# The causes of IBS are fairly well know - you just need a doc that will test for them



## betterthroughscience (Jan 13, 2006)

This is a great article in the journal Gut.http://gut.bmjjournals.com/cgi/content/full/53/10/1391The quote from it that you need to see is this:In common with allergic disease, IBS appears to result from an interplay between susceptibility genes and impaired gut barrier functions, immunological dysregulation, together with bacterial and viral infections and other environmental factors. There are tests that can be done to determine the underlying factors leading to your IBS. Real food allergy testing (done by a competant lab that has demonstrated reproducibility); stool testing for bacterial imbalance, infection, and parasites; and other tests can be used by a competant doctor to help you end your IBS. I see it all the time.


----------



## eric (Jul 8, 1999)

From the one study"Food elimination based on IgG antibodies *may be effective in reducing IBS symptoms * and is worthy of further biomedical research. "What do these numbers really mean?"Results: After 12 weeks, the true diet resulted in a 10% greater reduction in symptom score than the sham diet (mean difference 39 (95% confidence intervals (CI) 5â€"72); p = 0.024) with this value increasing to 26% in fully compliant patients (difference 98 (95% CI 52â€"144); p<0.001). Global rating also significantly improved in the true diet group as a whole (p = 0.048, NNT = 9) and even more in compliant patients (p = 0.006, NNT = 2.5). All other outcomes showed trends favouring the true diet. Relaxing the diet led to a 24% greater deterioration in symptoms in those on the true diet (difference 52 (95% CI 18â€"88); p = 0.003). "How much better and what symptoms?I would also like to see all these researchers debating thisComment in: Gut. 2004 Oct;53(10):1391-3. Gut. 2005 Apr;54(4):566. Gut. 2005 Apr;54(4):567. Gut. 2005 Aug;54(8):1203; author reply 1203. http://www.ncbi.nlm.nih.gov/entrez/query.f...pubmed_AbstractAlso From one of the authors who I am very familar with in IBS Dr Whorwell. Who in the last twenty years has shown Gut directed Hypnotherapy is one of the statistically most effective treatments to date." Curr Treat Options Gastroenterol. 2004 Aug;7(4):307-316. Related Articles, Links Dietary Treatment of the Irritable Bowel Syndrome.Whorwell P, Lea R.Education and Research Centre, Wythenshawe Hospital, Manchester, M23 9LT, United Kingdom. peter.whorwell###smuht.nwest.nhs.ukMost patients with functional gastrointestinal disorders report that food ingestion appears to exacerbate their symptoms and consequently conclude that they have some form of gastrointestinal food allergy or intolerance. Dietary management of functional gastrointestinal conditions is an attractive therapeutic option for the patient and physician alike because it is safe and economical and empowers the patient to help themselves. However, in practice, dietary manipulation frequently yields rather disappointing results. Exclusion diets can be helpful, but are labor intensive and occasionally can be very restrictive. Laboratory testing for immunoglobulin E food antibodies usually is not helpful, except in a small subgroup of patients with diarrhea, predominant irritable bowel syndrome (IBS), and atopy. There is some preliminary evidence to suggest that elimination diets based on immunoglobulin G food antibody testing may possibly have *therapeutic* potential in IBS, but this *requires confirmation*.PMID: 15238206"bacterial and viral infections " are post infectious IBS and leading to Clinical IBS, because a diagnoses of a parasite or a virus or bacteria, WOULD RULE OUT AN IBS DIAGNOSES!!!!


----------



## eric (Jul 8, 1999)

> quote:The causes of IBS are fairly well known


Integrated Approach to Irritable Bowel SyndromeThis is an online CME course featuring Dr. Drossman http://www.ja-online.com/dukeibs/#Informative public television broadcast on IBSView it from the link below.http://www.itvisus.com/programs/hbhm/episode_ibs.aspReport from the 6th International Symposium on Functional Gastrointestinal Disordershttp://www.iffgd.org/symposium2005report.html"Visceral Sensations and Brain-Gut MechanismsBy: Emeran A. Mayer, M.D., Professor of Medicine, Physiology and Psychiatry; Director, Center for Neurovisceral Sciences & Women's Health, David Geffen School of Medicine at UCLAIntroduction Over the past several years, different mechanisms located within the gut, or gut wall have been implicated as possible pathophysiologic mechanisms underlying the characteristic IBS symptoms of abdominal pain and discomfort. The list ranges from altered transit of intestinal gas, alterations in the colonic flora, immune cell activation in the gut mucosa, and alterations in serotonin containing enterochromaffin cells lining the gut. For those investigators with a good memory, these novel mechanisms can be added to an older list of proposed pathomechanisms, including altered gut motility ("spastic colitis") and alterations in mucus secretion. While the jury on any of these novel mechanisms is still out, one unique aspect about the gut and its connection to the brain are often forgotten: Our brain-gut axis is not designed to generate conscious perceptions of every alteration in gut homeostasis and internal environment, in particular when these changes are chronic, and when there is no adaptive behavioral response an affected organism could generate. "http://www.aboutibs.org/Publications/VisceralSensations.html


----------



## flux (Dec 13, 1998)

> quote:I see it all the time.


We "see" an awful lot of IBS here, yet we don't see this *ever*. So how can you see it?


----------



## Talissa (Apr 10, 2004)

I have the very strong feeling the problem, esp with post-infectious IBS, may be similar to what they're finding in crohn's disease(just to a lesser degree). This would be due to the decreased beneficial bacteria in IBS & IBD intestines~~"In Crohn's disease, abnormal activation of mucosal T lymphocytes against enteric bacteria is the key event triggering intestinal inflammation." http://www.ncbi.nlm.nih.gov/entrez/query.f...l=pubmed_DocSumBtw, in the above study, L. casei helped lower inflammation..."In conclusion, L. casei reduces the number of activated T lymphocytes in the lamina propria of Crohn's disease mucosa. A balanced, local microecology may restore immune homeostasis."If only they could tell us the exact strain of L casei used, and where to buy it...


----------



## eric (Jul 8, 1999)

FYI"Probiotics may ease gut disorders Numerous probiotics are available Probiotics may help ease gut disorders linked to long-term stress such as Crohn's disease, research suggests. A team at Canada's McMaster University analysed gut tissue taken from rats put in stressful situations. Animals fed drinking water containing probiotic bacteria showed less signs that harmful bugs were mobilising to cause damage. The gut study suggests probiotic bacteria literally crowd out their harmful peers. As we cannot always remove stress, it would be helpful if we could find new ways to ameliorate its effects Professor Alastair Forbes Chronic stress is known to be implicated in the development of irritable bowel syndrome and in the worsening of symptoms of inflammatory bowel disease, such as Crohn's and ulcerative colitis. *It also sensitises the gut, producing allergies to certain foodstuffs.* "http://news.bbc.co.uk/2/hi/health/4938020.stmThis is an expert on Post infectious IBS. This is an excellent article and I am posting a small part on new Probiotic research.Post-infectious Irritable Bowel SyndromePosted 12/08/2005Robin Spiller; Eugene Campbell "Anti-inflammatory Effect of Probiotics"There have been several previous studies in IBS with mixed results, but the most recent one used the same two probiotics, L. salivaris and B. infantis, as McCarthy et al..[30] Only B. infantis was demonstrated to improve composite symptom scores as well as abdominal pain, bloating and distension.[33**] Like previous studies, this showed a small improvement in symptoms but, unlike previous studies, they also demonstrated a mechanism by measuring the release of cytokines by peripheral blood lymphocytes. They showed that at baseline IBS patients had a depressed interleukin-10/interleukin-12 ratio and that the active probiotics normalized this ratio. Since interleukin-12 is recognized to be a key proinflammatory cytokine, while interleukin-10 is anti-inflammatory, this imbalance may be important. The study certainly needs repeating, but this is the first study in which alterations in mucosal inflammatory mediators have been demonstrated to relate to improvement in symptoms (for review see)[34].""ConclusionStudies of patients with PI-IBS over the last 2 years have been reviewed which demonstrate low-grade inflammation in the mucosa with increased inflammatory mediators, including serotonin and cytokines. Studies in other IBS groups have also shown increased mast cell numbers and in some cases increased release of mediators such as mast cell protease and histamine. This is plainly an active area in which significant advances with application to clinical practice can be expected in the foreseeable future."http://ibsgroup.org/eve/forums/a/tpc/f/761...m/686106671/p/9BY the way"Some of the major research advances that support the integrated or biopsychosocial approach include: "*"Demonstration of post-infectious IBS as a brain-gut disorder"*http://www.iffgd.org/symposium2005report.html


----------



## betterthroughscience (Jan 13, 2006)

"I see it all the time" What I meant was, I know a doctor who gets people well all the time. They have been diagnosed with IBS, he further diagnoses them with what they have, food allergies, bacterial problems, etc. He treats those problems and the patient gets back to normal. That is what I mean. The studies that "Eric" points to are good studies demonstrating that food allergies are the problem for some patients. If you read further in those studies you see that they only tested for a few foods, just a few. Even eliminating just those few foods had substantial impact on symptoms. Imagine if they had actually identified all of the food sensitivities for those patients. When my friend does just that, he gets good results. But not all patients with IBS have food allergies. Those with other problems need other treatment.


