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Small bowel diseases
- 2. Small Bowel - Irritable Bowel Syndrome - Microflora & Malabsorption disorders - Gluten Enteropathies Reuben Wong KM Gastroenterologist Associate Professor (Adjunct-NUS)
- 3. What you need to know about… 1. The small bowel • Anatomy 2. Gluten Enteropathies • Celiac Disease • Non-celiac gluten sensitivity 3. Irritable Bowel Syndrome • Etiology • Translating science to treating the root causes 4. Microbiota & Malabsorption Disorders • Small Intestinal Bacterial Overgrowth • FODMAPs
- 4. Anatomy • Function • Disorders • Infections • Malignancy • Inflammation • Immune reaction • Evaluation • MRI scan • Enteroscopy/Capsule • Biopsies • Breath Testing
- 5. Gluten Disorders Intestinal • Diarrhea • Bloating • Distension • Malabsorption • IBS/Lactose intolerance- like symptoms Extraintestinal • Iron deficiency • Folate/B12 • Stomatitis • Neurological • Growth issues
- 7. Diagnosis of Celiac Disease • Tissue Transglutaminase IgA • Endomysial (specific) IgA • Total serum IgA Antibody • HLA DQ2 • HLA DQ8Genetic • Gastroscopy with 4-6 duodenal biopsies (bulb + deep) • Marsh ScoreBiopsies
- 9. Management of Celiac C •CONSULTATION •Good dietitian E •EDUCATION •About the disease L •LIFELONG •Gluten free diet I •IDENTIFY •Nutritional deficiencies and disease A •ACCESS •Advocacy & support groups C •CONTINUOUS •Long term review by medical team
- 12. Diagnosis of IBS IBS Relief w defecation Change in frequency or stool consistency Associated with straining/urgency. mucus
- 14. Elsenbruch S. Brain, Behavior & Immunity 2011;25:386-94
- 17. IBS Subtyping Subtyping • IBS-C >25% BSS 1/2 & <25% 6/7 • IBS-D >25% BSS 6/7 & <25% 1/2 • IBS-M >25% BSS 1/2 & 3/4
- 19. Treatment : Abdominal Pain
- 21. The IBS Therapeutic Scale
- 22. The Small Bowel & IBS IBS Symptoms Genetics Gut Infections Stress Diet Gut Sensitivity Microbe Balance
- 23. Food Intolerance & Small Bowel - FODMAPs
- 24. What exactly are FODMAPs • FructansF • OligosaccharidesO • DisaccharidesD • MonosaccharidesM • AndA • PolyolsP
- 25. Evidence for FODMAPs EP Halmos, P Gibson et al. Gastroenterology 2014
- 26. EP Halmos, P Gibson et al. Gastroenterology 2014 SatisfactionwithStool
- 32. Prevalence of Intolerance & Malabsorption in FGID patients
- 33. WGO Probiotic & Prebiotic Guidelines 2011. J Clin Gastroenterol 2012
- 34. Gut Microbiota and Factors Affecting its Composition Simren et al. Intestinal Microflora in FBD: A Rome foundation Report. Gut 2014
- 35. Do IBS pts have a different microbiome? Simren et al. Intestinal Microflora in FBD: A Rome foundation Report. Gut 2014
- 36. Small Intestinal Bacterial Overgrowth
- 38. An illustration of PPIs and SIBO Lombardo et al. CGH 2010
- 39. Duration of PPI use and SIBO Lombardo et al. CGH 2010
- 40. Testing for SIBO SB aspiration & culture • >3 -5 log CFUs • Difficult to perform Carbon Breath testing • Radioactive • Reproducibility Hydrogen Methane Breath • Easy and Accessible • Reproducible
- 41. Consensus on testing for SIBO
- 44. Small Intestinal Bacterial Overgrowth • SIBO – Jejunal aspirates – H2-CH4 Breath Testing • Lactulose • Glucose M Pinementel. APT 2016
- 45. Effects of Rifaximin in SIBO positive IBS M Pinementel. APT 2016
- 46. My Opinion on SIBO… Breath Test Positive Test Rifaximin 550 BD
- 47. The Small Bowel in an Important Part of the Gut… Gluten Enteropathy • Celiac Disease and why it happens • Diagnosis and Treatment Irritable Bowel Syndrome • Etiology • How does it link in with the small bowel Microflora / Microbiota of the Small Bowel • SIBO • FODMAPs
- 48. Reuben Wong KM MBBS AGAF MRCP FRCPEd FAMS Gut Doctor Adj Associate Professor Email: reubenwongkm@gmail.com