The tongue is one of the primary articulators in the production of  speech , and this is facilitated by both the extrinsic muscles that move the tongue and the intrinsic muscles that change its shape. Specifically, different  vowels  are  articulated  by changing the tongue's height and retraction to alter the  resonant  properties of the  vocal tract . These resonant properties amplify specific  harmonic frequencies  ( formants ) that are different for each vowel, while attenuating other harmonics. For example, [a] is produced with the tongue  lowered and centered  and [i] is produced with the tongue  raised and fronted .  Consonants  are articulated by constricting airflow through the vocal tract, and many consonants feature a constriction between the tongue and some other part of the vocal tract. For example,  alveolar consonants  like [s] and [n] are articulated with the tongue against the  alveolar ridge , while  velar consonants  like [k] and [g] are articulated with the tongue dorsum against the soft palate (velum). Tongue shape is also relevant to speech articulation, for example in  retroflex consonants , where the tip of the tongue is curved backward.


The tongue plays a role in  physical intimacy  and  sexuality . The tongue is part of the  erogenous zone  of the mouth and can be used in intimate contact, as in the  French kiss  and in  oral sex .


A  congenital disorder  of the tongue is that of  ankyloglossia  also known as  tongue-tie . The tongue is  tied  to the floor of the mouth by a very short and thickened  frenulum  and this affects speech, eating, and swallowing.


The tongue is prone to several  pathologies  including  glossitis  and other  inflammations  such as  geographic tongue , and  median rhomboid glossitis ;  burning mouth syndrome ,  oral hairy leukoplakia ,  oral candidiasis  (thrush),  black hairy tongue , bifid tongue (due to failure in fusion of two lingual swellings of first pharyngeal arch) and  fissured tongue .


There are several types of  oral cancer  that mainly affect the tongue. Mostly these are  squamous cell carcinomas . [ 19 ] [ 20 ]


Food debris,  desquamated   epithelial cells  and  bacteria  often form a visible tongue coating. [ 21 ]  This coating has been identified as a major factor contributing to  bad breath  (halitosis), [ 21 ]  which can be managed by using a  tongue cleaner .


The  sublingual  region underneath the front of the tongue is an ideal location for the  administration  of certain medications into the body. The  oral mucosa  is very thin underneath the tongue, and is underlain by a plexus of veins. The sublingual route takes advantage of the highly  vascular  quality of the oral cavity, and allows for the speedy application of medication into the cardiovascular system, bypassing the gastrointestinal tract. This is the only convenient and efficacious  route of administration  (apart from  Intravenous therapy ) of  nitroglycerin  to a patient suffering chest pain from  angina pectoris .


The muscles of the tongue evolved in  amphibians  from  occipital   somites . Most amphibians show a proper tongue after their  metamorphosis . [ 22 ]  As a consequence, most  tetrapod  animals—amphibians, reptiles, birds, and mammals—have tongues (the  frog  family of  pipids  lack tongue). In mammals such as  dogs  and  cats , the tongue is often used to clean the fur and body by  licking . The tongues of these species have a very rough texture, which allows them to remove oils and parasites. Some dogs have a tendency to consistently lick a part of their foreleg, which can result in a  skin condition  known as a  lick granuloma . A dog's tongue also acts as a heat regulator. As a dog increases its exercise the tongue will increase in size due to greater blood flow. The tongue hangs out of the dog's mouth and the moisture on the tongue will work to cool the bloodflow. [ 23 ] [ 24 ]


Some animals have tongues that are specially adapted for catching prey. For example,  chameleons ,  frogs ,  pangolins  and  anteaters  have  prehensile  tongues.


Other animals may have organs that are  analogous  to tongues, such as a  butterfly 's  proboscis  or a  radula  on a  mollusc , but these are not  homologous  with the tongues found in vertebrates and often have little resemblance in function. For example, butterflies do not lick with their proboscides; they suck through them, and the proboscis is not a single organ, but two jaws held together to form a tube. [ 25 ]  Many species of fish have small folds at the base of their mouths that might informally be called tongues, but they lack a muscular structure like the true tongues found in most  tetrapods . [ 26 ] [ 27 ]


The tongue can serve as a  metonym  for  language . For example, the  New Testament  of the Bible, in the Book of  Acts of the Apostles ,  Jesus ' disciples on the Day of  Pentecost  received a type of  spiritual gift : "there appeared unto them cloven tongues like as of fire, and it sat upon each of them. And they were all filled with the  Holy Ghost , and began to speak with other tongues ....", which amazed the crowd of  Jewish  people in  Jerusalem , who were from various parts of the  Roman Empire  but could now understand what was being preached. The phrase  mother tongue  is used as a child's first language.  Many languages [ 28 ]  have the same word for "tongue" and " language ", as did the  English language  before the  Middle Ages .


A common temporary failure in word  retrieval  from  memory  is referred to as the    tip-of-the-tongue   phenomenon . The expression  tongue in cheek  refers to a statement that is not to be taken entirely seriously – something said or done with subtle ironic or sarcastic humour. A  tongue twister  is a phrase very difficult to pronounce. Aside from being a  medical condition , "tongue-tied" means being unable to say what you want due to confusion or restriction. The phrase "cat got your tongue" refers to when a person is speechless. To "bite one's tongue" is a phrase which describes holding back an opinion to avoid causing offence. A "slip of the tongue" refers to an unintentional utterance, such as a  Freudian slip . The "gift of tongues" refers to when one is uncommonly gifted to be able to speak in a foreign language, often as a type of  spiritual gift .  Speaking in tongues  is a common phrase used to describe  glossolalia , which is to make smooth, language-resembling sounds that is no true spoken language itself. A deceptive person is said to have a  forked tongue , and a smooth-talking person is said to have a  silver tongue .


Sticking one's tongue out at someone is considered a childish gesture of  rudeness  or defiance in many countries; the act may also have sexual connotations, depending on the way in which it is done. However, in  Tibet  it is considered a greeting. [ 29 ]  In 2009, a farmer from  Fabriano , Italy, was convicted and fined by  Italy's highest court  for sticking his tongue out at a neighbor with whom he had been arguing - proof of the affront had been captured with a cell-phone camera. [ 30 ]


Tongue piercing  and  splitting  have become more common in western countries in recent decades. [ when? ]  One study found that one-fifth of young adults in Israel had at least one type of oral piercing, most commonly the tongue. [ 31 ]


Protruding tongues appear in the art of several  Polynesian cultures . [ 32 ]


The tongues of some animals are consumed and sometimes prized as delicacies. Hot-tongue sandwiches frequently appear on menus in  kosher   delicatessens  in America.  Taco de lengua  ( lengua  being Spanish for tongue) is a taco filled with  beef tongue , and is especially popular in Mexican cuisine. As part of Colombian gastronomy, Tongue in Sauce (Lengua en Salsa) is a dish prepared by frying the tongue and adding tomato sauce, onions and salt.  Tongue can also be prepared as  birria . Pig and beef tongue are consumed in Chinese cuisine.  Duck  tongues are sometimes employed in  Sichuan  dishes, while  lamb 's tongue is occasionally employed in Continental and contemporary American cooking. Fried  cod  "tongue" is a relatively common part of fish meals in  Norway  and in  Newfoundland . In  Argentina  and  Uruguay  cow tongue is cooked and served in vinegar ( lengua a la vinagreta ).  In the Czech Republic and in Poland, a pork tongue is considered a delicacy, and there are many ways of preparing it. In Eastern Slavic countries, pork and beef tongues are commonly consumed, boiled and garnished with horseradish or jellied; beef tongues fetch a significantly higher price and are considered more of a delicacy.  In Alaska, cow tongues are among the more common. Both cow and moose tongues are popular toppings on open-top-sandwiches in Norway, the latter usually amongst hunters.


Tongues of seals and whales have been eaten, sometimes in large quantities, by sealers and whalers, and in various times and places have been sold for food on shore. [ 33 ] [ page needed ]


This article incorporates text in the  public domain  from  page 1125  of the 20th edition of   Gray's Anatomy   (1918)


The  transverse folds of rectum  (or  Houston's valves  or  the valves of Houston ) are semi-lunar transverse folds of the   rectal  wall that protrude into the rectum, not the  anal canal  as that lies below the rectum. Their use seems to be to support the weight of  fecal matter , and prevent its urging toward the  anus , which would produce a strong urge to  defecate . Although the term rectum means straight, these transverse folds overlap each other during the empty state of the intestine to such an extent that, as Houston remarked, they require considerable maneuvering to conduct an instrument along the canal, as often occurs in  sigmoidoscopy  and  colonoscopy .


These folds are about 12 mm. in width and are composed of the circular muscle coat of the rectum. They are usually three in number; sometimes a fourth is found, and occasionally only two are present.


Transverse folds were first described by Irish anatomist  John Houston , curator of the  Royal College of Surgeons in Ireland  Museum, in 1830. They appear to be peculiar to human physiology: Baur (1863) looked for Houston's valves in a number of mammals, including wolf, bear, rhinoceros, and several Old World primates, but found no evidence. They are formed very early during human development, and may be visible in embryos of as little as 55 mm in length (10 weeks of gestational age.) [ 1 ]


This article incorporates text in the  public domain  from  page 1183  of the 20th edition of   Gray's Anatomy   (1918)


Ure2 , or Ure2p, is a  yeast  protein encoded by a  gene  known as  URE2  (systematic designation  YNL229C ).  The Ure2 protein can also form a yeast  prion  known as [URE3]. [ 1 ]  When Ura2p is expressed at high levels in yeast, it will readily convert from its native  protein conformation  into an aggregate known as an  amyloid . [URE3], along with  [PSI+] , were both determined by Wickner (1994) to meet the genetic definition of a yeast prion.


The gene prefix "URE" stands for ureidosuccinate transport, as the Ure2 protein in its native state is responsible for repressing nitrogen  catabolism  of  glutamine  by controlling the GLN3  transcription factor . Gln3p is retained in the cytoplasm by Ure2p when a preferred nitrogen source like ammonium sulfate is present in the growth media, but enters the nucleus when the cells are shifted to a nonpreferred source of nitrogen such as proline. [ 2 ]  Ure2 protein also plays a role in responding to  oxidative stress . [ 3 ]


Ure2p is a protein composed of 354  amino acids  and has a  molecular weight  of 40,226. Its gene,  URE2 , been mapped to chromosome XIV, 5  map units  from  KEX2 . [ 4 ]


Uroguanylin  is a 16  amino acid   peptide  that is secreted by  enterochromaffin cells  in the  duodenum  and proximal  small intestine . Guanylin acts as an  agonist  of the  guanylyl cyclase  receptor  guanylate cyclase 2C  (GC-C), and regulates  electrolyte  and  water  transport in  intestinal  and  renal   epithelia . By agonizing this guanylyl cyclase receptor, uroguanylin and guanylin cause intestinal secretion of chloride and bicarbonate to dramatically increase; this process is helped by the second messenger  cGMP . [ 1 ]  Its sequence is H-Asn-Asp-Asp-Cys(1)-Glu-Leu-Cys(2)-Val-Asn-Val-Ala-Cys(1)-Thr-Gly-Cys(2)-Leu-OH.


