Помидоры противопоказания: При каком заболевании нельзя есть помидоры: строгий запрет врачей

Чем полезны помидоры для человека – 10 доказанных свойств

Помидоры – это овощи родом из Южной Америки, которые широко распространены по всему земному шару.  Они богаты многими минеральными веществами, витаминами и антиоксидантами.

По данным многочисленных исследований, свежие помидоры несут ощутимую пользу организму человека. Они снижают артериальное давление и предупреждают развитие заболеваний сердца, укрепляют кости и улучшают зрение, снижают риск появления злокачественных новообразований и способствуют похудению.

10 полезных свойств

Ниже рассмотрены 10 основных полезных свойств помидоров для здоровья с опорой на науку.

1. Богатый состав

Томаты богаты пищевыми волокнами, 87% из которых нерастворимы и являются пребиотиками, необходимыми для поддержания адекватного качественного и количественного состава микрофлоры кишечника. Основу волокон составляют гемицеллюлоза, целлюлоза и лигнин.

Помидоры также содержат ряд витаминов и минеральных веществ:

1. Витамин С. Мощный антиоксидант, который способствует нормализации обмена веществ и снижению массы тела. 1 помидор среднего размера обеспечивает до 28% от рекомендуемой суточной потребности.
2. Калий. Необходим для профилактики развития сердечно-сосудистых заболеваний.
3. Витамин К1. Является регулятором свёртываемости крови и поддерживает минеральную плотность костной ткани.
4. Фолиевая кислота. Обеспечивает полноценный рост тканей и поддерживает функциональную активность клеток. Крайне важна во время беременности для правильного развития органов будущего ребёнка.

Основными антиоксидантами растения являются:

1. Ликопин. Является пигментом, придающим томатам красный цвет. Учёные утверждают, что употребление данного вещества связано со сниженным риском онкологии и сердечно-сосудистых заболеваний.
2. Бета-каротин. Преобразуется в витамин А, который поддерживает нормальное развитие всех тканей (особенно органа зрения), замедляет старение.
3. Нарингенин. Является биофлавоноидом, содержащимся в кожице помидоров. Уменьшает хроническое воспаление и защищает мембраны клеток от различных повреждений.
4. Хлорогеновая кислота. Снижает артериальное давление и защищает стенки артерий от атеросклеротического повреждения и формирования тромботических масс.

Помидоры содержат многие ценные вещества, которые полезны для человека и обеспечивают надёжную профилактику ряда самых распространённых заболеваний.

2. Поддержание здоровья сердца и сосудов

Заболевания сердечно-сосудистой системы (ишемическая болезнь сердца, инфаркт миокарда, инсульты) – самая распространённая причина смерти во всех развивающихся странах.

Учёные из Финляндии обнаружили, что ликопин и бета-каротин существенно снижают риск развития ишемической болезни сердца и инсульта.

По данным специалистов из Японии, томаты уменьшают концентрацию самого вредного холестерина в крови – липопротеинов низкой и очень низкой плотности, которые способны откладываться в стенках артерий (в том числе коронарных) и формировать атеросклеротические бляшки.

Также помидоры снижают интенсивность течения свободно-радикальных процессов и угнетают хроническое воспаление. Данное действие дополнительно защищает сердечно-сосудистую систему от раннего развития смертельно опасных заболеваний.

Американские исследования демонстрируют высокую эффективность в целях снижения «вязкости» крови.

Употребление томатов также связано с низким риском формирования тромботических и тромбоэмболических осложнений любой природы.

Употребление томатов связано со снижением частоты развития самых распространённых и смертельно опасных сердечно-сосудистых заболеваний.

3. Снижение артериального давления

Гипертонической болезнью страдает, по различным данным, до 70 % взрослого населения.

По информации американских учёных, помидоры содержат большие объёмы калия, который расслабляет гладкую мускулатуру стенки сосудов, вызывая их расширение и снижение артериального давления.

Высокий уровень употребления калия (с ограничением приёма поваренной соли до 3 грамм в день) также связан со снижением вероятности смерти от любых причин на 20%.

Не менее важную роль играет хлорогеновая кислота. Японские учёные утверждают, что данное вещество эффективно снижает систолическое и диастолическое артериальное давление у лиц с умеренной артериальной гипертензией (до 160/100 мм. рт. ст.). При этом, хлорогеновая кислота, даже при приёме в больших дозах, не вызывает клинически значимых побочных эффектов.

Томаты, за счёт большого количества калия и хлорогеновой кислоты, способствуют снижению артериального давления и предотвращают раннее развития гипертонии.

4. Профилактика рака

Последние научные исследования показывают, что помидоры могут предотвратить развитие злокачественных новообразований.

По данным учёных из США, томаты, ввиду высокого содержания ликопина, снижают вероятность появления рака предстательной железы у мужчин, а также рака желудка и лёгких.

Доказано, что помидоры уменьшают риск появления рака молочных желёз у женщин. Биологическое действие связано с наличием в составе каротиноидов.

Помидоры также богаты антиоксидантными вещества (витамин С), которые защищают клетки от свободных радикалов, способных повредить генетическую структуру и вызвать патологическую пролиферацию.

Включение свежих помидоров в рацион снижает риск развития злокачественных новообразований в различных органах (желудок, молочные железы, лёгкие, предстательная железа).

5. Улучшение здоровья кожи

Помидоры богаты ликопином, а также другими растительными соединениями, которые защищают кожные покровы от вредного солнечного ультрафиолетового излучения и появления ожогов. К такому заключению пришли исследователи из Германии.

Также томаты (за счёт высокого содержания витамина С) нормализуют обмен веществ на уровне кожных покровов, обеспечивают профилактику гнойно-воспалительных заболеваний, повышают эластичность и упругость.

Помидоры улучшают эстетические свойства кожи и защищают её от воздействия солнечного света.

6. Укрепление костной ткани

Помидоры богаты витамином K, который принимает непосредственное участие в метаболизме костной ткани.

