About the Liver
The Liver is an organ on the right side of the body weighing about 1.5Kg. It is distinctly the largest and a key organ of a human body, characterized by its muddy red colour. It is strategically the first port of entry from the process of digestion before nutrients leave for the rest of the body. It is the only organ in the human body that can regenerate unless struck by disease.
Essential Functions of the Liver are
Using Food to make chemicals for essential functions of the body
Processing drugs to modified forms that are easily absorbed
Manufacturing essential substances
Storage of nutrients for various processes
Detoxification and excretion of substances that are no longer needed by the body
The liver's key role as a member of the human body
Production of Energy instantly
Making proteins for body building and tissue repair
Storing vitamins, minerals, and sugars for various functions
Regulating fat transport across the body
Regulating Blood clotting activities
Regulating levels of chemicals and drugs in the blood
Regulating hormone balance
Helping in digestion by production of bile
Helping to eliminate excess cholesterol levels
Neutralizing poisonous substances
Metabolism of alcohol
A vital organ in blood formation before birth
Helping to resist infection
Regenerating its own damaged tissue
Resisting infections by helping to remove bacteria from blood
Cleansing Blood by discharging waste products
Anatomy and physiology of the liver related to blood flow and biochemistry
The Liver and Blood Flow
Systemic circulation: Oxygenated blood that has returned from the lungs to the left ventricle of the heart is pumped to all of the tissues of the body.
Pulmonary circulation: After reaching the tissues, blood is returned to the right side of the heart, from where it is pumped to the lungs and then returned to the left side of the heart after taking up oxygen and giving off carbon dioxide.
Portal circulation: Blood from the gut and spleen flow to and through the liver before returning to the right side of the heart. The large vein through which blood is brought to the liver is called the portal vein. After passing through the liver, blood flows into the hepatic vein, which leads into the inferior vena cava to the right side of the heart. The liver also receives some blood directly from the heart via the hepatic artery. In the esophagus, stomach, small intestine and rectum, the portal circulation and veins of the systemic circulation are connected. Under normal conditions, there is little to no back flow from the portal circulation into the systemic circulation.
The Liver and Biochemical Functions
The liver performs many biochemical functions. Blood clotting factors are synthesized in the liver. Albumin, the major protein in the blood, is also synthesized in and secreted from the liver. The modification and/or synthesis of bile components also takes place in the liver. Many of the body's metabolic functions occur primarily in the liver including the metabolism of cholesterol and the conversion of proteins and fats into glucose. The liver is also where most drugs and toxins, including alcohol, are metabolized.
Bilirubin Secretion
The liver is the site of bile formation. Bile contains bile salts, fatty acids, cholesterol, bilirubin and other compounds. The components of bile are synthesized and modified in hepatocytes (the predominant cell type in the liver) and secreted into small bile ducts within the liver itself. These small bile ducts form a branching network of progressively larger ducts that ultimately become the common bile duct that takes bile to the small intestine. Bilirubin is a yellow pigment that derives primarily from old red blood cells. Bilirubin is taken up by hepatocytes from the blood, modified in the hepatocytes to a water soluble form and secreted into the bile.
What is liver disease ?
Liver disease is an acute or chronic damage to the liver, usually caused by infection which can be viral or non-viral, abnormal changes seen through growth of tumors or tumor-like processes, changes or abnormalities in the metabolic process or naturally through a congenital process.
Diseases of the liver can also be categorized by the effect. Hepatitis is inflammation of the liver, cirrhosis involves scarring and progressive cell death, stones develop and form blockages, fatty liver and cancer are modification effects from causes that could be related to genetic defects, lifestyle, environment, or other diseases. All these prevent vital functions of the liver and may cause a build-up of damaging substances to the liver itself that could even be a threat to life. Liver diseases can be acute (usually for a short duration) or chronic (commonly lifelong)
Signs and Symptoms
Liver disease is often discovered during routine testing. Having no symptoms at all is not uncommon.
Acute liver diseases present themselves with symptoms such as high bilirubin-counts (bilirubin is a by-product that is derived from the breakdown of red blood cells), jaundice (yellowing of the skin and eyes), dark yellow/orange coloured urine, or light, clay –coloured stools. A loss of appetite, nausea, vomiting, and diarrhea are not uncommon symptoms either.
Chronic liver disease can present themselves with jaundice (yellowing of the skin and eyes), dark yellow/orange coloured urine, abdominal swelling due to ascites (accumulation of fluid), pruritusunexplained weight loss or gain, (itching), and abdominal pain. Many of these symptoms may not be present until the disease has reached an advanced stage.
Detecting liver disease
Diagnosis of a liver disease considers the patient’s history, symptoms if experienced, a physical examination, laboratory tests, often a radiological study and a biopsy are conducted. A hepatologist would be the expert to make the most reliable diagnosis and recommendations.
Patients with liver diseases often have questions about their various results while trying to understand their importance. Our attempt is to explain some of the commonly prescribed tests for liver diseases that could be abnormal in individual patients. Please do bear in mind that abnormalities of these tests do not mean a diagnosis of a specific disease. Only a qualified physician who is aware of the entire case is able to give the best diagnosis.
What laboratory tests are used to detect a problem with the liver?
Three types of tests are often used to detect liver disease; these tests measure the levels of specific enzymes, bilirubin, or protein present as part of assessing the liver function. A test sample is usually a blood sample. This sample is extracted from the body using a syringe.
Enzymes: are proteins that help cells do their work. When cells are injured, enzymes tend to leak into the blood stream to produce higher-than-normal levels. All liver enzymes are measured by the amounts in the serum (blood), which is why they may be referred to as Serum ALT, AST, ALP. Three common enzymes used to detect liver diseases are:
Alanine aminotransferase (ALT) – an enzyme found mainly in liver cells. Raised ALT levels can be due to damage or death of a liver cell causing its leakage in the blood stream. All forms of hepatitis cause damage to liver cells where a raised ALT level can lead the physician to suspect a liver disease. Its severity, however, will be subject to other tests as part of confirmation.
Aspartate aminotransferase (AST) – another enzyme found in the liver and a few other places, particularly the heart and other muscles. It is less specific for liver disease alone as a raised AST could also be one early indication for a heart attack. Usually where the liver is inflamed, raised ALT and AST levels are in the ratio of 1:1. However, in specific diseases such as alcoholic hepatitis or liver shock, AST levels could be higher than blood ALT levels.
Alkaline phosphatase (ALP) – an enzyme related to the bile ducts; often increased when they are blocked. Alkaline phosphatase is also produced by the kidneys, intestine, placenta and bone. Increased levels of ALP in the presence of normal or moderately elevated AST and ALT are suggestive of an obstruction in the bile duct or a bile duct disease such as primary biliary cirrhosis or primary sclerosing cholangitis. ALP elevated can also be an indication of a bone disorder as it is also produced in bones.
Gamma-glutamyltranspeptidase (GGT) - another enzyme produced in the bile ducts which may be elevated in the blood alongside ALP in patients with bile duct diseases. GGT is an extremely sensitive test. There are also chances of increased GGT due to drugs and alcohol, particularly in heavy drinkers with no liver damage or inflammation.
Bilirubin is a waste product made from destruction of old red blood cells. It is a yellow compound that causes the jaundice and dark yellow coloured urine when present in increased amounts. Bilirubin is removed from the blood by the liver that chemically modifies it by a process called conjugation and secretes as bile. Tests for bilirubin are
Total bilirubin measures all the bilirubin in the blood (direct + indirect)
Conjugated or direct bilirubin - measures a form produced in the liver
Un-conjugated or indirect bilirubin- measures an indirect form of bilirubin that was not converted to the conjugated form in the liver.
A Variation in the ratios of direct and indirect bilirubin may be an indication for a liver disease that could be due to
increased production
decreased uptake by the liver
decreased conjugation
decreased secretion from the liver
due to blockage in the bile duct
Protein tests
Albumin - tell how well the liver is synthesizing this protein. Low albumin levels are suggestive of poor liver function. Chronic liver diseases that are compensated may show normal albumin levels. Decreased levels of albumin are common in cirrhosis or where significant liver damage is present. Low levels of albumin can also be indications for other diseases such as malnutrition and certain kidney disorders.
Serum Protein electrophoresis is a test where the major proteins in the serum are separated in an electric field to determine concentrations. The four major types of serum proteins are albumin, alpha-globulins, beta-globulins and gamma-globulins. Serum protein electrophoresis is a useful test for patients with liver diseases as it can give the physician several diagnostic possibilities. For instance: in cirrhosis the albumin can be decreased but the gamma-globulin level may be elevated. High gamma-globulin levels may also be found in types of autoimmune hepatitis whereas a low alpha-globulin level could suggest a metabolic disease such as alpha-1-antitrypsis deficiency.
Prothrombin time (PT)- Factors needed for blood clotting are made in the liver. In cases where the liver function is abnormal, the synthesis and secretion of these factors into the blood is lowered. The PT is a test where clotting time becomes prolonged if factors made by the liver are found to be low in the blood. In compensated chronic liver diseases, clotting factors are not low until the liver reaches the stage of cirrhosis or significant damage. An elevated PT can also be seen in acute liver diseases where there may be severe liver damage which becomes normal once the patient recovers. PT time can also be prolonged in cases of vitamin K deficiency and from drugs such as warfarin (which is used as an anti-coagulant) and in other non-liver diseases.
Platelet count- These are the smallest units of blood cells that are involved in clotting. In certain individuals with a liver disease, the spleen becomes enlarged as the blood flow to the liver is impaired. Platelet counts fall following development of cirrhosis, however, platelet counts could be abnormal in disorders other than liver diseases.
What types of imaging are used to detect the severity of a liver disease ?
Imaging is important for making an accurate diagnosis on various biliary tract diseases and for diagnosing focal liver lesions such as tumours. In diagnosing diffuse hepatic diseases such as cirrhosis or hepatitis, it is limited.
Transabdominal Ultrasound- is traditionally performed across the abdomen. Preparation for an ultrasound may require a period of fasting. It is the least expensive, safest and fairly sensitive for imaging the biliary system especially the gall-bladder. Often it is selected as the procedure of choice for screening biliary tract abnormalities and making a difference between a intrahepatic (that which occurs within liver cells and can be managed medically) and extrahepatic (that which occurs within a duct and can be managed surgically) causes of jaundice as well as detecting liver masses. The kidney, pancreas and blood vessels can also be seen on such ultrasounds. Usually presence of intestinal gas or obesity can obscure visibility.
Transabdominal ultrasound can detect focused liver lesions (> 1 cm in diameter) more accurately than diffuse diseases (eg, fatty liver, cirrhosis). Generally, cysts are echo-free; solid lesions (eg, tumors, abscesses) which are echogenic (can reflect high-frequency sound waves that allows imaging by ultrasound techniques).
Carcinoma (cancers) also appear as nonspecific solid mass. Ultrasound has been used to screen for hepatocellular carcinoma in patients at high risk (those with chronic hepatitis B). This ability to localize focal lesions can permits ultrasound-guided aspiration and biopsy.
Doppler ultrasound is a noninvasive method that assesses direction of blood flow and patency (extent of any obstruction) of key blood vessels around the liver. These are the portal vein and hepatic artery.70% of the blood and nutrients are supplied to the liver is through the portal vein and 30% through the hepatic artery. Doppler ultrasound can reveal evidence of portal hypertension with collateral flow, assess the patency (obstruction) of liver shunts (eg, surgical portocaval, percutaneous transhepatic), and reveal hepatic artery thrombosis after a liver transplantation. It also can detect any unusual vascular structures. Most patients with cirrhosis are recommended a Doppler ultrasound.
Computerized Tomography (CT) is commonly used to identify hepatic masses, particularly small metastases. It has an accuracy of about 80%. A CT with an intravenous (IV) contrast is accurate for diagnosing carvenous (deep-set) hemangiomas of the liver as well as distinguishing them from other abdominal masses. Unlike an ultrasound, neither obesity nor intestinal gas can cloud a CT image. CT can detect fatty liver and increased hepatic density possibly associated with iron overload. However, a CT is less helpful than ultrasound in diagnosing biliary obstruction.
Magnetic Resonance Imaging (MRI) consists of imaging blood vessels (without using a contrast dye) and hepatic tissues. It is an expensive technique where its indications are still evolving. MRI is superior to CT and ultrasound for diagnosing diffuse liver diseases such as fatty liver and hemochromatosis and for clarifying some focal defects such as hemangiomas. MRI can reveal blood flow and complements doppler ultrasound and CT angiography in diagnosing any vascular abnormalities and in performing vascular mapping before a liver transplantation.
Magnetic Resonance Cholangiopancreatography (MRCP). MRCP is more sensitive than CT or ultrasound in diagnosing common bile duct abnormalities, particularly stones. Its images are comparable to those from an ERCP and percutaneous transhepatic cholangiography, which are more invasive. MRCP is a useful screening tool where biliary obstruction is suspected and a usual step before proceeding to therapeutic ERCP.
Endoscopic Retrograde Cholangiopancreatography (ERCP) combines endoscopy through the second portion of the duodenum with contrast imaging of the biliary and pancreatic ducts. An endoscope is placed in the descending duodenum, then where the Papilla of Vater is cannulated (a procedure involving adding a tube so that fluids are drained to maximize the effect of the procedure) Meanwhile the pancreatic and biliary ducts are injected with contrast. ERCP is the procedure of choice when bile duct stones are suspected but have not been found on less invasive tests. The test is especially valuable for diagnosing correctable biliary tract lesions causing persistent jaundice (eg, stone, stricture, sphincter of Oddi dysfunction). Besides providing excellent images of the biliary tract and pancreas, ERCP reveals some of the upper GI tract. This procedure allows biopsies and other interventional procedures to be performed such as biliary stone extraction.
Percutaneous transhepatic cholangiography (PTC): PTC involves puncture of the liver with a needle under fluoroscopic or ultrasound guidance to cannulate (a procedure involving adding a tube so that fluids are drained to maximize the effect of the procedure) the peripheral intrahepatic bile duct system which is just above the common hepatic duct where contrast material is injected. PTC is highly diagnostic for biliary disease and can be therapeutic such as during decompression of the biliary system. However, ERCP is generally preferred because PTC causes complications such as sepsis, bleeding, bile leaks).
