Quest, have you ever heard of Post Infectious IBS? Do you know and understand what that really means?also"I call for a complete paradigm shift in the way that we view all disease states."They are doing that now.The History of Functional Bowel Disorders"To understand the historical classification of these disorders, two differing theories relating to theinteraction between the mind and body should be considered.o Holism: a theory built upon the foundation that the mind and body are integratedand utterly inseparable.o Dualism: a theory that proposes a separation between the mind and the body."There are progessing in Holism now and moving away from dualism."PRESENT PATHOPHYSIOLOGICAL OBSERVATIONSDespite differences among the functional gastrointestinal disorders, in location and symptomfeatures, common characteristics are shared with regard
to
motor and sensory physiology,o central nervous system relationships,o approach to patient care.What follows are the general observations and guidelines.MOTILITYIn healthy subjects, stress can increase motility in the esophagus, stomach, small and largeintestine and colon. Abnormal motility can generate a variety of GI symptoms includingvomiting, diarrhea, constipation, acute abdominal pain, and fecal incontinence. Functional GIpatients have even greater increased motility in response to stressors in comparison to normalsubjects. While abnormal motility plays a vital role in understanding many of the functional GIdisorders and their symptoms, it is not sufficient to explain reports of chronic or recurrentabdominal pain.VISCERAL HYPERSENSITIVITYVisceral hypersensitivity helps to account for disorders associated with chronic or recurrent pain,which are not well correlated with changes in gastrointestinal motility, and in some cases, wheremotility disturbances do not exist. Patients suffering from visceral hypersensitivity have a lowerpain threshold with balloon distension of the bowel or have increased sensitivity to even normalintestinal function. Additionally, there may be an increased or unusual area of somatic referral ofvisceral pain. Recently it has been concluded that visceral hypersensitivity may be induced inresponse to rectal or colonic distension in normal subjects, and to a greater degree, in personswith IBS. Therefore, it is possible that the pain of functional GI disorders may relate tosensitization resulting from chronic abnormal motor hyperactivity, GI infection, or trauma/injuryto the viscera.5BRAIN-GUT AXISThe concept of brain-gut interactions brings together observations relating to motility andvisceral hypersensitivity and their modulation by psychosocial factors. By integrating intestinaland CNS central nervous system activity, the brain-gut axis explains the symptoms relating tofunctional GI disorders. In other words, senses such as vision and smell, as well as enteroceptiveinformation (i.e. emotion and thought) have the capability to affect gastrointestinal sensation,motility, secretion, and inflammation. Conversely, viscerotopic effects reciprocally affect centralpain perception, mood, and behavior. For example, spontaneously induced contractions of thecolon in rats leads to activation of the locus coeruleus in the pons, an area closely connected topain and emotional centers in the brain. Jointly, the increased arousal or anxiety is associatedwith a decrease in the frequency of MMC activity of the small bowel possibly mediated by stresshormones in the brain. Based on these observations, it is no longer rational to try to discriminatewhether physiological or psychological factors produce pain or other bowel symptoms. Instead,the Functional GI disorders are understood in terms of dysregulation of brain-gut function, andthe task is to determine to what degree each is remediable. Therefore, a treatment approachconsistent with the concept of brain-gut dysfunction may focus on the neuropeptides andreceptors that are present in both enteric and central nervous systems.THE ROLE FOR PSYCHOLOGICAL FACTORSAlthough psychological factors do not define these disorders and are not required for diagnosis,they are important modulators of the patient's experience and ultimately, the clinical outcome.Research on the psychosocial aspects of patients with functional GI disorders yields three
generalobservations Psychological stress exacerbates gastrointestinal symptoms in patients withfunctional GI disorders and can even produce symptoms in healthy patients (but toa lesser degree).o Psychological disturbances modify the experience of illness and illness behaviorssuch as health care seeking. For example, a history of major psychological trauma(e.g. sexual or physical abuse) is more common among patients seen in referralcenters than in primary care and is associated with a more severe disorder and apoorer clinical outcome. Additionally, psychological trauma may increase painreportingtendency.o Having a functional GI disorder has psychological consequences in terms of one'sgeneral well-being, daily functional status, concerns relating to control oversymptoms, and future implications of the illness (e.g. functioning at work andhome)."