По информации учёных из Дании, витамин К активирует белки, отвечающие за отложение ионов кальция в костях. Тем самым происходит укрепление костей: повышается минеральная плотность костной ткани, уменьшается риск развития патологических переломов.

Данное обстоятельство особенно важно для пожилых людей, а также для женщин в период климакса.

Помидоры укрепляют кости и уменьшают вероятность развития переломов.

7. Защита глаз

Ликопин, лютаин и бета-каротин – мощные антиоксиданты, которые повышают устойчивость органов зрения к воздействию солнечного излучения, препятствуют появлению дегенеративных изменений жёлтого пятна и предупреждают раннее развитие катаракты – помутнения хрусталика.

Специалисты из США установили, что помидоры могут снизить активность возрастной инволюции офтальмологического аппарата, улучшить кровоснабжение глазного яблока, замедлить снижение зрения.

Рекомендуется регулярно употреблять помидоры с целью поддержания адекватной работы органа зрения и предупреждения возрастных изменений.

8. Профилактика и улучшение течения сахарного диабета

Помидоры являются хорошим источником клетчатки.

По данным исследований, пищевые волокна значительно снижают уровень сахара в крови у лиц, страдающих сахарным диабетом II типа, и уменьшают общий уровень глюкозы после приёма пищи при наличии сахарного диабета I типа.

Следовательно, потребление томатов может улучшить течение сахарного диабета, снизить дозу принимаемых сахароснижающих препаратов или инсулина.

Также овощ способен отсрочить раннее развитие данного заболевания.

Помидоры обеспечивают профилактику и улучшают течение сахарного диабета I и II типов за счёт снижения уровня глюкозы в крови.

9. Помидоры эффективны для похудения

Помидоры – уникальная кладезь витамина С и прочих антиоксидантных веществ, которые изменяют обмен веществ на уровне жировой ткани, повышают интенсивность окисления адипоцитов с целью получения энергии для удовлетворения собственных нужд организма.

Витамин С также замедляет скорость формирования жировых депо (особенно – абдоминального).

Также известно, что любые антиоксиданты обладают выраженным противовоспалительным действием, а жировая ткань находится в состоянии постоянного хронического воспаления. На фоне угнетения данного процесса наблюдается улучшение микроциркуляции и обмена веществ, что может способствовать замедлению отложения жиров в организме и скорейшему похудению.

Таким образом, включение помидоров в рацион помогает быстрее похудеть и поддерживать адекватную массу тела

10. Польза для беременных

Свежие томаты – источник фолиевой кислоты, которая необходима для правильного формирования нервной трубки плода, предупреждения аномалий её развития.

Женщинам рекомендуется регулярно употреблять фолиевую кислоту за несколько месяцев до запланированного зачатия, а также во время вынашивания плода.

Хотя помидоры содержат незначительный объём фолиевой кислоты, учёные из Венгрии рекомендуют включать их в рацион, так как естественный способ получения биологически активных веществ является предпочтительным, особенно при беременности.

Помидоры крайне важны для правильного формирования нервной системы у плода, так как содержат фолиевую кислоту.

Возможный вред и противопоказания

Помидоры, в большинстве случаев, хорошо переносятся организмом человека.

В редких случаях возможно развитие аллергических реакций, которые обычно имеют слабовыраженный характер. Крайне высокая чувствительность организма к помидорам (анафилактический шок, ангионевротический отёк и т.п.) встречается нечасто.

Важно отметить, что зафиксированы случаи перекрёстной аллергии. При наличии аллергии на латекс или пыльцу других растений, употребление помидоров может быть опасным для здоровья.

Томаты не противопоказаны беременным женщинам (при отсутствии аллергии). Наоборот, они крайне важны для правильного развития тканей будущего ребёнка. Рекомендуемая суточная норма – до 500 грамм в сутки.

В целом, помидоры имеют узкий круг противопоказаний и побочных эффектов.

Ответы на частые вопросы

Ниже рассмотрены самые частые вопросы касательно употребления томатов.

1. Каким сортам отдать предпочтение? В мире насчитывается свыше 1300 сортов и гибридов томатов. Самый простой способ их классификации – по цвету. Выделяют красные, зелёные (мякоть по виду напоминает киви, отличается кисловатым оттенком вкуса), чёрные (имеют окрас, приближенный к чёрному, были выведены учёными из СССР в середине 20 века), розовые, оранжевые и жёлтые помидоры. Наиболее ценными считаются все красные сорта томатов (Толстой F1, Король гигантов и т.д.). А помидоры черри являются едва ли не самыми полезными.
2. Что полезнее: огурцы или помидоры? Оба овоща имеют ценный состав и положительно сказываются на здоровье человека. Если взглянуть на них с точки зрения диетологии, то употребление огурцов предпочтительнее, так как они обладают меньшей калорийностью, содержат больше воды и клетчатки. Но не обязательно ограничиваться чем-то одним. Например, салат из помидоров, огурцов и сметаны принесёт ощутимую пользу. Рекомендуется отдавать предпочтение именно сметане вместо майонеза при приготовлении салатов.
3. Как на них влияет термическая обработка? Любая термическая обработка снижает концентрацию биологически активных веществ. Тем не менее, тушёные, варёные и печёные помидоры сохраняют большую часть своих лечебных свойств. А вот от жаренных томатов лучше отказаться.
4. Надо ли очищать кожуру? Кожура томатов не вредна, а наоборот полезна для организма. При полной уверенности в отсутствии применения химических веществ в процессе выращивания, помидоры можно употреблять с кожицей.
5. Свойства томатного сока. В нём отмечается высокое содержание фолиевой кислоты, витамина А и калия. К тому же, калорийность сока значительно ниже по сравнению с цельными плодами. Лучше принимать свежевыжатый сок, а не консервированный.
6. Как их лучше сохранить на зиму? В маринованных, консервированных и солёных помидорах практически отсутствуют ценные для организма питательные вещества, а вот в сушёных или вяленых, наоборот, их концентрация повышается. Высушенные плоды применяются в народной медицине для снижения артериального давления, повышения остроты зрения и замедления старения.
7. Применение ботвы. Листья томатов не применяются в народной и доказательной медицине, однако ботва используется для приготовления компоста, золы, удобрений.

