CfroI personally used the tapes and lot of others have used them on this forum. You can also ask questions there as well and get any help you need both on seeing one in person or using the home program. These are gut specific though for IBS and have other benefits as well to them.http://www.ibsgroup....php?showforum=9
I reread what you orginally posted again and its just hard for anyone to answer some of those questions, sometimes you have to wait and see what happens and do your best to get yourself well.Taking probiotics would be a good thing especially ones with a certain strain I will look it up for you.It was probably the intial infection that started the IBS.The condition itself puts a person into threat mode, will I have d or pain or be consitpated along with worry antisipatory anxiety, anxiety and negative reaction to the symptoms themselves all qualify as stressors. There can also be physical stressors such as hot and cold, humidity and other outside sources. There is also good stress excitement even. Not all stress is bad though.This is some more info. Once again I know this is all complex, but you can also just bring it to the doctor with you perhaps. These are top PI IBS Research experts. This is a little dated and more has been learned since this was written.With Permission from the The UNC Center for Functional GI & Motility DisordersPOST INFECTIOUS IRRITABLE BOWEL SYNDROMERobin C. Spiller, MD Reader in Gastroenterology at the University Hospital, Nottingham, UK An important subgroup of patients with Irritable Bowel Syndrome describe a previously entirely normal bowel habit with all their symptoms developing immediately after an acute bout of diarrhea and vomiting. This phenomenon has been recognized by clinicians for many years and was well described by Truelove and Chaudary who studied 130 patients with Irritable Bowel Syndrome, 34 of whom were described as having post-infective IBS. Most of the infections were bacillary dysentery but some were amoebic. Interestingly, they found there was an important interaction between psychological problems and infection. They found that a post-infectious origin and absence of anxiety, depression or neurotic features both predicted a good outcome. The commonest causes of gastroenteritis are viral, followed by Campylobacter, Salmonella and Shigella. Viral gastroenteritis typically heals rapidly with little residual injury, while the bacterial infections often produce ulceration and bleeding. They are generally associated with more prolonged illness and it is these infections which have been associated with post-infective Irritable Bowel Syndrome. The first prospective study was reported by McKendrick(1)who studied 38 individuals following a salmonella outbreak. He found that 11 out of the 38 met the Rome I criteria for IBS 6 months after the initial illness. Two further prospective studies of hospitalized patients from an infectious disease unit in Sheffield also confirmed this high incidence of post-infective IBS(2,3). Our own study of 386 cases of bacterial gastroenteritis obtained from a community survey showed a lower incidence of post infective IBS (7%) possibly reflecting a less severe illness, since only 1 in 10 of these patients were hospitalized However these were not trivial illnesses since the average duration of illness was 7 days with a third reporting bloody diarrhea and a median weight loss of 6kg. Interpreting this data requires knowledge of the normal incidence of new IBS, as was obtained in a large survey based on the British general practice database. This study of 584,308 patients found the incidence of new IBS per annum in non-infected patients to be 0.35%. However, in 300 patients who had a culture positive infectious gastroenteritis, the annual incidence was 4% giving a relative risk of 11.9% 95% CI (6.9-21)(4). Traveler’s diarrhea is of course extremely common in Canadian citizens traveling to Mexico and Ilnyckyj prospectively surveyed this group. Nearly 50% developed travelers diarrhea and in this group the incidence of new IBS three months later was 17.5% compared with just 2.7% for those who did not get travelers diarrhea, a relative risk of 6.6(0.8-53)(5). RISK FACTORSMost patients with bacterial gastroenteritis recover fully and only a small minority develop post-infective Irritable Bowel Syndrome. Female sex, hypochondriasis and adverse life events in the previous year all give an increased risk(6,7)with a relative risk of 3.4, 2.0 and 2.0 respectively. A much stronger risk factor is the duration of the initial illness, with a steadily increasing relative risk for each week of illness, reaching 11.4 for those with diarrhe a lasting more than 21 days. Bacterial factors are likely to be important http://www.med.unc.edu/ibsThe
