Colorectal Disorders And Diseases

This first reference to comprehensively address both the medical and surgical management of diseases affecting the colon, this source spans the wide array of colorectal disorders including rectal prolapse, irritable bowel syndrome, benign and malignant colonic tumors, fissures and ulcers, and Crohn's colitis, among other ailments. With chapters by

This open access book deals with imaging of the abdomen and pelvis, an area that has seen considerable advances over the past several years, driven by clinical as well as technological developments. The respective chapters, written by internationally respected experts in their fields, focus on imaging diagnosis and interventional therapies in abdominal and pelvic disease; they cover all relevant imaging modalities, including magnetic resonance imaging, computed tomography, and positron emission tomography. As such, the book offers a comprehensive review of the state of the art in imaging of the abdomen and pelvis. It will be of interest to general radiologists, radiology residents, interventional radiologists, and clinicians from other specialties who want to update their knowledge in this area.

The intestinal mucosa thus shows a unique morphological structure with many immune cells being present under physiological conditions. This condition is known as "controlled inflammation." These abundant immune cells also have characteristic functions: they are "negatively regulated" and have been educated not to overreact unnecessarily to the intestinal luminal milieu. Main players that control inflammation of the intestinal mucosa include regulatory cytokines and regulatory T cells which induce oral tolerance to intestinal bacteria and food antigens, and the secretory IgA system. The maintenance of unique immunological activity in the intestine is also related to an organized, orchestrated lymphocyte migratory mechanism called the "common mucosal immune system." --

The diagnosis and treatment of commonly encountered bowel diseases, including diarrhea, irritable bowel syndrome, diverticular disease of the colon and rectal cancer are reviewed. Pharmacologic treatment is discussed in detail. The ACG guidelines for management of ulcerative colitis and Crohn's disease are included.

Three distinct types of contractions perform colonic motility functions. Rhythmic phasic contractions (RPCs) cause slow net distal propulsion with extensive mixing/turning over. Infrequently occurring giant migrating contractions (GMCs) produce mass movements. Tonic contractions aid RPCs in their motor function. The spatiotemporal patterns of these contractions differ markedly. The amplitude and distance of propagation of a GMC are several-fold larger than those of an RPC. The enteric neurons and smooth muscle cells are the core regulators of all three types of contractions. The regulation of contractions by these mechanisms is modifiable by extrinsic factors: CNS, autonomic neurons, hormones, inflammatory mediators, and stress mediators. Only the GMCs produce descending inhibition, which accommodates the large bolus being propelled without increasing muscle tone. The strong compression of the colon wall generates afferent signals that are below nociceptive threshold in healthy subjects. However, these signals become nociceptive; if the amplitudes of GMCs increase, afferent nerves become hypersensitive, or descending inhibition is impaired. The GMCs also provide the force for rapid propulsion of feces and descending inhibition to relax the internal anal sphincter during defecation. The dysregulation of GMCs is a major factor in colonic motility disorders: irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), and diverticular disease (DD). Frequent mass movements by GMCs cause diarrhea in diarrhea predominant IBS, IBD, and DD, while a decrease in the frequency of GMCs causes constipation. The GMCs generate the afferent signals for intermittent short-lived episodes of abdominal cramping in these disorders. Epigenetic dysregulation due to adverse events in early life is one of the major factors in generating the symptoms of IBS in adulthood.

