Overt Hepatic Encephalopathy (OHE)

HE is a brain dysfunction caused by liver insufficiency and/or portal systemic shunting.¹

Because a damaged liver cannot function normally (as in cirrhosis), toxins from the gut can enter the bloodstream and travel to the brain, where they affect neurotransmission. This can cause episodes of HE, which may present as alterations in consciousness, cognition, and behavior that range from minimal to severe.^1-3

Overt HE occurs in 30% to 40% of patients with cirrhosis at some point during the clinical course of their disease.¹ As the burden of chronic liver disease and cirrhosis is increasing, the frequency of HE is also increasing.^4,5

Irritable Bowel Syndrome With Diarrhea (IBS-D)

IBS-D is a common disorder of the of the lower gastrointestinal (GI) tract.⁶ Up to 6 million British Citizens suffer from IBS-D.⁷ The symptoms of IBS-D can happen on a regular basis and vary widely, but often include abdominal pain and diarrhea.⁸

The cause of IBS-D is unknown, but may result from a disturbance in the way the gut, brain, and nervous system interact.⁸

Irritable Bowel Syndrome With Constipation (IBS-C), Chronic Idiopathic Constipation (CIC)

Constipation is something that everyone has likely experienced at one time or another. Two types of long term constipation are Chronic Idiopathic Constipation (CIC) and Irritable Bowel Syndrome with Constipation (IBS-C).⁹

The exact cause of these conditions is not known but may result from how the brain and the intestines communicate or changes in bacteria in the gut, among other factors.

Opioid-induced Constipation (OIC)

Constipation may be defined as having less than 3 bowel movements per week, plus one or more of the following characteristics: hard stools, the need for excessive straining, or a sense of incomplete bowel movements.¹⁰

Constipation can also be classified by etiology:

• Primary constipation¹¹
  • Results from intrinsic defects of colonic or anorectal function
  • Considered typically after secondary causes have been ruled out
• Secondary constipation¹¹
  • Caused by pathologic changes, such as disease or intestinal obstruction
  • Caused by medications (iatrogenic), such as opioids

Constipation is a frequent side effect of opioids^12-15

• Opioids are a major class of analgesics often used to relieve pain¹²
• Constipation is one of the most common side effects of the use of opioids in the treatment of chronic pain ^12,14,15

Bowel Preparation

A colonoscopy is one of the most important preventative care measures you can have done to reduce the risk of getting colon cancer. This procedure can help find and allow for the removal of growths (called polyps) before they become cancerous.¹⁶

To get ready for a colonoscopy, a full bowel prep is required. Your doctor will give you specific directions on how to prepare, but generally, all solids must be emptied from the stomach and bowel by following a clear liquid diet for 1-3 days before the procedure and a bowel prep taken.¹⁷

Ulcerative Colitis (UC)¹⁸

UC is a disease that causes inflammation in the colon, which can lead to bleeding, production of pus, diarrhea, and abdominal or stomach discomfort. Over 90,000 British Citizens have UC, and it equally affects men and women.

UC is chronic, with no known cure. It is a type of inflammatory bowel disease (IBD), not to be confused with irritable bowel syndrome (IBS), which does not cause inflammation in the colon.