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GIT j club ibd pregnancy
- 1. Kurdistan Board GEH/GIT SurgeryKurdistan Board GEH/GIT Surgery Weekly J ClubWeekly J Club Supervised by:Supervised by: Dr. Mohamed AlshekhaniDr. Mohamed Alshekhani
- 2. Introduction:Introduction: Incidence peaks during childbearing, as 50% diagnosed before 32Incidence peaks during childbearing, as 50% diagnosed before 32 making family planning & IBD management coincide.making family planning & IBD management coincide. Most IBD patients have successful pregnancies, but IBD womenMost IBD patients have successful pregnancies, but IBD women have fewer children than the general pop from voluntaryhave fewer children than the general pop from voluntary childlessness due to pprehension/misperceptions about fertility,childlessness due to pprehension/misperceptions about fertility, medication safety&potential adverse pregnancy outcomes.medication safety&potential adverse pregnancy outcomes. Fear of infertility is common &adversely impact family planningFear of infertility is common &adversely impact family planning decisions,but women with quiescent IBD & no prior pelvic surgerydecisions,but women with quiescent IBD & no prior pelvic surgery have similar infertility (5–14%) as the general population.have similar infertility (5–14%) as the general population. Active disease does impair fertility, via pelvic inflammation, poorActive disease does impair fertility, via pelvic inflammation, poor nutrition, decreased libido, dyspareunia, depression,pelvic surgerynutrition, decreased libido, dyspareunia, depression,pelvic surgery due to scarring/adhesions, IPAA surgery in ulcerative colitis (Lapdue to scarring/adhesions, IPAA surgery in ulcerative colitis (Lap total proctocolectomy with IPAA / colectomy with ileorectaltotal proctocolectomy with IPAA / colectomy with ileorectal anastomosismay preserve fertilityanastomosismay preserve fertility IPAA does not appear to impact success rates of in IVF.IPAA does not appear to impact success rates of in IVF.
- 3. Introduction:Introduction: In Infertile women occult disease activity, hypovitaminosis D, andIn Infertile women occult disease activity, hypovitaminosis D, and celiac disease should be sopught&If women remain as such after 6celiac disease should be sopught&If women remain as such after 6 months, reproductive endocrinologidt consulted.months, reproductive endocrinologidt consulted. Zinc deficiency in Crohn may impair sperm function.Zinc deficiency in Crohn may impair sperm function. Sulfasalazine causes reversible infertility due to dose-dependentSulfasalazine causes reversible infertility due to dose-dependent oligospermia,reduced sperm motility& altered sperm morphology.oligospermia,reduced sperm motility& altered sperm morphology. Methotrexate may reduce sperm quality, reversible when the drugMethotrexate may reduce sperm quality, reversible when the drug is discontinued&men should stop methotrexate at least 3 monthsis discontinued&men should stop methotrexate at least 3 months before attempting conception.before attempting conception. anti-TNF s accelerate germ cell apoptosis in the seminiferousanti-TNF s accelerate germ cell apoptosis in the seminiferous tubules,20 which might theoretically decrease sperm count.tubules,20 which might theoretically decrease sperm count.
Editor's Notes
- Irritable Bowel Syndrome Slide Cover
- IBS was long dismissed as a psychosomatic condition.1 It has no clear etiology or pathophysiology, affects mainly women, and is not fatal.2 However, attitudes are changing as physicians learn more about the pathophysiology of IBS. The incidence and prevalence of IBS have not been extensively monitored, so it is difficult to discern historical trends. Also, only a small proportion of IBS sufferers seek treatment,3 and diagnosis of the condition is difficult.4 References: 1.Maxwell PR, Mendall MA, Kumar D. Irritable bowel syndrome. Lancet. December 1997;350:1691-1695. 2. Sandler RS. Epidemiology of irritable bowel syndrome in the United States. Gastroenterology. August 1990;99:409-415. 3. Drossman DA, Thompson WG. The irritable bowel syndrome: review and a graduated multicomponent treatment approach. Ann Intern Med. June 1992;116(pt 1):1009-1016. 4. Paterson WG, Thompson WG, Vanner SJ, et al. Recommendations for the management of irritable bowel syndrome in family practice. Can Med Assoc J. July 1999;161:154-160.
