Irritable Bowel Syndrome (IBS): Causes and Treatments

Irritable Bowel Syndrome (IBS): Causes and Treatments Lucy Crawshaw Irritable Bowel Syndrome – What is IBS and what are the treatments? The aim of this report is to provide information on Irritable Bowel Syndrome (IBS) and inform those diagnosed with IBS about the treatments available. IBS is a common condition of the small and large intestine, or ‘bowel’. It affects about 15% of the population and of those affected, about 9% are female and 6% are male. IBS is a functional condition, meaning that it disrupts bowel function but does not cause detectable abnormalities in the structure of bowel. This can lead to doctors and the public trivialising the condition, even though it affects patients’ quality of life by causing pain, problems associated with passing faeces and psychological issues such as depression. The Digestive System The body’s cells require many different molecules and ions to function; it is the digestive system (shown in Figure 1) which supplies these nutrients. The term ‘digestion’ encompasses ingestion, digestion (the breakdown of food into its component nutrients), absorption of nutrients and excretion of waste products. During ingestion, food is placed into the mouth, chewed and mixed with saliva to form a soft mass, or bolus. Saliva contains enzymes which catalyse, or speed up, the breakdown of food. After the bolus is swallowed, it travels down the oesophagus into the stomach, aided by peristalsis (muscular contractions which travel down the particular organ). In the stomach, gastric juices including hydrochloric acid and enzymes break down the bolus into a liquid called chyme. The chyme enters the small intestine along with pancreatic juices containing enzymes, and bile (which is produced by the liver and 269 words stored in the gall bladder), where it is fully digested. The nutrients released are absorbed through blood vessels in the small intestine. Peristalsis pushes the undigested matter, including fibre, resistant starch and bacteria into the large intestine (which is divided into the cecum, colon and rectum). Once in the colon, water is absorbed, turning the matter into faeces. The faeces moves into the rectum by peristalsis, after which it is excreted from the anus. What are the symptoms? The severity of IBS symptoms vary but are usually worse in the morning and after eating. Typical symptoms include painful abdominal cramps, which ease after passing faeces, abdominal bloating, flatulence, changes in the consistency of faeces (ranging from diarrhoea to constipation) and passing mucus with faeces. Sufferers may also feel the sudden need to empty their bowels or feel that their bowels are not empty despite having been to the toilet. Other symptoms can include feeling sick, back ache, lethargy, bladder problems including the urgent need to urinate, difficulty emptying the bladder and incontinence and dyspareunia, or pain during sex. IBS is unpredictable in that sufferers may experience no symptoms for months, then experience a ‘flare-up’ for no discernible reason. Symptoms may settle within 2 to 3 days or can take months to settle. IBS has also been linked with psychological problems such as depression and anxiety. It has been estimated that 3 in 4 sufferers will develop depression and about 50% will develop Generalised Anxiety Disorder (GAD). What are the causes? The exact cause of IBS is unknown although several theories have been proposed. Some experts believe that IBS is caused by a change in the speed at which chyme is processed through the bowel; slower processing allows the colon more time to absorb water, causing constipation by making faeces harder and more difficult to excrete. If processed more quickly, less water is absorbed, resulting in diarrhoea. A second theory is that IBS is caused by disruption to nerve signals between brain and bowel, increasing sensitivity to pain, so that mild indigestion to a non-sufferer may cause severe pain to IBS sufferer. Both of these changes may be linked to food poisoning or intolerance to certain foods. Another theory suggests that these changes may be caused by stress, anxiety or trauma during childhood (such as abuse or neglect), which decreases the level of the neurotransmitter serotonin in the body. Serotonin is produced by the brain and intestines, and is important in controlling mood and digestion. Reduced serotonin levels have been linked to depression and slow peristalsis in the bowel, leading to constipation. Higher levels of serotonin in the body can increase peristalsis, causing diarrhoea; this theory may help to explain the link between IBS and