# IBS 80% OF THE TIME IS BS



## 19865 (Mar 17, 2007)

IBS 80% OF THE TIME IS BSI know this first hand and from my own experiences. Plus from many many others.


----------



## 19865 (Mar 17, 2007)

NEXT SUBJECT : THE DIAGNOSIS OF IBS= IRRITABLE BOWEL SYNDROME.Not only from what had been published but also from my own experiences with many again inconsistencies from the gastroenterology field of medicine. Most GIs have abused the diagnosis of IBS. It has also been told to me verbally by some gastroenterologists themselves.The Diagnosis of IBS was created many years ago for a small group of people that doctors could not diagnose that had some type of Motility GI disorder. Their diagnosis was greated and labeled as IBS.The Diagnosis of IBS was later abused by the field of gastroenterology using it more often since they either > Did not know what was wrong with their patients >Did not have the resources available to figure out exactly what was wrong > It was easier to temporarily label them as IBS since they did not appear to have any immediate life threatening illness and it was easier to just dope up their patients with anti-motility or motility, pain relieversâ€™, Phyc drugs etc.Much research has now proven that a Large portion approx 80 % of labeled IBS patients Are actually sufferers from other undiagnosed illnesses? More will be put into publics eyes in the next few years on this subject.Some suffer from an unknown cause of Small Bowel Bacteria Overgrowth.Some suffer from undiagnosed Carcinoids or gastrinomasSome suffer from undiagnosed Benign Endocrine problems â€“Thyroid or other.Some suffer from undiagnosed cancers â€“malignant or benignSome suffer from undiagnosed Immune system defects or problemsSome suffer from undiagnosed stubborn Ameba, bacterial, viral Some suffer from undiagnosed Pancreatic problems.Some suffer from undiagnosed IBD-Inflammatory Bowel Disease, Microscopic-Lymphocytic, Crohns, Ulcerative or other such as Celiac.Or other undiagnosed problems causing a domino effect on the Gut.Even though there is actually a small percentage of the IBS populationThat actually does have a Motility GI issue and are correctly labeled as IBS. The Numbers of IBS Patients is actually no where near what is publicized or stated by a majority of Gastroenterologistsâ€™.THE IBS DIAGNOSIS MOST OF THE TIME IS ABUSED AND USED AS A COP-OUT DIAGNOSIS.Should just be BS not IBS !


----------



## 18614 (Feb 24, 2007)

obviously you dont suffer from this. because when you are unable to stand up based on VERY real cramps you would not say that!


----------



## 19865 (Mar 17, 2007)

> quote:Originally posted by Sabramsonbviously you dont suffer from this. because when you are unable to stand up based on VERY real cramps you would not say that!


Sabramson,I have suffered and still sufferI am just making my opinion on the diagnosis that alot of people are falsley given.when thet actually may have another illness.


----------



## eric (Jul 8, 1999)

Most people diagnosed with IBS using the rome criteria actually have IBS. Studies have shown using the criteria there is less then 5 percent misdiagnoses and they have looked at this over many years."Some suffer from an unknown cause of Small Bowel Bacteria Overgrowth.Some suffer from undiagnosed Carcinoids or gastrinomasSome suffer from undiagnosed Benign Endocrine problems â€"Thyroid or other.Some suffer from undiagnosed cancers â€"malignant or benignSome suffer from undiagnosed Immune system defects or problemsSome suffer from undiagnosed stubborn Ameba, bacterial, viral Some suffer from undiagnosed Pancreatic problems.Some suffer from undiagnosed IBD-Inflammatory Bowel Disease, Microscopic-Lymphocytic, Crohns, Ulcerative or other such as Celiac."None of these are IBS and to even say there are basically shows you haven't done your homework on IBS. Everything above has red flag symptoms that would point to a different diagnoses then IBS or rule out IBS.Diagnosing IBShttp://ibsgroup.org/groupee/forums/a/tpc/f...261/m/316101372Motility alone does not explain IBS pain.There has been a tremedous amount of new and excellent research on IBS you have also missed.So with all do respect, I am not sure where your getting this information but its flat out wrong.


----------



## 13787 (Aug 25, 2006)

I smell a troll.Eric is right, we get tested for everything before we get labeled IBS. Its a matter of exclusion and when everything that YOU mentioned comes out normal or negative it then becomes IBS.I didnt walk in my docs office with symptoms and being told its IBS without fully knowing what is going on in there.


----------



## 20113 (Mar 17, 2007)

Why don't you go back to the *S*ess*P*ool you came from.


----------



## 17890 (Mar 11, 2007)

I can see both sides of the argument. There is evidence that GI dr.s admit to labeling patients with IBS because no other diseases are apparent. However, much more research has been done and yes the Rome III criteria does help classify patients based on symptoms and it is now known as a functional disorder. Everyone has there own opinion, lets all get along


----------



## hasenfuss (Dec 28, 2006)

sp, I wonder what tests have you had done ?


----------



## 14225 (Aug 15, 2006)

I think sp's point wasn't that IBS doesn't exist or that the symptoms aren't real; the point was that some doctors give up too easily and dismiss unexplainable bowel problems as IBS, when there could be other disorders present.Of course maybe that isn't the case, if Eric's got his statistics right. Isn't IBS defined as that certain set of symptoms (y'all know what they are) in the absense of any disease or defect?


