Other gastro intestinal disease

Diverticular Disease	Helicobacter Pylori
Coeliac Disease

What is Diverticular Disease?

Diverticular Disease is a disorder of the large intestine (colon).

The colon is a muscular tube about 2 metres long. The main function of the colon is to absorb water and allow fibre to be broken down by bacteria. Food residue passes along the colon by the well co-ordinated muscular action of the colon to be excreted as faeces from the rectum. Should the rhythm be disturbed, areas of high pressure within the colon produces small outpouchings at the points of weakness where blood vessels penetrate its muscular wall. These outpouchings are called diverticula.

Diverticulitis occurs when these pouches become inflamed.

Prevalence

Diverticular Disease is considered to be caused by inadequate bulk or fibre in the diet and therefore is very common in Western communities where we tend to eat more refined foods. The age of onset can be as early as the 3O's and increase thereafter.

Symptoms

1. Many people with Diverticular Disease have no symptoms.
   
2. Abdominal pain - crampy lower left abdominal pain is common. It is often worse in the morning and relieved by passing wind or bowel motion.
   
3. Variable bowel habits - diarrhoea, constipation.
   
4. Urgency of bowel motion.
   
5. Gas and / or bloating.
   
6. Bleeding.

Symptoms Of Diverticulitis May Also Include

1. Fever.
   
2. Pain - which is often continuous and severe in the left lower abdomen.
   
3. Bleeding
   
4. Marked constipation or diarrhoea.
   

Relevance To Cancer

Whilst there is no direct association, it is such a common disease that cancer can be hidden by it, producing similar symptoms and therefore colonoscopy is advised.

Complications Of Diverticular Disease

1. Narrowing and distortion of the bowel lumen.
   
2. Rarely - abscess formation which may rupture causing acute abdominal pain and requiring emergency treatment.
   
3. Fistula or abnormal communication to the bladder may produce infection or gas bubbles in the urine.

Treatment - Prevention And Control

1. A high fibre diet from an early age (cereals, vegetables, fruit and an avoidance of refined, processed foods).
   
2. Regular exercise and fluids are important particularly if constipation is prominent.
   
3. For severe spasmodic pains and cramps, antispasmodic medication may help temporarily.
   
4. Prolonged use of laxatives which stimulate the bowel wall to contract should be avoided. Instead, use bulk forming agents eg. bran.
   
5. Where inflammation develops (diverticulitis), antibiotics may be used, however in severe cases, or where complications such as abscess formation or obstruction occur, surgical removal of the diseased part of the colon may be required.
   
6. A permanent colostomy (bag) however is almost never necessary
   

Helicobacter Pylori

The Helicobacter pylori story is one of the most exciting, but complex chapters in the history of gastroenterology.

More than 10 years ago an Australian gastroenterologist and Nobel laureate, Dr Barry Marshall proposed that gastritis and ulcers may be due to bacteria. The story continues to be updated with new recommendations particularly concerning the treatments available.

The following information is to help you understand what the presence of this bacteria means and why your Doctor may or may not recommend treatment for it.

How do we get the bacteria?

The bacteria usually enters the stomach before the age of 10. It is thought that it is transmitted between children by direct contact. It may be transmitted because of poor food hygiene or hand washing.

The bacteria is extremely common with almost 50% of adults having evidence of the bacteria.

There is little risk of passing the bacteria between adults or from adults to children, as long as normal hygiene precautions are followed. These include washing of hands after using the toilet and before preparing food.

Where does the bacteria live?

In the normal stomach there are many bacteria present.

The Helicobacter pylori bacteria (HP) has special features that allow it to survive in the stomach. It is thought that it may remain in the stomach for many years before it causes problems.

The HP bacteria is able to produce a special substance that allows it to pass through the layer of mucus that protects the lining of the stomach.

This ability to hide beneath this layer sometimes makes it difficult to get rid of the bacteria.

How does the HP bacteria cause problems?

It is known that the HP bacteria does not cause problems in everyone.

Most have no problems at all.

In some the HP bacteria is thought to damage the cells lining the stomach and duodenal wall allowing acid to further attack the lining causing inflammation and, or ulcers.

Other treatments that reduced the acid levels in the stomach allowed the ulcer to heal only to form again at some time in the future because the bacteria were still present in the stomach.

What is the role of the bacteria in various diseases?

DUODENAL AND GASTRIC ULCER
There is now convincing evidence that the HP bacteria is the major cause of gastritis and ulcers. Other factors such as high levels of acid, smoking and taking some pain killing tablets act together with the bacteria. If we get rid of the bacteria we can cure ulcers.

HEARTBURN
At this stage we do not believe that HP is responsible for heartburn. In some patients who are on treatment for a long time we recommend that the HP bacteria is treated as a precaution.

DYSPEPSIA
In this condition there may be inflammation or the stomach may appear completely normal. Most patients with dyspepsia who have the HP bacteria present are no better after treatment to eradicate the bacteria. Your doctor may decide to treat the bacteria depending on your symptoms and response to other treatments.

OTHER CONDITIONS
The role of the HP bacteria in other diseases of the stomach at this stage is unclear. Remember that a large number of people without problems have the bacteria.

The result of the test to detect the bacteria will be kept and acted on later if necessary.

Treatment Options

Treatment of the HP bacteria is difficult, and involves a large number of tablets (with unpleasant side effects). The bacteria is so good at hiding under a layer of mucus in the stomach it is difficult for antibiotics to reach them.

It is very important with all treatments that you complete the whole course.

There is no concern that you will pass the bacteria to others.

The treatment given will depend an why you are receiving the treatment.

Helidac - A combined therapy based on a bismuth compound together with two antibiotics - metronidazole and tetracycline for 14 days.

Losec RelicoPak - An acid suppressing agent together with two antibiotics. amoxycillin and metronidazole for 14 days.

Side Effects - of both can include altered taste, vomiting, nausea, and diarrhoea. (if severe you should contact your doctor). Helidac can cause discoloration of the tongue and black motions.

You should not drink alcohol for the 14 days that you are taking the treatment.

Follow Up

Depending on your condition we may suggest a test to ensure that the bacteria has been cleared. A gastroscopy can also test again for the bacteria and can determine if the ulcer has healed.

If the bacteria has been cleared then it is unlikely that you will be reinfected.

Coeliac Disease

Coeliac disease (caused by gluten sensitivity) is much more common than previously thought. The prevalence in Australia is one in 300 - 500 people and may even he higher. It is most likely in patients of western European background.

Symptoms are very variable or may indeed be absent, only diagnosed during investigationfor the consequences of nutritional deficiencies. It can present at any age, Symptoms may include diarrhoea, weight loss and other gastrointestinal distrurbances. Nutrient deficiencies include iron and foliate leading to anaemia, and less commonly, calcium deficiency results in osteoporosis.

Gluten (a protein present in wheat, barley and rye) causes immune-mediated damage to the proximal small intestine in genetically susceptible individuals, leading to a marked reduction in the absorptive surface area of the small intestine. Corn and rice are safe. Up to 10% of first degree relatives of patients with coeliac, disease will he similarly affected.

The "gold standard" in diagnosis remains the endoscopic small bowel biopsy and must he performed before committing a patient to a life long gluten free diet. Serology is a useful screening test in those patients with suggestive symptoms or anaemia. Tests include transglutaminase and endomysial antibodies.

Management includes a strict lifelong gluten free diet and correction of nutritional deficiencies. Patients should be encouraged to join the Coeliac Society.

    Are you at risk?

• Has a family member had bowel cancer or polyps?

• Any blood with your bowel motion?

• Persistent change in bowel habits?