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Symptoms Alone Differentiate Between IBS,Organic Disease, And Food Allergy WESTPORT, CT (Reuters Health) Oct 2 - Specific symptoms can distinguishpatients with irritable bowel syndrome (IBS) from those with an organic disease orfood allergy, according to an Italian study. These findings confirm that IBS andallergy are distinct conditions, the investigators write. Dr. Matteo Neri, of the Universita G. D'Annunzio in Chieti, and colleaguesdiagnosed 99 patients with IBS and 79 with organic disease based on clinical andlaboratory evaluation. Another 22 patients with bowel symptoms were diagnosedwith food allergy based on immunological testing. Eighty-eight patients withextraintestinal allergies and no gastrointestinal symptoms served as controls. Patients completed the Bowel Disease Questionnaire, the results of which werecompared to patient diagnoses and subjected to stepwise logistic regression. Thefindings are reported in the September issue of the European Journal ofGastroenterology and Hepatology. Compared with control subjects, patients with IBS were significantly more likelyto report pain relieved by bowel movements, pain in the lower abdomen, pain inboth the lower and upper abdomen, frequent pain, and abdominal bloating. When the researchers compared IBS patients to those with organic GI disease,IBS was significantly associated with straining on defecation, diarrhea andabdominal bloating, while patients with organic disease were significantly morelikely to report pain in the upper abdomen, reflux, and appetite loss. Theinvestigators report that this model "provided near perfect discrimination betweengroups." IBS also differed significantly from food allergy. A diagnosis of IBS wassignificantly associated with pain in the lower abdomen, pain relieved by bowelmovements, pain occurring at least once per week, and abdominal bloating. "I think that doctors in the clinical practice might apply symptoms-based criteria todiagnose IBS," Dr. Neri told Reuters Health. If patients presented with symptomsspecific to IBS, patients would not need to undergo endoscopy, he pointed out. "It will be interesting to apply the same design to see whether food intolerance canbe differentiated based on symptoms," Dr. Neri said. "Will the discriminatingcapability of symptoms resist the confrontation with food intolerance? That wouldbe another story." Eur J Gastroenterol Hepatol 2000;12:981-988.
 

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Anything which continues to help clarify the confusion about "food allergy" vs. the abnormal food and chemical reactions associated with "IBS" as a symptom set is helpful. They are (2) sepaarate phenomena that can overlap, but so many practitioners themselves mix terms that it is a source of perpetual confusion. The reactions to food and additives that occur in IBS (with D and cyclic D&C in particular) are not Type I hypersensitivity reactions (allergies), though these can occur in IBS patients as a separate symptom set.MNL_______________________ www.leapallergy.com
 
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Locke et al (2000), American Journal of Gastroenterology, 95 (1), 157-165 were unable to detect any IBS-specific food "triggers", a result which has been consistently replicated by other authors. Locke et al conclude that... "The lack of specificity suggests that people with IBS have difficulties with food in general. We suspect the IBS causes the food sensitivity rather than vise versa."There is no evidence at this time which supports the view that foods which cause problems for IBS subjects are any different than those which cause problems for people without IBS. The visceral hypersensitivity characteristic of IBS appears to amplify the GI discomfort of the food, not the opposite. There is also no evidence that intolerance to foods (lactose or fructose intolerance, vasoactive amines, etc) is causally linked to the development of visceral hypersensitivity and IBS.
 