What invasive diagnostic procedures are used to confirm the severity of a liver disease?
Liver biopsy can provide a tissue of the liver, which is then mounted on a slide and studied for changes due to disease. A small core of tissue is obtained that is representative even with focal lesions. Ultrasound- or CT-guided biopsies definitely improve the yield. A biopsy is valuable in detecting tuberculosis (TB) or other infiltrations and help to clarifying the underlying cause of the liver inflammation such as ischemic injury, rejection after liver transplantation, biliary tract disease, or viral hepatitis. Serial biopsies are commonly performed over years, may be necessary for monitoring disease progression.
Gross examination and histopathology are often definitive. Cytology, frozen section, and culture are useful processes in selected cases. Metal content can be measured in the biopsy specimen: copper in suspected Wilson's disease and iron in hemochromatosis.
Limitations of liver biopsy include a sampling error and occasional errors or uncertainty in cases of cholestasis.
Indications for Liver Biopsy
Unexplained liver enzyme abnormalities
Alcoholic liver disease or nonalcoholic steatosis (diagnose and stage)
Chronic hepatitis (diagnose and stage)
Suspected rejection after liver transplantation that cannot be diagnosed by less invasive methods
Hepatosplenomegaly of unknown cause
Unexplained intrahepatic cholestasis
Suspected malignancy (focal lesions)
Unexplained systemic illness–eg, fever of unknown origin, inflammatory or granulomatous diseases (culture is performed with biopsy)
Endoscopy
An endoscope as used in the field of gastroenterology is a thin flexible tube which uses a lens or miniature camera to view various areas of the gastrointestinal tract. When the procedure is performed to examine certain organs such as the bile ducts or pancreas, the organs are not viewed directly, but rather indirectly through the injection of x-ray dye into the bile duct.
The performance of an exam using an endoscope is referred by the general term endoscopy. Diagnosis through biopsies or other means and therapeutic procedures can be done with these instruments.
Extracorporeal shock-wave lithotripsy (ESWL)
This is a technique that uses high-pressure waves similar to sound waves that can be "focused" on a very small area, thereby fracturing small solid objects such as gallstones, kidney stones, etc. The small fragments can pass more easily and harmlessly into the intestine or can be dissolved with medications.
The Hepatic Venous Pressure Gradient (HVPG)
The HVPG represents the gradient between portal vein and intra-abdominal vena cava pressure. HVPG measurement is done after an overnight fast, under conscious sedation and monitoring for vital signs (This includes heart rate, arterial blood pressures, digital oxygen saturation, and ECG).
Under local anesthesia, central vein (for pressure monitoring) is punctured using the Seldinger technique. There are four steps to the Seldinger technique
Venepuncture is performed with a introducer needle or trocar (a sharp hollow needle)
A soft tipped guide wire is passed through the needle and the needle removed
A cannula or dilator is passed over the guide wire
Cannula or dilator is removed and catheter is passed over wire using fluoroscopy to establish its position- The guidewire is then removed
The Seldinger technique has been refined to help reduce complications such as infection, haemorrhage and accidental perforation during intervention into a vein. The advantage of this procedure is a possibility of a biopsy alongside measurement of the pressure in the portal vein. Use of doppler ultrasound helps to minimize complications such as leakage, hematoma, and rarely, reaction in the vein, rupture of venous trocar, or arteriovenous puncture causing a fistula. The key measurement of a HVPG procedure are the Free Hepatic Venous Pressure and the Wedge Hepatic Venous Pressure. The difference between the two measurements will provide the pressure gradient in the liver to ascertain severity of portal hypertension.
Grading of pressure
Persons with normal portal pressure measure between 1-5mmHg.
Persons with portal pressure above 5mmHg are graded as subclinical portal hypertension.
Persons with portal pressure equal and over 10mmHg are assessed to be clinically significant portal hypertension.
Persons with a portal pressure over 12mmHg are at risk for a varaceal rupture.
What are some common liver disease symptoms?
When diagnosing liver disease, the physician looks at the patient's symptoms and conducts a physical examination. In addition, the physician may request a liver biopsy, liver function tests, an ultrasound, or a CT scan (computerized tomography scan).
Some common liver disease symptoms include the following, each of which are described briefly below:
jaundice
cholestasis
liver enlargement
portal hypertension
ascites
liver encephalopathy
liver failure
What is jaundice?
Jaundice is a yellow discoloration of the skin and eye whites due to abnormally high levels of bilirubin (bile pigment) in the bloodstream. Urine is usually dark because of the bilirubin excreted through the kidneys. High levels of bilirubin may be attributed to inflammation or other abnormalities of the liver cells or blockage of the bile ducts. Sometimes jaundice is caused by the breakdown of a large number of red blood cells, which can occur in newborns. Jaundice is usually the first sign, and sometimes the only sign, of liver disease.
What is cholestasis?
Cholestasis is reduced or stopped bile flow. Bile flow may be blocked inside or outside the liver. Symptoms may include:
jaundice
dark urine
pale stool
bone loss
easy bleeding
itching
small, spider-like blood vessels visible in the skin
enlarged spleen
fluid in the abdominal cavity
chills
pain from the biliary tract or pancrea
enlarged gallbladder
Some causes of cholestasis include:
hepatitis
primary biliary cirrhosis
drug effects
hormonal changes during pregnancy
a stone in the bile duct
bile duct narrowing
bile duct cancer
pancreatic cancer
inflammation of the pancreas
What is liver enlargement?
Liver enlargement is usually an indicator of liver disease, although there are usually no symptoms associated with a slightly enlarged liver (hepatomegaly). Symptoms of a grossly enlarged liver include abdominal discomfort or "feeling full."
What is portal hypertension?
The portal vein carries about 1500 ml/min of blood from the small and large bowel, spleen, and stomach to the liver at a pressure of about 5 mmHg. Any obstruction or increased resistance to flow or due to pathological increases in portal blood flow could lead to portal hypertension with portal pressures over 12 mm Hg. Although the differential diagnosis is extensive, alcoholic and viral cirrhosis are the leading causes of portal hypertension in Western countries, whereas liver disease due to schistosomiasis is the main cause in other areas of the world (caused by a parasitic worm). Portal vein thrombosis is the commonest cause in children. In India and Japan non-cirrhotic portal fibrosis is a known cause of portal hypertension seen in lower-social groups and low hygiene.
Portal hypertension is abnormal high blood pressure in the portal vein, which supplies the liver with blood from the intestine. Portal hypertension may be due to increased blood pressure in the portal blood vessels or resistance to blood flow through the liver. Portal hypertension can lead to the growth of collateral vessels that connect to the general circulation, bypassing the liver. When this occurs, substances that are normally removed by the liver pass into the general circulation. Symptoms of portal hypertension may include:
a distended abdominal cavity (ascites)
bleeding of the varicose veins at the lower end of the esophagus and in the stomach lining
What is gastric bleeding?
Increases in portal pressure disturb the portal systemic circulation. These factors are partly responsible for the important complications of chronic liver disease, including variceal bleeding, hepatic encephalopathy, ascites, hepatorenal syndrome, recurrent infection, and abnormalities in coagulation. Variceal or gastric bleeding is the most serious complication and is an important cause of death in patients with cirrhotic liver disease.
Patients with varices have a 30% lifetime risk of gastric bleeding, and a third of those who bleed will die. Patients who have bled once from oesophageal varices have a 70% chance of bleeding again and about a third of further bleeding episodes are fatal.
What is ascites?
Ascites is fluid build-up in the abdominal cavity, caused by fluid leaks from the surface of the liver and intestine. Ascites due to liver disease usually accompanies other liver disease characteristics such as portal hypertension. Symptoms of ascites may include a distended abdominal cavity, which causes discomfort and shortness of breath. Causes of ascites may include:
liver cirrhosis (especially cirrhosis caused by alcoholism)
alcoholic hepatitis
chronic hepatitis
obstruction of the hepatic vein
Ascites can also be caused by non-liver disorders.
What is Cirrhosis?
Cirrhosis is characterized anatomically by widespread nodules in the liver combined with fibrosis. The fibrosis and nodule formation causes distortion of the normal liver architecture which interferes with blood flow through the liver. Cirrhosis can also lead to an inability of the liver to perform its biochemical functions.
The journey of what goes wrong in Cirrhosis
Cirrhosis results from damage to liver cells from toxins, inflammation, metabolic derangements and other causes. In cryptogenic liver disease, the cause is unknown.
Damaged and dead liver cells are replaced by fibrous tissue leads to fibrosis (scarring). Liver cells begin to regenerate in an abnormal pattern primarily forming nodules that are surrounded by fibrous tissue
.
Grossly abnormal liver architecture leads to decreased blood flow to and through the liver. There is decreased blood flow to the liver and blood back up in the portal vein and portal circulation leads to some of the serious complications of cirrhosis. Blood can back up in the spleen causing it to enlarge and sequester blood cells.
Most often, the platelet count falls because of splenic sequestration (withholding of the blood) leading to abnormal bleeding. If the pressure in the portal circulation increases because of cirrhosis and blood withheld, blood can flow backwards from the portal circulation to the systemic circulation where they are connected. This can lead to varicose veins in the stomach and esophagus (gastric and esophageal varices) and rectum (hemorrhoids). Gastric and esophageal varices can rupture, bleed massively and even cause death.
Hypertension in the portal circulation, along with other hormonal, metabolic and kidney abnormalities in cirrhosis, can also lead to fluid accumulation the abdomen (ascites) and the peripheral tissue (peripheral edema).
Decreased bilirubin secretion from hepatocytes in cirrhosis leads to the back up of bilirubin in the blood. This leads to jaundice, the yellow discoloration of the skin and eyes. As the water-soluble form of bilirubin also backs up in the blood, bilirubin can also spill into the urine giving it a bright yellow to dark brown color.
Abnormal biochemical function of the liver in cirrhosis can lead to several complications. The serum albumin concentration falls which can lead to aggravation of ascites and edema. The metabolism of drugs can change requiring dose adjustments.
In men, breast enlargement (gynecomastia) sometimes occurs because metabolism of estrogen in the liver is decreased.
Decreased production of blood clotting factors can lead to bleeding complications.
Derangements in the metabolism of triglycerides, cholesterol and sugar can occur.
In earlier stages, cirrhosis frequently can cause insulin resistance and diabetes mellitus.
In later stages or in severe liver failure, blood glucose may be low because it cannot be synthesized from fats or proteins.
Cirrhosis, especially in advanced cases, can cause profound abnormalities in the brain. In cirrhosis, some blood leaving the gut bypasses the liver as blood flow through the liver is decreased.
Metabolism of components absorbed in the gut can also be decreased as liver cell function deteriorates.
Both of these derangements can lead to hepatic encephalopathy as toxic metabolites, normally removed from the blood by the liver, can reach the brain.
In its early stages, subtle mental changes such as poor concentration or the inability to construct simple objects occurs.
In severe cases, hepatic encephalopathy can lead to stupor, coma, brain swelling and death.
Cirrhosis can lead to immune system dysfunction causing an increased risk of infection. Ascites fluid in the abdomen often becomes infected with bacteria normally present in the gut (spontaneous bacterial peritonitis).
Cirrhosis can also lead to kidney dysfunction and failure.
End-stage cirrhosis, can trigger kidney dysfunction called hepatorenal syndrome can occur. This is fatal unless a liver transplant takes place.
Clinical Symptoms and Diagnosis of Cirrhosis
Cirrhosis is usually an easy diagnosis to make when any or all of the above abnormalities and complications are present. This is especially true when the underlying liver disease can be identified. The underlying liver disease is identified in most patients, however, sometimes it will not be discovered despite recommending specific diagnostic tests. Such cases are called "cryptogenic" cirrhosis.
Some patients with cirrhosis, especially early in the course of the disease, will have no overt clinical signs or symptoms. Some may have only subtle physical changes such as
Red palms or red spots that blanch on their upper body (spider angiomata)
Hypertrophy of the parotid glands
Gynecomastia or fibrosis of tendons in the palms.
Some patients may only have subtle abnormalities on blood tests, and in some cases, all blood tests may be normal.
Radiological and nuclear medicine tests may give clues as to the presence of cirrhosis
The diagnosis of cirrhosis can often be made by an ultrasound
The diagnosis of the liver architecture can only be made by a biopsy.
Treatment
Cirrhosis of the liver is irreversible but treatment of the underlying liver disease may slow or stop the progression. Such treatment depends upon the underlying etiology. In cryptogenic cirrhosis, since the cause is unknown, supportive therapy directed at alleviating symptoms due to progression and its complications is the only answer.
Bleeding esophageal varices can be treated with endoscopic sclerotherapy or rubber band ligation.
Ascites and edema are often responsive to a low sodium diet and such a diet must be emphasized in patients with these symptoms. More advanced ascites and edema can respond to diuretic therapy.
A low protein diet and agents such as lactulose may help hepatic encephalopathy.
Infections such as spontaneous bacterial peritonitis must be rapidly treated with appropriate antibiotics.
Drugs metabolized in the liver must be given with caution.
Coagulation disorders will sometimes respond to vitamin K.
Liver transplantation is highly effective for the treatment of end-stage cirrhosis. Transplantation is usually needed when complications such as encephalopathy, ascites or bleeding varices are uncontrollable or when biochemical function is severely depressed.
What is liver encephalopathy?
Liver encephalopathy is the deterioration of brain function due to toxic substances building up in the blood, which are normally removed by the liver. Liver encephalopathy is also called portal-systemic encephalopathy, hepatic encephalopathy, or hepatic coma. Symptoms may include:
impaired consciousness
changes in logical thinking, personality, and behavior
mood changes
impaired judgement
drowsiness
confusion
sluggish speech and movement
disorientation
loss of consciousness
coma
What is liver failure?
Liver failure is severe deterioration of liver function. Liver failure occurs when a large portion of the liver is damaged due to any type of liver disorder. Symptoms may include:
jaundice
tendency to bruise or bleed easily
ascites
impaired brain function
general failing health
fatigue
weakness
nausea
loss of appetite
Supportive Treatments in management of characteristics of Liver Disease
Sclerotherapy
In sclerotherapy a sclerosant solution (ethanolamine oleate or sodium tetradecyl sulphate) is injected into the bleeding varix or the overlying submucosa. Injection into the varix obliterates the lumen by thrombosis whereas injection into the submucosa produces inflammation followed by fibrosis. The first injection controls bleeding in 80% of cases. If bleeding recurs, the injection is repeated. Complications are related to toxicity of the sclerosant and include transient fever, dysphagia and chest pain, ulceration, stricture, and (rarely) perforation.
