Long muscular tubular organ which extends from the mouth to anus and functions mainly in digestion. Almost 9 m long/only. Arguably the most complex

Transcription

1 1

2 Long muscular tubular organ which extends from the mouth to anus and functions mainly in digestion. Almost 9 m long/only. Arguably the most complex organ system in the body. Has its own nervous and endocrine system 2

3 Elastin and collagen are present in all layers of the bowel Collagen I, III, IV and V are most abundant in the GI tract Supports, binds and encloses structures of the body, much iike scaffolding Full thickness colon specimen, stained with Millers Elastic Vangieson. Collagen in red, muscle in yellow. Different layers of bowel annotated to right of vertical bars. 3

4 So lots of collagen and elastin in the gut, in close apposition to the neuromuscular apparatus. And this is when our knowledge becomes quite limited. Partly due to poor access to full thickness gut tissue and to difficulties in studying CT in vivo. So really our knowledge of function of CT in the GI tract is very limited.but we can indirectly conclude that CT is important for GI structure and function as GI symptoms are very common in CT disorders. So one way of looking at this is to study CT disorders to find out what GI consequences there are as that may help us understand the role that CT fulfills in the GI tract. 4

5 Bar chart showing the percentage proportions of patients and controls reporting symptoms. OR tell a story. The association with GI was found accidentally when exploring autonomic dysfunction in JHS. This was published in a letter to the editor of rheumatology Bloating abdominal pain, reflux nausea, fecal incontinence are comon and more prevalent than population

6 6

7 7

8 8

9

10 Long muscular tubular organ which extends from the mouth to anus and functions mainly in digestion. Almost 9 m long/only. Arguably the most complex organ system in the body. Has its own nervous and endocrine system 10

11

12 There is an increasing body of evidence suggesting an association between the 2 Bloating abdominal pain, reflux nausea, fecal incontinence are comon and more prevalent than population Various studies have shown an increas in structural and physiological abnormalities that may account for these synptoms 32% RED, 14% controlsconnective tissue abnormalities may contribute to pathoaetiology in REDPatients with JHM had significantly increased: Constipation scores Abdominal pain Need for manual evacuation Use of laxatives Morphological abnormalities on proctography 12

13 There is an increasing body of evidence suggesting an association between the 2 Bloating abdominal pain, reflux nausea, fecal incontinence are comon and more prevalent than population Various studies have shown an increas in structural and physiological abnormalities that may account for these synptoms 32% RED, 14% controlsconnective tissue abnormalities may contribute to pathoaetiology in REDPatients with JHM had significantly increased: Constipation scores Abdominal pain Need for manual evacuation Use of laxatives Morphological abnormalities on proctography 13

14 14

15 15

16 If we are able to determine which mechanism is more prevalent in an individual patient then that will influence management. 16

17 17

18 18

19 19

20 20

21 21

22 22

23 23

24 24

25 25

26 Very important to keep challenging bowel otherwise it becomes lazy 26

27 27

28 28

29 29

30 Very important to keep challenging bowel otherwise it becomes lazy 30

31 If we are able to determine which mechanism is more prevalent in an individual patient then that will influence management. 31

32 Very important to keep challenging bowel otherwise it becomes lazy 32

33 Very important to keep challenging bowel otherwise it becomes lazy 33

34 Other problems in these patients: urinary, autonomic dysfunction partic POTS, chronci fatigue, FM, headaches, chronic pain, anxiety. Multiple functional somatic syndromes.the same athor also did a case series and concluded that GI symptoms are present in 86% of patients but there had been no controlled blinded studies to systematically look at this, and to find out whether there was a pattern of GI symptoms or GI disorders or whether there was a particular mechanism to the symtoms. and there was a concern that patients were overreporting symptoms and that they were mad and that is why they had all tehse symptoms. Multiple symptoms due to overreporting and madness, or due to an abnormality which causes widespread symptoms. To answer this we needed some less biased controlled studies. 34

35 35