Foods to Avoid If You Have a Stricture

It is important for people who have Crohn’s disease to know that they are at an increased risk of developing a stricture in their small intestine. Keeping inflammation from the disease under control is important for preventing strictures. Diagnosing strictures quickly and using the latest medications and surgical techniques can help get a stricture under control and prevent it from happening again.

A stricture is a narrowed section in the intestines. The intestines are normally an open tube (much like a hose) that allows food to pass through and become digested. For people with Crohn’s disease, the ​small intestine can become narrowed over time as inflammation causes scarring. The scars in the small intestine can become so prevalent that they actually start to block the open space inside, causing a stricture.

Strictures are of great concern to people with Crohn’s disease because if a stricture causes the small intestine to become too tight on the inside, it could lead to a blockage (bowel obstruction).  Blockages can be caused by one or more of several different factors, including adhesions, scar tissue, inflammation, or undigested food.

People who have strictures may need to alter their diet to ensure that the narrowed portion of their intestine does not become blocked. Certain foods may be more likely to get hung up inside the stricture and not be able to pass through.

If you have a stricture, some of the foods that you may want to avoid, limit, or chop and cook very well before eating are listed below.

Seek Help With Diet

Patients that have a stricture should be monitored closely by their gastroenterologist. A gastroenterologist will be the best resource for how and when the stricture should be treated. Any dietary restrictions should also be discussed with a healthcare professional.

In a best-case scenario, a dietitian or nutritionist with experience in managing patients with strictures should provide assistance with a diet plan. In some cases, a low fiber, or restricted-fiber diet may be recommended for a short period of time.

Cutting nutritional foods out of the diet whole-scale is typically not recommended. However, in the case of strictures, certain foods might need to be avoided for a period of time until the stricture is resolved. Patients who have any questions regarding their diet should always consult their gastroenterologist.

Colon Stricture – What You Need to Know

1. CareNotes
2. Colon Stricture

This material must not be used for commercial purposes, or in any hospital or medical facility. Failure to comply may result in legal action.

WHAT YOU NEED TO KNOW:

What is a colon stricture?

A colon stricture is the narrowing of the large intestine. A stricture slows or prevents waste from passing through your large intestine. Colon strictures can become life-threatening if they are not treated.

What causes colon strictures?

• Chronic inflammation and scars from inflammatory bowel disease, such as Crohn disease
• Your colon looping around itself (volvulus)
• Adhesions in your abdomen
• Hernias
• Tumors inside or outside of your colon

What are the symptoms of colon strictures?

You may not have any symptoms. The following are the most common symptoms:

• Constipation
• Pain or cramps in your abdomen
• Bloated or distended abdomen
• Nausea and vomiting

How are colon strictures diagnosed?

Your healthcare provider may see a stricture on an abdominal x-ray or CT scan.

How are colon strictures treated?

• Balloon dilation may be done. A scope with a light and camera is placed into your colon. A balloon is placed over a guidewire and inflated in the narrow area. Healthcare providers inflate the balloon several times for short periods. The inflated balloon pushes against the narrow wall and opens it.
• A stent may need to be placed to open the stricture. A stent is a metal coil. The stent will be left in place to keep the stricture open.
• Surgery may be needed if balloon dilation does not work. It may also be needed if your healthcare provider is not able to reach the stricture with a scope. There are 2 types of surgery:
  • A resection is used to remove the part of the intestine that has the stricture. Then, the remaining 2 ends or 2 sides are sewn together.
  • A stricturoplasty may be needed if you have had a large part of your intestine removed. It may also be needed if there many areas with strictures in your intestine.

How can I prevent colon strictures?

You may not be able to prevent strictures if you have certain chronic conditions, such as Crohn disease. The following may help to prevent colon strictures:

• Eat a variety of healthy foods. Choose foods that are low in fat. Eat more fruits and vegetables.
• Do not smoke. Nicotine can damage blood vessels and make it more difficult to manage your colon stricture. Smoking also increases your risk for colorectal cancer. Do not use e-cigarettes or smokeless tobacco in place of cigarettes or to help you quit. They still contain nicotine. Ask your healthcare provider for information if you currently smoke and need help quitting.
• Do not lift heavy items. This will help prevent hernias that can cause part of your intestine to go through your abdominal wall.

When should I seek immediate care?

• You have a fever.
• You have nausea and vomiting, and severe, worsening abdominal pain.
• You have severe abdominal swelling.
• You cannot have a bowel movement or pass gas.

When should I contact my healthcare provider?

• You have abdominal cramps that come and go.
• You have diarrhea but feel like your bowels are still full.
• You have questions or concerns about your condition or care.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your healthcare providers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© Copyright IBM Corporation 2021 Information is for End User’s use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or IBM Watson Health

Learn more about Colon Stricture

Associated drugs

IBM Watson Micromedex

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

Stricture – an overview | ScienceDirect Topics

Ileal Pouch Strictures

Strictures after IPAA are common, with a range from 10% to 40%, and they usually occur in the setting of pelvic sepsis, anastomotic tension, or ischemia.^48,72,116 Common locations of stricture are at the pouch-anal anastomosis, pouch inlet, and the side of loop ileostomy. ^117–120

Purported risk factors for strictures include the nonuse of diverting loop ileostomy,¹²¹ mesenteric tension,^116,121 pelvic sepsis,^116,121 increased body mass index,^94,121 handsewn anastomosis,^116,119 stapler size,¹²² surgery-associated ischemia, use of nonsteroidal antiinflammatory drugs (NSAIDs), and presence of de novo CD.^94,117,121 It was reported that stapled anastomoses are associated with shorter nonfibrotic strictures, whereas mucosectomy with handsewn anastomoses are associated with longer fibrotic strictures.

While multiple and/or complex strictures may result in pouch failure,¹¹⁷ most of pouch strictures in the diverted pouch are self-limiting and web-type which can be dilated digitally or endoscopically, at the time of stoma closure. The manifestation of a stricture is often late, occurring between 6 and 9 months after pouch construction.¹¹⁶ Patients with pouch-related stricture usually have symptoms including abdominal cramping, watery stools, straining, urgency, and a sensation of incomplete evacuation. ⁹⁴ Strictures can be characterized by the degree, length, and inflammatory component (see Chapter 8). Strictures can be managed with medical therapy,¹²³ endoscopic balloon or needle-knife therapy, surgical resection or stricturoplasty, pouch diversion, and even pouch excision.^84,124 Medical therapy may be useful in selected patients, including those with strictures from NSAID use, inflammatory strictures, or CD of the pouch. However, CD of the pouch must be a part of differential diagnosis for strictures. If a patient presence a pouch outlet or afferent limb stricture, a delayed diagnosis of CD should be suspected. If CD is diagnosed, initial treatment with medical therapy with immunomodulator or biologic therapy should be performed.

Local treatment including bougie or balloon dilation at home, in the operating room or via endoscopy, is safe and effective in strictures^116,121 Shorter and nonfibrotic strictures of the pouch are more responsive to the dilation. ¹²¹ Dilation lead to a 95% immediate success rate in nonfibrotic strictures and a 45% success rate in fibrotic strictures.¹¹⁶ In addition to medical treatment of underlying diseases, EBD, which can result in an overall success in 97% of patients,¹¹⁷ has been routinely used to treat patients with pouch strictures. The rate of success in EBD varies, depending on the degree, length, and number of strictures. Therefore, a shorter stricture which is associated with stapled IPAA is more responsive to dilation when compared with mucosectomy and handsewn anastomosis–associated longer fibrotic strictures.¹²¹ In addition, successful endoscopic dilation of pouch inlet and outlet strictures has also been reported.^117,123 Shen et al.⁹² from Cleveland Clinic have developed endoscopic needle-knife stricturotomy (NKSt) to treat these strictures. In contrast to being blind to depth or location with EBD therapy, the authors reported that the main advantage of NKSt over EBD in treating strictures is that the endoscopist has full control of the depth and location of incisions, which is particularly important in the treatment of distal pouch, anastomotic, or anal strictures. ¹²⁵

Surgical treatment modalities for strictures refractory to digital, bougie, or EBD include transanal advancement flap, anoplasty, and stricturoplasty, which have been used in CD-related pouch-anal strictures. CD-related stricture of the afferent limb can be treated with bypass procedure from above the area of stricture to the pouch or with stricturoplasty.⁴⁸ Short supple strictures that appeared as a “fibrous ring” can be treated with excision of the strictured segment and repairmen with the advancement of an ileal mucosal advancement flap.¹¹⁶ For pouch-related strictures, pouch excision or diverting loop ileostomy were rarely required, due to above available safer and effective endoscopic treatment choices.¹⁰⁴ Our proposed algorithm for management of anastomotic stricture after surgery for IBD is presented in Fig. 24.6.

Figure 24.6. Proposed algorithm for the management of anastomotic stricture after IBD surgery. IBD, inflammatory bowel disease.

An unusual cause for a colonic stricture: a case of Mycobacterium xenopi mimicking malignancy

Large bowel strictures are a common finding on radiological investigation. Causes include primary colonic malignancy, less commonly as a complication of diverticular disease, and may also occur in Crohn’s disease, ischaemia, sites of anastamosis, and rarely intra-abdominal mycobacterial infection.¹ We report a case of delayed diagnosis of a mycobacterial stricture mimicking malignancy due to a rare mycobacterial subtype.

CASE REPORT

A 64 year old woman was referred to our care in 2001. She was referred with a diagnosis made at our partner hospital of a malignant transverse colon stricture. This was identified by double contrast barium enema examination (fig 1) the patient having developed a change in bowel habit, weight loss, and abdominal pain. She had a past history of pulmonary mycobacterial infection during childhood.

Figure 1

Barium enema image showing transverse colon stricture.

Preoperative computed tomography of the abdomen confirmed the presence of a transverse colon mass but revealed no other intra-abdominal abnormality (fig 2).

Figure 2

Computed tomogram of the abdomen showing transverse colon stricture.

At the time of admission a hypochromic microcytic anaemia of 97 g/l and a preoperative albumin of 30 g/l were noted. A laparotomy was performed and a stricturing lesion was confirmed in the transverse colon. This did not have any malignant features and a stricturoplasty and full thickness biopsy was undertaken. Histological examination revealed fibrosis, capillary ectasia, and non-specific mild pericapillary chronic inflammatory cell infiltrate. The changes were consistent with but not specific for secondary ischaemia. There were no specific features of Crohn’s disease and no evidence of necrosis, granulomas, giant cell formation, and on Ziehl-Neelsen staining no acid fast bacilli were seen.

The patient remained well for nine months before developing symptoms of severe postprandial pain, distension, audible borborygmi, and severe weight loss. Contrast examination of the large bowel demonstrated a recurrent transverse colon stricture and new ascending colon and small bowel strictures.

The patient was readmitted; however, on admission she was found to be grossly hypoalbuminaemic (14 g/l) and anaemic. Enteral feeding was instituted and blood transfusion undertaken. A chest radiograph showed left upper lobe consolidation suggestive of tuberculosis. Sputum cultures were sent for analyses and initial results revealed acid fast bacilli. Antituberculous therapy was therefore started: isoniazid 300 mg/day; rifampacin 600 mg/day; ethambutol 25 mg/kg for two months and 15 mg/kg for 16 months.

Enteral nutrition was instituted in hospital and continued at home for four weeks. A six week culture revealed the organism to be Mycobacterium xenopi. Outpatient review at two, six, and nine months showed progressive resolution of the gastrointestinal symptoms with weight gain, normalisation of serum albumin, significant improvement in respiratory symptoms, and no recurrence of the previous anaemia.

DISCUSSION

Mycobacterium xenopi is an uncommon slow growing non-tuberculous mycobacterium that is usually non-pathogenic¹ and grows optimally at temperatures between 42°C and 45°C.² It is recognised to frequent hospital hot water systems, is of low pathogenicity, and can sometimes be found in the bronchial tree.³ It typically presents as a primary pulmonary infection in the immunosuppressed and those with coexisting pulmonary disease—for example, chronic obstructive airway disease.^4,5 The organism has also been implicated in a significant outbreak of infection in the context of improper surgical instrument sterilisation.⁶ It is resistant to routine disinfection and is a common finding in domestic drinking water. Thus significant caution must be exercised when cleaning and sterilising instruments that are not suitable for autoclaving—for example, colonoscopes.

