To Improve the Lives of People with Functional GI Disorders
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Books
Rome IV Print Collection
Rome IV Online Collection
Rome IV Expert Collection
Multi-Dimensional Clinical Profile
MDCP Slide Set
MDCP Book and Slide Set
Rome III: The Functional GI Disorders Cloth Bound
Rome III: The Functional GI Disorders
Rome III Spanish Version
Understanding the Irritable Gut
Apparel
Bristol Stool Scale Form Shirt - Medium
Bristol Stool Scale Form Shirt - Small
Bristol Stool Scale Form Shirt - Large
Bristol Stool Scale Form Shirt - Extra Large
Computer-Based Learning Program
Full Set - ON CD-ROM
Basic Science Set - ON CD-ROM
Diagnosis Set - ON CD-ROM
Epidemiology Set - ON CD-ROM
Integrated Module for IBS - ON CD-ROM
Integrated Module on Constipation - ON CD-ROM
Pediatric Set - ON CD-ROM
Psychosocial Set - ON CD-ROM
Treatment Set - ON CD-ROM
Individual Computer-Based Learning Program
Prevalence of GI Symptoms in General Population
Prevalence
Prevalence of Upper GI Symptoms
Definitional Problems with Studies of Upper GI Symptoms
Results of Endoscopy in the General Population with Dyspepsia Symptoms
Results of Endoscopy in the General Population with Reflux Symptoms
Epidemiology of Functional Disorders in the General Population
World Prevalence of Dyspepsia Symptoms
Rome I vs Rome II
Dyspepsia Prevalence According to Sex
Dyspepsia Prevalence According to Age
Dyspepsia Prevalence According to Socioeconomic Status
Dyspepsia Prevalence with NSAIDs Use
Dyspepsia Prevalence According to H pylori Status
Incidence of Dyspepsia in the General Population
Incidence of Dyspepsia in the UK General Population, Age 40 to 49 Years-Slide 1 of 2
Prognosis of Dyspepsia in the General Population-Slide 2 of 2
Quality of Life in the US and UK General Population in Those With and Without Dyspepsia
Quality of Life and Dyspepsia
Quality of Life and Dyspepsia vs IBD
Economic Impact of Upper GI Disease in Sweden
Economic Impact of Dyspepsia in a Sample of the UK General Population
Extrapolation of Economic Impact on Dyspepsia to Different Countries
Prevalence of GI Functional Disorders
Prevalence of Bowel Habits in US IBS Populations
Definitional Problems with Studies
World Prevalence of IBS
IBS Prevalence According to Sex
Prevalence by IBS Subgroups
IBS Prevalence According To Age
IBS Prevalence According to Socioeconomic Status
IBS Following Infectious Gastroenteritis
Risk Factors for IBS After Acute Gastroenteritis-Slide 1 of 2
Risk Factors for IBS After Acute Gastroenteritis-Slide 2 of 2
Familial Association in Adults with Dyspepsia and IBS
Impact of IBS on Quality of Life Compared to the General Population
Incidence of IBS in the General Population
Cost of IBS
Direct Cost of IBS: Patients vs Controls in the US
Direct vs Indirect Costs of IBS
IBS and Surgery
US Annual Costs (US$ Millions)
World Prevalence of Constipation
Definition of Constipation
Constipation and Gender
Constipation and Age
Constipation and Socioeconomic Status
Constipation and Quality of life
Constipation and Exercise: Conflicting Data
Diarrhea in the Population
Diarrhea and Gender
Functional Disorders Overlap
Overlap Among GI Symptoms
IBS Coexists With Many Other Functional Symptoms
IBS - Most Common Diagnosis In Women With Chronic Pelvic Pain
Autonomic Nervous System Has Three Divisions
Enteric Nervous System Comprises the Myenteric and Submucosal Plexuses
Enteric Nervous System (ENS): The “Brain-In-The-Gut” Concept
Microcircuits of the ENS Formed by Synaptic Connections
Bidirectional Communication Occurs Between the ENS and the CNS
Three Main Types of Chemical Signaling Occur in the Enteric Nervous System
Sensory Neurons in the Enteric Nervous System
Motor Neurons in the Enteric Nervous System
Multiple Mediators Activate Secretomotor Neurons And Stimulate Secretion
Multiple Mediators Inhibit Secretomotor Neurons And Suppress Secretory Activity
Multiple Mediators Inhibit Excitatory Musculomotor Neurons and Cause Smooth Muscle Relaxation
Multiple Mediators Activate Excitatory Musculomotor Neurons and Cause Smooth Muscle Contraction
Multiple Mediators Suppress Inhibitory Musculomotor Neurons and Cause Smooth Muscle Contraction
Multiple Mediators Activate Inhibitory Musculomotor Neurons and Cause Smooth Muscle Relaxation
Neural Control of Muscles During Perstaltic Propulsion
Vagus Nerves: Mixed Afferent and Efferent
Dorsal Vagal Complex in Medulla Oblongata
Schematic of Vago-Vagal Reflex Circuit
Section Title: Sensory Physiology and Pathophysiology of the Gut
Multiple Types of Sensory Receptors Are Present in the Digestive Tract
Sensory Receptors Transform Changes in Stimulus Energy into Action Potential Codes
Sensory Afferents Transmit Signals to Both ENS and CNS
Serotonergic 5-HT3 Receptors Are Expressed on Digestive Tract Afferents
Distension of the Esophagus Evokes Firing In Vagal Afferent Fibers
Enteric Neurons Project Sensory Info from Large Intestine to Spinal Cord
Spinal Gasting for 3 Classes of Sensory Receptors Accounts for Normal Regulatory Functions
Enteroendocrine Cells Are the First Step in the Transduction of Chemoreceptive Sensory Information
Chemoreceptors for Acid in the Gastric or Duodenal Mucosa Evoke Firing in Vagal Afferents
