caused by a specific strain of yeast known as Candida. Although a small amount of yeast is found in the body, yeast infection occurs when there is an overgrowth of Candida. Most yeast infections is caused by Candida albicans. Fungal that affects different areas of the body like skin, mouth, genitals, throat and blood. The yeast Candida albicans lives inside every one of us. Normally it presents no problems, but today's widespread use of broad-spectrum antibiotics, antacids, contraceptive pills, and steroids, as well as the all-too-common sugar-rich diet, can lead to a proliferation of this parasitic yeast within the body. Often overlooked by doctors, overgrowth of Candida has been linked to a wide variety of physical and mental problems such as: acne; heartburn; muscular pain; anxiety; irritable bowel syndrome (IBS); fibromyalgia; bloating and constipation; chronic fatigue; migraine; cystitis irritable bowel syndrome (IBS); allergies; menstrual problems; irritability Candida that causes the human infection candidiasis results from an overgrowth of the fungus is for example often observed in HIV-infected patients. C. albicans is the most common fungal species isolated from biofilms either formed on (permanent) implanted medical devices or on human tissue. C. albicans, C. tropicalis, C. parapsilosis, and C. glabrata are together responsible for 50 -- 90% of all cases of candidiasis in humans. A mortality rate of 40% has been reported for patients with systemic candidiasis due to C. albicans. Invasive candidiasis contracted in a hospital causes 2,800 to 11,200 deaths yearly in the U.S. C. albicans is commonly used as a model organism for biology. It is also known as sweet fungus and sugar inhibits its growth. It is generally referred to as a dimorphic fungus because it grows both as yeast and filamentous cells. However, it has several different morphological phenotypes. C. albicans was for a long time considered an obligate diploid organism without a haploid stage. This is, however, not the case. Next to a haploid stage C. albicans can also exist in a tetraploid stage. The latter is formed when diploid C. albicans cells mate when they are in the opaque form. Candida thrives well on sugar and needs an acidic environment to survive. Processed and refined foods high in gluten and sugar (including natural sugars) create an ideal home for Candida, so the most logical place to start battling the enemy is by restricting intake of alcohol, sweets, bread, vinegar and foods containing vinegar, peanuts and foods high in sugar a including sweet fruits such as bananas and dates. Include protein rich foods like avocados, chia seeds and wild-caught fish. Garlic and turmeric (also known as curcumin) is a natural anti-fungal that can kill Candida. The best potent and all-natural candida killer is coconut oil. It contains caprylic acid, which has anti-microbial properties that can kill yeasts and candida. Studies have shown that it is more effective in treating candidiasis than the prescription drug fluconazole. There are relatively few drugs that can successfully treat Candidiasis. Treatment commonly includes amphotericin B,echinocandin, or fluconazole for systemic infections. Nystatin for oral and esophageal infection and Clotrimazole for skin and genital yeast infections.

Management of Functional Gastrointestinal Disorders in Children presents biopsychosocial theory with respect to six groups of functional disorders: disorders of elimination, vomiting disorders, abdominal pain, infant colic, chronic non-specific diarrhea of infants and toddlers, and failure to thrive. It illustrates, through numerous clinical examples, concepts of management developed during 45 years of practice. A satisfactory clinical outcome for pediatric gastrointestinal disorders often depends on the clinician's ability to discern not only the biological factors in illness, but also the unique cognitive and emotional needs that patients bring to the task of healing. This book provides guidelines for integrating the biopsychosocial model, an approach that has been under-emphasized in the literature until now. It includes naturalistic descriptions of functional gastrointestinal disorders, clinical goals, and the theoretical bases for management techniques. Offering numerous real-world examples and tips, this book serves as a valuable resource for pediatricians, family practitioners, pediatric mental health practitioners, pediatric nurse practitioners, as well as pediatric gastroenterologists.