- IBS was long dismissed as a psychosomatic condition.1 It has no clear etiology or pathophysiology, affects mainly women, and is not fatal.2 However, attitudes are changing as physicians learn more about the pathophysiology of IBS. The incidence and prevalence of IBS have not been extensively monitored, so it is difficult to discern historical trends. Also, only a small proportion of IBS sufferers seek treatment,3 and diagnosis of the condition is difficult.4 References: 1.Maxwell PR, Mendall MA, Kumar D. Irritable bowel syndrome. Lancet. December 1997;350:1691-1695. 2. Sandler RS. Epidemiology of irritable bowel syndrome in the United States. Gastroenterology. August 1990;99:409-415. 3. Drossman DA, Thompson WG. The irritable bowel syndrome: review and a graduated multicomponent treatment approach. Ann Intern Med. June 1992;116(pt 1):1009-1016. 4. Paterson WG, Thompson WG, Vanner SJ, et al. Recommendations for the management of irritable bowel syndrome in family practice. Can Med Assoc J. July 1999;161:154-160.
- IBS is one of over 20 functional gastrointestinal (GI) disorders.1 The functional GI disorders vary clinically and are characterized by chronic or recurrent symptoms not explained by structural or biochemical abnormalities. It appears that these disorders relate to abnormalities in motility and/or afferent sensitivity as modulated by the central nervous system.2 IBS is defined as a functional bowel disorder in which abdominal pain is associated with a change in bowel habit with features of disordered defecation.3 Features of disordered defecation include3 Urgency Altered stool consistency Altered stool frequency Incomplete evacuation References: 1. Drossman DA, Thompson WG, Talley NJ, Funch-Jensen P, Janssens J, Whitehead WE. Identification of sub-groups of functional gastrointestinal disorders. Gastroenterol Int. December 1990;3:159-172. 2. Drossman DA. Review article: an integrated approach to the irritable bowel syndrome. Aliment Pharmacol Ther. 1999;13(suppl 2):3-14. 3. Thompson WG, Longstreth GF, Drossman DA, Heaton KW, Irvine EJ, Müller-Lissner SA. Functional bowel disorders and functional abdominal pain. Gut. 1999;45(suppl 2):1143-1147.
- IBS is one of over 20 functional gastrointestinal (GI) disorders.1 The functional GI disorders vary clinically and are characterized by chronic or recurrent symptoms not explained by structural or biochemical abnormalities. It appears that these disorders relate to abnormalities in motility and/or afferent sensitivity as modulated by the central nervous system.2 IBS is defined as a functional bowel disorder in which abdominal pain is associated with a change in bowel habit with features of disordered defecation.3 Features of disordered defecation include3 Urgency Altered stool consistency Altered stool frequency Incomplete evacuation References: 1. Drossman DA, Thompson WG, Talley NJ, Funch-Jensen P, Janssens J, Whitehead WE. Identification of sub-groups of functional gastrointestinal disorders. Gastroenterol Int. December 1990;3:159-172. 2. Drossman DA. Review article: an integrated approach to the irritable bowel syndrome. Aliment Pharmacol Ther. 1999;13(suppl 2):3-14. 3. Thompson WG, Longstreth GF, Drossman DA, Heaton KW, Irvine EJ, Müller-Lissner SA. Functional bowel disorders and functional abdominal pain. Gut. 1999;45(suppl 2):1143-1147.
