Irritable bowel syndrome
(IBS) is a disorder of brain –gut interaction (formerly known as a functional gastrointestinal disorder) typically characterized by at least weekly abdominal pain associated with a change in frequency and form of the stool. IBS is common, with a population prevalence of around 5%. It is associated with a marked reduction in q uality of life and significant healthcare expenditure. Its pathophysiology remains incompletely understood. IBS is subclassified according to the predominant bowel habit. (Source: Medicine)
Source: Medicine - March 4, 2024 Category: Internal Medicine Authors: Adam D. Farmer Tags: Motility and functional bowel disease Source Type: research

Crohn's disease
is a chronic, relapsing and remitting inflammatory disease  affecting any area of the gastrointestinal tract. It is becoming increasingly prevalent in western Europe, the USA and China, with the highest age-standardized prevalent rates in Norway. It is associated with modifiable risk factors such as smoking and diet, and non-modifiable risk factors includi ng gene variants; however, there is no specific method to prevent its onset or effect a cure. Patients often complain of diarrhoea and abdominal pain, but symptoms can occur intermittently for many years before diagnosis. (Source: Medicine)
Source: Medicine - March 4, 2024 Category: Internal Medicine Authors: Hannah Walton, Beatriz Gros, Shahida Din Tags: Inflammatory bowel disease Source Type: research

Anorectal function testing
Faecal incontinence and evacuation disorders are common conditions that cause significant morbidity. Patient-reported symptoms are poor predictors of underlying pathophysiology, so anorectal function testing is a key component of the clinical evaluation when initial management strategies fail. A number of investigations are available to assess anorectal structure (endoanal ultrasound, defaecography) and function (anorectal manometry, rectal sensory test, balloon expulsion test, defaecography). This review article outlines the usefulness and relevance of these investigations for investigating patients with faecal incontinen...
Source: Medicine - March 2, 2024 Category: Internal Medicine Authors: Emma V. Carrington, S. Mark Scott Tags: Motility and functional bowel disease Source Type: research

Contents
(Source: Medicine)
Source: Medicine - March 1, 2024 Category: Internal Medicine Source Type: research

Editorial Board
(Source: Medicine)
Source: Medicine - March 1, 2024 Category: Internal Medicine Source Type: research

Ulcerative colitis
is a chronic idiopathic inflammatory disease affecting the large intestine. In this chapter, we review current concepts in its assessment, including history-taking, examination findings, laboratory results and the role of faecal calprotectin and endoscopic and histological outcomes and use of the Montreal classification. The range of pharmacotherapeutic management options are reviewed for mild, moderate and severe disease including 5-aminosaliylates, steroids, biological and biosimilar agents and small molecules. (Source: Medicine)
Source: Medicine - February 26, 2024 Category: Internal Medicine Authors: Maiar Elghobashy, Helen Steed Tags: Inflammatory bowel disease Source Type: research

Oesophageal motility testing and 24-hour reflux studies
High-resolution manometry and 24-hour pH/impedance studies of the oesophagus have become more widely available and are useful tools for investigating symptoms, leading to better decision-making and ultimately improved outcomes. Advances in technology have made analysis more intuitive, and efforts have been made to better classify motility disorders and reflux exposure. However, pitfalls remain for the novice, and care is needed that the correct diagnosis is made before being applied to clinical management. (Source: Medicine)
Source: Medicine - February 26, 2024 Category: Internal Medicine Authors: Andres Vales, Anthony Hobson Tags: Motility and functional bowel disease Source Type: research

Immune deficiency and the gut
This article aims to raise awareness of PID-associated GI complications and highlight key features within GI presentations that may indicate an underlying PID. (Source: Medicine)
Source: Medicine - February 26, 2024 Category: Internal Medicine Authors: Lucy Leeman Tags: Infection Source Type: research