----------



## betterthroughscience (Jan 13, 2006)

"Eric" includes some great citations about treating bacterial problems. What is most infuriating to me is that few doctors who diagnose IBS go to the next step and test their patient for bacterial problems. How many of you with IBS have had a stool test for comprehensive bacteria? How many got treatment to kill off or crowd out the bad bacteria and increase the number of good bacteria?


----------



## betterthroughscience (Jan 13, 2006)

Flux: What do you mean you don't see it? Do you mean that you don't hear from patients that get treated and end their IBS? I suppose that may be because most doctors are not testing patients for food allergies by the only technology shown to be effective to measure the IgG antibodies that are important in IBS (blood serum testing by a lab using ELISA techniques under tight quality control). And most doctors are not testing patients for bacteria, infections and parasites. I have a friend who had IBS for more than 10 years. He went to many doctors, Gastroentros etc and never had a stool test for bacterial balance or a food allergy test. He had lots of biopsies and colonoscopies, but his problem was actually a small set of food allergies. Once he stopped eating the foods to which he was allergic, his symptoms stopped. He hasn't had IBS for about a year and a few months. Nice guy, prominent architect. Happy to have finally found a doctor that will test for these things that are known to cause IBS.


----------



## betterthroughscience (Jan 13, 2006)

Zar, Sameer; Martin J. Benson; and Devinder Kumar (2005). Food-Specific Serum IgG4 and IgE Titers to Common Food Antigens in Irritable Bowel Syndrome. American Journal of Gastroenterology 2005; 100:1550-1557Solid study in prestigous journal showing direct relationship between specific food allergies and IBS.


----------



## eric (Jul 8, 1999)

FYI Rev Gastroenterol Disord. 2006 Spring;6(2):72-8. Related Articles, Links A unifying hypothesis for the functional gastrointestinal disorders: really multiple diseases or one irritable gut?Talley NJ.Clinical Enteric Neuroscience Translational and Epidemiological Research Program, Mayo Clinic College of Medicine, Rochester, MN.The functional gastrointestinal disorders are defined by the Rome criteria as a heterogeneous group of symptom-based conditions that have no structural or biochemical explanation. However, this definition now seems outdated, because structural and molecular abnormalities have begun to be recognized in subsets of patients with the irritable bowel syndrome (IBS), the prototypic functional bowel disease. A complex classification system based arbitrarily on symptom criteria does not fit in with a number of emerging facts. For example, the symptom overlap of IBS with gastroesophageal reflux disease is not due to chance, and the emergence of post-infectious IBS, dyspepsia, or both after Salmonella gastroenteritis fits better with a 1-disease model. A new paradigm seems to be needed. All of these disorders may arise after infection or gut inflammation, but the phenotype depends on localized neuromuscular dysfunction in the predisposed human host (the "irritable gut").PMID: 16699476 Full TextExpert Opinion on Therapeutic TargetsJune 2006, Vol. 10, No. 3, Pages 351-353 (doi:10.1517/14728222.10.3.351)Current targets in irritable bowel syndrome: an interview with Eamonn Quigley http://www.expertopin.com/doi/full/10.1517...351?cookieSet=1


----------



## jjohnson (Apr 29, 2004)

Eric,I got an error message when I clicked on the Expert Opinions article. Is there anything you can tell us about the contents of the article, such as what the most promising targets are, for instance?


----------



## eric (Jul 8, 1999)

jjohnson. that link is a good link. Try it again and see what happens or perhaps a program is keeping it from opening. If not I will post somethings about it. It should work though.betterthroughscienceWhy is IBS more prevalent in women?Why is there mild, moderate and severe IBS?Your also asking people to get tested for a whole lot of things that could turn out to be very expensive and not lead anywhere. If they get all that food testing done, which costs how much? Then you say some people don't have food reactions but another cause for there symptoms and I bet the testing can go on for a while with that route.Also your center is the only one that say's they "cure" people. IF that is the case then it needs reproduction from IBS research centers. Correct me if I am wrong but your center doesn't do research right? Your just telling us people get better. Have you ever check on those people a year later or two years later or five?They actually know more about IBS then your even giving the researchers credit for and IBS is one of twenty five functional gi disorders, that can and do overlap and may have the same mechansims.I always find it odd that IBS, probably because its common, is the one all these food allergies and candida and such cause, because you don't see that being said with the other twenty four functional gi disorders they research along with IBS, like functional d or functional c or functional chronic gut pain. Or some of the others.IGA research is a good thing and so are thousands of other studies, but it all needs to be put into a better persceptive and a bigger picture.


----------



## jjohnson (Apr 29, 2004)

Eric,I did manage to retrieve the article. Thanks. Also, have you seen the DDW website? If you look at the Tuesday schedule there will be some presentations on Rome III which also feature the Dr. Talley article, which seems to suggest that symptom-based diagnostic criteria (like Rome) are at least beginning to become outdated. Any thoughts on the subject? Thanks in advance for any reply.http://ddw2006.abstractcentral.com/planner


----------



## betterthroughscience (Jan 13, 2006)

eric, In response to you query:Yes, we have quite a number of patients who have been IBS-free for several years, some as many as 5 years or longer.It is true that testing can be expensive. So is buying over the counter remedies, missing important business meetings, losing out on life events, and generally being in pain for years.I am not saying that there is anything wrong with the huge body of research. What I am saying is that it has not been translated into logical protocols for diagnosing and treating patients. The reasons are many and probably have more to do with politics, finances, complexity, etc. If the research has shown (and I think we all agree that it has) that there are things that you can do that have a substantial impact on IBS, then why not do them. Test patients for the immune system challenges that we can identify and address. We would welcome other researchers to duplicate our protocols and see what results they get.While we are not actively engaged in a research study at the moment we have formed a non-profit to do that research and are working with Dr. Heitkemper at the UW and others to fit research in as we can. As you know, it is much easier to get funding (research is very expensive) for things that might possibly lead to a pharmaceutical solution. Since the treatment of food allergies and bacterial issues don't lend themselves to new profit centers the sources of potential funding are quite limited, especially in the US. The UK and other nations seem to be willing to do this kind of research more often, probably because they have nationalized healthcare.Our clinic does say we cure IBS. For patients that have a bacterial infection/imbalance we are able to return them to normal and their IBS is over. I think that qualifies as a cure. Their genetics may still make them susceptible to recurrence of the imbalance in the future, but most of our long term patients have not had that problem. One might not call it a cure if we find the patient has both bacterial issues and food allergies because we don't make the patient un-allergic. However, if the patient addresses all their issues and stops eating the foods they are allergic to, they don't have IBS symptoms anymore so one might call that a cure. I would, and I know you wouldn't. In either case, most people, given the choice, would rather get to the point of not having IBS, even if it means giving up some foods. If not, that is their choice.


----------



## eric (Jul 8, 1999)

jjohnson, I have seen the ddw website.On rome 3 I have tried to get some info, but they were still working on it and I guess I don't rate high enough for them to tell me yet. LOLI am interested in this quite a bit, especially because whereas in the past they couldn't find biochemical or structural abnormalities, they now are begining to see them and figure them out. Although there is still a lot of research to be done for sure.I actually wrote more on this thread but lose the info, so I will do that again.betterthroughscience You missed my first two questions to you. Why is IBS more prevalent in women?Why is there mild, moderate and severe IBS?Also, if there are structural abnormalities in the gut in IBS, how exactly are you returning them to normal? IF foods trigger the mast cells and a person gets "explosive d from the enteric nervous sytem running the program to expell the pathogen, why is there "Relieve with defecation" ?Many people without IBS have had food poisonings and pathogens and 'relief after defication' is not a symptom of those infections or food allergies. That happens for different reasons in IBS.Also how is it they can give lab animals IBS?


----------



## eric (Jul 8, 1999)

I forgot to mention other conditions can trigger mast cells. Allergies such as hay fever ect.Isn't a Immediate Food Reaction occur up to three hours after ingestion? Also doesn't immediate ones cause other symptoms that are not part of IBS such as rashes ect.. I am no expert on food allergies or allergic responces in general. But aren't IGA food reactions delayed? Don't delayed food reactions occur up to several days after ingestion of the reactive food? Aren't delayed food reactions often associated with IgG4, a subclass of the whole IgG molecule?Yet in anormal person 15 minutes after eating in the sigmoid colon.







and in IBS 15 minutes after eating.







Don't they also know there is an altered gastro colonic responce in IBS where the sigmoid colon over reacts to the ACT of Eating.


----------



## flux (Dec 13, 1998)

> quote:Yes, we have quite a number of patients who have been IBS-free for several years, some as many as 5 years or longer.





> quote:Our clinic does say we cure IBS


Clinic? Could it be this clinic isn't real, that the patients aren't real? So far all we have are secondhand anecdotes (that may not be real) which appear to be based science that also appears not to be real.