----------



## eric (Jul 8, 1999)

There are many outsanding doctors, world recognized leaders in many different fields working to help solve IBS and other functional dsorders. A lot of times they don't get credit or importantly enough funding. They are working very hard on it however, this I know for sure.IBS is a secure diagnoses based on a SPECIFIC cluster of symptoms, minus red flag symptoms.There are also symptoms associated with IBS that help secure the diagnoses.One of the issues is there is not a specific Biological Marker they can see in EVERY IBSer. However there are an assortment of problems and issues seen in post infectious IBS and IBS. IBS is also one of some thrity functional disorders. It can also be seen more often along with some other disorders as well, like fibro, or CFS and some others like functional dyspepsia. Because there is no specific biological marker, they have to rely on a specific cluster of symptoms, minus red flag ones that they see in IBS patients. They have also known about and been studying IBS for some time now, but only recently starting to get to some of the underpinnings of the condition. There are also things IBS does not cause, like a fever or blood in the stool. There are also things that are uncommon in IBS like it awakening you at night, which is more a sign of an organic problem, although some IBSers do have that problem and there can be reasons for IBSers to have that problem as well. For example lite sleepers.People can also have IBS and other conditions.However newer state of the art research has made a whole lot of progress lately. They are begining to understand more and more how the body works and also problems seen in Post Infectious IBS and IBS. Other issues are subgroups being defined, like PI IBS. However even though someone has d and another c or another d/c its still IBS if there is also pain or discomfort and if the problems are chronic. There testing has also gotten better and they have also been able to look more closely at things. It wasn't untl recently when they were able to look more closely did the see Real problems.For example from one of the leaders in PI IBS research. Post-infectious Irritable Bowel SyndromeRobin Spiller; Eugene Campbell Curr Opin Gastroenterol. 2006;22(1):13-17."Abstract and IntroductionAbstractPurpose of Review: Irritable bowel syndrome patients form a heterogeneous group with a variable contribution of central and peripheral components. The peripheral component is prominent in irritable bowel syndrome developing after infection (post-infectious irritable bowel syndrome) and this has proved a profitable area of research.Recent Findings: Recent studies have overthrown the dogma that irritable bowel syndrome is characterized by no abnormality of structure by demonstrating low-grade lymphocytic infiltration in the gut mucosa, increased permeability and increases in other inflammatory components including enterochromaffin and mast cells. Furthermore, increased inflammatory cytokines in both mucosa and blood have been demonstrated in irritable bowel syndrome. While steroid treatment has proved ineffective, preliminary studies with probiotics exerting an anti-inflammatory effect have shown benefit.Summary: The study of post-infectious irritable bowel syndrome has revealed the importance of low-grade inflammation in causing irritable bowel syndrome symptoms. It has suggested novel approaches to irritable bowel syndrome including studies of serotonin and histamine metabolism which may be relevant to other subtypes of of the disease."http://www.medscape.com/viewarticle/518355_printIn IBS itself some of the strongest evidence is a problem with serotonin dysregulation."Irritable bowel syndrome (IBS) has been described as a â€œfunctionalâ€ disorder, which is a â€œdiagnosis of exclusion.â€ Thus, many physicians still think IBS has no demonstrable pathophysiologic defects and that it can only be diagnosed after other â€œorganicâ€ 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=2721Irritable Bowel Syndrome: How far do you go in the Workup?http://www.romecriteria.org/reading1.htmlYou might also here about inflammation alot when reading about IBS. However"But microscopic inflammation cannot be a diagnostic marker for IBS because it does not typically produce pain in those who have it. All patients with active celiac disease have microscopic inflammation, but a large proportion do not have abdominal pain, and patients with ulcerative colitis who also have microscopic inflammation when compared to patients with IBS appear to have higher pain thresholds (24). In individuals with these disorders, there may be central nervous system counter-regulatory measures responding to the peripheral pain/inflammatory processes that increase pain thresholds. With regard to IBS, the gut-related effects of microscopic inflammation may be only one component of a dysfunctional brain-gut system. In addition, and often in response to stress, there may be a failure to activate descending pain inhibitory systems that enable the clinical experience of pain and other symptoms that typify this disorder (25)."http://www.romecriteria.org/reading1.html


----------



## 17014 (Apr 13, 2005)

I sure there are not a lot mis-diagnosed. But anyway the rome criteria are not useful for IBS. IBS should only be diagnosed if visceral hypersensibility is included. People without visceral hypersensibility should not be a part of IBS. I`m sure there are a lot people on this board with only mild C or D problems or gas, and in my opinion this is not IBS.


----------



## eric (Jul 8, 1999)

FYIOne thing is there is mild, moderate and severe IBS. Also someone without pain maybe functional d or functional C or even functional abdominal pain or CFAP.Glossary"Visceral hypersensitivity (intestinal): Enhanced perception, or enhanced responsiveness within the gut -- even to normal events."This has to do with pain and pain perception.Sarmiento with all do respect"But anyway the rome criteria are not useful for IBS. "They are very useful for diagnosing IBS and other functional disorders and seperating organic diseases."History of Functional Disorders""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 large intestine and colon. Abnormal motility can generate a variety of GI symptoms includingvomiting, diarrhea, constipation, acute abdominal pain, and fecal incontinence. Functional GI patients have even greater increased motility in response to stressors in comparison to normal subjects. *While abnormal motility plays a vital role in understanding many of the functional GI*and their symptoms, *it is not sufficient to explain reports of chronic or recurrent abdominal pain. it is not sufficient to explain reports of chronic or recurrent*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, where motility disturbances do not exist. Patients suffering from visceral hypersensitivity have a lower pain 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 of visceral pain. Recently it has been concluded that visceral hypersensitivity may be induced in response to rectal or colonic distension in normal subjects, and to a greater degree, in persons with IBS. Therefore, it is possible that the pain of functional GI disorders may relate to sensitization resulting from chronic abnormal motor hyperactivity, GI infection, or trauma/injury to the viscera.BRAIN-GUT AXISThe concept of brain-gut interactions brings together observations relating to motility andvisceral hypersensitivity and their modulation by psychosocial factors. By integrating intestinal and CNS central nervous system activity, the brain-gut axis explains the symptoms relating to functional 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 central pain perception, mood, and behavior. For example, spontaneously induced contractions of the colon in rats leads to activation of the locus coeruleus in the pons, an area closely connected to pain 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 stress hormones in the brain. *Based on these observations, it is no longer rational to try to discriminate whether 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, and* 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."http://ibsgroup.org/groupee/forums/a/tpc/f...710974#19710974


----------



## eric (Jul 8, 1999)

also*Neuroimaging has provided evidence of physiological differences between normal individuals and those suffering from IBS in the way a visceral stimulus (ie, rectal distention) is processed in the brain*.[14,15] Initial data from positron emission tomography (PET) scans demonstrated increased activation of the anterior cingulate cortex (ACC) among normal individuals, compared to IBS patients. The ACC is a cerebral cortical area that is rich in opiate receptors and is thought to be a major component of cognitive circuits relating to perception as well as descending spinalpathways involving pain. More recently, fMRI was used to demonstrate increased activity in the ACC, prefrontal (PF), and insular cortex areas, and in the thalamus of IBS patients compared to normal individuals."














