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Menstrual -Intestinal gas discomfort - lactose-Practice-2018.pptx

  3. VI. GAS DISCOMFORT Bloating And Flatulence
  4. DEFINITION • Intestinal gas, or air in the digestive tract, is usually not noticed until we burp or pass it rectally (flatulence). • The entire digestive tract, from the stomach to the rectum, contains intestinal gas as the natural consequence of swallowing and digestion. • Bloating and flatulence are two of the most common complain. Bloating could be due to • Excess intestinal gas • Abdominal swelling from other serious disease (Colon Cancer) • Excessive intestinal gas sometimes indicates a digestive disorder, but everyone passes gas several times daily, and occasional burping or belching is normal
  5. DEFINITION …… • Excess upper intestinal gas can result from swallowing more than a usual amount of air, overeating, smoking or chewing gum. • Excess lower intestinal gas can be caused by eating too much of certain foods, by the inability to fully digest certain foods or by a disruption in the bacteria normally found in the colon.
  6. SOURCES OF GAS 1. Swallowed air (oxygen , nitrogen) 2. Bicarbonate neutralization of stomach acids (carbon dioxide) 3. Gas diffusion from blood to intestine 4. Bacterial fermentation produces hydrogen, carbon dioxide & methane as by-products
  7. ETIOLOGY I. Medical Conditions II. Medications III. Sensitivity To Gas Movement IV. Food V. Sweeteners
  8. ETIOLOGY…. I. Medical Conditions 1. lactose intolerance & other food allergies/ intolerance lead to flatulence, usually coupled with diarrhea & GI complaints 2. Irritable bowel syndrome (Abdominal distention and excess flatus 3. Subacute intestinal obstruction, a medical emergency
  9. ETIOLOGY…. I. Medical Conditions….. 4. Giardiasis , Cholelithiasis & Peptic ulcer 5. Malabsorption syndrome allows unabsorbed nutrients to pass through intestine and bacterial fermentation occurs with excess gas production
  10. ETIOLOGY…. II. Medications 1. Bulk laxative containing fermentable carbohydrates e.g. psyllium 2. R/ medications: Certain Abs (Cephalexin , Parenteral piperacillin) , NSAIDs , quinolones (ciprofloxacin , norfloxacin) , nicotine gum , lactulose & cholestyramine
  11. ETIOLOGY…. III. Sensitivity To Gas Movement Normally average individual has ≤10-200 ml gas in stomach and colon at any time. Patients may have normal amount of stomach & colon gases but rectum is abnormally sensitive to this amount leading to retrograde movement of gas.
  12. ETIOLOGY…. IV. Food • Foods that cause gas in one person might not cause it in another. • Foods such as legumes contain indigestible oligosaccharides raffinose, stachyose & verbascose transfer to colon & bacterial fermentation occurs with gas production as by-product . • Common gas-producing foods and substances include: • Beans and lentils • Vegetables such as cabbage, broccoli, cauliflower, and brussels sprouts (cruciferous vegetables), • Cereals and grain products like Bran, barley, wheat
  13. ETIOLOGY…. IV. Food….. • Fructose, which is found in some fruits and used as a sweetener in soft drinks and other products • Sorbitol, a sugar substitute found in some sugar- free candies, gums and artificial sweeteners • Carbonated beverages, such as soda or beer • Fatty foods also lead to flatulence as they decrease GIT motility & give chance for bacterial fermentation
  14. ETIOLOGY…. V. Sweeteners Sweeteners such as fructose, sorbitol & mannitol are poorly absorbed so they can lead to flatulence & diarrhea.