Sensory Signals Are Processed in Spinal Cord, Brain Stem, and Brain
Spinal Pain Circuits
Visceral Sensory Pathways: Ascending Pathways
Ascending Visceral Pain Pathway
Descending Pain Modulation
Mechanical Distention of the Colon Evokes Pain Referred to Specific Abdominal Regions
Convergence of Somatic and Visceral Afferents in the Spinal Cord Accounts for Referred Pain
Silent Gastrointestinal Afferents are Sensitized and Activated by Inflammation
Gastrointestinal Sensory Afferents are Sensitized by Inflammation
Repetitive Mechanical Stimulation Sensitizes the Spinal Cord
The Phenomena of Hyperalgesia and Allodynia
Schema for Evaluation of Enteric Sensation and Reflexes in the Functional GI Disorders
Visceral Hypersensitivity to Gut Distension in the Functional GI Disorders
Patients with Functional Dyspepsia Can Exhibit a Reduced Tolerance to Fundic Distension
Functional Dyspepsia Patients Show Increased Antral, as Well as Fundic, Sensitivity to Distention
Enhanced Perception of Physiological Intestinal Motility, Not Only Balloon Distension, Occurs in IBS
Rectal Hypersensitivity in IBS is Provoked by Repetitive Sigmoid Colon Distension
Functional Dyspepsia Patients, As Well As IBS, Exhibit Rectal Hypersensitivity
Type of Functional GI Disorder Determines Pattern of Gastric and Rectal Hypersensitivity
Colonic and Rectal Sensitivity, Both Pain and Non-Pain, to Phasic Distension are Correlated in IBS
Colonic Hypersensitivity to Barostat Distension in IBS is Increased After Duodenal Lipid Infusion
Colonic Distension Postprandially Provokes an Altered Autonomic Response in IBS
Rectal Hypersensitivity in IBS is Associated With Greater Symptom Severity
Hypersensitivity to Rectal Distension in IBS: Shorter Latencies of Cerebral Evoked Potentials
Rectal Barostat Sensory Testing in IBS: Sensitivity and Specificity
Colonic Hypersensitivity in IBS: Influence of Psychological Tendency Pain Reporting
Section Title: Motility and Dysmotility: Fundamental Concepts
IBS Patients, As Well As Functional Dyspepsia, Exhibit Esophageal Hypersensitivity
Gastrointestinal Smooth Muscles Have Properties of a Functional Electrical Syncytium
Electrical Activity Occurs at Different Frequencies in Stomach, Small Intestine, and Colon
Electrical Slow Waves Without Action Potentials Are Often Present in the Small Intestine
Contractions Are Seen When Action Potentials Appear on Slow Waves
Networks of Interstitial Cells of Cajal: Pacemakers for Elect Activity in the GI Musculature
Activ of Inhib Motor Neurons to the Intest Circ Muscle Tonically Inhibits Contractions
Inhib Innervation of Sphincters Contin Inactive & Transiently Activated for Timed Opening
Inhib Motor Innervation of Intest Circ Muscle Cont Active & Transiently Inactiv to Permit Musc Cont
Enteric Nervous System Contains a Library of Programs for Specific Patterns of Intest Motor Behavior
Gastrointestinal Motility and ENS-CNS Control
Measurement of Digestive Tract Motility: Transit I
Measurement of Digestive Tract Motility: Transit II
Measurement of Digestive Tract Motility: Intraluminal Pressure
Measurement of Digestive Tract Motility: Tone, Compliance and Reflexes
Measurement of Digestive Tract Motility: Myoelectric Activity
Measurement of Digestive Tract Motility: Wall Motion
Gastrointestinal Dysmotility in the Functional Gastrointestinal Disorders (FGIDs)
Gastrointestinal Dysmotility in the Functional Gastrointestinal Disorders (FGIDs)
Section Title: Regional Motility - Stomach
The Stomach Is Divided Into Multiple Anatomic and Only Two Functional Motor Regions
Relaxation in the Gastric Reservoir
Swallowing Evokes Gastric Receptive Relaxation
Swallowing Evokes Gastric Receptive Relaxation and Increased Gastric Volume
Adaptive Relaxation in the Gastric Reservoir Is a Vago-Vagal Reflex
Normal Meal-Induced Gastric Accommodation
Adaptive Relaxation in the Gastric Reservoir Is Absent After Vagotomy
CCK Is a Chemical Signal from the Duodenum for Feedback Reg of the Gastric Reservoir
Motility of the Antral Pump Is Initiated by a Dominant Pacemaker in the Mid-Corpus
Amount of Acetylcholine Determines Amplitude of Plateau Phase of Action Potential and Contraction
Onset and Rate of Gastric Emptying Varies With the Composition of the Meal
Dysmotility of the Stomach Reported in Functional Dyspepsia
Functional Dyspepsia: Putative Pathophysiological Mechanisms According to Predominant Symptom
Gastric Reflexes in FD: Impaired Fundic, Not Antral, Relax Occurs in Resp to Distention & Nutrients
Electrogastrography: Noninvasive Recording of Gastric Antral Electrical Activity
Tachygastria and Bradygastria Are Dysrhythmias Detected by Electrogastrography
Section Title: Regional Motility – Small Intestine
The MMC Is the Gastric & Small Intestinal Motor Pattern of the Interdigestive State
The MMC Complex Occurs Periodically in the Interdigestive State in the Stomach & Small Intestine
Functional Esophageal Disorders
Functional Heartburn: Diagnostic Criteria
Functional Chest Pain of Presumed Esophageal Origin: Diagnostic Criteria
Intercellular Spaces in Esophageal Squamous Epithelium by Transmission Electron Microscopy
Hypersensitivity to Esophageal Balloon Distention in Patients with Unexplained Chest Pain