Learning points

• In the presence of a history of previous mycobacterial infection a high index of suspicion should be held for mycobacteria as a cause of a colonic stricture.

• Colonoscopic examination is desirable in any patient who presents with a previous history of mycobacterial infection, or is atypical in any way even if contrast study has already been performed.

• That caution should be exercised in the sterilisation of any instruments used in these patients especially those not suitable for autoclave treatment.

• Prolonged antimycobacterial treatment, perhaps with the addition of clarithromycin, is indicated.

• Antimicrobial therapy leads to symptomatic resolution without the need for surgery.

Mycobacteria are well recognised as the cause of colonic disease. Manifestations include, typically colonic stricture but also bleeding, perforation, and cachexia. Strictures have been noted to mimic both malignancy and inflammatory bowel disease.⁷ Infection is most commonly diagnosed at colonoscopy, where strictures, ulcers, polyps, or masses may be seen. Biopsy of such lesions may reveal tuberculous granulomas and Ziehl-Neelsen staining can show acid fast bacilli.⁸ The majority of colonic disease arises because of M tuberculosis; however, rarely non-tuberculous mycobacteria have been identified—for example, M chelonae and M fortinum, although one report suggests these may be colonoscopic contaminants. Mycobacterium xenopi has not been previously described in the aetiology of gastrointestinal disease.

The treatment of M xenopi remains challenging. It is less susceptible to first line antituberculous agents when compared with M tuberculosis and requires prolonged treatment regimens. ⁷

Recent work in mice has shown that the use of clarithromycin may be advantageous; however, an ideal regimen using clarithromycin has not been identified and in vitro susceptibility testing of isolates may be helpful in tailoring chemotherapy.⁹

CONCLUSION

Mycobacterium xenopi is an uncommon cause of human infection and it typically causes pulmonary disease in the immunosuppressed and those with coexisting pulmonary pathology. Mycobacteria are well recognised in the aetiology of colonic strictures; however, M xenopi has never been described as a causative organism.

REFERENCES

1. ↵

   Murray PR, Baron EJ, et al., eds. Mycobacterium. Manual of clinical microbiology. 7th Ed. Washington, DC: American Society of Microbiology Press, 1997.

2. ↵

   Bachmeyer C, Blum L, et al. Mycobacterium xenopi pulmonary infection in an HIV infected patient under highly active retroviral treatment. Thorax2001;56:978–9.

3. ↵

   Salazar Schicchi J, Nachman SA. Mycobacterium xenopi. Thorax2002;57:658.

4. ↵

   Jiva TM, Jacoby HM, Weymouth LA, et al. Mycobacterium xenopi: innocent bystander or emerging pathogen? Clin Infect Dis1997;24:226–32.

5. ↵

   El Solh NP, Nopper J, Abdul Khoudoud MR, et al. Clinical and radiographic manifestations of pulmonary non tuberculous mycobacterial disease in AIDS patients. Chest1998;114:138–45.

6. ↵

   Dorozynski A. Poor sterilization of instruments leads to infection outbreak in Paris. BMJ1997;315:699.

7. ↵

   Lau CF, Wong AMC, Yee KS, et al. A case of colonic tuberculosis mimicking Crohn’s disease. Hong Kong Medical Journal1998;41:63–6.

8. ↵

   Wong SS, Chow E. Endoscopic diagnosis of colonic tuberculosis: unusual presentation with two colonic strictures. Endoscopy1996;23:783.

9. ↵

   Grosset JL, Meyer C, Truffot C, et al. Mycobacterium xenopi. Biological characteristics and sensitivity to antibiotics. Rev Fr Mal Respir1979;7:498–500.

10. Murray PR, Baron EJ, et al., eds. Antimycobacterial agents. Manual of clinical microbiology. 7th Ed. Washington, DC: American Society of Microbiology Press, 1997.

Terminal ileal stricture | Postgraduate Medical Journal

Q1: What does the small bowel enema show (see p 627)?

The small bowel enema shows normal jejunum. The ileum is shortened in its distal portion and uniformly narrowed with a smooth outline; the ileocaecal junction is well delineated and the caecum is normal.

Q2: What is the differential diagnosis?

The differential diagnosis of ileal stricture includes tuberculosis, Crohn’s disease, pelvic inflammation, ischaemia, radiation enteritis, carcinoid infiltration, lymphoma, and diffuse enteropathy—that is, disorders where there is inflammation, infiltration, or oedema of the small bowel. History and clinical findings in this case did not contribute to the diagnosis.

Q3: How can you confirm the diagnosis?

Enteroscopy/terminal ileoscopy is the investigation of choice. In active Crohn’s disease, the terminal ileum shows patchy asymmetrical and heterogenous mucosal lesions. Ulcers which may be aphthoid, superficial, or deep are seen surrounded by normal mucosa. Tuberculoid granuloma is the most specific finding on histology apart from infiltration of lamina propria by lymphocytes and plasma cells with aggretates of lymphocytes near the base of the crypts. In the present case, the smooth and featureless mucosa, and inflammatory cellular infiltrate of lamina propria suggests Crohn’s disease in remission. The patient has not been on any medication for over four years.

Discussion

Segmental areas of luminal narrowing of ileum referred to as ileal stricture is due to rigid thickening and fibrosis of its wall resulting in obstruction. It is a common complication of Crohn’s disease, tuberculosis, and intestinal ischaemia. A flare-up of inflammatory process causes temporary intestinal narrowing; when healing occurs with a scar or fibrous tissue formation the obstruction is complete. The narrowing could either be circumferential and concentric or eccenteric and irregular in nature. On barium contrast examination, these strictures typically appear as segmental narrowing without normal mucosal pattern and with smooth tapered ends—referred to as the “string sign”. Strictures themselves are painless and may not require treatment. But sometimes, these areas become so narrow and result in a partial or total obstruction.

What is the pathophysiology of stricture formation? The intestine can propel the lumenal contents only when the lumen remains fairly wide enough. When there is damage to the intestinal mucosa due to inflammation, the smooth muscle cells of the intestine activate a complex chain of events, involving a host of immune system components, for example, interleukin-1β. There is production and deposition of more than normal collagen at the site of injury. Scarring occurs, the layers of intestinal muscle thicken, and the muscles no longer move smoothly and easily. In short, a stricture forms, compromising the intestine’s ability to function efficiently.

An important differential diagnosis of ileal stricture in the present case is Crohn’s disease, based on the peroperative findings of mesenteric thickening and ileal stricture at enteroclysis. A featureless outline of a diseased ileal segment, due to atrophy of the folds from long standing inflammation, is not an uncommon finding in Crohn’s disease.¹ In one series this was seen in 29% of cases²; the biopsy is not likely to be helpful in these situations. Crohn’s disease is being increasingly reported from India. ³ It is today included as an important differential diagnosis for ileal tuberculosis. The strictures are caused by shrinkage of a tuberculous ileocaecal mass to form a fibrous constriction. In a country where both problems exist, distinction becomes difficult. Non-response to antituberculosis treatment favours the diagnosis of Crohn’s disease. The patient has not been treated for tuberculosis.

In Crohn’s disease, like tuberculosis, the small intestine is the most common affected site (80%).¹ In the early stages of the disease, the narrowing is due to oedema and spasm; with progression of the disease, fibrosis manifests as a lumenal narrowing. These findings are also seen in tuberculosis. Few radiological signs are specific for Crohn’s disease. These include fissures, ulcers, sinuses, fistulae, and asymmetrical involvement, skip lesions, and long longitudinal ulcers. Less specific findings include luminal narrowing, stricture formation, and dilatation proximal to stenosis, thickening of the mucosal folds, cobblestoning, discrete ulcers, or mural thickening. Long segmental narrowing of the terminal ileum was the only positive finding in the present case.

Khwaja and Subbuswamy reported ischaemic strictures of the small intestine from northern Nigeria.⁴ The radiological features are non-specific and simulate tuberculosis and Crohn’s disease. Even at laparotomy, it may be difficult to differentiate this from Crohn’s disease and tuberculosis. Hypotensive drugs can occasionally produce intestinal ulceration and stricture formation.⁵

The barium infusion technique (enteroclysis) is an ideal investigation for study of the small intestine, both for focal lesions and for extensive mucosal disease. In the best of hands, the procedure gives an optimal radiological-gross pathological correlation and satisfactory evaluation of the extent, depth of the disease, and complications.⁶

A histological difference between Crohn’s disease and tuberculosis is not always possible. Supportive information only helps in making a diagnosis. In the case reported, the peroperative findings of ileal stricture resembled Crohn’s disease and ileal tuberculosis; terminal ileoscopy and histology was not helpful. The possible diagnosis is Crohn’s disease in “remission”.

The patient under study has been asymptomatic for four years and is not on any medication. Intervention in ileal strictures is necessary when an individual is symptomatic. Steroids, aminosalicylic acid preparations, immunomodulators, and verapamil have been used during the inflammatory phase; the latter inhibits the smooth muscle cells’ response to intestinal injury and prevents collagen deposition. When the affected segment is fibrosed and scarred, endoscopic balloon dilatation can relieve the obstruction. Surgical options include stricturoplasty and resection of the affected segment.

A nationwide, multi-center, retrospective study of symptomatic small bowel stricture in patients with Crohn’s disease

Conflict of interest

SB received lecture fees from AbbVie GK, Mitsubishi Tanabe Pharma Co. , Ltd., Kyorin Pharmaceutical Co., Ltd., Janssen, Mochida Pharmaceutical, Nippon Kayaku, Zeria Pharmaceutical Co., Ltd., and EA Pharma Co., Ltd., and research support from AbbVie GK, and MSD Inc. RS received lecture fees from Mitsubishi Tanabe Pharma Co., Ltd., Janssen, AbbVie GK, EA Pharma Co., Ltd., and Nippon Kayaku. TF received research support from Eisai Co., Ltd., and Alfresa Co., Ltd., and lecture fees from AbbVie, Ajinomoto Pharma, Boehringer Ingelheim, Daiichi Sankyo Co., Ltd., EA Pharma Co., Ltd., Janssen, Kissei Pharmaceutical, Kyorin Pharmaceutical Co., Ltd., Kyowa Hakko Kirin, Mitsubishi Tanabe Pharma Co., Ltd., Mochida Pharmaceutical, Nippon Kayaku, and Zeria Pharmaceutical Co., Ltd. HS received research support from Bristol-Myers Squibb, AbbVie GK, MSD Inc., Daiichi Sankyo Co., Ltd., and Zeria Pharmaceutical Co., Ltd. SS received lecture fees from Mitsubishi Tanabe Pharma Co., Ltd., AbbVie GK, EA Pharma Co., Ltd., and Nippon Kayaku. HTan received lecture fees from JIMRO Co. , Ltd., AbbVie GK, EA Pharma Co., Ltd., Mochida Pharmaceutical Co., Ltd., Kyorin Pharmaceutical Co., Ltd., and Mitsubishi Tanabe Pharma Co., Ltd. RO received lecture fees from AbbVie GK. KKa received lecture fees from Mitsubishi Tanabe Pharma Co., Ltd. and AbbVie GK. YS received lecture fees from Mitsubishi Tanabe Pharma Co., Ltd. and EA Pharma Co., Ltd. KKi received lecture fees from Mitsubishi Tanabe Pharma Co., Ltd., AbbVie GK, EA Pharma Co., Ltd., Janssen, Nippon Kayaku, and Olympus, and research support from AbbVie GK and Zeria Pharmaceutical. SA received lecture fees from Janssen, Mitsubishi Tanabe Pharma Co., Ltd., and JIMRO Co., Ltd. TKo received lecture fees from AbbVie GK, Ajinomoto Pharma, Asahi Kasei Medical, Astellas, Alfresa Pharma, Celltrion, EA Pharma Co., Ltd., Eisai Co., Ltd., Gilead Sciences, Janssen, JIMRO Co., Ltd., Kyorin Pharmaceutical Co., Ltd., Nippon Kayaku, Mochida Pharmaceutical, Takeda Pharmaceutical, Mitsubishi Tanabe Pharma Co., Ltd., and ZERIA Pharmaceutical Co. , Ltd., and consulting fees from Alfresa Pharma, Covidien, Eli Lilly, Ferring Pharmaceuticals, Janssen, Kyorin Pharmaceutical Co., Ltd., Mochida Pharmaceutical, Nippon Kayaku, Pfizer, Takeda Pharmaceutical, and Thermo Scientific, and research support from EA Pharma Co., Ltd., Thermo Fisher Scientific, Alfresa Pharma, Nippon Kayaku, and Asahi Kasei Medical. AA received lecture fees from AbbVie GK, Mitsubishi Tanabe Pharma Co., Ltd., Kyorin Pharmaceutical Co., Ltd., Janssen, Astellas, Zeria Pharmaceutical, Miyarisan Pharmaceutical, Takeda Pharmaceutical, Bristol-Myers Squibb, Gilead Sciences, MSD Inc., and EA Pharma Co., Ltd., and research support from EA Pharma Co., Ltd., AbbVie GK, MSD Inc., and Mochida Pharmaceutical, and consulting fees from Mochida Pharmaceutical Co., Ltd., and Takeda Pharmaceutical. TH received lecture fees from Mitsubishi Tanabe Pharma Co., Ltd., Kyorin Pharmaceutical Co., Ltd., AbbVie GK, Janssen, JIMRO Co., Ltd., EA Pharma Co., Ltd., Mochida Pharmaceutical Co., Ltd. , Takeda Pharmaceutical, Gilead Sciences, Celltrion, Nippon Kayaku, Kissei Pharmaceutical, Miyarisan Pharmaceutical, Zeria Pharmaceutical Co., Ltd., and Ferring Pharmaceutical, and advisory/consultancy fees from AbbVie GK, Takeda Pharmaceutical, Mitsubishi Tanabe Pharma Co., Ltd., JIMRO Co., Ltd., EA Pharma Co., Ltd., Eli Lilly, Pfizer Japan Inc, Nichi-Iko Pharmaceutical, and Nippon Kayaku, and research support from EA Pharma, AbbVie GK, JIMRO Co., Ltd., Zeria Pharmaceutical Co. Ltd., and Otsuka Pharmaceutical Co., Ltd. However, none of the above is relevant to this article.