----------



## eric (Jul 8, 1999)

betterthroughscienceI thought your center was founded in 2005?http://www.ibstreatmentcenter.com/index.htm


----------



## betterthroughscience (Jan 13, 2006)

Eric and Flux. Yes the clinic is real. The clinic was founded in 2005, but Dr. Wangen has been seeing patients since the 1990s in private practice. He himself had IBS diagnosed and investigated to find that he actually had celiac disease. Unfortunately most doctors don't test for celiac disease as part of their standard IBS investigation. Dr. Wangen found that he was getting a lot of IBS patients and worked out a series of paths that one could follow to illuminate what was causing IBS in those patients. It is fairly complex because there can be multiple causes.I am not sure why Eric doesn't want to acknowledge the body of research on IgG (Not IgA, which has not been sufficiently studied and which I have not mentioned (unless I misstyped)) The studies have consistently shown that removal of foods to which the patient is allergic causes remission of symptoms and reintroduction causes symptoms to recur. You ask "Why is IBS more prevalent in women? and Why are there various severities?" I don't know. These questions do not invalidate the information that we do have. Dr. Heitkemper at UW has noted a statistical correlation between IBS symptoms and menses in women. Perhaps the biochemical changes in women take conditions in the immune system to the tipping point. As to why there are various degrees of symptoms - I think it is fairly obvious that in highly complex biochemical systems there are a wide variety of possible outcomes. Again, this is not a reason to deny that the research showing that treatments work is invalid.Structural abnormalities is another question. Do you mean that there are anatomical changes or that there are alterations in biochemistry (excess or insufficient production of neuro-transmitters, etc.)? In any case, I don't claim to be able to explain all IBS, but again, the research has shown that for many cases the treatment of the infection, reintroduction of the appropriate bacteria, removal of non-tolerated foods from the diet causes the symptoms of IBS to be reduced or eliminated. These were studies of patients who were diagnosed by physicians with IBS according to the ROME II criteria. The idea that pain relief upon defecation couldn't possibly occur if the person is having an immune response seems completely unsupported. The pain source (whether hypersensitive or not) is distention of the intestine in many cases. Removal of the distention should relieve the pain - and that is the experience reported in all those studies.I am not sure why Eric wants to deny the possibility that there are some ways to successfully address some cases of IBS. He and I have had personal conversations but he has stopped responding to me outside of this forum.


----------



## eric (Jul 8, 1999)

betterthroughscience only because I am really busy."I am not sure why Eric wants to deny the possibility that there are some ways to successfully address some cases of IBS."That is Totally untrue."I am not sure why Eric wants to deny the possibility that there are some ways to successfully address some cases of IBS."Both!!!If you understand mast cells enough to say foods are triggers, I think its important to understand chronic stress is just as much a trigger to them as foods, IF NOT MORE SO!!!For sure stress reduction in IBS is benefical.Your actually taking the dualizm approach to IBS, it is one thing in the gut, food allergies or candida, or infectious organisms, (IBS is not an infectious disease)while the researchers are taking a much more holistic view of IBS and trying to treat the whole person, because a lot more can lead to symptoms then I think you understand here. Take a while and study the HPA axis and IBS the bodies stress responce system and the role it plays in the bodies immune system. This is all very connected. Another part of this is we have seen the same pitch many times here. I have never ask you this but what role do you really play for the center, what is your job there?"Why is IBS more prevalent in women? and Why are there various severities?" I don't know. How come you don't research those things? Because it all adds up to a bigger picture. Hormones effect IBS and trigger symptoms, just like foods can trigger symptoms, but that doesn't mean cause of IBS.


----------



## betterthroughscience (Jan 13, 2006)

Eric,I understand busy.I think it would be beneficial for us to talk on the phone again sometime. You know my number. I am easiest to reach on Wednesdays and Fridays. www.IBSTreatmentCenter.com if you need the number again.I think that you misunderstand how our clinic works. We don't only treat food allergies. We do take into account many different factors, from stress, to undiagnosed infections (perhaps misdiagnosed as IBS) to food allergies, to bacterial issues, to celiac disease, to pancreatic dysfunction, to thyroid dysfunction, to etc. etc. etc. We do not only look at 2 things. If that is what you think please recognize that is not true.Your claim that researchers are taking a more holistic view than we do seems to have problems. First, you assume that we are not paying attention to the reseach. That is not correct. Second you assume that they are recommending holistic approach to the treatment of IBS and that is not true. The current treatment recommendations basically say diagnose, then stop testing, reassure the patient and recommend against caffeine, etc.. We have found that doing additional testing and treating the conditions that can be found results in substantial improvements. How many IBS patient on this board have been tested for celiac disease? How many have been tested for other things that would illuminate avenues they can take to address their condition? Our experience is that most patients are not getting all their options and are continuing to suffer. Once we work with them they almost always reduce their IBS to the point that they feel 'normal'.We strongly support continued research, especially in areas that show promise. It would be fantastic if there were more studies on IBS in women (after eliminating all the known issues). That type of work is probably coming. You ask why we don't research women and variety of intensity in IBS. The answer is simple. You give us the funding, we will be happy to conduct the research(as soon as our non-profit foundation gets IRS approval). Why don't the docs at UNC do the research? Probably because they are following the leads that interest them, that they have more expertise in and that they can get funding for.But I reiterate, our clinic has had many IBS diagnosed patients (before as a private practice, and since converting to the IBS Treatment Center). The vast majority have a problem we can identify and treat and get them back to 'normal'.My role in the clinic is Chief Operations Officer. My background is in science, IT, and I have a master's degree from the UW business school. My mother attended medical school while I was in high school. My uncle and cousin are ER docs. More than you wanted to know.


----------



## flux (Dec 13, 1998)

> quote:the information that we do have.


But you don't have information; you (or rather he) just has a sales pitch.


----------



## betterthroughscience (Jan 13, 2006)

Flux: What slander!







We all (at least those of us reading the research) have the information I am talking about. Probiotics can be effective at correcting bacterialogical imbalances in the gut and the result has been shown to improve IBS symptoms. Food allergies have been shown to cause IBS, removal of the foods often results in substantial improvement in symptoms and reintroduction of the foods results in resurgence of the symptoms.Celiac disease has been noted in the medical literature since the ancient romans. But many doctors still do not test for it. Lactose intolerance is fairly rare, but easily tested for and treated. And on and on and on. I am not making this stuff up. You tell me why doctors generally don't test IBS patients for celiac disease. And why many are still relying on biopsy samples even after several researchers have shown that the interpretation of the biopsy is highly subjective, with many samples being interpreted as positive by one expert and negative by another. While the better method is to test the immune system through blood serum. So I challenge your claim that there is no infomation. Look at the references! We even include many of them on the website. (please don't think that the list on our website is a complete list of everything we have ever looked at).


----------



## eric (Jul 8, 1999)

FYIIrritable Bowel Syndrome: How far do you go in the Workup?"What about celiac disease? This disorder should always be considered in evaluating IBS, because the diarrhea and abdominal discomfort due to proximal small intestinal villous atrophy and inflammation will specifically respond to a gluten-free diet. Therefore, making a diagnosis early may be cost-effective. The prevalence of celiac disease in the US is reported to range from 1:250 to 1:1500 (17). However, this is influenced by the method of assessment as well as the prior probability of the disorder being present in the population under study. With regard to the method of assessment, in a study set in Olmstead County (18), the reported prevalence was 1:4,600, and the cases were identified by clinical and pathological criteria. In contrast, when serological methods are used, the prevalence is at 1:250 or even higher (19), and in one recent study the prevalence for women was 1:125 compared to males at 1:250 (20). So, when clinically suspected, primary care physicians and specialists may now obtain anti-gliadin and anti-endomysial IgA antibody serologies. These are reasonably effective screening tests, given that the sensitivities and positive predictive values range from 90% - 100% (17). However, in populations where the prevalence of this disorder is low, many positive serological tests will be false positives. Therefore, because the gold standard of diagnosis requires upper endoscopy with duodenal biopsy, endoscopy is almost always needed for confirmation of the diagnosis. But can we be satisfied that these studies are enough to exclude celiac disease?"http://www.romecriteria.org/reading1.html


----------



## 18680 (Oct 7, 2005)

This is a very interesting thread. I was born with IBS. I've not had one day in 45 years that I didn't have this problem. Although the first half of my life I was chronically constipated, the second half has been a lot of alternating between the two. Much more D in the past 10 years. My condition is not food dependent. If it's time for D, I get it, no matter what I eat. If it's time for C, ditto. My stress levels, however, are very relative to my condition. But when stress rises, either side, C or D, will flare up without rhyme or reason. My problems have definitely been worsened by the presence of adhesions, yet the condition itself was there long before the advent of adhesions in my abdomen. I eshew medications, none of them work. I just eat whatever I want because C or D is going to happen anyway. Personally, I've just learned to live with it. I have no other choice. But it would be nice to have a job again. Not that I added so very much to the clinical side of this conversation, but I wanted to let you know that for at least one person out here, this curse has been a lifelong one with no reprieve.


