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Jaundice

Jaundice (also termed icterus ) is a distinctive and often striking yellow discoloration of the skin, conjunctivae, and mucous membranes that results from widespread tissue deposition of the compound bilirubin. Although jaundice is commonly viewed as a sign of liver and biliary tract disease, the differential diagnosis is broad, and identifying the cause of jaundice and how best to treat it have challenged clinicians for millennia.…

Gastrointestinal Bleeding

The annual rate of hospitalization for any type of GI hemorrhage in the US is estimated to be 350 hospital admissions/100,000 population, with more than 1,000,000 hospitalizations each year. Approximately 50% of admissions for GI bleeding are for UGI bleeding (from the esophagus, stomach, and duodenum), 40% are for LGI bleeding (from the colon and anorectum), and 10% are for obscure bleeding (from the small intestine).…

Constipation

Constipation is a term used to describe a person’s perception of altered bowel movements that includes hard stools, difficulty with defecation, and a sensation of incomplete evacuation, among others. Chronic constipation is diagnosed when a person describes symptoms of constipation for at least 3 consecutive months. Chronic constipation is usually due to a disorder of colonic propulsion and/or rectal evacuation and can be divided into 3…

Fecal Incontinence

Acknowledgment The author is most grateful for the excellent secretarial assistance of Ms. Helen Smith and Dr. Yun Yan. This work was supported in part by Grant U-34; U-01 and R-21from the National Institutes of Health. Fecal incontinence is defined as the involuntary leakage of fecal matter through the anus or inability to control the discharge of bowel contents. Its severity can range from occasional unintentional…

Intestinal Gas

Although many patients encountered in clinical practice complain about intestinal gas, systematic investigation of this subject did not begin until the 1960s, when studies by Michael Levitt, MD, and colleagues began to shed light on the pathophysiology of intestinal gas. Composition and Volume of Gastrointestinal gas The GI tract normally contains a relatively small amount of gas. The volume of gas within the intestinal lumen is…

Diarrhea

Diarrhea is a universal human experience. In an average month, 7.5% of Americans have symptoms of acute gastroenteritis. For most persons, episodes of diarrhea last a day or 2 and rapidly subside without medical intervention. For others, diarrhea lasts for more than a few days or is complicated by fever, prostration, or rectal bleeding. Such persons are likely to visit a health care provider. Over 3.5…

Nausea and Vomiting

Acknowledgment The authors acknowledge the contributions of Drs. Juan-R. Malagelada and Carolina Malagelada to this chapter in previous editions of the book. Nausea is an unpleasant subjective sensation of impending vomiting and can be associated with salivation, anorexia, perspiration, disinterest in ongoing activities, and anxiety. In many cases, the sensation cannot be localized, although in some instances, it is felt in the epigastrium or throat. Nausea…

Dyspepsia

Definition Dyspepsia is derived from the Greek words “δυς-” (dys-) and “πέψη” (pepse) and literally means “difficult digestion.” In current medical terminology, dyspepsia refers to a heterogeneous group of symptoms in the upper abdomen. In the literature, dyspepsia is often broadly defined as pain or discomfort centered in the upper abdomen but may include multiple and varying symptoms such as epigastric pain, postprandial fullness, early satiation,…

Symptoms of Esophageal Disease

Common symptoms that affect the esophagus include dysphagia, odynophagia, globus sensation, hiccups, chest pain, heartburn, regurgitation, and a number of “supraesophageal” complaints that have been attributed to gastroesophageal reflux. A carefully taken history can clarify many of these symptoms and is followed by selected testing, therapeutic trials, or both. Dysphagia is either proximal or distal and can be to solids only or to liquids and solids.…

Chronic Abdominal Pain

Evaluating any patient with a complaint of abdominal pain is challenging. Abdominal pain can be benign and self-limited or a harbinger of a serious life-threatening disease (see Chapter 11 ). Chronic abdominal pain poses a particularly challenging clinical problem. Not only is the management of chronic abdominal pain a frequently daunting task, but the clinician must also remain vigilant to avoid overlooking an otherwise specifically treatable…

