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Related Concept Videos

Drugs for Treatment of Diarrhea-Predominant IBS01:17

Drugs for Treatment of Diarrhea-Predominant IBS

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Diarrhea-predominant irritable bowel syndrome (IBS-D) is a subtype of IBS characterized primarily by frequent, loose, or watery stools, abdominal pain, and abdominal discomfort. Therapeutic approaches to managing IBS-D include dietary changes, stress management techniques, and pharmaceutical interventions.
Two specific drugs used in the treatment are alosetron (Lotronex) and eluxadoline (Viberzi). Alosetron, a 5-HT3 antagonist, works by slowing the movement of stools in the gut, reducing bowel...
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Pharmacological therapies for IBS-C are designed to alleviate abdominal discomfort and enhance bowel function. In patients with IBS-C, fiber supplements may help soften stools and decrease straining, but may also lead to increased gas production and bloating. Osmotic laxatives like milk of magnesia are frequently used to soften stools and increase stool frequency in IBS-C patients. In addition, two drugs approved for use in severe IBS-C adult cases are linaclotide (Linzess) and lubiprostone...
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Ulcerative colitis is a chronic inflammatory condition primarily affecting the colon and rectum. The primary drugs used in the treatment of ulcerative colitis are aminosalicylates. They exhibit anti-inflammatory and immunosuppressive properties. They modulate inflammatory mediators and inhibit the activity of nuclear factor κB (NF-κB). Aminosalicylates also reduce inflammation by inhibiting prostaglandin and leukotriene production and decreasing neutrophil chemotaxis and superoxide...
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Drugs Affecting GI Tract Motility: Adsorbents as Antidiarrheal Agents01:20

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Diarrhea is characterized by the occurrence of frequent, watery bowel movements. Various factors can trigger diarrhea, including viral or bacterial infections, foodborne illnesses, side effects from certain medications, and underlying digestive disorders. If not adequately managed, diarrhea can lead to complications such as dehydration, electrolyte imbalances, and nutrient deficiencies. Severe diarrhea can lead to significant weight loss, malnutrition, and weakened immune function.
Adsorbents...
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Assessment of the Rectum and Anus01:25

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Evaluating the rectum and anus plays a crucial role in conducting a thorough physical examination of the gastrointestinal system. Although it may be uncomfortable and often embarrassing for the patient, it holds immense diagnostic value, particularly in detecting gastrointestinal diseases and abnormalities. This guide will explain how to perform this assessment using inspection and palpation methods.
Rectal Inspection
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Chemotherapy-Induced Nausea and Vomiting: 5-HT3 Receptor Antagonists01:27

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5-HT3 receptor antagonists, such as dolasetron, granisetron (Kytril), ondansetron (Zofran), and palonosetron (Axoli), are crucial in managing chemotherapy-induced nausea and vomiting (CINV) and postoperative nausea. These drugs selectively block 5-HT3 receptors in the visceral vagal and spinal afferent nerves, chemoreceptor trigger zone, and the vomiting center. They have a rapid onset of action and can be given as a single dose before chemotherapy. Ondansetron and granisetron, in particular,...
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Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
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Total Neoadjuvant Therapy for Rectal Cancer: Why Japan Says "Not Yet".

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Total neoadjuvant therapy (TNT) is a global standard for rectal cancer, improving outcomes and enabling non-operative management. Japan

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Area of Science:

  • Gastroenterology and Oncology
  • Surgical Oncology
  • Clinical Practice Guidelines

Background:

  • Total neoadjuvant therapy (TNT) is increasingly adopted globally for locally advanced rectal cancer (LARC).
  • TNT demonstrates improved pathological complete response (pCR) rates, enhanced systemic control, and expanded non-operative management (NOM) options.
  • Major international guidelines now incorporate TNT as a core strategy for stage II/III rectal cancer.

Purpose of the Study:

  • To examine the global adoption of TNT for LARC.
  • To analyze Japan's divergent stance on TNT and NOM in its 2024 guidelines.
  • To explore barriers and contextual factors influencing TNT implementation.

Main Methods:

  • Review of key phase III clinical trials supporting TNT.
  • Analysis of international and Japanese colorectal cancer treatment guidelines.
  • Examination of healthcare system structures and practical challenges in Japan.

Main Results:

  • Global trend favors TNT, supported by robust trial data.
  • Japan's guidelines cautiously recommend against routine TNT/NOM, reflecting system-specific challenges.
  • Barriers include non-specialized treatment centers, surgeon experience, and unresolved toxicity/survival data.

Conclusions:

  • Japan's approach highlights the need to adapt TNT to local healthcare realities.
  • Universal TNT application may not be optimal; tailored integration is crucial.
  • Balancing oncologic efficacy with patient-centered care and local context is key for future TNT strategies.