In humans, the uroguanylin peptide is encoded by the  GUCA2B   gene . [ 2 ] [ 3 ]  Uroguanylin may be involved in appetite and perceptions of 'fullness' after eating meals, as suggested by a study into mice. [ 4 ]


This  biochemistry  article is a  stub . You can help Wikipedia by  expanding it .


The  appendix  ( pl. :  appendices  or  appendixes ; also  vermiform appendix ;   cecal  (or  caecal ,  cæcal )  appendix ;  vermix ; or  vermiform process ) is a finger-like, blind-ended tube connected to the  cecum , from which it  develops in the embryo .


The cecum is a pouch-like structure of the  large intestine , located at the junction of the  small  and the large intestines. The term " vermiform " comes from  Latin  and means "worm-shaped". The appendix was once considered a  vestigial organ , but this view has changed since the early 2000s. [ 1 ] [ 2 ]  Research suggests that the appendix may serve an important purpose as a reservoir for beneficial  gut bacteria .


The human appendix averages 9 cm (3.5 in) in length, ranging from 5 to 35 cm (2.0 to 13.8 in). The diameter of the appendix is 6 mm (0.24 in), and more than 6 mm (0.24 in) is considered a thickened or inflamed appendix. The longest appendix ever removed was 26 cm (10 in) long. [ 3 ]  The appendix is usually located in the lower right  quadrant  of the  abdomen , near the right  hip bone . The base of the appendix is located 2 cm (0.79 in) beneath the  ileocecal valve  that separates the large intestine from the small intestine. Its position within the abdomen corresponds to a point on the surface known as  McBurney's point .


The appendix is connected to the  mesentery  in the lower region of the  ileum , by a short region of the  mesocolon  known as the  mesoappendix . [ 4 ]


Some identical twins—known as  mirror image twins —can have a  mirror-imaged anatomy , a  congenital condition  with the appendix located in the lower left quadrant of the abdomen instead of the lower right. [ 5 ] [ 6 ]   Intestinal malrotation  may also cause displacement of the appendix to the left side.


While the base of the appendix is typically located 2 cm (0.79 in) below the  ileocecal valve , the tip of the appendix can be variably located—in the  pelvis , outside the  peritoneum  or behind the cecum. [ 7 ]  The prevalence of the different positions varies amongst populations with the retrocecal position being most common in  Ghana  and  Sudan , with 67.3% and 58.3% occurrence respectively, in comparison to  Iran  and  Bosnia  where the pelvic position is most common, with 55.8% and 57.7% occurrence respectively. [ 8 ] [ 9 ] [ 10 ] [ 11 ]


In very rare cases, the appendix may not be present at all ( laparotomies  for suspected appendicitis have given a frequency of 1 in 100,000). [ 12 ]


Sometimes there is a semi-circular fold of  mucous membrane  at the opening of the appendix. This  valve of the vermiform appendix  is also called  Gerlach's  valve. [ 4 ]


Although it has been long accepted that the immune tissue surrounding the appendix and elsewhere in the gut—called  gut-associated lymphoid tissue —carries out a number of important functions, explanations were lacking for the distinctive shape of the appendix and its apparent lack of specific importance and function as judged by an absence of side effects following  its removal . [ 13 ]  Therefore, the notion that the appendix is only  vestigial  became widely held.


William Parker, Randy Bollinger, and colleagues at  Duke University  proposed in 2007 that the appendix serves as a haven for useful  bacteria  when illness flushes the bacteria from the rest of the intestines. [ 14 ] [ 15 ]  This proposition is based on an understanding that emerged by the early 2000s of how the immune system supports the growth of beneficial  intestinal bacteria , [ 16 ] [ 17 ]  in combination with many well-known features of the appendix, including its architecture, its location just below the normal one-way flow of food and germs in the large intestine, and its association with copious amounts of immune tissue.


Research performed at  Winthrop–University Hospital  showed that individuals without an appendix were four times as likely to have a recurrence of  Clostridioides difficile  colitis . [ 18 ]  The appendix, therefore, may act as a "safe house" for beneficial bacteria. [ 14 ]  This reservoir of bacteria could then serve to repopulate the  gut flora  in the  digestive system  following a bout of  dysentery  or  cholera  or to boost it following a milder gastrointestinal illness. [ 15 ]


The appendix has been identified as an important component of mammalian  mucosal immune function , particularly  B cell -mediated immune responses and  extrathymically  derived  T cells . This structure helps in the proper movement and removal of waste matter in the digestive system, contains lymphatic vessels that regulate pathogens, and lastly, might even produce early defences that prevent deadly diseases. Additionally, it is thought that this may provide more immune defences from invading pathogens and getting the lymphatic system's B and T cells to fight the viruses and bacteria that infect that portion of the bowel and training them so that immune responses are targeted and more able to reliably and less dangerously fight off pathogens. [ 19 ]  In addition, there are different immune cells called  innate lymphoid cells  that function in the gut in order to help the appendix maintain digestive health. [ 20 ]


Research also shows a positive correlation between the existence of the appendix and the concentration of cecal lymphoid tissue, which supports the suggestion that not only does the appendix evolve as a complex with the cecum but also has major immune benefits. [ 21 ]


Common  diseases  of the appendix (in humans) are  appendicitis  and  carcinoid  tumors (appendiceal carcinoid). [ 22 ]   Appendix cancer  accounts for about 1 in 200 of all gastrointestinal malignancies. In rare cases,  adenomas  are also present. [ 23 ]


Appendicitis  is a condition characterized by  inflammation  of the appendix. Pain often begins in the center of the abdomen, corresponding to the appendix's development as part of the embryonic  midgut . This pain is typically a dull, poorly localized,  visceral  pain. [ 24 ]


As the inflammation progresses, the pain begins to localize more clearly to the right lower quadrant, as the  peritoneum  becomes inflamed. This peritoneal inflammation, or  peritonitis , results in  rebound tenderness  (pain upon removal of pressure rather than application of pressure). In particular, it presents at  McBurney's point , 1/3 of the way along a line drawn from the  anterior superior iliac spine  to the  umbilicus . Typically, point (skin) pain is not present until the  parietal peritoneum  is inflamed, as well. Fever and an immune system response are also characteristic of appendicitis. [ 24 ]  Other signs and symptoms may include  nausea  and vomiting, low-grade fever that may get worse,  constipation  or  diarrhea , abdominal bloating, or  flatulence . [ 25 ]


Appendicitis usually requires the removal of the inflamed appendix, in an  appendectomy  either by  laparotomy  or  laparoscopy . Untreated, the appendix may rupture, leading to  peritonitis , followed by  shock , and, if still untreated, death. [ 24 ]


The surgical removal of the appendix is called an  appendectomy . This removal is normally performed as an emergency procedure when the patient is suffering from  acute  appendicitis. In the absence of surgical facilities,  intravenous   antibiotics  are used to delay or avoid the onset of  sepsis . In some cases, the appendicitis resolves completely; more often, an inflammatory mass forms around the appendix. This is a relative  contraindication  to surgery.


The appendix is also used for the construction of an efferent urinary conduit, in an operation known as the  Mitrofanoff procedure , [ 26 ]  in people with a  neurogenic bladder .


The appendix is also used as a means to access the colon in children with paralysed bowels or major rectal sphincter problems. The appendix is brought out to the skin surface and the child/parent can then attach a catheter and easily wash out the colon (via normal defaecation) using an appropriate solution. [ 27 ]


Charles Darwin  suggested that the appendix was mainly used by earlier hominids for digesting fibrous vegetation, then evolved to take on a new purpose over time. The very long cecum of some herbivorous animals, such as in the  horse  or the  koala , appears to support this hypothesis. The koala's cecum enables it to host bacteria that specifically help to break down cellulose. Human ancestors may have also relied upon this system when they lived on a diet rich in foliage.


As people began to eat more easily digested foods, they may have become less reliant on cellulose-rich plants for energy. As the cecum became less necessary for digestion, mutations that were previously deleterious (and would have hindered evolutionary progress) were no longer important, so the mutations survived. It is suggested that these  alleles  became more frequent and the cecum continued to shrink. After millions of years, the once-necessary cecum degraded to be the appendix of modern humans. [ 28 ]


Dr. Heather F. Smith of  Midwestern University  and colleagues explained:


Recently ... improved understanding of gut immunity has merged with current thinking in biological and medical science, pointing to an apparent function of the mammalian cecal appendix as a safe-house for symbiotic gut microbes, preserving the flora during times of gastrointestinal infection in societies without modern medicine. This function is potentially a selective force for the evolution and maintenance of the appendix.
Three morphotypes of cecal-appendices can be described among mammals based primarily on the shape of the cecum: a distinct appendix branching from a rounded or sac-like cecum (as in many primate species), an appendix located at the apex of a long and voluminous cecum (as in the rabbit, greater glider and Cape dune mole rat), and an appendix in the absence of a pronounced cecum (as in the wombat). In addition, long narrow appendix-like structures are found in mammals that either lack an apparent cecum (as in monotremes) or lack a distinct junction between the cecum and appendix-like structure (as in the koala). A cecal appendix has evolved independently at least twice, and apparently represents yet another example of convergence in morphology between Australian marsupials and placentals in the rest of the world. Although the appendix has apparently been lost by numerous species, it has also been maintained for more than 80 million years in at least one clade. [ 29 ]


In a 2013 paper, the appendix was found to have independently evolved in different animals at least 32 times (and perhaps as many as 38 times) and to have been lost no more than six times over the course of history. [ 30 ]  A more recent study using similar methods on an updated database yielded similar, though less spectacular results, with at least 29 gains and at the most 12 losses (all of which were ambiguous), and this is still significantly asymmetrical. [ 31 ]


This suggests that the cecal appendix has a selective advantage in many situations and argues strongly against its vestigial nature. Given that this organ may have a selective advantage in numerous situations, it appears to be associated with greater maximal longevity, for a given body mass. [ 32 ]  For example, in a 2023 study, the protective functions conferred against diarrhea were observed in young primates. [ 33 ]  This complex evolutionary history of the appendix, along with a great heterogeneity in its evolutionary rate in various taxa, suggests that it is a recurrent trait. [ 34 ]


Such a function may be useful in a culture lacking modern sanitation and healthcare practice, where  diarrhea  may be prevalent. Current  epidemiological  data on the cause of death in developing countries collected by the  World Health Organization  in 2001 show that acute diarrhea is now the fourth leading cause of disease-related death in developing countries (data summarized by the  Bill and Melinda Gates Foundation ). Two of the other leading causes of death are expected to have exerted limited or no selection pressure. [ 35 ]


Zonulin  (haptoglobin 2 precursor) [ 1 ]  is a  protein  that increases the permeability of  tight junctions  between  cells  of the wall of the  digestive tract . [ 2 ]  It was discovered in 2000 by  Alessio Fasano  and his team at the  University of Maryland School of Medicine . As the mammalian analogue of  zonula occludens toxin , secreted by  cholera  pathogen  Vibrio cholerae , zonulin has been implicated in the pathogenesis of  coeliac disease  and  diabetes mellitus type 1 . [ 3 ]   Type 2 diabetic  patients have shown increased zonulin. [ 4 ]