As in the first edition of Inflammatory Bowel Diseases this new edition continues to provide readers with a concise, yet in-depth review of many of the important areas in the history, epidemiology, pathogenesis, diagnosis, and treatment of the inflammatory bowel diseases (ulcerative colitis and Crohn's disease), as well as associated issues: extraintestinal manifestations, ostomy care, women's issues, economics, etc. This Second Edition provides the reders with up-to-date, state-of-the art approaches to these disease states, with expansion into the newer topics that have emerged in the past few years which include the expansion of biological agents for treatment, new studies in the epidemiology of IBD, the changing economics of IBD, breakthroughs in new endoscopic evaluations, major advances in novel radiographic techniques, the detection of colorectal cancer in patients with IBD and new findings in the genetics of IBD. New Trend / Developments (* These all emerged since our last edition) The most critical trend that has arisen over the past few years has been the introduction and expansion of biological agents in the treatment of inflammatory diseases worldwide. While only one agent, infliximab (Remicade), existed at the time of publication of my first edition, there have been multiple other agents either approved or pending approval for the treatments of these diseases, or in the upper-stages of development. The impact is not only upon the patients, but also on the health-care providers, policy makers, researchers, biotech and pharmacompanies, and the business community. Major changes worldwide in the epidemiology of IBD has spurred new studies in the demographics of who is getting these diseases and why. Previously characterized as diseases primarily affected Caucasians in industrialized countries, there has been an explosion of growth amongst the African American and Hispanic populations in the United States, and well as in pockets of these and other ethnic groups worldwide. The economics of IBD has been changing greatly, given the issues raised above, as well as major changes in the United States Medicare program, and other insurance changes. The growing proportion of the GNP that healthcare costs are consuming in the US and worldwide has shifted attention to decreasing utilization of health care services, and other cost-savings measures. Again, up to this point this has been an exclusive part of our IBD book. New findings in the genetics of IBD have been recently published. Our first edition had the finding of the first Crohn’s disease gene inserted just before going to press; so much has been published about the phenotypes and other genotypes that have emerged. Breakthroughs in new endoscopic evaluations of the bowel (ie. Capsule endoscopy, double-balloon enteroscopy, endoscopic ultrasound) and their use in the inflammatory bowel diseases will be a key highlight of this new book. Major advances in novel radiographic techniques employed in patients with inflammatory bowel disease (ie. CT enterography, MR enterography, advanced ultrasounds, etc.) will also an important component of our work. There have been numerous areas related to the development and detection of colorectal cancer in patients with IBD that have emerged in the past few years. Techniques of better detection (ie. Narrow band imaging; special mucosal staining; endoscopic histological evaluations) as well as research in the putative role of mesalamine and other agents for colorectal cancer prevention are all hot topics that will attract much interest from a variety of interest groups I described above. Identification of additional disease states that probably belong in the IBD family, such as microscopic colitis (including lymphocytic colitis), and collagenous colitis add to the diseases that will be discussed in this new edition.

Interventional Inflammatory Bowel Diseases: Endoscopic Management and Treatment of Complications covers the preparation, principle, techniques, and damage control of complications in endoscopic therapy, providing the ultimate guidance in endoscopic management of IBD. With contributions from a panel of international leading experts in the field, perspectives are included from GI pathologists, GI radiologists, gastroenterologists, advanced endoscopists, IBD specialists and colorectal surgeons. Recommendations from experts are also included within each chapter. By bridging medical and surgical treatment modalities for IBD, this is the perfect reference for GI researchers, medical students, therapeutic GI endoscopists, IBD specialists, surgeons and advanced health care providers. Incorporates state-of-the-art of research in the area of therapeutic endoscopy in Crohn’s Disease and Ulcerative Colitis Makes the connection between the understanding of the complex nature and disease course of IBD with corresponding advanced endoscopic procedures Explores endoscopic treatment as the missing link between medical and surgical treatment for complex Crohn’s Disease and Ulcerative Colitis Contains access to videos demonstrating important procedural concepts

This book is dedicated to inflammatory bowel disease, and the authors discuss the advances in the pathogenesis of inflammatory bowel disease, as well as several new parameters involved in the etiopathogeny of Crohn's disease and ulcerative colitis, such as intestinal barrier dysfunction and the roles of TH 17 cells and IL 17 in the immune response in inflammatory bowel disease. The book also focuses on several relevant clinical points, such as pregnancy during inflammatory bowel disease and the health-related quality of life as an end point of the different treatments of the diseases. Finally, advances in management of patients with inflammatory bowel disease are discussed, especially in a complete review of the recent literature.