FYI:Symptoms Alone Differentiate BetweenIBS, Organic Disease, And Food Allergy WESTPORT, CT (Reuters Health) Oct 2 - Specific symptoms candistinguish patients with irritable bowel syndrome (IBS) from thosewith an organic disease or food allergy, according to an Italianstudy. These findings confirm that IBS and allergy are distinctconditions, the investigators write. Dr. Matteo Neri, of the Universita G. D'Annunzio in Chieti, andcolleagues diagnosed 99 patients with IBS and 79 with organicdisease based on clinical and laboratory evaluation. Another 22patients with bowel symptoms were diagnosed with food allergybased on immunological testing. Eighty-eight patients withextraintestinal allergies and no gastrointestinal symptoms served ascontrols. Patients completed the Bowel Disease Questionnaire, the results ofwhich were compared to patient diagnoses and subjected tostepwise logistic regression. The findings are reported in theSeptember issue of the European Journal of Gastroenterologyand Hepatology. Compared with control subjects, patients with IBS weresignificantly more likely to report pain relieved by bowelmovements, pain in the lower abdomen, pain in both the lower andupper abdomen, frequent pain, and abdominal bloating. When the researchers compared IBS patients to those with organicGI disease, IBS was significantly associated with straining ondefecation, diarrhea and abdominal bloating, while patients withorganic disease were significantly more likely to report pain in theupper abdomen, reflux, and appetite loss. The investigators reportthat this model "provided near perfect discrimination betweengroups." IBS also differed significantly from food allergy. A diagnosis ofIBS was significantly associated with pain in the lower abdomen,pain relieved by bowel movements, pain occurring at least once perweek, and abdominal bloating. "I think that doctors in the clinical practice might applysymptoms-based criteria to diagnose IBS," Dr. Neri told ReutersHealth. If patients presented with symptoms specific to IBS,patients would not need to undergo endoscopy, he pointed out. "It will be interesting to apply the same design to see whether foodintolerance can be differentiated based on symptoms," Dr. Nerisaid. "Will the discriminating capability of symptoms resist theconfrontation with food intolerance? That would be another story."Eur J Gastroenterol Hepatol 2000;12:981-988. ------------------ http://www.ibshealth.com/
Symptoms Alone Differentiate Between IBS, Organic Disease, And Food Allergy
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It is great to see that they are taking a look at this eric and trying to decern the differences without the sometimes unnecessary invasive testing. Of course things become complicated when some or all of these symptoms are involved. Perhaps it is then one should look at what other factors may have been involved at the time of oncet/change in symptoms. It appears that they still don't have a handle on this. With me, for instance, (I hate to talk about me all the time, but it is the only one on this board whose symptoms I can be sure of), I apparently was sensitive to citric acid/acid based foods in general, as a child, since I felt pain and perhaps a swelling sensation after a meal of spaghetti and a vinegar salad. Then I had difficult evacuation and slow transit along with abdominal discomfort when I was diagnosed with IBS. I was on birth control pills at the time, and the switch in hormones may have had something to do with it. When I went off to get pregnant and added fiber to my diet, I was able to manage the constipation, but still on occasion had that familiar ache near the left, lower side of my navel. Then 20 some years later after being on prolonged antibiotic therapy, I developed fullness, gas/bloating distention, and the frequent soft-stooling cycle with rectal pain. This was apparently the side-effect of the fungal take-over as the antifungal worked at eliminating the soft-stooling and rectal pain that was associated with it, along with a good share of the bloating, and distention. The abdominal pain and distention was reproduced with the provocative double-blinded sublingual challenge. The antigen drops took this effect away (with both the mold drops and the food additive drops). If it hadn't been taken away with the antigen drops, perhaps the delayed response of the spasming and stooling would have developed also, and perhaps the rectal pain that went along with it. The allergen and the infection response along with the "IBS" response is still not clear to me, nor do I think from this article that is totally clear yet. (IMHO)
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These findings can provide helpful guidelines for clinicians to discriminate "food allergy" (Type I IgE mediated reactivity), from IBS as highly reliable tests for Type I IgE food allergy are just not available. Existing tests based on various methods for identification of allergen-specific IgE are at best 50% positively predictive of actual food allergy...they create too many false positives. While elimination diets based on them will often be effective at reducing symptoms, the diet usually excludes foods unnecessarily (in the context of Type I G&C reactions), and by statistical probability removes some foods to which the patient may be experienceing non-Type I (non-ALLERGY) responses.Oral challenge for Type I food allergy is best, but not easily implemented by the average PCP. On the other hand, in practical terms, almost without exception by adulthoood (when most but not all IBS patients present themselves for treatment as pain or lifestyle compromise has become intolerable) anyone with actual FOOD ALLERGY ALMOST ALWAYS ALREADY KNOWS IT ANYWAY. Since they have had a lot of time to experience eating a food that makes them sick immediately after eating it! The sign of true food allergy. So the adult patients almost always present with acurate knowledge of actual food allergies, if any.The incidence is around 3% in the general population, and the higher incidence of true food allergy existing as a complicating factor in 'IBS" is speculative, but higher than 3%.The food or chemical intolerance associated with IBS, which is much more difficult to nail down, is a multi-pathway (immune mediated as well as non-immune mediated pathways) delayed hypersensitivity reaction, often dose and frequency related as regards clinical symptoms, and is referred to by many names defined differently by different clinicians. So these delayed-onset reactions have been lumped-together by some under the general term "delayed-allergy".Oral challenge discrimination is very difficult, but can be accomplished with a precise dietary regimen and extreme patience. This has led to several decades of research seeking better means, a shortcut if you will, via in vitro testing. Several in vitro tests have been used to isolate the offending substances by assessing the delayed-reactions in vitro, and have met with varying degrees of success. The newest test, patented in 2000, was developed to overcome the technical deficiencies of the prior methods and yields more clinically useful results quickly as compared to long term oral challenge methods (Mediator Release Test or MRT). Removal of foods and chemicals isolated by the method, in patients with symptomologic sets associated with non-Type I food intolerances, identified by the test results in symptomologic improvement by removing the underlying reaction which releases mediatiors which underly the hypersensitivity of the gut and its neuroimmune complex.MNL_____________________ www.laepallergy.com
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