Gliadin  (a glycoprotein present in  gluten ) activates zonulin signaling irrespective of the genetic expression of autoimmunity, leading to increased  intestinal permeability  of macromolecules. [ 3 ] [ 5 ]


Zonula occludens toxin is being studied as an adjuvant to improve absorption of drugs and vaccines. [ 6 ]  In 2014 a zonulin  receptor antagonist ,  larazotide acetate  (formerly known as AT-1001), completed a  phase 2b  clinical trial. [ 7 ] [ 8 ]


Elie Abadie  ( Arabic :  ايلي عبادي ) is Senior Rabbi in the  Association of Gulf Jewish Communities  and Senior Rabbi in Residence of the  Jewish Council of the Emirates  (JCE). [ 1 ] [ 2 ] [ 3 ]  He is the former Director of the Jacob E. Safra Institute of Sephardic Studies at  Yeshiva University , with an area of interest on the topics of  Sephardic Judaism , history, philosophy, and comparative traditional law. He is a member of the board of the  American Sephardi Federation  and the World Sephardic Educational Center, and co-president of  Justice for Jews from Arab Countries . He is a former member of the Board and an Officer of the  Rabbinical Council of America  (RCA), the Treasurer/Vice-president of the  New York Board of Rabbis , and co-chair of the Sadat Congressional Gold Medal Committee. [ 4 ] [ 5 ]


Abadie's parents were forced to flee  Aleppo, Syria , where his family had lived for millennia, under government pressure. [ 6 ]  Abadie explained his parents' flight from Syria:


“My parents lived right next to the  synagogue . They saw people enter the synagogue, pillage it, torched it, took out the  Torah scrolls  and holy books and burnt them. My parents escaped from their home through the backdoor as people tried to get into my parents’ house. They left and never returned.” [ 7 ]


Abadie was born in  Beirut , Lebanon in 1960. The Abadie family moved to  Mexico City  in 1971 after the  Palestinian Liberation Organization  relocated its headquarters from  Jordan  to Lebanon. They lived in Lebanon with no citizenship, as registered refugees, with identity documents reading "stateless." Abadie's father, had his picture posted on walls around Beirut claiming he was a  Zionist leader , prompting his family's emigration. [ 8 ]


After moving to the United States in 1979 to attend Yeshiva University, he earned his  B.A . in  Health Sciences  in 1983, B.S.C. in 1984 in  Bible Studies , Hebrew Teacher's diploma in 1985, and a master's degree in  Jewish Philosophy  in 1986 from  Bernard Revel Graduate School of Yeshiva University . Abadie received his ordination in 1986 from  Rabbi Isaac Elchanan Theological Seminary . He attended  SUNY Downstate Medical Center , where he graduated in 1990 with an M.D. degree. He did his residency in  Internal Medicine , and later his fellowship in gastroenterology at  Maimonides Medical Center  where he finished in 1995. [ 9 ]


Abadie became a rabbi at  Congregation Beit Edmond  in 2001. [ 10 ]


He was the founding rabbi of Shaare Mizrah-Manhattan East Synagogue, the Head of School of the  Sephardic Academy of Manhattan , and the Spiritual Leader of the Moise Safra Community Center in Manhattan. From 2003 to 2017 he was the founding Rabbi and Spiritual Leader of the  Edmond J. Safra Synagogue  in New York City (now Congregation Beit Edmond), one of the largest Sephardic synagogues in New York City. [ 11 ]


He is currently the President of  JJAC  ( Justice for Jews from Arab Countries ) and a member of the governing council of the  World Zionist Organization  (WZO). He is the founder of the  Sephardic Academy of Manhattan  and served as the Director of the Jacob E. Safra Institute of Sephardic Studies, at  Yeshiva University  and college professor of Sephardic Judaism, history, philosophy, and comparative traditional law. [ 12 ] [ 13 ] [ 14 ]


In November 2020, after the signing of the  Abraham Accords , which normalized relations between the  UAE  and  Israel , Abadie moved to  Dubai  to become the country's Senior Rabbi. [ 15 ]


In 2021, Abadie issued an official condemnation of the  Houthis  for imprisoning a Yemenite Jew,  Levi Salem Marhabi , for helping smuggle a group of  Jews  into  Israel ; dubbing it as a  crime against humanity . [ 16 ]


Abadie's native language is  Arabic  and is fluent in six languages. He is also a part-time  gastroenterologist. [ 7 ]  Abadie has received the  Orden Del Merito Civil , the highest civil decoration in  Spain . He has been married to Elise Eichler for over 36 years. [ 17 ]


Ken Croitoru  is a Canadian  gastroenterologist  who works at  Mount Sinai Hospital in Toronto , a scientist at the  Lunenfeld-Tanenbaum Research Institute , and a professor in the Department of Medicine at the  University of Toronto . He is best known for his leadership of the Genetic, Environmental, Microbial (GEM) Project, a comprehensive research initiative aiming to understand the triggers of  Crohn's disease . [ 1 ] [ 2 ]


Croitoru is a 1981 graduate of  McGill University Faculty of Medicine and Health Sciences . [ 3 ]   He did post-doctoral training with  John Bienenstock  at  McMaster University Medical School . [ 4 ]


Croitoru is a gastroenterologist at Mount Sinai Hospital, and also serves as a scientist at the Lunenfeld-Tanenbaum Research Institute. [ 5 ]


Croitoru is the lead investigator and architect of the GEM Project, which was launched in 2008. The project's purpose is to uncover the potential triggers of Crohn's disease by monitoring first-degree relatives of Crohn's patients. These individuals do not have the disease themselves but are at a higher risk of developing it. [ 1 ]


Under Croitoru's guidance, the GEM Project has made significant strides in Crohn's disease research. For instance, the team has discovered indications of barrier dysfunction, also known as "leaky gut," occurring before the onset of the disease. The researchers also identified specific bacteria that appear to be significantly different in people who develop the disease compared to those who do not. [ 5 ]


The work of the GEM Project, under the leadership of Croitoru, has significantly advanced the understanding of Crohn's disease and has the potential to improve prevention and treatment strategies. [ 1 ] [ 2 ]


Croitoru is a Tier 1  Canada Research Chair  in Inflammatory bowel diseases. [ 6 ]


Melita Alison Gordon   CMG   FRCP  is a  gastroenterologist  who works on invasive gut pathogens and tropical  gastrointestinal disease . She leads the  Malawi Liverpool Wellcome Trust  Salmonella and Enterics Group. Gordon was awarded the  British Society of Gastroenterology  Sir Francis Avery Jones Research Medal in 2011.


Gordon completed her undergraduate studies at the  University of Cambridge . She completed her clinical qualifications at the  University of Oxford  and eventually specialised in  internal medicine   Queen's University Belfast . She has since worked in  Zambia ,  Sheffield  and  Liverpool . [ 1 ]  In 1993 she was awarded the  Liverpool School of Tropical Medicine  Blacklock medal. [ 2 ]  In 1997 she was appointed a  Wellcome Trust  Clinical Fellow and Lecturer. [ 3 ]  She moved to  Malawi  in 1997, where she lived until 2005 and was part of the  Malawi Liverpool Wellcome Trust . [ 4 ]


In 2008 Gordon was made an NHS  Higher Education Funding Council for England  Clinical Fellow at the  University of Liverpool .  Her early work was the first to show how  Salmonella  becomes a lethal disease for  HIV-positive people . [ 5 ]  She was promoted to Reader in 2012 and Professor in 2015. In 2015 she returned to  Malawi  where she leads the  Malawi Liverpool Wellcome Trust  Salmonella and Enterics Group. [ 6 ]  Gordon's research focuses on the development of vaccinations to protect against invasive bloodstream diseases caused by two groups of  Salmonellae ;  typhoid fever  and  Invasive Non-Typhoidal Salmonellosis  (iNTS). [ 7 ]  Gordon is committed to identifying novel vaccinations that can protect children in Africa from bacterial disease.


iNTS is a rare bacterial disease that is caused by extraintestinal infection of certain  serotypes  of  Salmonella . iNTS kills around 80,000 people each year. It is more likely to occur in patients with  HIV infection  or  malaria  and the majority of people who suffer from iNTS are in  Sub-Saharan Africa . [ 8 ]  In 2011 Gordon was awarded the  British Society of Gastroenterology  Sir Francis Avery Jones Research Medal and in 2012 the Shire Awards for Gastrointestinal Excellence prize for Excellence in Gastroenterology. [ 9 ]  She became Director of the  World Gastroenterology Organisation  Blantyre Training Center in 2016. [ 10 ]


In 2018 Gordon led Africa's launch of the new  typhoid conjugate vaccine , and successfully vaccinated 24,000 children in  Malawi  in the first six months. [ 11 ]  The first child, Golden Kondowe, received the first vaccination in Ndirande,  Blantyre . [ 12 ] [ 13 ]  The Typhoid Vaccine Acceleration Consortium (TyVAC) study was funded by the  Bill & Melinda Gates Foundation  and was the result of twenty years of research of  Salmonella  in  Malawi . [ 11 ] [ 14 ]  The vaccine, which contains the Vi antigen  [ 15 ]  (a part of the Salmonella Typhi bacterium that helps it cause disease), is expected to protect against typhoid and other infections. [ 16 ] [ 17 ]  She works with local scientists, health workers and the Malawi Ministry of Health. [ 11 ]  The vaccine was shown to protect 81% of children from becoming infected with  typhoid fever . [ 11 ]


Gordon and the  University of Liverpool  Centre for Global Vaccine Research were awarded a multi-million pound research grant to establish the  Horizon 2020  Vacci-iNTS consortium. [ 18 ]  The consortium looks to develop new vaccines and research the financial and social impact of iNTS on communities in Africa impacted by the disease. [ 18 ]


In 2019 Gordon was made a  National Institute for Health Research  Global Research Professor. [ 19 ]  Her research has been supported by the  Bill & Melinda Gates Foundation ,  Medical Research Council ,  Wellcome Trust ,  British Society of Gastroenterology  and  Department for Business, Energy and Industrial Strategy . [ 20 ]


Her publications include:


Gordon is married to Stephen Gordon, former Director of the  Malawi Liverpool Wellcome Trust  Programme in Malawi. [ 21 ] [ 22 ] [ 23 ]


In the  2024 King's Birthday Honours , she was appointed  Companion of the Order of St Michael and St George  (CMG) "for services to global health". [ 24 ]


Bana Jabri  is a French gastroenterologist and immunologist of Syrian and Armenian descent. She is the Sarah and Harold Lincoln Thompson Professor in the Department of Medicine at the  University of Chicago . She researches inflammatory diseases of the intestine, including  celiac disease . She is an elected fellow of the  Association of American Physicians .