- IBS is one of over 20 functional gastrointestinal (GI) disorders.1 The functional GI disorders vary clinically and are characterized by chronic or recurrent symptoms not explained by structural or biochemical abnormalities. It appears that these disorders relate to abnormalities in motility and/or afferent sensitivity as modulated by the central nervous system.2 IBS is defined as a functional bowel disorder in which abdominal pain is associated with a change in bowel habit with features of disordered defecation.3 Features of disordered defecation include3 Urgency Altered stool consistency Altered stool frequency Incomplete evacuation References: 1. Drossman DA, Thompson WG, Talley NJ, Funch-Jensen P, Janssens J, Whitehead WE. Identification of sub-groups of functional gastrointestinal disorders. Gastroenterol Int. December 1990;3:159-172. 2. Drossman DA. Review article: an integrated approach to the irritable bowel syndrome. Aliment Pharmacol Ther. 1999;13(suppl 2):3-14. 3. Thompson WG, Longstreth GF, Drossman DA, Heaton KW, Irvine EJ, Müller-Lissner SA. Functional bowel disorders and functional abdominal pain. Gut. 1999;45(suppl 2):1143-1147.
- IBS is one of over 20 functional gastrointestinal (GI) disorders.1 The functional GI disorders vary clinically and are characterized by chronic or recurrent symptoms not explained by structural or biochemical abnormalities. It appears that these disorders relate to abnormalities in motility and/or afferent sensitivity as modulated by the central nervous system.2 IBS is defined as a functional bowel disorder in which abdominal pain is associated with a change in bowel habit with features of disordered defecation.3 Features of disordered defecation include3 Urgency Altered stool consistency Altered stool frequency Incomplete evacuation References: 1. Drossman DA, Thompson WG, Talley NJ, Funch-Jensen P, Janssens J, Whitehead WE. Identification of sub-groups of functional gastrointestinal disorders. Gastroenterol Int. December 1990;3:159-172. 2. Drossman DA. Review article: an integrated approach to the irritable bowel syndrome. Aliment Pharmacol Ther. 1999;13(suppl 2):3-14. 3. Thompson WG, Longstreth GF, Drossman DA, Heaton KW, Irvine EJ, Müller-Lissner SA. Functional bowel disorders and functional abdominal pain. Gut. 1999;45(suppl 2):1143-1147.
- IBS is one of over 20 functional gastrointestinal (GI) disorders.1 The functional GI disorders vary clinically and are characterized by chronic or recurrent symptoms not explained by structural or biochemical abnormalities. It appears that these disorders relate to abnormalities in motility and/or afferent sensitivity as modulated by the central nervous system.2 IBS is defined as a functional bowel disorder in which abdominal pain is associated with a change in bowel habit with features of disordered defecation.3 Features of disordered defecation include3 Urgency Altered stool consistency Altered stool frequency Incomplete evacuation References: 1. Drossman DA, Thompson WG, Talley NJ, Funch-Jensen P, Janssens J, Whitehead WE. Identification of sub-groups of functional gastrointestinal disorders. Gastroenterol Int. December 1990;3:159-172. 2. Drossman DA. Review article: an integrated approach to the irritable bowel syndrome. Aliment Pharmacol Ther. 1999;13(suppl 2):3-14. 3. Thompson WG, Longstreth GF, Drossman DA, Heaton KW, Irvine EJ, Müller-Lissner SA. Functional bowel disorders and functional abdominal pain. Gut. 1999;45(suppl 2):1143-1147.
- IBS is one of over 20 functional gastrointestinal (GI) disorders.1 The functional GI disorders vary clinically and are characterized by chronic or recurrent symptoms not explained by structural or biochemical abnormalities. It appears that these disorders relate to abnormalities in motility and/or afferent sensitivity as modulated by the central nervous system.2 IBS is defined as a functional bowel disorder in which abdominal pain is associated with a change in bowel habit with features of disordered defecation.3 Features of disordered defecation include3 Urgency Altered stool consistency Altered stool frequency Incomplete evacuation References: 1. Drossman DA, Thompson WG, Talley NJ, Funch-Jensen P, Janssens J, Whitehead WE. Identification of sub-groups of functional gastrointestinal disorders. Gastroenterol Int. December 1990;3:159-172. 2. Drossman DA. Review article: an integrated approach to the irritable bowel syndrome. Aliment Pharmacol Ther. 1999;13(suppl 2):3-14. 3. Thompson WG, Longstreth GF, Drossman DA, Heaton KW, Irvine EJ, Müller-Lissner SA. Functional bowel disorders and functional abdominal pain. Gut. 1999;45(suppl 2):1143-1147.
