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      Ayurvedic management of chronic constipation in Hirschsprung disease – A case study

      case-report

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          Abstract

          Hirschsprung disease (HSCR) or congenital intestinal aganglionosis is characterized by complete absence of neuronal ganglion cells from a portion of the intestinal tract, most commonly in the large intestine. The main sign or symptom of HSCR is constipation usually appearing shortly after birth. This constipation is chronic in nature and usually not relieved with laxatives. The present case is of a patient having HSCR which was successfully managed with Ayurvedic treatment. A four year old boy with complaint of severe constipation, abdominal pain, abdominal distension and occasional vomiting was treated with Panchakarma procedures and Ayurvedic oral drugs. The Ayurvedic diagnosis of the case was Pakvasayagata vata. Shashtikashali pinda swedana (sudation with medicated cooked bolus of rice) and Matra basti (enema with medicated oil) with Ashwagandha taila (Ayurvedic medicated oil) was given for first 16 days. From the 2nd month of treatment, Matra basti was administered daily for 3 months in the dose of 25 ml. In 5th and 6th month Matra basti was administered on alternate days in the dose of 25 ml. From the 7th month Matra basti was administered once weekly in the dose of 25 ml. In 14th month Shashtikashali pinda swedana and Erandmooladi yapna basti (medicated enema) was given for 16 days. Eight scales based Medical outcome study (MOS) – 36 item short form - health surveys was periodically assessed for outcome which shows good improvement. Experience of this case showed that HSCR may satisfactory be managed with Ayurvedic treatment.

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          Most cited references7

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          Hirschsprung disease, associated syndromes, and genetics: a review.

          J. Amiel (2001)
          Hirschsprung disease (HSCR, aganglionic megacolon) is the main genetic cause of functional intestinal obstruction with an incidence of 1/5000 live births. This developmental disorder is a neurocristopathy and is characterised by the absence of the enteric ganglia along a variable length of the intestine. In the last decades, the development of surgical approaches has dramatically decreased mortality and morbidity, which has allowed the emergence of familial cases. HSCR appeared to be a multifactorial malformation with low, sex dependent penetrance and variable expression according to the length of the aganglionic segment, suggesting the involvement of one or more gene(s) with low penetrance. So far, eight genes have been found to be involved in HSCR. This frequent congenital malformation now stands as a model for genetic disorders with complex patterns of inheritance.
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            Hirschsprung's disease.

            Hirschsprung's disease (HSCR) is characterized by absence of the enteric nervous system in a variable portion of the distal gut. Affected infants usually present in the days after birth with bowel obstruction. Despite surgical advances, long-term outcomes remain variable. In the last 2 decades, great advances have been made in understanding the genes and molecular biological mechanisms that underlie the disease. In addition, our understanding of normal enteric nervous system development and how motility develops in the developing fetus and infant has also increased. This review aims to draw these strands together to explain the developmental and biological basis of HSCR, and how this knowledge may be used in the future to aid children with HSCR. Crown Copyright 2010. Published by Elsevier Inc. All rights reserved.
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              Diagnosis of Hirschsprung's disease: a prospective, comparative accuracy study of common tests.

              To compare the diagnostic accuracy of contrast enema (CE), anorectal manometry (ARM), and rectal suction biopsy (RSB) for the detection of Hirschsprung's disease (HD). Following a prospective protocol, infants suspected of HD underwent all 3 index tests. Children with positive results on 2 or more index tests or who continued to have severe bowel problems underwent a full thickness biopsy as reference standard. Clinical follow-up was the reference standard in all other children. Between 2000 and 2003, 111 consecutive patients (67 boys; median age, 5.3 months) in whom HD was suspected were enrolled. HD was found in 28 patients. RSB had the highest sensitivity (93%) and specificity (100%) rates, but values were not significantly different from CE (sensitivity, 76%; specificity, 97%) or from ARM (sensitivity, 83%; specificity, 93%). Inconclusive test results occurred in 8 infants with CE, in 15 infants with ARM because of agitation, and in 2 infants with RSB. RSB is the most accurate test for diagnosing HD, and it has the lowest rate of inconclusive test results.
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                Author and article information

                Contributors
                Journal
                J Ayurveda Integr Med
                J Ayurveda Integr Med
                Journal of Ayurveda and Integrative Medicine
                Elsevier
                0975-9476
                0976-2809
                29 May 2018
                Apr-Jun 2018
                29 May 2018
                : 9
                : 2
                : 131-135
                Affiliations
                [1]Department of Panchakarma, National Institute of Ayurveda, Jaipur, Rajasthan, India
                Author notes
                []Corresponding author. sarveshksingh21@ 123456gmail.com
                Article
                S0975-9476(17)30475-8
                10.1016/j.jaim.2017.11.004
                6033722
                29853328
                445bb72b-cd64-4d61-98a7-4ca0e3a26c03
                © 2018 Transdisciplinary University, Bangalore and World Ayurveda Foundation. Publishing Services by Elsevier B.V.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 7 August 2017
                : 5 October 2017
                : 2 November 2017
                Categories
                Case Report

                Complementary & Alternative medicine
                ayurveda,erandmooladi yapna basti,hirschsprung disease,matra basti,pakvasayagata vata

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