There are differences between IBSer and normals in brain activation, when they do ballon distension studies. "Latest From the Literature in IBS""Lawal A, Kern M, Sidhu H, Hofmann C, Shaker R. Novel evidence for hypersensitivity of visceral sensory neural circuitry in irritable bowel syndrome patients. Gastroenterology. 2006;130:26-33.The pathophysiology of IBS involves multiple underlying factors, including abnormalities in visceral sensation, disturbances in gut motility, and differences in the central nervous system (CNS) processing of visceral pain""In addition, patients with IBS demonstrated a maximum response to subliminal distention, as compared with the graded response seen in healthy volunteers. *These findings are important for a number of reasons. One, it confirms the now widely accepted view that the brain-gut axis is a critical component in IBS. Two, it emphasizes that hypersensitivity is a key underlying pathophysiologic mechanism in the generation of symptoms in IBS patients. And finally, although not evaluated in this study, these findings point out that therapeutic options for patients with IBS should focus on treating both the hypersensitive gut and the hypersensitive CNS."*http://ibsgroup.org/groupee/forums/a/tpc/f...261/m/906107392Also PI IBS has recently been demonstrated as a brain gut axis disorder, like IBS."Some of the major research advances that support the integrated or biopsychosocial approach include: Genetic and early environmental influences on the functional GI disorders The role of neurotransmitter and neurohormonal signaling in intestinal/enteric functionThe use of animal modelsNewer research relating to altered neuroimmune function, cytokine (cell molecules involved in the immune system response) activation, and brain-gut interactions*Demonstration of post-infectious IBS as a brain-gut disorder*The role of brain imaging in understanding the modulation of visceral pain http://www.iffgd.org/symposium2005report.html


----------



## eric (Jul 8, 1999)

This is very important research when it comes to Visceral sensations and brain gut mechanisms."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


----------



## 23715 (Mar 10, 2007)

I accepted the diagnosis of IBS 5 years ago. I was told to live with it. It was not that debilitating but now it is, and now I've had stool tests 8 months apart both showing parasites. The symptoms of parasites are exactly the same as most IBS symptoms. My GP, gastroenterologist and endocrinologist - none of them can explain or cure this. Is it parasites causing IBS? Is it a coincidence, IBS first and then parasites? Or maybe something else - the GP thought it was an ulcer! In reading so many posts here, I notice that a lot of people had an attack of a flu bug or food poisoning, or went overseas, or some first incident, and it never went away. So there is the question, is there a first cause which leads to the IBS being chronic? These are all valid questions. I know we have to be methodical about it, that is what my doctor says, we examine one thing at a time and rule things out. Right now he knows I have a parasite and yet there is no known cure for it. So is it IBS caused by a parasite or IBS plus parasite? And other people have different complications. It's so disheartening to try many things and get no relief or answers. I just want the insides to work right again!


----------



## Jannybitt (Oct 13, 2006)

Thanks for your posts, Eric!!! Very informative and accurate!


----------



## 21857 (Aug 15, 2006)

Thanks for all the info Eric! nice one as usual!!Of course it is easy for someone from the outside to make those judgements, but i do see where he comes from in the sense that when i was first diagnosed i knew it was a palm off by my GP because they couldnt be bothered to find what was really wrong, but i went to a specialist and got all the tests done to make sure nothing else is wrong.So, yeah maybe there are a few people on here that dont actually have IBS if they havent had any tests done, but its not nice for an outsider to come and tell us what we are going through - which is hell, is BS!!!


----------



## 19865 (Mar 17, 2007)

Eric,I am not a doctor either. I am entitled to my own opinion too. I have my own personal experiences and my own resources with proof.I am not saying that IBS does not exhist.I am simply stating my opinion from my own experiences and from many others i know including Patients & doctors -Gastroenterologists or non GIs.IBS does exhist.IT IS NOT IN AS MANY PEOPLE AS IS PORTRAYED BY TOO MANY -of GASTROs- UNFORTUNATLEY MOST GO BY A MORE SIMPLE SET OF THIER OWN PERSONAL ROME CRITERIA CREATED AMUNGST THEMSELVES.# 1 IS IT SOMETHING LIFE THREATENING THAT NEEDS IMMEDIATE CARE?# 2 IS IT EASY TO FIND CANCER OR INFLAMATORY BOWEL =CROHNS,ULCERATIVE ETC.? # 3 IS IT CELIAC ?# 4 ITS PROBABLY IBS SINCE THEY DO NOT HAVE ANY IMMEDIATE THREAT OR DANGER !# 5 They dont have any immediate danger and thier insurance wont cover much more testing unless i have some kind of proof  So i will just diagnose them as IBS so it makes it easier.YOU CAN SHOW ME AS MANY ->PET SCANS AS YOU LIKE.THE (PET -IBS) STUDY SIMPLY INDICATES THAT THERE IS PAIN AND THE BRAIN SEES IT. (THATS IT )(NO MATTER HOW YOU SLICE IT)IT IS WHAT IT IS . AND MOST OF THE TIME TO ME AND MANY OTHERS ITS >BS NOT IBS.I am 36 yrs oldHad seen approx 18 Gastroenterologists since 1992Some are terrific people and great doctors.Some had been Famous for thier IBS treatments and others were just simple local GIs.Other many great GIs are convinced that IBS in a majority of people is acually Small Bowel Bacteria Overgrowth.The Small Bowel Bacteria Overgrowth is more likeley < Most IBSrs problem.I had met many nice people through my search for help.Many of those people were in the same boat, i was in.(The Falsey labeling of IBS for our problems)I CANNOT Say that i am healthy right now. But I am trying.Once again i will state again. I am not a doctor, do not want to be portrayed as a (know it all) I AM SIMPLY STATING MY OPINION FROM MY OWN EXPERIENCES and resources to share with others on this board.My opinion for everyone who has been diagnosed with IBS.Dont settle so easy on your IBS diagnosis and never take NO for an answer when you keep requesting tests.I found my way from a saint of a doctor who is not a Gastroenterologist.He heard my story about years of IBS & GI issues and decided to go against my Health insurance and Order me a FULL BODY PET for CancerWhile approx 11 prior GIs had refused and kept stating "NO "On what grounds""""you dont need any more tests"""I am currently requesting more studies be done with Octreotide scanning for any missed carcinoid which my Endocrinologists now suspects.I still get the run around when i requests testing even though i had already proof & diagnosed with Thyroid Cancer during that prior PET that was prooven to be there since 1996 and had spread.I have had several other medical problems since, I am now told that contributed to my years of GI issues.IT is not over for me yet. I am lucky and fortunate to have many loving people. Current terrific doctors. and fortunate to be financially able with resouces to hire doctors to do my own personal study -which will be done in about a year. I will proove to everone one day. The BULL that is given to many people about IBS from the a large group of main book writing Gastroenterogists' and Drug companies and Insurance companies backing themMY WHOLE STORY IS A VERY LONG ONE AND DOES NOT END HERE. I HOPE ONE DAY I WILL BE HEALTHY ENOUGH TO SIT AND WRITE IT OUT FOR EVERYONE.I DID NOT SAY IBS DOESnT EXHIST. IT DOES.IT IS NOT -I REPEAT --IN MY OWN PERSONAL OPINION- AND FROM OTHERS I KNOW--IT IS NO WHERE NEAR THE AMOUNT OF PEOPLE THAT IS SAID IT IS TODAY to have IBS.I DONT WANT EVERY ONE TO THINK THEY ALL HAVE CANCER. THATS NOT TRUE.THAT IS NOT THE CASE EITHER.MOST MORE THAN LIKELY HAVE --SMALL BOWEL BACTERIA OVERGROWTH - FALSELY LABELED AS IBS.To all IBSrs Stay healthy, Proof is on its way.