- IBS is one of over 20 functional gastrointestinal (GI) disorders.1 The functional GI disorders vary clinically and are characterized by chronic or recurrent symptoms not explained by structural or biochemical abnormalities. It appears that these disorders relate to abnormalities in motility and/or afferent sensitivity as modulated by the central nervous system.2 IBS is defined as a functional bowel disorder in which abdominal pain is associated with a change in bowel habit with features of disordered defecation.3 Features of disordered defecation include3 Urgency Altered stool consistency Altered stool frequency Incomplete evacuation References: 1. Drossman DA, Thompson WG, Talley NJ, Funch-Jensen P, Janssens J, Whitehead WE. Identification of sub-groups of functional gastrointestinal disorders. Gastroenterol Int. December 1990;3:159-172. 2. Drossman DA. Review article: an integrated approach to the irritable bowel syndrome. Aliment Pharmacol Ther. 1999;13(suppl 2):3-14. 3. Thompson WG, Longstreth GF, Drossman DA, Heaton KW, Irvine EJ, Müller-Lissner SA. Functional bowel disorders and functional abdominal pain. Gut. 1999;45(suppl 2):1143-1147.
- IBS is one of over 20 functional gastrointestinal (GI) disorders.1 The functional GI disorders vary clinically and are characterized by chronic or recurrent symptoms not explained by structural or biochemical abnormalities. It appears that these disorders relate to abnormalities in motility and/or afferent sensitivity as modulated by the central nervous system.2 IBS is defined as a functional bowel disorder in which abdominal pain is associated with a change in bowel habit with features of disordered defecation.3 Features of disordered defecation include3 Urgency Altered stool consistency Altered stool frequency Incomplete evacuation References: 1. Drossman DA, Thompson WG, Talley NJ, Funch-Jensen P, Janssens J, Whitehead WE. Identification of sub-groups of functional gastrointestinal disorders. Gastroenterol Int. December 1990;3:159-172. 2. Drossman DA. Review article: an integrated approach to the irritable bowel syndrome. Aliment Pharmacol Ther. 1999;13(suppl 2):3-14. 3. Thompson WG, Longstreth GF, Drossman DA, Heaton KW, Irvine EJ, Müller-Lissner SA. Functional bowel disorders and functional abdominal pain. Gut. 1999;45(suppl 2):1143-1147.
- IBS is one of over 20 functional gastrointestinal (GI) disorders.1 The functional GI disorders vary clinically and are characterized by chronic or recurrent symptoms not explained by structural or biochemical abnormalities. It appears that these disorders relate to abnormalities in motility and/or afferent sensitivity as modulated by the central nervous system.2 IBS is defined as a functional bowel disorder in which abdominal pain is associated with a change in bowel habit with features of disordered defecation.3 Features of disordered defecation include3 Urgency Altered stool consistency Altered stool frequency Incomplete evacuation References: 1. Drossman DA, Thompson WG, Talley NJ, Funch-Jensen P, Janssens J, Whitehead WE. Identification of sub-groups of functional gastrointestinal disorders. Gastroenterol Int. December 1990;3:159-172. 2. Drossman DA. Review article: an integrated approach to the irritable bowel syndrome. Aliment Pharmacol Ther. 1999;13(suppl 2):3-14. 3. Thompson WG, Longstreth GF, Drossman DA, Heaton KW, Irvine EJ, Müller-Lissner SA. Functional bowel disorders and functional abdominal pain. Gut. 1999;45(suppl 2):1143-1147.