Portal hypertension is the abnormal pathophysiologic state that develops in liver cirrhosis and certain other disorders with characteristic clinical and hemodynamic features. There has been great progress in our under standing and management of portal hypertension, particularly in the diagnostic and therapeutic approaches. The so-called Banti's syndrome, a disorder whose existence had long been questioned, is now a well-defined portal hypertensive disease. The recently introduced Doppler ftowmetry is currently yielding new information on portal hemodynamics. Endoscopic sclerotherapy and beta-blockers have come to be widely used in the man agement and prevention of variceal bleeding. In spite of all these advances, a number of unsolved questions remain, such as whether sclerotherapy, pharmacotherapy or surgery is warranted for prevention of bleeding, which is more effective as an elective treatment, the surgical or endoscopic approach, and whether surgical portacaval shunt should be totally replaced by selective shunt operations. These new developments and problems are clearly and comprehensively described and discussed by the foremost authorities in 44 chapters, which are divided into five sections: 1) Patho physiology, 2) Hemodynamic Investigations, 3) Imaging Investigations, 4) Clinical and Pathological Features, and 5) Esophageal and Gastrointestinal Bleeding. The primary goal of this monograph, to provide a framework of patho physiology of portal hypertension with authoritative descriptions of the clinical and laboratory manifestations of various portal hypertensive dis orders, has clearly been achieved by these excellent contributions.

Often, information in review books can raise as many questions as it answers. This interferes with the study process, because the learner must either look up additional information or skip ahead without truly comprehending what he or she has read. As an alternative, Pediatric Gastroenterology and Nutrition: A Practically Painless Review presents bite-size chunks of information that can be read and processed rapidly, helping learners to stay active while studying and to pick up new information the first time they read it. This book's question and answer format allows for self-testing or study with a partner or a group. The format also facilitates dipping into the book during a few minutes of downtime at the hospital or office. Pediatric Gastroenterology and Nutrition: A Practically Painless Review is a quick and easy way to master these tricky topics and is suitable for those studying for the pediatric board exam, practicing physicians brushing up their skills and any busy clinician who wants to learn more about these topics while on the go.

This volume provides a practical hands on guide to gastrointestinal physiology. The book emphasizes an appreciation of basic physiological concepts and their application to novel clinical situations. It exposes the physician-in-training to fundamental principles that are useful in treating patients and lays the groundwork for more advanced study in the future. The authors present relevant cases which incorporate newer adult learning strategies in medical education. These cases provide a forum in which the student can apply acquired knowledge, skills and attitudes. Connections are made to reader's life, whether in the classroom, on the wards or out and about town. Designed for medical students who are studying gastrointestinal physiology for the first time, Gastrointestinal Physiology: A Clinical Approach provides a superb review for upper level medical students and house officers. Nursing and allied health professions students will also find this text to be a useful guide. GI fellows and attending physicians in need of a concise review of fundamental GI physiology principles will also benefit from reading this book.

As we approach the end of this millennium, enteric diseases remain impor tant public health problems. In many parts of the world, sanitary measures have advanced little over the last century, although some of the governments in those areas are striving to improve facilities for sanitation and to educate their people in proper handling of food, water, sewage, and other modes of transmission of pathogenic microbes. Even in highly developed countries, outbreaks of diarrheal diseases occur today. Globally, the annual morbidity from enteric infections is estimated at several billion and deaths at several million per year. In this volume, descriptions of some of these diseases, of immunity that results from them, of clinical studies that promote under standing of individual and community immunity, of molecular factors of pathogenesis, and/or of advances in vaccine development have been pro vided by leading researchers. At present, the application of molecular methods is enhancing the identification of protective antigens of many microorganisms. In addition, new methods for design and delivery of vac cines are being devised. Perhaps then more effective tools for reducing at least some of these diseases will be available within the next decade. Lois J. Paradise Herman Friedman Mauro Bendinelli vii Contents Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv LOIS J. PARADISE 1. Indigenous Microorganisms as a Host Defense 1 KENNETH H. WILSON 1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2. Composition of Intestinal Biota. . . . . . . . . . . . . . . . . . . . . . . . 2 3. Molecular Approaches to Determine Composition of the Biota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 4. Role of the Host in Determining the Composition of the Biota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Recent clinical trials of adjuvant therapy for gastric cancer in Japan have shown improved survival benefits, but the results have been considered controversial and have been viewed with some skepticism in the West. Until now, the efforts of Japanese surgical oncologists in multimodality therapy have not been fully understood because they have not been adequately reported in English. This volume now presents the experience and expertise of Japanese surgeons who utilize preoperative or intraoperative chemotherapy, or a combination of systemic and regional chemotherapy. Their collected work provides valuable insight in the Japanese perspective and success in treating gastric cancer. Included in the appendix is an extensive tabular analysis of the gastric cancer database at the Cancer Institute Hospital of Tokyo. Probably the largest such database in the world from a single institution, the analyses present the state of the art in treatment of gastric cancer.

