Post- Douglas

Respond on two different days who selected different treatments and factors than you, in the following ways:

Offer alternative common treatments for the disorders.

Share insight on how the factor you selected impacts the treatment of alterations of digestive function.

                                                        Main Post

Many patients will present with disease processes that have the same or similar symptoms, and it will be the responsibility of the practitioner to diagnose and provide treatment accurately. The gastrointestinal tract is one area where misdiagnoses occur due to the common signs and symptoms. Inflammatory bowel disease and irritable bowel syndrome are two common misdiagnosed disorders that will be explored, the pathophysiology explained, proper treatment, and the effects gender has on these diseases.

Pathophysiology of Inflammatory Bowel Disease and Irritable Bowel Syndrome 

Inflammatory bowel disease (IBD) comprises three key disorders; Crohn’s disease (CD), ulcerative colitis (UC), and microscopic colitis all attributed to an inflammation process but each affects the body differently. Research by El-Salhy and Hausken (2016) explains that the inflammation in Crohn’s disease is transmural in nature and occurs in any part of the gastrointestinal tract, while the inflammation in ulcerative colitis is more superficial and affects the rectocolonic mucosa, and the inflammation in microscopic manifests as mucosal and submucosal infiltration of immune cells without ulcerations or crypt abscesses and occurs in the colon.

Irritable bowel syndrome (IBS) is a common disease, although the pathophysiology is still not fully understood. Combination of low-grade mucosal inflammation with visceral hypersensitivity and impaired bowel motility could be the underlying etiology for IBS pathogenesis (Chong et al., 2019). Alterations in the gut microbiota and dietary choices play a central role in disease development. According to O’Malley (2019), IBS is complex multifactorial pathophysiology, that involves dysfunction of the bi-directional signaling axis between the brain and the gut, this axis incorporates efferent and afferent branches of the autonomic nervous system, circulating endocrine hormones and immune factors, local paracrine and neurocrine factors and microbial metabolites. 

Treatments for Inflammatory Bowel Disease and Irritable Bowel Syndrome

Treatment for IBS and IBD focuses on treating not only the symptoms but the underlying cause of the disease. Treatment for IBS includes; dietary interventions, probiotics, prebiotics, synbiotics, non-absorbable antibiotics, mixed μ-opioid receptor agonist–δ-opioid receptor antagonist and κ-opioid receptor agonist, Serum-derived bovine immunoglobulin (SBI), and fecal microbiota transplantation (FMT).  Treatment for IBD is more complex due to IBD being composed of three different diseases, each requires different treatment plans, but there is some crossover. Corticosteroids, probiotics, immunomodulatory drugs, immunosuppressants, antitumor necrosis factor therapy, anti-interleukin 12/23 antibody drugs, janus kinase (JAK) inhibitor, SMAD 7 inhibitor, and FMT are treatments available for IBD. 5-aminosalicylates (5-ASAs) are the first-line therapy for induction and maintenance of remission in patients with UC (Su et al., 2019). Anti-tumor necrosis factor (TNF) therapy works well on both UC and CD, JAK inhibitor works for UC and not CD, SMAD 7 inhibitor works for CD but not UC.

Gender’s Affect on Inflammatory Bowel Disease and Irritable Bowel Syndrome

Research conducted by Kosako, Akiho, Miwa, Kanazawa, and Fukudo (2018) acknowledges that the higher prevalence of IBS in women compared with men may be associated with sex hormone fluctuations, which reportedly affect IBS symptoms, with symptoms appearing stronger before menstruation. Women may also receive a delay in treatment to both IBD and IBS due to the perceived perception of pain being misdiagnosed by the primary care practitioner. 

Conclusion

The gastrointestinal tract has many disorders where the signs and symptoms are the same. It is imperative that the practitioner distinguishes between diseases as the therapies can become complicated. The practitioner must do a comprehensive physical exam, as well as a health history with the patient to determine the path towards diagnosis. Laboratory data and imaging can also play a key role in determining the proper treatment plan and diagnosis. Unsuccessful medical treatment will warrant more invasive procedures in an attempt to visualize the underlying issue.