PPI Test for Unexplained Chest Pain
Correlation of Chest Pain with Episodes of Acid Reflux
Combined Multichannel Intraluminal Impedance (MII) and pH Monitoring
Combined MII and pH Monitoring
Possible Symptom-Reflux Correlations-Slide 1 of 4
Symptom Index-Slide 2 of 4
Symptom Sensitivity Index-Slide 3 of 4
Symptom-Association Probability-Slide 4 of 4
Functional Dysphagia: Diagnostic Criteria
Globus: Diagnostic Criteria
Functional Gastroduodenal Disorders
Functional Gastroduodenal Disorders: Functional Dyspepsia
Uninvestigated Dyspepsia
Functional Dyspepsia: Two Categories
Functional Dyspepsia: Diagnostic Criteria
Dyspeptic Symptoms
Epigastric Pain Syndrome: Diagnostic Criteria
Postprandial Distress Syndrome: Diagnostic Criteria
Dyspeptic Symptoms
Functional Gastroduodenal Disorders: Belching Disorders
Belching Disorders: Diagnostic Criteria
Multichannel Intraluminal Impedance (MII) Monitoring
MII Monitoring
Functional Gastroduodenal Disorders: Nausea and Vomiting Disorders
Nausea and Vomiting
Functional Vomiting: Diagnostic Criteria
Cyclic Vomiting Syndrome: Diagnostic Criteria-Slide 1 of 2
Cyclic Vomiting Syndrome: Diagnostic Criteria-Slide 2 of 2
Functional Gastroduodenal Disorders: Rumination Syndrome
Rumination Syndrome: Diagnostic Criteria
Esophagogastric Manometry in the Rumination Syndrome
Antroduodenal Manometry and pH Monitoring of the Distal Esophagus in the Rumination Syndrome
Functional Biliary Disorders
Gallbladder and Sphincter of Oddi Pain: Diagnostic Criteria-Slide 1 of 5
Gallbladder and Sphincter of Oddi Pain: Diagnostic Criteria-Slide 2 of 5
Gallbladder and Sphincter of Oddi Pain: Diagnostic Criteria-Slide 3 of 5
Gallbladder and Sphincter of Oddi Pain: Diagnostic Criteria-Slide 4 of 5
Rome III Diagnostic Criteria for Gallbladder and Sphincter of Oddi Pain-Slide 5 of 5
Gallbladder and Sphincter of Oddi Pain: Diagnostic Criteria
Functional Biliary Disorders: Clinical Presentation and Differential Diagnosis
Functional Biliary Disorders
Rome III Algorithm for Functional Gallbladder Disorder
Scintigraphic Gallbladder Ejection Fraction (GBEF) During CCK Infusion
Pain Relief and Histological GB Findings After Cholecystectomy According to GBEF in GB Dysfunction
Proposed Origin of Defective Gallbladder Emptying and Pain
Epidemiology of Functional Gallbladder Disorder
Rome III Algorithm for Functional Biliary Sphincter of Oddi Disorders
Rome III Algorithm for Functional Biliary Sphincter of Oddi Disorders
Sphincter of Oddi (SO) Motor Abnormalities
Endoscopic Manometry of the Sphincter of Oddi in a Patient with Normal Motor Activity
Endoscopic Manometry in a Patient with Sphincter of Oddi Hypertonicity
Endoscopic Sphincter of Oddi Manometry in a Patient with Tachyoddia
Biliary (Choledocho) Scintigraphy
Common Bile Duct (CBD) Pressure in the Absence or Presence of a Gallbladder
Epidemiology of Functional Sphincter of Oddi Disorders
Functional Pancreatic Sphincter of Oddi Disorder: Diagnostic Criteria
Rome III Diagnostic and Therapeutical Algorithm for Functional Pancreatic SO Disorder
Functional Bowel Disorders
Irritable Bowel Syndrome: Diagnostic Criteria
History and Physical Examination for Lower GI Symptoms
Alarm Features for Organic Disorders
Usefulness of Red Flags
Diagnostic Strength of Red Flags in IBS
Investigation in Patients With No Alarm Features
Diagnostic Cost of Excluding Red Flags
Stool Form Depends on Water Content and Correlates With Transit Time
IBS Subtypes
IBS Subtypes: Stool Form is the Differentiating Factor
Proposed Pathophysiology of IBS
Multiple Contributing Factors for IBS
Natural History of IBS
Pragmatic Issues in IBS
Functional Bloating: Dagnostic Criteria
Primary Constipation Syndromes
Overlap Between Chronic Constipation and IBS With Constipation
Supporting Symptoms for IBS-C and Chronic Constipation
BM Infrequency Is Not the Defining Symptom
ACG Task Force Recommendations on Diagnostic Testing for CC
Some Causes of Secondary Constipation
Primary Constipation Syndromes
Conceptual Categorization of Constipation
Colonic Transit Study (Hinton Technique)
Colonic Transit Study (Metcalf Technique)
Constipation: Diagnostic Algorithm
Primary Constipation Syndromes: Coexistent Slow Colonic Transit and Defecation Disorder
Functional Diarrhea: Diagnostic Criteria
Evaluation of Functional Diarrhea: History
Evaluation of Functional Diarrhea: Diagnostic Testing
Differential Diagnosis for Functional Diarrhea
Functional Abdominal Pain Syndrome: Diagnostic Criteria
Clinical Assessment in FAPS
Functional Anorectal Disorders
Functional Fecal Incontinence
Digital Exam for Continence-Slide 1 of 5
Digital Exam for Continence-Slide 2 of 5
Digital Exam for Continence-Slide 3 of 5
Digital Exam for Continence-Slide 4 of 5
Digital Exam for Continence-Slide 5 of 5
IAS Weakens With Passive Incontinence
Digital Exam - Coccygodynia
Chronic Proctalgia Syndrome
Proctalgia Fugax
Primary Constipation Syndromes: Association with Dyssynergia
Diagnostic Tests for Constipation
Defecography
Pelvic MRI
Rectocele
Anorectal Manometry
Rectoanal Pressure Profiles
Balloon Expulsion Test
Balloon Expulsion Device
Algorithm for Evaluation of Difficult Defecation
Feeding Shifts Neural Programming from the MMC to the Postprandial Pattern (Small-Bowel Segm.)