depression. IBS may also be related to Small Intestinal Bacterial Overgrowth (SIBO), where bacteria from the large intestine migrates to the small intestine and ferment the indigestible components of chyme, and giving off hydrogen, carbon dioxide and methane gas. How is IBS diagnosed? As IBS causes no physical changes to the bowel, doctors must rely on patients describing their symptoms. A diagnosis can be made if the patient has been suffering from the typical symptoms for the previous 6 months. However, doctors may wish to carry out tests including blood tests and faeces tests, to rule out other conditions which cause similar symptoms, like inflammatory bowel disease, 1eliac disease or infections. What are the treatments? As yet, no cure has been found for IBS, however symptoms can be managed. One of the easiest treatments is modification of the diet. Dietary advice is best provided by healthcare professionals on an individual basis, based on the patient’s symptoms and reactions to certain foods. Recording a food diary detailing what is eaten and any ill-effects is an effective way of identifying the changes which are needed. Seeking dietary advice may also benefit other aspects of patient health, including ensuring a balanced diet, and weight management. Fibre, from components of plants like cellulose, lignin and pectin which are resistant to digestive enzymes, is an important factor in the diet. Soluble fibre dissolves in water, causing it to swell and form a gel, softening faeces and stimulating peristalsis. It is though that increasing soluble fibre and water in the diet can ease the symptoms of IBS. In contrast, insoluble fibre acts as an irritant to IBS sufferers as it remains intact during digestion, increasing the speed at which faeces travels through the bowel. Soluble fibre is found in foods like rice, pasta, oats, root vegetables and fruits including bananas and mangoes. Generally, foods which are stringy, have tough skin or contain seeds are high in insoluble fibre. Specific examples include cereals, wholegrain foods, nuts and seeds, salad and dried fruit. Insoluble fibre should not be completely excluded from the diet but should be consumed in small quantities alongside soluble fibre. Cooking, chopping and pureeing foods containing insoluble fibre may help to reduce their ill-effects. To reduce flatulence, a low FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols) diet is recommended. FODMAPs are carbohydrates which are resistant to digestion and as a result, ferment in the bowel. Foods containing FODMAPs include processed wheat products, dairy products containing the sugar lactose, beans and some fruit and green vegetables, including peaches, nectarines, apples, cherries, cabbage, broccoli and peas. Other ‘trigger foods’ that should be avoided include red meat, dark poultry meat and skin, saturated fats (such as butter and lard), sulphur-rich foods including onions and garlic, acidic foods like vinegar and citrus fruits, fructose (fruit sugar) and artificial sweeteners. IBS sufferers are advised to eat regularly, avoid skipping meals and take their time whilst eating. Drinking about 2 litres of non-caffeinated, non-alcoholic liquid per day is also recommended. It is though that probiotic products like yoghurts and capsules may ease IBS symptoms in some patients. It is currently recommended that patients should use a product for 4 weeks before deciding whether it is beneficial. Other suggested ‘off-the-shelf’ products include remedies containing herbs like peppermint, fennel and acacia. Another effective way to manage IBS, whilst also benefiting other aspects of a patient’s health, like weight management and fitness, is to conduct about 150 minutes of moderate-intensity exercise per week (like cycling and walking). Exercise reduces stress by increasing serotonin levels and also pumps blood away from the bowel and towards other muscles, which may help to ease IBS symptoms both during exercise and in the long-term. Stress can also be reduced with relaxation techniques such as breathing exercises and meditation and activities like yoga. Other methods to reduce stress or treat IBS-linked depression are counselling, hypnotherapy and Cognitive behavioural therapy (CBT), which teaches people to alter their thinking and behaviour. Alternative treatments like acupuncture and reflexology are not recommended. When other treatments fail, doctors may recommend medication. While medication can ease the symptoms of IBS, it may also pose a risk to health due to possible side effects. Antispasmodics such as Mebeverine are prescribed to relax the bowel muscles thus reducing painful