Friday, September 16, 2016

September Pelvic PT Distance Journal Club

This month we discussed three articles about bowel dysfunction.   One on diet in IBS and two on hands on treatments in patient with IBS and constipation. 

 Meeting recording

 Next month's meeting is October 5th.

The Science, Evidence, and Practice of Dietary Interventions in Irritable Bowel Syndrome. Brian Lacey Clinical Gastroenterology and Hepatology 2015;13:1899-1906

Pelvic PT Distance Journal Club
September 7, 2016
Jane O’Brien Franczak, PT, MSPT

Summary: This article is a review of pathophysiologic mechanisms that may explain IBS food related symptoms (sx) and evaluates clinical trials of specialized diets used to treat IBS sx.

Premise: Food can cause GI distress due to stimulation of mechanoreceptors and chemoreceptors (ie capsaicin) or alterations in GI transit, intestinal osmolarity and secretion. IBS patients report more food related issues than healthy controls

What causes food symptoms? :

Food Allergies

1. IgE mediated = Rapid onset, ie nuts, wheat, shellfish, strawberries.

Sx of nausea, dysphagia, abdominal pain, vomiting, diarrhea (urticaria)

2. Non IgE -mediated : cell mediated response (T helper 2 cells), delayed onset, IgG antibodies are more prevalent with IBS pts. Sx= GI only.

Food Intolerances

Non- immunologic events, (non-celiac gluten sensitivity, presence of chemicals in foods, histamine, enzyme defects, short chain carbohydrates.)

70% of IBS patients report symptoms representative of food intolerances.

A Comprehensive physical therapy approach including visceral manipulation after failed biofeedback therapy for constipation. Archambault-Ezenwa, L. Tech Coloprotology, June 24, 2016.

Journal Club September 7, 2016
Jane O’Brien Franczak, PT, MSPT

Case study of 41 year old female severe constipation, rectal pain, levator ani spasm, 8 year hx. 2x/mo BM from daily use of laxative and enemas/ 4-6 glasses H2O/day, 15g fiber/day. 75% time, strain for BM,  hard stool, difficulty emptying 25% time, 15 min per attempt to evacuate, difficulty initiating urination 10% time, abdom pain 3-5/10, rectal pain with defecation, 5-7/10, suprapubic pain with full bladder and dysuria 3/10.

Bristol stool rating type 2,3,4. 5/7 sx for Rome III criteria for chronic constipation.

Treatment of Refractory IBS with Visceral Osteopathy. Attali, Thu-Van. J of Digestive Diseases 14; 654-661 (2013).

Pelvic PT Distance Journal Club September 7, 2016
Jane Franczak

To investigate the effectiveness of Visceral Osteopathy for IBS

IBS: Association between abdominal pain and or abdominal distention and bowel dysfunction for recurrent periods. Rome III criterion recurrent abdominal pain or distention lasting at least 3 days/month over 3 months with 2 or more of these:
1.       Improves with defecation
2.       Onset assoc. with change in stool frequency
3.       Onset assoc with change in form of stool

32 Consecutive refractory IBS patients study: failed to improve after variety of drug therapies or high health care usage despite aggressive treatment and unhappy about care.
Osteopathy: manual treatment that relies on various mobilization procedures aimed at relieving patient’s pain. Visceral mobilization was provided by an osteopath.