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Diet in the Pathogenesis and Management of Crohn's Disease
Crohn ’s disease (CD) is chronic immune-related disease of the gastrointestinal tract hypothesized to be caused by an interplay of genetic predisposition and environmental exposures. With the global incidence increasing, more patients are exploring dietary exposures to explain and treat CD. However, mos t patients report minimal nutritional education from their provider, and providers report few nutritional resources to help them educate patients. This highlights the previous deficit of literature describing the role and influence of diet in CD. To address this need, this article reviews available literature on the possi...
Source: Gastroenterology Clinics of North America - April 22, 2022 Category: Gastroenterology Authors: Phillip Gu, Linda A. Feagins Source Type: research

Complementary and Alternative Medicine in Crohn ’s Disease
Complementary and alternative medicine (CAM) is a growing entity within inflammatory bowel disease (IBD). CAM includes mind-based therapies, body-based therapies, supplements, vitamins, and probiotics. Limitations currently exist for health care providers as it pertains to IBD and CAM that stem from knowledge gaps, conflicting reports, limited oversight, and a lack of well-organized clinical data. Even without well-described data, patients are turning to these forms of therapy at increasing rates. It is imperative that the ongoing review of CAM therapies is performed, and future trials are performed to better understand ef...
Source: Gastroenterology Clinics of North America - April 22, 2022 Category: Gastroenterology Authors: Jennifer Seminerio Source Type: research

Intestinal Cancer and Dysplasia in Crohn ’s Disease
Crohn ’s disease is associated with an increased risk of adenocarcinoma of the involved portions of the small bowel and colorectum and has similar risk factors to those described in ulcerative colitis, most significantly, extent of bowel involvement, PSC, and duration of unresected disease. Prevention s trategies include risk stratification and secondary prevention with colonoscopic screening and surveillance to identify dysplasia or early-stage cancers, with surgery when needed. There is emerging information to suggest that control of inflammation may provide primary prevention of neoplasia, but f urther studies are req...
Source: Gastroenterology Clinics of North America - April 22, 2022 Category: Gastroenterology Authors: Scott Friedberg, David T. Rubin Source Type: research

Anorectal Anatomy and Function
Anatomy of pelvic floor muscles has long been controversial. Novel imaging modalities, such as three-dimensional transperineal ultrasound imaging, MRI, and diffusion tensor imaging, have revealed unique myoarchitecture of the external anal sphincter and puborectalis muscle. High-resolution anal manometry, high-definition anal manometry, and functional luminal imaging probe are important new tools to assess anal sphincter and puborectalis muscle function. Increased understanding of the structure and function of anal sphincter complex/pelvic floor muscle has improved the ability to diagnose patients with pelvic floor disorde...
Source: Gastroenterology Clinics of North America - February 6, 2022 Category: Gastroenterology Authors: Ravinder K. Mittal, Lori J. Tuttle Source Type: research

The Pelvic Floor: Complex Interplay Between Gastrointestinal and Urogenital Structures and Function
Pelvic floor disorders are common and defined as a group of conditions affecting the neurologic and muscular structures of the pelvis. While many gastroenterologists consider this synonymous with constipation and/or fecal incontinence, the reality is that these disorders cover a spectrum inclusive of but not limited to the bowel, bladder, uterus, and vagina. That said, individuals seeking care from gastroenterologists will predominately present with chief complaints of constipation and/or fecal incontinence, and in most circumstances, when initial therapies focused on modifying stool frequency and texture have failed, more...
Source: Gastroenterology Clinics of North America - February 6, 2022 Category: Gastroenterology Authors: Darren M. Brenner Tags: Preface Source Type: research

Foreword
The pelvic floor includes essentially all ligaments, muscles, and nerves that are connected to and interact with the pelvic floor organs, rectum, bladder, uterus, and vagina. When the support of these organs weakens, the organs themselves are affected. Both men and women may experience problems in this realm. (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - February 6, 2022 Category: Gastroenterology Authors: Alan L. Buchman Source Type: research

Pelvic Floor Disorders
GASTROENTEROLOGY CLINICS OF NORTH AMERICA (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - February 6, 2022 Category: Gastroenterology Authors: Darren M. Brenner Source Type: research

Copyright
Elsevier (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - February 6, 2022 Category: Gastroenterology Source Type: research

Contributors
ALAN L. BUCHMAN, MD, MSPH, FACP, FACN, FACG, AGAF (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - February 6, 2022 Category: Gastroenterology Source Type: research

Contents
Alan L. Buchman (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - February 6, 2022 Category: Gastroenterology Source Type: research

Forthcoming Issues
Medical and Surgical Management of Crohn's Disease (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - February 6, 2022 Category: Gastroenterology Source Type: research

Diagnostic Strategy and Tools for Identifying Defecatory Disorders
This article reviews the indications, techniques, interpretation, strengths, and weaknesses of tests (anal manometry, anal surface electromyography, rectal balloon expulsion test, barium and MRI defecography, assessment of rectal compliance and sensation, and colonic transit) that are used diagnose defecatory disorders in constipated patients. The selection of tests and the sequence in which they are performed should be individualized to and interpreted in the context of the clinical features. Because anorectal functions are affected by age, results should be interpreted with reference to age- and sex-matched normal values...
Source: Gastroenterology Clinics of North America - January 7, 2022 Category: Gastroenterology Authors: Adil E. Bharucha, Enrique Coss-Adame Source Type: research

The Digital Rectal Examination
Disorders of defecation, including constipation and fecal incontinence, are very common. The digital rectal examination (DRE) is a key component in the early evaluation of patients with these complaints. Confident performance of a DRE requires dedicated training for the clinician and hands-on experience with the technique. DRE can yield a diagnostic accuracy comparable to specialized physiologic tests, including anorectal manometry. This review will describe in detail the steps required to perform a thorough DRE evaluation, as well as the proper interpretation of observations. Thereafter, the current evidence-based finding...
Source: Gastroenterology Clinics of North America - January 7, 2022 Category: Gastroenterology Authors: Gregory S. Sayuk Source Type: research

Dyssynergic Defecation and Other Evacuation Disorders
Constipated patients are frequently referred to gastroenterologists for symptoms refractory to lifestyle modifications and laxatives. Dyssynergic defecation, the dyscoordination of rectoanal, abdominal, and pelvic floor muscles to facilitate defecation, is a major cause of refractory primary constipation. Understanding of the diagnosis, evaluation, and management of dyssynergic defecation and other evacuation disorders will allow providers to effectively manage these patients. This review focuses on the definition, pathophysiology, evaluation, and treatment of dyssynergic defecation and other evacuation disorders. Emerging...
Source: Gastroenterology Clinics of North America - January 7, 2022 Category: Gastroenterology Authors: Amol Sharma, Anam Herekar, Yun Yan, Tennekoon Karunaratne, Satish S.C. Rao Source Type: research

Fecal Incontinence
Fecal incontinence (FI) is defined as the involuntary loss or passage of solid or liquid stool in patients. FI is a common and debilitating condition in men and women. The incidence increases with age and also often goes unreported to health care providers. It is crucial that providers ask at-risk patients about possible symptoms. Evaluation and management is tailored to specific symptoms and characteristics of the incontinence. If conservative methods fail to improve symptoms, then other surgical options are considered, such as sacral nerve stimulation and anal sphincter augmentation. This review provides an update on cur...
Source: Gastroenterology Clinics of North America - January 7, 2022 Category: Gastroenterology Authors: Stacy Menees, William D. Chey Source Type: research