Acute Abdominal Pain

Acute abdominal pain is a frequent complaint that causes patients to visit an emergency department. In 2014, 11.1 million emergency department visits in the USA were due to abdominal pain, accounting for 8% of all emergency department visits that year. Approximately 40% of these patients have nonspecific findings. Of the remainder in whom a specific diagnosis is ascertainable, most causes are surgical disorders that warrant further…

Food Allergies

The first recorded account of food allergy is attributed to Hippocrates, but it was not until 1921 that Prausnitz’s classic experiment initiated scientific investigation of food allergy and established the immunologic basis of allergic reactions. In his experiment, Prausnitz injected serum from his fish-allergic patient, Küstner, into his own skin; the next day he injected fish extract into the same areas and into control sites. A…

Feeding and Eating Disorders

Acknowledgment The authors would like to thank Anne E. Becker and Sarah A. Kearney for their enormous contribution to this chapter in the 10th edition. Eating disorders (EDs) are mental disorders characterized by disturbances in body image, weight control, and/or dietary patterns. In the Diagnostic and Statistical Manual of Mental Disorders , 5th edition (DSM-5), an updated and expanded section summarizes feeding and EDs that include:…

Surgical and Endoscopic Treatment of Obesity

Severe obesity is the leading public health crisis of the industrialized world (see Chapter 7 ). The prevalence of obesity in the USA continues to rise at an alarming rate, with two thirds of adults currently considered overweight, half of whom are obese. The etiology of obesity is complex and only partially understood. Genetic, epigenetic, environmental, and psychological factors are all involved to varying degrees, but,…

Nutritional Management

Nutrition in Specific Disease States Nutritional assessment and directed nutritional therapy are important in the treatment of many GI diseases. Familiarity with appropriate nutritional intervention is imperative to obtain good clinical outcomes. The preceding chapter reviewed nutritional assessment, and this chapter will give an overview of nutritional concerns in common GI disorders and treatment of nutritional deficiencies by parenteral nutrition (PN) and enteral nutrition (EN). Intestinal…

Nutritional Principles and Assessment of the Gastroenterology Patient

Diligent attention to patients’ nutritional needs can have a major positive impact on medical outcomes. This is particularly true in GI and liver disease because many of these conditions, in addition to altering nutrient metabolism and requirements, are prone to interfere with ingestion and assimilation of nutrients. Nutritional management, however, often continues to be an inadequately or incorrectly addressed component of patient care. Inadequate or misdirected…

Gut Sensory Transduction

The gastrointestinal (GI) tract relies on hormones and neurotransmitters to integrate signals arising in the lumen with whole-body homeostasis. For instance, satiety in the brain is, to a great extent, induced by the presence of food in the gut. This process begins with ingestion of nutrients that stimulate sensory cells in the intestinal epithelium that modulate food intake via the release of specific chemical messengers. GI…

The Enteric Microbiota

Characteristics of the Human Intestinal Microbiome The intestinal microbiome is a diverse ecosystem comprising microorganisms (bacteria, archaea, fungi, and viruses including bacteriophages), their genomes (i.e., genes), and the surrounding environmental conditions. The population of microorganisms alone in a particular niche is referred to as microbiota ( Box 3.1 ) and is often used interchangeably with microbiome, which includes the genomes of the microorganisms. Each of these…

Mucosal Immunology and Inflammation

Mucosal immunity refers to immune responses that occur at mucosal sites. The demands on the mucosal immune system are quite distinct from their systemic counterparts. At mucosal sites, the “outside world” is typically separated from the inner world by a single layer of epithelium. The mucosal immune system exists at a number of sites, including the intestinal tract, respiratory tract (especially the upper respiratory tract), urogenital…