A distinguished panel of world authorities reviews the current state of today's understanding, diagnosis, and treatment of pancreatic cancer. Their cutting-edge reviews discuss both medical and surgical modalities and include numerous insights into the basic molecular processes underlying the disease. Among the key topics covered are the prospects for early diagnosis using molecular techniques, the latest diagnostic and therapeutic methods, the role of laparoscopy (diagnostic and therapeutic), and nonsurgical treatment. The reviewers also address the future possibilities for clinical advances, quality of life concerns, and the value of the Japanese "extended Whipple resection." Pancreatic Cancer will become the new standard reference for all clinicians who diagnose and treat this disease, as well as for basic scientists needing a summary of the many recent advances.
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Gastrointestinal motility has evolved from an esoteric laboratory tool into a sophisti cated diagnostic technique that is now widely used clinically to guide in management of complex gastrointestinal problems. Today, it is the most rapidly growing subspecialty within gastroenterology. Previously, many of the gastrointestinal motility problems were either ignored or attributed to a disturbance of "psyche." But with the growing knowledge and understanding of how a dysfunction of the gastrointestinal muscle and nerves can cause disease, we are at the threshold of a revolution in our approach to the diagnosis and treatment of gastrointestinal motility disorders. The purpose of this book is to serve as a useful, up-to-date reference manual and guide for the diagnostic and therapeutic approach towards common adult and pediatric gastrointestinal motility problems. In order to enhance the understanding of these disor ders, a problem-oriented approach has been chosen, and wherever possible the authors have provided clinical case scenarios to illustrate their message. The emphasis has been on how to diagnose and treat motility disorders rather than to provide an encyclopedic infor mation. The reference list at the end of each chapter should enable the enthusiast to seek further information. Some of the material presented in this book has been derived from the proceedings of the annual University ofIowa College of Medicine GI Motility Symposia."

Molecular Genetics of Colorectal Neoplasia A Primer for the Clinician provides the latest information on the genetics of colorectal cancer within a context of basic genetics, describing the subject in understandable language and making it clinically relevant. In this way, clinicians can become familiar with genetic terms and techniques related to colorectal neoplasia, providing a background upon which to build an appreciation of future advances and an ability to include them in the practicalities of patient care. This edition is intended for the healthcare provider or industry concerned with colorectal neoplasia: including general and colorectal surgeons, pathologists, oncologists, gastroenterologists, internal medicine and family practice physicians, nurses, geneticists, counsellors, registry co-ordinators, epidemiologists, and statisticians.

Endoscopic ultrasound has revolutionized the approach to lesions inside and outside the gastrointestinal tract. It has opened the door for gastroenterologists to explore organs outside of the GI lumen, such as the lymph nodes, lung, pancreas, and liver. Endoscopic Ultrasound covers all aspects of endoscopic ultrasound, from the basics to the interventional indications. Richly detailed chapters describe the utility of EUS in different parts of the body and are organized based on body site Pioneers in the field summarize new studies, and the direction of EUS in practice. Endoscopic Ultrasound provides a ready reference that will help physicians and support staff that are beginning EUS, as well as trained ultrasonographers who wish to arm themselves with a comprehensive reference and explore the future of the field.

