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High-Fiber Diet. In: American Dietetic Association. Manual of Clinical Dietetics, Sixth Edition. Chicago, IL: American Dietetic Association. 2000. p.709-717.

This chapter describing a high-fiber diet is from a comprehensive manual of clinical dietetics designed to help dietitians, physicians, and nurses deliver quality nutrition care. The chapter includes the purpose of the high-fiber diet, the indications for use, a description of the diet, meal planning approaches, and a discussion section. The high-fiber diet is used to increase fecal bulk and promote regularity, to normalize serum lipid (fats) levels, and to blunt postprandial (after a meal) blood glucose response. A high-fiber diet can be used in the prevention or treatment of various gastrointestinal, cardiovascular, and metabolic diseases and conditions including diverticular disease, cancer of the colon, diabetes mellitus, endometrial cancer, constipation, irritable bowel syndrome, Crohn's disease, hypercholesterolemia, and obesity. 2 tables. 20 references.

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House Call. Digestive Health and Nutrition. p. 26-27. May-June 2000.

This column is a regular feature in Digestive Health and Nutrition; in each issue, the medical editor and associate editors answer reader questions about gastroenterological concerns. This entry addresses six topic areas: the outward symptoms of hepatitis C, diarrhea and gas with weight loss (possibly triggered by the use of herbal remedies), chronic hepatitis C, tests to monitor liver cancer, posttherapy complications of antibiotics, and uncontrollable weight loss. Chronic hepatitis C infection can result in cirrhosis (scarring) of the liver with ascites (fluid in the abdominal cavity) and low clotting factors, leading to easy bruising. Low response to the hepatitis C drugs is disappointing, but they should still be tried, since some responses are dramatic. In some patients, chronic hepatitis C may lead to cirrhosis followed by liver failure or the development of primary liver cancer (hepatocellular carcinoma), usually after 20 to 40 years of infection. It is generally recommended that patients with hepatitis C and cirrhosis undergo semiannual testing with ultrasound and alphafetoprotein. There are many herbs that can cause diarrhea, but in almost all cases the diarrhea stops when the patient stops taking the herbal remedy. Antibiotics can themselves cause diarrhea (notably the antibiotic induced infection Clostridium difficile). Ciprofeoxacin and metronidazole may help chronic diarrhea if the condition is due to bacterial overgrowth secondary to a blind loop syndrome, small intestinal diverticulosis, or a stagnant small intestine. The author concludes that weight loss is not a symptom of irritable bowel syndrome and usually indicates another condition.

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Inflammatory Bowel Disease in the Elderly. In: Williams, C.N., et al., eds. Trends in Inflammatory Bowel Disease Therapy 1999. Boston, MA: Kluwer Academic Publishers. 2000. p. 96-104.

Inflammatory bowel disease (IBD) characteristically presents in early adulthood, but a second incidence peak is observed in the sixth to eighth decade of life. This chapter on IBS in the elderly is from a monograph that reprints the presentations given at the Trends in Inflammatory Bowel Disease Therapy Symposium, held in Vancouver, British Columbia, Canada, in August 1999. The general objective of the conference was to provide an update in the etiology, pathogenesis, and treatment of inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD). In this chapter, the authors note that UC presenting in older patients tends to show a preference for distal involvement, with the initial attack often being more severe than in younger patients. The response to medical management, risk of extension and requirement for surgery, however, are similar to younger patients. The treatment options are also similar, although the risk of complications related to prolonged steroid use (including hyperglycemia, hypertension, and osteoporosis) may be higher and the use of immunosuppressive agents may be associated with a higher risk of infection. A small increase in mortality occurs postoperatively and seems more often related to comorbid disease rather than to UC. For CD in older patients, the spectrum of clinical presentations, including extraintestinal manifestations and perianal disease, is no different from a younger population, with the exception of a higher incidence of Crohn's colitis and a lower rate of surgery. However, in elderly Crohn's colitis patients who require surgery either due to disease severity or complications, postoperative mortality (death) and complication rates related to surgery may be higher. The overall mortality rate in elderly patients with CD is, however, not different from the general population. Important differential or coexistent diagnoses in the evaluation of elderly patients with possible IBD include ischemic colitis, diverticulitis, neoplasms, infectiou causes (Clostridium difficile and Escherichia coli 0157:H7), and nonsteroidal antiinflammatory drug (NSAID) related fibrosis. The authors conclude that, with certain exceptions, the presentation, clinical course, and response to therapy for elderly patients presenting with IBD tend to be comparable to a younger population. 49 references.

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Mayo Clinic on Digestive Health. Rochester, MN: Mayo Clinic. 2000. 194 p.