UNC Center for Functional GI& Motility Disorderssince we found around 1 in 10 of Campylobacter infected individuals developed post-infective IBS compared with just 1 out of 100 with Salmonella. It is likely therefore that the severity of tissue damage and ulceration is a major predictor. PATHOPHYSIOLOGYDiarrheal illnesses are characterized by accelerated GI transit and increased gut sensitivity. This gradually returns to normal but at a variable rate. By three months most of those who are going to recover will have done so and thereafter the rate of recovery is much slower. As Gwee found colonic transit is accelerated in all infected individuals at 3 months, but those who meet the Rome I criteria for IBS have a faster transit than those who do not. Similarly rectal sensitivity is increased in those meeting Rome criteria, though again all those infected show a similar trend. Although conventional histological examination of mucosal biopsies in IBS shows no abnormality, when detailed quantification is undertaken changes are noted. We performed serial rectal biopsies in individuals recovering from Campylobacter gastroenteritis at 2, 6, 12 and 52 weeks. We note initial increases in both inflammatory cells and enteroendocrine cells, which mostly returned towards normal, but remained abnormal in a few markedly symptomatic individuals(8). Similar abnormalities were noted in patients attending the outpatients with a history of post-infectious Irritable Bowel Syndrome. There is a good correlation between the inflammatory cells and the enteroendocrine cells suggesting that cytokines might drive the enteroendocrine cell hyperplasia. The main content of the enteroendocrine cells is 5HT, an agent that stimulates peristalsis and intestinal secretion causing diarrhea in normal subjects. Drugs, which inhibit the action of 5HT such as Alosetron, are likely to show benefit in this group thought they have not been specifically studied. Other authors have noted increased enteroendocrine cells in unselected irritable bowel patients(9)but this needs confirmation. More important than increase in numbers may be the increase in release of 5HT. Several pilot studies(10)including some reported at DDW this year suggested that there was an exaggerated release of 5HT following a meal particularly in those who got meal related symptoms(11).
MANAGEMENTIt is important that patients should understand the important roles of anxiety, stress, and diet and persisting low-grade inflammation in this condition
. Providing the Rome criteria are met and general physical examination is normal then the probability of another diagnosis is low. However, infections can unmask other disease particularly coeliac disease, inflammatory bowel disease such as Crohn's and tropical sprue together with hypolactasia. Such patients should therefore undergo a minimum set of screening tests including endomysial antibodies, hemoglobin, CRP, ESR, albumin and stool culture. In the absence of alarm features such as weight loss, fever, rectal bleeding and nocturnal diarrhea, only 5% of all these tests will be abnormal. Since microscopic colitis has also been reported to develop acutely after an infectious illness it is important to do a colonic biopsy and, if suspicions are high, also a duodenal biopsy to exclude coeliac disease. Lactose intolerance developing after a viral gastroenteritis is well recognized by pediatricians. This occurs because lactase, the enzyme responsible for digesting lactose, is expressed fully only in the mature enterocyte at the tip of the villus. Since viral gastroenteritis generally specifically damages the villi, lactose levels remain low for some months. A low lactose diet is therefore worth trying, particularly in those racial groups with an a priori greater risk of lactose intolerance such as Asians, Africans and Chinese. A low lactose diet is only relevant if the subjects take more than 240mls of milk. Even those with documented lactose intolerance can tolerate amounts smaller than this when spread throughout the day. Since psychological factors are so important, it is necessary to make some formal assessment of this.
Where anxiety and depression levels are high they should be treated on their own merits since it is unlikely the patient will recover without addressing these issues. There are no specific diets recommended for post infective IBS but reduction of poorly absorbed carbohydrates, particularly wheat, potatoes together with other items such as citrus fruits have been reported to be beneficial in patients with diarrhoea-predominant IBS and should be tried
(12). Loperamide and codeine are well tried treatments for diarrhea predominant IBS regardless of origin and are likely to be effective though at the risk of some side-effects, including sedation and nausea in the case of codeine and abdominal pain in the case of Loperamide. Alosetron has also been reported to be effective in diarrhea predominate IBS but again has not been specially tried in post infective patients. PROGNOSISWhatever treatments are offered, the clinician can afford to be reassuring since the prognosis is relatively good. Chaudary's original study found 77% had recovered within 2 years(13)while Harvey also found 82% of those with acute illness at onset had recovered by 5 years(14). In our own follow-up 5 to 6 years following the initial survey we found that 11 out of 17 post infective Irritable Bowel Syndrome patients had actually recovered though we also noted that a past history of psychiatric disorder predicted a poor outcome.