Заключение

1. Таким образом, помидоры имеют много доказанных положительных эффектов.
2. Они снижают риск развития злокачественных новообразований, заболеваний со стороны сердечно-сосудистой, опорно-двигательной и эндокринной систем.
3. Также они улучшают состояние кожных покровов и здоровье офтальмологического аппарата, замедляют старение и обеспечивает профилактику ожирения.
4. Томаты рекомендуется включать в рацион беременным женщинам с целью предупреждения дефектов развития нервной трубки у плода.

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Our contributing authors average over 20 years of clinical experience. 90005 90050 Vibrant Online Community 90051 90002 Our 90077 Forums 90078 provide an engaging community offering much-needed emotional support and encouragement from others who are having similar experiences.90005 90050 Pre-eminent Medical Advisory Board 90051 90002 Quality oversight for all Veritas Health content is provided by our Medical Advisory Board – which is composed of recognized leaders in spine medicine, each with more than 30 years of clinical experience. 90005 .90000 Colonoscopy – Indications and Contraindications 90001 90002 2.1. Lower gastrointestinal (GI) bleeding 90003 90004 Lower GI bleeding may occur in the form of occult bleeding, melena, scant intermittent hematochezia, or severe hematochezia [3]. Lower GI bleeding from any cause requires colonoscopy either urgently or routinely. Patients with occult GI bleeding require colonoscopy to exclude malignant or adenomatous etiologies. Patients who are not good candidates for colonoscopy can be evaluated using CT colonography [4].In patients presenting with melena, upper GI endoscopy is performed first to identify any upper GI causes. If the upper GI endoscopy does not reveal a source of bleeding, colonoscopy is then indicated to identify any colonic source. Intermittent scant hematochezia can be diagnosed by anoscopy with / without sigmoidoscopy for low-lying lesions in the anus, rectum, and sigmoid in patients who are younger than 40. However, colonoscopy may still be required if a definitive source can not be identified.On the other hand, colonoscopy is the recommended procedure for patients with intermittent hematochezia who have one of the following risk factors: age> 50, family history of colon cancer, or other alarming symptoms such as weight loss, anemia, and change in bowel habits [5, 6]. Overall, colonoscopy has been reported to have a higher yield than other modalities such as proctosigmoidoscopy, single-contrast barium studies, or combined flexible sigmoidoscopy and double-contrast barium enema for diagnosis of lower GI bleeding.In case of severe hematochezia, hemodynamic stability determines the diagnostic and therapeutic approach [7-9]. In hemodynamically stable patients, urgent (within 8-24 h) colonoscopy is recommended [10-13]. In critically ill patients, upper endoscopy is indicated first followed by colonoscopy after excluding the upper GI tract as the source of bleeding [14]. The therapeutic indications of colonoscopy for the treatment of lower GI bleeding are discussed separately in this chapter. 90005 90006 90007 90008 90009 90010 90011 Indications for colonoscopy: 90012 90013 90014 90015 90009 90017 1.Lower GI bleeding 90013 90014 90009 90017 2.Screening and surveillance of colorectal polyps and cancers: 90022 a. Colon cancer 90022 b. Surveillance after polypectomy 90022 c. Colorectal cancer post-resection surveillance 90022 d. Inflammatory bowel diseases 90013 90014 90009 90017 3.Acute and chronic diarrhea 90013 90014 90009 90017 4.Therapeutic indications for colonoscopy: 90022 a. Excision and ablation of lesions 90022 b. Treatment of lower GI bleeding 90022 c. Colonic decompression 90022 d.Dilation of colonic stenosis 90022 e. Foreign body removal 90013 90014 90009 90042 5.Miscellaneous indications: 90022 a. Abnormal radiological examinations 90022 b. Isolated unexplained abdominal pain 90022 c. Chronic constipation 90022 d. Preoperative and intraoperative localization of colonic lesions 90013 90014 90049 90002 Table 1. 90003 90004 Indications for colonoscopy 90005 90002 2.2. Screening and surveillance of colorectal polyps and cancers 90003 90056 2.2.1. Colon cancer 90057 90004 According to the World Health Organization report in 2012 colorectal cancer (CRC) is the third most common cancer in men (746,000 cases, 10% of the total) and the second in women (614,000 cases, 9.2% of the total) worldwide. In 2014 року, the American Cancer Society predicted that about 136,830 people would be diagnosed with colorectal cancer in the United States, and about 50,310 people were predicted to die of the disease. Recent studies show declining in the CRC incidence and mortality rates, which have been attributed to the awareness of the risk factors and reduced exposure to them, the effect of early detection and prevention through polypectomy, and improved treatment [15]. The recommendations for screening colonoscopies are divided based on the known risk factor profile: 1) screening in the average-risk population and 2) screening in patients with a family history of colon cancer.90005 90004 In the average-risk patient, current American, European, and Asian guidelines recommend beginning CRC screening with colonoscopy at the age of 50 years and every 10 years thereafter regardless of the gender. However, the American College of Gastroenterology recommends that the screening colonoscopy begin at the age of 45 years in African Americans [16, 17]. Published evidence favoring the effectiveness of colonoscopy in reducing mortality from CRC by routine colonoscopy is insufficient because of a lack of randomized controlled trials and the limited consensus in guidelines on the appropriateness of colonoscopy.However, a few studies have modeled and predicted the impact of screening colonoscopy on CRC incidence and mortality using various transition models in hypothetical average-risk individuals aged 50 years. These studies have found that initial screening colonoscopy and repeat colonoscopy every 10 years might reduce CRC incidence by 58% and the reduction in CRC mortality is approximately 64% [18, 19]. In the average-risk individuals, yearly fecal occult blood testing (FOBT) and flexible sigmoidoscopy (FSIG) every 3 years are also accepted methods of screening for CRC.A follow-up colonoscopy, however, is warranted to completely visualize the entire length of the colon for patients with positive FOBT results or FSIG findings of adenoma in the distal colon [20-23]. 