Band ligation
Band ligation is achieved by a banding device attached to the tip of the endoscope. The varix is aspirated into the banding chamber, and a trip wire dislodges a rubber band carried on the banding chamber, ligating the entrapped varix. One to three bands are applied to each varix, resulting in thrombosis. Band ligation eradicates oesophageal varices with fewer treatment sessions and complications than sclerotherapy.
Balloon tube tamponade
The balloon tube tamponade may be life saving in patients with active variceal bleeding if emergency sclerotherapy or banding is unavailable or not technically possible because visibility is obscured. In patients with active bleeding, an endotracheal tube is inserted to protect the airway before attempting to place the oesophageal balloon tube.
A Minnesota balloon tube has four entry points
1for gastric aspiration
2 to inflate the gastric and oesophageal balloons
1 above the oesophageal balloon for suction of secretions to prevent aspiration.
The tube is inserted through the mouth, and correct positioning in the stomach is checked by auscultation while injecting air through the gastric lumen. The gastric balloon is then inflated with 200 ml of air. Once fully inflated, the gastric balloon is pulled up against the oesophagogastric junction, compressing the submucosal varices. The tension is maintained by strapping a split tennis ball to the tube at the patient's mouth.
An oesophageal balloon is rarely required. Complications could be
gastric and oesophageal ulceration
pneumonia
oesophageal perforation.
Continued bleeding during balloon tamponade indicates an incorrectly positioned tube or bleeding from another source. After resuscitation, and within 12 hours, the tube is removed and endoscopic treatment repeated.
Transjugular intrahepatic portosystemic shunt (TIPS)
Transjugular intrahepatic portosystemic shunt is the best procedure for patients whose bleeding is not controlled by endoscopy. It is effective only in portal hypertension of hepatic origin (caused by fibrosis of the liver for example). The procedure is performed via the internal jugular vein under local anaesthesia with sedation. The hepatic vein is cannulated and a tract created through the liver from the hepatic to the portal vein, with a needle under ultrasonographic and fluoroscopic guidance. The tract is dilated and an expandable metal stent inserted to create an intrahepatic portosystemic shunt. The success rate is excellent. Haemodynamic effects are similar to those found with surgical shunts, with a lower procedural morbidity and mortality. The process lasts one to three hours, but you should expect to stay in the hospital overnight after the procedure.
Transjugular intrahepatic portosystemic shunting is an effective salvage procedure for stopping acute variceal haemorrhage, controlling bleeding from gastric varices, and congestive gastropathy after failure of medical and endoscopic treatment.
What Tests Are Required Before the TIPS?
Before receiving either of these procedures, the following tests may be performed to determine the extent and severity of your condition:
Evaluation of your medical history
A physical examination
Blood tests
Angiogram (an X-ray test that takes pictures of the blood flow within a particular artery)
Ultrasound
Endoscopy
Before either the TIPS procedure, your doctor may ask you to have other preoperative tests, which may include an electrocardiogram (EKG) (a test that records the electrical activity of your heart), chest X-ray, or additional blood tests. If your doctor thinks you will need additional blood products they will be ordered at this time.
How Successful Is the TIPS Procedure?
The TIPS procedure controls bleeding immediately in more than 90% of patients. However, in about 20% of patients, the shunt may narrow, causing varices to re-bleed at a later time.
What Complications Are Associated With TIPS?
Shunt narrowing or occlusion (blockage) can occur within the first year after the procedure. Follow-up ultrasound examinations are performed frequently after the TIPS procedure to detect these complications. The signs of occlusion include increased ascites (accumulation of fluid in the abdomen) and re-bleeding. This condition can be treated by a radiologist who re-expands the shunt with a balloon or repeats the procedure to place a new stent.
Encephalopathy, or abnormal functioning of the brain, can occur with severe liver disease. Hepatic encephalopathy can become worse when blood flow to the liver is reduced by TIPS, which may result in toxic substances reaching the brain without being metabolized first by the liver. This condition can be treated with medications, diet, or by occluding the shunt (making the shunt inaccessible).
What is the Distal splenorenal shunt (DSRS) Procedure?
The DSRS is a surgical procedure during which the vein from the spleen (called the splenic vein) is detached from the portal vein and attached to the left kidney (renal) vein. This surgery selectively reduces the pressure in the varices and controls the bleeding. It is usually performed only in patients with good liver function. General anesthesia is given before the surgery, which lasts about four hours. You should expect to stay in the hospital from seven to 10 days.
How Successful Is the DSRS Surgery?
DSRS controls bleeding in more than 90% of patients, with the highest risk of any re-bleeding occurring in the first month. The DSRS procedure provides good long-term control of bleeding.
What Complications Are Associated With DSRS Surgery?
Ascites, an accumulation of fluid in the abdomen, can occur. This can be treated with diuretics and restricted sodium intake.
Follow-Up Care Following TIPS or DSRS Procedures
DSRS controls bleeding in more than 90% of patients, with the highest risk of any re-bleeding occurring in the first month. The DSRS procedure provides good long-term control of bleeding.
Ten days after hospital discharge, meet with your surgeon or hepatologist (liver specialist) to evaluate your progress. Lab work will be done at this time.
Six weeks after the TIPS procedure (and again three months after the procedure), have an ultrasound so your doctor can check that the shunt is functioning properly. You will have an angiogram (an x-ray of blood vessels) only if the ultrasound indicates that there is a problem. You will also have lab work done at these times.
Six weeks after the DSRS procedure (and again three months after the procedure), meet with the surgeon to evaluate your progress. Lab work will be done at this time.
Six months after either the TIPS or DSRS procedure, have an ultrasound to make sure the shunt is working properly. Also, visit the surgeon or hepatologist.
Twelve months after either procedure, have another ultrasound of the shunt. Also, you may have an angiogram so that your doctor can check the pressure within your veins across the shunt.
If the shunt is working well, every six months after the first year of follow-up appointments, have an ultrasound, lab work, and visit with your doctor.
More frequent follow-up visits may be necessary, depending on your condition.
Attend all follow-up appointments as scheduled to ensure that the shunt is functioning properly. Be sure to follow the dietary recommendations that your healthcare providers give you.
Long term management
After the acute variceal haemorrhage has been controlled, treatment should be initiated to prevent rebleeding, which occurs in most patients.
Repeated endoscopic treatment
Repeated endoscopic treatment eradicates oesophageal varices in most patients, and provided that follow up is adequate serious recurrent variceal bleeding is uncommon. Because the underlying portal hypertension persists, patients remain at risk of developing recurrent varices and therefore require lifelong regular surveillance endoscopy.
Long term drug treatment
The use of beta blockers after variceal bleeding has been shown to reduce portal blood pressures and lower the risk of further variceal bleeding. Patients would be recommended beta blockers unless they have contraindications. Best results are obtained when portal blood pressure is reduced by more than 20% of baseline or to below 12 mm Hg.
Surgical management of varices
Surgical procedures
Patients with good liver function in whom endoscopic management fails or who live far from centres where endoscopic sclerotherapy services are available are candidates for surgical shunt procedures. A successful portosystemic shunt prevents recurrent variceal bleeding but is a major operation that may cause further impairment of liver function.
Partial portacaval shunts with 8 mm interposition grafts are equally effective to other shunts in preventing rebleeding and have a low rate of encephalopathy. Oesophageal transection and gastric devascularisation are now rarely performed but have a role in patients with portaland splenic vein thrombosis who are unsuitable for shunt procedures
and continue to have serious variceal bleeding despite endoscopic and drug treatment. Liver transplantation is the treatment of choice in advanced liver disease. Hepatic decompensation is the ultimate decompressive shunt for portal hypertension and also restores liver function. Transplantation treats other complications of portal hypertension and has one year and five year survival rates of 80% and 60% respectively.
Prophylactic management
Most patients with portal hypertension never bleed, and it is difficult to predict who will. Attempts at identifying patients at high risk of variceal haemorrhage by measuring the size or appearance of varices have been largely unsuccessful. Beta blockers have been shown to reduce the risk of bleeding, and all patients with varices should take them unless contraindicated.
Hypertensive portal gastropathy
Gastric varices and portal hypertensive gastropathy
Gastric varices are the source of bleeding in 5.10% of patients with variceal haemorrhage. Higher rates are reported in patients with left sided portal hypertension due to thrombosis of the splenic vein. Endoscopic control of gastric varices is difficult unless they are located on the proximal lesser curve in continuation with oesophageal varices. Endoscopic administration of cyanoacrylate monomer (superglue) is useful for gastric varices. The transjugular intrahepatic portosystemic shunt is increasingly used to control bleeding in this group. Bleeding from portal hypertensive gastropathy accounts for 2.3% of bleeding episodes in cirrhosis. When bleeding occurs its diffuse nature precludes the use of endoscopic treatment. Optimal management is with a combination of terlipressin and beta blockers.
http://thelivercarefoundation.org
Sunday, June 21, 2009
CENTRE FOR LIVER DISEASE AND TRANSPLANT CHENNAI
The Liver Center aims to become a ‘one stop shop’ for patients with chronic liver disease as well as Hepatobiliary & pancreatic disorders by providing multidisciplinary comprehensive evaluation of the at our ‘Liver Clinics’. These liver clinics house several specialists of the liver center simultaneously under one roof.
http://www.livercenterindia.org/
http://www.livercenterindia.org/
NRI US SURGEON WANT TO HELP
The president-elect of the International College of surgeons (USA) and chairman of the Critical Care Task Force for the American Society of Transplant surgeons, Dinesh Ranjan, has offered to provide free medical service to the people of Jharkhand.
An alumnus of the Rajendra Medical College and Hospital (now Rajendra Institute of Medical Sciences RIMS), Ranjan addressed a gathering of the RMCH-RIMS alumni here on Tuesday.
After deliberating extensively on liver transplant techniques, a field in which he attained expertise after moving out to the USA in 1979, Ranjan said that liver transplant, considered one of the most sophisticated organ transplant techniques, is still in a primary stage in India.
Ranjan has conducted over 1000 liver transplants in the University of Kentucky and helped set up transplant facilities in Albama and Egypt. He acknowledged his association with this tribal-dominated state of the country.
"In India, liver transplantation is practised in metros like Delhi and Mumbai. Since it is difficult for people to bear the cost of transplantation and lodging in metros, it would be convenient for patients if such a facility is available here," he said.
Ranjan called upon the local medical fraternity to come up with a project here. He offered free medical serviceto such a facility on behalf of his team. He said even the state government could utilize his expertise and experience. "Recently, I facilitated set-up of transplantation facilities in Albama and Egypt. I would be happy to do this for my own state," he said.
Speaking on the success of liver transplant and the intricacies involved in it, Ranjan said that the survival rate is more than 90 per cent in the first year of surgery and the risk gradually diminishes with time. "Liver is the only organ in the human body that grows to its normal size even if half of the portion is removed. This unique aspect of the liver encouraged surgeons to try liver transplants. The results, so far, have been highly encouraging," he said.
As against over 16000 liver transplantation carried out all over the world annually, more than 5000 transplantation is done in the USA.
Ranjan said that live donor transplantation and cadaveric transplantation are two different aspects in which surgeons have to be very cautious while dealing with the live donors. "Our expertise comes into play when we operate upon a healthy person and take a part of his liver for transplanting it into another patient and ensuring at the same time that the healthy person's condition remains fit," he said.
Speaking about the medical expenses on liver transplantation, Ranjan said that the process is cheaper in India and involves an expenditure of around Rs 15-20 lakh. He said the same process is carried out in the USA at an expense of around $200,000.
source::
http://timesofindia.indiatimes.com
An alumnus of the Rajendra Medical College and Hospital (now Rajendra Institute of Medical Sciences RIMS), Ranjan addressed a gathering of the RMCH-RIMS alumni here on Tuesday.
After deliberating extensively on liver transplant techniques, a field in which he attained expertise after moving out to the USA in 1979, Ranjan said that liver transplant, considered one of the most sophisticated organ transplant techniques, is still in a primary stage in India.
Ranjan has conducted over 1000 liver transplants in the University of Kentucky and helped set up transplant facilities in Albama and Egypt. He acknowledged his association with this tribal-dominated state of the country.
"In India, liver transplantation is practised in metros like Delhi and Mumbai. Since it is difficult for people to bear the cost of transplantation and lodging in metros, it would be convenient for patients if such a facility is available here," he said.
Ranjan called upon the local medical fraternity to come up with a project here. He offered free medical serviceto such a facility on behalf of his team. He said even the state government could utilize his expertise and experience. "Recently, I facilitated set-up of transplantation facilities in Albama and Egypt. I would be happy to do this for my own state," he said.
Speaking on the success of liver transplant and the intricacies involved in it, Ranjan said that the survival rate is more than 90 per cent in the first year of surgery and the risk gradually diminishes with time. "Liver is the only organ in the human body that grows to its normal size even if half of the portion is removed. This unique aspect of the liver encouraged surgeons to try liver transplants. The results, so far, have been highly encouraging," he said.
As against over 16000 liver transplantation carried out all over the world annually, more than 5000 transplantation is done in the USA.
Ranjan said that live donor transplantation and cadaveric transplantation are two different aspects in which surgeons have to be very cautious while dealing with the live donors. "Our expertise comes into play when we operate upon a healthy person and take a part of his liver for transplanting it into another patient and ensuring at the same time that the healthy person's condition remains fit," he said.
Speaking about the medical expenses on liver transplantation, Ranjan said that the process is cheaper in India and involves an expenditure of around Rs 15-20 lakh. He said the same process is carried out in the USA at an expense of around $200,000.
source::
http://timesofindia.indiatimes.com
FIRST LIVER TRANSPLANT IN GOVT. HOSPITAL IN INDIA
South India’s first successful liver transplant in the public sector was performed at the Government Stanley Hospital’s Centre for Surgical Gastroenterology and Liver Transplantation, here, on Thursday. The recipient, a 40-year-old woman with cirrhosis of the liver, was operated upon early Thursday morning and was said to be doing well after surgery.