KEY POINTS•Post infective Irritable Bowel Syndrome accounts for around 1 in 10 of all cases of IBS. •Females with prolonged illnesses and previous adverse life events are more likely to develop post-infective IBS. •Low-grade inflammatory changes may persist in some of these patients. •Overall prognosis is good with 2 out of 3 recovering over a period of 3-5 years. Reference List 1.McKendrick MW,.Read NW. Irritable bowel syndrome - Post salmonella infection. Journal of Infection 1994;29:1-3. 2.Yeoh KG, Kang JY, Tay HH, Gwee KA, Tan CC, Wee A et al. Effect of Cisapride on functional dyspepsia in patients with and without histological gastritis: a double-blind placebo-controlled trial. J. Gastroenterol. Hepatol. 1997;12:13-8. http://www.med.unc.edu/ibsThe
UNC Center for Functional GI& Motility Disorders3.Gwee KA, Leong YL, Graham C, McKendrick MW, Collins SM, Walters SJ et al. The role of psychological and biological factors in postinfective gut dysfunction. Gut 1999;44:400-6. 4.Rodriguez LA,.Ruigomez A. Increased risk of irritable bowel syndrome after bacterial gastroenteritis: cohort study. BMJ. 1999;318:565-6. 5.Ilnyckyj A, Choudri SH, Duerksen D. Association of travel related diarrhea(TD) with irritable bowel syndrome (IBS): Is post-infectious IBS a true entity? Gastroenterology 1999; 116:A1011-A1011. 6.Neal KR, Hebden J, Spiller R. Prevalence of gastrointestinal symptoms six months after bacterial gastroenteritis and risk factors for development of the irritable bowel syndrome: postal survey of patients [see comments]. BMJ. 1997;314:779-82. 7.Gwee KA, Graham JC, McKendrick MW, Collins SM, Marshall JS, Walters SJ et al. Psychometric scores and persistence of irritable bowel after infectious diarrhea Lancet 1996;347:150-3. 8.Spiller RC, Jenkins D, Thornley JP, Hebden JM, Wright T, Skinner M et al. Increased rectal mucosal enteroendocrine cells, T lymphocytes and increased gut permeability following acute Campylobacter enteritis and in post-dysenteric irritable bowel syndrome. Gut 2000;47:804-11. 9.Bose M, Nickols C, Feakins R, Farthing MJG. 5-hydroxytryptamine and enterochromaffin cells in the irritable bowel syndrome. Gastroenterology 2000;118:A563. 10.Bearcroft CP, Perrett D, Farthing MJ. Postprandial plasma 5-hydroxytryptamine in diarrhea predominant irritable bowel syndrome: a pilot study. Gut 1998;42:42-6. 11.Houghton LA, Atkinson W, Whitaker P, Whorwell PJ, Rimmer M, Fricker J et al. A role for 5-hydroxytryptamine (5-HT) in the postprandial exacerbation of symptoms in femal patients with diarrhea predominant irritable bowel syndrome. Gastroenterology 2003;120:A-67. 12.Parker TJ, Naylor SJ, Riordan AM, Hunter JO. Management of patients with food intolerance in irritable bowel syndrome: The development and use of an exclusion diet. Journal of Human Nutrition & Dietetics 1995;8:159-66. 13.Chaudary NA,.Truelove SC. The irritable colon syndrome. Quart.J.Med. 1962;123:307-22. 14.Harvey RF, Maudad EC, Brown AM. Prognosis in the irritable bowel syndrome: a 5 year prospective study. Lancet. 1987;1:963-5.
I am not a doctor. All information I present is for educational purposes only and should not be subsituted for the advise of a qualified health care provider.
Please make sure you have your symptoms diagnosed by a medical practitioner or a doctor.