abdominal cramps. For patients with constipation, bulk-forming laxatives, like Normacol or Fybogel, can make bowel movements easier and more regular, due to the insoluble fibre contained within these drugs. In contrast, antimotility medicines such as Loperamine slow peristalsis allowing faeces time to solidify in the bowel, thus easing symptoms for patients with diarrhoea. Finally, irrespective of whether a patient is displaying psychological symptoms of IBS, antidepressants may be prescribed. Tri-Cyclic Antidepressants (TCAs), like Amitriptyline, interact with neurotransmitters (including serotonin) in the brain where they reduce anxiety and pain, and in the intestines where they slow peristalsis, making them effective for treating patients with diarrhoea. Selective Serotonin Reuptake Inhibitors (SSRIs), like Citalopram, increase serotonin levels in the body, proving them beneficial to patients with constipation. Is treatment effective? A study entitled ‘Effects of a health program comprising reassurance, diet management, probiotics administration and regular exercise on symptoms and quality of life in patients with irritable bowel syndrome’ found that such treatment significantly eased the symptoms of 143 IBS patients who suffered from pain, diarrhoea-dominant IBS or constipation-dominant IBS (as shown in Figure 2). However, this study does not show the individual effect of each treatment. With regards to probiotics, the NHS argues that little evidence supports their use, however studies such as those cited by probiotic manufacturer OptiBac suggest that their products can be highly efficacious. There is also little evidence to support the use of herbal remedies. A review of previous studies entitled ‘Efficacy of antidepressants and psychological therapies in irritable bowel syndrome: systematic review and meta-analysis’ found that antidepressants were 34% more effective than placebo drugs in reducing the symptoms of IBS, while psychological therapies reduced symptoms in 33% of patients. The conclusion stated that both treatments are ‘effective’. What are the implications treatment? The ease of availability of information about self-help treatments, (especially on the internet) could be considered unethical as patients may fail to seek professional medical help. The implication is that patients may receive inadequate treatment for their IBS or that other causes of their symptoms may not be diagnosed, which could prove fatal. The lack of conclusive evidence supporting the use of herbs and probiotics as self-help treatments raises questions as to the ethics of manufacturers promoting such products as they may give rise to ‘false hope’ of a cure. There are also questions as to the ethics of prescribing medication for a ‘functional’ condition. In addition, social stereotyping could lead to patients prescribed antidepressants being labelled as ‘crazy’ etcetera. Finally, the treatment of IBS has a significant economic impact on the UK; the National Institute of Health And Care Excellence (NICE) estimate that diagnosis and management of IBS cost the NHS  £7,879000 in 2008. Evaluation of reference materials Websites like ‘NHS Choices’ and ‘Patient’ provide a useful overview on IBS and cover a wide range of topics, however fail to fully explore many areas including how the different types of fibre affect IBS, why exercise is beneficial to sufferers and how certain drug treatments work. Despite the ethical issues related to selling untested remedies, of all the references cited, ‘Help for IBS’ provides the most practical advice on changing dietary fibre intake, including food preparation tips. In contrast, other websites like ‘NHS Choices’ purely state that changes should be made. ‘Help for IBS’ also includes information on other ‘trigger foods’, which was not available in the other resources. Bibliography SOANES, C., STEVENSON, A., (2009), Oxford Dictionary of English, Oxford, OUP http://www.bsg.org.uk/clinical/commissioning-report/ibs/functional-symptoms.html  (12 Nov 2014) http://www.patient.co.uk/health/irritable-bowel-syndrome-leaflet (11 Nov 2014) http://www.nhs.uk/Conditions/Irritable-bowel-syndrome/Pages/Introduction.aspx  (11 Nov 2014) http://www.bbc.co.uk/bitesize/standard/biology/animal_survival/the_need_for_ food/ revision/4/ (12 Nov 2014) PAUL, I., (2002), Digestive System: Biology, USA, Macmillan Reference Science Library http://www.medicalnewstoday.com/articles/232248.php (13 Nov 2014) http://ibs.about.com/od/medicationforibs/a/Antidepressants-For-IBS.htm  (13 Nov 2014) http://digestivehealthinstitute.org/2013/05/10/resistant-starch-friend-or-foe/  (14 Nov 2014) (2008), Diagnosis