Led by S. Surendran, head, Surgical Gastroenterology, a large team comprising nearly 40 people, helped perform the nearly 12-hour-long surgery.
The donated liver came from 19-year-old Karthik, who was declared brain dead after a road accident. Kumaran Hospital, where he was admitted, informed the Tamil Nadu Organ Registry and the transplant coordinator about the availability of organs, including the liver. The availability of a matching recipient at Stanley Hospital and the fact that the team was finally ready to perform its first transplantation seem fortuitous.
“For us, it is a dream come true,” says Dr. Surendran. He explains that a decade ago, an attempt was made at liver transplantation, but it was premature and unsuccessful.
Health Secretary V.K. Subburaj, lauding the team, said, “It is a historic day for us. We have been waiting for this day for a long while.”
Stanley Dean J. Mohanasundaram said this achievement would encourage more people to enrol with the organ liver registry at the hospital.
Yet another liver surgery was done in Tamil Nadu on Thursday at the Christian Medical College, Vellore. The Tamil Nadu registry coordinated with its Karnataka counterpart to procure the organ from Manipal Hospital, Bangalore.
SURGERY WAS PERFORMED ON 30TH JANUARY 2009
SOURCE:--
http://www.india-transplant.com/2009/01/stanley-records-first-in-liver.html
Led by S. Surendran, head, Surgical Gastroenterology, a large team comprising nearly 40 people, helped perform the nearly 12-hour-long surgery.
The donated liver came from 19-year-old Karthik, who was declared brain dead after a road accident. Kumaran Hospital, where he was admitted, informed the Tamil Nadu Organ Registry and the transplant coordinator about the availability of organs, including the liver. The availability of a matching recipient at Stanley Hospital and the fact that the team was finally ready to perform its first transplantation seem fortuitous.
“For us, it is a dream come true,” says Dr. Surendran. He explains that a decade ago, an attempt was made at liver transplantation, but it was premature and unsuccessful.
Health Secretary V.K. Subburaj, lauding the team, said, “It is a historic day for us. We have been waiting for this day for a long while.”
Stanley Dean J. Mohanasundaram said this achievement would encourage more people to enrol with the organ liver registry at the hospital.
Yet another liver surgery was done in Tamil Nadu on Thursday at the Christian Medical College, Vellore. The Tamil Nadu registry coordinated with its Karnataka counterpart to procure the organ from Manipal Hospital, Bangalore.
SURGERY WAS PERFORMED ON 30TH JANUARY 2009
SOURCE:--
http://www.india-transplant.com/2009/01/stanley-records-first-in-liver.html
FIRST LIVER TRANSPLANT IN GOVT. HOSPITAL IN INDIA
South India’s first successful liver transplant in the public sector was performed at the Government Stanley Hospital’s Centre for Surgical Gastroenterology and Liver Transplantation, here, on Thursday. The recipient, a 40-year-old woman with cirrhosis of the liver, was operated upon early Thursday morning and was said to be doing well after surgery.
Led by S. Surendran, head, Surgical Gastroenterology, a large team comprising nearly 40 people, helped perform the nearly 12-hour-long surgery.
The donated liver came from 19-year-old Karthik, who was declared brain dead after a road accident. Kumaran Hospital, where he was admitted, informed the Tamil Nadu Organ Registry and the transplant coordinator about the availability of organs, including the liver. The availability of a matching recipient at Stanley Hospital and the fact that the team was finally ready to perform its first transplantation seem fortuitous.
“For us, it is a dream come true,” says Dr. Surendran. He explains that a decade ago, an attempt was made at liver transplantation, but it was premature and unsuccessful.
Health Secretary V.K. Subburaj, lauding the team, said, “It is a historic day for us. We have been waiting for this day for a long while.”
Stanley Dean J. Mohanasundaram said this achievement would encourage more people to enrol with the organ liver registry at the hospital.
Yet another liver surgery was done in Tamil Nadu on Thursday at the Christian Medical College, Vellore. The Tamil Nadu registry coordinated with its Karnataka counterpart to procure the organ from Manipal Hospital, Bangalore.
SOURCE:--
http://www.india-transplant.com/2009/01/stanley-records-first-in-liver.html
Led by S. Surendran, head, Surgical Gastroenterology, a large team comprising nearly 40 people, helped perform the nearly 12-hour-long surgery.
The donated liver came from 19-year-old Karthik, who was declared brain dead after a road accident. Kumaran Hospital, where he was admitted, informed the Tamil Nadu Organ Registry and the transplant coordinator about the availability of organs, including the liver. The availability of a matching recipient at Stanley Hospital and the fact that the team was finally ready to perform its first transplantation seem fortuitous.
“For us, it is a dream come true,” says Dr. Surendran. He explains that a decade ago, an attempt was made at liver transplantation, but it was premature and unsuccessful.
Health Secretary V.K. Subburaj, lauding the team, said, “It is a historic day for us. We have been waiting for this day for a long while.”
Stanley Dean J. Mohanasundaram said this achievement would encourage more people to enrol with the organ liver registry at the hospital.
Yet another liver surgery was done in Tamil Nadu on Thursday at the Christian Medical College, Vellore. The Tamil Nadu registry coordinated with its Karnataka counterpart to procure the organ from Manipal Hospital, Bangalore.
SOURCE:--
http://www.india-transplant.com/2009/01/stanley-records-first-in-liver.html
Wednesday, June 10, 2009
IRRITABLE BOWEL SYNDROME (world gastroenterology org. )
source: world gastroenterology organisation website
How can my doctor be sure I have IBS? Shouldn't they run more tests?
If the doctor makes a diagnosis based on a good history and the application of validated criteria, it is very unlikely that the symptoms are caused by any other condition. Additional tests or examinations will not usually be necessary if your doctor follows recent guidelines developed by the World Gastroenterology Organisation (WGO).
References:
World Gastroenterology Organisation Practice Guidelines 2009. Irritable Bowel Syndrome – A Global Perspective. Available at www.worldgastroenterology.org/global-guidelines.html Paterson WG, et al. Predictive value of the Rome criteria for diagnosing the irritable bowel syndrome. Am J Gastroenterol 1999;94:2912-7.
If it’s not IBS, what else could it be?
A number of other conditions may have symptoms such as abdominal pain or discomfort, or a change in the frequency and appearance of your stool that are similar to IBS. However, your doctor will base his/her clinical assessment on a
Reference:
World Gastroenterology Organisation Practice Guidelines 2009. Irritable Bowel Syndrome – A Global Perspective. Available at www.worldgastroenterology.org/global-guidelines.html
Is it a common disease in the world?
Yes, IBS is surprisingly common throughout the world and appears to be becoming more common. In developed countries it may affect up to 1 in 5 adults – an average figure based on a number of surveys is approximately 1 in 10 people (11%).
Reference:
McFarland LV. State-of-the-art of irritable bowel syndrome and inflammatory bowel disease research in 2008. World J Gastroenterol. 2008;14(17):2625-9. Hungin APS, Whorwell PJ, Tack J, Mearin F. The prevalence, patterns and impact of irritable bowel syndrome: an international survey of 40 000 subjects. Aliment Pharmacol Ther. 2003; 17(5):643-50.
Is diet a causative factor?
Diet is not the cause of IBS but there is evidence that dietary factors may exacerbate symptoms. The prevalence of IBS has increased in countries which have introduced Western style diets and these diets often contain more refined foods and additives. The impact of diet and other factors on the bacterial gut flora may play a role in the
Reference:
Alpers DH. Diet and Irritable Bowel Syndrome. Curr Opin Gastroenterol. 2006;22(2):136-139. Dapoigny M, Stockbrugger RW, Azpiroz F, et al. Role of alimentation in irritable bowel syndrome. Digestion. 2003;67(4):225-33.
Is there a relationship between IBS and food allergies?
No, there is no evidence suggesting food allergies cause IBS. However, people often believe that food allergies exacerbate their IBS symptoms - food allergy testing or exclusion diets have not been shown to affect IBS symptoms so their routine use is not recommended. It is more important to adopt a healthy balanced diet, as advocated by the WGO.
Reference:
Brandt LJ, Chey D, Foxx-Orenstein AE et al. An evidence-based systematic review on the management of Irritable Bowel Syndrome. American College of Gastroenterology Task Force. American Journal of Gastroenterology. Vol 104. Supplement. 2009. World Gastroenterology Organisation Practice Guidelines 2009. Irritable Bowel Syndrome – A Global Perspective. Available at www.worldgastroenterology.org/global-guidelines.html
What is irritable bowel syndrome?
IBS is one of the most common digestive disorders, affecting a significant proportion of the world’s population. Typically, people with IBS experience symptoms which include abdominal pain, bloating, constipation and/or diarrhoea. The symptoms are often chronic (long-term) and recurrent (episodic). IBS is a condition that is taken seriously because it has a significant impact of people’s ability to work productively or
Reference:
Spiller R, Aziz Q, Creed F, et al. Guidelines on the irritable bowel syndrome: mechanisms and practical management. Gut. 2007;56(12):1770-98 McFarland LV. State-of-the-art of irritable bowel syndrome and inflammatory bowel disease research in 2008. World J Gastroenterol. 2008;14(17):2625-9. Hungin APS, Whorwell PJ, Tack J, Mearin F. The prevalence, patterns and impact of irritable bowel syndrome: an international survey of 40 000 subjects. Aliment Pharmacol Ther. 2003; 17(5):643-50.
What are the risk factors for IBS?
There is a strong association between intestinal infection and IBS and the risk substantially increases (6-fold) after an acute gastrointestinal infection – this is one reason why probiotics are being investigated for managing IBS symptoms. Women have a 2-3 fold higher prevalence of IBS than men and recurrent abdominal pain as a child is a risk factor for IBS as an adult. A Western style diet may also be a risk factor as there is an increased prevalence of IBS in countries that adopt Western cuisine. Stress is also a risk factor for IBS.
Reference:
Heitkemper MM, Jarrett ME. Update on irritable bowel syndrome and gender differences. Nutr Clin Pract. 2008;23(3):275-83. Gwee KA. Irritable bowel syndrome in developing countries - a disorder of civilization or colonization? Neurogastroenterol Motil 2007;17(3):317-24. McOmber ME, Shulman RJ. Recurrent abdominal pain and irritable bowel syndrome in children. Curr Opin Pediatr 2007;19(5):581-5. Jarrett M, Heitkemper M, Czyzewski DI, et al. Recurrent abdominal pain in children: forerunner to adult irritable bowel syndrome? J Spec Pediatr Nurs. 2003;8(3):81-9. Thabane M, Kottachchi DT, Marshall JK. Systematic review and meta-analysis: the incidence and prognosis of post-infectious irritable bowel syndrome. Aliment Pharmacol & Ther 2007;26:535-544.
Living with IBS
Does IBS affect how intensely I should exercise?
No, a study revealed that occupations involving work in the open air and physical exercise were protective against bowel symptoms.
Reference:
Sonnenberg A. Occupational distribution of inflammatory bowel disease among German employees.Gut 1990;31:1037-1040. World Gastroenterology Organisation Practice Guidelines 2009. Irritable Bowel Syndrome – A Global Perspective. Available at www.worldgastroenterology.org/global-guidelines.html
Will IBS cause me to lose or gain weight?
There is no clinical evidence to suggest that IBS causes either weight gain or weight
Reference:
World Gastroenterology Organisation Practice Guidelines 2009. Irritable Bowel Syndrome – A Global Perspective. Available at www.worldgastroenterology.org/global-guidelines.html
Will IBS shorten my life?
No, patients with IBS have a normal life expectancy, although most individuals experience an impact of IBS on their daily lives as well as on their attitudes, fears and beliefs. However, your doctor can help you manage the condition.
Reference:
World Gastroenterology Organisation Practice Guidelines 2009. Irritable Bowel Syndrome – A Global Perspective. Available at www.worldgastroenterology.org/global-guidelines.html
Will my IBS worsen as I get older?
IBS tends to be less common in older people and there is evidence that people with IBS under the age of 50 years have a lower quality of life compared with those over the age of 50 years. This has been attributed to the older age group having a more established social network. The better quality of life could also be due to less severe
Reference:
Minocha A, Johnson WD, Abell TL, et al. Prevalence, sociodemography, and quality of life of older versus younger patients with irritable bowel syndrome: a population-based study. Dig Dis Sci. 2006;51(3):446-53.
Prognosis
Am I at risk for colorectal cancer?
No, IBS does not increase the risk for colon cancer. IBS has not been shown to be associated with the longer term development of any serious disease and there is no evidence that it is associated with higher mortality. Although many people with IBS are concerned that the condition will develop into a more worrisome disease, such as cancer, there is absolutely no evidence that this is the case
Reference:
Amouretti M, Le Pen C, Gaudin AF, et al. Impact of irritable bowel syndrome (IBS) on health-related quality of life (HRQOL). Gastroenterol Clin Biol. 2006;30(2):241-6.
Can IBS be cured?
There is no single treatment that will cure people with IBS but there are therapies that can improve IBS symptoms. Approximately 25-30% of people with IBS will get better
Reference:
El-Serag HB, Pilgim P, Schoenfeld P. Systematic review: Natural history of irritable bowel disease. Aliment Pharmacol Ther. 2004;19:861-70. Tack J, Fried M, Houghton LA, et al. Syatematic review: The efficacy of treatments for irritable bowel syndrome- a European perspective. Aliment Pharmacol Ther. 2006;24:183-205.
What are the complications of IBS?
There are no complications of IBS. The majority of people with IBS typically have symptoms which respond well to therapy and life-style changes, education and reassurances about the condition.
Reference:
Hammels CW, Surawicz CM. Updates on treatment of irritable bowel syndrome. World J Gastroenterol. 2008;14:2639-49.
What are the long-term health consequences of IBS?
Long-term follow up studies of large numbers of patients with IBS have shown that there was no difference in the long-term health of patients with IBS compared with
Reference:
Owens DM, Nelson DK, Talley NJ. The irritable bowel syndrome: long-term prognosis and the physician-patient interaction. Ann Intern Med 1995;15:107-12.
What is the prognosis, is there a chance it just goes away?
IBS is often a long-term condition, but in a proportion of people there is a complete disappearance of symptoms during a 2 year follow up period. Long-term studies of IBS patients showed that in over two-thirds of patients IBS substantially improved after 5 years. However, there are a number of factors including stress and dietary factors that can contribute to a return of the symptoms. New approaches to managing IBS may mean that people will experience less impact of the condition in the future.