----------



## 19865 (Mar 17, 2007)

http://209.85.165.104/search?q=cache:iexx3...clnk&cd=2&gl=usPresented by Richard R. P. Warner MDClinical Professor of The Mount Sinai School of Medicine, New York, NY, Clinical Associate Professor of Medicine, Weill Medical College of Cornell University , New York, NY, Medical Director, Carcinoid Cancer Foundation, Inc. A Quote from this lecture.Now, into the clinical field. Again, as so many of you know, carcinoid is often misdiagnosed, especially carcinoid of the intestinal tract. Often it is thought to be irritable bowel syndrome (IBS) with vague digestive symptoms intermittently sometimes for many years. In other instances, it gets misdiagnosed as Crohn's disease, an inflammatory disease of the intestine. It can be treated as Crohn's disease for varying lengths of time, even years, until finally the progression of symptoms become such that surgery is required. Then everybody's surprised to find it was carcinoid all along. I've actually seen over a dozen such instances in the past year. And as we've said, it's less rare than we used to think. It's more malignant than we previously thought. ------------------------------------------------Curr Treat Options Gastroenterol Treatment of Functional Diarrhea. Dellon , Ringel Department of Medicine, Division of Gastroenterology and Hepatology and Center for Functional GI and Motility Disorders, University of North Carolina School of Medicine, 4107 Bioinformatics Building, CB #7080, 130 Mason Farm Road, Chapel Hill, NC 27599-7080, USA. ringel###med.unc.edu. Functional diarrhea (FD), one of the functional gastrointestinal disorders, is characterized by chronic or recurrent diarrhea not explained by structural or biochemical abnormalities. The treatment of FD is intimately associated with establishing the correct diagnosis. First, FD needs to be distinguished from diarrhea-predominant irritable bowel syndrome (IBS), in which, unlike in FD, abdominal pain is a primary diagnostic criterion. Next, FD must be differentiated from the myriad organic causes of chronic diarrhea. Unlike IBS, in which a positive diagnosis can be made with an acceptable level of confidence using symptom-based criteria and minimal testing, the diagnosis of FD is still primarily a diagnosis of exclusion. Thus, the onus is on the physician to eliminate potential underlying causes, both common and uncommon, in the proper clinical setting. Once the diagnosis has been established, the clinician and patient should first focus on identifying, eliminating, and/or treating aggravating factors. These may include physiologic factors (eg, small bowel bacterial overgrowth), psychological factors (eg, stress and anxiety), and dietary factors (eg, carbohydrate malabsorption). Thereafter, appropriate treatment for functional diarrhea may be instituted. Treatment options include dietary and lifestyle modification, pharmacologic therapies, and alternative modalities. Although many of these strategies have been studied in IBS, almost none of them has been examined specifically in FD. Furthermore, given the poorly understood pathophysiologic basis of FD, these treatments primarily target a patient's symptoms and presumed altered physiology rather than underlying etiologic mechanisms. Therefore, we stress that treatment must be approached in an individualized manner and that dietary and pharmacologic therapies should be part of a comprehensive therapeutic approach in which education and reassurance form the foundation. In general, we attempt to remove dietary triggers and recommend increased fiber intake. We then add anticholinergic, antispasmodic, antimotility, and antidiarrheal agents as the first line of pharmacotherapy. Should a patient not respond to these, and for patients who have a significant degree of psychological dysfunction, central acting agents, including antidepressants and/or anxiolytics, may be beneficial. During the treatment period, we also recommend that physicians keep an open mind. If signs or symptoms that suggest an ongoing or previously unrecognized organic process develop, then a re-evaluation of the clinical picture is indicated. PMID: 16836952 PubMed - as supplied by publisher ------------------------------------------------Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome: What Is the Association? QuestionWhat is the evidence for the role of small intestinal bacterial overgrowth in the etiology of irritable bowel syndrome? Response from Yehuda Ringel, MD Assistant Professor of Medicine; Staff Physician, Department of Medicine, University of North Carolina at Chapel HillSeveral studies over the last few years have suggested an association between abnormal hydrogen breath test findings and irritable bowel syndrome (IBS), and proposed small intestinal bacterial overgrowth (SIBO) as a potential etiologic factor in the disorder. In 2 early provocative studies, Pimentel and colleagues,[1,2] from Cedars-Sinai Medical Center in Los Angeles, California, reported that 78% to 84% of their IBS patients had abnormal lactulose hydrogen breath test results compared with 20% of patients in a control group (P < .01). Furthermore, neomycin treatment resulted in significant improvement in their patients' symptoms (eg, 35.3% bowel normalization in the treated group compared with 13.9% in the placebo group; P < .001), and up to 48% of eradicated subjects no longer met the Rome criteria for IBS. Although these studies were first criticized because of patient-selection bias and the low accuracy of lactulose breath testing in defining SIBO, several studies with glucose breath testing have also shown a higher prevalence of SIBO in patients with IBS. For example, a recent retrospective epidemiologic case-control study demonstrated positive glucose breath tests in 31% of patients with IBS vs only 4% in the control group (odds ratio [OR], 2.65; 95% confidence interval [CI], 3.5-33.7; P < .00001).