----------



## betterthroughscience (Jan 13, 2006)

Eric. Finally we agree. Celiac disease should always be ruled out. Testing is not that hard and confirmation by diet change is also relatively easy.Mrs. Publisher: I am sorry to hear about your IBS. What kind of testing have you had? I wonder if you have some genetic variation that has effected how your immune system and gut barrier work. Individual variation is one of the most fascinating aspects of IBS. No one seems to react exactly the same, even when they have very similar profiles.


----------



## flux (Dec 13, 1998)

> quote:And on and on and on. I am not making this stuff up. You tell me why doctors generally don't test IBS patients for celiac disease.


Generally, the symptoms are not the same. Celiac affects absorption and IBS cannot, though I'll give you the blood tests are relatively easy to order.


> quote:And why many are still relying on biopsy samples even after several researchers have shown that the interpretation of the biopsy is highly subjective, with many samples being interpreted as positive by one expert and negative by another. While the better method is to test the immune system through blood serum.


Biopsies are the gold standard. You either have it or you don't. It's really hard to mistake it what villous atrophy looks like.


> quote:Lactose intolerance is fairly rare, but easily tested for and treated.


Lactose malabsorption is fairly common, about 1/3 the population. Symtoms from it rare, but that's only because it requires one to consume a lot of lactose, which people don't ordinarily do.


> quoterobiotics can be effective at correcting bacterialogical imbalances in the gut and the result has been shown to improve IBS symptoms.


Only in scattered studies. So far the clinical signficance of that is unknown.


> quote:Food allergies have been shown to cause IBS, removal of the foods often results in


That just ain't so.


----------



## betterthroughscience (Jan 13, 2006)

On Celiac: We still see patients who have been diagnosed by gastroenterologist with IBS that have celiac. They symptoms overlap enough that celiac is being diagnosed as IBS.The following is from the June issue of Current Opinion Allergy Clin Immuniol. (2006, june;6(3):191-6) Recent studies have placed the prevalence of celiac disease in Western populations at between 1:250 and 1:67. Celiac disease is common throughout the world and most cases go undiagnosed.While most pathologist still consider biopsy interpretation to be the "gold-standard" there have been discussions outside the published arena regarding the difference of interpretation of the same samples by different pathologists. The patient's best option is to get the blood test and if gliadin antibodies are high, try a gluten free diet for a month or two. If the improvement is substantial, they can suspect celiac. If symptoms return with reintroduction of glutens, I would consider that definitive. Perhaps not of celiac disease, per se, but of the patient's being better off not eating gluten.On probiotics: Eric just emailed me a whole bunch of studies on probiotics, including this gem from back in 2003: 'But Dr. Fedorak cautioned that "we don't know how they work. They appear to strengthen the mucosal barrier of the bowel and improve immune function. And we don't know which probiotics to use or in what combination."' DDW 2003: Abstract M1582, presented May 19, 20003; Abstract W1523, presented May 21, 2003.Since then the studies have been much better.For example, Mahony et al in Gastroenterology: Volume 128, Issue 3, Pages 541-551 (March 2005)Conclusions: B infantis 35624 alleviates symptoms in IBS; this symptomatic response was associated with normalization of the ratio of an anti-inflammatory to a proinflammatory cytokine, suggesting an immune-modulating role for this organism, in this disorder.On Food Allergies: Some don't like the word 'cause' and prefer 'trigger'. I won't quibble. The evidence is that removal of foods to which the patient shows elevated immune response results in reduction in symptoms. Not the whole story, but part of the complex whole that is IBS. For example, in Gut 2004;53;1391-1393, The notion of food allergy in irritable bowel syndrome (IBS)is not new. However, recent evidence suggests significant reduction in IBS symptom severity in patients on elimination diets, provided that dietary elimination is based on foods against which the individual had raised IgG antibodies. These findings should encourage studies dissecting the mechanisms responsible for IgG production against dietary antigens and their putative role in IBS.I won't bore you with all the studies that measured food antibodies, provided dietary restrictions to 'real' patients and controls and demonstrated (even with a limited number of foods tested) that statistically significant improvements could be achieved and that reintroduction of the indicated foods resulted in relapse. Seems like good science to me. Check 'em out on pubmed.


----------



## eric (Jul 8, 1999)

There is a huge body of research you are leaving out with the immune system they have worked on for years now. The alterations in the HPA Axis and the role of chronic stress and role they have on mast cells, the same cells ativated by food. Both can degradulate the mast cell. It also has to do with the proinflammatory cytokines.The chronic stress actually sensitizes the mast cells so foods trigger it easier. I don't think your getting that really. You seem to be leaving out all the neurogastroenterology information on IBS. We have also been giving you a whole lot of information you have never seen before. You seemed to be focused to a almost biased extenet to problems in the gut and have not yet taken the whole system BRAIN GUT AXIS into account. Your leaving a ton of information OUT in making your cases. I personally believe that is why you don't understand some MAJOR aspects of IBS. I also don't think you fully understand or have done much research in Post Infectious IBS."Some don't like the word 'cause' and prefer 'trigger'."Finally!!!! That is more accurate. You should change your website to refect this more accurate approach.On the probiotics, "They appear to strengthen the mucosal barrier of the bowel and improve immune function. "They have known this now for at least a couple years. They also know the ACT of eating can trigger IBS regarless of the foods.An exaggerated sensory component of the gastrocolonic response in patients with irritable bowel syndromehttp://gut.bmjjournals.com/cgi/content/full/48/1/20In IBD ""Itâ€™s not food itself thatâ€™s the culprit in IBD, but an overactive intestinal immune system that sounds the alarm when it encounters perfectly harmless foods, explains Dr. Sacher. "You canâ€™t eliminate all stimuli," he says. "IN IBS there is also an underlying disorder having to do with the CNS the ENS and the ANS and foods can be triggers to those underlying dysregulations.So again the system can react TO HARMLESS FOODS in IBS as well as a whole host of foods that can trigger IBS. You never mention how fats trigger IBS or fructose or other chemicals in foods that have nothing to do with an allergic reponce. Its not really good dieatary advise to just tell people there IBS is "caused by an allergic reaction to foods".On the gut flora bacteria, are you gonna test for all 500 KNOWN species? Especially since they don't know what they all do? Even candida can be benefical to the system.


----------



## betterthroughscience (Jan 13, 2006)

Eric: Relax -







I am not sure why you think I haven't seen any of the research on the brain-gut axis, or that we don't take it into account. There are several ways to interprete the studies. One is that the brain causes biochemical changes that drive IBS. Another is that there is a feedback loop - biochemical conditions (whether immune response, or other conditions) cause changes in the neural system that cause more biochemical changes that drive IBS. And yet another is that there is a complex combination of the two above options. Further research will probably help illuminate it, but I am betting the picture gets more complicated before it gets clearer. There are clear indicators that stress is strongly related to IBS. No one denies this. Different levels of stress are tolerated to different degrees by different people. No one denies this. This article titled: "Does psychological treatment help only those patients with severe irritable bowel syndrome who also have a concurrent psychiatric disorder?" Aust N Z J Psychiatry. 2005 Sep;39(9):807-15. indicates that perhaps only those patients with a psychiatric disorder benefit from psychological treatments for IBS. Is this ultimately true?I don't know if further research will bear that out. Clearly there is a lot of research supporting the relationship between stress and IBS. You ask if we are going to test for some very large number of gut flora. It doesn't work quite like that. We send the stool sample to the lab. They culture the various flora and then identify and report what they find and relative amounts of each strain. It is a fairly simple and reasonably inexpensive test, compared to a colonoscopy or whatever. The result of the test is that we can tell if the patient has enough of the 'good' bacteria and if they have substantial colonies of 'bad' bacteria. Pretty much exactly what the probiotics studies imply should be done. Get the patient's gut environment to normal - a kill the weeds and water the flowers kind of idea. What we have seen (and what the probiotics articles you sent me show) is that patients benefit from returning to a more normal balance of the right kinds of bacteria in their gut.Also, I am not the doctor. He is far too busy to spend time on these boards. My ability to share with you everything that goes into his process is limited. But rest assured that he reads LOTS of research and is dedicated to high-quality science.I am really not sure why you and I are apparently on different sides. We both agree that the studies show various ways the patient can achieve improvement. We have developed protocols to ensure that we get valid data and treat patients based on what we find. Why are we arguing?


----------



## Jeffrey Roberts (Apr 15, 1987)

I knew this sounded familiar. I wrote a book review related to this:


> quote:The Irritable Bowel Syndrome Solution Stephen Wangen, ND, Innate Health Publishing, January 2006 ISBN 0976853787 Rating: 3 out of 5 - It's a solution for some, but not likely for a real IBS suffererStephen Wangen is a Doctor of Naturopathic medicine who provides an informative book that some will find helpful for understanding their IBS-like symptoms. There is no magic here. A great deal of attention is given to allergies and intolerance which may explain symptoms in a great deal of individuals. In the classic sense they unlikely could be diagnosed as suffering from IBS based on the widely supported Rome II criteria, of which there is no mention in the book. Also left out of discussion is the brain-gut axis which has gained so much attention in recent press. The solution is focused on the solution of the IBS Treatment Center, for which he is the founder.