Reference:
Collins AM. The irritable bowel syndrome. CMAJ. 1988;138:309-15. Harvey RF, Mauad EC, Brown AM. Prognosis in the irritable bowel syndrome. Lancet 1987;1: 963-5. El-Serag HB, Pilgim P, Schoenfeld P. Systematic review: Natural history of irritable bowel disease. Aliment Pharmacol Ther. 2004;19:861-70.
Will I eventually need surgery for my IBS?
No, there is no evidence to suggest that surgery is ever required for IBS. Few patients with long-term IBS symptoms progress to alternative diagnoses which
Reference:
El-Serag HB, Pilgim P, Schoenfeld P. Systematic review: Natural history of irritable bowel disease. Aliment Pharmacol Ther. 2004;19:861-70.
Will IBS turn into colitis?
No, the long-term outcome of patients with IBS is very good. Most patients will respond to appropriate therapies and many new therapies are being developed which could further improve the lives of patients with IBS.
Reference:
Spiller RC. Irritable bowel syndrome. Br Med Bull. 2004;72:15-29.
Symptoms
Does IBS pain move and change?
Abdominal pain is a common symptom of IBS with 86% of patients reporting pain and 46% defining their pain as severe. IBS pain has been shown to commonly move and change and can be reduced by dietary changes and reduction in stress. The use of drugs may be beneficial in the short-term to reduce intense pain.
Reference:
Collins AM. The irritable bowel syndrome. CMAJ. 1988;138:309-15.
What are the alarm symptoms that may point to an ‘organic’ cause?
The main symptoms that point to an ‘organic’ cause include; unintentional weight loss, bleeding in the stool, persistent diarrhoea, anemia and vomiting. Patients with
Reference:
Spiller RC. Irritable bowel syndrome. Br Med Bull. 2004;72:15-29.
Treatment
Can exercise help my IBS?
Yes, occupations involving work in the open air and physical exercise have been shown to offer some protective effects against bowel symptoms.
Reference:
Sonnenberg A. Occupational distribution of inflammatory bowel disease among German employees.Gut 1990;31:1037-1040
Are there medications that treat IBS?
There are several treatments available for IBS. However, as the causes of IBS are multifactorial the treatment approach is individualized to meet the specific needs of the patient. Therapy depends on the intensity of symptoms and the degree of other
Reference:
Hammels CW, Surawicz CM. Updates on treatment of irritable bowel syndrome. World J Gastroenterol. 2008;14:2639-49.
Can other types of therapy help with IBS?
In some cases, psychotherapy can help people with IBS. Two of the most common factors that exacerbate IBS or cause a relapse are anxiety and depression and obtaining counseling or psychotherapy has been shown to have a long-lasting benefit in IBS. There is a connection between the brain and the gut that is thought to contribute to the symptoms of IBS.
Reference:
Luscombe FA. Health-related quality of life and associated psychosocial factors in irritable bowel syndrome: a review. Qual Life Res 2000; 9: 161–76. Lacy BE, Weiser K, Noddin L, et al. Inflammatory bowel syndrome: Patients attitudes, concerns and level of knowledge. Aliment Pharmacol Ther. 2007;25:1329-41. Spiller RC. Irritable bowel syndrome. Br Med Bull. 2004;72:15-29.
Can vitamins help IBS?
Vitamins have not been shown to have a specific effect on IBS. However, a balanced healthy diet is good advice for anyone with digestive discomfort.
Reference:
ToriiA, Toda G. Management of irritable bowel syndrome. Intern Med. 2004;43:353-59. WGO – www.worldgastroenterology.org/global-guidelines.html
Should I practice relaxation techniques while I am sitting on the toilet?
Yes, relaxation therapy has been shown to be effective in reducing the symptoms of IBS and can be applied in all aspects of daily life.
Reference:
Spiller RC. Irritable bowel syndrome. Br Med Bull. 2004;72:15-29.
What foods should I avoid so my IBS won’t worsen?
This varies so much from person to person that it is impossible to make general rules but attention should be paid to identifying those foods that upset a given individual. There are several foods that have been implicated in IBS including high intake of sugary foods, lactose intolerance and low fibre diets but clinical trials have often been inconclusive. The WGO provides advice on a balanced healthy diet that may help control the symptoms of IBS.
Reference:
Spiller RC. Irritable bowel syndrome. Br Med Bull. 2004;72:15-29. w
How can my doctor be sure I have IBS? Shouldn't they run more tests?
If the doctor makes a diagnosis based on a good history and the application of validated criteria, it is very unlikely that the symptoms are caused by any other condition. Additional tests or examinations will not usually be necessary if your doctor follows recent guidelines developed by the World Gastroenterology Organisation (WGO).
References:
World Gastroenterology Organisation Practice Guidelines 2009. Irritable Bowel Syndrome – A Global Perspective. Available at www.worldgastroenterology.org/global-guidelines.html Paterson WG, et al. Predictive value of the Rome criteria for diagnosing the irritable bowel syndrome. Am J Gastroenterol 1999;94:2912-7.
If it’s not IBS, what else could it be?
A number of other conditions may have symptoms such as abdominal pain or discomfort, or a change in the frequency and appearance of your stool that are similar to IBS. However, your doctor will base his/her clinical assessment on a
Reference:
World Gastroenterology Organisation Practice Guidelines 2009. Irritable Bowel Syndrome – A Global Perspective. Available at www.worldgastroenterology.org/global-guidelines.html
Is it a common disease in the world?
Yes, IBS is surprisingly common throughout the world and appears to be becoming more common. In developed countries it may affect up to 1 in 5 adults – an average figure based on a number of surveys is approximately 1 in 10 people (11%).
Reference:
McFarland LV. State-of-the-art of irritable bowel syndrome and inflammatory bowel disease research in 2008. World J Gastroenterol. 2008;14(17):2625-9. Hungin APS, Whorwell PJ, Tack J, Mearin F. The prevalence, patterns and impact of irritable bowel syndrome: an international survey of 40 000 subjects. Aliment Pharmacol Ther. 2003; 17(5):643-50.
Is diet a causative factor?
Diet is not the cause of IBS but there is evidence that dietary factors may exacerbate symptoms. The prevalence of IBS has increased in countries which have introduced Western style diets and these diets often contain more refined foods and additives. The impact of diet and other factors on the bacterial gut flora may play a role in the
Reference:
Alpers DH. Diet and Irritable Bowel Syndrome. Curr Opin Gastroenterol. 2006;22(2):136-139. Dapoigny M, Stockbrugger RW, Azpiroz F, et al. Role of alimentation in irritable bowel syndrome. Digestion. 2003;67(4):225-33.
Is there a relationship between IBS and food allergies?
No, there is no evidence suggesting food allergies cause IBS. However, people often believe that food allergies exacerbate their IBS symptoms - food allergy testing or exclusion diets have not been shown to affect IBS symptoms so their routine use is not recommended. It is more important to adopt a healthy balanced diet, as advocated by the WGO.
Reference:
Brandt LJ, Chey D, Foxx-Orenstein AE et al. An evidence-based systematic review on the management of Irritable Bowel Syndrome. American College of Gastroenterology Task Force. American Journal of Gastroenterology. Vol 104. Supplement. 2009. World Gastroenterology Organisation Practice Guidelines 2009. Irritable Bowel Syndrome – A Global Perspective. Available at www.worldgastroenterology.org/global-guidelines.html
What is irritable bowel syndrome?
IBS is one of the most common digestive disorders, affecting a significant proportion of the world’s population. Typically, people with IBS experience symptoms which include abdominal pain, bloating, constipation and/or diarrhoea. The symptoms are often chronic (long-term) and recurrent (episodic). IBS is a condition that is taken seriously because it has a significant impact of people’s ability to work productively or
Reference:
Spiller R, Aziz Q, Creed F, et al. Guidelines on the irritable bowel syndrome: mechanisms and practical management. Gut. 2007;56(12):1770-98 McFarland LV. State-of-the-art of irritable bowel syndrome and inflammatory bowel disease research in 2008. World J Gastroenterol. 2008;14(17):2625-9. Hungin APS, Whorwell PJ, Tack J, Mearin F. The prevalence, patterns and impact of irritable bowel syndrome: an international survey of 40 000 subjects. Aliment Pharmacol Ther. 2003; 17(5):643-50.
What are the risk factors for IBS?
There is a strong association between intestinal infection and IBS and the risk substantially increases (6-fold) after an acute gastrointestinal infection – this is one reason why probiotics are being investigated for managing IBS symptoms. Women have a 2-3 fold higher prevalence of IBS than men and recurrent abdominal pain as a child is a risk factor for IBS as an adult. A Western style diet may also be a risk factor as there is an increased prevalence of IBS in countries that adopt Western cuisine. Stress is also a risk factor for IBS.
Reference:
Heitkemper MM, Jarrett ME. Update on irritable bowel syndrome and gender differences. Nutr Clin Pract. 2008;23(3):275-83. Gwee KA. Irritable bowel syndrome in developing countries - a disorder of civilization or colonization? Neurogastroenterol Motil 2007;17(3):317-24. McOmber ME, Shulman RJ. Recurrent abdominal pain and irritable bowel syndrome in children. Curr Opin Pediatr 2007;19(5):581-5. Jarrett M, Heitkemper M, Czyzewski DI, et al. Recurrent abdominal pain in children: forerunner to adult irritable bowel syndrome? J Spec Pediatr Nurs. 2003;8(3):81-9. Thabane M, Kottachchi DT, Marshall JK. Systematic review and meta-analysis: the incidence and prognosis of post-infectious irritable bowel syndrome. Aliment Pharmacol & Ther 2007;26:535-544.
Living with IBS
Does IBS affect how intensely I should exercise?
No, a study revealed that occupations involving work in the open air and physical exercise were protective against bowel symptoms.
Reference:
Sonnenberg A. Occupational distribution of inflammatory bowel disease among German employees.Gut 1990;31:1037-1040. World Gastroenterology Organisation Practice Guidelines 2009. Irritable Bowel Syndrome – A Global Perspective. Available at www.worldgastroenterology.org/global-guidelines.html
Will IBS cause me to lose or gain weight?
There is no clinical evidence to suggest that IBS causes either weight gain or weight
Reference:
World Gastroenterology Organisation Practice Guidelines 2009. Irritable Bowel Syndrome – A Global Perspective. Available at www.worldgastroenterology.org/global-guidelines.html
Will IBS shorten my life?
No, patients with IBS have a normal life expectancy, although most individuals experience an impact of IBS on their daily lives as well as on their attitudes, fears and beliefs. However, your doctor can help you manage the condition.
Reference:
World Gastroenterology Organisation Practice Guidelines 2009. Irritable Bowel Syndrome – A Global Perspective. Available at www.worldgastroenterology.org/global-guidelines.html
Will my IBS worsen as I get older?
IBS tends to be less common in older people and there is evidence that people with IBS under the age of 50 years have a lower quality of life compared with those over the age of 50 years. This has been attributed to the older age group having a more established social network. The better quality of life could also be due to less severe
Reference:
Minocha A, Johnson WD, Abell TL, et al. Prevalence, sociodemography, and quality of life of older versus younger patients with irritable bowel syndrome: a population-based study. Dig Dis Sci. 2006;51(3):446-53.
Prognosis
Am I at risk for colorectal cancer?
No, IBS does not increase the risk for colon cancer. IBS has not been shown to be associated with the longer term development of any serious disease and there is no evidence that it is associated with higher mortality. Although many people with IBS are concerned that the condition will develop into a more worrisome disease, such as cancer, there is absolutely no evidence that this is the case
Reference:
Amouretti M, Le Pen C, Gaudin AF, et al. Impact of irritable bowel syndrome (IBS) on health-related quality of life (HRQOL). Gastroenterol Clin Biol. 2006;30(2):241-6.
Can IBS be cured?
There is no single treatment that will cure people with IBS but there are therapies that can improve IBS symptoms. Approximately 25-30% of people with IBS will get better
Reference:
El-Serag HB, Pilgim P, Schoenfeld P. Systematic review: Natural history of irritable bowel disease. Aliment Pharmacol Ther. 2004;19:861-70. Tack J, Fried M, Houghton LA, et al. Syatematic review: The efficacy of treatments for irritable bowel syndrome- a European perspective. Aliment Pharmacol Ther. 2006;24:183-205.
What are the complications of IBS?
There are no complications of IBS. The majority of people with IBS typically have symptoms which respond well to therapy and life-style changes, education and reassurances about the condition.
Reference:
Hammels CW, Surawicz CM. Updates on treatment of irritable bowel syndrome. World J Gastroenterol. 2008;14:2639-49.
What are the long-term health consequences of IBS?
Long-term follow up studies of large numbers of patients with IBS have shown that there was no difference in the long-term health of patients with IBS compared with
Reference:
Owens DM, Nelson DK, Talley NJ. The irritable bowel syndrome: long-term prognosis and the physician-patient interaction. Ann Intern Med 1995;15:107-12.
What is the prognosis, is there a chance it just goes away?
IBS is often a long-term condition, but in a proportion of people there is a complete disappearance of symptoms during a 2 year follow up period. Long-term studies of IBS patients showed that in over two-thirds of patients IBS substantially improved after 5 years. However, there are a number of factors including stress and dietary factors that can contribute to a return of the symptoms. New approaches to managing IBS may mean that people will experience less impact of the condition in the future.
Reference:
Collins AM. The irritable bowel syndrome. CMAJ. 1988;138:309-15. Harvey RF, Mauad EC, Brown AM. Prognosis in the irritable bowel syndrome. Lancet 1987;1: 963-5. El-Serag HB, Pilgim P, Schoenfeld P. Systematic review: Natural history of irritable bowel disease. Aliment Pharmacol Ther. 2004;19:861-70.
Will I eventually need surgery for my IBS?
No, there is no evidence to suggest that surgery is ever required for IBS. Few patients with long-term IBS symptoms progress to alternative diagnoses which
Reference:
El-Serag HB, Pilgim P, Schoenfeld P. Systematic review: Natural history of irritable bowel disease. Aliment Pharmacol Ther. 2004;19:861-70.
Will IBS turn into colitis?