90005 90004 Family history of CRC is a major risk factor for CRC. It has been estimated that the first-degree relatives of CRC patients have two- to threefold increased risk of dying from CRC, and the risk is inversely associated with the age of diagnosis of the affected family member [24]. Patients with a single first-degree relative with CRC or advanced adenoma (adenoma ≥1 cm in size, with high-grade dysplasia, or villous elements) diagnosed at age ≥60 years are recommended to undergo routine CRC screening same as an average-risk individual beginning at age 50 years.On the other hand, patients with a single first-degree relative with CRC or advanced adenoma diagnosed at age <60 years, or two first-degree relatives with CRC or advanced adenomas should receive colonoscopy every 5 years beginning at age 40, or 10 years earlier than the age at diagnosis of the youngest affected relative, whichever comes first [16]. The data supporting these recommendations emerge from the retrospective studies rather than the randomized control trials [25, 26]. 90005 90004 Patients with a family history of hereditary nonpolyposis colorectal cancer (HNPCC), an autosomal dominant disease, are recommended to start the CRC screening at the age of 20-25 years or 10 years prior to the earliest age of HNPCC diagnosis in the patient's family member, whichever comes first.The recommended interval for colonoscopy is every 1-2 years until age 40, then annually thereafter [27-30]. This condition, in particular, has two-thirds of adenomas occurring on the right side and warrants colonoscopy for complete colonic surveillance [31]. Indications for performing colonoscopy in individuals with a history of familial adenomatous polyposis (FAP) are guideline-dependent after genetic testing returns positive. FSIG and colonoscopy have not been compared head-to-head regarding their effectiveness and reducing mortality in patients with FAP in the clinical trials and, as such, either FSIG or colonoscopy annually is recommended, starting at the age of 10-12 years [16 ].A colonoscopy is deemed necessary when polyps are detected on FSIG and a decision to perform polypectomy is made. 90005 90056 2.2.2. Surveillance after polypectomy 90057 90004 Post-polypectomy surveillance constitutes 20% of the performed colonoscopies, thereby constituting a large share in the amount of health care expenditure [32, 33]. Adhering to the indications for the repeat colonoscopy for the surveillance of CRC after the first colonoscopy, therefore, is very important as earlier colonoscopy can increase the risks to the patient and add to the health care cost whereas delaying the surveillance can also increase the risks by increasing the chances of missed interval cancers.Various observational studies report a 2-5% risk of an advanced neoplasia 5-10 years after a negative colonoscopy, a risk that is comparable to the risk of advanced colonic neoplasia in the average-risk patients undergoing their first colonoscopy [34-39] . Moreover, the risk of developing CRC 10 years after a negative colonoscopy is reported to be significantly lower (adjusted OR 0.26) [36, 40], supporting the current recommendation of repeat colonoscopy every 10 years in the average-risk general population.90005 90004 Although the detection and removal of polyp (s) can offer a significant reduction in the mortality of CRC, the development of interval cancers, ie, the cancers occurring after the initial colonoscopy with polypectomy, appears to be the highest in the first 3 -5 years. In 2012 the United States Multi-Society Task Force (USMSTF) published a revision of the 2006 guidelines on post-polypectomy surveillance and divided recommendations based on the presence of polyp (s) (hyperplastic vs. adenomatous), the number and the size of adenomatous polyp (s), villous component and high-grade dysplasia in the polyp, and the presence of serrated lesions or serrated polyposis syndrome (> 20 serrated polyps of any size throughout the colon) at baseline colonoscopy.In 2013, the European Society of Gastrointestinal Endoscopy (ESGE) published its post-polypectomy surveillance guidelines, stratifying risk into: low risk (1-2 adenomas <1 cm), intermediate risk (3-4 small adenomas or one> 1 cm) , and high risk (> 5 small adenomas or> 3 adenomas with at least one> 1 cm) based on the first colonoscopy. According to the USMSTF guideline, it is indicated that patients with 1-2 tubular adenomas <1 cm have a repeat colonoscopy in 10 years; whereas patients with a high-risk adenoma (defined as adenoma with villous histology, high-grade dysplasia, adenoma> 10 mm, or three or more adenomas) are recommended to have surveillance interval of 3 years.According to the ESGE guideline, the high-risk group should undergo surveillance at 1 year, the intermediate-risk group at 3-yearly intervals until two consecutive examinations are negative, and the low-risk group requires no surveillance colonoscopy or 5-yearly colonoscopy until one negative examination after which surveillance can be discontinued. The evidence supporting the indications in the arena of surveillance for the serrated polyp is insufficient. According to the USMSTF guideline, sessile serrated polyp (s) <1 cm with no dysplasia should be considered low risk and can be followed at a 5-year interval.However, sessile serrated polyp (s) ≥1 cm or sessile serrated polyp with dysplasia or serrated adenoma should undergo surveillance at 3 years and serrated polyposis syndrome should be surveyed annually. The ESGE recommends that patients with serrated polyps <10 mm in size without dysplasia should be classified as low risk, whereas patients with large serrated polyps (≥10 mm) or those with dysplasia as high risk and undergo surveillance accordingly. Patients with ≥5 serrated polyps proximal to the sigmoid, of which ≥2 are sized ≥10mm, or with ≥20 serrated polyps of any size are classified as serrated polyposis and should be referred for genetic testing.90005 90056 2.2.3. CRC post-resection surveillance 90057 90004 There are no clear survival benefits for performing colonoscopy in patients who have had colon cancer resection. However, a majority of the groups and societies such as American Cancer Society (ACS), and a joint American Cancer Society / US Multi-Society Task Force on Colorectal Cancer, Cancer Care Ontario [41-44], recommend post CRC resection surveillance. An indication to perform colonoscopy in these patients will help detect metachronous CRCs and polyps as well as anastomotic recurrences of the initial primary cancer at a stage that would allow further treatment.Currently, a follow-up colonoscopy is indicated at 1 year after the surgical removal of CRC. If no new cancer or polyp (s) is identified, a colonoscopy is repeated at 3 years and at 5 years if the findings are negative for interval development of cancer. An exception to this indication is HNPCC, which requires colonoscopic surveillance every 1-2 years regardless of the surgical resection of the cancer. 