                                                                                                                                 References

Chong, P. P., Chin, V. K., Looi, C. Y., Wong, W. F., Madhavan, P., & Yong, V. C. (2019). The Microbiome and Irritable Bowel Syndrome–A Review on the Pathophysiology, Current Research and Future Therapy. Frontiers in Microbiology, 10, 1136.. https://doi-org.ezp.waldenulibrary.org/10.3389/fmicb.2019.01136

El-Salhy, M., & Hausken, T. (2016). The role of the neuropeptide Y (NPY) family in the pathophysiology of inflammatory bowel disease (IBD). Neuropeptides, 55, 137–144. https://doi-org.ezp.waldenulibrary.org/10.1016/j.npep.2015.09.005

Kosako, M., Akiho, H., Miwa, H., Kanazawa, M., & Fukudo, S. (2018). Impact of symptoms by gender and age in Japanese subjects with irritable bowel syndrome with constipation (IBS-C): A large population-based internet survey. BioPsychoSocial Medicine, 12(1). https://doi-org.ezp.waldenulibrary.org/10.1186/s13030-018-0131-2

O’Malley, D. (2019). Endocrine regulation of gut function – a role for glucagon‐like peptide‐1 in the pathophysiology of irritable bowel syndrome. Experimental Physiology, 104(1), 3–10. https://doi-org.ezp.waldenulibrary.org/10.1113/EP087443

Su, H.-J., Chiu, Y.-T., Chiu, C.-T., Lin, Y.-C., Wang, C.-Y., Hsieh, J.-Y., & Wei, S.-C. (2019). Inflammatory bowel disease and its treatment in 2018: Global and Taiwanese status updates. Journal of the Formosan Medical Association, 118(7), 1083–1092. https://doi-org.ezp.waldenulibrary.org/10.1016/j.jfma.2018.07.005Many patients will present with disease processes that have the same or similar symptoms, and it will be the responsibility of the practitioner to diagnose and provide treatment accurately. The gastrointestinal tract is one area where misdiagnoses occur due to the common signs and symptoms. Inflammatory bowel disease and irritable bowel syndrome are two common misdiagnosed disorders that will be explored, the pathophysiology explained, proper treatment, and the effects gender has on these diseases.

Pathophysiology of Inflammatory Bowel Disease and Irritable Bowel Syndrome 

Inflammatory bowel disease (IBD) comprises three key disorders; Crohn’s disease (CD), ulcerative colitis (UC), and microscopic colitis all attributed to an inflammation process but each affects the body differently. Research by El-Salhy and Hausken (2016) explains that the inflammation in Crohn’s disease is transmural in nature and occurs in any part of the gastrointestinal tract, while the inflammation in ulcerative colitis is more superficial and affects the rectocolonic mucosa, and the inflammation in microscopic manifests as mucosal and submucosal infiltration of immune cells without ulcerations or crypt abscesses and occurs in the colon.

Irritable bowel syndrome (IBS) is a common disease, although the pathophysiology is still not fully understood. Combination of low-grade mucosal inflammation with visceral hypersensitivity and impaired bowel motility could be the underlying etiology for IBS pathogenesis (Chong et al., 2019). Alterations in the gut microbiota and dietary choices play a central role in disease development. According to O’Malley (2019), IBS is complex multifactorial pathophysiology, that involves dysfunction of the bi-directional signaling axis between the brain and the gut, this axis incorporates efferent and afferent branches of the autonomic nervous system, circulating endocrine hormones and immune factors, local paracrine and neurocrine factors and microbial metabolites. 