Bana Jabri was born in Syria; her father was Syrian and her mother was Armenian. She moved to Germany when she was two years old and to France when she was twelve. [ 1 ]
She attended  Paris Diderot University , graduating in 1986 with a bachelor's degree in  biochemistry . She graduated from the  Pasteur Institute  in 1991 with her  Doctor of Medicine , followed by a residency at  Assistance Publique – Hôpitaux de Paris , [ 2 ]  which is when she had her first child. [ 1 ]  She then completed a fellowship at the US  National Institutes of Health . She returned to Paris Diderot University for a PhD in immunology, graduating in 1996. [ 2 ]


In 1994, she accepted a position as an assistant professor in the department of  pediatric gastroenterology  at  Necker–Enfants Malades Hospital , remaining through 1998. In 1999, she worked at  Princeton University  as a staff researcher, becoming a research scientist the following year. She accepted a position at the  University of Chicago  in 2002 as an assistant professor; she was promoted in 2005 to associate professor and in 2011 to full professor. In 2006, she became the co-director of its Digestive Disease Research Core Center and in 2011 she was made the director of research for its Celiac Disease Center. [ 3 ]  In 2018 she received a named professorship, becoming the Sara and Harold Lincoln Thompson Professor. [ 4 ]


In 2009, she became the first researcher in the US to win the William K. Warren, Jr. Prize for Excellence in Celiac Disease Research. [ 5 ]  In 2017 she received the Lloyd Mayer Prize in  Mucosal Immunology . [ 4 ]  She is also an elected member of the  Association of American Physicians  and a recipient of the Llewellyn John and Harriet Manchester Quantrell Award for Excellence in Undergraduate Education. [ 6 ]


Khursheed Nowrojee Jeejeebhoy  (born August 26, 1935) was a gastroenterologist at the  Toronto General Hospital ,  St. Michael's Hospital ,  Unity Health Toronto  and professor of medicine, nutrition and physiology at the  University of Toronto , best known for his pioneering work in the development of  parenteral nutrition .


Jeejeebhoy was born to an  Indian Parsi family  in  Rangoon ,  Burma  on August 26, 1935, Nowrojee Jeejeebhoy and Gulbanoo Nowrojee (Tarapore) Jeejeebhoy. [ 1 ]  The family was evacuated to  India  by air in a  DC-3  ahead of advancing Japanese forces during the  Japanese invasion of Burma . His father joined the  Indian Army , and his maternal grandfather Pheroze Khurshetjee Tarapore was recalled to service after he had retired as an officer in the  Indian Medical Service . [ 2 ]


Due to  World War II  and his family's flight to India as refugees, Jeejeebhoy's schooling was initially very checkered. After his family fled to India, they lived a nomadic life and whether or not he attended school depended on where his father was stationed. However, his maternal grandmother Rattan Tarapore, a medical doctor trained at  JJ Hospital Medical School  in  Bombay , home schooled him. At age 15 he entered  Nirmala College  in  Delhi  and studied  economics  and  political science . At age 17, upon hearing of the excellence of  Christian Medical College Vellore  he applied for one of the ten spots available to students not sponsored by a Christian Mission. Entrance was by competitive written exam and interview. He was the first one called to fill one of the ten spots. He convocated in February 1959, capturing nine of ten gold medals. [ 2 ]


His graduate medical training was in  London . [ 2 ]


He is married and had three children.


This biography related to medicine in Canada is a  stub . You can help Wikipedia by  expanding it .


Orestes Manousos  ( Greek :  Ορέστης Μανούσος , 15 May 1931 – 21 June 2021), was a Greek  gastroenterologist  and Professor of Medicine at the  University of Crete . He was Director of the First Gastroenterology Clinic of the  Evangelismos Hospital  (1977–1985), President of the Hellenic Society of Gastroenterology (1981–1982), founding member and first President of the Mediterranean Medical Society (1989), founding member and first President of the Hellenic Society for the Study of  Helicobacter Pylori  (1996).


Orestes Manousos published a large number of clinical and research papers on digestive diseases in international medical journals. [ 1 ] [ 2 ] [ 3 ] [ 4 ] [ 5 ] [ 6 ] [ 7 ] [ 8 ] [ 9 ] [ 10 ]  He also wrote three medical textbooks,  Introduction to Clinical Medicine  with Professor Theodoros Mountokalakis,  The Immunology of Enteropathies  with Professor Ioanna Economidou, and  Colitis and... "Colitis" , which had a significant impact on the Greek gastroenterological community. After his retirement in 1998, he wrote several books on Cretan history and folklore as well as a historical novel.


Orestes Manousos was born in 1931 in the  Cretan  village of  Anogeia . His father was Nikolaos Manousos, a local doctor with significant activity and recognition during  World War II , and his mother was Irini Kefalogianni, sister of Kostas Kefalogiannis, a local war hero of the  Greek resistance .


Orestes Manousos attended the Heraklion High School and studied medicine at the  University of Thessaloniki . In 1959, after completing his military service in the Air Force, he left for England for postgraduate studies in London ( Central Middlesex  and  St Marks Hospitals ) and Oxford ( Radcliffe Infirmary ). He stayed in the UK for the next six years, gaining specialties in  internal medicine  (1961) and  gastroenterology  (1965). In 1964 his research into  diverticular disease  was acknowledged with the degree of Doctor of Philosophy (Ph.D.) from the  University of Oxford . [ 11 ]  His professors were Sidney Truelove, Sir Francis Avery Jones,  Leslie Witts , and John Lennard-Jones.


After his return to Greece, he worked initially at  Evangelismos Hospital  and at the University Clinic of Hippocrateon Private Hospital, under the guidance of Professor George Merikas. In the following years, he became head of the Department of Pathology at the Columbia Clinic of Evangelismos, chaired by Cushman Haagensen, a professor at  Columbia University College  in New York.


In 1973 he was elected Lecturer of the Faculty of Medicine of the  University of Athens  and from 1977 to 1985 he was Director of the first Gastroenterology Clinic of Evangelismos Hospital.


His work on immunology of the digestive tract, in collaboration with Professor Ioanna Economidou was important. In particular, their work on α-heavy chain disease and Mediterranean Lymphoma was of global impact. [ 3 ] [ 8 ] [ 9 ] [ 12 ] [ 13 ]


He organized an important and unique for his era, endoscopic department at the Evangelismos Hospital and played a leading role in the Hellenic Society of Gastroenterology, of which he was president in 1981 and 1982. He was also President of the 8th Panhellenic Congress of Gastroenterology, which was held with great success in Heraklion, Crete.


In 1985 he was elected Professor of Gastroenterology at the Medical School of the  University of Crete  and during the period 1990–1998, he was Director of the Gastroenterology Clinic of the University Hospital of Heraklion. He was an important pioneer in the first difficult steps of both the Medical University of Crete and the University Hospital of Heraklion. In 2003 he was awarded Professor Emeritus of the Faculty of Medicine of the University of Crete.


In his spare time, Orestes Manousos played chess with his friends, read detective novels, took walks at the foothills of  Mount Hymettus , and spent time with his family. In 1955, when he was 24 years old, he married Mary Papastefanakis. In the 66 years of their marriage, they had five children and four grandchildren.


In 2015 he was diagnosed with  Alzheimer's disease . He died in 2021. [ 14 ] [ 15 ] [ 16 ]  In November 2022, in honor of his work and contribution, the University Hospital of Heraklion renamed the hospital's Gastroenterology Clinic to "Orestes Manousos Gastroenterology Clinic". [ 17 ]


This template is used to identify a  gastroenterology  stub. It uses {{ asbox }}, which is a meta-template designed to ease the process of creating and maintaining stub templates.


Typing  {{Gastroenterology-stub}}  produces the message shown at the beginning, and adds the article to the following category:


This is a  stub template . A brief explanation of these templates follows; for full details please consult  Wikipedia:Stub .


A stub is an article containing only a few sentences of text which is too short to provide encyclopedic coverage of a subject.


Further information can be found at:


New stub templates and categories (collectively "stub types") should not be created without prior proposal at  Wikipedia:WikiProject Stub sorting/Proposals . This allows for the proper coordination of all stub types across Wikipedia, and for the checking of any new stub type for possible problems prior to its creation.


Brainerd diarrhea  is a sudden-onset watery, explosive  diarrhea  that lasts for months and does not respond to  antibiotics ; the cause of Brainerd diarrhea is unknown.  Brainerd diarrhea was first described in  Brainerd, Minnesota  in 1983. [ 1 ]
It has been associated with the consumption of  raw milk [ 1 ]  and untreated water. [ 2 ] [ 3 ]   Of the ten  outbreaks  reported since 1983, nine have been in the  U.S.   The characteristics of each outbreak have been similar to that caused by an  infectious agent .


Although a comparatively large outbreak (117 patients) occurred in 1996 in  Fannin County, Texas , [ 4 ]  the largest outbreak (122 patients) was the original one in Brainerd, MN.  There have been no secondary cases reported in any of the outbreaks, suggesting that the
 causative agent  cannot be  passed  from person to person, but boiling water appears to inactivate the Brainerd agent.  Although there is no treatment available, the disease does appear to resolve itself, although this process takes months if not years. [ 5 ] [ 6 ]


In  surgical pathology ,  strawberry gallbladder , more formally  cholesterolosis of the gallbladder  and  gallbladder cholesterolosis , is a change in the  gallbladder  wall due to excess  cholesterol . [ 1 ]


The name  strawberry gallbladder  comes from the typically stippled appearance of the  mucosal  surface on  gross examination , which resembles a  strawberry . Cholesterolosis results from abnormal deposits of cholesterol esters in macrophages within the lamina propria ( foam cells ) and in mucosal epithelium. The gallbladder may be affected in a patchy localized form or in a diffuse form. The diffuse form macroscopically appears as a bright red mucosa with yellow mottling (due to lipid), hence the term  strawberry  gallbladder.
It is not tied to  cholelithiasis  ( gallstones ) or  cholecystitis  ( inflammation  of the gallbladder). [ 2 ]


De Garengeot's hernia  is a rare subtype of an incarcerated  femoral hernia . This eponym may be used to describe the incarceration of the  vermiform appendix  within a  femoral hernia . [ 1 ]  This mechanism is contrasted with the Amyand hernia, in which the appendix protrudes through an inguinal hernia.


Akopian and Alexander, named this  hernia  after the 18th century Parisian surgeon Rene Jacques Croissant de Garengeot. He is quoted in the surgical literature as the first to describe this hernia in 1731. Although the surgeon's full last name is Croissant de Garengeot, for linguistic convenience it has been suggested to abbreviate this eponym to "de Garengeot". De Garengeot's first-described patient developed tenderness and a bulge in her right upper thigh after lifting 24 lb of bread. The bulge was unable to be reduced, after which surgery was conducted and a femoral hernia was discovered. The hernia was reduced back into the peritoneal cavity and the patient made an adequate recovery in 6 weeks. [ 2 ] [ 3 ]


Similar as with the situation of an  Amyand's hernia , the true nature of the incarcerated tissue is rarely diagnosed preoperatively. Patients present clinically similar to other incarcerated femoral herniae. Treatment consists of an  appendectomy  and hernia repair. Laparoscopic options are described. [ 4 ]


De Garengeot hernia are most commonly seen in females and patients between 60 and 90 years of age. [ 5 ]


Diagnosis of De Garengeot hernia is most commonly made at the time of surgery, but some are diagnosed pre-operatively by CT scan, ultrasound, or MRI. If De Garengeot hernia is suspected based on general clinical signs of abdominal tenderness or bulging, CT scan is recommended. [ 6 ]


A individualized treatment approach is required based on the severity of the hernia and the surgeon's skill level and experience. Since the condition is rare, there have not been documented randomized control trials. De Garengeot hernias can be treated with closed reduction, laparoscopic repair, appendectomy, and open repair. [ 4 ]  Mesh placement can be considered based on severity of the hernia. The most common route of surgical management was through a groin incision, and appendectomy was performed in 98.5% of patients. [ 5 ]


Prevention of De Garengeot hernia involves measures that prevent hernias generally, such as maintaining a healthy weight, avoiding tight-fitting clothes, avoiding heavy straining when using the restroom, and avoiding improper heavy lifting.