Strictureplasty & Inflammatory Bowel Los Angeles

One of the more common complications of inflammatory bowel disease (IBD) is narrowing of the intestinal tract, also known as stricture. Slight narrowing of the intestines is often managed conservatively. However, partial to complete obstruction of the bowel may cause serious complications unless surgically corrected. Strictureplasty is a well-established procedure used to widen and preserve an obstructed segment of intestine.

At the IBD Center of Excellence, our patients benefit from a team of physicians dedicated to the comprehensive management of IBD symptoms and complications. When surgery is necessary, our GI and colorectal surgeons are adept at performing the most advanced and effective procedures to deliver the best results. To learn more about complications of IBD or to schedule a consultation with one of our surgeons, contact us at (888) 593-1042.

How Do Intestinal Strictures Form?

When a segment of the intestinal tract is chronically inflamed, scar tissue begins to develop within the lining. Over time, this segment can become narrowed or obstructed and is then known as a stricture. Strictures are far more common in patients with Crohn’s disease, because this form of IBD is a transmural disease and affects all layers of the intestinal wall.

A stricture may not cause any symptoms until the narrowing impedes flow of intestinal contents. Once an obstruction occurs, patients often experience pain, abdominal cramping, bloating, and an inability to pass stools. Diagnostic examination of the intestinal tract should be performed at the first sign of an obstruction.

Preparation for Surgery

Before undergoing a strictureplasty, the extent and location of intestinal obstruction must be confirmed. This is typically done using a CT or MRI scan of the abdomen. In some cases, an upper GI endoscopy (EGD) or colonoscopy may be performed to locate the stricture. If the obstruction is severe, emergency surgery may be necessary to prevent further complications.

Surgical Procedure

Prior to surgery, you will be placed under general anesthesia and closely monitored by one of our expert anesthesiologists. An incision is then made in the abdomen over the precise section of damaged intestine. Once the stricture has been located, it may be repaired in one of several ways depending on the length and number of obstructions.

For small strictures or multiple obstructions that are close together, an incision is made longitudinally along the length of intestine. The incision is then pulled transversely and tied with sutures to widen the segment. Medium length obstructions require a technique in which the segment of intestine is folded and then joined to widen the interior.

If a large obstruction has narrowed the intestine beyond the capacity of traditional repair, the damaged segment can by bypassed with the joining of healthy intestinal tissue from either end. After the segment of bowel has been widened, the incision is closed with sutures.

Recovery from Surgery

Following a strictureplasty, an expert team of health professionals will closely monitor you to ensure optimal recovery. Complications from strictureplasty are rare, but may include bleeding, infection, or obstruction of the intestine. Since Crohn’s disease is a chronic condition, some patients will develop new strictures in different portions of the intestine that may require additional surgery. Studies have shown that there is a very low risk of a recurring stricture at the original site following strictureplasty.  Patients who undergo strictureplasty can sometimes experience a quicker recovery than those who have resection surgery.

Contact an IBD Specialist in Beverly Hills

The IBD Center of Excellence in Beverly Hills offers a team of world-renowned gastroenterologists and colorectal surgeons who have trained at some of the top medical schools and residencies in the country. Our extensive experience in the treatment of inflammatory bowel disease, coupled with a highly individualized approach, helps us to deliver compassionate and effective care to each patient. For more information on the complications of IBD and surgical treatment, or to schedule a consultation with one of our physicians, please call (888) 593-1042 or fill out our contact form.

Next, read about colectomy.

Computed tomography and magnetic resonance imaging in the diagnosis of small and colon strictures in Crohn’s disease. Radiation semiotics, assessment of the activity of the inflammatory process | Dubrova

1. Stolyarova TA, Gorgun SE. Inflammatory Bowel Disease: Current State of the Problem. Healthcare. 2017; (5): 65–74.

2.Gajendran M, Loganathan P, Catinella AP, Hashash JG. A comprehensive review and update on Crohn’s disease. Dis Mon. 2018; 64 (2): 20–57. doi: 10.1016 / j.disamonth.2017.07.001.

3. Paine E, Shen B. Endoscopic therapy in ammatory bowel diseases (with videos). Gastrointest Endosc. 2013; 78 (6): 819–35. doi: 10.1016 / j.gie.2013.08.023.

4.Lenze F, Wessling J, Bremer J, Ullerich H, Spieker T, Weckesser M, Gonschorrek S, Kannengiesser K, Rijcken E, Heidemann J, Luegering A, Schober O, Domschke W, Kucharzik T, Maaser C. Detection and di ff erentiation of in fl ammatory versus fbromatous Crohn’s disease strictures: prospective comparison of 18F-FDG-PET / CT, MR-enteroclysis, and transabdominal ultrasound versus endoscopic / histologic evaluation. In fl amm Bowel Dis. 2012; 18 (12): 2252-60. doi: 10.1002 / ibd.22930.

5.Bettenworth D, Nowacki TM, Cordes F, Buerke B, Lenze F. Assessment of structuring Crohn’s disease: Current clinical practice and future avenues. World J Gastroenterol. 2016; 22 (3): 1008-16. doi: 10.3748 / wjg.v22.i3.1008.

6. Khatkov IE, Parfenov AI, Knyazev OV, Mikhailyants GS, Atroshchenko AO, Ruchkina IN. Inflammatory bowel disease in the practice of the therapist and surgeon. M .: VITAPRESS; 2017.119 p.

7.Chang CW, Wong JM, Tung CC, Shih IL, Wang HY, Wei SC. Intestinal stricture in Crohn’s disease. Intest Res. 2015; 13 (1): 19–26. doi: 10.5217 / ir.2015.13.1.19.

8. Quencer KB, Nimkin K, Mino-Kenudson M, Gee MS. Detecting active in fl ammation and fbrosis in pediatric Crohn’s disease: prospective evaluation of MR-E and CT-E. Abdom Imaging. 2013; 38 (4): 705-13. doi: 10.1007 / s00261-013-9981-z.

9.Fiorino G, Bonifacio C, Malesci A, Balzarini L, Danese S. MRI in Crohn’s disease – current and future clinical applications. Nat Rev Gastroenterol Hepatol. 2011; 9 (1): 23–31. doi: 10.1038 / nrgastro.2011.214.

10. Paquet N, Glickman JN, Erturk SM, Ros PR, Heverhagen JT, Patak MA. Crohn’s disease activity: abdominal computed tomography histopathology correlation. Eur J Radiol Open. 2016; 3: 74-8. doi: 10.1016 / j.ejro.2016.03.001.

90,000 Crohn’s disease – complications, extraintestinal manifestations on the site vzk.info

Fig. 1. Intestinal complications of Crohn’s disease

Complications of Crohn’s disease

Most complications of Crohn’s disease are associated with deep ulcerative lesions of the intestinal wall or its consequences. A separate type of purulent complications of the disease are perianal manifestations, in which the rectum and surrounding tissues are affected.

Intestinal fistula

When a deep ulcer in Crohn’s disease reaches the outer layers of the intestinal wall, infiltration forms around the affected area of ​​the intestine – a collection of inflammatory cells that delimit the inflamed segment of the intestine from the abdominal cavity. The infiltration often involves neighboring organs, as a rule, the adjacent loop of the intestine. Since ulcers in Crohn’s disease do not spread instantly, and a potential hole in the intestinal wall is “covered” by an infiltrate, perforation – the sudden appearance of an opening in the intestine with the entry of its contents into the abdominal cavity – is extremely rare in Crohn’s disease (unlike ulcerative colitis).

By the time the ulcer reaches the adjacent loop of the intestine, a hollow organ or the surface of the abdomen, it is a purulent passage, resembling a narrow passage through which intestinal contents can move. Most often, in Crohn’s disease, there are 90,025 interintestinal fistulas, for a number of reasons representing a serious danger. First, the pus dissolves ( melts ) the tissue surrounding the fistula. This can lead to abscess (limited accumulation of pus), and therefore to blood poisoning – sepsis.Secondly, a fistula between different parts of the intestine leads to the fact that food stops passing through some parts of the intestine, which means that nutrients will not be absorbed into the blood. For example, a wide fistula between the duodenum and the large intestine will lead to the “shutdown” of the entire small intestine from the digestion process, which will quickly lead to exhaustion of a person.

At intestinal-urinary fistula , the contents of the intestine are excreted in the urine. Fecal particles, dietary fibers, and gas bubbles appear in the urine.Because the intestines contain a large number of bacteria, a person develops urinary tract infections that do not respond to standard treatment.

External fistulas lead to the release of intestinal contents to the surface of the skin. At the first appearance, the external opening of the fistulous tract may resemble a pimple or boil.

Intestinal fistulas almost always require surgical treatment – removal of the part of the intestine in which a deep ulcer has appeared, which has spread beyond the intestinal wall in the form of a fistula.In exceptional cases, if it is certain that an abscess has not formed along the course of the fistula (or it was possible to drain it – release pus – through the skin), it is possible to monitor the patient against the background of powerful therapy with biological drugs.

Strictures

Cicatricial narrowing of the intestine ( stricture or stenosis ) occurs when the muscle tissue at the site of the ulcer, destroyed by the disease, is replaced by dense fibers of connective tissue . This narrowing interferes with the normal movement of feces and food, eventually leading to intestinal obstruction . Above the narrowed ( stricted ) section, the intestine expands under the pressure of food or stool: suprastenosic expansion appears.

With long strictures (more than 10 cm), the affected area of ​​the intestine must be removed. Non-extended (less than 2 cm) strictures can be temporarily expanded using an inflatable balloon, which is introduced into the intestine in a compressed state through an endoscope.In case of strictures of intermediate size, stricturoplasty is sometimes performed – a sparing operation in which the narrowed area is incised and smoothed, restoring patency along the intestine.