90005 90056 2.2.4. Inflammatory bowel diseases and other colitis 90057 90004 The indications for colonoscopy in inflammatory bowel disease (IBD), namely ulcerative colitis (UC) and Crohn's disease (CD) fall under a large spectrum.Colonoscopic diagnosis and differentiation between the UC and CD, assessment of the extent and severity of disease activity, treatment effectiveness, surveillance of malignancies, and endoscopic treatment, such as stricture dilation, are all within the scope of colonoscopy and its indications in IBD. Currently, American, European, and other international societies and guideline-defining bodies recommend endoscopic visualization of the entire colon for the initial diagnosis of IBD and other colitis [45-48].The clinical presentation and laboratory data characterizing both diseases may overlap but endoscopic visualization of the mucosa of the rectum, colon, and terminal ileum, and the extent of the disease involvement may help differentiate the disease processes. Moreover, colonoscopy offers the opportunity to perform biopsy, which is the major advantage of colonoscopy. Unless contraindicated because of severe colitis or possible toxic megacolon, a full colonoscopy with intubation of the terminal ileum should be performed during the initial evaluation of patients with a clinical presentation suggestive of IBD.Ileoscopy is superior for the diagnosis of CD of the terminal ileum when compared with radiological methods, especially for mild lesions [49, 50]. During the colonoscopic examination, biopsy samples should be obtained both from areas affected by the disease and from unaffected areas. After initiating therapy, a smaller number of biopsy samples may be necessary to confirm the diagnosis. In postsurgical follow-up, biopsies of the neoterminal ileum are indicated when disease recurrence is suspected.In patients who have undergone ileal pouch-anal anastomosis, biopsies of the afferent limb are indicated when Crohn's disease is suspected [46]. Other forms of colitis, such as drug-induced, infectious, vascular, and radiation colitis also present in a similar pattern and require colonoscopy at baseline for the diagnosis and the assessment of severity. 90005 90004 Patients with IBD have an increased risk of CRC compared to those without IBD [51-55]. In fact, CRC accounts for one-sixth of ulcerative colitis-related deaths [56].There is a lack of randomized control studies demonstrating the effectiveness of colonoscopy in improving survival in the IBD patients from CRC. However, numerous observational studies have reported that colonoscopic surveillance of CRC in IBD offers early detection of cancers and improves CRC-related survival in IBD patients [57, 58]. In a retrospective study of 6,823 patients with IBD in US tertiary referral hospitals followed-up for at least 3 years, the incidence of CRC among patients without a recent colonoscopy was 2.7% which was significantly higher than among patients with a recent colonoscopy (1.6%) [59]. Additionally, a colonoscopy within 6-36 months before diagnosis was associated with a 64% reduction in mortality rate [59]. According to most guidelines, colonoscopies are indicated for CRC screening starting at 8-10 years from initiation of IBD-related symptoms [48, 53, 60-62]. The National Institute for Health and Clinical Excellence (NICE) London 2011 guideline, however, recommends only offering colonoscopic surveillance to patients with Crohn's colitis involving more than 1 segment of the colon or left-sided or more extensive UC, but not isolated ulcerative proctitis.Most guidelines recommend yearly follow-up colonoscopy for high-risk patients (those with primary sclerosing cholangitis, extensive colitis, active endoscopic or histologic inflammation, a family history of CRC in a first-degree relative before 50 years of age, personal history of dysplasia , presence of strictures on colonoscopy, and, possibly, gender), and every 2-5 years for those without major risk factors. 90005 90002 2.3. Acute and chronic diarrhea 90003 90004 Patients presenting with acute diarrhea should undergo initial evaluation with stool studies.If blood and stool cultures are inconclusive, or if symptoms persist or worsen despite empiric therapy, then colonoscopy is indicated due to its high diagnostic yield [63]. For most patients with chronic diarrhea, patients with suspected acute diffuse 90085 Clostridium Difficile 90086 colitis, pregnant patients, patients with predominantly left-sided symptoms (tenesmus / urgency) and patients with multiple morbidities, a flexible sigmoidoscopy can be used for the initial evaluation. Even if patients have macroscopically normal-appearing mucosa, biopsies must be obtained to exclude microscopic diseases.If flexible sigmoidoscopy yields inconclusive results, if diarrhea persists, or if there is suspicion of inflammatory bowel disease (IBD) or cancer, then colonoscopy should be the next investigative study. 90005 90004 Histology is an integral component of colonoscopic evaluation of chronic diarrhea because several diseases, such as microscopic colitis, eosinophilic colitis, amyloidosis, and IBD, may appear normal on endoscopy but are abnormal on microscopy. In patients undergoing colonoscopy for chronic diarrhea, IBD or colitis is the most likely disease to be detected [64].Microscopic colitis can be lymphocytic or collagenous and is characterized by nonbloody, watery diarrhea. On endoscopy, microscopic colitis can be missed because of patchy colonic involvement. Even if mucosa appears normal endoscopically, multiple biopsies from both sides of the colon are necessary to avoid missing microscopic colitis [65]. If there is suspicion of inflammatory diarrhea, then a biopsy of the terminal ileum is helpful in the diagnosis. However, a biopsy of the terminal ileum has the highest diagnostic yield in patients with known or suspected Crohn's disease, terminal ileal abnormalities on imaging, or endoscopic findings of ulcers, ileitis, or erosions [66].90005 90004 Colonoscopy is not routinely used to evaluate acute diarrhea because it is commonly due to infectious etiology. If stool tests are negative and / or if diarrhea persists, then endoscopy is indicated. An additional important exception is the case of an immunocompromised patient. In a patient with diarrhea with HIV, organ or bone marrow transplant, or on immunosuppressive medications, a colonoscopy with biopsy is necessary to exclude CMV colitis and graft versus host disease (GVHD). In such cases, colonoscopic evaluation of diarrhea has higher sensitivity and cost-effectiveness than FSIG [67].Patients who undergo stem cell transplant often present with diarrhea in the initial 3 months following transplantation. In these patients, abnormal mucosa on endoscopy has not been shown to correlate with biopsy results. Therefore, biopsies of normal and abnormal-appearing mucosa are indicated, especially of the distal colon, which has the highest diagnostic yield in patients undergoing endoscopy for gastrointestinal symptoms [68]. Based on the location of highest diagnostic yield, a flexible sigmoidoscopy with distal colon biopsy is indicated in patients with diarrhea suspected of acute GVHD.However, some centers endorse combined upper GI endoscopy as well as colonoscopy in patients following hematopoietic stem cell transplantation to diagnose disease more quickly. 