Treatments for Inflammatory Bowel Disease and Irritable Bowel Syndrome

Treatment for IBS and IBD focuses on treating not only the symptoms but the underlying cause of the disease. Treatment for IBS includes; dietary interventions, probiotics, prebiotics, synbiotics, non-absorbable antibiotics, mixed μ-opioid receptor agonist–δ-opioid receptor antagonist and κ-opioid receptor agonist, Serum-derived bovine immunoglobulin (SBI), and fecal microbiota transplantation (FMT).  Treatment for IBD is more complex due to IBD being composed of three different diseases, each requires different treatment plans, but there is some crossover. Corticosteroids, probiotics, immunomodulatory drugs, immunosuppressants, antitumor necrosis factor therapy, anti-interleukin 12/23 antibody drugs, janus kinase (JAK) inhibitor, SMAD 7 inhibitor, and FMT are treatments available for IBD. 5-aminosalicylates (5-ASAs) are the first-line therapy for induction and maintenance of remission in patients with UC (Su et al., 2019). Anti-tumor necrosis factor (TNF) therapy works well on both UC and CD, JAK inhibitor works for UC and not CD, SMAD 7 inhibitor works for CD but not UC.

Gender’s Affect on Inflammatory Bowel Disease and Irritable Bowel Syndrome

Research conducted by Kosako, Akiho, Miwa, Kanazawa, and Fukudo (2018) acknowledges that the higher prevalence of IBS in women compared with men may be associated with sex hormone fluctuations, which reportedly affect IBS symptoms, with symptoms appearing stronger before menstruation. Women may also receive a delay in treatment to both IBD and IBS due to the perceived perception of pain being misdiagnosed by the primary care practitioner. 

Conclusion

The gastrointestinal tract has many disorders where the signs and symptoms are the same. It is imperative that the practitioner distinguishes between diseases as the therapies can become complicated. The practitioner must do a comprehensive physical exam, as well as a health history with the patient to determine the path towards diagnosis. Laboratory data and imaging can also play a key role in determining the proper treatment plan and diagnosis. Unsuccessful medical treatment will warrant more invasive procedures in an attempt to visualize the underlying issue.

                                                                                                                                 References

Chong, P. P., Chin, V. K., Looi, C. Y., Wong, W. F., Madhavan, P., & Yong, V. C. (2019). The Microbiome and Irritable Bowel Syndrome–A Review on the Pathophysiology, Current Research and Future Therapy. Frontiers in Microbiology, 10, 1136.. https://doi-org.ezp.waldenulibrary.org/10.3389/fmicb.2019.01136

El-Salhy, M., & Hausken, T. (2016). The role of the neuropeptide Y (NPY) family in the pathophysiology of inflammatory bowel disease (IBD). Neuropeptides, 55, 137–144. https://doi-org.ezp.waldenulibrary.org/10.1016/j.npep.2015.09.005

Kosako, M., Akiho, H., Miwa, H., Kanazawa, M., & Fukudo, S. (2018). Impact of symptoms by gender and age in Japanese subjects with irritable bowel syndrome with constipation (IBS-C): A large population-based internet survey. BioPsychoSocial Medicine, 12(1). https://doi-org.ezp.waldenulibrary.org/10.1186/s13030-018-0131-2

O’Malley, D. (2019). Endocrine regulation of gut function – a role for glucagon‐like peptide‐1 in the pathophysiology of irritable bowel syndrome. Experimental Physiology, 104(1), 3–10. https://doi-org.ezp.waldenulibrary.org/10.1113/EP087443

Su, H.-J., Chiu, Y.-T., Chiu, C.-T., Lin, Y.-C., Wang, C.-Y., Hsieh, J.-Y., & Wei, S.-C. (2019). Inflammatory bowel disease and its treatment in 2018: Global and Taiwanese status updates. Journal of the Formosan Medical Association, 118(7), 1083–1092. https://doi-org.ezp.waldenulibrary.org/10.1016/j.jfma.2018.07.005

 

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