Perianal manifestations

This complication – lesion of the anal area – occurs in 30-50% of people with Crohn’s disease. The most common option is long-term non-healing cracks in the anal canal – a narrowed section of the intestine behind the anus, surrounded by sphincter muscles that hold the stool. Unlike cracks in healthy people, which, as a rule, heal on their own, cracks in Crohn’s disease are deep, do not disappear for a long time and can lead to cicatricial narrowing of the anus – a stricture.

Rectal fistulas in Crohn’s disease also differ from typical fistulas in people without Crohn’s disease. They often branch, form extensions with pus (purulent streaks ) and open on the skin around the anus with several holes. Around the outer opening of the fistula, the skin grows – a rough skin fold appears.

A fistula can connect the rectal lumen to the vagina. Such fistulas – rectovaginal – are difficult to treat and are accompanied by frequent vaginitis due to the ingress of stool with bacteria from the rectum into the genital tract.

A large accumulation of pus in the tissue surrounding the rectum ( paraproctitis ) leads to an increase in body temperature, intolerable pain and the need for urgent surgery, in which the abscess is opened with a wide incision.

One of the most unfavorable variants of the course of Crohn’s disease is the presence of perianal manifestations and active ulcerative lesions of the rectum. In such a situation, inflammation of the intestine does not allow adequate treatment of complications in the tissue surrounding the rectum, and the perianal purulent process, in turn, maintains constant inflammation in the intestine. Such a “vicious circle” often leads to the need to form a stoma – to shut off the passage of the stool through the anus.

Colon cancer in Crohn’s disease, in contrast to ulcerative colitis, is generally much less common. However, in Crohn’s disease with extended colon involvement, experts recommend the same frequency of preventive examinations as in ulcerative colitis.

Extraintestinal manifestations

These complications are common not only for Crohn’s disease, but also for ulcerative colitis and other autoimmune diseases.Typical extraintestinal manifestations are erythema nodosum and pyoderma gangrenosum (inflammation of the skin), iritis and iridocyclitis (inflammation of the eyes), and various arthritis (inflammation of the joints). Primary sclerosing cholangitis (inflammation of the bile ducts in the liver) is less common in Crohn’s disease than in ulcerative colitis

Unlike ulcerative colitis, Crohn’s disease rarely causes dangerous intestinal bleeding.

* Does not replace medical advice.To diagnose and prescribe treatment, you must consult a specialist.

Large intestine, symptoms of diseases – Clinic Health 365, Yekaterinburg

Signs of diseases of the colon and rectum are very diverse, however, a number of important symptoms can be distinguished, when they appear, we strongly recommend that you make an appointment with a coloproctologist in Yekaterinburg. Proctologists Kuzmin S.N. (the highest category, Honored Doctor of the Russian Federation) and Ryamov Yu.S.(Head of the Surgical Department, the highest category) are receiving appointments at the Zdorov’e 365 clinic.

Abdominal pain is a fairly characteristic symptom of diseases of the colon and ampullar rectum, but they cannot be considered an early manifestation. Pain can be constant or cramping and radiate to the lumbar region, back, supraclavicular space (more often with irritation of the diaphragm peritoneum). Cramping pains usually indicate a limited narrowing of the intestine as a result of various pathological processes (cicatricial strictures in ulcerative colitis and Crohn’s disease of the colon, adhesive disease as an outcome of the inflammatory process in the intestinal anastomosis, benign and malignant tumors).Less commonly, they are noted with intestinal dyskinesia with a predominance of the spastic component.

Persistent abdominal pain is more characteristic of progressive inflammatory lesions, they are observed in granulomatous and nonspecific ulcerative colitis, irritable bowel syndrome, bowel tumor with perifocal inflammation, diverticulosis with diverticulitis and the formation of inflammatory infiltrate or the development of peritonitis. Dull pain in the epigastric region is often the first manifestation of diffuse familial colon polyposis and can be explained by a violation of the secretory and motor activity of the stomach.

Pain in the anus and perineum is often constant, bursting or twitching and burning. With an acute anal fissure, acute thrombosis of hemorrhoids, acute paraproctitis after an act of defecation, they can become unbearable. A number of rectal diseases (benign tumors, chronic fistulas, cancer, etc.) can proceed for a long time without pain. In the most common disease of the rectum – uncomplicated hemorrhoids – pain usually does not occur or they are mild (a feeling of swelling).

The secretion of mucus and pus from the anus can be noted only during bowel movements or be permanent (with rectal fistulas and insufficiency of the sphincter of the anus). In the latter case, maceration of the perianal skin often occurs, multiple erosions and poorly healing deep cracks occur, which is accompanied by itching, burning and sharp pain. An admixture of mucus and pus to feces is usually observed in chronic and acute proctitis, proctosigmoiditis, ulcerative and granulomatous colitis, as well as in villous tumors and cancer of the rectum and sigmoid colon. The secretion of mucus and pus in these cases is often combined with an admixture of blood. The secretion of mucus in the feces often accompanies such pathology as irritable bowel syndrome.

Bleeding or admixture of blood in stool is one of the most common symptoms of diseases of the rectum and colon. Discharge of drops of scarlet blood or even jet bleeding, more often at the end of the act of defecation, is characteristic of hemorrhoids and anal fissures. Sometimes such hemorrhage leads to a loss of 100-200 ml of blood per day and, with frequent repetitions, causes the development of anemia.

Blood streaks and blood clots visible in feces are commonly seen in inflammatory processes (colitis), diverticulosis and tumors. The more proximal is the source of bleeding in the colon, the more homogeneous the admixture of blood to the feces and the darker their color. With bleeding from the cecum and the ascending intestine, the blood can be so strongly changed under the influence of intestinal enzymes that the feces take on a typical tarry appearance, as with bleeding from the upper gastrointestinal tract.

Slightly altered blood in a liquid state or in the form of clots can be released during bowel movements in patients with ulcerative colitis and Crohn’s disease of the colon, with diverticulosis, as well as with disintegrating and ulcerated villous and cancerous tumors. Profuse bleeding is rarely observed in diseases of the colon. They can occur with diverticulosis of the colon, less often with ulcerative colitis and Crohn’s disease of the colon.

Anemia in diseases of the colon develops more often due to chronic or acute blood loss.In cancer localized in the right sections of the colon, anemia is often observed and is caused by both chronic blood loss and impaired hematopoiesis due to intoxication, which develops early and rapidly at this localization of the tumor.

Constipation – difficulty in defecation and stool retention until it is absent for several days and weeks – is a common symptom of both functional and organic diseases of the colon.

Functional constipation can be atonic and spastic and, depending on this, proceed with less or more severe pain syndrome.With organic narrowing of the colon (cicatricial strictures, tumors, external compression, etc.), constipation usually precedes or is one of the symptoms of partial intestinal obstruction, often progressing to complete obstruction. The alternation of constipation and diarrhea is often a symptom of irritable bowel syndrome.

Colon obstruction – a syndrome of violation of the passage of contents through the colon, manifested in the absence or delay of stool, difficulty in passing gas, bloating and distension of the abdomen, constant and cramping pains, the growth of other dyskinetic phenomena (appetite disturbance, nausea, vomiting, etc.).P.). Obstruction can be partial or complete and is more often observed with organic lesions of the large intestine, but it also occurs with functional (atonic and spastic constipation, coprostasis, etc. ).

With the progression of colon obstruction, both local (bloating, signs of inflammation of the peritoneum) and general (symptoms of intoxication and metabolic disturbances) increase. Partial obstruction of the colon is characterized by periodic, but incomplete passage of stool and gas, sometimes a change of constipation with diarrhea, temporary cessation of pain and bloating, short or long periods of remission with an improvement in general condition, especially under the influence of therapeutic measures (enemas, light laxatives).

Bloating can occur not only with constipation and intestinal obstruction. It is often associated with flatulence caused by alimentary disorders, congenital or acquired enzymatic insufficiency (especially in the upper gastrointestinal tract), as well as colon dysbiosis, irritable bowel syndrome. In modern conditions, dysbiosis occurs especially often due to the widespread use of various antibacterial and antiseptic drugs. There is also reason to believe that dysbiosis and associated bloating are largely determined by inappropriate nutrition, especially among the urban population (the predominance of high-calorie animal products with a high content of fats and proteins, a small amount of vegetable fiber).

Diarrhea – frequent loose stools – is a characteristic symptom of a number of non-infectious diseases of the colon (colitis, diffuse polyposis). In nonspecific ulcerative and granulomatous colitis, diarrhea is often accompanied by tenesmus.Diarrhea can be a symptom of dysbiosis, irritable bowel syndrome.

Tenesmus – frequent false urge to defecate (without excretion of feces or with the separation of a small amount of mucus, blood or liquid intestinal contents) – exhaust patients and may be accompanied by maceration of the perianal skin, the formation of cracks and erosions. Tenesmus is a consequence of reflex excitation of motor activity in the distal colon, especially the rectum, as a result of inflammatory changes in the sensory zone of the mucous membrane of the anal rectum.

Fecal and gas incontinence is observed with congenital or acquired anatomical lesions of the sphincter apparatus of the rectum or a violation of its reflex regulation of the central, including psychological, or peripheral nature. Most experts distinguish between three clinically determined degrees of insufficiency of the sphincter of the anus: I degree – incontinence of gases, II degree – incontinence of gases and liquid feces, III degree – incontinence of gases, liquid and solid feces.

Related articles:

90,000 🧬 Diverticular disease of the colon. In simple words

GMS Clinic gastroenterologist Aleksey Golovenko answers frequently asked questions about this disease in his article.

What are diverticula?

A diverticulum is a protrusion of the intestinal wall that resembles a “hernia” on a soccer ball. Most often, diverticula are found in the large intestine – these are the last 1. 5 meters of the digestive tube, where water is absorbed, making the stool solid from liquid.Less common are diverticula in the esophagus and small intestine. A person’s gender does not affect whether diverticula appear, but with age, the likelihood of their occurrence increases.

Why do these diverticula appear?

There is no unified theory of the origin of diverticula. Diverticula appear in the “weak” places of the intestinal wall – the places where blood vessels penetrate it. It is also noticed that diverticula appear more often in people with constipation and in residents of Western countries, where the diet is low in dietary fiber – natural “softeners” of stool.Apparently, if, due to a lack of dietary fiber, the stool becomes too dense and moves along the intestine not in one mass, but in solid fragments, pressure in the lumen rises too much in some parts of the colon. This leads to protrusion of the mucous membrane and submucous layer of the intestine towards the abdominal cavity through the muscle layer.

I found diverticula. I am sick?

Most probably not. The mere presence of diverticula (in the absence of symptoms) is called “diverticulosis”.Only every fifth person with diverticula has some manifestations of the disease, and they are not always associated with active inflammation of the diverticula.

Can my stomach hurt from diverticula?

Maybe, but there are several reasons for this pain. Intense constant pain over the area of ​​the intestine where the diverticula are located, more often indicates inflammation of the diverticulum – diverticulitis. Inflammation occurs when the orifice of a diverticulum is blocked by a dense piece of stool (coprolite).This disrupts the blood supply to the diverticulum, and also facilitates the movement (translocation) of bacteria from the lumen of the colon into the wall of the diverticulum. Together, this leads to inflammation of the diverticulum, and sometimes – to bleeding from it.

Most often, diverticulitis disappears without a trace during antibiotic therapy. In some people, diverticulitis becomes chronic — the inflammation does not go away. This can lead to complications: abscesses (abscesses in the tissue surrounding the diverticulum), fistulas (purulent passages connecting the lumen of the diverticulum, for example, with neighboring organs), infiltration (tumor-like accumulation of cells around the inflamed diverticulum) and stricture (narrowing of the intestinal lumen at the site of inflammation ).However, colon diverticulum pain can occur without inflammation.

How so? There is no inflammation, so where does the pain in the actually healthy intestine come from?

In the thickness of the colon wall, there is a network of nerve fibers that control its motor skills – which segments of the intestine will contract, pushing out the stool. When the pressure in the intestinal lumen rises (passing stool or gas), special cells are activated that release neurotransmitters (for example, serotonin).This signals the nervous system to contract the intestine and empty its contents. Normally, we hardly feel this “work” of the intestine.