90005 90002 2.4. Therapeutic indications for colonoscopy 90003 90056 2.4.1. Excision and ablation of lesions 90057 90004 Endoscopic mucosal resection (EMR) is a method for treating early CRC. Most adenomas and intramucosal cancers can be removed by EMR. For tumors larger than 2 cm, EMR is less likely to achieve complete resection (histopathologically tumor-free lateral and vertical margins of the resected specimens) [69, 70].Another method, known as endoscopic submucosal dissection (ESD) is also performed in several countries. The procedure is simpler than the laparoscopic colectomy but is time-consuming and carries a higher risk of perforation than EMR. ESD is indicated in lesions> 2 cm, lesions that are suspected to be invasive submucosal cancer, and mucosal lesions with fibrosis or local residual early cancer after endoscopic resection. The rate of complete resection for large colorectal tumors by ESD has been reported to be 80-98.9% [71-74]. However, both procedures are operator-dependent and have limited data supporting their use. 90005 90056 2.4.2. Treatment of lower GI bleeding 90057 90004 Treatment of acute lower GI bleeding from any sources described earlier is indicated either urgently or as an elective procedure. In case of urgent colonoscopy, the colon is prepared using polyethylene glycol based solution administered orally or via nasogastric tube. Currently, metallic clip placement, thermal coagulation, and epinephrine injection are the available methods.Depending on the lesion and the severity of bleeding, colonoscopic intervention with any one of these methods is indicated as the first step in achieving hemostasis. In case of persistent diverticular bleeding, a bleeding vessel can be treated with metallic clip placement [75, 76]. Vascular ectasias can be treated with either thermal or epinephrine injection, though thermal cauterization has 87% of success rate [77]. Cases where a definite bleeding site can not be located or cases where the visualization of the bleeding source is poor due to inadequate views due to bleeding need referral for angiographic or surgical treatment.90005 90056 2.4.3. Colonic decompression 90057 90004 Acute colonic obstruction is a common presentation of colon cancer and, often, the presenting patient is in poor overall health making surgical intervention a suboptimal choice. Since 1990, the utility of colonoscopic interventions via either self-expanding metal stent (SEMS), placement of a decompression tube, or tumor debulking has become very popular and has been studied more frequently in recent years in various populations. Endoscopic interventions serve as a bridge to surgery or as a palliative measure in patients who are poor surgical candidates.A majority of the studies comparing SEMS placement with surgery has reported high clinical success rates (92%), better symptomatic relief, lower complication rates (<5%), cost-effectiveness, and higher patient acceptance and shorter hospital stay with endoscopic SEMS placement [78-83]. Argon plasma coagulation (APC) and snare polypectomy have been used to treat colonic obstruction and maintain luminal patency, and are good alternatives to endoscopic SEMS in treating colonic obstruction [84-86].90005 90004 Endoscopic decompression of an acute colonic pseudo-obstruction or Ogilvie syndrome is another therapeutic indication for colonoscopy. The etiology of this condition is multifactorial (post-intraabdominal surgery, sepsis, hypothyroidism, neurological disorder, spinal cord injury, etc.) in the absence of a true mechanical obstruction. Bowel ischemia and perforation are dreaded complications and management is often conservative, involving the correction of the underlying disorder. However, in cases where the initial management fails, colonoscopic decompression is indicated [87, 88].90005 90004 Colonoscopy is also used for decompression of sigmoid and cecal volvulus. Volvulus is a condition in which a part of colon twists upon itself. Due to venous congestion and obstruction to blood flow, tissue viability becomes a major issue. Patients presenting with signs of perforation, peritonitis, bowel necrosis or profound hemodynamic instability need immediate surgery. However, patients with less severe sigmoid and cecal volvulus can be managed endoscopically [89, 90]. Endoscopic correction of sigmoid volvulus achieves better success rates than the correction of cecal volvulus and is associated with a lesser need for surgical intervention [91].A study by Oren and colleagues reported that sigmoidoscopic correction of sigmoid volvulus with a rectal tube was successful in 78% of patients [92]. Nevertheless, the rate of recurrence of sigmoid volvulus is high, ultimately requiring surgical treatment [93]. Cecal volvulus has been treated endoscopically but due to the high failure rate, often requires surgical intervention for most patients. Surgeons usually combine operative detorsion of cecal volvulus with right hemicolectomy (to prevent recurrence) and either a primary anastomosis or an ileostomy with mucus fistula.In medically unstable, high-risk patients who are poor surgical candidates or have poor vascular supplies to the cecum, cecal volvulus detorsion may be achieved with a cecostomy and cecopexy, which also are associated with significant morbidity and mortality [94]. Colonic volvuluses in other areas such as flexural territories are less common and the indication to perform colonoscopic interventions in these situations is not well studied. 