Factitious diarrhea  is a condition in which a person deliberately produces  diarrhea , most commonly by surreptitious  laxative  abuse ( laxative abuse syndrome ).


These people tend to have persistent and unexplained watery diarrhea that is high in volume and frequency and, despite extensive evaluation, the cause may remain unknown. Many cases may mimic  inflammatory bowel disease  or  malabsorption syndromes . [ 1 ]   Bowel movements  are generally about 10 to 20 a day and may be especially associated with nocturnal movements. Factitious diarrhea is most often seen in people of high  socioeconomic  status and many are employed in the medical field.


Melanosis coli  is a frequent find in long-standing factitious diarrhea. [ 2 ] [ 3 ]  It demonstrates  hyperpigmentation  of the  colon  with white  lymph nodes  showing through on  colonoscopy . An alternative means of diagnosis is by detecting  pigment  in  macrophages  of the  lamina propria .


Gastric pacing  is the process where a  pacemaker  is placed external to the  stomach , [ 1 ]  and leads penetrate the  gastric tissue  to ensure that an adequate current is running through the cells. It is used as a treatment for  gastroparesis . [ citation needed ]


The  gastroileal reflex  is one of the three extrinsic reflexes of the  gastrointestinal tract , the other two being the  gastrocolic reflex  and the  enterogastric reflex . The gastroileal reflex is stimulated by the presence of food in the stomach and gastric peristalsis. Initiation of the reflex causes peristalsis in the ileum and the opening of the ileocecal valve (which allows the emptying of the ileal contents into the large intestine, or colon). [ 1 ]  This in turn stimulates colonic peristalsis and an urge to defecate.


High-resolution manometry  ( HRM ) is a  gastrointestinal motility   diagnostic system  that measures  intraluminal pressure activity  in the  gastrointestinal tract  using a series of closely spaced  pressure sensors . For a  manometry  system to be classified as "high-resolution" as opposed to "conventional", the pressure sensors need to be spaced at most 1 cm apart. [ 1 ] [ 2 ]  Two dominant  pressure transduction  technologies are used:  solid state pressure sensors  and  water perfused pressure sensors . [ 2 ] [ 3 ]  Each pressure transduction technology has its own inherent advantages and disadvantages. HRM systems also require advanced  computer hardware  and  software  to store and analyze the manometry data. [ 2 ]


The  Journal of Pediatric Gastroenterology and Nutrition  is a monthly  peer-reviewed   medical journal  covering research on  digestive diseases  and nutrition in children. It is published by   Lippincott Williams & Wilkins  and was established in 1982. [ 1 ]  It is an official journal of the  European Society for Paediatric Gastroenterology, Hepatology and Nutrition  and the  North American Society for Pediatric Gastroenterology, Hepatology and Nutrition . [ 2 ]  The journal provides a forum for original papers and reviews dealing with pediatric gastroenterology and nutrition, including normal and abnormal functions of the alimentary tract and its associated organs, including the salivary glands, pancreas, gallbladder, and liver. Particular emphasis is on development and its relation to infant and childhood nutrition [ 3 ]


This article about a  pediatrics   journal  is a  stub . You can help Wikipedia by  expanding it .


See tips for writing articles about academic journals . Further suggestions might be found on the article's  talk page .


Umbilical cord ulceration and intestinal atresia  is a rare [ 1 ]   congenital  disease that leads to  intestinal atresia , umbilical cord ulceration and severe intrauterine  haemorrhage . Only 15 cases have so far been reported, [ 2 ]  though newer studies are beginning to conclude that this disease has a higher incidence rate than has been previously reported. [ 3 ]  A particular study has given intestinal atresia and umbilical cord ulceration a clear link after 5 such cases were reported at the time of publication. [ 4 ]


This article about a disorder arising in the  perinatal  period is a  stub . You can help Wikipedia by  expanding it .


Endoscopic image of diverticulosis, taken by myself, and released with permission of patient under GFDL --  Samir       (the scope)   धर्म    16:36, 2 May 2006 (UTC)


GFDL with disclaimers
 GNU Free Documentation License with  disclaimers
 //en.wikipedia.org/wiki/Wikipedia:Text_of_the_GNU_Free_Documentation_License


This licensing tag was added to this file as part of the GFDL  licensing update .


Any user may perform this transfer; refer to  Wikipedia:Moving files to Commons  for details.


If this file has problems with  attribution ,  copyright , or is otherwise  ineligible  for Commons, then  remove  this tag and  DO NOT  transfer it; repeat violators may be  blocked  from editing.


Endoscopic image of patient with  eosinophilic esophagitis  showing multiple rings and linear furrows.  Signed release into public domain from patient. --  Samir  08:37, 8 October 2007 (UTC)


GFDL
 GNU Free Documentation License
 //en.wikipedia.org/wiki/Wikipedia:Text_of_the_GNU_Free_Documentation_License


Fluoroscopic image of multiple  common bile duct   stones  seen at the time of  ERCP  and  duodenoscope assisted cholangiopancreatography  (DACP).  The stone was impacted in the distal common bile duct and was crushed with intracorporeal  lithotripsy .  Released into public domain on permission of patient/substitute decision maker. --  Samir   धर्म  06:13, 19 January 2007 (UTC)


Fluoroscopic image of two  metal biliary stents  in the  common bile duct .  The large black tube across the image is the duodenoscope.  Released into public domain on written permission of patient --  Samir   धर्म  06:52, 19 January 2007 (UTC)


Endoscopic picture of gastric ulcer with visible vessel.  Reproduced with permission of patient. --  Samir     (the scope)   धर्म    00:45, 5 May 2006 (UTC)


Isolated gastric varices seen on retroflexion of the  gastroscope .  The picture was placed into the public domain on the permission of the patient.  --  Samir   धर्म  04:53, 17 May 2006 (UTC)


Endoscopic image of  glycogenic acanthosis , placed under GFDL with permission of patient --  Samir   धर्म  05:53, 17 May 2006 (UTC)


Endoscopic  still of  common bile duct stone  impacted at  ampulla of Vater .  Released into public domain on permission of patient. --  Samir   धर्म  07:20, 15 August 2006 (UTC)


Colonoscopic  image of  ulcer  seen bleeding after  polypectomy , closed with an  endoclip .


c:Template:PD-medical


The person who associated a work with this deed has dedicated the work to the  public domain  by waiving all of his or her rights to the work worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law. You can copy, modify, distribute and perform the work, even for commercial purposes, all without asking permission.
 https://creativecommons.org/publicdomain/zero/1.0/deed.en
 CC0
 Creative Commons Zero, Public Domain Dedication
 false


The  American College of Gastroenterology  ( ACG ) is a  Bethesda ,  Maryland –based  medical association  of  gastroenterologists .


The association was founded in 1932 [ 1 ]  and holds annual meetings and regional postgraduate  continuing education  courses, establishes  research grants , and publishes  The American Journal of Gastroenterology ,   Clinical and Translational Gastroenterology  and  The ACG Case Reports Journal . More than 20,000 physicians from 86 countries are members of the ACG.  The ACG provides its members with scientific information on  digestive health  and the  etiology ,  symptomatology  and treatment of  GI disorders . [ citation needed ]


The current president (2024–25) is Amy S. Oxentenko, MD, FACG. [ 2 ]


The  American Gastroenterological Association  ( AGA ) is a  medical association  of  gastroenterologists . Approximately 16,000  scientists  and  physicians  are members of the organization.


The American Gastroenterological Association is a professional association for gastroenterologists. The AGA was founded in 1897 and has grown to include 16,000 members worldwide who are involved in all aspects of the science, practice, and advancement of  gastroenterology . [ 1 ]  The AGA Institute administers the practice, research and educational programs of the organization. [ citation needed ]


The AGA, a  501(c)(6)  organization, administers all membership and public policy activities, while the AGA Institute, a  501(c)(3)  organization, runs the organization's practice, research, and educational programs. [ citation needed ]


On a monthly basis, the AGA Institute publishes two journals,  Gastroenterology  and  Clinical Gastroenterology and Hepatology . [ citation needed ]


The organization's annual meeting is Digestive Disease Week, which is held each May and is the largest international gathering of physicians, researchers and academics in the fields of  Gastroenterology ,  Hepatology ,  Endoscopy  and  Gastrointestinal surgery . [ citation needed ]


The  AGA Research Foundation provides digestive disease research grants on behalf of the AGA Institute [ citation needed ]


The American Society for Gastrointestinal Endoscopy  ( ASGE ) is a  professional organization  of  physicians  dedicated to improving  endoscopy . The ASGE is made up largely of  gastroenterologists  from the  United States . Included in its membership are endoscopists from other medical specialties as well as from other countries. ASGE publishes the  medical journal   Gastrointestinal Endoscopy .


"The core purpose of the American Society for Gastrointestinal Endoscopy is to be the leader in advancing and promoting excellence in gastrointestinal endoscopy." [ 2 ]


American Society for Gastrointestinal Endoscopy was founded on December 30, 1941. [ 3 ] [ 4 ]  Established as the American Gastroscopic Society, the organization changed its name in 1961 to the "American Society for Gastrointestinal Endoscopy." [ 5 ]  As of 2017, the budget for ASGE was about $17.8 million. [ 1 ]


American Society for Gastrointestinal Endoscopy sponsors grants for research in gastroenterology and endoscopy. [ 6 ]


The  British Society of Gastroenterology  ( BSG ) is a British professional organisation of  gastroenterologists , surgeons, pathologists, radiologists, scientists, nurses, dietitians and others amongst its members, which number over 4,000. It was founded in 1937, [ 1 ]  and is a registered charity. Its offices are in  Regent's Park ,  London . [ 2 ]


The society is  an organisation focused on the promotion of gastroenterology within the United Kingdom . [ 3 ]  It is involved with the training of gastroenterologists in the  United Kingdom , and with  original research  into gastroenterology. The society also produces information for patients with gastrointestinal diseases. [ 4 ]


The society publishes the  medical journals   Gut ,  BMJ Open Gastroenterology  and  Frontline Gastroenterology . [ 5 ] [ 6 ] [ 7 ]


It produces  clinical practice guidelines  and various other documents relevant to the field of gastroenterology including diseases of the  gastrointestinal tract ,  liver ,  pancreas  and  biliary tract , and the disciplines of gastrointestinal  endoscopy ,  nutrition ,  pathology  and  gastrointestinal surgery . [ 8 ] [ 9 ] [ 10 ] [ 11 ] [ 12 ] [ 13 ]


The society holds an Annual General Meeting during which original research, updates and reviews in gastroenterology and hepatology are presented.  Named lectures include the Sir  Arthur Hurst  lecture and the Sir  Francis Avery Jones  BSG Research medallist.