[3] These results support Pimentel and colleagues' early findings of an association between IBS and SIBO. However, other studies have shown a much lower prevalence of SIBO in patients with IBS. In a recently reported retrospective study of patients who were referred for glucose hydrogen breath testing for SIBO, only 11% of 113 patients who met the Rome II criteria for IBS tested positive for SIBO, suggesting that IBS symptoms are often unrelated to SIBO.[4] On the basis of currently available data, the contributing role of SIBO in the pathophysiology of IBS remains controversial, and the large variation in the prevalence of SIBO in IBS (10% to 84%) indicates the problematic state of this research, particularly with regard to the accuracy of breath testing in detecting SIBO in patients with altered (particularly accelerated) gastrointestinal motility.Further epidemiologic studies and placebo-controlled clinical trials aiming at eradicating SIBO are necessary to clarify the true impact of SIBO on IBS symptoms. With regard to the latter, several small treatment trials have been reported and demonstrated improvement in IBS symptoms with antibiotic (eg, neomycin and rifaximin) therapy.[2,5] However, the results of a larger multicenter study with rifaximin are awaited with anticipation.From a clinical standpoint, until this issue is clarified, clinicians should consider SIBO in an IBS patient with typical symptoms (eg, bloating, distention, and diarrhea), as well as in patients with these symptoms who do not fulfill the diagnostic criteria for IBS.Posted 09/18/2006--------------------------------------------------------------------------------Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome: What Is the Association? QuestionWhat is the evidence for the role of small intestinal bacterial overgrowth in the etiology of irritable bowel syndrome? Response from Yehuda Ringel, MD Assistant Professor of Medicine; Staff Physician, Department of Medicine, University of North Carolina at Chapel HillSeveral studies over the last few years have suggested an association between abnormal hydrogen breath test findings and irritable bowel syndrome (IBS), and proposed small intestinal bacterial overgrowth (SIBO) as a potential etiologic factor in the disorder. In 2 early provocative studies, Pimentel and colleagues,[1,2] from Cedars-Sinai Medical Center in Los Angeles, California, reported that 78% to 84% of their IBS patients had abnormal lactulose hydrogen breath test results compared with 20% of patients in a control group (P < .01). Furthermore, neomycin treatment resulted in significant improvement in their patients' symptoms (eg, 35.3% bowel normalization in the treated group compared with 13.9% in the placebo group; P < .001), and up to 48% of eradicated subjects no longer met the Rome criteria for IBS. Although these studies were first criticized because of patient-selection bias and the low accuracy of lactulose breath testing in defining SIBO, several studies with glucose breath testing have also shown a higher prevalence of SIBO in patients with IBS. For example, a recent retrospective epidemiologic case-control study demonstrated positive glucose breath tests in 31% of patients with IBS vs only 4% in the control group (odds ratio [OR], 2.65; 95% confidence interval [CI], 3.5-33.7; P < .00001).[3] These results support Pimentel and colleagues' early findings of an association between IBS and SIBO. However, other studies have shown a much lower prevalence of SIBO in patients with IBS. In a recently reported retrospective study of patients who were referred for glucose hydrogen breath testing for SIBO, only 11% of 113 patients who met the Rome II criteria for IBS tested positive for SIBO, suggesting that IBS symptoms are often unrelated to SIBO.[4] On the basis of currently available data, the contributing role of SIBO in the pathophysiology of IBS remains controversial, and the large variation in the prevalence of SIBO in IBS (10% to 84%) indicates the problematic state of this research, particularly with regard to the accuracy of breath testing in detecting SIBO in patients with altered (particularly accelerated) gastrointestinal motility.Further epidemiologic studies and placebo-controlled clinical trials aiming at eradicating SIBO are necessary to clarify the true impact of SIBO on IBS symptoms. With regard to the latter, several small treatment trials have been reported and demonstrated improvement in IBS symptoms with antibiotic (eg, neomycin and rifaximin) therapy.[2,5] However, the results of a larger multicenter study with rifaximin are awaited with anticipation.From a clinical standpoint, until this issue is clarified, clinicians should consider SIBO in an IBS patient with typical symptoms (eg, bloating, distention, and diarrhea), as well as in patients with these symptoms who do not fulfill the diagnostic criteria for IBS.Posted 09/18/2006CHECK OUT THE BELOW STUDIES ALSO IN MY OPINION DR PIMENTEL IS THE MOST EXPERIENCED WITH THE SMALL BOWEL BACTERIA OVERGROWTH --IBS ReferencesPimentel M, Chow EJ, Lin HC. Eradication of small intestinal bacterial overgrowth reduces symptoms of irritable bowel syndrome. Am J Gastroenterol. 2000;95:3503-3506. AbstractPimentel M, Chow EJ, Lin HC. Normalization of lactulose breath testing correlates with symptom improvement in irritable bowel syndrome. a double-blind, randomized, placebo-controlled study. Am J Gastroenterol. 2003;98:412-419. AbstractLupascu A, Gabrielli M, Lauritano EC, et al. Hydrogen glucose breath test to detect small intestinal bacterial overgrowth: a prevalence case-control study in irritable bowel syndrome. Aliment Pharmacol Ther. 2005;22:1157-1160. AbstractHarris LA, Crowell MD, DiBaise JK, Olden K. Is small intestinal bacterial overgrowth (SIBO) really prevalent in irritable bowel syndrome (IBS)? Am J Gastroenterol. 2005;100:S336-S337.Pimentel M, Park S, Kong Y, et al. A 10-day course of rifaximin, a non-absorbable antibiotic, produces a durable improvement in all symptoms of irritable bowel syndrome: a double-blind randomized controlled study. Gastroenterology. 2006;130