Power Propulsion Is a Specialized Pattern of Intestinal Motility
Power Propulsion Is an Intestinal Motor Pattern Specialized for Rapid Propulsion Over Long Distances
Emesis Interrupts the ENS Postprandial Program and Initiates Power-Propulsion Program
Video: Emesis Interrupts the ENS Postprandial Program and Initiates Power-Propulsion Program
Dysmotility of the Small Intestine Reported in Irritable Bowel Syndrome
Postprandial Jejunal Dysmot Is more Freq in IBS Pts with Jejunal Perception Hypersensitivity
High Amplitude Propagated Contractions in Ileum Reflect Power Propulsion
Section Title: Regional Motility: Large Intestine/Pelvic Floor
Colonic Motility: High-Amplitude Propagated Contractions (HPACs) Are Triggered on Waking From Sleep
Colonic Motility: Nonpropagating Contractions Decrease During Sleep and Increase on Waking
Colonic Motility: Normal Tonic Response of Sigmoid Colon to a Meal
Activity of Inhibitory Neurons is Important for Generation of Haustra in the Colon
Dysmotility of the Colon Reported in Irritable Bowel Syndrome
Sigmoid Colon Motility Is Increased in IBS Both Fasting and Postprandially
Postprandial Sigmoid Colon Motility Index is Related to Plasma 5-HT Concentration in IBS
Power Propulsion in the Colon is More Frequent in IBS
The Normal Colorectal Tonic Reflex Is Attenuated in Female IBS Patients
Dysmotility of the Colon and Ano-Rectum Reported in Functional Constipation
High-Amplitude Propagated Contractions (HAPCs) Occur Less Frequently in Slow-Transit Constipation
External Anal Sphincter and Puborectalis Are Skeletal Muscles Under Spinal Motor Control
Balloon Distension in the Rectum Normally Evokes Relaxation of the External Anal Sphincter
Patterns of Anal Sphincter Dysfunction
Genetic Factors May Modulate Adrenergic and Serotonergic Functions in IBS
Section Title: Intestinal Bacteria, Intestinal Gas, Abdominal Bloating, and Distension
The Microbiota of the Human GI Tract
Alterations in Intestinal Microflora May Occur in IBS
Mild Increases of Small-Bowel Bacteria, but Not Overgrowth, Can Occur in IBS Patients
Normal Intestinal Gas Dynamics Balance Gas Production and Gas Elimination
Intestinal Gas Retention Occurs in the Supine but Not in the Standing Position
Distribution of Abdominal Gas on CT Scans Before and After Meal Ingestion in a Healthy Subject
Abdominal Distension in IBS Increases During the Day and Decreases at Night
Mild Exercise Enhances Transit of Intestinal Gas
Tolerance is Less for Jejunal Than for Colonic Gas Infusion
Gas Retention Due to Intest Relaxation Is Better Tolerated Than Retention Due to Restraint Evac
Composition of Intest Gas Is Not Different in Healthy Subjects & Pts with FGI Symptoms
Methane Infusion Into the Canine Distal Small Bowel Slows Transit in the Proximal Small Bowel
The Degree of Breath Methane Production in IBS Correlates With Severity of Constipation
Evacuation of Intestinal Gas is Impaired in IBS
IBS Patients Exhibit Impaired Gas Transit Associated With Enhanced Perception
Impaired Intestinal Transit of Gas in Patients with Bloating Occurs in the Small Bowel
Reflex Inhibition of Intestinal Gas Transit by Lipid Is Enhanced in IBS
Pts with Functional Bloating Exhibit Impaired Abdom Muscle Tone in Response to Colonic Gas Infusion
Functional Abdominal Bloating and Distension: Mechanistic Hypotheses
Section Title: Stress, Inflammation, and Brain-Gut Interactions
Mast Cell Signaling: Intestinal Mast Cells Release Multiple Mediators
Sensory Afferents Express Receptors for Inflammatory Mediators
Inflammatory Mediators From Mast Cells Excite Enteric Neurons
Histamine Released From Mast Cells Binds to Enteric Neurons
Inflammatory Mediators Have a Dual Action to Evoke Neurogenic Secretion
Jejunal Mast Hyperplasia and Activation Is Present in IBS-Diarrhea Patients (IBS-D)
Mast Cells Infiltrate and Associate With Nerve Fibers in Colonic Mucosa of IBS Patients
Increased Mast Cell Mediators From Colonic Mucosa of IBS Patients Excite Rat Visceral Sensory Nerves
Patients With Postinfective IBS Exhibit Mucosal 5-HT-Containing Enterochromaffin Cell Hyperplasia
Postprandial 5-HT Release Is Elevated in IBS
IBS-C Pts Show Impaired and Postinfective IBS Pts Show Enhanced Posprandial 5-HT Release
Brain-Gut Interactions as a Consequence of Psychosocial Stress
Cold Water Stress or Antigen Challenge Leads to Degranulation of Enteric Mast Cells in Humans
Psychological Stress Converts Absorption of Water, Sodium, and Chloride to Secretion
Neonatal Stress Leads to Visceral Hypersensitivity and Altered Bowel Function in Adult Rats
Acute Psychological Stress Provokes Rectal Hypersensitivity to distension in IBS
Experimentally-Induced Anxiety Impairs Gastric Accommodation to a Meal
Alteration of the MMC by Psychological Stress in Healthy Subjects and IBS Patients
Functional GI Disorders: Delayed Gut Transit Is Associated With Female Gender and Depression
Corticotropin-Releasing Factor (CRF) Provokes an Exaggerated Descending Colon Motor Response in IBS
A CRH Antagonist Inhibits Electrically-Stimulated Colonic Motility in IBS
The Mucosal Epithelium Is a Barrier to the Entry of Antigenic Threats From the Intestinal Lumen
Increased Small-Intestinal Permeability Is Present in Both Postinfective-IBS (PI-IBS) and IBS
Cold-Restraint Stress Increases Mucosal Permeability and Stimulates Secretion in Rats
Stress in Mice Is Associated With Mast-Cell Hyperplasia and Increased Colonic Permeability
CRH Regulates In Vitro Permeability of Human Colonic Mucosa via Mast Cells
Section Title: Neuropharmacology of the Digestive Tract
Dynamics of Enteric Serotonin (5-HT)
Multiple Serotonergic (5-HT) Receptor Subtypes Are Expressed in the Gut
Cisapride & Tegaserod Act at Presynaptic 5-HT4 Receptors to Enhance the Amp of EPSPs
Alosetron Is an Antag at Serotonergic 5-HT3 Recept on Terminals of Spinal & Vagal Sensory Afferents
Drugs Acting at Enteric Serotonergic (5-HT) Receptors
Serotonin (5-HT) Acts at 5-HT3 Receptors to Excite Neurons in the Enteric Nervous System
Alosetron Blocks Serotonin-Evoked Excitation of Secretomotor Neurons
Domperidone Suppresses Presynaptic Inhibitory Action of Dopamine at the D2 Receptor Subtype
Erythromycin Enhances Gastric Emptying by Stimulating Antral and Pyloric Contractions
The Gastrointestinal Prokinetic Action of Erythromycin Is at Motilin Receptors
Prokinetic Drugs Used to Enhance Gastric Emptying Have Different Sites and Mechanisms of Action
Opening of CIC-2 Channels by Lubiprostone Increases the Liquidity in the Intestinal Lumen
Opiates and Opioid Antidiarrheal Drugs Suppress Excitability of Secretomotor Neurons
Mouth to Cecum Transit Time Can Be Pharmacologically Regulated in Healthy Subjects
Stim Laxatives Evoke Release of Serotonin From Enterochromaffin Cells Exciting Secretomotor Neurons
Tricyclic Antidepressants (TCA) Block the Reuptake of Norepinephrine
Selective Serotonin Reuptake Inhibitors (SSRIs)
Imaging Slides-Overview
Why do Functional Imaging?