Endoscopy has revolutionized clinical gastroenterology. In 1961 Basil Hirschowitz published the first flexible endoscopic examination of the stomach and duodenal bulb. We moved from flexible fiberendoscopes to current video-endoscopic equip ment. Current video-endoscopes incorporate a black and white or color 'chip' at the tip of the instrument which transforms the visual image into electronic signals. The size of the pincet is constantly getting smaller, heading for 5 /Lm, further increasing the resolution. The signals are reassembled into high-quality color images in a video monitor. Endoscopes are now used to examine the entire gastrointestinal tract from esophagus to rectum, including the biliary and pancreatic ductal system. Targeted endoscopic biopsy offers rapid and precise diagnosis. Endoscopic ultrasonography is of unsurpassed accuracy in staging gastrointestinal tumors, in assessing pancreatic and biliary disease, and disorders of the rectum and anal canal. Moreover, targeted cytological sampling is possible of abnormalities of the intestinal wall or peri intestinal lymph node. Yet despite these glamorous achievements changes are to be expected in the overall emphasis of diagnostic endoscopy. Magnetic resonance cholangiopancreatography may very well compete for a substantial fraction of diagnostic ERCP. Virtual colonoscopy or computed tomographic colography may well compete with (and take over?) screening/surveillance colonoscopy.

A concise, practical guide to the diagnosis and treatment of liver disease. Authoritative and practical, this important new book not only spells out the advantages and limitations of the latest diagnostic tests, but also provides numerous algorithms for evaluating patients and treating the liver problems commonly encountered by primary care physicians. Here, too, the reader will find described the nuances of serological tests for the detection of viral infections and how best to use invasive and noninvasive radiological tests in specific circumstances. Common complications are fully discussed and detailed practical information is given on how to recognize the patient's immediate problems and deal with them effectively. This book's numerous diagrams, clinical "pearls", and cost comparisons will clarify the often complex and bewildering array of conditions associated with liver disease and make it a definitive and indispensable guide for primary care physicians, medical students, and residents.

The Scientification of Gastroenterology During the 20th Century * Science contributes to medicine in three ways: It provides a body of relatively secure knowl edge. Some of that knowledge has been applied to develop technologies which have had a major impact upon the practice and effectiveness of medicine. Last, science offers to medicine a way of thinking. - 1. McCormick [(1993) The Contribution of Science to Medicine. Perspect. Bioi. Med. 16,315.] Awareness of the digestive system began with the dawn of civilization, when man, observing the feeding habits of animals in the surrounding environment, experimented with foods, edible and inedible. Identity came with discoveries of the digestive organs during the 16th and 17th centuries. Function was revealed by physiologic studies of digestion, absorp tion and secretion, metabolism, and motility during the 18th and 19th centuries. Diagnostic access improved with the technological advances of the 20th century. Understanding of gas trointestinal (GI) disease followed the growth of the basic sciences and gastroenterology's involvement in scientific research during the latter half of the 20th century. Early in the 20th century, gastroenterology was yet an undefined activity without clinical or scientific guidelines. Diagnostic approach to the digestive tract was minimal. Valid con cepts of disease were lacking. Visceroptosis, sitophobia, and "colonic autointoxication" were common "diagnoses." Therapeutic resources were scarce.

Endoscopic ultrasonography (EUS) has evolved from an obscure method of investigation in the 1980s to a distinct endoscopy subspecialty with interventional and therapeutic capabilities. The art of interpreting EUS images is a skill every endoscopist needs to master. This book helps to meet that need as it is concise, simple to read, and amply illustrated, and describes the technique in a step-by-step manner. Many high-resolution EUS images of diseases are included, and literature reviews are kept short and concise while separate discussions and illustrations are devoted to radial and linear techniques. The book can be used as a reference handbook in the endoscopy room, yet contains all of the relevant information required to perform EUS, interpret images, and reach a diagnosis. Important pathological conditions are thoroughly discussed using representative EUS images, pointing out salient differentiating features, and relevant literature reviews are included. The section on interventional EUS deals with advanced interventional or therapeutic procedures, and potential complications and methods to avoid them are discussed. For the novice, the book is designed to teach EUS using a step-by-step approach, and for the seasoned endosonographer it is a practical reference tool for use while performing EUS and may also serve in the differentiation of various pathologies.