http://ibsgroup.org/groupee/forums/a/tpc/f...710974#19710974Do you know and understand about serotonin in the gi tract? Its function and research into IBS as well?also do you know about some of this?"Irritable bowel syndrome (IBS) has been described as a “functional†disorder, which is a “diagnosis of exclusion.†Thus, many physicians still think IBS has no demonstrable pathophysiologic defects and that it can only be diagnosed after other “organic†disorders have been ruled out with multiple diagnostic tests.Recent data demonstrate the fallacy of this assumption. Irritable bowel syndrome IS characterized by multiple pathophysiologic
defects:Altered gastrointestinal motility (1-2) Visceral hypersensitivity (1-2) Abnormal IL-10/IL-12 ratios consistent with pro-inflammatory Th-1 state (3) Infiltration of lymphocytes and neuronal degeneration in the myenteric plexus (4)
Defects in serotonergic signaling mechanisms in the enteric nervous system of the GI tract (5) Unfortunately,
these pathophysiologic defects cannot be identified by conventional laboratory testing. Therefore, we rely on the symptom-based IBS diagnostic criteria of the ROME committee (i.e., the presence of abdominal discomfort for at least 12 weeks in the past 12 months associated with a change in the consistency/frequency of stool or relief of discomfort with passage of stool) or the American College of Gastroenterology (i.e., IBS is defined as abdominal discomfort associated with altered bowel habits) (1-2). However, the reliance on symptom-based criteria to diagnose IBS should not de-emphasize the pathophysiologic defects expressed by IBS patients."
http://www.gastro.org/wmspage.cfm?parm1=2721Because your not mentioning any of the abnormalites already found in IBS?There is already strong evidence although not completely understood yet about "Defects in serotonergic signaling mechanisms in the enteric nervous system of the GI tract "That help explain d and c and d/c in IBS. It is also important that serotonin is the neurotranmitter that signals sensation to the brain about what is going on in the gut."Dr. Drossman is a Co-director of the Center and Professor of Medicine and Psychiatry at UNC-CH. He established a program of research in functional gastrointestinal disorders at UNC more than 15 years ago and has published more than 250 books, articles, and abstracts relating to epidemiology, psychosocial and quality of life assessment, design of treatment trials, and outcomes research in gastrointestinal disorders. Dr Drossman's comments on foods for IBS Health.Shawn,To say that people with IBS may get symptoms from food intolerances is an acceptable possibility, since the gut will over react to stressors of all types including food (high fat or large volumes of food in particular). Futhermore, there can be specific intolerances. So if you have a lactose intolerance for example, it can exacerbate, or even mimic IBS. Other examples of food substances causing diarrhea would be high consumers of caffeine or alcohol which can stimulate intestinal secretion or with the latter, pull water into the bowel (osmotic diarrhea). The same would be true for overdoing certain poorly absorbed sugars that can cause an osmotic type of diarrhea Sorbitol, found in sugarless gum and sugar substituted foods can also produce such an osmotic diarrhea. Even more naturally, people who consume a large amount of fruits, juices or other processed foods enriched with fructose, can get diarrhea because it is not as easily absorbed by the bowel and goes to the colon where it pulls in water. So if you have IBS, all of these food items would make it worse. However, it is important to separate factors that worsen IBS (e.g., foods as above, stress, hormonal changes, etc.) from the cause or pathophysiology of IBS. Just like stress doesn't cause IBS, (though it can make it worse), foods must be understood as aggravating rather than etiological in nature. The cause of IBS is yet to be determined. However, modern research understands IBS as a disorder of increased reactivity of the bowel, visceral hypersensitivity and dysfunction of the brain-gut axis. There are subgroups being defined as well, including post-infectious IBS which can lead to IBS symptoms. Other work using brain imaging shows that the pain regulation center of the brain (cingulate cortex) can be impaired, as well as good evidence for there being abnormalities in motility which can at least in part explain the diarrhea and constipation. So finding a specific "cause" of IBS has grown out of general interest in place of understanding physiological subgroups that may become amenable to more specific treatments. Hope that helps.Doug "
http://www.ibshealth.com/ibs_foods_2.htmThere is already some excellent hard evidence on IBS. They also see overlap with other function disorders like Functional dyspepsia, which also entails, altered motility, viceral sensation and brain gut axis dysfunction.And looking at CFS and fibro they have made connections as well in the autonomic nervous system, the HPA axis of the brain and bodies stress responce, which is the bodies stress system, but also fights infection. They are working on basically understanding things.The model for IBS incorporates genetics,early life environment, physiologogy (motility and sensation),psychosocial,(life stress, psycological state, coping and social support,)IBs and then treatment outcomes, daily function, and quality of life.This is a holistic approach to the entire BIGGER picture, not dualism, which is a major problem in IBS, because for one its no longer rational that the gut or the brain cause IBS symptoms, but they are both operational to cause the symptoms and hence they both need to be researched for answers. It is not a competition between the two, because they both work very closely together. Its understanding better the connections better, being biochemical or structural or whatever. This is exactly why people are different even from the start of their personal genetic makeup. The environmental aspects are what we are taught and believe about illness, reacting to pain ect., that can effect the person and that is important also, because it can effect treatment and treatment outcomes.You might also want to read this? on page 2 in PDF formatFunctional gi disorders; What's in a name?
http://www.fbgweb.org/2005-spring-fbg-newsletter.pdf