Evolution of Brain Imaging Studies of Visceral Sensation
Physiological Correlates of Brain Electrical Activity
Most Common Functional Brain Imaging Techniques for Activation Studies
Complementary Techniques to fMRI Brain Imaging
Functional Mapping Methods
Imaging Outcomes are Statistical Maps and Not Direct Measures of Activity
Modulation of Visceral Perception
Ascending Projections of the Lamina I Spino-Thalamo-Cortical System(1 of 5)
Ascending Projections of the Lamina I Spino-Thalamic-Cortical System(2 of 5)
Ascending Projections of the Lamina I Spino-Thalamo-Cortical System(3 of 5)
Ascending Projections of the Lamina I Spino-Thalamo-Cortical System(4 of 5)
Ascending Projections of the Lamina I Spino-Thalamo-Cortical System(5 of 5)
Prevalence of Activations from Rectal Inflations Across Imaging Studies
Cognitions and Emotions Modulate Visceral Pain and Discomfort(1 of 2)
Cognitions and Emotions Modulate Visceral Pain and Discomfort(2 of 2)
Increased Thalamus and Insula Activation and Decreased PAG Activation in IBS
Repeated Exposure to Rectal Distension Results in Decreased Perceptual Responses(1 of 2)
Repeated Exposure to Rectal Distension Results in Decreased Perceptual Responses(2 of 2)
IBS-Related Differences in Response to Visceral Stimulation
IBS Patients Show Greater Activation in dACC, INS, and Dorsal Brain Stem, Including Locus Coeruleus
Increased dACC in IBS Consistent with Greater Affective Pain Experience
Increased ACC Activation In Somatic Pain Patients During Noxious Stimulation
Differences in Brain Responses to Visceral Pain Between Patients with IBS and Ulcerative Colitis1-2
Differences in Brain Responses to Visceral Pain Between Patients with IBS and Ulcerative Colitis2-2
IBS Patients Show Increased Volume of Cortical Activation to Subliminal Rectal Distensions
More Activation to Noxious Rectal Distension in Subjects with History of Abuse
Increased Activation in Cingulate and Prefrontal Regions During Visceral Distension
Brain Imaging and Treatment Outcome
Alosetron Reduces Activation in Limbic and Paralimbic Regions of IBS Patients
Reduction in ACC Following Treatment with Amitriptyline (50 mg/day) vs Placebo During Distension
Reduction in rCBF Following CBT During PostInflation Rest Scan
Developing Brain Imaging Technologies
Brain Stem Activations During Visceral and Somatic Pain
Spinal Cord Imaging
Connectivity Tracts from the Periaqueductal Grey (PAG)
Imaging Genomics – Functional Imaging as an Intermediate Biomarker of Gene Behavior Interactions
Hypothesized Affective Circuit Altered in Subjects with 5-HTTLPR s Allele
Pediatrics - Topic Areas
Role of Development in Pediatric FGIDs
Pediatric FGIDs are Common
Prevalence of Pediatric Constipation
Prevalence of Functional Abdominal Pain in Children
Infant Regurgitation: Diagnostic Criteria
Prevalence of Regurgitation in Healthy Chicago Infants
Prevalence of Regurgitation in Healthy Thai Infants
Pathophysiology of Infant Regurgitation
Pathophysiology of Infant Regurgitation
Shorter Intra-Abdominal Esophagus in Infants
Volume of Feedings: Infant vs Adult
Infant Regurgitation Treatment: Commandments
Infant Colic: Diagnostic Criteria
Infant Colic: Theories for Genesis
Differences in Crying Characteristics Between Infants With Colic and Infants Without Colic
Reassuring Parents About Infant Crying: The Traffic Light Parable
Film: Inconsolable Crying Behavior
Evaluation of Treatment for Infant Colic
Lactobacillus reuteri vs Simethicone in the Treatment of Breast-fed Infants with Colic
Treatment of Infant Colic: Limitations
Severe Infantile Colic May Indicate Susceptibility to GI Disease, Allergy, and Psychological Disorde
Pediatric Functional Diarrhea: Diagnostic Criteria
Pediatric Functional Diarrhea: Possible Contributory Factors
Infant Dyschezia: Diagnostic Criteria
Infant Dyschezia: Treatment
Pediatric Cyclic Vomiting: Diagnostic Criteria
Cyclic vs Chronic Vomiting in Children
Pediatric CVS: On-Off, Intense, Stereotypical-Slide 1 of 2
Pediatric CVS: On-Off, Intense, Stereotypical-Slide 2 of 2
Characteristics of Pediatric Cyclic Vomiting Syndrome
Symptoms Associated with Pediatric CVS
Pediatric Cyclic Vomiting Syndrome: Episode Triggers
Pediatric Cyclic Vomiting Syndrome: Diagnostic Considerations
Management of Pediatric Cyclic Vomiting Syndrome
Progression: CVS to Abdominal Migraine to Migraine Headache
Abdominal Migraine: Diagnostic Criteria
Abdominal Migraine is a Real Entity
Similar Features in Abdominal Migraine and Migraine Headaches
Treatment and Prognosis of Abdominal Migraine
Paroxysmal Disorders Involving Interactions Between the CNS and GI Tract
Infant Rumination Syndrome: Diagnostic Criteria
Risk Factors for Infant Rumination
Adolescent Rumination Syndrome: Diagnostic Criteria
Adolescent Rumination Syndrome: Study Data
Esophagogastric Manometry in the Rumination Syndrome
Antroduodenal Manometry and pH Monitoring of the Distal Esophagus in the Rumination Syndrome
Adolescent Rumination Syndrome: Treatment Options
Differential Diagnosis of Rumination
Aerophagia: Diagnostic Criteria
Clinical Manifestations in Children with Aerophagia
Esophageal Air Sign in Patients with Aerophagia and in Controls
Recurrent Abdominal Pain (RAP) vs Functional Gastrointestinal Disorder (FGID)
Irritable Bowel Syndrome in Children and Adolescents: Diagnostic Criteria
Pediatric Functional Abdominal Pain: Diagnostic Criteria
Abdominal Pain and IBS: Prevalence in Adolescents
Lower QOL in Children with Functional Abdominal Pain
Pain-Predominant FGID-Pediatric
Biopsychosocial Model of Pain & Coping in Children
Do Noxious Early Life Events Predispose to FGID?