Recent presidents have been  Hermon Dowling  (1996–1997),  Chris Hawkey  (2010),  Jon Rhodes  (2011–12),  Ian Gilmore  (2013–14),  Ian Forgacs  (2014–16),  Martin Lombard  (2016–18),  Cathryn Edwards  (2018–20), Alastair McKinlay (2020-22), and Andy Veitch (2022-24).  The current president is Professor Colin Rees. [ 14 ]


The British Society of Gastroenterology is a National Society Member of the  United European Gastroenterology .


51°31′30.76″N   0°8′42.45″W  /  51.5252111°N 0.1451250°W  /  51.5252111; -0.1451250


The Canadian Association of Gastroenterology  (CAG) was founded in 1962 to promote the  study  of the  digestive tract  in  health  and disease, including  liver disease . The Association is built on broad principles and includes individuals of different disciplines ( physicians ,  surgeons ,  paediatricians ,  radiologists ,  basic scientists ). Today, the Association comprises more than 1,100 members. CAG members are actively involved in research, education and patient care in all areas of digestive health and disease, contributing to the  economic  and social health of all Canadians.  The  Canadian Digestive Health Foundation  is the  foundation  of the CAG.


The  Journal of the Canadian Association of Gastroenterology  is a  peer-reviewed   medical journal  dealing with topics in  gastroenterology  and in  liver disease . It was established in 2018 as the official journal of the Canadian Association of Gastroenterology. [ 1 ]  The journal is published by  Oxford University Press . The  editor-in-chief  is Eric Benchimol ( University of Toronto ). [ 2 ]


Crohn's & Colitis UK  (formerly  NACC ) is a UK  charity  dedicated to  Crohn's disease ,  ulcerative colitis , and other forms of  inflammatory bowel disease  (IBD). It was founded in 1979 as the  National Association for Colitis and Crohn's Disease .


Crohn's & Colitis UK brings together people of all ages who have Crohn's or colitis, their families, and the health professionals involved in their care. These two illnesses are both forms of  Iinflammatory bowel disease  (IBD) and they affect over 500,000 people in the UK.


Crohn's & Colitis UK provides information and support to enable people to manage their conditions. They work with the UK health sector to improve diagnosis, treatment and management of IBD. They fund  research  to increase knowledge of the causes and the best treatments for Crohn's and colitis, and they campaign for greater awareness, better services and more support for Crohn's and colitis patients.


This article about a UK medical organisation, hospital, or association is a  stub . You can help Wikipedia by  expanding it .


Guts UK , formerly known as the  Digestive Disorders Foundation , is a British medical  research   charity  dedicated to the research of  digestive disorders . [ 1 ] [ 2 ]


In 1970, the Council of the  British Society of Gastroenterology  first considered founding a charity to promote research in this speciality. A steering group, chaired by their President at the time, Dr Nelson Coghill, compiled facts and figures which established the importance of digestive disorders as a national health problem. Using this evidence as a basis for appeal, a Digestive Disorders Trust Fund was established.


Dr Thomas Hunt, a founder member of the British Society of Gastroenterology, agreed to launch the new charity. [ 3 ]  He succeeded in attracting prominent lay and professional support. By 1974 its funds were sufficient to award the first research fellowship and to inaugurate the charity as a Foundation with Hunt as its first President. On his death in 1980, Sir Francis Avery Jones took over the presidency for the next 12 years. Important landmarks during this time were the appointment of the first full-time director, expansion of research support and the development of the successful patient information programme.


This article about a charitable organisation in the United Kingdom is a  stub . You can help Wikipedia by  expanding it .


The  United European Gastroenterology  ( UEG ) is a  non-profit organisation  combining European societies concerned with  digestive health .


Founded in 1992 United European Gastroenterology (UEG) is the leading non-profit organisation for excellence in digestive health in  Europe  and beyond with its headquarters in Vienna.


We improve the prevention and care of digestive diseases in Europe through providing top tier education, supporting research and advancing clinical standards. As Europe’s home and umbrella for multidisciplinary  gastroenterology , we unite over 50,000 engaged professionals from national and specialist societies, individual digestive health experts and related scientists from all fields and career stages.


UEG unites 17 Specialist Member Societies and 50 National Societies working in the broad area of digestive health, constantly adapting to the changing requirements of scientific research and health care.


Following our mission and a dedicated  strategic plan , the overall leadership and strategic direction of UEG rests with the Council. The committees and task forces enable interested volunteers to play an active role in shaping current and future UEG initiatives and form the operating body of the organisation.


Member Societies are represented in the Meeting of Members that elects or appoints UEG Council members. Each Specialist Member Society has the opportunity to send one representative to UEG’s committees.


All officers of UEG, regardless of position, provide their effort and time on a complete voluntary basis, and therefore make UEG a non-profit organisation concerned solely with the well-being of patients.


UEG is a Regional Affiliate Association of the  World Gastroenterology Organisation . UEG is a member of the  European Medicines Agency , the Biomedical Alliance in Europe, the AC Forum, the Optimal Nutritional Care for All, and Pancreatic Cancer Europe.


Presidents  of UEG:


The House of European Gastroenterology (HEG) is UEG's home and offers a meeting point and communication hub to the European gastroenterological community. The HEG is situated in the heart of  Vienna , near the  Rathaus  (City Hall) in a 19th-century building.


UEG Week [ 8 ]  is the largest congress  of its kind in  Europe  and is held once a year. It has been running since 1992 and now attracts more than 10,000 people from around the world. It features the latest advances in clinical management and  research in the field of digestive health. A two-day Postgraduate Teaching Programme is also held on occasion of UEG Week. The programme provides continuing medical education for  gastroenterologists  in training and practice.


UEG provides educational online and face-to-face courses, a podcast and webinars in the field of digestive health.


Additionally  Gutflix , UEG's interactive and personalised GI learning platform, provides all educational content in one place. Gutflix includes UEG Week recordings, online courses, clinical practice guidelines, webinars, "Mistakes in..." articles, podcasts, webinars and more.


UEG aims to act as a united voice of European  gastroenterology  in the  Institutions of the European Union  and the  governments  of the member states in order to promote digestive health in  Europe . [ 9 ]


UEG offers fellowships, awards and grants in the following fields and categories: Fellowships and awards for researchers under the age of 40, a prize for researchers having achieved the highest level of international recognition, an award honouring outstanding contributions to digestive health and UEG, national as well as international scholarship awards, prizes for best abstracts, an award to recognise the first named author of the best original scientific research published in UEG Journal and travel grants. [ 10 ]


Focuses on providing coverage of both translational as well as clinical studies from different fields of gastroenterology. The latest impact factor ranking indicates that the UEG Journal has already established itself as an authoritative, high quality and trusted journal in the field. [ 11 ]


UEG's latest pan-European study on digestive health where the burden of digestive diseases and associated research gaps are highlighted. [ 12 ]


The  World Gastroenterology Organisation  ( WGO ) is an international federation of over 100 national GI societies and 4 regional associations of gastroenterology representing over 50,000 individual members.


WGO is focused on "the improvement of standards in gastroenterology training and education on a global scale." [ 1 ]


The association was founded in 1935 and incorporated in 1958.  The WGO was originally known as the Organisation Mondiale de Gastroenterologie (OMGE) and was renamed the World Gastroenterology Organisation in 2006. [ 2 ]


Its activities include educational initiatives such as  Training Centers ,  Train the Trainers Workshops , public awareness campaigns such as  World Digestive Health Day [ 3 ]  and  Global Guidelines  which cascade, providing viable solutions which are adaptable to varying resource levels around the world, as well as a quadrennial World Congress of Gastroenterology.


The WGO Foundation was incorporated in 2007 and is dedicated to raising funds to support the ongoing WGO education initiatives and activities.


Georges Brohée (1887–1957), a Belgian surgeon who promoted modern gastroenterology, is largely responsible for the origin of the WGO, in particular by founding the Belgian Society of Gastroenterology in 1928 and by organizing the first International Congress of Gastroenterology in Brussels in 1935.  In May 1958 the first World Congress of Gastroenterology was held in Washington DC, where Georges Brohée’s continuing efforts culminated in the constitution of the "Organisation Mondiale de Gastro-entérologie" (OMGE) on May 29, 1958.


Dr H.L. Bockus was the organisation’s first President.  His vision was to enhance standards of education and training in gastroenterology.


Developed nations  were the initial focus of the organization, however today the WGO embraces a global approach with a special emphasis on  developing regions [ 4 ]


General management of the WGO is conducted by a Governing Council.  Acting through the Governing Council, the organisation is empowered to undertake those activities necessary to fulfill the goals and mission of the WGO.


The Executive Committee oversees various program and consists of  the President, Vice President, Past President, Secretary General, and Treasurer.


A General Assembly reviews and approves the work of the Governing Council and attends to other business (including the World Congress venue).  The General Assembly is composed of representatives from all WGO Member Societies and regional associations.  Each WGO Member Society has one vote in the General Assembly. [ 5 ]


WGO has a number of committees including: [ 6 ]


The elections and renewal of the WGO officers and committees takes place on the occasion of the General Assembly, which is held during the quadrennial World Congress of Gastroenterology. [ 5 ]


There are currently 20 WGO Training Centers: [ 7 ]


Each guideline is translated into six languages including English, French, Spanish, Portuguese, Russian and Mandarin Chinese.


Guidelines with cascades:


Guidelines with cascades in development:


The WGO celebrates World Digestive Health Day (WDHD) every May 29, initiating a worldwide public health campaign through its national societies and 50,000 individual members.  Each year, WDHD focuses upon a particular digestive disorder and seeks to increase general public awareness of prevention and therapy.  WDHD themes have included: [ 8 ]


In 2008, the WGO, together with Danone, launched a global campaign to improve digestive health, titled " Optimum Health and Nutrition ."  The campaign is part of a three-year partnership between WGO and Danone to " help raise awareness of digestive disorders and the importance of maintaining good digestive health ." [ 3 ]


The WGO Foundation  was established in 2007 to raise financial support to develop and sustain the World  Gastroenterology  Organisation's global training and education programs.  These programs focus primarily on developing, low-resource countries and aim to meet the increasing demand for digestive disorder prevention and treatment worldwide. [ 1 ]


To raise financial support to develop and sustain WGO's global training and education programs, especially in developing and low-resource countries. [ 9 ]


The WGO Foundation has fund raising activities including Initiating fund raising campaigns:


Colorectal surgery  is a field in medicine dealing with disorders of the  rectum ,  anus , and  colon . [ 1 ]  The field is also known as  proctology , but this term is now used infrequently within medicine and is most often employed to identify practices relating to the anus and rectum in particular. [ clarification needed ]  The word  proctology  is derived from the  Greek  words  πρωκτός   proktos , meaning "anus" or "hindparts", and  -λογία   -logia , meaning "science" or "study".


Physicians specializing in this field of medicine are called colorectal surgeons or proctologists. In the United States, to become colorectal surgeons, surgical doctors have to complete a general surgery residency as well as a colorectal surgery fellowship, upon which they are eligible to be certified in their field of expertise by the  American Board of Colon and Rectal Surgery  or the  American Osteopathic Board of Proctology . In other countries,  certification  to practice proctology is given to surgeons at the end of a 2–3 year subspecialty  residency  by the country's board of surgery.


