Books
Rome III: The Functional Gastrointestinal Disorders
Understanding the Irritable Gut
Computer-Based Learning Program - Full Set
Full Set - ON CD-ROM
Computer-Based Learning Program - Epidemiology Set
Epidemiology Set - ON CD-ROM
Computer-Based Learning Program - Basic Science Set
Basic Science Set - ON CD-ROM
Computer-Based Learning Program - Diagnosis Set
Diagnosis Set - ON CD-ROM
Computer-Based Learning Program - Treatment Set
Treatment Set - ON CD-ROM
Computer-Based Learning Program - Pediatric Set
Pediatric Set - ON CD-ROM
Computer-Based Learning Program - Psychosocial Set
Psychosocial Set - ON CD-ROM
Computer-Based Learning Program - Primary Care Set
Computer-Based Learning Program - Integrated Module for IBS
Computer-Based Learning Program - Integrated Module on Constipation
Computer-Based Learning Program - Integrated Module on Dyspepsia
Individual Computer-Based Learning Program
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
IBS Patients, As Well As Functional Dyspepsia, Exhibit Esophageal 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
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
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
Colonic Motility: Nonpropagating Contractions Decrease During Sleep and Increase on Waking
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)
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
Incidence of IBS in the General Population
Impact of IBS on Quality of Life Compared to 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
Overlap Among GI Symptoms
IBS Coexists With Many Other Functional Symptoms
IBS - Most Common Diagnosis In Women With Chronic Pelvic Pain
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
Associations Between Maternal Reinforcement and Parental IBS, and Illness Behavior-Slide 2 of 2
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
Children of IBS Patients Make More Health Care Visits Overall
Children of IBS Patients Make More Health Care Visits for GI Symptoms
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
Targets for Psychological Treatment of FGIDs
Red Flags – Mental Health Consultation
IBS - Doctor’s Agenda
A Typical Scenario: Physician Reaction
A Treatment Algorithm for Patients with FGIDs
Psychological Comorbidity: Let’s Get Focused
Psychological Comorbidity: Approach
What the Doctor Says - What the Patient Hears
Common Psychiatric Diagnoses in FGIDs
Anxiety Disorders
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