and management of Irritable Bowel Syndrome in primary care, London, NICE http://www.co-operativepharmacy.co.uk/Pharmacy/Medicine-Chest/NHS-Articles/L/Laxatives/ (13 Nov 2014) http://www.webmd.com/diet/fiber-health-benefits-11/insoluble-soluble-fiber  (13 Nov 2014) http://www.helpforibs.com/diet/fiber2.asp (15 Nov 14) http://www.optibacprobiotics.co.uk/faq/which-probiotics-are-for-ibs (16 Nov 2014) http://www.sparkpeople.com/resource/fitness_articles.asp?id=840 (13 Nov 2014) http://www.lef.org/protocols/gastrointestinal/constipation/page-04 (16 Nov 2014) (2008), National Costing Report: Irritable Bowel Syndrome, London, NICE EL-SALHY, M., LILLEBO, E., REINEMO, A., SALMELID, L., HAUSKEN., (2008), Effects of a health program comprising reassurance, diet management, probiotics administration and regular exercise on symptoms and quality of life in patients with irritable bowel syndrome, Gastroenterology Insights FORD, A.C., TALLEY, N.J., SCHOENFELD, P.S., QUIGLEY, E.M.M., MOAYYEDI, P., (2008), Efficacy of antidepressants and psychological therapies in irritable bowel syndrome: systematic review and meta-analysis, Gut

Greek Mythology and Medea Essay

Medea – Protagonist of the play, Medea’s homeland is Colchis, an island in the Black Sea, which the Greeks considered the edge of the earth–a territory of barbarians. A sorceress and a princess, she used her powers and influence to help Jason secure the Golden Fleece; then, having fallen in love with him, she fled her country and family to live with Jason in Iolcus, his own home. During the escape across the Mediterranean, she killed her brother and dumped him overboard, so that her pursuers would have to slow down and bury him. While in Iolcus, she again used her devilish cleverness to manipulate the daughters of the local king and rival, Pelias, into murdering their own father. Exiled as murderers, Jason and Medea settled in Corinth, the setting of Euripides’ play, where they established a family of two children and gained a favorable reputation. All this precedes the action of the play, which opens with Jason having divorced Medea and taken up with a new family. The play charts Medea’s emotional transformation, a progression from suicidal despair to sadistic fury. She eventually avenges Jason’s betrayal with a series of murders, concluding with the deaths of her own children. Famously, the pleasure of watching Jason suffer their loss outweighed her own remorse at killing them. Jason – Jason can be considered the play’s villain, though his evil stems more from weakness than strength. A former adventurer, he abandons his wife, Medea, in order to marry Glauce, the beautiful young daughter of Creon, King of Corinth. Hoping to advance his station through this second marriage, he only fuels Medea to a revenge that includes the deaths of his new bride, her father, and his children. Jason’s tactless self-interest and whiny rationalizations of his own actions make him a weak, unsympathetic character. Children – The offspring of Jason and Medea, the children are presented as naive and oblivious to the intrigue that surrounds them. Medea uses them as pawns in the murder of Glauce and Creon, and then kills them in the play’s culminating horror. Their innocent deaths provide the greatest element of pathos–the tragic emotion of pity–in the play. Chorus – Composed of the women of Corinth, the chorus chiefly serves as a commentator to the action, although it occasionally engages directly in the dialogue. The chorus members fully sympathize with Medea’s plight, excepting her eventual decision to murder her own children. Creon – The King of Corinth, Creon banishes Medea from the city. Although a minor character, Creon’s suicidal embrace of his dying daughter provides one of the play’s most dramatic moments, and his sentence against Medea lends an urgency to her plans for revenge. Glauce – Daughter of Creon, Glauce is the young, beautiful princess for whom Jason abandons Medea. Her acceptance of the poisoned coronet and dress as â€Å"gifts† leads to the first murder of the play. Although she never utters a word, Glauce’s presence is constantly felt as an object of Medea’s jealousy. (Glauce is also referred to as Creusa. ) Aegeus – The King of Athens, Aegeus passes through Corinth after having visited the Oracle at Delphi, where he sought a cure for his sterility. Medea offers him some fertility-inducing drugs in exchange for sanctuary in Athens. His appearance marks a turning point in the play, for Medea moves from being a passive victim to an aggressor after she secures his promise of sanctuary. Messenger – The messenger appears only once in the play–he relates in gruesome, vivid detail the death scenes of Glauce and Creon, which occur offstage. Nurse – Caretaker of the house, the nurse of the children serves as Medea’s confidant. Her presence is mainly felt in the play’s opening lament and in a few speeches addressing diverse subjects not entirely related to the action of the play. Tutor – A very minor character, the tutor of the children mainly acts as a messenger, as well as the person responsible for shuffling the children around from place to place