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Unfortunately, this is an erronoeus belief. Fortunately for IBS vitims it is not a universal belief upon which patient care is based.Even when one chooses to ignore a body of work going back over 20 years indicating that abnormal immunologic and non-immunologic responses to foods and/or chemicals within food elicit IBS symptoms, the fact remains that in the year 2000 the specific end-point reactions can now be and are daily identified in vitro not only in IBS patients but other symptom sets. And if one is referring to Lockes epidemiologic study published in October..."A comparison of the Rome and Manning criteria for case identification in epidemiological investigations of irritable bowel syndrome."Am J Gastroenterol. 2000 Oct;95(10):2816-24....there is nothing in the protocol of this study which would at all be sensitive to or discriminatory of the role of food intolerance in IBS...this must be an erroneous reference, or there is another study of Lockes in the same issue with a different protocol. One cannot analyze the physiology of food or chemical intolerance with an epidemiologic study, of the design referenced in particular.The failure by some investigators to be able to establish the correct correlations is due to a general lack of understanding of these reactions, what they are, and how to elicit them correctly. This is due to the fact no technology has existed which has allowed investigators to see and learn about these reactions. As has been the case throughout the evolution of medicien, dogma formed from limited technology is again being replaced with new knowledge which is emerging. Even the standard Gel & Coombs descriptions of hypersensitivity reactions are out of date. Depending upon whom one talks to there are now defined either 6 or 8 distinct pathways.The systemic loss of cellular integrity of polymorphonuclear cells results in the local (microvasculature of the small intestine) release of several immunologic mediators with specific known effects on vascular tissue, nerve tissue, epithelial tissue and other circulating cells, such as lymphocytes and platelets. These mediators are not restricted to the microvasculature of the small intestine and the surrounding tissue, this is simply the primary site of effect. This is where allergen is presented initially thus the initial reactivity begins here, and continues throughout the systemic circulation. The postulate that the hypersensitivity of the myenteric plexus causes reactivity to food is 180 degrees backwards. It is (when one looks at what is actually occurring in the GIT microvasculature) the reactions elicited by the foods and additives which produces the altered state of reactivity of the GIT and the neuroimmune system and CNS with which it is integrated. The effects of the specicic mediators preformed or synthesized in these reactions of polymorphonuclear cells is well knwon, and they cannot be released into the plasma without producing these effects.Until now, the specific technology to identify these reactions has not been available, and the methods used to investigate food intolerance used by many investigators are flawed, thus the conclusions are flawed. Even their oral challenge methods are often flawed, as the oral challeng methods used to elicit food allergy are inappropriate to elicit these more subtle reactions. The method for identifiying these reaction is vastly different than the methods of identifying food allergies.While the findings are not in the textbooks yet, since they are so recent and the technology was just patented in the USA 9/05/00, (and a second patent approval granted within the last 14 days on other elements of the technology in reference) it is a little early for a new clinical application to have seen more than its early limited use. So it does exist. So far a limited number of doctors have had the opportunity to witness first hand. That number will increase substantially over the next several years.Fortunately hundreds of patients (so far) have enjoyed the benefits of these new findings, achieved symptomologic remission and reduced or eliminated their need for pharmacotherapy under the dietary care of physicians and dieticians knowledgable in the application of the methods associated with this area of care.MNL_____________________ www.leapallergy.com [This message has been edited by Mike NoLomotil (edited 11-23-2000).][This message has been edited by Mike NoLomotil (edited 11-23-2000).]
 

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quote:Unfortunately, this is an erronoeus belief.
Only when applied to these creatures...
Needless to say, IBSers are human.
 

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Visitors to this planet can read about one of My Favorite Martians, Lisa, from the Nevada Digestive Disease Association, who has been in remission for over 2 months so far, at this thread: http://www.ibsgroup.org/ubb/Forum1/HTML/013431.html __________________________Comment:Until recently, as no star had ever been seen which had a planetary system associated with it, it was dogma that there was was no such thing since no one had ever seen one. Then a new method of detection was developed and the first planet was found. Within a short period of time this dogma was shown to have been a false belief based upon inadequate technology, as now multiple planets have been identified.So dogma dies, like such which preceded it for hundreds of years, back to the time when science affirmed the earth was a "flat plain with a dome above it through which pinholes in the dome allowed light through at night".This type of dogma has always existed within medicine as much as any other science(ie: were there bacteria before people believed there were bacteria because there was no microscope invented?). Over the last 30 years I have been in healthcare, I have personally seen so much medical dogma overturned by advances, and the behaviors of the promulgators of dogma, that it is laughable I should spend time on same.So, this subject is rhetorical since it is dead dogma, and I know it to be so by first hand experience, as do those doctors, researchers, dieticians and lucky patients who have used this new technology and method so far.Fortunately these paractitioners patients are benefitting from the discoveries seen with this newly patented technology as it is applied to their care. Also fortunate for other patients yet to come as advancement continues, not all dogmacrats are responsible for the care of the sick.For dogmacrats of all ilk, keep up the fine work: http://members.tripod.com/~Narf_3/Flat_earth.htm Have a DFD.MNL__________________ www.leapallergy.com [This message has been edited by Mike NoLomotil (edited 11-27-2000).][This message has been edited by Mike NoLomotil (edited 11-27-2000).]
 
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