90005 90056 2.4.4. Dilation of colonic stenosis 90057 90004 Colonoscopic intervention of stenotic lesions such as anastomotic strictures and strictures caused by IBD are among the common indications for performing colonoscopy.Several studies have reported high success rate with a low complications rate. However, recurrence is common. The methods commonly employed for the treatment of colonic stenosis are balloon dilation with or without steroid injection and electro-incision, all of which have been shown to have a variable amount of success [95-101]. 90005 90056 2.4.5. Foreign body removal 90057 90004 The current management of the foreign bodies lying in the lower GI tract is based on the type of foreign body, the proximity to the anus, the injury to the adjacent structure, as well as the surgical and endoscopic expertise at the health care center.A foreign body in the GI tract presents after voluntary or involuntary insertion or ingestion of the foreign body. Very often, the patient tries to manipulate the object and attempts self-exploration to remove it before presenting to the hospital. Endoscopy provides an opportunity to avoid abdominal exploration. However if the radiological exam or clinical presentation indicates perforation or higher-lying object (s), colonoscopy may fail and may pose a delay in surgical management [102-106]. 90005 90002 2.5. Miscellaneous indications 90003 90056 2.5.1. Abnormal radiological examination 90057 90004 Colonoscopy is commonly performed after an abnormal or suspicious radiological finding in the search for true pathological lesions such as cancers or ulcerative lesions. Filling defect or mucosal defect on barium enema or a luminal narrowing on barium enema or CT scan is routinely evaluated with a colonoscopy. Patients presenting with symptoms suggestive of acute diverticulitis with supportive CT scan findings also need to be evaluated with colonoscopy, but only after the acute inflammation has resolved.Air insufflation during colonoscopy in acute diverticulitis can lead to the bowel perforation and is considered a contraindication. A luminal defect or polyp (s) on CT scan or CT colonography is usually followed-up by a colonoscopy when feasible. However, controversy exists between the American College of Radiology, the American Gastroenterology Association, and American College of Gastroenterology regarding the size and number of polyps on CT colonography that meet the requirement for colonoscopy [107-109].Patients with abnormal positron emission tomography (PET) scan showing a possible colorectal lesion should undergo colonoscopic evaluation. Nevertheless, in the light of insufficient clinical data, the indications for colonoscopy after abnormal radiological exam are based on individual presentation, availability of the endoscopist, age, and other comorbidities of the patient. 90005 90056 2.5.2. Isolated unexplained abdominal pain 90057 90004 Patients presenting with symptoms of chronic (> 3 months) abdominal pain and nonspecific abdominal discomfort might require colonoscopy.In the era of thorough radiologic studies, the need for colonoscopy emerges after noninvasive diagnostic modalities fail and symptoms persist. There is no clear indication for performing colonoscopy in patients presenting with unexplained abdominal pain or discomfort. A detailed history and physical examination provide diagnostic clues but a diagnostic workup often ends up requiring colonoscopy. The diagnostic yield of colonoscopy has been previously studied in retrospective studies. For example, in a study by Neugut et al., A total of 7% of patients who presented with abdominal pain (n = 113) either had carcinoma or a polyp> 1 cm in size on colonoscopy [110]. It is worth mentioning that detection of the pathological process does not offer symptomatic relief in these cases. In a more recent study by Kueh and colleagues, the diagnostic yield of colonoscopy was evaluated from 2005 to 2010 in a tertiary center in New Zealand among the patients who presented with isolated abdominal pain, which accounted for 1.2% of all colonoscopies (n = 2633 ).The diagnostic yield of colonoscopy for a cancer, adenoma, diverticulosis, or hemorrhoid in the patients with abdominal pain was significantly lower in this cohort than the yield of colonoscopy performed for other symptoms such as rectal bleeding and / or iron deficiency anemia [111]. 90005 90056 2.5.3. Chronic constipation 90057 90004 Chronic constipation, as defined by the Rome III criteria [112], is reported to be associated with an increased risk of colon cancer in retrospective studies from the United States [113, 114], Australia [115], and Japan [116].In contrast, no such association was found in several other studies [117-119]. Interestingly, the yield of colon cancer in colonoscopy performed for constipation alone was lower than in colonoscopy performed for routine colorectal cancer screening [120]. Patients with chronic constipation who present with alarming symptoms such as rectal bleeding, melena, iron-deficiency anemia, unintentional weight loss, or are> 50 years should be evaluated with a colonoscopy to identify the etiology of the obstruction, such as cancer, stricture, or extrinsic compression.Colonoscopy can be used to treat chronic constipation based on the etiology. In patients who have undergone prior abdominal surgery, have inflammatory bowel disease, or are prone to ischemia, colonoscopy is used to dilate fibrotic strictures that lead to constipation [121-123]. Patients suffering from chronic constipation due to neurogenic bowel or acute colonic pseudo-obstruction also benefit from a percutaneous endoscopic colostomy [124]. Importantly, chronic constipation as a procedural indication for colonoscopy is independently associated with poor colon preparation requiring a rigorous amount of laxative (s) or a longer duration of preparation [125, 126].90005 90056 2.5.4. Preoperative and intraoperative localization of colonic lesions 90057 90004 Colonic lesions, depending on the size and consistency, may pose some difficulty in localization by surgeons during the surgical procedure, and this could be even more difficult for laparoscopic surgeries than for open procedures. In such cases, localization of a mass or polyp of interest is very important. Preoperative colonoscopy to localize the lesion using penetrating India ink, Spot, or indocyanine green is becoming a common practice [127, 128].The dye migrates to the peritoneal surface and allows for accurate localization. An alternative colonoscopic method of applying clips around the area of ​​interest has also been studied, which requires intraoperative ultrasound to precisely locate the site. Both methods have their own advantages and disadvantages, such as inflammatory reaction to the dye, micro-abscesses, broad spreading of the dye in the field in smaller lesions, migration of the metallic clips, false localization, or