No, the long-term outcome of patients with IBS is very good. Most patients will respond to appropriate therapies and many new therapies are being developed which could further improve the lives of patients with IBS.
Reference:
Spiller RC. Irritable bowel syndrome. Br Med Bull. 2004;72:15-29.
Symptoms
Does IBS pain move and change?
Abdominal pain is a common symptom of IBS with 86% of patients reporting pain and 46% defining their pain as severe. IBS pain has been shown to commonly move and change and can be reduced by dietary changes and reduction in stress. The use of drugs may be beneficial in the short-term to reduce intense pain.
Reference:
Collins AM. The irritable bowel syndrome. CMAJ. 1988;138:309-15.
What are the alarm symptoms that may point to an ‘organic’ cause?
The main symptoms that point to an ‘organic’ cause include; unintentional weight loss, bleeding in the stool, persistent diarrhoea, anemia and vomiting. Patients with
Reference:
Spiller RC. Irritable bowel syndrome. Br Med Bull. 2004;72:15-29.
Treatment
Can exercise help my IBS?
Yes, occupations involving work in the open air and physical exercise have been shown to offer some protective effects against bowel symptoms.
Reference:
Sonnenberg A. Occupational distribution of inflammatory bowel disease among German employees.Gut 1990;31:1037-1040
Are there medications that treat IBS?
There are several treatments available for IBS. However, as the causes of IBS are multifactorial the treatment approach is individualized to meet the specific needs of the patient. Therapy depends on the intensity of symptoms and the degree of other
Reference:
Hammels CW, Surawicz CM. Updates on treatment of irritable bowel syndrome. World J Gastroenterol. 2008;14:2639-49.
Can other types of therapy help with IBS?
In some cases, psychotherapy can help people with IBS. Two of the most common factors that exacerbate IBS or cause a relapse are anxiety and depression and obtaining counseling or psychotherapy has been shown to have a long-lasting benefit in IBS. There is a connection between the brain and the gut that is thought to contribute to the symptoms of IBS.
Reference:
Luscombe FA. Health-related quality of life and associated psychosocial factors in irritable bowel syndrome: a review. Qual Life Res 2000; 9: 161–76. Lacy BE, Weiser K, Noddin L, et al. Inflammatory bowel syndrome: Patients attitudes, concerns and level of knowledge. Aliment Pharmacol Ther. 2007;25:1329-41. Spiller RC. Irritable bowel syndrome. Br Med Bull. 2004;72:15-29.
Can vitamins help IBS?
Vitamins have not been shown to have a specific effect on IBS. However, a balanced healthy diet is good advice for anyone with digestive discomfort.
Reference:
ToriiA, Toda G. Management of irritable bowel syndrome. Intern Med. 2004;43:353-59. WGO – www.worldgastroenterology.org/global-guidelines.html
Should I practice relaxation techniques while I am sitting on the toilet?
Yes, relaxation therapy has been shown to be effective in reducing the symptoms of IBS and can be applied in all aspects of daily life.
Reference:
Spiller RC. Irritable bowel syndrome. Br Med Bull. 2004;72:15-29.
What foods should I avoid so my IBS won’t worsen?
This varies so much from person to person that it is impossible to make general rules but attention should be paid to identifying those foods that upset a given individual. There are several foods that have been implicated in IBS including high intake of sugary foods, lactose intolerance and low fibre diets but clinical trials have often been inconclusive. The WGO provides advice on a balanced healthy diet that may help control the symptoms of IBS.
Reference:
Spiller RC. Irritable bowel syndrome. Br Med Bull. 2004;72:15-29. w
Probiotics and Prebiotics
What are probiotics?
Probiotics are live microbes that can be formulated into many different types of products, including foods, drugs, and dietary supplements. Species of Lactobacillus and Bifidobacterium are most commonly used as probiotics, but the yeast Saccharomyces cerevisiae and some E. coli and Bacillus species are also used as probiotics. Lactic acid bacteria (LAB), including species of Lactobacillus, which have been used for preservation of food by fermentation for thousands of years, can serve a dual function by acting as agents of food fermentation and, in addition, potentially imparting health benefits. Strictly speaking, however, the term "probiotic" should be reserved for live microbes that have been shown in controlled human studies to impart a health benefit. Fermentation of food provides characteristic taste profiles and lowers the pH, which prevents contamination by potential pathogens. Fermentation is globally applied in the preservation of a range of raw agricultural materials (cereals, roots, tubers, fruit and vegetables, milk, meat, fish etc.).
References:
World Gastroenterology Organisation Practice Guidelines 2009.
Probiotics are live microbes that can be formulated into many different types of products, including foods, drugs, and dietary supplements. Species of Lactobacillus and Bifidobacterium are most commonly used as probiotics, but the yeast Saccharomyces cerevisiae and some E. coli and Bacillus species are also used as probiotics. Lactic acid bacteria (LAB), including species of Lactobacillus, which have been used for preservation of food by fermentation for thousands of years, can serve a dual function by acting as agents of food fermentation and, in addition, potentially imparting health benefits. Strictly speaking, however, the term "probiotic" should be reserved for live microbes that have been shown in controlled human studies to impart a health benefit. Fermentation of food provides characteristic taste profiles and lowers the pH, which prevents contamination by potential pathogens. Fermentation is globally applied in the preservation of a range of raw agricultural materials (cereals, roots, tubers, fruit and vegetables, milk, meat, fish etc.).
References:
World Gastroenterology Organisation Practice Guidelines 2009.
Monday, March 16, 2009
CAPSULE ENDOSCOPY IN INDIA
Endoscopy is one of the most fascinating and fast growing fields of medicine which enables accurate detection and treatment of alimentary or digestive tract diseases. Over the last several years, this discipline has advanced enormously and this has resulted in a boon for patients who are able to get non-surgical treatment in case of alimentary tract pathological conditions that not long ago used to be within the domain of surgery.
Modern diagnostics of the alimentary tract takes advantage of the most modern endoscopic visualization techniques. These include high-resolution endoscopy, magnifying or zoom endoscopy, double balloon enteroscopy, capsule endoscopy, chromoendoscopy, fluorescein endoscopy, narrow band imaging, endosonography and other radiological techniques such as virtual colonoscopy.
One of the major advancements that helps patients is Capsule Endoscopy. In this, a miniature capsule is used to record images through the digestive tract for use in the diagnosis of digestive disorders. The capsule, also known as a capsule camera, is the size and shape of a large vitamin pill used to visualize the gastrointestinal tract. The capsule includes a miniature color video silicon chip camera, a light, a battery and a transmitter. The images captured by the video camera are transmitted to sensors attached to the patient's body and recorded digitally on a device similar to a walkman that is worn around the patient's waist.
Capsule endoscopy is not a substitute for regular endoscopy. It serves as an additional diagnostic tool for patients who have been suffering from unexplained GI disorders especially of the small bowel. Capsule endoscopy is helpful in cases of unexplained GI bleeding, suspected small bowel obstruction, Crohn's disease or tumours or unexplained chronic diarrhoea or pain abdomen. The limitations include high cost (around Rs.20,000 per capsule), limited availability, inability to have therapeutic potential and small but definite chance of capsule retention in a patient of suspected bowel obstruction.
Another new helpful technique is Videoenteroscopy - a new endoscopic visualization of the small intestine. A typical double balloon enteroscope is composed of a 200-cm long endoscope, 145-cm long semielastic external tube and two latex balloons to better fix the endoscope inside the small intestine and for easier penetration. The technique is effective in up to 86 per cent cases and so far there have been few complications described. In addition to diagnostic possibilities, enteroscopy allows biopsy and endoscopic therapy, where it scores over capsule endoscopy. Considerably long time of the examination, sedation and use of fluoroscopy may pose some limitations to the procedure.
The good news for patients is that in the new endoscopic area, we have invented better endoscopes that can go farther and deeper and at that the same time with miniature pill cameras, we can explore uncertainties of human intestine with great certainty. This has led to better understanding, diagnosis and treatment of many digestive disorders considered uncommon or difficult to treat.
Modern diagnostics of the alimentary tract takes advantage of the most modern endoscopic visualization techniques. These include high-resolution endoscopy, magnifying or zoom endoscopy, double balloon enteroscopy, capsule endoscopy, chromoendoscopy, fluorescein endoscopy, narrow band imaging, endosonography and other radiological techniques such as virtual colonoscopy.
One of the major advancements that helps patients is Capsule Endoscopy. In this, a miniature capsule is used to record images through the digestive tract for use in the diagnosis of digestive disorders. The capsule, also known as a capsule camera, is the size and shape of a large vitamin pill used to visualize the gastrointestinal tract. The capsule includes a miniature color video silicon chip camera, a light, a battery and a transmitter. The images captured by the video camera are transmitted to sensors attached to the patient's body and recorded digitally on a device similar to a walkman that is worn around the patient's waist.
Capsule endoscopy is not a substitute for regular endoscopy. It serves as an additional diagnostic tool for patients who have been suffering from unexplained GI disorders especially of the small bowel. Capsule endoscopy is helpful in cases of unexplained GI bleeding, suspected small bowel obstruction, Crohn's disease or tumours or unexplained chronic diarrhoea or pain abdomen. The limitations include high cost (around Rs.20,000 per capsule), limited availability, inability to have therapeutic potential and small but definite chance of capsule retention in a patient of suspected bowel obstruction.
Another new helpful technique is Videoenteroscopy - a new endoscopic visualization of the small intestine. A typical double balloon enteroscope is composed of a 200-cm long endoscope, 145-cm long semielastic external tube and two latex balloons to better fix the endoscope inside the small intestine and for easier penetration. The technique is effective in up to 86 per cent cases and so far there have been few complications described. In addition to diagnostic possibilities, enteroscopy allows biopsy and endoscopic therapy, where it scores over capsule endoscopy. Considerably long time of the examination, sedation and use of fluoroscopy may pose some limitations to the procedure.
The good news for patients is that in the new endoscopic area, we have invented better endoscopes that can go farther and deeper and at that the same time with miniature pill cameras, we can explore uncertainties of human intestine with great certainty. This has led to better understanding, diagnosis and treatment of many digestive disorders considered uncommon or difficult to treat.
UNIQUE LIVER TRANSPLANTS
New Delhi, February 20: 22-month old boy Shourya and two-year old girl Siya Thakur have got a fresh lease of life, thanks to the ‘domino liver transplant’. Two of them are perhaps the world’s youngest patients to have had such an operation.
A team of 20 specialists from Sir Ganga Ram Hospital, New Delhi, successfully performed the domino liver transplant that entails sequential surgery, on January 31. The procedure went on for about 16 hours.
The transplant that made use of 20 percent of his aunt’s liver, has healed Shourya who was suffering from Maple Syrup Urine Disease (MSUD).
Meanwhile, his own liver was transplanted to 2-year old Siya, who was struggling for life due to an uncommon liver failure condition called Langerhans’s cell histiocytosis (LCH).
Numerous chemotherapy sessions however helped Siya in checking LCH; the process damaged her liver to such an extent that a transplant was the only solution left.
According to doctors, Shourya is the first patient in India and youngest in the world to receive a living donor liver transplant for curing MSUD. And Siya, she is the youngest in the world to get a domino liver transplant.
The operation was conducted upon Shourya, his aunt Mukta and Siya in three distinct theatres. Initially, the donor liver was removed followed by removal of Shourya’s liver. Thus, the boy got his aunt’s liver, and his liver in turn was transplanted into Siya.
Dr. AS Soin, director of liver transplantation at Ganga Ram Hospital, and the chief surgeon involved in the transplants, remarked, “Domino transplants are rare because there are very few conditions in which you can cure the patient with a transplant and then transplant his or her organ into someone else without passing on the disease.”
MSUD is the outcome of the deficiency of an enzyme in the body. A liver transplant can enable the patient to tide over its shortfall in other body parts by making sufficient amount of the enzyme in the new organ.
A patient suffering from MSUD has an otherwise normal liver that can be transplanted into somebody else without the risk of communicating the disease.
MSUD is characterized by vomiting, poor feeding, weight loss, convulsions and finally results in coma. High acid levels in the urine cause it to smell like burnt sugar- the reason why it is named Maple Syrup Urine Disease.
SOURCE:-
http://www.themedguru.com/articles/unique_liver_transplant_gives_fresh_life_to_kids-86120738.html
DOMINO LIVER TRANSPLANT
It was like a game of passing the parcel. Only, the parcel was a precious life-saver.
Doctors at New Delhi's Sir Ganga Ram Hospital performed a rare 'domino liver transplant' on two children, believed to be the world's youngest patients to undergo such an operation.
Domino liver transplant involves sequential surgery. About 20 specialists performed the surgery on 22-month-old boy Shourya Verma and two-year-old girl Siya Thakur on January 31. The operation lasted 16 hours.
Shourya has been cured of maple syrup urine disease (MSUD) through the transplant that used 20% of his aunt's liver; his own liver was given to Siya, who was battling liver failure owing to a rare condition called Langerhans's cell histiocytosis (LCH).
Siya had many sessions of chemotherapy to contain LCH, and though her disease went into remission her liver was irreversibly damaged, making a transplant the only option.
Doctors at the hospital claimed that Shourya is India's first and the world's youngest recipient of a living donor liver transplant for MSUD, while Siya is the world's youngest recipient of a domino liver transplant.
For the surgery, Shourya's aunt Mukta, Shourya, and Siya were operated upon in three different theatres. First the donor liver and then Shourya's liver were removed. Shourya got a transplant; then his liver was transplanted into Siya.
SOURCE:::---
http://www.dnaindia.com/report.asp?newsid=1232560
"Domino transplants are rare because there are very few conditions in which you can cure the patient with a transplant and then transplant his or her organ into someone else without passing on the disease," said Dr AS Soin, the chief surgeon who conducted the transplants and director of liver transplantation at Ganga Ram Hospital.
MSUD is caused by the lack of an enzyme in the body. Once the patient gets a liver transplant, he is able to make enough of the enzyme in the new organ to overcome the shortfall elsewhere in the body.
In turn, an MSUD patient's liver, which is otherwise normal, can be transplanted into someone else without passing on the disease as other cells in the patient can make the enzyme lacking in the liver.
Shourya was born with MSUD. The disease causes vomiting, poor feeding, weight loss, and convulsions and ultimately leads to coma. High levels of acids in the urine give it the smell of burnt sugar; hence the name Maple Syrup.