Health Care Cost and Use Over a 3-year Calendar Period for All Children of IBS Parents
Evidence for Social Learning over Genetics in Twin Study
Relation Between Childhood Functional Abdominal Pain and Parental Health Complaints
Rectal Barostat Demonstrates Visceral Hyperalgesia in Children
Gastric Barostat Demonstrates Visceral Hyperalgesia in Children
Reproducibility of Pain During Rectal Barostat Testing in Children
Parent Attention vs Distraction-Pediatric
Mother’s/Child’s Agenda-Pediatric
Doctor’s Incorrect Agenda-Pediatric
Doctor’s Correct Agenda-Pediatric
Adult Outcomes of Functional Abdominal Pain
Prognostic Indicators in Children with Severe Functional Abdominal Pain (FAP)
Hypnotherapy in Children with FAP-Slide 1 of 2
Hypnotherapy in Children with FAP-Improvement After Therapy-Slide 1 of 2
Lactobacillus GG for Abdominal Pain in Children
Peppermint Oil in IBS in Children
Pain-Associated Disability Syndrome (PADS)
Pediatric Functional Dyspepsia: Diagnostic Criteria
Accommodation is Abnormal in 53% of Dyspeptic Children
Pediatric Functional Constipation: Diagnostic Criteria
Role of Genetics in Constipated Children
Age of Onset for Constipation
Population-Based Age Distribution of the Prevalence of Childhood Constipation
Cow Milk Intolerance and Chronic Constipation in Children
Pediatric Functional Constipation: Parents’ Reported Quality of Life
Retentive Posturing
Symptoms of Pediatric Functional Constipation
Long-Term Pediatric Functional Constipation
Volume at Urge to Defecate in Children with Functional Constipation
Disimpaction: Dose Response to PEG 3350-Pediatric
Effect of PEG 3350 With Electrolytes vs Lactulose-Pediatric
Effect of PEG 3350 vs Milk of Magnesia-Pediatric
Biofeedback Training: Defecation Disorders-Pediatric-Part 1
Biofeedback Training: Defecation Disorders-Pediatric-Part 2
Anorectal Biofeedback in Childhood Constipation
Treating Childhood Constipation
Cecostomy
Effect of Antegrade Colonic Enemas (ACE) in Children with Constipation
Outcome of Child Constipation-Part 1
Outcome of Child Constipation-Part 2
Nonretentive Fecal Incontinence: Diagnostic Criteria
Achievement of Bowel Control in Children
Prevalence of Fecal Incontinence in Children
Features of Nonretentive Fecal Incontinence (NRFI)
Symptoms in Nonretentive Fecal Incontinence (NRFI)
Functional Nonretentive Fecal Incontinence: Treatment Options
Outcome of Nonretentive Fecal Incontinence (NRFI) After Behavioral Therapy
Nonretentive Fecal Incontinence
Outcome of Childhood NRFI
Nature and Nurture
Evidence for Influence of Social Learning Over Genetics in Twin Study
Associations Between Maternal Reinforcement and Seriousness of Stomach Ache-Slide 1 of 2
Children of IBS Patients Make More Health Care Visits for GI Symptoms
Children of IBS Patients Make More Health Care Visits Overall
Effect of Family Life Events and Mothers’ Somatic Symptoms on Children’s FGID Symptom Outcomes-Slide
Effect of Family Life Events and Mothers’ Somatic Symptoms on Children’s FGID Symptom Outcomes-Slide
Effect of Family Life Events and Mothers’ Somatic Symptoms on Children’s FGID Symptom Outcomes-Slide
Effect of Family Life Events and Mothers’ Somatic Symptoms on Children’s FGID Symptom Outcomes-Slide
Associations Between Maternal Reinforcement and Parental IBS, and Illness Behavior-Slide 2 of 2
Associations Between Distraction and Amount of Symptom Talk in Laboratory Setting
Parents Can Help Maximize Wellness Behaviors in Their Children
Associations Between Outcomes in FGIDs and Psychological Background in Adolescents
Academic Success Protects from More Severe Symptoms
Social Competence Moderates Effect of Stress on IBS Symptoms
Relationships Among Risk Factors and Outcomes in Children with FAP
Sexual and Physical Abuse
Stress Events Predict: Onset of FGIDs, Sx Exacerb, Health Seeking, & IBS Sx Intensity
Cognitive Triad
Health Beliefs & Coping-FGIDs-Cognitions
Psychosocial Assessment Toolkit-Slide 1 of 2
Psychosocial Assessment Toolkit-Slide 2 of 2
Depression and Anxiety Screening: Hospital Anxiety and Depression Scale (HADS)
Multiple Symptom Screening: Patient Health Questionnaire-15 (PHQ-15)
Catastrophizing Screening: Coping Strategies Questionnaire-Catastrophizing Scale (CSQ-C)
Symptom-Specific Anxiety: Visceral Sensitivity Index (VSI)
Screening for IBS-Specific Quality of Life: IBS QOL
Structured Clinical Interview for DSM (SCID)
Mini-International Neuropsychiatric Interview (MINI)
IBS - Patient’s Agenda
IBS - Doctor’s Agenda
A Typical Scenario: Physician Reaction
Psychological Comorbidity: Let’s Get Focused
Psychological Comorbidity: Approach
What the Doctor Says - What the Patient Hears
Common Psychiatric Diagnoses in FGIDs
Anxiety Disorders
A Treatment Algorithm for Patients with FGIDs
Red Flags – Mental Health Consultation
Targets for Psychological Treatment of FGIDs
Psychological Treatment Components
Barriers to Psychotherapy
Cognitive Behavioral Therapy
Hypnotherapy
Psychodynamic Interpersonal Therapy
Response to Psychological Treatment: Women versus Men
Future Research Directions
Paroxetine vs Psychological Treatment-Slide 1 of 2
Paroxetine vs Psychological Treatment Change in Health Care Costs-Slide 2 of 2
Antidepressants: Mechanism of Action?