Why Almost Everything Youve Learned About Gcc 141 English Essay Samples Is Wrong and What You Should Know

Why Almost Everything You've Learned About Gcc 141 English Essay Samples Is Wrong and What You Should Know Things You Should Know About Gcc 141 English Essay Samples The organization has been in a position to get a huge section of the market due to the strategies it has formulated in the past couple of decades. As a promotion strategy it's important to grasp the culture where the company is operating. The service delivery to the clients plays an essential part in building the reputation of the institution in the business. The customers have test for unique services which are provided by the organization. The subject of your essay is vital. The moment the essay itself should consist of 3 parts, it's desirable to generate an outline for every one of them. What's a persuasive essay. Such sample essays can be very helpful, as they can give a complete picture of what a wonderful essay is. Essay writing is usually practiced is schools. Essays don't need to be difficult! 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An important consideration to bear in mind is to ensure you don't have a thing in the essay which is not related to your topic. This informative article explains a number of the popular GCC compiler alternatives. That is the reason why you have to have the ideal sample outline for the research working with this template. We can supply you with school letter templates which you might use as references in creating documents which are either needed or required for a certain school function. English essay format is extremely imp ortant, so you need to adhere to a specific structure. Writing an essay is a vital role in academe life. Late homework isn't accepted. Quizzes and in-class work can't be made up. Intrinsic motivation depends upon various things that should be considered by the teacher. Gcc 141 English Essay Samples Fundamentals Explained A seasoned professional will make an error-free assignment very quickly and can help you boost your grades. Intrinsic motivation is supposedly improved when the students have a chance to acquire more autonomy. Then simply follow the prompts to finish the enrollment procedure. After four absences you are going to be dropped from the class or will get an F in the event the drop date has passed. Always bear in mind, any essay have three distinct components. Remember which you must have a duplicate of the reading beside you on the day we discuss it in class. And this isn't the close of the story yet. The culture of the folks at that city influences the ope ration of the airline. When competition is rising day by day, it will become important for the airline to use a mixture of strategies so it can face competition. The airline business has lots of competition throughout the world. It has grown tremendously over the last few years. The adoption of corporate strategy by Emirate Airline has been shown to be a solution for the business in the times of financial recession. 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Personal Statement My Passion - 968 Words

I sit in the back of the class. Not by force, but of my own accord. I am aware that this is a paper about my passion and we will proceed to that, but there is much more to people that sit in the back that you think. My seating is a segment of my ‘passion’, for it is where I am most comfortable and where I can access my desires the most efficiently. Yes, you might think it is purely to avoid the looming eye of the professor, but it is just the opposite. It is so I can access the start, or the outlet to my passion†¦ imagination. The cognitive freedom I have is my passion and it very well manifests itself on the physical plane of existence. In my eyes the subject of this essay is not even a ‘passion’, but my way of life, it is the way I can function freely without succumbing to the stressors in my surroundings. This is an endeavor of the mind as much as it is a verbal exhibition of my art, better yet, this is a journey, for us both. 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