  15. Complications of bloating and Intestinal GAS •For most patients bloating presents only a minor discomfort while flatulence is Socially embarrassing, but nothing more. • Fear of passing gas – withdraw from social contact and give up lucrative careers. •Increase risk of mechanical bowel obstruction, gut necrosis or perforation •An increase in the pressure of ambient air can cause trapped gas to expand, known as “Trapped
  16. Treatment of bloating and Intestinal GAS 1. Non Pharmacological Therapy •Lifestyle modification 1. Avoid chewing gums 2. Avoid smoking 3. Patient with lactose intolerance should avoid lactose containing foods or take lactase enzyme with these foods 4. Avoid carbonated beverages (soft drinks & beer) 5. Avoid rapid eating 6. Masticate food well 7. Remain upright several hours after meal
  17. Treatment of bloating and Intestinal GAS 2. Pharmacological OTC Therapy 1.Carminatives 2.Alpha-galactosidase 3.Simethicone 4.Activated Charcoal
  18. Treatment of bloating and Intestinal GAS 2. Pharmacological OTC Therapy …. 1.Carminatives • Such as peppermint reduce flatulence • Reduce pressure of lower esophageal sphincter so allow patient to belch • They can worsen the problem of gastroesophageal reflux: • Don’t prevent excessive gas • Don’t easing the gas passage through GI
  19. Treatment of bloating and Intestinal GAS 2. Pharmacological OTC Therapy …. 2. Alpha-galactosidase • Beano tablets or liquid contain alpha galactosidase which degrades oligosaccharides into digestible sugars (sucrose and glucose) • Tablets are taken after first bite of food • It is affected by heat so hot food should be cooled
  20. Treatment of bloating and Intestinal GAS 2. Pharmacological OTC Therapy …. 3. Simethicone • It is a defoaming agent • It was used in endoscopic procedure to clear small bubbles that obscured the visual field when bile mixed with infused air. • Hypothesis: It might alter the elasticity of interfaces of mucus embedded bubbles in the GI tract, allowing the gas bubbles to coalesce. • Gas becomes more easily eliminated as belching or flatus • The only antiflatulent!! recognized by the FDA as safe and effective with no ADE (No absorption from GI) • It is used at any age • It relives symptoms of bloating pressure, fullness, or stuffed feeling caused by gas by facilitating the passage of gas through the GI tract, allowing the patient to more
  21. Treatment of bloating and Intestinal GAS 2. Pharmacological OTC Therapy …. 4. Activated Charcoal • It is used to reduce frequency of flatus events and to improve symptoms of gaseousness. • It is not approved by FDA. • It can be found in combination with simethicone (Also not FDA approved).
  22. 22 Thank You
  24. LACTOSE INTOLERANCE (LI) (Hypolactasia) / Lactose deficiency What is lactose? • Lactose is a unique carbohydrate found in the milk of most mammals. • The small intestine produces an enzyme called lactase. • Lactase breaks down (hydrolysis) lactose in milk or dairy products into two simpler forms (monosaccharides) of sugar: glucose and galactose. • The body absorbs these simpler sugars into
  25. WHAT IS LACTOSE INTOLERANCE? • It indicates low lactase activity in the brush boarder membrane of the small intestine (The outer most layer of the small intestine epithelium, composed of many microvilli) specially in the microvillus membrane • It is a condition in which people have digestive symptoms (bloating, diarrhea, and gas) after eating or drinking milk or milk products. • Lactase deficiency and lactose malabsorption may lead to lactose intolerance:
  26. WHAT IS LACTOSE INTOLERANCE? • Lactose malabsorption. Lactase deficiency may cause lactose malabsorption. • In lactose malabsorption, undigested lactose passes to the colon. • The colon, part of the large intestine, absorbs water from stool and changes it from a liquid to a solid form. • In the colon, bacteria break down undigested lactose and create fluid and gas. • Not all people with lactase deficiency and lactose malabsorption have digestive symptoms.
  27. How much lactose can a person with lactose intolerance have? •Most people with lactose intolerance can tolerate some amount of lactose in their diet and do not need to avoid milk or milk products completely. •Avoiding milk and dairy products altogether may cause people to take in less calcium and vitamin D than they need. •Individuals vary in the amount of lactose they can tolerate (inter- individual variability. •A variety of factors—including how much lactase the small intestine produces •Other people can easily eat yogurt and hard cheeses such as cheddar and swiss, while they are not able to eat or drink other dairy products without having digestive symptoms. •Research suggests that adults and adolescents with lactose malabsorption could eat or drink at least 12 grams of lactose in one sitting without symptoms or with only minor symptoms (1 cup of milk).
  28. TYPES OF LI Four types of lactase deficiency may lead to lactose intolerance: Primary lactase deficiency (lactase non persistence), is the most common type of lactase deficiency (70%). • In people with this condition, lactase production declines over time. This decline often begins at about age 2; however, the decline may begin later. • Children who have lactase deficiency may not experience symptoms of lactose intolerance until late adolescence or adulthood. • Researchers have discovered that some people inherit
  29. TYPES OF LI …. Secondary lactase deficiency results from injury to the small intestine (acute gastroenteritis) . It occurs secondary to various environmental problems: 1. Infection: Such as acute gastroenteritis, rotavirus, invasion of parasites as hookworm or giardia (damage villus architectures) 2. Medical conditions: Celiac disease (gluten sensitivity), sprue syndrome, malnutrition 3. Surgery: Resection of small intestine leads to short bowl syndrome & insufficient contact between lactose & intestine 4. Drugs & alcohol: Some medications also contain lactose as diluents e.g. tetracycline, cimetidine,
  30. TYPES OF LI …. Developmental lactase deficiency may occur in infants born prematurely. This condition usually lasts for only a short time after they are born. Congenital lactase deficiency (Congenital Alactasia) is an extremely rare disorder in which the small intestine produces little or no lactase enzyme from birth. Genes inherited from parents cause this disorder.
