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Pierre Poitras Editor The Digestive System: From Basic Sciences to Clinical Practice 123 The Digestive System: From Basic Sciences to Clinical Practice Pierre Poitras Editor Marc Bilodeau • Mickael Bouin • Jean-Eric Ghia Co-Editors The Digestive System: From Basic Sciences to Clinical Practice Editor Co-Editors Pierre Poitras Marc Bilodeau Université de Montréal Professor of Medicine Montréal, QC, Canada Université de Montréal Montreal, QC, Canada Mickael Bouin Clinical Professor of Medicine Université de Montréal Montreal, QC, Canada Jean-Eric Ghia Professor of Immunology University of Manitoba Winnipeg, MB, Canada ISBN 978-3-030-98380-2 ISBN 978-3-030-98381-9 (eBook) https://doi.org/10.1007/978-3-030-98381-9 © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022 0th edition: © Les Presses de l’Universite de Montreal 2020 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of reprinting, reuse of illustrations, recita- tion, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland V Preface This book aims to facilitate your learning experience during your undergraduate stud- ies, as well as to guide you later in your clinical practice as a general practitioner or as a physician nonspecialist in digestive diseases. We deliberately chose a direct style, unencumbered by references, hoping to stimulate in you the desire to further explore the scientific literature. As editor, I wanted to offer a personalized version of digestive medicine, as I discov- ered it with outstanding mentors such as Robert Modigliani, Jean- Claude Rambaud, John H. Walsh, Charles Code, Morton Grossman, and Serge Bonfils during my years of training in gastroenterology, and as I evolved within it during 40 years of profes- sional life with my colleague gastroenterologists, GI surgeons, radiologists, and pathologists at Hôpital Saint- Luc in Montreal, all passionate like me about the digestive system. Our approach is to introduce the disease as a dysregulation of the healthy state. Anatomy, histology, and physiology illustrate the normal functioning of the organs, and pathophysiology teaches us the dysregulation process involved. Semiology allows us to build a differential diagnosis from the patient symptoms. Finally, we confirm the diagnosis by various measures of investigation, and we use pharmacology to apply the proper treatment. The amount of bioscientific knowledge is huge and is growing every day. It is impos- sible to assimilate and control, quantitatively or qualitatively, all available data from genetics, molecular biology, etc. Some of these basic discoveries will have an immediate impact on our medical practice, while others will have to wait. This book seeks to link basic sciences and clinical practice. The authors made special efforts to highlight the fundamental notions that impact on current patient care, but, needless to say, this requires continual reassessment. We thank you in advance for sending us your comments and suggestions to improve this work. You can reach us at the following address: [email protected] Pierre Poitras Montreal, QC, Canada VII Acknowledgments This book was made possible thanks to the contribution of many people, who I would like to thank here: Thank you to my teachers and mentors, who taught me to give the best for the care of my patients. Thank you to my colleagues at Hôpital Saint-Luc de Montréal, gastroenterologists, hepatologists, surgeons, radiologists, pathologists, biochemists, and experts in digestive diseases who have been able to create, during all these years, a hospital environment conducive to happy and efficient work. Thank you to the University of Montreal, which has allowed me to have a career that has been as exciting as it has been fruitful. Thank you to all the students that I have met throughout my career and who were a constant stimulus for this profession as a clinician and a teacher. Thank you to all the colleagues who participated in the writing of this book. Thank you to all our readers of previous French editions. Your appreciation and comments have been an inspiration to us. Thank you to all our past and present sponsors who support us in the dissemination of knowledge. Thank you to our publishers, Springer Nature for this English version and Les Presses de l’Université de Montréal for the French editions, for their editorial expertise and support. Finally, special thanks to Monique, an exceptional life companion, psychotherapist, and constant collaborator, who has taught me so much about life and medical human- ism, and who has allowed me to become who I am, personally, socially, and profession- ally. It is to her that I dedicate this book. Pierre Poitras Montreal, QC, Canada IX Introduction This book is organized into two parts. In the first part, the eight main organs of the digestive system are studied, and in the second part, the major clinical symptoms that afflict the digestive system are revised. In the first part, each organ is presented in the same way: the first five sections of a chapter deal with "basic" knowledge of macroscopic and microscopic anatomy, embry- ology, absorption-secretion, and motor-sensory functions; the clinical disorders are then listed in three general sections: inflammation, tumor, and function disorders. In the second part, digestive symptoms are presented in order to facilitate rapid and effective clinical management. To guide your readings, colored boxes are used to highlight important issues: blue for diagnostic key points, orange for therapeutic considerations, green for pediatric aspects, yellow for tropical specificities, and pink for interactions between basic and clinical sciences. Our goal is to make you appreciate the digestive system and thus stimulate your interest and curiosity. Do not hesitate to increase your knowledge by consulting spe- cialized books to answer any questions that may arise in you while reading this book. XI Contents I The Digestive Organs 1 T he Esophagus ..................................................................................................................................... 3 P. Poitras, M. Bouin, C. Faure, J. P. Galmiche, R. Ratelle, and W. G. Paterson 2 T he Stomach .......................................................................................................................................... 31 P. Poitras, M. Bradette, V. Groleau, R. Ratelle, X. Marchand, and D. Armstrong 3 The Small Intestine ........................................................................................................................... 67 P. Poitras, J. Carrier, V. Marchand, A. Serme, G. Soucy, and J. P. Allard 4 T he Colon ................................................................................................................................................. 125 P. Poitras, J. E. Ghia, A. Sawadogo, C. Deslandres, R. Wassef, M. Dapoigny, and C. Bernstein 5 T he Pancreas ......................................................................................................................................... 