TCA Receptor Activity
SSRI Antidepressant Receptor Activity
SNRI Antidepressant Receptor Activity
Tricyclic Antidepressant (TCA) Dosing
SSRI: Dosing Guidelines
Anti-anxiety or Antidepressants for Functional Dyspepsia: A Systematic Review
Psychotropic Drug Treatment: Females vs Males in FGIDs
Sex, Gender, and Gender Role
Key Characteristics of Sex Stereotypes in Western Culture
Gender Differences in Psychological Distress in FGIDs
Gender & Psychosocial Factors - Summary
Reported IBS Prevalence: Females Compared to Males
FGID Prevalence by Sex
Sex Differences in Visceral Pain in Healthy Humans-Slide 1 of 2
Sex Differences in Visceral Pain in Healthy Humans-Slide 2 of 2
Sex Differences in Rectal Perception in IBS
Sex Differences in Visceral Sensitivity
Central Processing of Visceral Stimuli
Men and Women May Process Aversive Information from the Pelvic Viscera Differently
Cardioautonomic Tone Differs Between Men and Women with IBS
Social Factors
FGID Prevalence by Age
Living with Functional Gastrointestinal Disorders
Uncertainty of Living With FGIDs
Patient-Physician Encounter
Patient-Physician Partnership
Culture and Health Care
Lack of Awareness of Cultural Factors
Patients’ Explanatory Models
Doctors’ Explanatory Models
Culture-Related Skills for the Health Care System: Doctors
Culture-Related Skills for the Health Care System: Patients
Cross-Cultural Research Competence
Summary
Multicomponent Approach to Functional GI Disorders-Slide 1 of 9
Establish Therapeutic Relationship
Multicomponent Approach to Functional GI Disorders-Slide 2 of 9
Assess Patient’s Medical History, Psychosocial Situation, and Family
Multicomponent Approach to Functional GI Disorders-Slide 3 of 9
Assess Quality of Life and Level of Daily Functioning
Multicomponent Approach to Functional GI Disorders-Slide 4 of 9
Assess Recent Life Stress and Psychological Distress or Any Precipitating Factors
Multicomponent Approach to Functional GI Disorders-Slide 5 of 9
Review Appropriate Diagnostic Testing and Discuss Results
Multicomponent Approach to Functional GI Disorders-Slide 6 of 9
Make A Confident Diagnosis
Multicomponent Approach to Functional GI Disorders-Slide 7 of 9
Explain and Reassure
Multicomponent Approach to Functional GI Disorders-Slide 8 of 9
Institute Appropriate Treatment
Multicomponent Approach to Functional GI Disorders: Summary Slide-Slide 9 of 9
Suggested General Measures for Constipation
Assess “Severity”: Mild-Slide 1 of 4
Assess “Severity”: Moderate-Slide 2 of 4
Assess “Severity”: Severe-Slide 3 of 4
Assess “Severity”: Mild, Moderate, Severe-Slide 4 of 4
Graded Treatment-Slide 1 of 4
Graded Treatment Response-Slide 2 of 4
Graded Treatment Response-Slide 3 of 4
Graded Treatment Response-Slide 4 of 4
Dietary Advice for IBS
Food: The forgotten Factor
Dietary Advice
Wheat Bran and Stool Weight: A Dose Response
Placebos in Clinical Trials
Components of a Therapeutic Outcome-Slide 1 of 2
Without Placebo and Time Effects . . .-Slide 2 of 2
The Power of a Positive Message-Slide 1 of 2
The Power of a Positive Message-Slide 2 of 2
To Maximize the Placebo Effect
Section Title-Design of Treatment Trials
Challenges to FGID Study Design-Slide 1 of 7
Challenges to FGID Study Design-Slide 2 of 7
Challenges to FGID Study Design-Slide 3 of 7
Challenges to FGID Study Design-Slide 4 of 7
Challenges to FGID Study Design-Slide 5 of 7
Challenges to FGID Study Design-Slide 6 of 7
Challenges to FGID Study Design-Slide 7 of 7
Defining the Question for a Treatment Trial
Population Sample-Slide 1 of 3
Population Sample-Slide 2 of 3
Population Sample-Slide 3 of 3
Defining Subject Eligibility-Slide 1 of 2
Defining Subject Eligibility-Slide 2 of 2
Population Characteristics Influence Outcome
Study Design
Maximizing Blinding
Minimize Bias
Outcome Assessment
Primary Outcome
Define Responder ‘A Priori’
Psychometric Validation: Face Validity
Psychometric Validation: Content Validity
Psychometric Validation: Construct Validity
Psychometric Validation: Reliability
Psychometric Validation: Responsiveness
Adequate Relief
Improved Pain and Stool Parameters in Alosetron Responders with “Adequate Relief”
Improved IBSQOL Quality of Life Scores in Alosetron Responders With “Adequate Relief”
Satisfactory Relief
Number of Symptoms Improved With Subjective Global Assessment (SGA) of Relief
Mean Symptom Score Changes in Responders Reporting Satisfactory Relief
Adequate and Satisfactory Relief
Secondary Outcome
Scales for Primary or Secondary Outcomes: Combined Scale-Slide 1 of 4
Scales for Primary or Secondary Outcomes: Combined Scale-Slide 2 of 4
Scales for Primary or Secondary Outcomes: Combined Scale-Slide 3 of 4
Scales for Primary or Secondary Outcomes: Combined Scale-Slide 4 of 4
Statistical Analysis: Sample Size
Main Data Analysis
The Consort E-Flowchart-August 2005
Ethics and Reporting
Section Title: Functional Dyspepsia
Dietary Recommendations for Functional Dyspepsia: What’s the Evidence?