Jeff


----------



## betterthroughscience (Jan 13, 2006)

Mr. Roberts. You did write that review. I am not sure what you mean by 'real IBS sufferer' though. We have seen a lot of patients who have been diagnosed by gastro docs with IBS (according to ROMEI and later ROME II) who never had a stool culture and never got screened for celiac disease. Those with celiac are probably the angriest. I suppose they aren't "real IBS sufferers". It would have been nice if they had been tested. And you are correct that there is no magic. Just using the information that has been published in peer-reviewed journals and then actually performing testing (using high-quality labs) to find things that can be addressed.


----------



## Arnie W (Oct 22, 2003)

Betterthroughscience, I correspond regularly with a lady who used to be on this forum. She is currently getting treatment at your clinic and has been giving me regular updates. I must say that I am enjoying your contributions, as it is good to get another slant on how to treat digestive problems.


----------



## betterthroughscience (Jan 13, 2006)

Arnie,Thanks for the kind words. I hope your friend is one of our success stories. Due to HIPPA I won't ask you to tell me who she is.I am glad that you are enjoying the discussion. I became involved primarily because I wanted more people to get better treatment. The medical system in this country leaves a lot to be desired. Currently I have two family members in and out of hospital. There have been repeated instances where simple problems like dehydration were not addressed. It is really infuriating. Getting simple CBC run to check basic stats is like pulling teeth.But it is really rewarding to have patients come back after a few months with lavish praise. Making people well rocks!


----------



## flux (Dec 13, 1998)

> quote:You ask if we are going to test for some very large number of gut flora. It doesn't work quite like that.


So what is that saying? Most of the bacteria aren't good or bad, but just there? What if all those other bacteria are true culprits?


----------



## eric (Jul 8, 1999)

betterthroughscience "There are several ways to interprete the studies.""*It is no longer reasonable to discriminate between physiological and psychological factors; both are operative in IBS.* "http://www.fdhn.org/html/education/gi/ibs_nosology.htmPlease read the above link.Do you have psychotherapists at your center? How do your treat stress at your center.When I first starting corresponding with you you did not know about HT as a treatment for IBS and that it is arguably and statistically the most effective treatment to date and long term for IBS. It maybe though your focus is narrower on foods and bacteria?So a commment like this of yours"Making people well rocks!"Might incorporate this information?" It is one of the most successful treatment approaches for chronic IBS. The response rate to treatment is 80% and better in most published studies to date. - The treatment often helps individuals who have failed to get improvements with other methods (see for example: Whorwell et al., 1984, 1987; Palsson et al., 1997, 2000).- It is a uniquely comfortable form of treatment; relaxing, easy and generally enjoyable.- It utilizes the healing power of the person's own mind, and is generally completely without negative side effects. - The treatment sometimes results in improvement in other symptoms or problems such as migraine or tension headaches, along with the improvement in IBS symptoms.- The beneficial effects of the treatment last long after the end of the course of treatment. According to research, individuals who improve from hypnosis treatment for IBS can generally look forward to years of reduced bowel symptoms."These people are better regardless of foods, although I am sure some stay away from certain foods that trigger there IBS. A lot of people over the years figure out on their own what foods trigger there IBS. Many people who thought certain foods were a problem now eat them after HT as well as a lot of them reducing their medications.Research though in IBS now focuses on the bowel reacting to ALL stressors. Very importantly though is anxiety and emotions and well as physical stressors. There is a major correalation with the HPA axis (the bodies stress system) and the fight or flight responce and inflammation of mast cells in IBS and that has been established and being researched. In Post infectious IBS after resolution of the intial infection there are changes of EC and mast cells found. THAT IS IMPORTANT. Those are molecular changes and some of them are now being seen in IBS that did not develop after an enteric infection. Stress can re-inflammed the cells after resolution of the intial inflammation. Then they can become sensitized to food allergens.This is a way cracks me up really. Although I am sure it needed to be studied and is really helping severe IBS."This article titled: "Does psychological treatment help only those patients with severe irritable bowel syndrome who also have a concurrent psychiatric disorder?" It is totally clear that stress reduction is helpful to almost every IBSers as well as almost every condition on the planet, but VERY importantly in IBS because of the close connections in gut function and the role of stress to modulate it, even as a contributing factor to develop it. Do you know why stress can contribute to the development of IBS?Although that is talking about psychotherapy.Hypnotherapy has already been shown to help IBS regardless of psych comorbidity. Also if something like HT continues to help five years after treatment stops at least, then it is working on some basic level of the root of the disorder. There are many ways and on many levels it could be doing this and is being researched.Basic relaxation works on IBS.However, mild IBS probably does need as much psychological intervention then moderate and severe IBS, which by the way is in part (the severity) generated by more psychological distress and possible lack of coping skills as well as other reasons, including the physical condition of the persons digestive system.Anyone seriously working with IBS patients I believe understands like the researchers do, or should understand the role of the fight or flight mechanism and the sympathetic and parasympathetic nervous systems in regards to IBS. The majority of IBS patients also effectively demonstrate dysregulation of the serotonin system from the gut to the brain and back. Serotonin is the neurotranmitter that signals sensations from the gut to the brain and back, and pain or discomfort is a must for an IBS diagnoses. It has aslo been majorally implicated in why there is c and d and c/d!!!You know the Paing Gate is basically lost in IBS, can you show me information on how foods could cause that? or even bacterial imbalances?So far no infection has been found in IBS no single bacteria infection, other then in Post infectious IBS, which is a subgroup of IBS. IBS is not an infectious disease.


----------



## betterthroughscience (Jan 13, 2006)

Flux:I guess I didn't explain it very well. Lab testing for gut flora (as our lab does it) works like this: A sample of the patients fecal matter is collected. The material is cultured (allowed to grow - there is way more to it, but essentially it is spread out, given a medium on which it can live and reproduce, and so the bacteria, etc. grow). Then the lab determines the quantity and relative amounts of all the flora and reports that. The bacteria that are normally present and are known to be helpful are quantified. So are all the other organisms!! Those not normally present are generally harmful, to the extent that they crowd out the beneficial bacteria. Perhaps they don't actually cause immune response, but just by taking up space that should be occupied by good bacteria they are interfering with the optimal gut function. Sometimes we see staph infection, sometimes other unpleasant bacteria. Sometimes there are other things that crowd out the good bacteria that you need. The gut works best when we have a nice balance between the good bacteria and they dominate the landscape. Think of it like an ecosystem (because that is what it is). If you have organisms that don't belong they displace those that do because there is only so much room and a limited supply of resources. And the system doesn't function quite right.


----------



## Kathleen M. (Nov 16, 1999)

I think the problem is you are ignoring all the non-culturable species.There are usually many more species of bacteria in a sample of anything (based on PCR of the ribosomal genes which are different in each different species) than you can determine by spreading it on a plate (even if you do a separate set of plates under conditions where there is absolutely no oxygen which is required if you want to do a really complete job of culturing the bacteria in the colon. You need to get both the ones that like oxygen and all the ones that live in there because they die when exposed to oxygen in air).Yep, some of the "good" bacteria are culturable, but many of the very normal bacteria that are in there are difficult to culture under the best of conditions (a big part of the micro department where I studied worked on methanogens which are one of the normal things in many people, but can be hard to work with even when you only work with ones that have to date actually been cultured in a lab).It isn't just a problem for stool samples. We really only study bacteria that grow well on standard media preparations. Many bacteria from any location don't grow in the lab under any sort of standard conditions. Another bunch grow under very specialized conditions, but like I said if you do DNA analysis with PCR of all the ribosomal DNA in a sample from all the bacteria present and you find many more species in there than anyone has ever cultured.


----------



## betterthroughscience (Jan 13, 2006)

Eric: I know you really value psychological approaches. I also know that you have read Dr. Drossman's articles about the complete cycle of interactions. Stress reduction can be accomplished many different ways. But if you remove the source of the stress - by reducing the symptoms - you often actually reduce the anxiety in the patient. I am sure that there will be more research on this. Many of our patients report that, in addition to IBS they also have mild anxiety attacks, headaches, and other problems. Without any prompting from us they often report back that not only have we resolved their IBS, but they have not had any anxiety attacks or headaches, or that the frequency is dramatically reduced.These things are all connected, as you say. Our focus is on the physiological. We are getting excellent results. So far we have not had patients who needed additional psychological treatment, but we are not averse to referring patients if they are not getting as healthy as they want to be. The rates of patient improvement are very very high when you address all of their physiological issues. This study talks about 48% complete conversion from IBS to no-longer qualify as IBS patient by only addressing the bacterial overgrowth - http://www.ncbi.nlm.nih.gov/entrez/query.f...t_uids=11151884When you combine that with all the other medical treatments that also have high success rates you get healthy patients the vast majority of the time.I am not saying that it is invalid to do hypnotherapy. I have no idea if it is cost-competitive with what we do, but I don't see any reason why a person shouldn't try it. People have choices. You like hypnotherapy, others like medical approaches. As long as the patient gets to their health goal, that is what is important. My point in initiating this post was to point out that there are effective treatments for IBS.