When a diverticulum becomes inflamed, the balance of neurotransmitters is disturbed, which is partly facilitated by changes in the composition of bacteria within the diverticulum. An imbalance in neurotransmitters can persist even after the inflammation has passed. This leads to an increase in the sensitivity of the intestine to stretching (doctors call this “visceral hypersensitivity”).This phenomenon is confirmed by experiments. If a healthy person and a patient with diverticular disease are introduced into the intestine and begin to smoothly inflate it with air, then a person with a disease will experience discomfort earlier than a healthy person (that is, pain will occur with a smaller volume of the balloon). The same pain mechanism has been described in irritable bowel syndrome.

How is it determined if there is inflammation and other complications?

Computed tomography is the best test for suspected diverticulum inflammation. In this study, several emitters rotate around the human body and numerous X-ray images are obtained. Then a computer program uses these fragments to create integral “slices” of the body. Tomography allows not only to see changes in the contour of the intestinal wall (that is, the actual diverticula), but also changes in the tissues surrounding the colon (for example, abscesses). A less accurate way to find diverticula is an irrigoscopy or, in a simpler way, an enema with barium sulfate, which is clearly distinguishable in X-rays and allows you to see the inner contour of the intestine and some very gross complications (for example, strictures).

Instead of computed tomography, some centers use ultrasound (ultrasound), which, unlike tomography, is completely safe and, apparently (in experienced hands), has almost the same accuracy. The downside is that an ultrasound specialist must undergo special long-term training in order to learn how to diagnose diverticula, therefore, such doctors, alas, are not in every clinic.

What about colonoscopy?

Colonoscopy – that is, examining the large intestine with a flexible apparatus with a video camera – is also a way to detect diverticula.Most diverticula are discovered by accident during routine colonoscopy, which is done for early detection of cancer. However, if acute inflammation of the diverticulum (diverticulitis) is suspected, colonoscopy is not used as the first line of diagnosis. During colonoscopy, the intestine is inflated from the inside with gas, and this can lead to perforation (rupture) of the diverticulum.

At the same time, after the inflammation of the diverticulum has passed, colonoscopy should be performed without fail.Research shows that colon cancer is more likely to be found within the first year after acute diverticulitis. Apparently, inflammation in some patients “masks” the tumor on X-ray images, and it is both unsafe and impossible because of pain to see the entire colon with an endoscope during acute inflammation.

Can you protect yourself from diverticulitis and other complications?

Yes, if you have diverticula, you can reduce your risk of inflammation by having a soft stool emptying your bowels every day.Stool consistency is most influenced by the fiber content. Try to eat at least a plate or cup of vegetables and fruits every day, add wheat bran to porridge and yogurt, and drink at least a glass of liquid (not necessarily water) with each meal. Eating dried fruit instead of candy and other sweets will also help keep your weight in check.

It happens that gas production increases from a plentiful intake of plant foods. Then, to normalize the stool, they take balanced dietary fibers that are not so strongly fermented by bacteria, for example, psyllium is a psyllium seed husk that can be consumed indefinitely.By the way, vegetarians who, refusing meat, begin to consume more plant foods, and the diverticula themselves, and their complications, occur less frequently than non-vegetarians.

They say you can’t eat seeds and popcorn – it’s all stuck in diverticula.

This is an old theory that has been completely refuted by modern research. American scientists have observed 47,000 people who, during a routine examination at the age of 40 to 75, did not reveal any diseases of the colon, as well as diverticula.For 18 years, participants filled out questionnaires about their condition and talked about their diet every 2 years for 18 years. It turned out that diverticulitis and bleeding from diverticula occurred with the same frequency in people who do not eat nuts, popcorn and seeds, and in those who eat well. Moreover, those who took nuts twice a week, not only not more often, but less often ended up with doctors due to diverticulitis than people who consumed nuts only once a month.

I have been diagnosed with uncomplicated clinical diverticular disease.The stomach on the left hurts, and the doctors do not find inflammation. Is it being treated?

Yes, because of similar pain mechanisms, treating uncomplicated diverticular disease is similar to treating irritable bowel syndrome. Pain is eliminated by taking antispasmodics – drugs that relieve painful contraction of the intestine, which are often taken for a long time. A non-absorbable (non-absorbable) antibiotic is sometimes prescribed to change the composition of bacteria in the gut. Some patients may need a small dose of antidepressants to improve the metabolism of serotonin, which regulates gut motility.

I see, what if it hurts today not from inflammation, but tomorrow – diverticulitis and peritonitis? When to go to the doctor?

It is necessary to consult a doctor if the pain has sharply increased and has become constant, does not go away at night, and also if the body temperature rises, chills, nausea or vomiting appear, or fainting occurs. You should also always consult your doctor if there is blood in your stool. It is very important. Without timely treatment, diverticulitis can result in surgery.And even worse.

Manual coloanal or instrumental colorectal anastomosis? Comparative Analysis of Laparoscopic Low Rectum Resections | Chernikovsky

1. Bondar G.V., Basheev V.Kh., Dumansky Yu.V. Progress and Challenges in Rectal Cancer Treatment. New Year 2009; 3-4: 19-24. [Bondar G.V., Basheev V.H., Dumansky Yu.V. Successes and problems of rectal cancer management. Novoutvorennya = Neoplasms 2009; 3-4: 19-24.(In Russ.)].

2. Pikunov D.Yu., Kashnikov V.N., Dzhanaev Yu.A., Rybakov E.G. Long-term results of preservation of the elements of the external sphincter in inferior ampullar cancer of the rectum. Clinical Oncology 2011; 1: 43–6. [Pikunov D.Yu., Kashnikov V.N., Djanaev Yu.A., Rybakov E.G. Long-term results of external sphincter elements preservation at rectal lower ampulla cancer. Klinicheskaya onkologiya = Clinical Oncology 2011; 1: 43-6.(In Russ.)].

3. Jemal A., Siegel R., Ward E. et al. Cancer statistics 2009. CA Cancer J Clin 2009; 59 (4): 225-49.

4. Karanjia N.D., Schache D.J., North W.R., Heald R.J. “Close shave” in anterior resection. Br J Surg 1990; 77 (5): 510-2.

5. Leo E., Belli F., Andreola S. et al. Total rectal resection and complete mesorectum excision followed by coloendoanal anastomosis as the optimal treatment for low rectal cancer: the experience of the National Cancer Institute of Milano. Ann Surg Oncol 2000; 7 (2): 125-32.

6. Martin S.T., Heneghan H.M., Winter D.C. Systematic review of outcomes after intersphincteric resection for low rectal cancer. Brit J Surg 2012; 99 (5): 603-12.

7. Tilney H.S., Tekkis P.P. Extending the horizons of restorative rectal surgery: intersphincteric resection for low rectal cancer. Colorectal Dis 2008; 10 (1): 3-15.

8. Vorobiev G.I., Shelygin Yu.A., Eropkin P.V. et al. Proctectomy with preservation of the elements of the external sphincter in surgery for lower ampullar rectal cancer. Surgery 2008; 9: 10-5.[Vorobyev G.I., Shelygin Yu.A., Eropkin P.V. et al. Proctectomy with preservation of external sphincter elements in surgery of rectal lower ampulla cancer. Khirurgiya = Surgery 2008; 9: 10–5. (In Russ.)].

9. Enker W.E. Total mesorectal excision – the new golden standard of surgery for rectal cancer. Ann Med 1997; 29 (2): 127-33.

10.Heald R.J., Moran B.J., Ryall R.D. et al. Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978–1997. Arch Surg 1998; 133 (8): 894-9.

11. Jehle E.C., Haehnel T., Starlinger M.J., Becker H.D. Level of the anastomosis does not influence functional outcome after anterior rectal resection for rectal cancer. Am J Surg 1995; 169 (1): 147-52.

12.Guillou P. J., Quirke P., Thorpe H. et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial) multicenter, randomized controlled trial. Lancet 2005; 365 (9472): 1718-26.

13. Kang S.B., Park J.W., Jeong S.Y. et al. Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomized controlled trial.Lancet Oncol 2010; 11 (7): 637–45.

14. van der Pas M.H., Haglind E., Cuesta M.A. et al. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomized, phase 3 trial. Lancet Oncol 2013; 14 (3): 210-8.

15. Jeong S., Park J., Nam B. et al. Open versus laparoscopic surgery for mid-rectal or lowrectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomized controlled trial.Lancet Oncol 2014; 15 (7): 767-74.

16. Green B., Marshall H., Collinson F. et al. Long-term follow-up of the Medical Research Council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer. Br J Surg 2013; 100 (1): 75-82.

17. Reybard J.F. Memoire sur une tumeur cancereuse affectant l’illiaque du colon: ablation de la tumeur et de l’intestin.Bull Acad Roy Med 1833; 2.

18. Petrov B.A. Abdominal rectal resection. In the book: Proceedings of the Institute of Emergency Medicine. Sklifosovsky. M .: Medgiz, 1943. S. 256–64. [Petrov B.A. Abdominal proctectomy. In book: Treatises of Sklifasovsky Ambulance Institute. Moscow: Medgiz, 1943. Pp. 256-64. (In Russ.)].

19. Dixon C.F. Anterior resection for malignant lesions of the upper part of the rectum and lower part of the sigmoid.Ann Surg 1948; 128 (3): 425–42.

20. Lytkin M.I., Clur V.Yu., Chalisov I.A. Comparative evaluation of proximal resections for rectal cancer. Bulletin of Surgery 1989; 8: 38–42. [Lytkin M.I., Klur V. Yu., Chalisov I.A. Comparative assessment of proximal resections made for rectal cancer. Vestnik khirurgii = Herald of Surgery 1989; 8: 38–42. (In Russ.)].

21.Polglase A.L., McMurrick P.J., Tremayne A.B., Bhathal P.S. Local recurrence after curative anterior resection with principally blunt dissection for carcinoma of the rectum and rectosigmoid. Dis Colon Rectum 2001; 44 (7): 947-54.

22. Lee M.R., Hong C.W., Yoon S.N. et al. Risk factors for anastomotic leakage after resection for rectal cancer. Hepatogastroenterology 2006; 53 (71): 682-6.

23.Law W.I., Chu K.W., Ho J.W., Chan C.W. Risk factors for anastomotic leakage after low anterior resection with total mesorectal excision. Am J Surg 2000; 179 (2): 92-6.

24. Peeters K.C., Tollenaar R.A., Marijnen C.A. et al. Risk factors for anastomotic failure after total mesorectal excision of rectal cancer. Br J Surg 2005; 92 (2): 211-6.

25.Wang L., Gu J. Risk factors for symptomatic anastomotic leakage after low anterior resection for rectal cancer with 30 Gy / 10 f / 2 w preoperative radiotherapy. World J Surg 2010; 34 (5): 1080-5.

26. Shiomi A., Ito M., Maeda K. et al. Effects of a diverting stoma on symptomatic anastomotic leakage after low anterior resection for rectal cancer: a propensity score matching analysis of 1,014 consecutive patients. J Am Coll Surg 2015; 220 (2): 186–94.

27. Khubezov D.A. Choice of technique and boundaries of laparoscopic anterior rectal resection. Abstract of the thesis. dis. … Dr. med. sciences. Ryazan, 2009. [Khubezov D.A. Choice of methods and limits of laparoscopic anterior resection of rectum. Autors abstract of thesis of … doctor of medical sciences. Ryazan, 2009. (In Russ.)].

28. Tsar’kov P.V, Tulina I.A. Some controversial issues in the history of rectal cancer surgery. Surgery. Journal them. N. I. Pirogova 2012; 1: 53–57. [Tsarkov P.V., Tulina I.A. Several outstanding issues of rectal surgery development. Khirurgiya. Zhurnal im N.I. Pirogova = Surgery. N.I. Pirogov Journal 2012; 1: 53-57. (In Russ.)].

29. Rubin F., Douard R., Wind P. The functional outcomes of coloanal and low colorectal anastomoses with reservoirs after low rectal cancer resections.Am Surg 2014; 80 (12): 1222-9.