Current Management of Functional Dyspepsia
Cochrane Collaboration Meta-Analysis of H pylori Cure for FD
The Rationale for Antisecretory Therapy in Functional Dyspepsia
Meta-Analysis of PPI Therapy for Functional Dyspepsia
Efficacy of PPI Therapy in Functional Dyspepsia Subgroups
Meta-Analysis of H2RA therapy for Functional Dyspepsia
Types of Prokinetics
Meta-Analysis of Prokinetic Therapy for Functional Dyspepsia
Funnel Plot Prokinetic Trials: Publication Bias?
Metoclopramide for Functional Dyspepsia
Domperidone for Functional Dyspepsia
Forest Plot of Domperidone Trials for Functional Dyspepsia
Cisapride for Functional Dyspepsia: A Meta-Analysis
Tegaserod Accelerates Gastric Emptying
Effect of Tegaserod on Gastric Accommodation in Functional Dyspepsia
Tegaserod for Functional Dyspepsia: Effect on Satisfactory Relief
Alosetron for Functional Dyspepsia: Effect on Adequate Relief
Levosulpiride or Cisapride for Dysmotility-like Functional Dyspepsia
Itopride for Functional Dyspepsia
Motilin Agonist ABT-229: The Disconnect Between Gastric Emptying and Symptoms
Influence of Motilin on Gastric Accommodation: Stiffens the Fundus
Investigational Therapies for Functional Dyspepsia
Herbal Remedies for Functional Dyspepsia: A Systematic Review
Other Complimentary Therapies for Functional Dyspepsia
STW 5 for Moderate to Severe FD: Results from a Placebo-Controlled, Double-Blind Study
Treatment of Functional Dyspepsia-Epigastric Pain
Treatment of Functional Dyspepsia-Postprandial Distress
Section Title-IBS
Pharmacologic Treatments
Pharmacotherapy in IBS Should Be Directed to the Dominant Symptom(s)
Role of Food Allergy and Intolerance in IBS
Food Elimination Reduces IBS Symptoms
Practical Approach to Traditional Therapies
Efficacy of Fiber in IBS-C
Fiber/Bulking Agents for IBS: Effect on Global Symptoms
Antispasmodics in IBS
Efficacy of Antispasmodics in IBS
Loperamide for IBS-D
The Role of Neurotransmitters in GI Function
Serotonergic Agents
Efficacy of Alosetron in IBS: A Meta-Analysis of RCTs
Alosetron Improves Global Symptoms in Women with Severe IBS-D
Long-Term Efficacy with Alosetron
Safety Profile of Alosetron
Indications for Restricted Use of Alosetron
Ischemic Colitis in the General Population and IBS Patients Taking Alosetron
Tegaserod Improves Global Symptoms in IBS-C
Safety Profile of Tegaserod
Tegaserod
Lubiprostone for IBS-C: Data from 2 Phase III Trials
Incidence of Nausea with Lubiprostone in Clinical Trials
Effect of Linaclotide on Colonic Transit in IBS-C
Effect of Rifaximin in Patients with Bloating Without SIBO
Rifaximin for IBS: Global Improvement at 4 Weeks
Antibiotics for IBS: Points to Consider
Bifidobacterium infantis 35624 for IBS
Probiotic Bifidobacterium infantis Normalized Cytokine Levels in IBS
Complementary Therapy for IBS: Chinese Herbal Therapy
Complementary Therapy for IBS: Acupuncture
Drugs in Development for IBS-D
Autonomic Modulators
Renzapride, a 5-HT4 Agonist / 5-HT3 Antagonist, Accelerates Colonic Transit in Patients with IBS-C
Emerging Therapies for IBS
Evidence-Based Summary of Medical Therapies for IBS-C
Evidence-Based Summary of Medical Therapies for IBS-D
Section Title: Constipation
Functional Constipation
General Measures for Constipation
Medications Associated With Constipation
Fiber Supplementation and Bulk Laxatives Classification
Wheat Bran and Stool Weight: A Dose Response
Stimulant Laxatives: Classification and Mechanism of Action-Slide 1 of 2
Stimulant Laxatives: Classification and Mechanism of Action-Slide 2 of 2
Efficacy of Stimulant Laxatives
FDA-Approved Treatment Options for Constipation
Complete Spontaneous Bowel Movement Rate with Tegaserod vs Placebo in Chronic Constipation
Osmotic Laxatives: Mono- and Disaccharides-Slide 1 of 2
Osmotic Laxatives: Mono- and Disaccharides-Slide 2 of 2
Osmotic Laxatives: Saline Laxatives
Osmotic Laxatives: Classification
Effectiveness and Safety Profile of Lactulose
Short-Term Effectiveness of PEG 3350 in Chronic Constipation
Long-Term Effectiveness of PEG 3350 in Chronic Constipation
Effectiveness and Safety Profile of PEG 3350
Serotonin Plays an Important Role in Bowel Function and Sensation
Sustained Improvement in Chronic Constipation With Tegaserod Over 13 Months
Polyethylene Glycol vs Tegaserod in Chronic Constipation
Chloride Channels in Intestinal Transport
Effects of Lubiprostone on Number of Spontaneous Bowel Movements
Lubiprostone: Global Assessment of Treatment from Open-Label Follow-up Trials
Safety Profile of Lubiprostone
Investigational Therapies for Chronic Constipation: Something Old, Something New…
Effect of Methylnaltrexone* on Opioid-Induced Constipation
Effects of Biofeedback on Dyssynergic Defecation
Biofeedback Improves Dyssynergic Defecation: Results from a Controlled Trial
Biofeedback for Dyssynergic Defecation
Comorbid Psych & Eating Dis Reduce Efficacy of Pelvic Floor Biofeedback
Colectomy for Refractory Slow-Transit Constipation
Section Title: Fecal Incontinence
Treatment of Fecal Incontinence
Biofeedback for Fecal Incontinence: Training Methods
Surgical Approaches for Fecal Incontinence
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