----------



## administrator (Aug 20, 2004)

Moving to Products, Services and Websites forum as this has a lot of post promoting a particular clinic.


----------



## eric (Jul 8, 1999)

Sibo is NOT IBS!!!Is there a relationship between IBS and small intestinal bacterial overgrowth?"Although the theory that SIBO causes IBS is tantalizing and there is much anecdotal information that supports it, the rigorous scientific studies that are necessary to prove or disprove the theory have just begun. Nevertheless, many physicians have already begun to treat patients with IBS for SIBO. In addition, a lack of rigorous scientific studies demonstrating benefit from antibiotics and probiotics has not stopped physicians from using them for treating patients.""Although it has been hypothesized that IBS may be caused by intestinal bacteria, specifically by small intestinal bacterial overgrowth, there is little rigorous scientific support for the hypothesis. "http://www.medicinenet.com/irritable_bowel...drome/page7.htm*"The most popular theory is that patients with irritable bowel syndrome have a subtle abnormality in the function of their intestinal muscles that allows SIBO to occur." * http://www.medicinenet.com/small_intestina...rowth/page5.htmSeccion de Gastroenterologia, Departamento de Medicina, Hospital Clinico de la Universidad de ChileChile.Small intestinal bacterial overgrowth (SIBO) is characterized by nutrient malabsorption, associated with an excessive number of bacteria in the proximal small intestine. Unfortunately, the diagnosis of bacterial overgrowth presents several difficulties and limitations, and as yet there is not a widespread agreement on the best diagnostic test. SIBO occurs when there are alterations in intestinal anatomy, gastrointestinal motility, or a lack of gastric acid secretion. The true association between SIBO and irritable bowel syndrome and celiac disease remains uncertain. The treatment usually consists in the eradication of bacterial overgrowth with repeated courses of antimicrobials, nutritional support and when it is possible, the correction of underlying predisposing conditions.PMID: 16446861Hydrogen glucose breath test to detect small intestinal bacterial overgrowth:1: Aliment Pharmacol Ther. 2005 Dec;22(11-12):1157-1160. Related Articles, Links Hydrogen glucose breath test to detect small intestinal bacterial overgrowth: a prevalence case-control study in irritable bowel syndrome.Lupascu A, Gabrielli M, Lauritano EC, Scarpellini E, Santoliquido A, Cammarota G, Flore R, Tondi P, Pola P, Gasbarrini G, Gasbarrini A.Internal Medicine Department, Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy.Background: Studies assessing the prevalence of small intestinal bacterial overgrowth in irritable bowel syndrome gave contrasting results. Differences in criteria to define irritable bowel syndrome patients and methods to assess small intestinal bacterial overgrowth may explain different results. *Moreover, no data exist on small intestinal bacterial overgrowth prevalence in a significant population of healthy non-irritable bowel syndrome subjects. * Aim: To assess the prevalence of small intestinal bacterial overgrowth by glucose breath test in patients with irritable bowel syndrome symptoms with respect to a consistent control group. Methods: Consecutive patients with irritable bowel syndrome according to Rome II criteria were enrolled. The control population consisted of 102 sex- and age-matched healthy subjects without irritable bowel syndrome symptoms. All subjects underwent glucose breath test. A peak of H(2) values >10 p.p.m above the basal value after 50 g of glucose ingestion was considered suggestive of small intestinal bacterial overgrowth. Results: A total of 65 irritable bowel syndrome patients and 102 healthy controls were enrolled. Positivity to glucose breath test was found in 31% of irritable bowel syndrome patients with respect to 4% in the control group, the difference between groups resulting statistically significant (OR: 2.65; 95% CI: 3.5-33.7, P < 0.00001). Conclusions: The present case-control study showed an epidemiological association between irritable bowel syndrome and small intestinal bacterial overgrowth. Placebo-controlled small intestinal bacterial overgrowth-eradication studies are necessary to clarify the real impact of small intestinal bacterial overgrowth on irritable bowel syndrome symptoms.PMID: 16305730 and of course, Dr Lin " Another diagnostic test that has increasingly gained interest in this setting is the breath test to detect small intestinal bacterial overgrowth (SIBO). It has been proposed that many IBS patients have symptoms due to the presence of SIBO, as measured by the lactulose breath test, which has been detected in as much as 78% to 84% of patients.[39,40] Harris and colleagues[41] presented a retrospective chart review assessing the presence of GI symptoms, in particular those associated with IBS, in patients referred for glucose hydrogen breath tests for SIBO. *They predicted that lactulose breath testing overpredicted the actual prevalence of SIBO in IBS.* Glucose hydrogen breath testing has a sensitivity of 75% for SIBO[42] compared with the sensitivity of 39% with lactulose breath testing for the "double-peak" phenomenon characteristic of SIBO.[43] There has been considerable debate regarding the accuracy of the lactulose breath test compared with small bowel aspirates to detect the number of bacteria, which has been considered the gold standard for diagnosing SIBO.[44] Of the 182 patient charts reviewed, 113 patients (88 women; mean age, 58 years) met the Rome II criteria for IBS (IBS-D, 56%; IBS-C, 32%; and IBS-A, 12%).[41] Only 11% of these patients had a positive breath test for SIBO. The study authors concluded that etiologic factors other than SIBO are likely involved in the pathophysiology of IBS. Despite the standard use of the Rome II diagnostic criteria for IBS, the prevalence of SIBO in these patients appears to vary widely depending on the patient population and type of methodology used."http://www.medscape.com/viewarticle/517739From UNC chat with the experts."psychophysiological arousal is the core of treating functional gi disorders. There is som much distress, anxiety, antisipatory anxiety, and negative reaction to symptoms, that calming the mind and body often makes a significant difference to symptoms."An international study of irritable bowel syndrome: Family relationships and mind-body attributionsMary-Joan Gerson, Charles D. Gerson, Richard A. Awad, Christine Dancey,Pierre Poitras, Piero Porcelli, Ami D. SperberAbstractIrritable bowel syndrome (IBS) is a functional gastrointestinal illness, characterized by potentially debilitating symptoms without pathologic findings, often associated with psychological conditions. Little is known about the psychosocial aspects of this condition on an international scale. A total of 239 patients in eight countries were given a series of psychological and medical questionnaires, including IBS activity, relationships with signi.cant others, beliefs regarding the etiology of symptoms, and assessment of quality of life. There were highly signficant associations between IBS severity and all other measures. Symptoms were worse if relationship conflict was high and if attributions about illness were physiological rather than psychological. Symptoms were less severe if relationship depth and support were high, and illness was viewed as psychological. Implications for treatment are discussed.Full article:http://www.ibsgroup.org/other/mindbodyarticle.pdf(By permission of author)IBS Beyond the Bowel:The Meaning of Co-existing Medical Problemshttp://ibsgroup.org/eve/forums/a/tpc/f/712...610974#86610974The Functional Gastrointestinal Disorders and the Rome III ProcessD. A. Drossmanhttp://www.romecriteria.org/PDFs/p1377_FGI...I%20Process.pdfI personally find it hard to believe you address ALL the "Our focus is on the physiological." When it seems your not even understanding the big picture of the condition. Tell me exaclty how you address faulty molecular (sert) experssion from 5ht 3 and 5ht4 cells?Part of the bacteria inbalance in IBS stems from altered chemical and electrical motility of the colon, which allows foods to ferment in the colon longer and hence perhaps alter bacteria populations.Many peoples bacteria of the colon can be out because of stress!!! Because of medications there on and even drinking booze and for a host of other reasons, including what they are eating.Your way behind on your research it seems to me personally.I am also not sure you really got this?"It is no longer reasonable to discriminate between physiological and psychological factors; both are operative in IBS. "http://www.fdhn.org/html/education/gi/ibs_nosology.htmAgain treating the whole person takes a more holitic approach to a person as a whole person mind and body and not a seperate view of JUST the physiological, because that approach is now dated and obsolete.Read the rome lll info above. Have you ever heard of neurogenic inflammtion?