----------



## Jeffrey Roberts (Apr 15, 1987)

sp,Your comments are understood. Maybe it is better to state that 80% of the time, IBS is misdiagnosed because of the common symptoms with other ailments. You highlight an important point that it is very important to feel confident about the diagnosis and to always work closely with your healthcare professional(s).Jeff


----------



## overitnow (Nov 25, 2001)

sp: for whatever it is worth, I thought this was a very useful discussion.I hope you find a successful treatment for your tumor. (Again, for whatever it is worth, the logger who is working on my property has been recovered from mouth/lymph node cancer for over 10 years with essiac, which he got from one of his customers.)Mark


----------



## eric (Jul 8, 1999)

SP, I too hope you find the right treatment for the tumor.I think we can all agree there are good doctors and bad ones and getting a second opinion can be helpful for a variety of reasons. also if symptoms change its time to see a doctor again. Something else maybe how long ago someone was diagnoses, because testing and the understanding of IBS has progressed rapidly. Newer stool testing can help to seperate IBD or inflammation conditions from IBS for one.Its also helpful to do some research on How accurate the Rome Criteria is in diagnosing IBS or world population studies on the occurence of IBS in different countries. Its also known more women then men have IBS and that begs the question why?A lot of the conditions you mentioned however caused "red flag" symptoms or can be seen in testing. Bleeding, fever, weight loss, awakening at night ect..It can also be and this is important, someone can have more then one problem.There is a lot of controversy in regards to SIBO and IBS right now and the asscociation of the two. People can have SIBO and not have IBS, so what does that mean really? Or have IBS and not have SIBO? Other IBS researchers have not found the same results as Cedar in there IBS patients, which is also stated in what you posted, but even more in other abstracts. Also the test is not very accurate. Another issue was the last study was not very effective regardless of the hype basically, bloating improved but not pain or d or c? So again what does that mean? And SIBO could be chronic as well and require antibiotics all the time to keep it at bay possibly. SIBO and IBS research is one part of IBS research and there is a lot of IBS research going on in all the fields. You might want to look at more of the research in the sibo forum. SIBO can also cause malabsorbtion, which IBS does not, but no one seems to be mentioning that yet it seems.IF you want to read something really interesting on this you can get this via email or on the phone from the IFFGD. This is also something you can get from the IFFGD on SIBO and IBS and I highly recommend reading it. One the common test lactulose breath testing for it is not that accurate."Gut Bacteria and Irritable Bowel Syndrome By: Eamonn, M. M. Quigley M.D., Alimentary Pharmabiotic Centre, University College Cork, Cork, IrelandBacteria are present in the normal gut (intestines) and in large numbers the lower parts of the intestine. These "normal" bacteria have important functions in life. A variety of factors may disturb the mutually beneficial relationship between the flora and its host, and disease may result. The possibility that gut bacteria could have a role in irritable bowel syndrome (IBS) may surprise some; there is indeed, now quite substantial evidence to support the idea that disturbances in the bacteria that populate the intestine may have a role in at least some patients with IBS. This article presents a discussion of the possible role of bacteria in IBS and various treatment approaches."Do bacteria play a role in IBS?The possibility that gut bacteria could have a role Irritable Bowel Syndrome (IBS) may surprize some; there is indeed, now quite substantial evidence to support the idea that distrubances in the bacteria that populate the intestines may have a role in at least some patients with IBS. What is this evidence? It can be summarized as follows:1. surveys which found that antibiotic use, well known to distrub flora, may predispose individuals to IBS.2. The observation that some individuals may develop IBS suddenly, and for the first time, following an episode of stomach or intestinal infection (gatroenteritis) caused by a bacterial infection.3. recent evidence that a very low level of inflammation may be present in the bowel wall of some IBS patients, a degree of inflammation that could well have resulted from abnormal interactions with bacteria in the gut.4. The Suggestion that IBS maybe Associated with the abnormal presents, , in the small intestines, of types and numbers; a condition termed small bacterial overgrowth (SIBO)>5. Accumaliting evidence to indicate that altering the bacteria in the gut, by antibiotics or probiotics, may improve symptoms in IBS.For some time, various studies have suggested the presence of changes in the kind of colonic flora in IBS patients. The most consistent finding is a relative decrease in the population of one species of 'good' bacteria, bifidobacteria.However, the methods employed in these studies have been subject to question and other studies have not always reproduced these finding. Nevertheless, these changes in the flora, maybe primary or secondary, could lead to the increase of bacterial species that produce more gas and other products of their metabolism. These could CONTRIBUTE to symptoms such as gas, bloating and diarrhea."http://www.aboutibs.org/Publications/currentParticipate.htmlSo really they don't know the exact role of bacteria in IBS, except more so in Bacteria and post infectious IBS, where they know much more.Does Bacterial Overgrowth Play a Role in IBS?Bacterial Overgrowth & IBS: Too Soon To Tellhttp://www.gastro.org/wmspage.cfm?parm1=2721I would also be gald to send you an editorial on that last study if you email me, although it will get posted in the upcoming months.This article on IBS is also quite helpful in differential diagnostics and in general. But"Stool testing for Ova and Parasites are generally of low yield (0-2%) and the outcome of therapy on symptoms of IBS in patients with parasites is unknown. "http://hopkins-gi.nts.jhu.edu/pages/latin/...se=43&lang_id=1


----------



## David LA (Dec 21, 2005)

SP: You make some outstanding POINTS! Its so re-freshing to read posts like yours!!!!!It gives me hope in our Society.That while people with "IBS" suffer with this.... Your common sense is still working great!!!!Keep up the posts!!!!!