With his survival at stake, Shourya's parents moved to the US where they put him on an MSUD diet. But they realised it would severely cramp his life as he grew up, besides making it difficult for them to return to India.
"This made the family go ahead with the transplant," said Dr Neelam Mohan, chief paediatric hepatologist at the hospital. "Now, for the first time in his life, Shourya can eat like any other child."
Doctors at New Delhi's Sir Ganga Ram Hospital performed a rare 'domino liver transplant' on two children, believed to be the world's youngest patients to undergo such an operation.
Domino liver transplant involves sequential surgery. About 20 specialists performed the surgery on 22-month-old boy Shourya Verma and two-year-old girl Siya Thakur on January 31. The operation lasted 16 hours.
Shourya has been cured of maple syrup urine disease (MSUD) through the transplant that used 20% of his aunt's liver; his own liver was given to Siya, who was battling liver failure owing to a rare condition called Langerhans's cell histiocytosis (LCH).
Siya had many sessions of chemotherapy to contain LCH, and though her disease went into remission her liver was irreversibly damaged, making a transplant the only option.
Doctors at the hospital claimed that Shourya is India's first and the world's youngest recipient of a living donor liver transplant for MSUD, while Siya is the world's youngest recipient of a domino liver transplant.
For the surgery, Shourya's aunt Mukta, Shourya, and Siya were operated upon in three different theatres. First the donor liver and then Shourya's liver were removed. Shourya got a transplant; then his liver was transplanted into Siya.
SOURCE:::---
http://www.dnaindia.com/report.asp?newsid=1232560
"Domino transplants are rare because there are very few conditions in which you can cure the patient with a transplant and then transplant his or her organ into someone else without passing on the disease," said Dr AS Soin, the chief surgeon who conducted the transplants and director of liver transplantation at Ganga Ram Hospital.
MSUD is caused by the lack of an enzyme in the body. Once the patient gets a liver transplant, he is able to make enough of the enzyme in the new organ to overcome the shortfall elsewhere in the body.
In turn, an MSUD patient's liver, which is otherwise normal, can be transplanted into someone else without passing on the disease as other cells in the patient can make the enzyme lacking in the liver.
Shourya was born with MSUD. The disease causes vomiting, poor feeding, weight loss, and convulsions and ultimately leads to coma. High levels of acids in the urine give it the smell of burnt sugar; hence the name Maple Syrup.
With his survival at stake, Shourya's parents moved to the US where they put him on an MSUD diet. But they realised it would severely cramp his life as he grew up, besides making it difficult for them to return to India.
"This made the family go ahead with the transplant," said Dr Neelam Mohan, chief paediatric hepatologist at the hospital. "Now, for the first time in his life, Shourya can eat like any other child."
LIVER TRANSLANT ON 11TH MONTHS OLD CHILD
Doctors at Sir Ganga Ram Hospital (SGRH), New Delhi have once again created history in the field of liver transplantation in India. After an 8-year-old child Arif Mischaal was saved by being airlifted and performing emergency liver transplantation a year back, another child, 11-month-old Siddharth became India's youngest liver transplant recipient. Siddharth's aunt Saroja has donated the left lateral part of her liver to Siddharth. The transplant was performed by a team of surgeons led by Head of Liver Transplant, Dr AS Soin on 15th February, this year.
Siddharth, a resident of Chennai, developed jaundice at two days of life. "However, it was only at the age of five months that he was diagnosed to have biliary atresia, a condition in which the bile ducts of the liver (responsible for draining the bile produced in the liver into the intestinal tract for digestion) are absent. The bile is trapped within the liver cells rapidly causing damage, scarring up and cirrhosis ultimately resulting in liver failure and death," informed Dr Soin.
He underwent an operation in Chennai at the age of five months attempting to correct it, but at the time of surgery his liver was already diagnosed to be cirrhotic. Doctors in Chennai informed them that the only chance for his survival was a liver transplant. Thus, the child landed at SGRH.
Dr Neelam Mohan, Consultant Paediatric Haepatologist and Physician Incharge Paediatric Liver Transplantation said that the child was in a very sick condition with severe infection. "We had to toil for a few weeks and high level of intensive medical and nutritional care was necessary to get him to shape for the surgeons to do the surgery. The child's liver's main blood supply was irreparably blocked due to the late stage of his disease. A graft was used between the donor's liver and the patient's portal vein," she added.
The post operative period was relatively smooth except a mild infection which would be well tackled, added Dr Mohan. Siddharth was discharged after three weeks.
Last year, the hospital claims to have performed over 90 liver transplants and have completed over 235 liver transplants with over 90 per cent success rate.
Siddharth, a resident of Chennai, developed jaundice at two days of life. "However, it was only at the age of five months that he was diagnosed to have biliary atresia, a condition in which the bile ducts of the liver (responsible for draining the bile produced in the liver into the intestinal tract for digestion) are absent. The bile is trapped within the liver cells rapidly causing damage, scarring up and cirrhosis ultimately resulting in liver failure and death," informed Dr Soin.
He underwent an operation in Chennai at the age of five months attempting to correct it, but at the time of surgery his liver was already diagnosed to be cirrhotic. Doctors in Chennai informed them that the only chance for his survival was a liver transplant. Thus, the child landed at SGRH.
Dr Neelam Mohan, Consultant Paediatric Haepatologist and Physician Incharge Paediatric Liver Transplantation said that the child was in a very sick condition with severe infection. "We had to toil for a few weeks and high level of intensive medical and nutritional care was necessary to get him to shape for the surgeons to do the surgery. The child's liver's main blood supply was irreparably blocked due to the late stage of his disease. A graft was used between the donor's liver and the patient's portal vein," she added.
The post operative period was relatively smooth except a mild infection which would be well tackled, added Dr Mohan. Siddharth was discharged after three weeks.
Last year, the hospital claims to have performed over 90 liver transplants and have completed over 235 liver transplants with over 90 per cent success rate.
LIVER RE-TRANSPLANT IN INDIA
A terminally ill lawyer has been brought back from the jaws of death, thanks to two rare gifts by his sons. Each son donated half a
liver to the man in what is claimed to be the country's first successful re-transplant using living donor liver.
Fifty-four-year-old Suman Kapoor is now back to normal life after doctors at the capital's Gangaram Hospital conducted a second liver transplant on him, a year and a half after the first.
Kapoor's woes began in 2006, when he was diagnosed with cryptogenic cirrhosis (cirrhosis due to unidentified causes) and needed an immediate liver transplant. His younger son, 20-year-old Kanv, then donated the right half of his liver to save his father.
Though Kapoor made steady progress after the surgery, ill fate struck once again. His liver failed in December 2007 after getting infected with hepatitis E.
And this time, it was his elder son, Aayush, who immediately came forward as donor.
Dr A S Soin, head of liver transplantation at Gangaram, told TOI, "The re-transplant was conducted on January 9 and both Kapoor and Aayush did well after the 15-hour surgery. Today, all the three male members of the family are hale and hearty and have returned to normal life."
He added, "There is only 10% possibility that a transplanted liver would fail twice due to new infections. When Kapoor returned to the ICU fighting for his life in January 2008, I felt that the only option was a re-transplant, which had never been successfully done in India before. So, I sought opinions from my colleagues at two of the world's best transplant centres — UPMC, Pittsburgh, and King's College, London. They also agreed that a re-transplant was the only option."
SOURCE:
http://timesofindia.indiatimes.com/Sons_donate_half_a_liver_each_to_dad/articleshow/2886180.cms
liver to the man in what is claimed to be the country's first successful re-transplant using living donor liver.
Fifty-four-year-old Suman Kapoor is now back to normal life after doctors at the capital's Gangaram Hospital conducted a second liver transplant on him, a year and a half after the first.
Kapoor's woes began in 2006, when he was diagnosed with cryptogenic cirrhosis (cirrhosis due to unidentified causes) and needed an immediate liver transplant. His younger son, 20-year-old Kanv, then donated the right half of his liver to save his father.
Though Kapoor made steady progress after the surgery, ill fate struck once again. His liver failed in December 2007 after getting infected with hepatitis E.
And this time, it was his elder son, Aayush, who immediately came forward as donor.
Dr A S Soin, head of liver transplantation at Gangaram, told TOI, "The re-transplant was conducted on January 9 and both Kapoor and Aayush did well after the 15-hour surgery. Today, all the three male members of the family are hale and hearty and have returned to normal life."
He added, "There is only 10% possibility that a transplanted liver would fail twice due to new infections. When Kapoor returned to the ICU fighting for his life in January 2008, I felt that the only option was a re-transplant, which had never been successfully done in India before. So, I sought opinions from my colleagues at two of the world's best transplant centres — UPMC, Pittsburgh, and King's College, London. They also agreed that a re-transplant was the only option."
SOURCE:
http://timesofindia.indiatimes.com/Sons_donate_half_a_liver_each_to_dad/articleshow/2886180.cms
APOLLO LIVER SURGERY UNIT
Apollo Liver Surgery Unit (ALSU)
deals with complex gastrointestinal surgery. Surgical Gastroenterology was coming in to its own in various teaching hospitals all over India in the late eighties. The first to be established in North India was the Unit of Gastrointestinal Surgery in All India Institute of Medical Sciences under Professor S. Nundy in 1985. This unit has its roots from this institution.
This unit now has an outstanding reputation for all aspects of liver surgery. Complex liver resection can be carried with a mortality and morbidity comparable to the best centers in the world. There is also can an active interventional radiology setup that deals with chemoembolization, radiofrequency ablation and percutaneous alcohol injection into tumour tissue.
This centre is very active in liver transplantation and is equipped for both cadaveric and living related transplant. It has to its credit first successful reduced liver transplant from an adult cadaveric liver to a paediatric recipient.
Pancreatic surgery is also carried out in great numbers and possibly we have one of the largest series of pancreaticoduodenectomy operation for cancers of the periampullary region. The unit has treated patients from all over India as well as patients from Middle East, Africa and South East Asia. Apart from malignancies this unit has considerable skills in dealing with surgical management of all aspects of pancreatitis. Its faculty consists of nationally and internationally known consultants.
This unit has a reputation for shunt surgery for patients who have bled from varices. In situations where the liver is not diseased, then shunt surgery is quite an appropriate form of treatment. Often because of blockage of hepatic veins mesocaval shunts can reverse the damage to liver.
This unit is a referral centre for patients who have been operated elsewhere and has developed a complication. One such common condition is intestinal fistula and these have been managed very successfully here. A paper from our unit was awarded the best paper in one of the recent Indian Society of Gastroenterology meetings. The unit has a very active Stoma Clinic, which deals with wound care in intestinal fistulae.
Colorectal cancer is another active area of our unit and there is a major emphasis on sphincter saving surgery either using staplers or by intersphincteric resection. Ulcerative colitis generally can be treated by medicine but surgery has a major role in certain situation. The entire diseased colon is removed and the end of small intestine folded on itself and joined to create a pouch, which is then joined to the anus so that the patient can pass stool normally.
The unit has skilled consultants who are backed by a huge team of experienced registrars, theatre personnel and equipment such as ultrasonic aspirator, argon beam coagulator and thromboelastograph which all helps in conducting major surgery.
The Unit of Surgical Gastroenterology and Liver transplantation has a proven track record of dealing with complex gastrointestinal cases and is at the forefront of clinical medicine and liver surgery in India.
http://transplantliverindia.com/
deals with complex gastrointestinal surgery. Surgical Gastroenterology was coming in to its own in various teaching hospitals all over India in the late eighties. The first to be established in North India was the Unit of Gastrointestinal Surgery in All India Institute of Medical Sciences under Professor S. Nundy in 1985. This unit has its roots from this institution.
This unit now has an outstanding reputation for all aspects of liver surgery. Complex liver resection can be carried with a mortality and morbidity comparable to the best centers in the world. There is also can an active interventional radiology setup that deals with chemoembolization, radiofrequency ablation and percutaneous alcohol injection into tumour tissue.
This centre is very active in liver transplantation and is equipped for both cadaveric and living related transplant. It has to its credit first successful reduced liver transplant from an adult cadaveric liver to a paediatric recipient.
Pancreatic surgery is also carried out in great numbers and possibly we have one of the largest series of pancreaticoduodenectomy operation for cancers of the periampullary region. The unit has treated patients from all over India as well as patients from Middle East, Africa and South East Asia. Apart from malignancies this unit has considerable skills in dealing with surgical management of all aspects of pancreatitis. Its faculty consists of nationally and internationally known consultants.
This unit has a reputation for shunt surgery for patients who have bled from varices. In situations where the liver is not diseased, then shunt surgery is quite an appropriate form of treatment. Often because of blockage of hepatic veins mesocaval shunts can reverse the damage to liver.
This unit is a referral centre for patients who have been operated elsewhere and has developed a complication. One such common condition is intestinal fistula and these have been managed very successfully here. A paper from our unit was awarded the best paper in one of the recent Indian Society of Gastroenterology meetings. The unit has a very active Stoma Clinic, which deals with wound care in intestinal fistulae.
Colorectal cancer is another active area of our unit and there is a major emphasis on sphincter saving surgery either using staplers or by intersphincteric resection. Ulcerative colitis generally can be treated by medicine but surgery has a major role in certain situation. The entire diseased colon is removed and the end of small intestine folded on itself and joined to create a pouch, which is then joined to the anus so that the patient can pass stool normally.
The unit has skilled consultants who are backed by a huge team of experienced registrars, theatre personnel and equipment such as ultrasonic aspirator, argon beam coagulator and thromboelastograph which all helps in conducting major surgery.
The Unit of Surgical Gastroenterology and Liver transplantation has a proven track record of dealing with complex gastrointestinal cases and is at the forefront of clinical medicine and liver surgery in India.
http://transplantliverindia.com/
Thursday, March 12, 2009
PROBIOTICS : NEXT BIG THING
What are probiotics?