This comprehensive guidebook from the Mayo Clinic focuses on a variety of digestive symptoms, including heartburn, abdominal pain, constipation, and diarrhea, and the common conditions that are often responsible for these symptoms. Written in nontechnical language, the book includes practical information on how the digestive system works, factors that can interfere with its normal functioning, and how to prevent digestive problems. After two introductory chapters in which the authors review the anatomy and physiology of the digestive tract and practical suggestions for maintaining a healthy digestive tract, the book includes 12 chapters on symptoms, common diagnostic tests, gastroesophageal reflux disease (GERD), ulcers and stomach pain, irritable bowel syndrome, Crohn's disease and ulcerative colitis (together called inflammatory bowel disease or IBD), celiac disease, diverticular disease, gallstones, pancreatitis, liver disease, and cancer. Each chapter on a specific condition reviews the symptoms, diagnosis, risk factors, prognosis, and treatment options for that condition. The book concludes with a list of resource organizations through which readers can obtain more information, and a subject index.

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Meckel's Diverticulum. American Family Physician. 61(4): 1044. February 15, 2000.

Meckel's diverticulum is a true intestinal diverticulum (pouch) that is the most prevalent congenital (present from birth) abnormality of the gastrointestinal tract. This brief patient education handout reviews the diagnosis and management of Meckel's diverticulum. The handout notes that most people who have a Meckel's diverticulum have no problems. However, complications can include bleeding in the gastrointestinal tract and intestinal blockage. The symptoms of these complications can include stomach pain, vomiting, fever, constipation, and swelling of the stomach. Currently, there is no safe, simple way to test for Meckel's diverticulum. When this condition causes complications, it can be diagnosed by taking special x-rays of the intestines. Sometimes the treatment includes surgery to remove the diverticulum and repair the intestine. This patient education handout appears in the same issue as an article for physicians on the care of patients with Meckel's diverticulum.

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Meckel's Diverticulum. American Family Physician. 61(4): 1037-1042. February 15, 2000.

Meckel's diverticulum is a true intestinal diverticulum (pouch) that is the most prevalent congenital (present from birth) abnormality of the gastrointestinal tract. This article reviews the diagnosis and management of Meckel's diverticulum. The authors stress that the diagnosis of this condition is often difficult because it may remain completely asymptomatic, or it may mimic such disorders as Crohn's disease, appendicitis, and peptic ulcer disease. Ectopic tissue, found in approximately 50 percent of cases, consists of gastric (stomach) tissue in 60 to 85 percent of cases and pancreatic tissue in 5 to 16 percent of cases. The diagnosis of Meckel's diverticulum should be considered in patients with unexplained abdominal pain, nausea and vomiting, or intestinal bleeding. Major complications include bleeding, obstruction, intussusception, diverticulitis (infection), and perforation. The most useful method of diagnosis is with a technetium 99m pertechnetate scan, which is dependent on uptake of the isotope in heterotopic tissue. Management is by surgical resection. A patient education handout on Meckel's diverticulum is included in the same issue. 1 figure. 1 table. 35 references.

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Ostomy. In: American Dietetic Association. Manual of Clinical Dietetics, Sixth Edition. Chicago, IL: American Dietetic Association. 2000. p.421-424.

Medical nutrition therapy (MNT) is used for patients who have had a surgical ileostomy or colostomy to minimize the risk of obstruction, to prevent fluid and electrolyte imbalances, to reduce excessive output, and to minimize gas and unpleasant odors. This chapter on nutrition care for patients with an ostomy is from a comprehensive manual of clinical dietetics designed to help dietitians, physicians, and nurses deliver quality nutrition care. The chapter includes the purpose of nutrition care, the indications for use, a description of the diet, meal planning approaches, a definition of the disease or condition, and a discussion section. Conditions most commonly associated with ostomy placement include Crohn's disease, diverticulitis, ulcerative colitis, colorectal cancer, familial polyposis, intestinal trauma, bowel ischemia, and radiation enteritis. One chart summarizes food selection guidelines for people with ostomies. 1 table. 4 references.

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Peritoneal Dialysis: Its Indications and Contraindications. Dialysis and Transplantation. 29(2): 71-77. February 2000.

