Archive for the ‘Disease’ Category


Chronic Constipation: TREATMENT OPTIONS

Mar 16, 2010 Author: Walter Mcneil | Filed under: Disease

Chronic constipation is an undertreated disorder. Only 26% of patients meeting the Rome II diagnostic criteria for this condition are thought to seek medical attention.

Many patients mistakenly believe that constipation is a temporary and personal problem rather than a medical problem. In addition, the social stigma and embarrassment surrounding discussions of bodily functions may deter some people from seeking medical help. Attempts to self-treat with over-the-counter products resulted in slightly more than $700 million in sales of laxatives in 2004.

For those who do eventually seek medical care for this disorder, there are currently three treatment options: lifestyle and dietary changes, pharmacological treatments, and bio-feedback.

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Chronic Constipation: EPIDEMIOLOGY

Mar 15, 2010 Author: Walter Mcneil | Filed under: Disease

EPIDEMIOLOGY

Prevalence

The exact number of people who experience chronic costipation is not known. The prevalence varies according to the demographic features and the definition used. Studies of prevalence have estimated the rate to be as high as 27%, but 15% is the more commonly accepted number.

Demographic patterns from several studies suggest that chronic constipation is more prevalent in certain popula­tions such as women and people older than 65 years of age. For every man who experiences chronic constipation, it is thought that two to three women have the same disorder. The rate of chronic constipation for patients over 65 years of age has been reported to be as high as 40%, signaling that this group of patients is particularly at risk.

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Chronic Constipation: SUBTYPES OF PRIMARY CHRONIC CONSTIPATION

Mar 14, 2010 Author: Walter Mcneil | Filed under: Disease

Primary chronic constipation has been divided into three pathophysiological subtypes: (1) slow-transit constipation, (2) dyssynergic defecation, and (3) normal-transit constipation. There is a significant overlap among different types of constipation, and symptoms alone cannot differentiate the various types.

Slow-transit constipation, also known as colonic inertia, is the diagnosis when the measured colonic transit time is prolonged. This type of constipation most commonly occurs in young women who present with infrequent defecation and bloating.

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Chronic Constipation

Mar 13, 2010 Author: Walter Mcneil | Filed under: Disease

Chronic Constipation

INTRODUCTION

Chronic constipation, widely prevalent and commonly seen in clinical practice, can have a significant impact on patients’ quality of life. It also has a major impact on the U.S. economy in terms of both health care costs and lost productivity.

Commonly accepted treatments vary in terms of their efficacy and safety—and both physicians and their patients have expressed a strong desire for improved therapeutic options. This article provides a brief overview of chronic constipation, including its definition, potential impact, and treatment. The objective is to give managed care decision makers and prescribing physicians the means to make informed choices about this all-too-prevalent condition.

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insulin

This study of a national sample of American men aged 40-74 years confirmed that seropositivity for H. pylori is associated with MI prevalence in men with diabetes but not in men without diabetes. Seropositivity for H. pylori was not significantly associated with prevalent diabetes mellitus or certain variables of the metabolic syndrome. For example, fasting serum insulin and glucose concentrations showed no significant associations with seropositivity for H. pylori in nondiabetic men. Serum or blood markers of inflammation were not associated with seropositivity for H. pylori, with the exception of serum ferritin.

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Prevalence

Figure 1 shows the prevalence of infection with H. pylori by age in American men aged 40-74. The prevalence generally rose in each decade of life from the fifth through seventh decades.

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NHANES III was conducted in 1988-1994 on a nationwide multistage probability sample of approximately 40,000 persons from the civilian, noninstitu-tionalized population of the United States aged two months and over excluding reservation lands of American Indians. Of these, 31,311 were examined. The analysis was restricted to men to eliminate confounding by gender, pregnancy, menopause, parity, or female hormone use. IgG antibodies to H. pylori were measured only in the first half of the survey (Phase I), itself a representative sample of the U.S. population. The analyses in this report are limited to examined men aged 40-74 years for whom a valid serum H. pylori antibody measure and data on history of doctor diagnosed diabetes and glycated hemoglobin measured in the survey were available. The study was restricted to men older than 40 and younger than 75 years because that was the age range of the subsample, which received an oral glucose tolerance test in NHANES III. The analyses of serum antibody and fasting serum glucose, insulin, and triglycerides are restricted to men examined in the morning after fasting nine-to-24 hours with valid serum antibody and insulin data, no history of diabetes, and not taking insulin or oral hypoglycemic agents. Numbers of persons in various regression analyses that follow may vary slightly due to differing numbers with missing values on selected other variables. Details of the plan, sampling, operation, and response have been published as have procedures used to obtain informed consent and to maintain confidentiality of information obtained.

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Helicobacter pylori

INTRODUCTION

Few studies have examined the relationship of infection with Helicobacter pylori and prevalence of diabetes, increased serum insulin concentration, or insulin resistance, despite the relationship postulated for all these variables with coronary heart disease (CHD), and atherosclerosis. Some studies report higher prevalence of infection with H. pylori in persons with type-2 or type-1 than in nondiabetics, while others do not. No study was found of the association of infection with H. pylori and glucose utilization measured using a hyperinsulinemic euglycemic clamp, the best indicator of insulin resistance. The existence of an independent association of H. pylori infection status with future risk of myocardial infarction (MI) has been reported in a few studies but not in others, an association in unadjusted analysis often being greatly or completely diminished after adjusting for confounders. One study found a strong association of H. pylori status with prevalence of coronary disease, stroke, and HDL and triglyceride concentration in a series of diabetics. Studies of infection with H. pylori and obesity or other risk factors failed to find a consistent association. Well-established are associations of metabolic risk factor clustering with insulin sensitivity and hyperinsulinemia, the metabolic syndrome.

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