----------



## eric (Jul 8, 1999)

BY the way I email Dr Drossman on SIBO and IBS."Dear Shawn, I do feel that the issue of bacterial overgrowth is an important considerations in IBS, and these authors have gone a long way to advance this area of investigation and raise awareness of bacterial overgrowth as a possible player in IBS. It kind of relates to other work being done in the area of post-infectious IBS and altered mucosal immunity in subsets of IBS. However, there is some disagreement within the community with regard to the prevalence in patients with IBS, these authors claiming up to 80% and others finding far less by standard methods. Another issue of concern is that explaining bacterial overgrowth as the cause of so many other aspects of the condition is going beyond the available scientific data. Their work should be considered more in the way of opinion/speculation, rather than accepted dogma within the medical community, and further confirmation is needed. You should keep in mind that all scientists will from time to time try to extend their data into understanding other aspects of a condition, but the checks and balances within medicine lead to common acceptance when there is confirmation from other groups and more conclusive evidence. That has not happenned as of yet but remains an area of interest in the field.Doug"


----------



## betterthroughscience (Jan 13, 2006)

Wow! Strong response. I suppose we should differentiate between overgrowth and the condition wherein the patient has a deficit of the right bacteria (often associated with the presense of non-beneficial bacteria). All the data on probiotics point to the importance of having the right balance of the right bacteria in your gut.Dr. Drossman kind of contradicts your statement in the previous post. If you look at all the articles about breath testing and etc. there is quite a bit of confusion about how to test for overgrowth so it is not surprising that there is no definitive answer on what the correlation is with IBS. If you can't agree on how to measure something, it is hard to form conclusions about it.Is there a defined treatment protocol being used someplace that incorporates everything you want it to? Can you point to a clinic or practice that performs the 'holistic' or complete range of treatments? There are thousands of GI docs across the country diagnosing and 'treating' IBS. Most are not addressing any of the things we have talked about. So I think that calling our physiological protocols out of date you logically should be calling the majority of medical treatment for IBS positively ancient.Why criticize someone for not doing everything if they are getting good results? If we were not getting our patients to where they wanted to go we would do more. Most doctors just throw up their hands and say, 'That's all I can do'. How does criticizing us help people reading these posts get healthy? If you can point to something we do that harms the patient or stops them from getting better, do so. But you have repeatedly acknowledged that there is lots of data to show that IBS can be substantially improved by addressing the physiological concerns. How does it help the readers of the forum to try to tear me and my point of view down? I am not claiming anything that isn't published in lots of peer reviewed journals. I am not claiming that there is a single drug or therapy that magically cures IBS (like many of the advertisers you see).Why so hostile? Why not write something along the lines of this: BetterthroughScience has a point. though the approach he espouses may not work for everyone it may help some people. I (eric) feel strongly that the evidence is pointing to psychological solutions to IBS and recommend hypnosis therapy. But I (eric) acknowledge that lots of studies have shown that IBS can be significantly mitigated through various techniques. Fortunately researchers continue to pursue promising leads.Instead you ask why we don't research the prevalence of IBS in women. Why don't you ask Dr. Drossman that? Please try to discuss things as logically as possible and withhold the personal attacks and unwarranted hostility.


----------



## Kathleen M. (Nov 16, 1999)

SIBO and breath testing has nothing to do with which bacteria you have growing in the colon.Bacterial overgrowth in the small intestine where there should not be a lot of bacteria of any kind is often bacteria that are considered totally normal and healthy to have when they live in the mouth or the colon.It isn't bad bacteria. It is normal bacteria living in the wrong location.The gender differences between men and woman both in IBS and in how drugs effect them has been under study for quite some time.K.


----------



## eric (Jul 8, 1999)

> quote:I (eric) feel strongly that the evidence is pointing to psychological solutions to IBS and recommend hypnosis therapy.


Your not getting my point.Addressing IBS psychophysiologically!!! The mind and body are not seperate!HT is one tool in treating IBS, which seems to be very effective and has twenty years of research behind it already and is recommended by the rome experts!"'holistic' or complete range of treatments? There are thousands of GI docs across the country diagnosing and 'treating' IBS. Most are not addressing any of the things we have talked about."I disagree, while there are centers behind in the research many centers are not, to name a few, who by the way are very cautious about using thew word "Cure" on there homepage and calling conditions that are NOT IBS, IBS. This doesn't mean your center doesn't help anyone at all. A caring doctor who is sympathetic to the patient can help a lot of IBS pateints regardless with compassion which in turn helps the person.The UNC Center for Functional GI & Motility Disorders:http://www.ibs.med.ucla.edu/UCLA Center for Neuroviceral Sciences and womens healthhttp://www.ibs.med.ucla.edu/The Cleveland Clinic: Gastroenterology and Hepatology:http://cms.clevelandclinic.org/digestivedisease/Mayo Clinic IBShttp://www.mayoclinic.com/health/irritable...yndrome/DS00106THE JOHNS HOPKINS UNIVERSITY Gastroenterology and Hepatologyhttp://hopkins-gi.nts.jhu.edu/pages/latin/...FTOKEN=58619122Mind-Body Digestive Center Research and Treatment http://mindbodydigestive.com/and many others. I personally see major contridictions in the information those sites provide with the information your site provides. I DO NOT believe IBS is a psychological disorder and only psychological treatments are the answer. It is a real physical entity. The medical research confirms a psychophysiological approach to treatment in IBS.


----------



## eric (Jul 8, 1999)

betterthroughscience I hope all this information enlightens what we are all talking about, but for me its time consuming and getting to be counter productive. The information is there to clarify a bigger picture of GI disorders of function.How a person will use it is up to them, hopefully to benefit people with IBS and functional GI disorders.


----------



## Talissa (Apr 10, 2004)

> quote:The medical research confirms a psychophysiological approach to treatment in IBS.


Not acc to WJG. That seems to have more to do w/ how diff patients respond to IBS symptoms~~World J Gastroenterol 2006 January "*Changing face of irritable bowel syndrome*""... IBS has also been associated with a variety of psychological disorders; here, in contrast, the evidence for a true association is less firm, more recent analyses suggest that the occurrence of such symptomatology in IBS is largely the preserve of those who seek further referral alone and *is not a feature of IBS in the community*. Psychopathology should be viewed, therefore, not as a fundamental prerequisite for the development of IBS, but, rather, as a co-factor which, _*if present*, will modify the individualâ€™s response to IBS symptomatology._"http://www.wjgnet.com/1007-9327/12/1.aspIn other words, like bts so sanely states, hypnotherapy may help some people with IBS. But as psychological issues aren't part of the IBS "community" as a whole, it wouldn't help everyone.


----------



## Kathleen M. (Nov 16, 1999)

Psychosocial issues may determine who seeks treatment, but psychological treatments work in the absense of psychological problems.see http://www.ncbi.nlm.nih.gov/entrez/query.f...l=pubmed_docsumThe study I was in.Really, I have no pain now. It isn't that I feel better about my life destroying pain.Oddly the CBT didn't help the people who were depressed in the study.K.


----------



## Talissa (Apr 10, 2004)

> quotesychological treatments work in the absense of psychological problems.


That's really interesting K. Although, I read the abstract from the study you were in & couldn't find that conclusion or even implication. Would you mind pointing out how you make that conclusion from the study? Thx, T-ps--was glad to see the CBT worked so much better, even though not 100%, than the antidepressants, which are potentially very dangerous to the body & the mind.


----------



## Kathleen M. (Nov 16, 1999)

> quote:CBT was beneficial over EDU for all subgroups except for depression


Includes the normal without psychological problems.Also they did really extensive psych evaluations before you got in, and I think if you were really bad you couldn't get in.I'd have to look at the whole paper to see what all the subgroups were, but it was a very large study so had lots of people who were not psychologically challanged.K.


----------



## Kathleen M. (Nov 16, 1999)

I can get to full text on-line some quotes


> quote:Eligible participants were excluded if they had heart disease, glaucoma, pregnancy, urinary retention, bipolar disorder, schizophrenia, or substance abuse/dependency; any gastrointestinal disorder that would explain the gastrointestinal symptoms; another psychiatric disorder that would preclude participation in the study; an unwillingness to discontinue anticholinergic medication, calcium channel blockers, or antidepressants (for 3 months); had previously taken DES; or did not use an acceptable method of birth control.


So yep, they did exclude a lot of peeps with psych issues.Here are the subgroups.


> quote:Ancillary analyses were performed using the per-protocol study sample to address whether there are differential effects of treatment for clinically relevant subgroups. These exploratory analyses identified clinically meaningful subgroups relating to (1) severe and moderate symptoms, (2) some abuse history and no abuse history, and (3) depression (BDI, >16) and no depressive symptoms (BDI, <16).


60 were depressed compared to 258 not depressed. For the abuse not abuse there wasn't any difference in the CBT section of the trial, but the numbers of peeps in each group was a bit more even.K.


----------



## Kathleen M. (Nov 16, 1999)

PS. I think most of the pre-trial logic would tend to make you think the depressed people would get more better than the non-depressed peeps as one would expect that even though the CBT proticol was gut-focused that sort of therapy usually works well on those who are depressed.PPS. 70% get better is about as good as any clinical trial published ever seems to get with IBS. I've seen all the websites claiming 90+% cure rates but usually there isn't much hard data to back those claims up with.K.


----------



## Talissa (Apr 10, 2004)

Thx. That really -is- interesting--esp how it didn't help those depressed. Strange.Other studies show antidepressants, if they help, help w/ IBS pain but not the change in bowel patterns. Is CBT like that for most people?...Am really glad you no longer have the pain. I had that my first year w/ IBS, before finding natural antibacterials(paragone) & probiotics--it was h*ll. T-


----------



## Kathleen M. (Nov 16, 1999)

I had a normalization of stool consistancy and frequency (during the one year follow up I remember the day I had a fully formed stool rather than the soft snakey ones...my hemmies didn't love me that day







) I'm not sure about the overall data, I can check later.Most of the CBT folks who do better see additional improvement at the one year follow up mark.I still tend to more BM's a day than typical, but the consistancy is OK, although they tend to be smaller as well as more frequent, they are not urgent or painful, and I don't have public restroom phobia so it isn't a problem.K.