30. Rink A.D., Haaf F., Knupper N., Vestweber K.H. Prospective randomized trial comparing ileocaecal interposition and colon-J-pouch as rectal replacement after total mesorectal excision. Int J Colorectal Dis 2007; 22: 2: 153-60.

31. Hamel C. T., Metzger J., Curti G. et al. Ileocecal reservoir reconstruction after total mesorectal excision: functional results of the long-term follow-up. Int J Colorectal Dis 2004; 19 (6): 574-9.

32. Hochenegg J. Die sakrale methode der extirpation von mastdaimkrebsen nach Prof. Kraske. Wien Klin Wochensch 1888; 1: 254.

33. Bacon H.E. Evaluation of sphincter muscle preservation and reestablishment of continuity in the operative treatment of rectal and sigmoidal cancer. Surg Gynecol Obstet 1945; 81: 113.

34. Schumpelick V., Braun J. Intersphincteric rectum resection with radical mesorectum excision and colo-anal anastomosis Chirurg 1996; 67 (2): 110–20.

35. Pavlidis T.E., Pavlidis E.T., Sakantamis A.K. The role of intersphincteric resection in very low rectal cancer. Letter to the Editor. Sotiety of surgical oncology.

36.Pankratov I.V., Klokov S.S., Koshel A.P. A method of choosing surgery for low rectal cancer. 3rd Congress of Surgeons of Siberia and the Far East. Tomsk, 2009. P. 113–4. [Pankratov I.V., Klokov S.S., Koshel A.P. Surgery choice method at lower rectum cancer. 3rd Congress of surgeons of Siberia and Far East. Tomsk, 2009. Pp. 113-4. (In Russ.)].

37. Chekanov M.N., Shtofin S.G., Yakushenko V.K. Intersphincteric intrapuborectal resection in surgery for distal rectal cancer.New Surgical Archives 2001; 1 (1). [Chekanov M.N., Shtofin S.G., Yakushenko V.K. Intersphincter intrapuborectalis resection in surgery of distal rectal cancer. Novyi khirurgicheskiy arkhiv = New Surgery Archive 2001; 1 (1). (In Russ.)].

38. Shchepotin I.B., Kolesnik E.A., Priymak V. V. Evolution of sphincter-sparing surgery in patients with cancer of the lower ampullar rectum. Clinical Oncology 2013; 4: 16–20.[Schepotin I.B., Kolesnik E.A., Priymak V.V. Evolution of sphincter-preserving surgery in patients with cancer of rectal lower ampulla. Klinicheskaya onkologiya = Clinical Oncology 2013; 4: 16–20. (In Russ.)].

39. Denost Q., Adam J. P., Pontallier A. et al. Laparoscopic total mesorectal excision with coloanal anastomosis for rectal cancer. Ann Surg 2015; 261 (1): 138–43.

40.Bretagnol F., Rullier E., Couderc P. et al. Technical and oncological feasibility of laparoscopic total mesorectal excision with pouch coloanal anastomosis for rectal cancer. Colorectal Dis 2003; 5 (5): 451-3.

41. Rasulov A.O., Mamedli Z.Z., Kulushev V.M. et al. Laparoscopic intersphincteric abdominal anal resection of the rectum for inferior ampullar cancer with transanal removal of the drug, formation of a colonic J-shaped reservoir and coloanal anastomosis.Endoscopic Surgery 2014; 20 (1): 42–7. [Rasulov A.O., Mamedli Z.Z., Kulushev V.M. et al. Laparoscopic intersphincter abdominoanal resection of rectum for rectal lower ampulla cancer with transanal resection of surgical specimen, formation of colonic J-pouch and coloanal anastomosis. Endoskopicheskaya khirurgiya = Endoscopic Surgery 2014; 20 (1): 42–7. (In Russ.)].

42. Benoist S., Panis Y., Boleslawski E. et al.Functional outcome after coloanal versus low colorectal anastomosis for rectal carcinoma. J Am Coll Surg 1997; 185 (2): 114-9.

43. Hiranyakas A., Ho Y.H. Laparoscopic ultralow anterior resection versus laparoscopic pull-through with coloanal anastomosis for rectal cancers: a comparative study. Am J Surg 2011; 202 (3): 291-7.

Endoscopic bougienage of the stomach and esophagus in Nizhny Novgorod

She came to this center on the recommendation of her doctor at the local clinic.Before that I was in two honey. institutions where she did not receive clear explanations about her diagnosis and left in doubts without solving the problem. In this center, the administrator picked up a convenient time of appointment by phone to see two specialists at once (gastroenterologist and endoscopist). Doctor Kryazhov V.A. politely listened to my complaints, questions and gave a clear explanation of the diagnosis, Dr. Mikhailova Ya.V. gave recommendations on the diagnosis with inflammation of the pancreas, explained all the examination results and made recommendations for a long period.I signed up for the removal of the polyp here. I express my gratitude for the professionalism and competence of the doctors and administrators of this center!

Maria

Visited this clinic on the recommendation of friends and did not regret it. The staff is very friendly, when you come there, you understand that everything will be fine and the examination will be done at the highest level, and that a team of professionals is working with the patients! I want to thank all the staff of the clinic who performed a comprehensive examination for me.

Natalya

I was looking for a woman doctor with experience and good reviews. I was advised by friends Smirnova from the Nizhny Novgorod oncological dispensary, but there she is on maternity leave, and now she works 2 times a week only at the regional endoscopy center. So I got to them on Yamskaya. A clinic in an interesting style, some kind of oriental theme. Very clean, beautiful, comfortable sofa, relaxing music, smiling receptionist. I don’t remember the procedure itself, because I did it in a dream, so I remember a conversation with doctors and nurses, delicious coffee after waking up (it was incredibly handy) and the joy that I made up my mind and underwent the examination.Thanks to the staff for their attitude, to the doctor for a detailed story about the state of my intestines, about further treatment tactics. It turned out to be not as scary as I imagined myself. 😀 I recommend the clinic, everything is competent, sincere and with great attention, willingness to answer all questions and help in everything. Bravo!

Svetlana

I would like to thank Roman Sergeevich Bushuev and all the staff who performed a comprehensive examination under sedation. I was very worried, but the result made me happy.In the future, I will check your health and recommend to friends.

anna

I would like to express my gratitude to the staff of the center. A colonoscopy was scheduled, I was very worried about how it would pass, it took a long time to adjust, but upon arrival at your center, all fears were gone. Thanks to the endoscopist Bushuev Roman Sergeevich and his entire team of qualified specialists for the work done. Administrators Maria and Anastasia for their attention and support.

Raisa

Hello.I would like to express my deep gratitude to the staff of the Center. This is not the first time I have been examined in this Center. Before the first examination, I spent a long time choosing between various clinics in N. Novgorod, now I am sure that my choice was correct. I am very glad to be in good hands! Postoperative examination was carried out by endoscopist Yevgeny Yuryevich Serebryakov, anesthesiologist Sergei Olegovich Dyadyura, nurses Ekaterina Guskova (anesthesia) and Irina Moskova (endoscopy). Indeed, the professionals are of the highest class! Competently, confidently and very calmly, they carry out all the manipulations.They want to trust. Modern medical equipment allows you to conduct examinations at the highest level! And Dr. Serebryakov will explain the results in great detail and clearly, answering all the questions. But an accurate examination is the key to further successful treatment. This excellent medical team knows how to create a comfortable psychological mood for the patient, which is very important for us, probably, the positive attitude of a sick person also contributes to a speedy recovery. And many thanks to the administrator of the Center Natalya Auzyak.She is the first to meet patients, receive phone calls. Responsive and friendly, will always help to solve the problem! Thank you all very much! You are awesome! I wish you all good health, personal well-being and all the very best! With great respect, Olga Smirnova.

Olga Smirnova

I don’t write reviews often, but here I just can’t help but share, suddenly someone is also in constant search. Lots of letters)) How glad I am that I chose this particular center to do a comprehensive examination! (colonoscopy and gastroscopy).From the very beginning, I really liked the atmosphere, the interior, even the site. Nice colors, comfortable and understandable. This is important for me, my mental perception is heightened. After all, what surrounds us is a reflection of the inner. Lovely girls at the reception, everything is beautifully arranged, oriental themes, I would even say cozy, does not make you nervous). I love Japanese culture and their approach to many things. I was very impressed that the doctors of the center undergo advanced training abroad, constantly learn new things, develop.I read all the articles on the site))) I have a rather difficult health situation, I have tried so many clinics this year, and everything is not right. Sedation cannot be done, so I was preparing for the examination in consciousness, it was a little scary, of course. But when I saw the doctor – Kryazhov Vladimir Alekseevich, I even felt better at once)) kind, sympathetic, competent person, many thanks to him for his support and understanding! The office itself is comfortable, disposable linen, dim lights, a pillow, everything is as it should be. I asked a lot of questions about my problem and not only, I wanted to learn more from an experienced specialist, since there was such an opportunity) I was struck by how the doctor turned this hose with buttons and wheels, as if playing some instrument masterly: D Since anesthesia was not, I tried to distract myself as I could) but actually not as scary as it seemed.Vladimir Alekseevich always warned when it would be unpleasant (at the bends of the gut). Since I’m quite thin, it felt stronger. But in general, the procedure is tolerable, when your life and health depend on it … all the more when you entrust it to a professional and a good person! On occasion, I will undoubtedly recommend it, especially to relatives, grandparents of the age. With a patient approach like the Regional Endoscopy Center, there is nothing to be afraid of. At the expense of prices, although it is a little more expensive than in some other clinics, the main thing for me, in addition to reliable results, is the humane attitude and the mood that remains after the admission.Thanks to all the workers, doctors who have chosen this difficult path! Prosperity to the center! Thank you from my heart

Marina

Good afternoon, everyone! When the doctor prescribed me a comprehensive examination (FGS + colonoscopy), I was horrified, to be honest, it was VERY scary! For two weeks I was worried and collected my thoughts. I chose the procedure under sedation at the Regional Endoscopy Center clinic, and never regretted it! When choosing a clinic specialist, I got acquainted with his high qualifications, with reviews, watched the video, and decided – Roman Andreevich Gagaev.I was very pleased with the doctor and the entire team of the team of doctors who worked with me. All specialists are correct, there was no shyness or fear. The experts told and supported everything. Waking up from the procedure, there were no unpleasant sensations, everything is cool! Probably to say thank you, this is nothing to say! There would be more such young highly qualified specialists – professionals. Thank you so much – Roman Andreevich! I would also like to say a huge thank you to the doctors who worked with me: the anesthesiologist – Dyadyura Sergey Olegovich, and the anesthetist Olga Ryabinchuk – all professionals, provided support.For those who have doubts about doing or not doing such a procedure, I will say this – be sure to do it!

Elena

Visited this clinic for the first time, chose for a long time, and did not regret her choice. At the reception, the administrator of the center, Maria, professionally explained the procedure for conducting the survey, answered all the questions asked, and helped with the paperwork. The examination procedure and surgery (removal of polyps in the intestines), in my opinion, went perfectly. The medical staff Serebryakov Evgeny Yurievich (endoscopist), Dyadyura Sergei Olegovich (anesthesiologist), nurses Maskova Irina and Guskova Ekaterina are high-class professionals.Before the procedure, anesthesiologist Sergei Olegovich asked questions in order to have a complete “picture” of my condition. After that, Evgeny Yuryevich talked to me, who listened to me attentively and clearly explained how the examination would take place. The nurses are very attentive, I especially want to mention Katyusha Guskova. I am very grateful to Doctor (with a capital letter) Evgeny Yuryevich Serebryakov. My husband and I decided that in a couple of months he will also undergo a comprehensive examination in your clinic by Doctor Serebryakov E.Yu It’s already been three days, I feel great! Thanks a lot! …

natalia 68 years old

Good afternoon! I want to express my deep gratitude to Raisat Saidovna Smirnova for her work! For her reverent attitude towards the patient! For her light hand, I have already done a colonoscopy 4 times! The first three times I did it in an oncological dispensary without medication, on the fourth I decided to try it in my sleep! Excellent doctor! Good results, very grateful for the consultation and before the procedure! Helped, advised a medicine to cleanse the intestines! If all the doctors were like that, believe me, it would be possible to not bring to a lot! And find out about your problems before! All health! Raisat Saidovna, thank you from my whole family!