Colorectal surgical disorders include: [ 2 ]


Surgical forms of treatment for these conditions include:  colectomy , ileo/colostomy,  polypectomy ,  strictureplasty , hemorrhoidectomy (in severe cases of  hemorrhoids ), minimally invasive surgery, anoplasty, and more depending on the condition the patient has. Diagnostic procedures, such as a  colonoscopy , are very important in colorectal surgery, as they can tell the physician what type of diagnosis should be given and what procedure should be done to correct the condition. Other diagnostic procedures used by colorectal surgeons include:  proctoscopy ,  defecating proctography ,  sigmoidoscopy .   In recent times, the  laparoscopic  method of surgery has seen a surge of popularity, due to its lower risks, decreased recovery time, and smaller, more precise incisions achieved by using laparoscopic instruments. [ 3 ]


Mechanical bowel preparation (MBP) is a procedure lacking evidence in literature, [ 4 ]  wherein fecal matter is expelled from the bowel lumen prior to surgery, most commonly by using  sodium phosphate . [ 5 ]


Shafi Ahmed  is a chief surgeon, teacher,  futurist , innovator, professor and entrepreneur. [ 1 ]


Ahmed lives in London. He is married to Farzana Hussain, a  general practitioner , with whom he has two children. [ 2 ]


He was born on 26 January 1969 in  Sylhet District ,  East Pakistan  (now  Bangladesh ), and came to the United Kingdom as a child. [ 3 ]


Ahmed attended Chadwell Heath High School (now  Chadwell Heath Academy ) before attending the Redbridge technical college.


From 1988 to 1993, he studied medicine at  King's College Hospital  School of Medicine. As the elected President of the Medical and Dental Society, he helped introduce medical ethics into the curriculum.


During his surgical training in London, he undertook a period of research at The  Royal London Hospital  and the  Queen Mary University of London . In 2010, he obtained a PhD with a thesis entitled "The role of microarray profiling in predicting outcome in patients with colorectal cancer". [ 4 ]


Ahmed has been awarded four honorary PhDs (Honoris Causa) from Udabol University Bolivia, SIISDET Colombia, the University of Peru of Science and Informatics and EXIBED, Spain. [ citation needed ]


In 2017, he was appointed as an honorary professor at The  University of Bradford  and awarded an Honorary Doctorate of Medicine in 2019. [ 5 ]


In 2020 he was awarded the Spinoza Honorary professorship at the  University of Amsterdam . [ 6 ] [ non-primary source needed ]


Ahmed is a specialist advisor to the Abu Dhabi Ministry of Health to help deliver innovation and  digital health . [ 7 ]


Ahmed works in the Academic Centre of Surgery and has established  minimally invasive   colorectal surgery  at the  Royal London Hospital ,  Barts Health NHS Trust . [ 8 ]


His main clinical interest is  colorectal cancer , and he performs surgery for primary and recurrent disease as well as multi-visceral resections.


He has pioneered single incision  laparoscopic  colorectal surgery (virtual scarless surgery) and also works with liver surgeons to perform simultaneous laparoscopic liver and  bowel resections  for cancer. His other clinical interest is advanced stage 3/4  endometriosis , performing laparoscopic surgery with  gynaecologists . This has led to the development and recognition of a national centre for endometriosis. In addition, he has specialist experience in complex abdominal wall  hernias  and reconstruction. [ 3 ]


From 2010 to 2015, Ahmed was the lead clinician and multi-disciplinary team lead for colorectal cancer at Barts Health NHS Trust. He was also a CQC specialist advisor in general surgery. [ citation needed ]


Ahmed was the Associate Dean for Barts and the London undergraduate medical students at  The Royal London Hospital  from 2010 to 2019 and was the lead for surgery. He was programme director for core surgical trainees for North East London 2012–2013 and Tutor in Surgery for the Royal London Hospital 2011–2013. He teaches innovation and digital transformation for surgeons at  Harvard Medical School  and  Imperial College London . [ 9 ]


He is the civilian advisor for the  British Armed forces  for general surgery. [ citation needed ]


From 2013 to 2019, Ahmed was elected to the council of the  Royal College of Surgeons of England . [ 10 ]  He had numerous roles and led the International Surgical Training Programme. He was part of the Cancer 2020, 5 Year Forward View Taskforce 2015. [ 11 ]  He is a member of the court of examiners and is an international convenor of the MRCS for Bangladesh. [ 12 ]


In 2007, Ahmed was appointed as a Consultant General, Laparoscopic and Colorectal surgeon to  The Royal London Hospital  and  St Bartholomew's Hospital ,  Barts Health NHS Trust .


He was chosen to curate the  NHS  Twitter account from 27 February 2017 to 3 March 2017 and tweeted the world's first live operation via this account.


He was the clinical lead for surgery at the  NHS Nightingale  Hospital at Excel London during the COVID-19 pandemic in 2020.


Ahmed performed a live cancer operation at  The Royal London Hospital  on Channel 5 for the series  Operation Live  in 2018.


Ahmed is the module lead for an innovative new course at Barts and the London Medical School which aims to teach the third year medical students about future medicine and how to generate ideas to improve clinical care. [ 13 ] [ 1 ]  The students are taught by  digital health  innovators and those involved in Medtech from the UK and US.


Ahmed has been working on new technologies to enhance surgical education globally. His online videos have been watched hundreds of thousands of times, earning him the accolade of the most-watched surgeon in human history. [ 14 ]


He aims to teach surgery and surgical processes to thousands of students at a time using VR technology. [ 15 ]


Ahmed's company Virtual Medics developed the use of  wearable technology  in education and clinical practice. This has allowed the development of a web-placed platform to stream live and interactive teaching.


In May 2014, using  Google Glass , he performed and streamed a live operation to 14 thousand students across 132 countries and 1100 cities. [ 16 ]


Ahmed is the co-founder of Medical Realities, a group offering surgical training products, specialising in virtual reality, augmented reality and  serious games . [ 17 ]  Through Medical Realities, he aims to provide tutorials in a modular format to teaching hospitals around the world. This will be made accessible to students and surgical trainees.


On 14 April 2016, in collaboration with  Barts Health , Medical Realities and Mativision, he performed the world's first virtual reality operation recorded and streamed live in  360 degrees . [ 8 ] [ 17 ] [ 18 ] [ 19 ]  This was viewed by 55,000 people in 140 countries and 4000 cities and reached 4.6 million people on Twitter.


This event was covered worldwide on over 400 newspaper/online articles and  BBC Click , Sky News, ARD German, TRT News, South American NTN,  ABC News ,  Aljazeera , and Press TV. [ 20 ] [ 21 ] [ 22 ] [ 23 ]  His work has been featured on  Wired ,  The Guardian ,  The Telegraph , ABC News,  CNET ,  The Verge ,  Huffington Post , and Tech China. [ 24 ] [ 25 ] [ 26 ] [ 27 ] [ 16 ] [ 28 ] [ 29 ] [ 30 ]


On 9 December 2016, he performed the world's first live operation using Snapchat Spectacles where he trained 200 medical students and surgical trainees, which was covered by  Time  magazine, and  BBC . [ 31 ] [ 32 ] [ 33 ]  The operation has been viewed over 100,000 times. [ 34 ]


He is a non-executive director of Medic creations, GPDQ and Imera. [ 35 ]


He is the chair of the GIANT (Global Innovation and New Technologies) Health Event in London and also the chair of the Webit Health conference in Sofia, Bulgaria, which showcases startups, innovation, technology and entrepreneurship. [ 36 ] [ 37 ]


Ahmed is a three time  TEDx  speaker and four times Wired Health and international  keynote speaker , and a member of the faculty at Exponential Medicine,  Singularity University .


On 15 March 2017, Ahmed delivered the Cantor Technology Lecture at the  University of Bradford  and also delivered the public lecture to open the Digital Health Enterprise Zone. [ 47 ]


He is Vice-President of Proshanti, a local charity community project to set up a health programme in Bangladesh, He is an advisor to Beani Bazaar Cancer Hospital, Bangladesh. [ 48 ]  He also teaches and trains surgeons in Dhaka, Bangladesh where he is the Dean for education at Rahetid, a postgraduate surgical training centre. [ 49 ]


The  American Board of Colon and Rectal Surgery  ( ABCRS ) is a member of the  American Board of Medical Specialties  that issues certificates for practitioners of  Colorectal surgery .


The board was established in 1934 as the American Board of Proctology. [ 1 ]


The  American Osteopathic Board of Proctology  ( AOBPR ) is an organization that provides  board certification  to qualified  Doctors of Osteopathic Medicine  (D.O.) who specialize in the medical and surgical treatment of disorders of the  anus ,  colon , and  rectum  of the  gastrointestinal tract  ( proctologists ). The board is one of 18  medical specialty  certifying boards of the  American Osteopathic Association Bureau of Osteopathic Specialists  approved by the  American Osteopathic Association  (AOA), [ 3 ]  and was established in 1941. [ 1 ]  As of April 2011, there were 25 osteopathic proctologists certified by the AOBPR. [ 4 ]


To become board certified in proctology, candidates must have completed an AOA-approved  residency  in proctology and one year of practice as a licensed proctologist. [ 5 ]   Additionally, candidates must have successfully completed the required oral and written examinations. Since 2004, board certified osteopathic proctologists must renew their certification every ten years to avoid expiration of their board certified status. [ 6 ]  Physicians certified by the AOBPR are known as fellows of the American Osteopathic College of Proctology.


Anal dysplasia  is a pre-cancerous condition which occurs when the lining of the  anal canal  undergoes abnormal changes. It can be classified as  low grade squamous intraepithelial lesions  (LSIL) and high-grade squamous intraepithelial lesions (HSIL). [ 1 ]
Most cases are not associated with symptoms, but people may notice lumps in and around the  anus . [ 2 ]


Anal dysplasia is most commonly linked to  human papillomavirus  (HPV), a usually  sexually-transmitted infection . [ 3 ]  HPV is the most common  sexually transmitted infection  in the United States [ 4 ]  while  genital herpes  ( HSV ) was the most common sexually transmitted infection globally. [ 5 ]


This  oncology  article is a  stub . You can help Wikipedia by  expanding it .


Anal fistula  is a chronic  abnormal communication  between the  anal canal  and the perianal skin. [ 1 ]  An anal fistula can be described as a narrow tunnel with its internal opening in the anal canal and its external opening in the skin near the anus. [ 2 ]  Anal fistulae commonly occur in people with a history of  anal abscesses . They can form when anal abscesses do not heal properly. [ 3 ]


Anal fistulae originate from the  anal glands , which are located between the  internal  and  external anal sphincter  and drain into the  anal canal . [ 4 ]  If the outlet of these glands becomes blocked, an  abscess  can form which can eventually extend to the skin surface. The tract formed by this process is a fistula. [ 5 ]


Abscesses can recur if the fistula seals over, allowing the accumulation of  pus . It can then extend to the surface again – repeating the process. [ 5 ]


Anal fistulae  per se  do not generally harm, but can be very painful, and can be irritating because of the drainage of pus (it is also possible for formed stools to be passed through the fistula). Additionally, recurrent abscesses may lead to significant short term morbidity from pain and, importantly, create a starting point for systemic infection. [ 5 ]


Treatment, in the form of surgery, is considered essential to allow drainage and prevent infection. Repair of the fistula itself is considered an elective procedure which many patients opt for due to the discomfort and inconvenience associated with an actively draining fistula. [ 5 ] [ 3 ]


Anal fistulae can present with the following symptoms: [ 4 ]


Diagnosis is by examination, either in an  outpatient  setting or under  anaesthesia  (referred to as  EUA  or Examination Under Anaesthesia). The fistula may be explored by using a fistula probe (a narrow instrument). In this way, it may be possible to find both openings. The examination can be an  anoscopy . Diagnosis may be aided by performing a fistulogram, proctoscopy and/or sigmoidoscopy.
Possible findings:


Depending on their relationship with the  internal  and  external sphincter  muscles, fistulae are classified into five types:


Other conditions in which infected perianal "holes" or openings may include  pilonidal cyst .


