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Discussion Starter · #1 ·
Does this strike a chord with anyone else ? It's the nearest description I've found to my own case, although by no means an exact match, and I'd welcome reports as to how others cope with specifically this type of problem.http://www.ibs-research-update.org.uk/IBS/mmd1ie4.html"Midgut Motility Disorder...Although common, this variant of IBS is in our experience the most difficult to treat......abdominal pain - often right sided - and profound abdominal bloating are typical symptoms. Sufferers often feel very full after meals. Alternatively they feel hungry but get full and bloated after not much more than a mouthful......They do not have any real disturbances of bowel action, and none of their symptoms are relieved by opening their bowels or passing wind, which distinguishes them from the other two groups." (That would be IBS-D & IBS-C) - mekis"Symptoms are thought to arise as a consequence of abnormal motility and sensation in the small or middle intestine. There is evidence that contents in the small intestine move slower than normal from the small intestine through the valve mechanism between the small intestine and the colon (ileocaecal valve) into the colon. This results in pooling of contents in the lower regions of the small intestine, an effect that leads to distension and pain at this site."(Note that this hypothesis is in no way linked to the nonsensical alt/comp med notion of "ileocaecal valve syndrome") - mekis"We have had some success in treating patients with the prokinetic agent Cisapride. Unfortunately, this drug has been withdrawn recently because very rarely it causes irregularities of heart rhythm and is only available on a 'named patient basis' for selected patients....Maxalon (metoclopromide) and Motilium (domperidone) are less effective. The antidepressant paroxetine (Seroxat; Paxil)...also promotes movement through the small or middle intestine by directly effecting motility......Patients with this varient of IBS often consider that they are 'allergic' or 'sensitive' to various different foodstuffs. In our opinion, though, the intestines of these patients are likely to be 'sensitive' to the effects of eating per se."The whole article is worth reading, IMO.
 

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I suffer from most of that except my bowels are disturbed a lot most of the time. But even when they are not I still have all the pain and bloating etc that goes along with IBS. Interesting too that once my doctor said to me that he suspected I have problems with my small bowel rather than my large one. I couldn't be treated with the heart problem drug though if it was the case as I have a heart murmur, and I've been on Paxil. It was the best thing for my IBS until it started interfering with my hormones and I got all sorts of weird side effects!Have you raised this with your doctor at all?
 

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Discussion Starter · #3 ·
I shall show a print out from the site to my GP shortly. After a rocky start he's proving to be quite helpful, very open about what he doesn't know. Quite different from the various "specialists" I've seen over the past couple of years.....He was in any case about to start me on one of the SSRIs, hopefully Seroxat, and I shall ask him about his policy with Cisapride - I always like to be have a plan for at least 2 treatment options or experiments in advance, otherwise you spend all your time waiting, waiting, waiting....
 

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quote:We have shown that in this variant, small intestinal motility and sensation is very abnormal and that patients have normal colonic motility.
Unfortunately, it doesn't tell us who the authors are or where they wrote this up. I don't immediately recognize any specific paper naming or even referring to any novel motility disorder. It also doesn't say how motility and sensation are abnormal.The most common abnormalities, which are not IBS, seen are inability to convert to fed state and lack of phase IIIs. Both of these indicate pseudoobstruction.
quote:The alternative prokinetic agents Maxalon and Motilium are less effective.
Does this mean that erythromycin, neostigmine or octreotride were not tried?
quote:Accordingly we advise patients to eat small frequent meals
It is not really clear how this would help. That would (in a healthy person) put the gut in a perpetual fed state.
 

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Discussion Starter · #5 ·
(long drawn out sighhhhhhhhhhh)Flux - I guess you didn't bother to follow the link, but relied solely on my (necessarily selective) extracts. It's a summary page, not a scientific paper. By concentrating on what isn't there, you miss the point. We haven't all got what you've got; if you have nothing constructive to say, say nothing, and let the rest of us try to solve our problems collaboratively.I'd still like to hear from anyone who feels that their symptoms may fit into this category.
 

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quote:It's a summary page, not a scientific paper.
Of some unknown paper or is it?
quote:By concentrating on what isn't there, you miss the point.
What's not there is the point.
quote:fit into this category
What category? The article doesn't tell us.
 