Oksana

My mother was examined today at your clinic and asked me to express my gratitude for the sensitive attitude and support.She is not “friendly” with a computer due to her age, but after recovering from anesthesia she forgot everything from absent-mindedness and could not thank her doctor Vladimir Alekseevich Kryazhov and his assistants for delicately and very kindly performed the procedure. Thank you, doctor! Prosperity and more grateful patients, and, of course, good health to everyone. Respectfully yours, Anna Mikhailovna

Anna

08/01/2021 did an endoscopy at the doctor Elena Anatolyevna Kirgintseva. the doctor “came running” to work at 10 minutes 9.literally in 5 minutes the doctor called me. I came to this clinic because my stomach ached, the pains were gone, but I wanted to find out why I had them. Elena Anatolyevna performed the procedure for me. I will say this, there are doctors who directly conduct a dialogue with the patient. Elena Anatolyevna just did her job and wrote out a conclusion to me. I myself clarified what I should take if there are pains, the doctor prescribed Omez. then I come home. I don’t eat anything. everything hurts me. just severe pains in the stomach, belching is coming, I can neither walk, nor sit, nor lie down, as my stomach ached very badly.my body was shaking all over. with tears in my eyes, I went to the pharmacy, where the pharmacist was horrified to see me and hear my story. the pharmacist contacted another pharmacist and decided that Almagel A. would help me by the evening my temperature rose by 39. The night passed. in the morning I get up. I still have a burp of air !! although I did not eat anything and I have never had anything like it. temperature 37.5. called the clinic. my doctor Elena Anatolyevna did not contact me. Mitrakov Alexander Anatolyevich contacted me.after that he accepted me. Thank you very much for taking the time to examine me. also the doctor is constantly in touch with me! I am very grateful to Alexander Anatolyevich. I refused to do FGDS again, because I still have pains. my opinion is the unprofessionalism of the doctor Kirgintseva E.A. … The question is, why am I still belching ?! I believe that I have accumulated air in my stomach and it expands the walls of the stomach. this gives me great pain. for such a procedure, I gave a total of 3.500tr. and in addition to this, I am being treated and buy medications after this procedure.although I went to the clinic to be examined, my health. but it turned out that they also crippled me with a plus! I still have a temperature of 37.5, belching (I don’t eat anything), stomach pains. Why should I give so much money for a poorly performed procedure? Why didn’t my doctor Elena Anatolyevna contact me? Why is it still burping? Alexander Anatolyevich is in touch with me for which I am grateful to him! …

Olga Goncharova

My choice of a doctor and clinic met all my expectations.I was going to do a comprehensive examination for a very long time, but I was scared by the preparation for the examination, and the procedure itself, because. I read all sorts of “horror stories” on the Internet, but on the site everything was described in detail and the girls administrators called back several times, clarified whether everything was clear and could have any questions. My preparation went well, I did not experience any negative consequences. I chose the doctor, Mitrakova Alexander Anatolyevich, got acquainted with his high qualifications, with reviews, with his scientific works, and decided to go only to him.My intuition did not disappoint me, neither in choosing a clinic, nor in choosing a doctor, this is a DOCTOR, there are only a few of them today. Thank you very much, Alexander Anatolyevich !!! A friendly administrator met and escorted me to Alexander Anatolyevich, who asked me in detail about my complaints, looked through the tests, told me how the examination would take place. I was very afraid, I was just shaking with fear, he calmed me down, assuring me that everything would go well, Then the anesthesiologist Dyadyura Sergei Olegovich talked to me, questioned, reassured me, and handed me over to the wonderful nurses Elena and Irina, who also supported me very much with their sensitivity and kind attitude towards me, thank them very much.From fear, my blood pressure jumped up, a drug was injected to normalize the pressure, and I very gently and imperceptibly sank into sleep. The whole examination went well. There were no negative sensations after the procedure, as if I just slept and that’s it. It turned out that all my fears were in vain, I got into the excellent professional hands of the medical staff! After the procedure, Alexander Anatolyevich told me everything and issued a conclusion on the diagnostics performed. I will definitely recommend your center to all my friends and acquaintances who need such an examination.I wish you, Alexander Anatolyevich, and your center new achievements in your work. With gratitude, Galina Gennadievna.

Galina Gennadievna

I would like to tell a very sensitive and attentive doctor Bushuev Roman Sergeevich. Previously I was examined by him in another clinic, but since he now works here, I signed up and came to you. The doctor already 3 years ago saw a polyp, albeit a very small, but still not very good polyp, which was not seen in the district clinic.It’s good that, feeling that something was wrong, I went to double-check, as a result, Roman Sergeevich deleted everything on time and without consequences. This time, fortunately, everything is fine, the doctor congratulated me sincerely! I recommend both the doctor and the clinic to everyone. Do not be afraid of anything, the attitude here is like with a child, no discomfort, in a kind way, you really want to live. All the best! Now I will celebrate the New Year calmly and without worries. Hope everyone has it better than this one. Happy New Year!)

Tatiana V

In November 2020, I arrived for hospitalization from Saransk, I was placed in a comfortable environment, then an operation was performed to remove a polyp in my stomach.I would like to express my gratitude to Mitrakov A.A. and all the medical staff for their professionalism, attentive attitude to the patient. The operation was successful thanks to their skill. Thank you so much!

Ekaterina Chetvergova

Good afternoon! Thanks for the info. My wife Tatyana Nikolaevna Bulakh expresses her gratitude to the doctor Serebryakov Evgeny Yurievich for the research (gastroscopy and colonoscopy). Before the examination, the doctor talked to her, and after the examination, he explained everything in detail based on the results of the study.Thanks also to the doctor – anesthesiologist Dedyura Sergey Olegovich, very friendly and attentive. Best regards, Bulakh family.

Anatoly Bulakh

I applied to the Regional Endoscopy Center in October 2020 regarding the removal of intestinal polyps. Many thanks to everyone! I would like to express my gratitude to the dearest girl consultant Natalya, who called several times, explained everything in detail, was interested in her well-being, gave her tea, and, of course, a deep bow to the maestro-doctor himself! Vladimir Alekseevich Kryazhov, attentive, tactful, explained everything clearly and in detail.I am surprised and shocked that we still have such doctors. Good luck and prosperity to your clinic! Hold on, Gentlemen! (As far as possible, at this difficult time) I will definitely come in the spring.

Anna

In October 2020, underwent a comprehensive examination under sedation. Dear Nina Nikolaevna! Thank you, as the head of the “Regional Endoscopy Center”, which has created a wonderful medical institution in which you feel very comfortable from the first minute of your stay until the end of the examination.Your well-chosen staff has made your center one of the best in the city. I would like to express my gratitude to you for your great skill, the highest professionalism and the warm atmosphere that lives in your center. I wish you and your team good health, energy, great success and joy, so that you have the strength to do good as long as possible. My thanks to you, sincere, huge, from the bottom of my heart! Sincerely, Lemzyakova S.F.

Lemzyakova S.F.

This is not the first time I visit the Regional Endoscopy Center, and there are only positive impressions, friendly and tactful Administrators at the reception, and what is really important is competent and attentive Doctors.Reception is carried out at exactly the appointed time. This medical center can be recommended with confidence to your relatives and friends.

Elizaveta

Passed FGDS at E.Yu. Serebryakov in June 2020. The clinic is clean and comfortable. Before the examination, the doctor asked everything, clarified what worries and what was in the previous examinations. I froze my throat thoroughly (I underwent FGDS without anesthesia), told everything about how the procedure would be carried out, then carried out the procedure itself. Since I have something to compare with, I have about a dozen FGDS behind me, I can say that the doctor does the procedure itself well, which is important, he is not silent during the whole procedure, he says what and how to do, talks with the patient))) looks carefully and neat.After the procedure, the doctor told me what he saw during the examination. The only thing that remained incomprehensible to me when atrophy was detected, for some reason, they did not take a biopsy.

Ekaterina

Good clinic. Very friendly staff. Doctors with excellent practice, explain everything in detail.

Maria

June 22 was at the FGDS in this center. Everything went smoothly and painlessly. They met, explained everything, took him to Doctor Serebryakov Yevgeny Yuryevich, he explained everything literally, what and how it would be carried out.Then they took me to the anesthesiologist, talked to him (unfortunately I did not remember the name of the anesthesiologist). Then the medical staff started to work, they did everything and put them down neatly. Then you fall asleep and wake up. They took me to the resting place, gave me tea and cookies, and went home. After several days I was at the reception of the gastroenterologist Y.V. Mikhailova. she explained everything and chewed it up in a language I could understand. I liked everything about this center. Many human thanks to everyone.

Alexander

June 20, 2020 underwent a comprehensive examination by Vladimir Alekseevich Kryazhov.The doctor is very pleasant, as well as the whole team. Previously, I heard not the most pleasant reviews about such procedures, so I decided to trust only the experienced team of the Regional Endoscopy Center and only under intravenous sedation (anesthesia). It went like a fairy tale. They turned you off – turned on and you’re done. And most importantly, not any painful sensations. I wish the whole team health and family well-being.

Denis

On May 16, a very large polyp in the sigmoid colon was removed.I was received by Dr. Vladimir Alekseevich Kryazhov. A handsome, attentive, courteous young man met me at the receptionists. The operation went well, for which I am very grateful to Dr. Vladimir Alekseevich Kryazhov and all the medical workers who were fussing around me. After the operation, they gave me tea, gave the appropriate recommendations and documents, and took them to the exit. We were invited to consultations. I would like to say about the center itself: a beautifully decorated room and a polite lady at the reception cheer you up.What surprises me is that I sent all the analyzes, all certificates and other documents for the operation by e-mail. The doctor got acquainted with my documents and by phone appointed the day and time of the operation. When I arrived at the appointed time, they were already waiting for me in the center. Once again, I thank all the workers of the regional endoscopy center for your work and wish you all HEALTH, HEALTH and HEALTH, Sincerely Zueva Lyudmila Nikolaevna Kulebaki, Nizhny Novgorod region

Lyudmila

I did a comprehensive examination at Vladimir Alekseevich Kryazhov on Saturday.Everything went great – many thanks to all the staff for such a friendly attitude towards their patients.

Sergey

I liked the clinic very much !!! I did a comprehensive study (FGDS and colonoscopy) under sedation. Everything went perfectly! I want to express my deep gratitude to the doctor Elena Anatolyevna Kirgintseva and all the specialists who were near me. All are friendly, masters of their craft, professionals! I was very afraid and worried before this procedure, but it was in vain.I fell asleep, and woke up after all the manipulations. I will recommend this clinic to friends and family, because health is the most expensive !!! Thank you BIG to all the staff.

Yana, 36 years old

I visited this clinic for the first time and never regretted my choice. I signed up for a not very pleasant procedure (as it seemed to me initially) gastroscopy and colonoscopy under medical anesthesia, but then my opinion changed for the better, thanks to the friendly doctors and staff. Everything went perfectly, from making an appointment to saying goodbye.I’ll tell you from the very beginning. Upon entering the clinic, you immediately switch to a spiritual and calm mood, everything is very clean, neat and home-like. The affable and radiant administrator Julia immediately told everything and took him to the doctor Serebryakov Evgeny Yuryevich. The doctor inquired about my complaints in detail, looked through all the available tests and previously done studies, told in detail how my procedure would be held. After talking with him, my fears just disappeared. Then I went to the office, where nurse Irina and anesthesiologist Daria met me, measured my blood pressure, and provided me with special underwear for colonoscopy.Everything went just perfect. I express my deep gratitude to you all for your work, responsiveness, understanding. I will definitely recommend this clinic to my friends and acquaintances. I wish you health and prosperity to the clinic!