inadvertent injection of dye in the adjacent vital structures.A recent review reported that the accuracy of endoscopic tattooing is 70-100% and the incidence of intraoperative invisible lesions is 1.6-15% [129]. The complications reviewed were mostly related to transmural injection and the spillage rates varied from 2.4 to 13% and were asymptomatic. Intraoperative colonoscopy can also be performed to localize the site of a tumor or a polypectomy site. However, intraoperative colonoscopy is an understudied field and has reported problems with insufflated air in the colon which interferes with the surgical technique.90005.90000 meaning in the Cambridge English Dictionary 90001 Neither cross-sectional echocardiography nor aortography is entirely reliable in identifying those patterns of the coronary arteries which are a 90002 contraindication 90003 to the arterial switch operation. Finally, the subjects were screened for medical contraindications to the method, and if these were absent, the contraceptive was then provided.90004 These examples are from the Cambridge English Corpus and from sources on the web. Any opinions in the examples do not represent the opinion of the Cambridge Dictionary editors or of Cambridge University Press or its licensors.90005 90004 More examples Fewer examples 90005 However, the multifocal disease is only a relative 90002 contraindication 90003, that is it could be applied in well-selected patients.This excluded persons with medical contraindications to exercise, but not those with dementia. First, to be treated as a clinical “need,” a 90002 contraindication 90003 requires a clear label that ideally would also indicate a relevant remedy.A temporary 90002 contraindication 90003 is the small size of the left ventricle in deeply cyanosed children. Regular follow up is essential, the gradient itself is no 90002 contraindication 90003 for a pregnancy..90000 Electrotherapy | Contraindications 90001 90002 There has been on ongoing controversy over the various and diverse contraindication for electrotherapy modalities over recent years. Many of the widely held beliefs in this area have been challenged in that there appears to be little by way of ‘concrete evidence’ for many and a lot of anecdotal evidence and supposition about some of the others. If you look in a selection of the major texts, they tend to provide a ‘sircular reference list’ in that they all X refer to each other without getting to grips with the original work.90003 90002 A group, under the auspices of the Chartered Society of Physiotherapy in the UK have spent some time working through as much of the original evidence as we could find in order to establish what actually is and what is not a contraindication for the most commonly employed modalities. A group in Australia have undertaken a similar exercise. 90003 90002 The 90007 Contraindication Grid 90008 is probably the most useful quick reference guide, and although I used to have it up on the web page, it seems like this new format really does not like large tables, so have given up trying to reproduce in full here for the moment.It is still available as a 90007 90010 download file 90011 90008 (.pdf – good for printing if you want a copy for the department / clinic). 90003 90002 The information below is a summary of the CSP group outcomes 90007 (Bazin, S.et al. (2006). Guidance for the Clinical use of Electrophysical Agents. London, Chartered Society of Physiotherapy, also reproduced as a chapter in Electrotherapy: Evidence Based Practice. (2008) T Watson, Elsevier) 90008 – contact the CSP (90010 90007 www.csp.org.uk 90008 90011) if you want a copy – which is fully referenced. For copyright reasons, I can not reproduce it in full here. 90003 90002 Additionally, there was a set of Guidelines published recently in a special edition of the Canadian Physiotherapy Journal. I am not permitted to reproduce them here (copyright) but well worth a look if you are able to gain access: 90007 Houghton PE, Nussbaum EL, Hoens AM: Electrophysical Agents: Contraindications and Precautions. Physiotherapy Canada 2010 року; 62 (5) 90008 The Canadian document appears to b openly accessible from 90007 HERE 90008.There was a similar paper in the Australian Journal some while back 90007 (Robertson, VJ, LS Chipchase, et al. (2001). Guidelines for the use of Electrophysical Agents. Victoria, Australia, Australian Physiotherapy Association) 90008 and I gather they are currrently being revisited – will post an update when it appears. 90003 90002 Laakso and Young (Laakso, E.-L. and C. Young (2010). “Electrophysical agents (EPAs) for symptom control in cancer care-what is the evidence?” Physical Therapy Reviews 15 (4): 334-343 ) provide an excellent narrative review of the controversy re the use of Electro Physical Agents in cancer care which you are strongly encouraged to access (looks like you can get if for FREE at: http: // bit.ly / 1tyucTF) 90003 90002 I have a lot of additional material that I am trying to pull together to explain some of the commonly held misconceptions with regards the contraindications, precautions and dangers relating to electrophysical agents, but in the meantime, the grid that follows will provide a quick and easy summary about the key issues. 90003 90002 A version of the grid – in 90007 FRENCH 90008 – can be downloaded HERE. My thanks to Evan O’Neil. My French is pathetic, so I can not verify the translation, though I have no reason to doubt it.90003 90002 90003 90040 Notes 90041 90002 Where there is no entry in a popup grid, it means that there is no known / demonstrated detrimental effect. 90003 90002 Where an entry relates to a ‘LOCAL CI’ in relates to whether the applied energy would reach the tissue in question. 90003 90002 The current issues regarding the use of TENS during pregnancy is dealt with in some considerable detail in a specific TENS During Pregnancy document which can be obtained from the 90007 90010 download 90011 90008 page.90003 90002 Click on a title below to see its Contraindication popup grid. 90003 90054 Non Thermal Applications 90055 90002 Ultrasound (non thermal) 90003 90002 Laser Therapy 90003 90002 Pulsed Shortwave (Low dose, non thermal application) 90003 90054 Electrical Stimulation 90055 90002 TENS 90003 90002 Interferential 90003 90002 Other Low Frequency (e.g. muscule stim, diadynamics etc) 90003 90054 Heat 90055 90002 Infra Red 90003 90002 Wax 90003 90002 Shortwave (continuous, thermal) 90003 90002 Ultrasound (continuous / thermal) 90003 90002 Microwave 90003 90002 Hot Pack 90003 90054 Others 90055 90002 Biofeedback (with no adjunctive stim) 90003 90002 Cold Therapy 90003 90002 Ultraviolet Radiation 90003 .