173 R. G. Lahaie, S. Bouchard, P. Poitras, F. Vandenbroucke-Menu, U. Halac, P. Hammel, and P. D. James 6 T he Biliary Tree .................................................................................................................................... 205 M. Dagenais, R. G. Lahaie, F. Alvarez, P. Poitras, and A. Barkun 7 T he Anorectum .................................................................................................................................... 225 M. Bouin, R. Wassef, P. Jantchou, D. Bernard, P. Poitras, and C. N. Andrews 8 T he Liver ................................................................................................................................................... 249 M. Bilodeau, J. Bissonnette, H. Castel, D. Corsilli, D. Fenyves, C. Fournier, J. M. Giard, G. Huard, P. M. Huet, D. Marleau, G. Pomier- Layrargues, J. P. Villeneuve, C. Vincent, B. Willems, F. Alvarez, and Mark G. Swain II Digestive Symptoms, Signs and Other 9 Esophageal Symptoms: Heartburn, Dysphagia, and Chest Pain........................ 307 P. Poitras and M. Bouin 10 N ausea and Vomiting ...................................................................................................................... 311 P. Poitras, L. Tremblay, and K. Orlicka 11 Upper Gastrointestinal Bleeding (UGIB) ............................................................................ 315 P. Poitras, J. Bissonnette, and Alan Barkun 12 D yspepsia ................................................................................................................................................ 321 P. Poitras 13 D iarrhea.................................................................................................................................................... 325 P. Poitras X II Contents 14 Abdominal Distension and Bloating ..................................................................................... 331 P. Poitras 15 C onstipation .......................................................................................................................................... 337 P. Poitras, M. Bouin, C. Faure, and M. Dapoigny 16 A bdominal Pain ................................................................................................................................... 345 P. Poitras, A. Archambault, and V. Marchand 17 A bdominal Hernias ........................................................................................................................... 353 R. Ratelle 18 F ecal Incontinence............................................................................................................................. 359 M. Bouin, R. Wassef, C. Faure, and P. Poitras 19 A norectal Pain ...................................................................................................................................... 363 M. Bouin, P. Poitras, and R. Wassef 20 R ectal Bleeding.................................................................................................................................... 367 R. Wassef and P. Poitras 21 Lower GI Bleeding .............................................................................................................................. 371 R. Wassef and P. Poitras 22 F ood Allergies ...................................................................................................................................... 377 E. Drouin 23 Undernutrition and Nutritional Support ........................................................................... 381 L. D’Aoust, M. Lemoyne, and Johane P. Allard 24 O besity ...................................................................................................................................................... 389 L. D’Aoust, V. Groleau, and F. S. Hould 25 Genes and Digestive Cancers ..................................................................................................... 397 B. Panzini 26 J aundice ................................................................................................................................................... 403 P. Poitras and S. Paquin 27 A bnormal Liver Tests ....................................................................................................................... 407 J. P. Villeneuve 28 A scites........................................................................................................................................................ 413 J. Bissonnette 29 Diets and Digestive Diseases ..................................................................................................... 417 L. D’Aoust and P. Poitras Supplementary Information Index ............................................................................................................................................................. 427 XIII Contributors Johane P. Allard, MD Division of Gastroenterology and Hepatology, Toronto General Hospital, University Health Network, Toronto, ON, Canada Professor of Medicine, University of Toronto, Toronto, ON, Canada Fernando Alvarez, MD Department of Gastroenterology, Hepatology and Nutrition, CHU Sainte-Justine, Montreal, QC, Canada Professor of Pediatrics, Université de Montréal, Montreal, QC, Canada Christopher N. Andrews, MD Division of Gastroenterology & Hepatology, Foothills Medical Centre, Calgary, AB, Canada Clinical Professor of Medicine, University of Calgary, Calgary, AB, Canada André Archambault, MD Department of Anesthesiology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC, Canada Assistant Clinical Professor of Anesthesiology, Université de Montréal, Montreal, QC, Canada David Armstrong, MA, MB, BChir Division of Gastroenterology & Farncombe Family Digestive Health Research Institute, McMaster University Medical Centre, Hamilton, ON, Canada Professor of Medicine, McMaster University, Hamilton, ON, Canada Alan Barkun, MD Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada Professor of Medicine, McGill University, Montreal, QC, Canada Denis Bernard, MD Digestive and Colorectal Surgery, CHUM, Montreal, QC, Canada Professor of Surgery, Université de Montréal, Montreal, QC, Canada Charles N. Bernstein, MD Director, University of Manitoba IBD Clinical and Research Cen- tre, Winnipeg, MB, Canada Distinguished Professor of Medicine, Bingham Chair in Gastroenterology, University of Mani- toba, Winnipeg, MB, Canada Marc Bilodeau, MD Liver Unit, CHUM, Montreal, QC, Canada Professor of Medicine, Université de Montréal, Montreal, QC, Canada Julien Bissonnette, MD Liver Unit, CHUM, Montreal, QC, Canada Assistant Clinical Professor of Medicine, Université de Montréal, Montreal, QC, Canada Simon Bouchard, MD GI Unit, CHUM, Montreal, QC, Canada Assistant Clinical Professor of Medicine, Université de Montréal, Montreal, QC, Canada Mickael Bouin, MD, PhD GI Unit, CHUM, Montreal, QC, Canada Clinical Professor of Medicine, Université de Montréal, Montreal, QC, Canada Marc Bradette, MD Division of Gastroenterology, CHU Québec, Quebec, QC, Canada Clinical Professor of Medicine, Université Laval, Quebec, QC, Canada