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MekisI found your post and the attached link to be very interesting. It 'feels' almost like me. In fact that is how I have been describing my symptoms to the doctors/consultants for years, but I do think that they see IBS as a catch-all phrase and don't seem to appreciate the tremendous variation there is between different people who all suffer from the 'same' thing. As it happens, I was going back to the GP on the 11th January (nearest appointment can you believe?!) to ask her for some kind of extra help, because although the Motilium helps partially + the Lansoprazole + the Aloe Vera and Acidopholus, I also tend to get really anxious with it and I had worked out in my head (sor of) that if I had some kind of tranquiliser or something, then perhaps my digestion would calm down a bit and be a bit less awful, so when I read the link I thought what a great idea it would be to print it out and bring it with me, so thanks for that.Even though I go to the loo every morning, it doesn't releive my symptoms at all. I am bloated and in pain all day and it seems to move upwards as the day goes on. By the time I get to bed, I usually have really bad wind (yeah nice ennit?!) and then pray that it won't also go up into my chest. I suffer with GERD and have in the past, suffered with 2 and 3 days long 'heart attack' type pains. It's really awful and so I thought that if I got some kind of 'chill out' medication, then at least I might sleep. I seem to sleep with my brain still on full alert and am often awake 4 or 5 times during the night. Tough when you have a days work ahead of you.Anyway, thanks for info...
 

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quote:also promotes movement through the small or middle intestine by directly effecting motility......
Yeah the small bowel.I think the fermentation comes from there.Also the pill camera is approove for IBS now so it maybe a good idea.
 

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Discussion Starter · #9 ·
Wotsupdoc - the most helpful thing about the article as far as I was concerned was that it described, or at least postulated, a subtype of IBS where neither constipation nor diarrhoea were predominant symptoms. I had previously been doing my nut when being dismissed by doctors with an IBS diagnosis, yet not finding any point of reference with either the textbooks or the BB posters.It's interesting you mention chest pain as a symptom. That's something I get, but only in response to exercise, although it is now so severe as to curtail even light exercise. And it's also resistant to lansoprazole & any other PPI or antacid. Any similarities ?I (briefly & ephemerally) tried diazepam on the basis of your theory, but without success. I find whisky more effective now - after not drinking for years, but I decided I needed some form of chill out help....Spasman - yeah, I think eric posted something scientific recently regarding abnormalities of gas propulsion in the small intestine, and its relation to bloating. And you posted something about mebeverine promoting motility in the small intestine.With that in mind, has anyone successfully used mebeverine to deal with bloating in the absence of D & C ? (And I'm having trouble finding pharmacological info on mebeverine for some reason, so if any of the knowledgeable can tell me how it works, ie via which receptors, I'd be most grateful!)
 

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I was able to determine the source of information is this paper,http://www.ncbi.nlm.nih.gov/entrez/query.f...l=pubmed_docsumThe paper is comparing swaths of individuals with gut symptoms and attempting to categorize them based on both symptoms and findings based on specific motility measures.However, the study sort of chases its own tail because it's not clear if they invented the groups before or after the study. It is also not clear if the measures them made, counting peaks of phasic contractions, comparing amplitudes of phasic contractions, and a generalized index of gut activity means much in terms of pathophysiology.Anyway, they basically found that persons who they say have this midgut motility disorder have essentially normal colonic function. I don't think their measurements measure transit, so one could only infer the transit of these individual is normal.They only allude to the differences in small bowel motility, but they say they are similar to that found in pseudoobstruction, which in my understanding includes:1) inability to convert to fed state2) absence of phase III3) innefficient transit independent of 1 and 2 related to inefficient peristalsis.However, they haven't as far as I can tell presented actual data confirming this.It doesn't say anything about esophageal or stomach motility in these individuals and it doesn't appear they studied that.I think their conclusion is that this midgut motility disorder is basically a form of neuropathic pseudoobstruction confined to the small bowel.Generally, pseudobstruction is thought of as panenteric and when it is confined to the large intestine as either colonic inertia or slow transit constipation. Having it confined to the small bowel is not ordinarily considered a clinical entity.
quote:mebeverine for some reason, so if any of the knowledgeable can tell me how it works, ie via which receptors
In a fashion similar to phosphodiesterase inhibitors like Viagra. Of course, you would not want this drug to treat a condition similar to what I described above. You want some sort of prokinetic agent.
 

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Discussion Starter · #11 ·
Although I have learnt from other BBs not to feed the trolls, I consider the behaviour of flux here to be pretty much beyond the pale. More than 9 thousand posts on this site - although, from the ones I've seen, not a positive, constructive or helpful one amongst them. Merely ego feeding. "I...utilise information not available online to ensure accuracy" he (rather pompously, in my view) tells us. Yeah, I've got a book too. Loads in fact. And, I can even read them. And I have 15 years experience of research in the pharmacology of gut smooth muscle - published loads, in fact, on novel transmitters in the colon - purinergic & peptidergic mostly - although flux, in his infinite wisdom, has attacked me & each of my posts every time I've said so, and for not proving the case or (initially) posting up a list of my symptoms. Why the F should I want to identify myself to my previous coworkers with my current illness ? I do value my privacy, but also felt I could contribute something here; and, yes, unlike those who clearly know *everything* about ibs, and can learn nothing from others, I needed to learn about the condition as there were aspects of my illness that did not fit with anyone else here or in the textbooks.And finally, after 2 years of searching, I found something which described a set of symptoms with some correlation to my own situation. But of course knowitall here has to poison the attempt to generate discussion & learn something new by shouting it down in his usual fashion. It beats me why the moderators permit it, but I guess I'll have to give up on this thread.Thanks a lot, for spoiling my one and only chance of comparing notes on my condition.Incidentally, the site I originally posted up was run by a reputable prof, leader of a team of IBS researchers at Middlesex Hospital Medical School, London. Maybe it's because it's British that flux hates it so.
 