Gastrointestinal Oncology is an expanding field with important medical, scientific, socio-political and ethical challenges. In the last few years, the discipline has undergone changes in our knowledge of tumour biology, diagnosis and treatment. The rate of progress in some gastrointestinal malignancies as oesophageal adenocarcinoma or malignancies of the rectum is dramatic, in other malignancies as pancreatic carcinoma or not. It is generally accepted that the management of these tumours deserves a multidisciplinary approach. Our current understanding of the management of these tumours is the specific focus of this two-day interdisciplinary Postgraduate Course.

DDDDDDDDDDDDD Effective management logically follows accurate diagnosis. Such logic often is difficult to apply in practice. Absolute diagnostic accuracy may not be possible, particularly in the field of primary care, when management has to be on analysis of symptoms and on knowledge of the individual patient and family. This series follows that on Problems in Practice which was concerned more with diagnosis in the widest sense and this series deals more definitively with general care and specific treatment of symptoms and diseases. Good management must include knowledge of the nature, course and outcome of the conditions, as well as prominent clinical features and assess is on what to do best for the ment and investigations, but the emphasis patient. Family medical practitioners have particular difficulties and advantages in their work. Because they often work in professional isolation in the com munity and deal with relatively small numbers of near-normal patients their experience with the more serious and more rare conditions is restricted. They find it difficult to remain up-to-date with medical advances and even more difficult to decide on the suitability and application of new and rela tively untried methods compared with those that are 'old' and well proven. Their advantages are that because of long-term continuous care for their patients they have come to know them and their families well and are able to become familiar with the more common and less serious diseases of their communities."

The basis of this book is a ten-lecture course on the control of gastrointesti nal motility given each year to the final year undergraduate students in Physiology at Sheffield University. A naive thought led me to believe that the conversion of my lecture notes into the present book would be a relatively easy task. I now know differently. As there is no equivalent undergraduate course elsewhere that I know of, it would be dishonest of me to claim this book to be an undergraduate text. The comprehensive way in which I have dealt with the subject, together with the inclusion of the most up-to-date material, make the book more relevant to postgraduate students of physiology, medicine and related sciences who require an introduction to the field of gastrointestinal motility and its control. I have, however, attempted to present the current concepts on the physiological mechanisms regulating motility in a way which under graduates, as well as postgraduates, will find readable, informative and, hopefully, enjoyable."

This book is a completely up-to-date review of the basic tests available in gastroenterology. It is based on a detailed critical analysis of recently described procedures and the review of more traditional methods; each is as signed its correct place in the modern management of patients. Emphasis is placed on those techniques with which the authors have practical experience. The most useful investigations are indicated in the table of contents by heavy type. Comprehensive references are included to provide information about the selection, performance and interpretation of tests. The book is designed for trainees and clinicians without special expertise in gastroenterology, as well as being a shelf manual for the gastroenterologist and the staff of gastrointestinal investigation units. Special thanks are due to the nursing staff of the Day Ward, Bishop Auck land General Hospital; Mr P. Grencis, Medical Photographer; Dr S. Desai, Radiologist; and Amanda Gallagher who typed the manuscript. Malcolm C. Bateson Ian A. D. Bouchier 1988 xu CHAPTER 1 Intubation The passage of various forms of nasogastric, duodenal and intestinal tubes is basic to many of the diagnostic procedures performed in the gastrointestinal system. Method Whenever possible the patient's fullest co-operation should be obtained. If the patient is taking any drugs which might influence the test to be under taken these should be discontinued."