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Review of normal gastrointestinal tract, ulcerative colitis, proctitis and rectal medication adherence

23 July 2020
Volume 29 · Issue 14


The gastrointestinal (GI) tract has a number of functions—ingestion, digestion, absorption and elimination. When the GI tract is working normally, it is efficient. However, this can change when disease, such as inflammatory bowel disease (IBD) occurs. IBD is a long-term relapsing and remitting autoimmune disease; it incorporates ulcerative colitis (UC). In UC, part or all the mucosa lining the rectum and colon becomes inflamed and ulcerated. UC that affects the rectum only is called proctitis. Effective treatment is essential. It is better to target the rectal mucosa directly in proctitis, using topical rectal medications in enemas or suppositories, as these have fewer side-effects and resolve symptoms more quickly than systemic drugs. However, patients may not feel clear about aspects of their IBD care and can find it difficult to initiate and comply with treatment and maintenance regimens. Nurses need to educate and support them to achieve optimal therapeutic outcomes in both the immediate and long terms.

The gastrointestinal tract begins at the mouth and ends at the anus. In health, the time taken from ingestion to elimination in the Western world is about 1–3 days (Tortora and Derrickson, 2014). This transit time is longer for people with constipation and shorter for people with diarrhoea.

The mouth contains teeth, required for chewing food, and saliva, which keeps the mouth moisturised and supple as well as being responsible for the first part of the chemical breakdown of food. Once food has been ingested and chewed, it passes to the stomach where chemical breakdown continues with the gastric juices. The stomach is acidic; this helps to prevent infection caused by any ingested bacteria. The stomach's strong muscle walls mechanically churn the food to help to break it down into the various components that are required by the body, such as amino acids, which are broken-down proteins. Food stays in the stomach for several hours while breakdown occurs. Little is absorbed directly from the stomach (Watson, 2011).

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