Centrally mediated abdominal pain syndromes
Centrally mediated abdominal pain and the associated narcotic bowel syndrome are functional bowel disorders that are challenging to manage and associated with significant medical harm, including unnecessary investigations, opioids and surgery. They are distinguished from more common conditions, such as irritable bowel syndrome, by the near-continuous nature of the pain, irrespective of gastrointestinal physiological functioning. Their pathophysiology is obscure and incompletely understood, but they have features consistent with central sensitization. (Source: Medicine)
Source: Medicine - February 24, 2024 Category: Internal Medicine Authors: Peter Paine Tags: Motility and functional bowel disease Source Type: research

Gastric, small bowel and colonic motility and breath-testing
The gastrointestinal (GI) tract is responsible for the digestion, absorption and excretion of ingested food and drink. From ingestion to excretion, movement of luminal contents is regulated by the enteric and central nervous systems, which stimulate contractions of the smooth muscle of the stomach, small intestine and colon. Dysfunction of GI motility can relate to pathology of these neural complexes or changes to the smooth muscle, or appear idiopathic. When dysmotility occurs, individuals can experience a diverse array of symptoms including abdominal symptoms, changes in bowel habit and serious consequences such as malnu...
Source: Medicine - February 24, 2024 Category: Internal Medicine Authors: Sam Treadway, Anthony Hobson Tags: Motility and functional bowel disease Source Type: research

Intestinal pseudo-obstruction
(IPO) describes a rare family of diseases with both acute and chronic forms. It remains incompletely understood but can also be subdivided by the underlying pathophysiology into myopathic or neuropathic forms. Multiple pathogenic processes have been posited and there are varying aetiologies according to individual phenotype. The hallmark features are symptoms of bowel obstruction with vomiting, constipation, abdominal pain and distension. The key differentiator between IPO and other functional disease is radiological features of bowel dilatation in keeping with obstruction with no identifiable structural or mechanical cau...
Source: Medicine - February 24, 2024 Category: Internal Medicine Authors: Anton Emmanuel, Jeyam Emmanuel Tags: Motility and functional bowel disease Source Type: research

Microscopic colitis
describes a condition of chronic watery diarrhoea in the absence of macroscopic evidence of colonic inflammation or with only subtle endoscopic changes, but with characteristic appearances on histopathological examination of colonic biopsies. It comprises mainly two separate but related conditions of lymphocytic and collagenous colitis, with a third variant called incomplete microscopic colitis that does not fulfil the classical histological criteria. Disease severity ranges from mild and self-limiting to severe and refractory. (Source: Medicine)
Source: Medicine - February 24, 2024 Category: Internal Medicine Authors: Miles Parkes, Mohammed Tauseef Sharip Tags: Inflammatory bowel disease Source Type: research

Infectious diarrhoea
remains a major cause of morbidity and mortality worldwide. Viruses, bacteria and protozoa are responsible for most infections, which are most commonly transmitted by the faecal –oral route through water, food and person-to-person transmission. The clinical presentation conforms to four patterns: acute watery diarrhoea; bloody diarrhoea (dysentery); persistent non-bloody diarrhoea, which can include steatorrhoea; and persistent bloody diarrhoea. Diagnosis still rests heav ily on stool microscopy and culture, although faecal antigen tests and molecular assays are increasingly used. (Source: Medicine)
Source: Medicine - February 24, 2024 Category: Internal Medicine Authors: Paul Kelly, Phoebe Hodges Tags: Infection Source Type: research

Self-assessment/CPD answers
Question 1 (Source: Medicine)
Source: Medicine - February 24, 2024 Category: Internal Medicine Tags: Self-assessment/cpd answers Source Type: research

Gastro-oesophageal reflux disease and hiatus hernia
Gastro-oesophageal reflux disease (GORD) is a common disorder with an increasing prevalence in the UK. The presence of a hiatus hernia is the strongest risk factor for developing GORD, although it is not essential. The most common symptoms experienced by patients with GORD are heartburn and acid regurgitation. The diagnosis of GORD is usually made from the clinical history. Endoscopy and ambulatory pH monitoring are adjunctive tests that can influence management decisions. The main goals of treatment are symptom control and the prevention of complications such as Barrett's oesophagus and peptic stricture. (Source: Medicine)
Source: Medicine - February 12, 2024 Category: Internal Medicine Authors: Estefania Moreno, Philip Woodland Tags: Mouth and oesophagus Source Type: research