Probiotics are live microorganisms (small single-celled bacteria) that are similar to the beneficial microorganisms found in the human gut. According to the currently adopted definition by FAO / WHO, probiotics are: ‘Live microorganisms which when administered in adequate amounts confer a health benefit on the host’. Popularly known as friendly or good bacteria, these bacteria are said to be beneficial for the body. Theoretically, bacteria are categorised by genus, species and strain names. Most probiotic foods contain bacteria of the species like Lactobacillius and Bifidobacterium. These are said to benefit the host by improving the balance of the intestinal microflora, upon ingestion. They also secrete enzymes that aid in digestion and enhance the workings of immune-system cells in the digestive tract. It is said that consuming probiotics helps maintain a healthy balance of good bacteria in the digestive tract. Probiotics can have immunomodulatory and anticarcinogenic effects as well. Often, nutritionists recommend them after a course of antibiotics or as part of the treatment for gut related candidiasis.
How do probiotics work?
Human body contains miniature ecology of microbes, collectively known as the gut flora. Most of these bacteria are harmless and are said to contribute to our growth and health. It is important that the balance of microbes is maintained to promote the beneficial bacteria over the potentially harmful ones. Due to the use of antibiotics, excess alcohol, stress, or exposure to toxic substances, a number of these bacterial types can get thrown out of balance. In such cases, the bacteria that suit our body can decrease, allowing the harmful ones to thrive and pose a threat to our health. This can be prevented by improving the quality of our food intake. By including foods rich in probiotics, we can maintain a healthy gut flora and thereby, avoid potential health problems.
What are the benefits of probiotics?
Probiotics have a lot of benefits for our health. At times, the balance between the good and the bad bacteria can get haywire due to the use of antibiotics and other toxic substances. Foods rich in probiotics can offset their side effects and also prevent further infections. They can also ease symptoms of lactose intolerance, where certain active strains may help lactose intolerant individuals tolerate more lactose. Probiotics could also halt the unfriendly bacteria and suppress their growth and activity in conditions like diarrhoea, irritable bowel syndrome, inflammatory bowel disease, skin and vaginal infections. It is also said that certain strains of probiotics can exert anti-carcinogenic effects by decreasing the activity of enzymes that generate carcinogens. They can exert a positive influence on the gastrointestinal environment and also reduce the risk of cancer. Besides, some types of probiotics can also lower cholesterol levels, by breaking down bile in the gut and thus, inhibiting its reabsorption. The benefits of probiotics can also include their role in improving the body’s immune function. There are cells in the digestive tract that are connected to the immune system. By introducing probiotic bacteria, one can alter these microorganisms that influence the immune system's defenses and thereby help in building immunity.
What are their side effects?
There is an ongoing debate on the safety of the use of probiotics in young children, elderly people and people with compromised immune systems. Side effects of probiotics tend to be mild and digestive (like gas or bloating). But they can also be serious leading to infections and unhealthy metabolic activities, if taken in excess. Some people also question the idea that the bacteria taken by mouth can survive the process of human digestion. Thus, along with their benefits, there also exist questions that challenge some of the claims made for probiotics.
What are the foods that contain probiotics?
Probiotics are available in foods as well as dietary supplements. They can be found in fermented food products such as yoghurt, fermented and unfermented milk, cabbage kimchee and soybean-based miso and natto (fermented traditional Japanese health foods). Some probiotic foods date back to ancient times, such as fermented foods and cultured milk products.
source
http://doctor.ndtv.com/topicsh/Probiotics.asp
Probiotics are live microorganisms (small single-celled bacteria) that are similar to the beneficial microorganisms found in the human gut. According to the currently adopted definition by FAO / WHO, probiotics are: ‘Live microorganisms which when administered in adequate amounts confer a health benefit on the host’. Popularly known as friendly or good bacteria, these bacteria are said to be beneficial for the body. Theoretically, bacteria are categorised by genus, species and strain names. Most probiotic foods contain bacteria of the species like Lactobacillius and Bifidobacterium. These are said to benefit the host by improving the balance of the intestinal microflora, upon ingestion. They also secrete enzymes that aid in digestion and enhance the workings of immune-system cells in the digestive tract. It is said that consuming probiotics helps maintain a healthy balance of good bacteria in the digestive tract. Probiotics can have immunomodulatory and anticarcinogenic effects as well. Often, nutritionists recommend them after a course of antibiotics or as part of the treatment for gut related candidiasis.
How do probiotics work?
Human body contains miniature ecology of microbes, collectively known as the gut flora. Most of these bacteria are harmless and are said to contribute to our growth and health. It is important that the balance of microbes is maintained to promote the beneficial bacteria over the potentially harmful ones. Due to the use of antibiotics, excess alcohol, stress, or exposure to toxic substances, a number of these bacterial types can get thrown out of balance. In such cases, the bacteria that suit our body can decrease, allowing the harmful ones to thrive and pose a threat to our health. This can be prevented by improving the quality of our food intake. By including foods rich in probiotics, we can maintain a healthy gut flora and thereby, avoid potential health problems.
What are the benefits of probiotics?
Probiotics have a lot of benefits for our health. At times, the balance between the good and the bad bacteria can get haywire due to the use of antibiotics and other toxic substances. Foods rich in probiotics can offset their side effects and also prevent further infections. They can also ease symptoms of lactose intolerance, where certain active strains may help lactose intolerant individuals tolerate more lactose. Probiotics could also halt the unfriendly bacteria and suppress their growth and activity in conditions like diarrhoea, irritable bowel syndrome, inflammatory bowel disease, skin and vaginal infections. It is also said that certain strains of probiotics can exert anti-carcinogenic effects by decreasing the activity of enzymes that generate carcinogens. They can exert a positive influence on the gastrointestinal environment and also reduce the risk of cancer. Besides, some types of probiotics can also lower cholesterol levels, by breaking down bile in the gut and thus, inhibiting its reabsorption. The benefits of probiotics can also include their role in improving the body’s immune function. There are cells in the digestive tract that are connected to the immune system. By introducing probiotic bacteria, one can alter these microorganisms that influence the immune system's defenses and thereby help in building immunity.
What are their side effects?
There is an ongoing debate on the safety of the use of probiotics in young children, elderly people and people with compromised immune systems. Side effects of probiotics tend to be mild and digestive (like gas or bloating). But they can also be serious leading to infections and unhealthy metabolic activities, if taken in excess. Some people also question the idea that the bacteria taken by mouth can survive the process of human digestion. Thus, along with their benefits, there also exist questions that challenge some of the claims made for probiotics.
What are the foods that contain probiotics?
Probiotics are available in foods as well as dietary supplements. They can be found in fermented food products such as yoghurt, fermented and unfermented milk, cabbage kimchee and soybean-based miso and natto (fermented traditional Japanese health foods). Some probiotic foods date back to ancient times, such as fermented foods and cultured milk products.
source
http://doctor.ndtv.com/topicsh/Probiotics.asp
Wednesday, March 11, 2009
PROBIOTICS
What are probiotics?
They are ‘live’ micro-organisms, which when administered in adequate amounts, confer a health benefit on the host. If you are wondering how one can knowingly take in live bacteria, there are a few more facts to surprise you…
What are the benefits of healthy bacteria?
The resident bacteria (also called commensals) help guard the body against pathogenic bacteria. Of the many resident beneficial bacteria, lactobacillus has been the most widely studied. Lactobacillus strains prevent the adhesion and growth of urinary and intestinal pathogens and produce high concentration of hydrogen peroxide and lower the pH of the intestine, making it inhospitable for the harmful bacteria.
What causes disturbance in the intestinal flora?
Intestinal flora may be disrupted sometimes due to factors like prolonged use of antibiotics, stress and most importantly diets high in sugar and simple carbohydrates. Exposure to radiation and parasitic infestation may be the other causes. This precisely is the reason why probiotic preparations are sometimes recommended after a course of antibiotics, or as part of treatment.
Which probiotics are helpful?
Among the probiotics, S. boulardii, E. faecium and Lactobacillus sp. are useful in preventing antibiotic-related diarrhoea. Lactobacillus GG reduces the severity and duration of rotavirus diarrhoea in infants. Some lactic acid bacteria have immuno-regulatory effects that might protect against some allergic disorders. There is some evidence that some of these probiotic strains can reduce the intestinal inflammation associated with some food allergies. Some animal experiments have even shown that products containing L. acidophilus have cholesterol lowering effect. In addition, probiotics improve absorption of nutrients, improve synthesis of vitamins and essential fatty acids and also prevent some bacterial and yeast infections.
How do we take in healthy bacteria?
The best way is through dietary sources. In fact, for centuries our native diets have had a good proportion of fermented foods, some of which have probiotic health benefits. Curd, the lactobacillus fermented product, has also been part of the Indian diets for centuries. Similarly pickles, dhokla, butter, are also good sources.
What are the probiotic preparations available in the market?
Food products or supplements and pharmaceutical preparations containing viable probiotic strains are available in the market either as fermented foods or in lyophilised (freeze-dried) form.
A probiotic preparation can be effective only if the healthy bacteria are available in required concentration for consumption; there are concerns about the preservation of probiotic strains in these products and hence there are doubts about their health effects after consumption.
Can probiotics be liberally consumed by everyone?
Studies show that probiotics are contraindicated in those who are proven to be hypersensitive to such products. It is better that pregnant and nursing women use probiotic nutritional supplements only on the physician’s advice. Similarly, the use of probiotics for the treatment of any disorder must be medically supervised. Some commercial foods, which are being marketed as containing probiotics are very high in sugar and are empty calories (poor in vitamins and minerals). Such foods may be unhealthy because of their ‘junk’ nature.
Regulatory Issues?
There is a need for standardisation in order to sift the genuine products from the artificial ones. Considering this, the Indian Council of Medical Research (ICMR), Ministry of Health has recently set up a committee to formulate guidelines for the probiotic foods.
Once the guidelines are out, the products claiming to be probiotic should go through stringent quality checks and disclosure on the labels so that the consumers can make more informed choices.
***
Did you know
Over 400 distinct species of micro organisms inhabit our digestive tract.
They make up nearly 2 kg of your total body weight.
The bacteria outnumber the cells in your body.
Several of these bacteria are beneficial to health and can boost immunity.
Even nascent tummies of babies acquire some beneficial bacteria from the mother during the birth process, multiply in the gastrointestinal tract and boost the baby’s immunity.
Bifidobacteria infantis are the dominant bacteria in the infant’s digestive tract. They hinder the growth of rotaviruses, which cause diarrhoea and thrush, and protect the newborn against some common infections.
These bacteria help prevent lactose intolerance and increase absorption of minerals and B vitamins.
Breast-fed babies become dominated by bifidobacteria due to the favourable growth factors in breast milk.
source
http://www.hindu.com/mag/2009/03/01/stories/2009030150200600.htm
They are ‘live’ micro-organisms, which when administered in adequate amounts, confer a health benefit on the host. If you are wondering how one can knowingly take in live bacteria, there are a few more facts to surprise you…
What are the benefits of healthy bacteria?
The resident bacteria (also called commensals) help guard the body against pathogenic bacteria. Of the many resident beneficial bacteria, lactobacillus has been the most widely studied. Lactobacillus strains prevent the adhesion and growth of urinary and intestinal pathogens and produce high concentration of hydrogen peroxide and lower the pH of the intestine, making it inhospitable for the harmful bacteria.
What causes disturbance in the intestinal flora?
Intestinal flora may be disrupted sometimes due to factors like prolonged use of antibiotics, stress and most importantly diets high in sugar and simple carbohydrates. Exposure to radiation and parasitic infestation may be the other causes. This precisely is the reason why probiotic preparations are sometimes recommended after a course of antibiotics, or as part of treatment.
Which probiotics are helpful?
Among the probiotics, S. boulardii, E. faecium and Lactobacillus sp. are useful in preventing antibiotic-related diarrhoea. Lactobacillus GG reduces the severity and duration of rotavirus diarrhoea in infants. Some lactic acid bacteria have immuno-regulatory effects that might protect against some allergic disorders. There is some evidence that some of these probiotic strains can reduce the intestinal inflammation associated with some food allergies. Some animal experiments have even shown that products containing L. acidophilus have cholesterol lowering effect. In addition, probiotics improve absorption of nutrients, improve synthesis of vitamins and essential fatty acids and also prevent some bacterial and yeast infections.
How do we take in healthy bacteria?
The best way is through dietary sources. In fact, for centuries our native diets have had a good proportion of fermented foods, some of which have probiotic health benefits. Curd, the lactobacillus fermented product, has also been part of the Indian diets for centuries. Similarly pickles, dhokla, butter, are also good sources.
What are the probiotic preparations available in the market?
Food products or supplements and pharmaceutical preparations containing viable probiotic strains are available in the market either as fermented foods or in lyophilised (freeze-dried) form.
A probiotic preparation can be effective only if the healthy bacteria are available in required concentration for consumption; there are concerns about the preservation of probiotic strains in these products and hence there are doubts about their health effects after consumption.
Can probiotics be liberally consumed by everyone?
Studies show that probiotics are contraindicated in those who are proven to be hypersensitive to such products. It is better that pregnant and nursing women use probiotic nutritional supplements only on the physician’s advice. Similarly, the use of probiotics for the treatment of any disorder must be medically supervised. Some commercial foods, which are being marketed as containing probiotics are very high in sugar and are empty calories (poor in vitamins and minerals). Such foods may be unhealthy because of their ‘junk’ nature.
Regulatory Issues?
There is a need for standardisation in order to sift the genuine products from the artificial ones. Considering this, the Indian Council of Medical Research (ICMR), Ministry of Health has recently set up a committee to formulate guidelines for the probiotic foods.
Once the guidelines are out, the products claiming to be probiotic should go through stringent quality checks and disclosure on the labels so that the consumers can make more informed choices.
***
Did you know
Over 400 distinct species of micro organisms inhabit our digestive tract.
They make up nearly 2 kg of your total body weight.
The bacteria outnumber the cells in your body.
Several of these bacteria are beneficial to health and can boost immunity.
Even nascent tummies of babies acquire some beneficial bacteria from the mother during the birth process, multiply in the gastrointestinal tract and boost the baby’s immunity.
Bifidobacteria infantis are the dominant bacteria in the infant’s digestive tract. They hinder the growth of rotaviruses, which cause diarrhoea and thrush, and protect the newborn against some common infections.
These bacteria help prevent lactose intolerance and increase absorption of minerals and B vitamins.
Breast-fed babies become dominated by bifidobacteria due to the favourable growth factors in breast milk.
source
http://www.hindu.com/mag/2009/03/01/stories/2009030150200600.htm
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