  31. Manifestations of LI 1. Abdominal pain , cramp 2. Diarrhea , nausea 3. Stomach rumbling 4. bloating, dyspepsia 5. Watery or frothy stool 6. Involuntary leakage of stool in severe cases
  32. TESTS AND DIAGNOSIS Hydrogen breathe test • This test measures the amount of hydrogen in a person’s breath. • Normally, only a small amount of hydrogen is detectable in the breath when a person eats or drinks and digests lactose. • Undigested lactose produces high levels of hydrogen. • The patient drinks a beverage that contains a known amount of lactose. • A health care provider asks the patient to breathe into a balloon-type container that measures breath hydrogen level. • In most cases, a health care provider performs this test at a hospital, on an outpatient basis. • Smoking and some foods and medications may affect the accuracy of the results.
  33. TESTS AND DIAGNOSIS ….. Lactose tolerance test • It measures your body's reaction to a liquid that contains high levels of lactose. • Two hours after drinking the liquid, you'll undergo blood tests to measure the amount of glucose in your bloodstream. • If your glucose level doesn't rise, it means your body isn't properly digesting and absorbing the lactose-filled drink. Stool acidity test • Used for infants and children who can't undergo other tests • The fermenting of undigested lactose creates lactic acid and other acids that can be detected in a stool sample.
  34. Differentiating LI from other medical conditions: A. lactose intolerance versus milk allergy • Milk allergy is a true food allergy caused by an allergic reaction to the protein in milk. • "Milk allergy” usually shows up early in life. • Lactose intolerance is more common, takes longer to develop, and can occur at any time of life." • Lactose intolerance can be genetic, or it can be caused by damage to the small intestine due to a viral or bacterial infection • Lactose intolerance increases with age and is quite common in the elderly • Lactose intolerance symptoms are between 30 min and 2 h after ingesting milk or a dairy food. • The same symptoms are seen in both but the most differentiating symptoms is vomiting within first hour of ingestion in Cow’s milk
  35. Differentiating LI from other medical conditions: …. B. Irritable bowl Syndrome (IBS) • They have duplicate symptoms • Exclude LI before the diagnosis of IBS
  36. Complications of LI: • Patient will lose important nutrients found in lactose containing food such as phosphorous, magnesium, calcium, vitamin A and D which leads to poor skeletal growth and osteoporosis • Pharmacist may suggest supplemental Calcium for LI patients who on restrict milk and dairy products intake.
  37. TREATMENT GUIDELINES • There's currently no way to increase the body's production of lactase, but we can usually avoid the discomfort of lactose intolerance. • Many people can manage the symptoms of lactose intolerance by changing their diet. • Some people may only need to limit the amount of lactose they eat or drink. • Others may need to avoid lactose altogether. 1. Determination of lactose tolerance level 2. Non pharmacological treatment 3. Pharmacological treatment
  38. DETERMINATION OF LACTOSE TOLERANCE LEVEL 1. Prevent patient from taking foods, drinks and medications containing lactose for 3 weeks 2. Gradually increase lactose containing products until symptoms occur 3. Drop back to the previous amount
  39. NON PHARMACOLOGICAL TREATMENT Counsel the patient to: 1. Eat several small meals rather than large meals 2. Eat other food with lactose containing food to dilute lactose & facilitate hydrolysis 3. Taking yogurt (fermented milk product) with other dairy products 4. Use special lactose reduced milk products 5. Neither cultured milk (buttermilk) nor unfermented milk containing lactobacillus acidophilus improves LI.
  40. PHARMACOLOGICAL TREATMENT 1. Lactase enzyme medications that can be in liquid, tablet / capsule form can be added to milk or taken after first bite of lactose containing products 2. Calcium supplement for patients who are completely restricted from taking milk and dairy products
  41. 41 Thank You

Notas do Editor

  1. Original Power Point file of this lecture
  2. Original Power Point file of this lecture
  3. Lactose is a sugar found in milk and milk products.