Colonic and Anorectal Motility Disorders – Brooks Cash, M.D.
Previous Video
Next Video
Questions asked for this faculty member during the 2025 Live Course
On the colon questions – There was a case of ischemic colitis.
I agree the case is c/w left sided ischemia, and CT would be helpful.
However, the patient also has CRI (no creatinine given). As most of these cases resolve with supportive care, is it worth giving a dye load for a typically self-limited disease and subject the patient to potential renal failure? I would suggest the CT is done if the patient worsens.
This patient has multiple risk factors for right sided CI. Either approach is reasonable based on your clinical decision making but the guidelines would support imaging
Is the modified glucose test for dumping syndrome readily available? I guess it is an office-based test?
It would generally be done via Endocrine. Availability is variable. The clinical unit where the test is performed should be familiar with symptomatic hypoglycemia during the OGTT and how to manage it. However, the literature does not report problematic adverse effects during repeated OGTT in patients with dumping syndrome
Is there any role of colonoscopy for the evaluation of FI?
There is no strong data supporting the role of colonoscopy in FI but I would generally recommend it to exclude inflammation or luminal contributors to FI
Isn’t the most simple therapy for anal incontinence is to start out the day by evacuating the rectum with an enema? You mention this but don’t emphasize it.
It depends on the type and severity of incontinence and there is no “best” therapy; the etiology of FI should be elucidated and ideally treated based on the etiology; there is no comparative data demonstrating the effects of start of day enema compared to other therapies but may be helpful for some patients.
Have you used the vibrating capsule for constipation ? What has been your experience?
Yes; mixed results; generally positive but rec excluding slow transit constipation; have had 2 pts with capsule retention; not an emergency and can be cleared with bowel prep. Reasonable option in pts who may be medication averse
Considering how much water the small bowel can absorb, is there any rationale for advising drinking increased amounts of water to treat constipation? I would think it would increase urination and do nothing for constipation.
Correct; there is minimal evidence (little bit in institutionalized elderly adults) that increasing fluid intake can ameliorate constipation and should not be routinely recommended; it is important to ensure adequate fluid intake with fiber supplementation (8 oz at least) but additional fluid intake will simply be reabsorbed and increase urination.
Is there blood test to test for Disaccharidase deficiency? If patient is deficient in Disaccharidase, can we replace it exogenously?
No, there is no blood test for disaccharidase deficiency. Lactase and sucrase have replacement enzymes that can be used for patients with these disaccharidase intolerances. Lactaid (OTC) and sucraid (Rx)
IBS: Thanks for a great lecture on a most common yet challenging problem. With difficulty in getting the Rifaximin approved by payors, do you have any experience with the use of nitazoxanide in IBS? There is a small study published in red journal in 2007 about its efficacy, however I have not seen it widely used though personally I have some degree of success in practice.
Yes, anecdotally I have used alinia and have seen improvement similar to rifaximin, however it is also expensive and not indicated for IBS-D so I would recommend using rifaximin and using one of the ACG prepared appeal letters when insurance fails to approve rifaximin. These are available vie the ACG website in the practice mgmt section I believe.