----------



## eric (Jul 8, 1999)

SP a couple more things you maybe interested in.Have you ever looked at all the IBS info in the IBS resource center in medscape?andAmerican Gastroenterological Association Teaching project slides IBS Originally posted on May 15, 2003 https://www.gastroslides.org/Main/browse_deck.asp?tpc=4 Irritable Bowel Syndrome 2004 Update Originally posted on May 15, 2003 https://www.gastroslides.org/Main/browse_deck.asp?tpc=9This is newerIntegrated Approach to Irritable Bowel SyndromeThis is an online CME course featuring Dr. Drossman http://www.ja-online.com/dukeibs/#This thread can also be helpful. The stronest evidence they have on IBS has to do with serotonin. It maybe that problem which is part of altered motility in IBS predisposes one to SIBO. It is also the neurotransmitter that sends singals of sensation to the brain. The post below explains that and other IBS mechansims that are important. In PI IBS they have found increases of the EC cells that store serotonin and increases in mast cells that contribute to pain in IBS. in IBS d predominate IBSer release more serotonin after a meal. Its more complicated then that, but it helps expalin d and c and why there is D?C in IBS.http://ibsgroup.org/groupee/forums/a/tpc/f...261/m/906107392


----------



## eric (Jul 8, 1999)

People of course what to make sure they are diagnose accurately.Symptoms and Characteristicsof IBS http://www.aboutibs.org/characteristics.htmlCurrent Approach to the Diagnosis of Irritable Bowel Syndrome"In the past two decades, medical opinion has changed regarding how to diagnose IBS. The older view emphasized that IBS should be regarded primarily as a "diagnosis of exclusion;" that is, diagnosed only after diagnostic testing excludes many disorders that could possibly cause the symptoms. Because many medical disorders can produce the cardinal IBS features of abdominal discomfort or pain and disturbed bowel habit as well as other symptoms caused by IBS, this approach often led to extensive diagnostic testing in many patients. Since the era when such thinking about IBS was common, laboratory, motility, radiologic, and endoscopic tests have proliferated. Although each of these tests is useful in evaluating certain problems, their routine or indiscriminate use can cause unnecessary inconvenience and cost for patients, and complications even occur infrequently from some of the tests. Fortunately, physicians can now diagnose IBS in most patients by recognizing certain symptom details, performing a physical examination, and undertaking limited diagnostic testing. This simpler approach is grounded on recent knowledge of the typical symptoms of IBS, and it leads to a reliable diagnosis in most cases. Extensive testing is usually reserved for special situations. "http://www.aboutibs.org/Publications/diagnosis.htmlOne reason why working closely with a good doctor is important. So what if someone is accurately diagnosed with IBS, but doesn't except it and continues to get tested and worry its something else. That is important also, because it causes more anxiety and more worry, which will cause more symptoms and increased pain.


----------



## Carlyn (Jan 15, 2005)

i have to agree with sp IBS is just i dont know what it is lable, many people i know who had been told by gp's they had ibs and to get on with things avtually didnt. Some had allergies to dairy and once that was sortted everything was fine, one even had colon cancer and was told for months by her gp it was ibs when it wasn't, 2 people actually had crohn's and 1 with UC who was told for years by many doctors it was ibs.Too many doctors are becoming lazy and saying ibs and telling people to get on with things, i've met people through support groups in my area where laziness in doctors are a major factor. i agree most of the time the diagnosies of ibs is bs alot of the time because it just goes on word of mouth where no tests are done to find out for certain.


