[iainshaw]

Flux,OK perhaps we have gotten off on the wrong foot here, that was never meant to be the case. I have read what you have to say on several matters and I do think you have very valid points, and obvioulsy have the literature to back them up, and as a scientist I respect that. Now you have got me thinking, and chewing over things you have said in this thread, mostly:-"No, IBS is a diagnosis based on symptoms not on a specific motor physiology. In general, specific dysmotility is something that scientists have not been able to associate with IBS. Even visceral hypersensitivity doesn�t show up in all cases: hence the reason the diagnosis is based on symptoms and the reason the term "spastic colon" was dropped. Once a specific motor problem is found then that is the problem and not IBS."and"No, IBS is a term invented by doctors based soley on symptoms, and it covers what are almost certainly many disparate disorders. In many cases, there is no physical motor correlate in the gut. Once something like "spasms", whatever that really is, is detected, the diagnosis should be changed."Now both the Manning and the Rome criteria for IBS definition refer to pain:-(Manning) Onset of pain linked to more frequent bowel movements(Rome) 3 months of continuous or recurring symptoms of abdominal pain or irritation that May be relieved with a bowel movement, May be coupled with a change in frequency, or May be related to a change in the consistency of stools.Now my questions are what are your thoughts on the pain ? If that pain is brought about by a sudden contraction of the muscles in the gut (a 'spasm') then do you not think that a spasm IS (or should be made) a symptom of IBS (assuming that definate physical recording of the spasm can be made). I realise that pain and 'spasm' on their own would not be sufficient to warrant a 'diagnosis' of IBS, as there are plenty of other criteria to also fill. Do you feel there are other reasons for the pain often associated with an IBS 'diagnosis' ?"Once something like "spasms", whatever that really is, is detected, the diagnosis should be changed.", do you have any suggestions as to what that diagnosis should be changed to ?I would sincerely value your opinionsIainP.S. Stace, as to your comment about misinformation, flux does tag onto his posts:- "I am not a doctor, nor do I work for profit in the medical/pharmacological field, but I have read scientific and medical texts, and have access to numerous sources of medical information that are not readily available to others. One should always consult a medical professional regarding advice received." so you should not assume that what read from flux (or anyone else) is gospel and 'as it is' flux (like myself) read scientific journals and have to form our own opinion on data that we read there, that opinion maybe flawed or any logical assumptions maybe made on flawed original data, so I would say be careful when you are being given misinformation, as I think that would imply a deliberate act, and I don't think anyone would say that flux is being deliberately misleading.

 

[eric]

Iain, did you read this by any chance. http://www.med.unc.edu/medicine/fgidc/hist...aldisorders.htm

 

[DietesVegeta]

I've been on almost every anti-spasmatic drug out there, and I still have them! Sometimes the simplest actions can induce spasms in me...bending to the left for some odd reason...just bending down PERIOD...walking up stairs...being on a moving train sometimes causes spasms (?!?!)When they're happening on their own ( not along with an IBS-D attack ), I just try my best to ignore then ( NOT an easy thing to do!! ). I usually just force myself to stay in motion...go for a walk, go to the gym, etc.They're a big pain in the ###ss to deal with at times, but it's amazing the things we get used to!~Veggie~

 

[eric]

This is part of this."This abnormality is an increased sensitivity of sensors within the bowel wall. This internal hypersensitivity is comparable to what occurs when you have a sunburn; the slightest touch or even breeze can be painful while unburned skin will hardly feel the same stimulus. For someone with the hypersensitivity, normal contraction and expansion of the rectum or colon can result in intense sensations. It therefore appears that most of the symptoms of IBS are due to an excessive perception of internal sensations. Frequently, other symptoms of hyper-sensitivity are associated with IBS. A patient may experience headaches, lower back pain, or pain during intercourse. This may be related to the fact that whatever mechanisms cause the hypersensitivity in the colon can also have the same effect on other parts of the body. Why this hypersensitivity develops is not yet understood. There may be genetic factors that make an individual susceptible to this problem. However, once someone is susceptible, factors in that person's environment become the most important triggers and aggravating forces." http://www.healthcare.ucla.edu/pls/ibs.htm More however has been learned really on this since it was written.

 

[flux]

quote:Now my questions are what are your thoughts on the pain ? If that pain is brought about by a suddencontraction of the muscles in the gut (a 'spasm') then do you not think that a spasm IS (or should be made) a symptom of IBS (assuming that definate physical recording of the spasm can be made).

The definition of IBS is based on the fact that enough patients are reporting similar symptoms that the experts have felt (presumably while enjoying the sights and food in Rome

constitute a single entity they term IBS.The goal is here is to identify a specfic disease state so that doctors in practice can diagnose IBS and follow a specific protocol for treatment.The reason that symptoms are used is largely because there is no one physiological correlate that is present in everyone who reports these symptoms. If it were found to be the case that every IBS subject had a particular abnormal physiological correlate, such as spasms, I think the experts would incorporate this into Rome. At that point, IBS is technically no longer is a syndrome but a disease.In actuality, the Rome criteria as it stands almost certainly includes persons who have something that will ultimately be the "true" IBS and others who have something that is not IBS.Currently, many, but not all, IBS subjects who have been tested have visceral hypersensitivity, which is measured using a barostat in the rectum. These IBS subjects feel pain at slight distension of the barostat while healthy people do not.So it is a possibility that the next "version" of Rome: Rome 3.0 will formally name a specific irritable bowel disease.

quoteo you feel there are other reasons for the pain often associated with an IBS 'diagnosis' ?

Not sure what you mean, the cause of the pain being the result of something other than visceral hypersensitivity? If so, I tend to think that the pain is mainly due to visceral hypersensitivity. However, it is conceivable that a particular person's disease could be affecting motility as well and the two be present simultaneously.

quote:"Once something like "spasms", whatever that really is, is detected, the diagnosis should be changed.", do you have any suggestions as to what that diagnosis should be changed to ?

Currently, our means of studying gut motility is pretty pathetic. The intestine is about 30 feet long but most motility testing looks at just the first and last two feet of that. In addtion, most people with IBS symptoms do not even get these tests. Even with the limited testing, there are a number of specific motily disordersdiffuse esophageal spasmachalasiaGERDgastroparesispseudo-obstructionslow-transit constipationpelvic floor dysfunctionHirschprung's disease

 

[iainshaw]

Flux,Thank you, I feel I have a better understanding now.Iain

 

[d-gasblaster]

Does Flux even have IBS? I never hear him talk about his own symptoms or experiences.

 

[LisaL]

No, he does not have IBS.

 

[d-gasblaster]

That's what I figured

.

 

[iainshaw]

Does it matter ? Iain

 

[whoaIsMe]

Hmmm... this is what I experience: In the morning I have to go to the bathroom over and over, until it seems everything in the lower bowel is out. I can tell because by the 10-15th time all there is is mucous/water, and after that nothing, yet I still have the urge. This is what I have always called spasms... as the colon seems to be still trying to expell things even when there is nothing left. As for pain, sometimes it's painful, sometimes it's not. Pasta for example seems to make it painful. Flux, does this sound like spasms?