Comments for Gut Check on Gastroenterology

Comment on What is your best treatment for “refractory” constipation? by Dingane Baruti MD

Dingane Baruti MD — Thu, 11 Apr 2013 12:44:02 +0000

For adult males, use a fiber foods chart to demonstrate how to consume 35 grams of fiber daily (from foods, not supplements). Women should consume 25 grams daily. Children and adolescents, 10 – 15 grams daily. Also, 8 oz of water with breakfast, lunch and dinner is a minimum amount of water each day.

If constipation persists then ask the patient to drink 470 ml of Magnesium Citrate (this entire volume should be consumed within 15 minutes). One hour after drinking the Mag Citrate, have the patient use any Sodium Phosphate enema (Fleets). This approach is not likely to work in patients with mega colon.

Comment on What is your best treatment for “refractory” constipation? by Julie Stansfield MD, FACP

Julie Stansfield MD, FACP — Tue, 02 Apr 2013 02:02:12 +0000

For constipation refractory to all prescription medicine and noted above otc agents, I have had good luck with Alli ( the obesity medicine) and adding a tablespoon of olive oil with it as a chaser.

Comment on What is your best treatment for “refractory” constipation? by lucina jackson

lucina jackson — Fri, 08 Mar 2013 19:50:30 +0000

First address diet, increase fibre and fluids and increase exercise
for younger patients trial fybogel bd , this is rarely effective for older population so in all those > 40 years I prescribe movicol 1 to 3 daily.. If ineffective add senna 2 alt days or sodium docusate 200mg alt nights.
For more resistant cases trial resilor 2mg increasing to 4mg whilst continuing movicol.
I tend to colonoscope older group ie > 50 years if constipation new symptom. I would like to do transit studies in all refractory cases but when not available do sweetcorn transit time!!
always check TFTs and Ca

Comment on Can colonoscopy cause diverticulitis? by Frankie

Frankie — Thu, 07 Mar 2013 12:34:59 +0000

I had abdominal surgery to repair colon/intestinal adhesions and blockage a couple of years ago. The only symptoms I had had before sugery was loose stools and pelvic floor pain. After surgery I developed typical symptoms of diverticulitis that I’ve had ever since. I finally reached a point where it seemed to calm down . Then, after getting a CT scan for a tailbone issue my doctor told me I was constipated. I took a mild laxative (epsom salts) which worked great (no pain) and within days the diverticulitis symptoms came back with a vengeance and have stayed. I believe that the sudden cleaning out of the bowel irritated it severely. Since then I have started drinking raw milk, taking probiotics and drinking slippery elm bark tea. It seems to be really helping. One other thing. No doctor tells you that when you take antibiotics, the good bacteria necessary for healthy bowels are killed off along with the bad bacteria and that you really need to take probiotics to get the balance back. Why not?

Comment on What is your best treatment for “refractory” constipation? by Victor Boran

Victor Boran — Tue, 05 Mar 2013 03:00:48 +0000

I’m a pharmacist in Canada. I think at this point it’s time to break out the suppositories. I’d go with glycerin suppositories, or suppositories with laxative in them. Maybe use a suppository that has both.

Comment on What is your best treatment for “refractory” constipation? by Michael Bluth

Michael Bluth — Sun, 24 Feb 2013 08:12:37 +0000

In our hospital we use Gastrografin a idoine based contrast dye usually 100ml diluted with 100ml water in cases of refractory constipation borderling ileus especially in patients with high doses of opiods or peritoneal carcinosis.
Usually a very strong evacuation is achieved and then Laxoberal (Natriumpicosulphate) and Macrogrol do it´s work again.
A similar effect is usually achieved by the preparation for colonoscopy i.e. drinking 4l of Clean prep. etc. but it´s usually unnecessary execept it has never been done or other reasons for believing it could be cancer loom around.

Comment on Can colonoscopy cause diverticulitis? by Orville

Orville — Fri, 22 Feb 2013 02:46:30 +0000

I had a colonoscopy about 5 months ago and had a polyp removed, everything else was fine, never had any issues prior to my colonoscopy. Two weeks ago I end up in the emergency room with severe pain, diarrhea, bloody stools. They said I had an infection in my colon, gave me antibiotics, felt better. Went to the Dr. for a follow-up and they tell me I have diverticulitis. I believe it was definately caused from the colonoscopy.

Comment on Can colonoscopy cause diverticulitis? by Karin Myers

Karin Myers — Wed, 20 Feb 2013 18:05:33 +0000

I am 69 female. Had diverticulitis Sept.2012 and Jan. 2013 dx via CAT-Scan.
Rx antibiotic regimen both times. GI scheduled colonoscopy next week. I asked him to look at the CAT-Scans, he refused to look. I am very apprehensive and not sure if I should have this Colonoscopy done. Stool was not checked for occult blood. Please, I need advice. Thank you.

Comment on What is your best treatment for “refractory” constipation? by Geoffrey L. Braden MD

Geoffrey L. Braden MD — Wed, 20 Feb 2013 02:19:42 +0000

Dear Brian,
You have posted a great question that is difficult to answer because a certain number of patients with truly refractory constipation will have megacolons, enteric nerve cell damage and dropout in the colon and/or severe pelvic floor dysfunction. I frequently order a Sitzmark study to try to sort out the contributions of the problems to the patient’s case. I have had some success using lubiprostone 24 mgs bid, Miralax twice per day and one or two doses of liquid MOM per day. What we need is a true prokinetic agent that does not damage the enteric nervous system. I have started to use linaclotide 290mcgs. It is really potent and I have received many calls from IBS-C patients that are developing diarrhea on the reduced dose of 145 mcgs per day. I have had +/- results using linaclotide in patients with acquired megacolon.

Comment on What is your best treatment for “refractory” constipation? by Laji Samuel

Laji Samuel — Tue, 19 Feb 2013 17:19:35 +0000

i am eagerly awaiting the responses to these relevant questions from other experts in the field. However i would also like your own expert opinion, Dr Fennerty.