Stopping or reducing dietary fiber intake reduces constipation and its associated symptoms

AIM: To investigate the effect of reducing dietary fiber on patients with idiopathic constipation. METHODS: Sixty-three cases of idiopathic constipation presenting between May 2008 and May 2010 were enrolled into the study after colonoscopy excluded an organic cause of the constipation. Patients with previous colon surgery or a medical cause of their constipation were excluded. All patients were given an explanation on the role of fiber in the gastrointestinal tract. They were then asked to go on a no fiber diet for 2 wk. Thereafter, they were asked to reduce the amount of dietary fiber intake to a level that they found acceptable. Dietary fiber intake, symptoms of constipation, difficulty in evacuation of stools, anal bleeding, abdominal bloating or abdominal pain were recorded at 1 and 6 mo. RESULTS: The median age of the patients (16 male, 47 female) was 47 years (range, 20-80 years). At 6 mo, 41 patients remained on a no fiber diet, 16 on a reduced fiber diet, and 6 resumed their high fiber diet for religious or personal reasons. Patients who stopped or reduced dietary fiber had significant improvement in their symp-toms while those who continued on a high fiber diet had no change. Of those who stopped fiber completely, the bowel frequency increased from one motion in 3.75 d (± 1.59 d) to one motion in 1.0 d (± 0.0 d) (P < 0.001); those with reduced fiber intake had increased bowel frequency from a mean of one motion per 4.19 d (± 2.09 d) to one motion per 1.9 d (± 1.21 d) on a reduced fiber diet (P < 0.001); those who remained on a high fiber diet continued to have a mean of one motion per 6.83 d (± 1.03 d) before and after consultation. For no fiber, reduced fiber and high fiber groups, respectively, symptoms of bloating were present in 0%, 31.3% and 100% (P < 0.001) and straining to pass stools occurred in 0%, 43.8% and 100% (P < 0.001). CONCLUSION: Idiopathic constipation and its associated symptoms can be effectively reduced by stopping or even lowering the intake of dietary fiber.

Fiber and colorectal diseases: Separating fact from fiction

Whilst fruits and vegetables are an essential part of our dietary intake, the role of fiber in the prevention of colorectal diseases remains controversial. The main feature of a high-f iber diet is its poor digestibility. Soluble fiber like pectins, guar and ispaghula produce viscous solutions in the gastrointestinal tract delaying small bowel absorption and transit. Insoluble f iber, on the other hand, pass largely unaltered through the gut. The more fi ber is ingested, the more stools will have to be passed. Fermentation in the intestines results in build up of large amounts of gases in the colon. This article reviews the physiology of ingestion of fiber and defecation. It also looks into the impact of dietary fiber on various colorectal diseases. A strong case cannot be made for a protective effect of dietary fi ber against colorectal polyp or cancer. Neither has fi ber been found to be useful in chronic constipation and irritable bowel syndrome. It is also not useful in the treatment of perianal conditions. The fiber deficit -diverticulosis theory should also be challenged. The authors urge clinicians to keep an open mind about fi ber. One must be aware of the truths and myths about fi ber before recommending it.

Innovations in chronic anal fissure treatment:A systematic review

A chronic anal fissure is a common perianal condition.This review aims to evaluate both existing and new therapies in the treatment of chronic fissures.Pharmacological therapies such as glyceryl trinitrate(GTN),Diltiazem ointment and Botulinum toxin provide a relatively non-invasive option,but with higher recurrence rates.Lateral sphincterotomy remains the gold standard for treatment.Anal dilatation has no role in treatment.New therapies include perineal support devices,Gonyautoxin injection,fissurectomy,fissurotomy,sphincterolysis,and flap procedures.Further research is required comparing these new therapies with existing established therapies.This paper recommends initial pharmacological therapy with GTN or Diltiazem ointment with Botulinum toxin as a possible second line pharmacological therapy.Perineal support may offer a new dimension in improving healing rates.Lateral sphincterotomy should be offered if pharmacological therapy fails.New therapies are not suitable as first line treatments,though they can be considered if conventional treatment fails.

Intestinal type gastric adenocarcinoma with unusual synchronous metastases to the colorectum and bladder

A 75-year-old male presented with difficult defecationand increasing urinary frequency over a few months. He had a significant history of previous partial gastrectomy for gastric carcinoma 20 years prior. Computed tomography of the abdomen and pelvis showed extensive lymphadenopathy, a gastric mass and rectal as well as bladder wall thickening with bilateral ureterohydronephrosis. Normal looking serosal surfaces of the bladder and bowel were seen on laparoscopy and a defunctioning ileostomy was created. Gastroscopy revealed a malignant mass while cystoscopy and sigmoidscopy found extensive tumour growth lining the mucosal surfaces. Biopsies from all sites were compatible with intestinal type adenocarcinoma of gastric origin with few signet ring cells. Metabolic response to palliative chemotherapy was good and the patient's symptoms have improved on follow-up four months post ileostomy. We discuss the immunohistochemical profile of the tumour and review the literature.

直肠癌根治术中的盆腔自主神经保护:30年变迁

全直肠系膜切除(TME)理念及微创技术(如腹腔镜结直肠手术和机器人手术)的出现大大提高直肠癌的外科疗效。然而,术后排尿功能和性功能障碍率仍然较高,从而给患者造成巨大的痛苦,同时也会给手术医生带来困扰。新辅助和辅助放疗应用的增多也带来了更多的功能问题。在本文中,我们对盆腔神经解剖的目前认识进行了评价,将盆腔神经分为肠系膜下动脉根部、侧盆壁及泌尿生殖器官周围等区域,探讨了在这些区域如何进行手术操作。同时,我们也讨论了过去30年不同手术方式(包括开腹、腹腔镜和机器人)的功能状况。