There are several stages to treating an anal fistula:


Definitive treatment of a fistula aims to stop it recurring.  Treatment depends on where the fistula lies, and which parts of the  internal  and  external anal sphincters  it crosses. However, treatment is challenging as complete eradication of the anal sphincters may lead to continence impairment, but failure to excise the affected areas results in recurrence. Those already treated for recurring anal fistula are at higher risk to experience re-recurrence of the disease.  [1]


The VAAFT procedure is done in two phases, diagnostic and operative. Before the procedure, the patient is given a spinal or general anaesthetic and is placed in the lithotomy position (legs in stirrups with the perineum at the edge of the table).  In the diagnostic phase, the fistuloscope is inserted into the fistula to locate the internal opening in the anus and to identify any secondary tracts or abscess cavities. The anal canal is held open using a speculum and irrigation solution is used to give a clear view of the fistula tract. Light from the fistuloscope can be seen from inside the anal canal at the location of the internal opening of the fistula, which helps to locate the internal opening.  In the operative phase of the procedure, the fistula tract is cleaned and the internal opening of the fistula is sealed. To do this, the surgeon uses the unipolar electrode, under video guidance, to cauterise material in the fistula tract. Necrotic material is removed at the same time using the fistula brush and forceps, as well as by continuous irrigation. The surgeon then closes the internal opening from inside the anal canal using stitches and staples.


Some people will have an active  infection  when they present with a fistula, and this requires clearing up before definitive treatment can be decided.


Antibiotics  can be used as with other infections, but the best way of healing infection is to prevent the buildup of pus in the fistula, which leads to abscess formation.  This can be done with a  seton .


A literature review published in 2018 showed an incidence as high as 21 people per 100,000. "Anal fistulas are 2–6 times more prevalent in males than females, with the condition occurring most frequently in patients in their 30s and 40s." [ 20 ]


Anal stricture  or  anal stenosis  is a narrowing of the anal canal. [ 1 ]  It can be caused by a number of surgical procedures including:  hemorrhoid  removal and following  anorectal wart  treatment. [ 2 ]


Anorectal anomalies  are congenital malformations of the  anus  and  rectum . [ 1 ]  One anal anomaly,  imperforate anus  has an estimated incidence of 1 in 5000 births. [ 2 ] [ 3 ]  It affects boys and girls with similar frequency. [ 4 ]


Examples of anorectal anomalies include: [ citation needed ]


Anorectal manometry  ( ARM ) is a  medical test  used to measure  pressures  in the  anus  and  rectum  and to assess their function. [ 1 ] [ 2 ]  The test is performed by inserting a  catheter , that contains a probe embedded with pressure sensors, through the anus and into the rectum. [ 3 ]  Patients may be asked to perform certain maneuvers, such as coughing or attempting to  defecate , to assess for pressure changes. [ 3 ]  Anorectal manometry is a safe [ 4 ]  and low risk [ 3 ]  procedure.


From 2014 to 2018, the international anorectal physiology working group (IAPWG) meet several times to develop consensus on  indications  for anorectal manometry. [ 5 ]  Their assessment concluded that anorectal manometry was indicated when used in assessment of  fecal incontinence ,  constipation , evacuation disorders (including  Hirschsprung's disease [ 6 ] ), functional anorectal pain and in the assessment of anorectal function  preoperatively  or after a traumatic  obstetric  injury. [ 5 ]  In addition to the indications outlined by the IAPWG, anorectal manometry has been used as a component of anorectal  biofeedback . [ 6 ]


Since its introduction in 2007,  high resolution  anorectal manometry (HR-ARM) has increasingly replaced conventional anorectal manometry as the standard. [ 7 ]  There has been increasing usage of high-definition (3D) anorectal manometry (HD-ARM) as well. [ 7 ]  Current advances in anorectal manometry include the development of  bedside  portable technology. [ 7 ]


After eliminating structural causes of  fecal incontinence  from the  differential diagnosis , anorectal manometry may be used to evaluate deficiencies in  sphincter  function or anorectal sensation. [ 4 ] [ 7 ]  An abnormal resting pressure or squeeze pressure may indicate problems with either the  internal anal sphincter  or the  external anal sphincter  respectively. [ 4 ]  Both increased and decreased anorectal sensation has also been detected in individuals with fecal incontinence. [ 6 ]  The use of HD-ARM can allow recognition of pressure asymmetry within the anorectum. [ 4 ]  Some patients with fecal incontinence benefit from muscle strength training which may make use of anorectal biofeedback. [ 6 ]


Anorectal manometry can be used in the diagnostic workup of individuals with  chronic constipation  without a known cause [ 8 ]  or with chronic constipation that has not improved on a trial of  laxatives  and/or  fiber . [ 9 ]  For example, on a  digital rectal exam , a physician may notice specific findings that point to  dyssynergic defecation , a cause of chronic constipation. [ 8 ]  In such instances, the physician may order an anorectal manometry study to verify their findings. [ 8 ]  Abnormal results, such as the presence of a  paradoxical  contraction of the anal sphincter muscles during  defecation  (i.e. the muscles are squeezing instead of relaxing), can also be used to guide treatment (e.g. anorectal  biofeedback ). [ 4 ] [ 8 ]  Other abnormal findings on manometry consistent with chronic constipation include an unsatisfactory generation of the propulsive  force  needed to defecate and a decreased movement of  pelvic floor  muscles. [ 4 ]


Anorectal manometry, especially HR-ARM and HD-ARM, has also been used to evaluate constipation due to structural causes such as a  rectocele , [ 2 ]  an  enterocele , or an intra-anal  intussusception . [ 4 ]


In infants and children, anorectal manometry may be used to assist in the diagnosis of  Hirschsprung's disease . [ 2 ]  The absence of the  rectoanal inhibitory reflex  (RAIR) is almost always  pathognomonic  for Hirschsprung's disease in this population. [ 6 ]  Anorectal manometry is not significantly less  sensitive and specific  when compared to the  gold standard  method of diagnosis, rectal suction  biopsy . [ 6 ]  In adults, the absence of the RAIR is less likely due to Hirschsprung's disease and may indicate the presence of  megarectum . [ 6 ] [ 7 ]


Functional anorectal pain includes disorders such as  levator ani syndrome ,  proctalgia fugax  and unspecified functional anorectal syndrome. [ 4 ]  Although diagnosis of these disorders is largely clinical, anorectal manometry may be used for further diagnostic assessment. [ 4 ]  For example, the degree of anal sphincter hypertension may be determined [ 7 ]  which may be useful information when treating functional anorectal pain with biofeedback therapy. [ 4 ]


The goal of anorectal  biofeedback  is to help patients improve  defecating  behaviors by providing patients with visual and verbal feedback. [ 10 ]  Visual feedback tools, such as anorectal manometry, are often used to aid patients in learning how to modify their behaviors. [ 10 ]  Patients may work on improving muscle strength, muscle relaxation or sensation during defecation. [ 8 ]


The effectiveness of anorectal biofeedback as a treatment remains an ongoing source of debate and research. A systemic review article [ 11 ]  concluded that although better than  placebo , there remained limited evidence demonstrating the effectiveness of anorectal biofeedback for chronic  idiopathic  constipation. [ 8 ]  In patients with  defecatory  disorders, including  dyssynergic defecation ,  pelvic floor  biofeedback therapy had been shown to be more effective than laxatives. [ 6 ] [ 9 ]  An American-European  Neurogastroenterology & Motility  task force (ANMS-ESNM) recommended the use of biofeedback in the short and long treatment of constipation with dyssynergic defecation and fecal incontinence. [ 10 ]  They did not recommend biofeedback treatment for constipation without dyssynergic defecation, nor in children with constipation. [ 10 ]


Types of anorectal manometry include:


HR-ARM and HD-ARM are newer methods that use multiple closely spaced sensors in the anus and rectum, compared to 3-6 widely spaced sensors used by non-HRM, to generate a more refined view. [ 3 ] [ 6 ]  An additional benefit to HR-ARM and HD-ARM is the increased ease in analyzing the results as pressure readings are displayed in both color and as a line plot. [ 3 ]  Accompanying the benefits shared by both high-resolution and high-definition methods, the HD-ARM method employs additional sensors placed circumferentially around the catheter allowing for closer interpretation of individual sensor pressure readings. [ 3 ]  In comparison to non-HRM, however, both of the newer methods utilize equipment that is more expensive and has a shorter  design life . [ 3 ]


The specifics of the equipment used for the procedure will ultimately depend on the type of manometry and the manufacturer of the device. Nonetheless, most share some common features: [ 3 ]


In 2019, the International Anorectal Physiology Working Group (IAPWG) released a standardized testing protocol for the use of anorectal manometry. [ 5 ]  One of the goals of this protocol was to standardize procedural techniques to better facilitate meaningful data sharing. [ 5 ]  This protocol is the most recent published guideline for anorectal manometry since the one published in 2002 [ 12 ]  which was not widely adopted. [ 7 ]


Fasting  is not a requirement for this procedure. [ 5 ]  Patients are  informed  as to how the procedure is performed, its benefits and risks. Risks include the possibility of developing discomfort, pain, minor bleeding, dizziness or a rare  perforation . [ 3 ] [ 13 ]  In the testing room, the patient is placed on their left side with their knees bent. [ 5 ]  A  digital rectal exam  is then performed prior to the procedure to evaluate initial anatomy and function, check for stool, and to assess patient's understanding of the verbal instructions employed during the procedure. [ 5 ]


Anorectal manometry is often performed alongside a rectal sensory test (RST) and a balloon expulsion test (BET). [ 5 ]  The RST is performed after the manometry while the BET may be performed immediately prior to the manometry or subsequent to the RST. [ 5 ]  The total time to conduct all three tests is 15 to 20 minutes. [ 5 ]


This test takes approximately 10 minutes. [ 5 ]  With the use of a lubricant, an anorectal manometry catheter is introduced into the anus. [ 5 ]  The catheter is advanced until the base of the balloon is above the  anal canal  by 3–5 cm (1.2–2.0 in) and the most  distal  sensor is below the  anal verge . [ 5 ]  In order, the following maneuvers are then performed:


During the rectal sensory test, air is placed into the catheter balloon and slowly inflated either continuously or step-wise. [ 5 ]  The patient is asked to verbalize when they first sense the balloon, when the urge to defecate is first present and when they can no longer tolerate the balloon. [ 5 ]