----------



## eric (Jul 8, 1999)

FYICognitive-behavioral therapy, hypnosis can help soothe irritable bowel syndrome7/28/2004 4:22:36 PMBy: Dr. Olafur S. Palsson, UNC Health Care "Many types of psychological treatment have been tested for IBS. The two that have been most consistently successful are cognitive-behavioral therapy and hypnosis. *The majority of studies on both of these therapies have shown that they substantially improve all the central symptoms of IBS in up to 70-80 percent of treated patients and that the benefit often lasts for years after treatment.*Both hypnosis and cognitive-behavioral therapy typically require about 8-12 visits to a therapist. In cognitive-behavioral therapy, the therapists work to help patients to overcome distorted and negative thinking patterns that adversely affect life functioning and amplify symptoms, and help them to adopt more effective ways to handle life situations that aggravate the bowel problems.Hypnosis uses a special altered mental state of heightened focus to produce its beneficial effects. Mental imagery and hypnotic suggestions are used to bring about overall relaxation of the bowels and the whole body, lessened sensitivity to gut discomfort, and increased mental control over bowel symptoms. These psychological treatments have proven to have several important advantages that make it likely that they will be increasingly important in the care of IBS in the coming years. They often work well for patients who have not improved from regular medical treatment, they have no uncomfortable side effects and they produce long-term improvement in symptoms. Finally, they often enhance psychological well-being and quality of life in addition to improving gastrointestinal symptoms. "http://rdu.news14.com/shared/print/default.asp?ArID=52106Why does relaxation techniques help Pain?How does antisipatory anxiety contribute to D in IBS?How does stressors effect the parasympathitic and sympathetic nervous system and the enteric nervous system?Why would these treatments help Brain gut axis dysfunction or effect nervous system problems.Is it stressful to a person to constantly be on the look out for bathrooms or think at any second they could be in horrific pain, or that they have not gone to the bathroom in four days?Does that chronic stress contribute to reactivation of inflammation or changes in gut flora, or alteration in neurotransmitters?Sublte thoughts effect the autonomic nervous system and hence digestion. Many people don't realize I think how really important this is to the GI disorders of function.This was written in 97 by the expert Marvin Schuster and the cases for these treatments have gotten much stronger."Anyone who has ever had butterflies before giving a speech or a bellyache before taking an exam knows that the emotions and the intestines are interwoven. This mind-gut relationship was scientifically explored in a classic set of experiments that were conducted in the late 1940s and early '50s by Cornell University gastroenterologist Tom Almy. While monitoring the rectal mucosa of medical student volunteers through a proctoscope, Almy and his collaborators would make a number of potentially embarrassing or anxiety-provoking remarks. For example, the researchers would say, "I heard you flunked the exam yesterday," or whisper, "Colon cancer." In response, the rectal mucosa would turn beefy red, the way some people blush when they are embarrassed, explains Bayless, who was an Almy protege. Once the investigators explained the "hoax" to the volunteers, the mucosa returned to its normal color.The experiments would be ethically suspect today, says Bayless, but they gave some credence to the saying, "My stomach is tied in knots." Even in healthy volunteers, the gut and the emotions are closely linked; in IBS, the connection may simply be tighter."http://www.jhu.edu/~jhumag/0497web/gastro1.htmlThe brain can triiger gut symptoms and the gut can trigger the brain. How a person reacts to these processes can have a major impact on the symptoms either for better or for worse.From this you can clearly see they are incorporating the whole person in disease processes.http://www.romecriteria.org/PDFs/p1377_FGI...I%20Process.pdfCan you modify serotonin or chemicals in the body by your thoughts and are thoughts and emotions tied in to some of the same brain centers?Do positive thoughts and emotions cause positive chemical and electrical changes in the body and do negative emotions cause negative chemical and electrical changes in the body.Have you ever had a family pet die and feel nauseas over it or physically sick?


----------



## eric (Jul 8, 1999)

FYI this is newStudies find cognitive therapy benefits IBSLOS ANGELES (May 24, 2006) â€" Cognitive behavioral therapy and hypnotherapy have been successfully used in the treatment of a variety of chronic syndromes, including common functional disorders of the gastrointestinal tract, such as irritable bowel syndrome. New research presented today at Digestive Disease WeekÂ® 2006 (DDW) again asserts that these therapies may have a powerful impact on the digestive system including improving symptoms of lower GI tract disorders. DDW is the largest international gathering of physicians and researchers in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery. "These studies illustrate the intricate ties between the digestive tract and other major body systems," said Emeran Mayer, M.D., professor of medicine, physiology and psychiatry, University of California, Los Angeles. "Physicians must recognize these connections to help treat patients more effectively." "In a large proportion of patients in both studies, a clinically significant improvement in the gastrointestinal symptom burden could be seen after hypnotherapy â€" an improvement that was clearly superior to the patients in the control group. After one year, the improvement for both groups was sustained, and in some cases, enhanced. In addition, the hypnotherapy patients in study two reported an improvement in anxiety and depression. Overall, both hypnotherapy groups reported significant improvements in GI symptoms including abdominal pain, distention and bloating in comparison to the control groups. "The use of hypnotherapy is an exciting new option in treating IBS," said Magnus Simren, M.D., Sahlgrenska University Hospital and study co-author. "More studies should be conducted to adapt hypnotherapy techniques from highly specialized settings to standard clinical practices that can be regularly available to IBS patients." http://www.eurekalert.org/pub_releases/200...a-sfc051906.php


----------



## 21627 (Feb 26, 2006)

Sounds like there are a lot of options and even more people suffering. I keep reading this girls websiteWhat is she doing right? Has anyone been able to talk with her? Maybe she would join our group and share some insights.[edited out MLM product website-please start your own thread in the product website to discuss products. do not "hijack" a thread being used to discuss other issues. thanks]


----------



## Talissa (Apr 10, 2004)

Well, I've gotten complete control of my IBS with natural supplements. I didn't need hypnotherapy. I do yoga regularly though--this may have helped in some way. Probably. ...tibby, Are you this Annie? A relative? Reliv seems to be a network marketing deal. 4 posts, all about this site of yours... One thing would make MLM peeps a bit more legit is if they were upfront from the start about their intentions.Talissa


----------



## Kathleen M. (Nov 16, 1999)

She looks like a fairly standard Reliv sales person (they all have stories like that) so I don't know that having yet another Reliv sales person stop by for awhile is going to give us more info than is already here. We get them every so often you can click the search above for Reliv and probably get all the same information. It is one of those things that seems to work much better in sales people's testimonials than random people from the board trying it out. K.


----------



## 21627 (Feb 26, 2006)

NO I'm not Amy but I do like what she has to say. Kathleen are you one of the "random" people who have tried her products? Maybe you should talk with her and see if this could help you. It does not appear that she even sells it but could probably tell you where to get it. Gosh what if it worked?


----------



## betterthroughscience (Jan 13, 2006)

> quote:Reliv


Where is Eric now? Here is a nutritional supplement sold by a multilevel marketing firm with no basis in any peer-reviewed research to support it, no biochemical mechanism by which it might be affecting the motility, inflammation, etc. that make up the symptomology and physiology of IBS.Why should you be suspicious of a multilevelmarketing product? Because MLM is the strategy businesses use when they have to rely on emotional means to convince people. What better way to convince someone than to give them a huge financial incentive to convince others?When you can point to hard science, you don't resort to MLM.


----------



## eric (Jul 8, 1999)

betterthroughscienceI agree with the comments on reliv. Its amazing they posted to this thread. betterthroughscienceHave you read the rome lll info I sent you.Specifically Fundamentals of Neurogastroenterology: Basic ScienceAnd the information on mast cells. Also notice DR Wood co-authored that article. http://www.romecriteria.org/GastroIssue.htm


----------



## Kathleen M. (Nov 16, 1999)

Gosh what if what my doctor did for me in a clinical trial that is published in a peer-reviewed medical journal worked for me. I no longer have to take medication or supplements of any kind.FWIW it works better around here if you avoid the same old standard tired MLM sales tactic arguements.You didn't try it yourself is classic.I suspect she sells because of the way the testimonial reads and what she uses as her email address.But that is just me.PS the "random" people are usually members who have been here awhile and seem to really have IBS and don't just come here to get the product's name out there. Did you know they pay people just to mention product names on bulliten boards?


----------



## 15157 (Jan 13, 2006)




----------



## 14135 (Sep 22, 2005)




----------



## Talissa (Apr 10, 2004)

So now you're not only a scam artist, but also a highjacker.You guys have highjacked a very interesting thread that has ABSOLUTELY nothing to do w/ your bs.Start your own thread & you can try to rip off peeps from there.


----------



## 14135 (Sep 22, 2005)

good post Talissa!







Now can we get back to the good information? Eric and BTS?


----------