Anna

It was necessary to undergo an unpleasant colonoscopy procedure; I went to your clinic and was very pleased. The atmosphere is more friendly – everything is clear, calm, from the reception to the procedure itself.The procedure itself took place in a dream, the nerve cells were not wasted. Doctor Serebryakov Yevgeny Yuryevich explained everything in detail, before the procedure, and after that he acquainted with the results of the examination, everything in a very understandable language. Thank you all! I would be pleased to recommend your clinic.

Tatiana

I would like to share with you about the FGDS procedure (gastroscopy with sedation). I did this procedure in a polyclinic (without anesthesia) and it was so terrible that it was postponed for the rest of my life. When I needed to repeat EGD, I turned to the Regional Endoscopy Center.From the first step I found myself in a friendly atmosphere, I was met by a wonderful girl at the reception – Ksenia, and then everything was like in a fairy tale, first I talked to a wonderful doctor – Serebryakov E. Yu., He asked me everything, calmed me down and passed me on to anesthesiologists A. A. and Olechka R., they set me up, calmed me down and a wonderful nurse Irina made a professional injection into a vein, and I fell asleep. Then they woke me up. I am very grateful to this team, which is doing their job at the highest professional level.Thank you very much. Respectfully yours, IA Lipatova. I recommend this center to everyone.

Lipatova I.A.

I liked the atmosphere, attentive administrators, very pleasant and attentive nurse Irina. Special thanks to Doctor Kryazhov! I went through FGDS urgently, everything was very neat and not painful, very attentive doctors and medical staff, they explained everything, set up. Excellent new equipment, high-quality repairs, tea / coffee (not even useful) – they accepted it right away. I didn’t think that such a procedure would cause such positive emotions.And a week earlier, my mother had a colonoscopy in this clinic, without sedation, she was pleased with the attentive attitude and the absence of severe discomfort! Accepted on time, reminding us of the visit in advance! I would recommend the “Regional Endoscopy Center” to my friends, everything is at the highest level, thank you very much, you are real professionals!

Anonymous

Got an appointment with the chief physician, Professor Nina Nikolaevna Mitrakova. This is the first time I have met a doctor of this level, I have already tried to do the third colonoscopy and finally it worked! I want to say one thing: there are many good equipment now, but golden hands are rare.It doesn’t hurt, with detailed comments and an attentive tactful attitude – that’s how I can tell you about the examination itself. You rarely meet such a competent doctor (I can only compare her with Abelevich). I recommend the center itself to everyone, and especially Mitrakova, now I only send all my relatives to her. Thank you!

Elena

I visited this center for the first time, signed up for a study. I really liked that, from the point of view of the client’s safety, the work there was very well organized during the quarantine period.There were no clients except me, when I entered, a woman came out in front of me. That is, the recording is carried out so that people do not intersect with each other. All surfaces are treated with antiseptics. Roman Andreevich Gagaev is a calm, attentive, tactful person, he looked at everything very carefully. He correctly identified my problem, although he was not obliged to advise me. I got the result in my hands, the description is detailed. I am very pleased!

Natalia

Visited an endoscopist.I was accepted even early. The doctor is polite and helpful. The procedure was performed with anesthesia. The doctor immediately wrote the description. It can be seen that the doctor is a professional with a capital letter, as he explained everything clearly and intelligibly to me and I was very pleased. And everything in the center, I would even say, is sterile and at the reception everyone is polite and everything is at the highest level!

Sergey

I want to express my deep gratitude to the doctor Vetyugov Dmitry Evgenievich for the professionally conducted research (colonoscopy and gastroscopy).I am very lucky that my doctor is a highly qualified and responsible specialist who listened very carefully to all the complaints before the examination and gave detailed explanations based on the results of the study. Many thanks to the anesthesiologist Olga Vyacheslavovna Polyakova, Elena Guseva, the nurse, and Lyubov, the administrator of Loginova, for their kind and sensitive attitude.

Kolomytova V.I., 70 years old

I would like to express my gratitude to the endoscopist Gagaev Roman Andreevich and the anesthesiologist Isakov Oleg Vyacheslavovich for their professionalism, efficiency in decision-making, and attentive, humane attitude.In September 2019, my mother was contacted at this center, a colonoscopy (with sedation) was performed with the simultaneous removal of intestinal polyps. The operation was painless, and there were no discomfort after the operation either. Thank you again and further success in your profession !!!!

Julia

Everything is at the highest level – starting with the provision of parking, the clinic itself – everything is beautiful, cozy, comfortable, everything you need is provided. up to shoe care products and deodorant. Well, in fact, the medical services are at the highest level.I am very happy! Many thanks to Alexander Anatolyevich and all the other specialists who participated. I was very afraid of the procedure itself (colonos and gastroscopy), but even after the examination there were no unpleasant sensations in the body – as if I had just slept. Previously, I did FGDS in other places – the larynx hurt for a couple of days later. I was afraid to even think about the column. Attentive staff, informal, human attitude. While I was resting after the procedure, after consulting a doctor, a nutritionist talked to me, clarified how to eat after a diet and examination.offered tea and treated with personal chocolate, which was very supportive both mentally and physically – I really wanted to eat))). Many thanks to everyone again! I will come to you, as the doctor prescribed, in a year and a half!

Svetlana

My mother needed to check the upper and lower intestines. We made an appointment with Raisat Saidovna Smirnova for a diagnostic examination. At the first visit, an FGDS study was performed: everything went very easily and painlessly. This is not the first time Mom has done FGDS – and always unpleasant sensations, it was much better here.During the third visit, a colorectal examination was scheduled. Preparations for the study went smoothly on Moviprepe. Everyone who talked about this procedure said that the preparation for it is difficult: you need to drink a lot of liquid, and as a result, the intestines are not clean. But the preparation and the procedure itself went well. Mom did it without anesthesia, carbon dioxide was injected into the intestines. On the first day after the study, the intestines “did not swell”. Before that, they did it in another center “in the air” and for a long time there were unpleasant sensations: (After the procedure, they gave me the opportunity to rest and sent me home by taxi.I recommend this center to everyone. The staff is friendly, competent specialists!

Ekaterina

I thank all the staff of the clinic for their friendly attitude towards their patients! The clinic has an atmosphere of kindness and comfort. All medical processes are organized at a high level! The examinations are carried out in very comfortable conditions for the patient. As a doctor, I would like to note the highest professionalism of the center’s specialists! I wish you success and prosperity!

Ekaterina

I express my HUGE THANKS to the specialists of the center and especially to Mitrakov Alexander Anatolyevich for HUGE PROFESSIONALISM.Before contacting the “ENDOSCOPY CENTER” For several years we have been trying to make the correct diagnosis, underwent a large number of examinations, did a colonoscopy – the result was zero. On the advice of friends, we turned to Alexander Anatolyevich, although we had to go to another city, we are from Samara, but Mom’s health is more expensive. Nice and polite staff, they made high-quality anesthesia, conducted a thorough examination (there is something to compare with), they explained and told everything. Finally, the correct diagnosis was made. Now we are undergoing treatment in our city.We will definitely apply for a follow-up examination after undergoing a course of treatment. THANK YOU!!! Health to all!

Radjabov Kazbek

Dear Alexander Anatolyevich! Many thanks to you and the staff of the endoscopy center for a prompt and high-quality operation. I wish you success, health and well-being! Thank you! Respectfully yours, patient Igor Vasilievich G.

Igor Vasilievich

Vladimir Alekseevich Kryazhov is one of the best endoscopists in our city, he has a lot of well-deserved awards and certificates.I studied the reviews for a long time before deciding to remove the formation in the intestine, and did not regret choosing it. I did everything neatly, removed the tumor, nothing bled with sweat, did not hurt, and after six months, no traces remained in this place at the control examination. Thank you, doctor!

Nikiforova Olga

I did the examination of the intestines under anesthesia at Elena Anatolyevna Kirgintseva. As soon as I opened my eyes, first the anesthesiologist talked to me, and then the doctor came to the ward and answered my questions in general terms.There was nothing special to tell, as it turned out that everything was fine with me. And those horror stories that scared me in another clinic are just functional features. There is nothing that needs to be removed, you just need to change your attitude towards nutrition and lifestyle !!! And I also liked the attitude towards myself, the paramedics reassured me, the anesthesiologist was also good, the doctor consulted me, fully informed me about the procedure. She told everything with humor to relieve my tension. She managed to calm me down.The main thing is that after the examination, I do not feel the consequences. Judging by the conclusion received, I do not need to reapply. But if the need arises – only to her.

Oksana Mamontova

Swallowing the intestine for bowel examination – it became pleasant, of course, but at least without pain and quickly enough, as it turned out. I did it for the first time, so I was afraid. It was done by the doctor Raisat Saidovna. I fell asleep and then they woke me up when it was over. There was no pain. Thank you!

Ekaterina

I have been undergoing treatment for a year with a gastroenterologist and everything is unsuccessful, I change one medicine for another.I accidentally heard from my friends about a good consultation with Dr. Gagaev and decided to go. The examination was good, there is something to compare with (it was the 4th FGDS, a couple of times the throat was ripped off, which then could not eat). We also discussed nutrition with the doctor, recommendations on diet and lifestyle were given. The doctor has a wide knowledge of his field. I think that I will be able to recommend it to my friends, as well as to me in due time. Later, I visited a gastroenterologist on his recommendation, and finally the treatment began to help, and I have experience of referring to other doctors, so I have something to compare with.He brought with him fresh examinations, a week ago, and there were also analyzes with him. I would also like to note that I was given twice as much time as previously agreed, although it was the end of the working day and the clinic was already closing. Summary: score 5 points for professionalism and attitude towards patients!

Pavel Alekseevich

I want to express my deep gratitude to the endoscopist Mitrakov Alexander Anatolyevich for his excellent work, professionalism and attentive attitude.I am very glad that I fell into the hands of such a highly qualified doctor! I also thank A.V. Klyueva. and Belyakov O.B. for a sensitive attitude and benevolence. I wish you all health, prosperity and success in everything! Thank you!

Lyudmila

I want to express my gratitude to the excellent specialist – Mitrakov Alexander Anatolyevich, as well as his assistants for professional, responsible and qualified work! For your attention and responsiveness, understanding and goodwill! I would like to wish you good health and great success!

Galina Vasilievna

Minimally invasive method of restoring patency in cicatricial lesions of the bile ducts and cholangiojunal fistulas

Antegrade balloon cholangioplasty

Cicatricial strictures (narrowing) of the bile ducts are a complication of diseases or damage to the liver, bile ducts, pancreas, 12 duodenum and can be accompanied by a formidable complication – obstructive jaundice, requiring urgent surgical treatment.

Currently, the main treatment for cicatricial narrowing of the bile ducts is the removal of scar tissue and the connection of the bile ducts with the intestine outside the scars. However, this operation, as a rule, is performed by laparotomic access (a large incision on the anterior abdominal wall), is a highly traumatic method of treatment with a long postoperative period (10-12 days), and the need for prolonged standing of drains (“tubes on the abdomen”), accompanied by a high percentage of relapses (the appearance of narrowing again).

One of the methods for treating cicatricial strictures is a highly effective, minimally invasive method developed on the basis of GBUZ GKB No. 5 DZM – antegrade balloon cholangioplasty.

The method is carried out through an incision on the skin with a length of 5 mm through which a special balloon is installed in the narrowing area in which high pressure is created (up to 12-15 atm), as a result of which the destruction of scar tissue occurs, and the patency of the bile ducts is restored.

Advantages of this method:

• minimum incision (5 mm),

• no need to stay for a long time after the operation in the intensive care unit (patients are in the intensive care unit for no more than 1 day, in the absence of indications for a longer stay associated with concomitant pathology),

• drainage standing time 5-6 days,

• early activation of the patient (the patient can walk on his own after 3 hours),

• lack of severe pain syndrome,

• discharge home in 7 – 10 days,

• it is possible to perform it in patients with severe concomitant pathology (heart attack, stroke, severe diabetes mellitus…).

This technique has all the advantages of minimally invasive interventions, it creates a stable patency of the bile ducts. This method of treatment, due to its low trauma, is feasible in patients with a high operational and anesthetic risk, for whom traditional methods of treatment are intolerable.