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MekisDon't shut down on this thread. I, for one, am very interested in it - as I am sure are lots of other members here.I don't have time to post further tonight. Getting late and have been at the hospital with a sick member of the family, so my mind isn't really with it, but will reply to your earlier post soon.
 

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Discussion Starter · #13 ·
Wotsupdoc - Thanks for the support! Positive cooperation is much more likely to achieve success than sheer negativity.Has anyone had any personal experience of, or been referred to, this Professor Silk (whose team are responsible for the originally posted website concerning, amongst other things, Midgut Motility Disorder), at the Middlesex Hospital in London?
 

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Discussion Starter · #15 ·
The Cat - good to have more support!I've spoken to my GP today, and have 2 months worth of Seroxat (20mg) to see what that does, prokinetically. He's also willing to give Cisapride a go after that, and also an antibiotic clearout, and surprisingly brought up the topic of candidiasis, so I guess some kind of antifungal treatment might be #4 on the list. And, yes, I know the SIBO &/or Candida treatments/hypotheses are (to say the least) somewhat controversial, but I'll discuss them in detail with him, & decide in due course. So *please* no pantomime-style "Oh yes it is"; "Oh no it isn't" replies here.(On the downside, I *may* have 2 months worth of Seroxat-induced low libido to look forward to.....)
 

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quote:He's also willing to give Cisapride a go after that,
Cisapride is no longer considered a safe drug and there are other safer drugs that do the same thing.
 

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Discussion Starter · #17 ·
Hi FluxI get conflicting reports on cisapride. Most of the stuff that comes up via internet searches talks about it, by itself, being dodgy - for some people - through cardiac arrhythmias. My GP, when I asked him about it on the phone today, said that it was a problem in combination with some antibiotics (erythromycin, I think). By implication, I assume he means it's not considered a problem by itself. Of course, its status may well be different in the UK as compared with the US - drug safety is not an absolute, more of a statistical calculation (how else do you justify the existence of actuaries & their salaries ?!).I'm not sure which drugs you have in mind that are safer & do the same thing. Domperidone & metoclopromide, both D2 antagonists, don't do much *for me*, despite repeated trials. As I understand it, cisapride, in addition to its D2- effect, is also supposed to have a 5HT4+ action; so theoretically, as well as practically, cisapride may well be worth trying for me. And tegaserod is not without its own problems.Of course, nothing will be decided on a whim; but I will weigh up information from many sources before deciding on a course of action. Further comment welcomed.
 

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Hmmmm flux,Cisapride
Pharmacist researcher please continu your good work.
 

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The effects can occur on their own, but they are more likely when taking certain drugs, such as erythromycin that interfere with its metabolism.So Cisapride has been taken off the market by Janssen, the manufacturer, in all countries as an ordinary prescription drug AFAIK. In the US, it is available only through some sort of limited access program in conjunction with the FDA. I'd be surprised a GP could just give it to you without the company's approval and would without trying every other option first.It probably wouldn't hurt to have your condition more fully evaluated by having a gastric emptying scan, electrogastrogram and antroduodenal manometry done.Drugs like erythromycin and octreotride can influence small bowel motility. There are some other drugs for treating constipation, but they probably don't effect small bowel motility as much.Finally, cisapride gave "birth" to two other drugs, mosapride and itopride. Itopride appears to be safe and effective and it appears that it will be approved by the FDA in 2006. Mosapride is identical to cisapride minus the bad cardiac effects. I'm not certain it will become available. I believe both drugs are already available in some other countries, Japan, of course, where the drugs were invented.
 

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Discussion Starter · #20 ·
Hi fluxI don't think any of the fancy upper GI tests are appropriate, or likely to be called for in my case. I've had an op to remove a "giant duodenal diverticulum" (actually not that big - maybe 4 cm) which was, in my opinion at least, more of a result of increased pressure in the small intestine, than a cause of my problems. Also had 2 gastroscopies, pyloroplasty (probably misguided, but my idea, mea culpa,), and small intestine barium follow through.The cisapride daughter drugs aren't on line, so aren't relevant at present.Like I said, cisapride ain't the first thing we're trying; but my symptoms are severe & debilitating & thus it will be worth trying nevertheless.I'm happy as a pharmacologist to follow the seroxat => cisapride => antibiotic (for possible SIBO) => mushroom-munching timescale.Your "signature" slogan refers to "bacterial overgrowth".I want to know more about this, and short-term antibiotic treatment thereof, but can you give me a brief summary &/or a good ref without proselytising?
 
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