Global utilization of peritoneal dialysis ranges from 6 to 91 percent of the people on dialysis in various parts of the world; in the United States, approximately 14 percent of the patients with end stage renal disease (ESRD) use peritoneal dialysis. This article reviews the indications and contraindications for chronic peritoneal dialysis (PD), provides evidence when available, and offers recommendations based on the experiences of the authors. Strong indications for PD include situations such as vascular access failure and intolerance to hemodialysis (HD); medical preferences such as congestive heart failure, prosthetic valvular disease, and children aged 0 to 5 years; and social situations such as patient preference and living far from a dialysis clinic. The situations where PD is preferred include bleeding tendencies, multiple myeloma (bone tumors), labile diabetes (hard to control), chronic infections, possibility of transplantation in the near future, age between 6 and 16 years, needle anxiety, and active lifestyle. Situations where PD is not preferred but is still possible with some special considerations include obesity, multiple hernias, severe backache, multiple abdominal surgeries, impaired manual dexterity, blindness, less than ideal home situation, and depression. Relative contraindications (reasons not to use the technique) for PD include patients with severe malnutrition, multiple abdominal adhesions, ostomies, proteinuria greater than 10 grams per day, advanced COPD (chronic pulmonary disease, usually attributed to smoking), ascites (fluid accumulation), upper limb amputation with no help at home, poor hygiene, dementia, and homelessness. PD is contraindicated in patients with documented Type II ultrafiltration failure, severe inflammatory bowel disease (IBD), active acute diverticulitis, abdominal abscess, active ischemic bowel disease, severe active psychotic disorder, marked intellectual disability, and the third trimester of pregnancy. In most of the remaining situations, either HD or PD is equally preferred. The authors conclude that in order to take full advantage of the advances that have occurred over the past decade, successful PD requires committed and knowledgeable physicians and nurses, and a center with at least 20 to 25 patients on this modality. 1 table. 30 references.

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Prescription Medications That Can Be Harmful to the Digestive System. Digestive Health and Nutrition. p. 26-29. September-October 2000.

This article reviews the possible negative impact of prescription medications on the digestive system. Drugs that are swallowed enter the body through the gastrointestinal (GI) tract, making it an easy target for side effects. However, injected or infused drugs can also upset the GI tract. Sometimes taking the drug with food will decrease GI side effects; however, food can interfere with the actions of some medications. Nonsteroidal antiinflammatory drugs (NSAIDs) are very effective in helping to reduce the inflammation and pain caused by arthritis and other conditions, however, they increase the risk of ulcers when taking long term. Damage also can occur in the small and large intestine due to the prolonged use of NSAIDs. The drugs can bring about a relapse of inflammatory bowel disease (IBD) and they may cause a rare condition called collagenous colitis or cause diverticula pouches in the colon wall to bleed or perforate. Diarrhea is another common and potentially serious side effect of some prescription drugs; antibiotics, in particular, often cause diarrhea. Other drugs that cause diarrhea, include chemotherapy cancer drugs, magnesium-containing antacids, the antiobesity drug Xenical, and some diabetes drugs. In addition, some drugs can slow the motility of the GI tract or can limit activities, resulting in constipation. Other GI problems can include esophageal irritation (from oral pills getting stuck in the esophagus), liver toxicity, and pancreatitis (inflammation of the pancreas). The author concludes by reminding readers that most drugs have the potential for causing GI upset and that patients should work closely with their physicians to monitor side effects. 1 table.

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Surgical Management of Gastrointestinal Bleeding. Gastroenterology Clinics of North America. 29(1): 189-222. March 2000.

The role of surgery in gastrointestinal (GI) bleeding has recently diminished because of the development of effective endoscopic and interventional radiologic therapies. Nevertheless, operation remains an important salvage strategy for failure of less invasive interventions and is required in most patients with bleeding GI neoplasms other than small benign polyps. This article reviews the surgical management of GI bleeding. Operations for upper tract bleeding are often designed to address the specific pathophysiology responsible for the bleeding lesion. Operations for lower GI tract bleeding more commonly entail simple segmental bowel resections that encompass the bleeding lesion. The combined application of endoscopic and laparoscopic techniques now provides a minimally invasive alternative to treat a highly selected group of patients with GI bleeding. The authors review surgical strategies for hemorrhagic gastritis, esophageal and gastric varices, esophageal ulcers and erosions, Mallory-Weiss tears, Dieulafoy's lesion, angiodysplasia, neoplastic lesions, hemobilia, pancreatic pseudocysts and pseudoaneurysms, aortoenteric fistula, diverticular disease, arteriovenous malformations, inflammatory bowel disease (IBD), tumors of the colon and rectum, anorectal disease, and Meckel's and other small intestinal diverticula. The authors conclude that, despite the less frequent need for surgical intervention, traditional operative approaches, such as suture ligation, lesion or organ excision, vagotomy, portasystemic anastomosis, and devascularization procedures, continue to be life saving in many instances. 8 figures. 2 tables. 156 references.

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