----------



## eric (Jul 8, 1999)

Criteria to diagnose IBS have been around for years and have developed themselves to be more accurate or as accurate as they can get now. Testing has also improved majorally over the years. You can be more accuratly diagnosed perhaps if you ask the doctor how he is coming to the IBS diagnoses and are they using the Criteria to diagnose IBS and rule out other conditions or find out if there is more then one condition. Red flags are a major issues on all this.HoweverCeliac is NOT IBS.Tumors or cancer are NOT IBS.IBD conditions are NOT IBS.Parasite infection is NOT IBSAt this time there is not enough research on bacteria as the Root cause, except in the development of PI IBS and there structual cell changes matter for one.They use to think lactose intolerence was IBS.So I am surprized others are not mentioning this really.Irritable Bowel Syndrome: How far do you go in the Workup?"Efforts to consolidate these many influences on diagnostic decision making have occurred by creating specific published guidelines obtained by consensus (3;6) (7). Most all authors agree that an initial diagnosis of IBS should be fulfilled by: a) meeting symptom-based diagnostic criteria, such as Rome II (6;8), Rome I (9) (10), or occasionally, Manning (11) criteria, obtaining a negative physical examination, and performing a cost-effective, conservative set of screening studies. These usually include a sigmoidoscopy (or colonoscopy for patients older than 50 years), a few laboratory tests (e.g., CBC, stool for occult blood or ova and parasites) and additional studies if certain "alarm" features are found: fever, an abnormal physical examination, blood in the stool, an abnormal CBC or elevated sedimentation rate, significant weight loss, nocturnal symptoms that awaken the patient, or a family history of cancer or inflammatory bowel disease (12;13). Several prospective studies now offer evidence that the proper application of such recommendations rarely leads to a revision in diagnosis, even for patients followed over many years (14;15) (6). In one study, the positive predictive value for the diagnosis of IBS using Rome I criteria and excluding "red flags" *over 1-year follow-up was 98% * (12). "As we continue to develop the means to assess the pathophysiological determinants of IBS symptoms, we will continue to identify subgroups that will change our diagnostic assessment, and may even redefine what we mean by IBS. Post-infectious IBS, and patients having concurrent psychosocial disturbances (among others to be determined) characterize subgroups that will be more responsive to more specific treatments. For the present, we must still make a diagnosis of IBS based on established guidelines including symptom-based (e.g., Rome) criteria. We must also remain vigilant to identifying other relevant disorders like celiac disease that may mimic or exacerbate IBS, and will use clinical judgment (e.g., ordering anti-endomysial antibodies for patients with predominant diarrhea), rather than routinely ordering tests in all IBS patients just to exclude other disease. With careful appraisal of the historical and laboratory data and good clinical judgment, a positive diagnosis of IBS can be made in a cost-effective manner and with confidence." http://www.romecriteria.org/reading1.htmlSome of you might also find this interesting, its in PDF format.Functional gi disorders what's in a name. They are taking a much more holitic approach to patients by looking at the whole patient.http://www.fbgweb.org/2005-spring-fbg-newsletter.pdfIn someways it seems were talking about different issues here, one bad doctors or if the test were done years ago, perhaps they did not have what they have now to test and then the diagnoses and legtimaztion of IBS. I think first its important to look at how accurate the diagnoses using those crtieria are in the first place. Thats not to say there are not a whole lot of challenges to it all. This goes back to Rome 1Toward a Positive and Comprehensive Diagnosis of Irritable Bowel Syndrome"Validity of the DiagnosisHow confident can a physician (and the patient) be with the diagnosis? In addition to the symptoms included in the major criteria, the Rome committee also listed symptoms that are not essential for the diagnosis but that are commonly present in patients with IBS (see Table). The presence of these symptoms can add to the physician's confidence regarding the origin of the symptoms (ie, GI) and the diagnosis (ie, IBS).[41] Nevertheless, development of symptom-based criteria in the absence of a diagnostic ("gold") standard has obvious limitations. The consensus achieved by expert clinicians and investigators can only provide face validity, and additional validation studies are needed to support the utility of the published criteria. Unfortunately, available data on the validity of the Rome criteria are still limited. In a recent study, Vanner and colleagues[48] examined the predictive value of the Rome I criteria using the gastroenterologist's final diagnosis as the gold standard. The study authors found that the combination of the Rome criteria and the absence of "red flags" (weight loss, nocturnal symptoms, blood in stools, recent antibiotic use, family history of colon cancer, and abnormal physical examination) yielded 63% sensitivity and 100% specificity, with a positive predictive value (PPV) of 98% to 100% and negative predictive value of 76%. Additional studies on the validation of the Rome criteria, particularly the new (Rome II) criteria, are currently under way.*Additional support for a positive diagnosis of IBS also comes from studies that have looked at long-term outcomes. In long-term follow-up studies (up to 9 years from the diagnosis), no other explanation for the symptoms was found in 95% to 100% of patients.*49-51] *This suggests that a positive diagnosis using symptom-based criteria, the absence of "red flags," and limited investigations rarely requires revision. "*http://www.ibsgroup.org/other/pnt-mgi7350.ring.htmlSince Rome lll is new, they have addressed some issues and have others to work on.OF course people that have been misdiagnosed perhaps years ago or even recently or developed something new along with IBS or have found another problem along with IBS you usally will hear more about then others that have been diagnosed accurately. So its good for a person to be educated about somethings and know the red flags and find a good doctor they like and work with them. A lot of people don't trust them when they walk in the door. An issues that is of major importantance and a major problem is the amount of time spent with Patients to help explain IBS, the diagnoses, why red flags mattter and the patient confidence in being diagnosed. There are always going to be Misdiagnoses and horror stories in medicine and bad doctors, but that is what we should work on here to try to avoid, is how to get the best diagnoses and work with a good doctor and get treated right and feel better.What treatments work in research for IBS are more clues into the mechanisms that generate the symptoms. IBS is also already being broken down into subgroups to better treat people. The goal is to legitimize Functional disorders that haven't gotten the attension in the past, accurately diagnose the problem/s and treat them effectively. SO I don't personally think its all BS, there is a lot of basic research and science behind it all and a TON of progress made lately. I personally worried when I was young for many years about what was causing my IBS. All the worry didn't do me any good what so ever and I still ended up with IBS diagnoses. That's just my personal experience, other have of course had other issues and good and bad experiences.


----------



## eric (Jul 8, 1999)

FYIFrom Medscape General Medicineâ„¢Gastroenterology Expert ColumnDiagnosing Irritable Bowel Syndrome: What's Too Much, What's Enough?Posted 03/12/2004Susan Lucak, MD IntroductionEpidemiologySymptom-based Criteria"Alarm Features"Physical ExaminationDiagnostic TestingDifferential Diagnosis and Durability of DiagnosisLegal Risks in Diagnosing IBSSummary and Conclusions"IntroductionIrritable bowel syndrome (IBS) is the most common gastrointestinal disorder diagnosed in clinical practice in the United States. Because there is no biological marker to confirm the diagnosis of IBS, it is a diagnosis that has challenged clinicians for decades. In the past, IBS was a "waste-basket" diagnosis given to patients with unexplained gastrointestinal symptoms. It was considered to be "the diagnosis of exclusion" when extensive work-up for organic disease yielded no diagnosis.In recent decades, it was recognized that patients with IBS experienced a constellation of specific gastrointestinal symptoms. Manning criteria were described in 1978,[1] followed by Rome I in 1989[2] and Rome II criteria in 1999.[3] Rome I and Rome II criteria were initially developed by multinational working groups to provide a framework for the selection of patients in diagnostic and therapeutic trials. These criteria are being continuously modified as we gain new knowledge about functional bowel disorders.Recently published diagnostic guidelines[4,5] recommend using symptom-based criteria in making the diagnosis of IBS in clinical practice. Using these criteria in conjunction with "alarm features" allows a physician to minimize the extent of diagnostic testing needed to make the diagnosis of IBS. Furthermore, recent systematic review of the literature indicates that performing a number of diagnostic tests did not result in a significant increase in the diagnosis of organic gastrointestinal disease.[6]"This column discusses novel approaches to the diagnosis of IBS.http://66.218.69.11/search/cache?p=Diagnos...&icp=1&.intl=us


----------



## 16229 (Jan 28, 2006)

I think the question is more how many doctors, percent, properly use Rome to dx IBS. I'd agree when Rome is properly used correct dx is probably made 95% of the time, just in the real world not many doctors use that criteria properly, if at all.And you always have the part where if they don't know, they will call it IBS. So more people get lumped in the pile when the doc really hasn't the slightest clue.


----------



## overitnow (Nov 25, 2001)

Additional support for a positive diagnosis of IBS also comes from studies that have looked at long-term outcomes. In long-term follow-up studies (up to 9 years from the diagnosis), no other explanation for the symptoms was found in 95% to 100% of patients.49-51] This suggests that a positive diagnosis using symptom-based criteria, the absence of "red flags," and limited investigations rarely requires revision. -----------------I know this goes back to Rome 1 but it sounds as though the same criteria is operating today, the major difference being the specificity of symptoms. Since I never talked about this with a doctor until I had it under control, never had a colonoscopy, and lay at the discomfort end of the pain scale, it would be simplist to just assume a functional D problem. Fine. The thing is, I have had stool tests, in the 20 years since this began no cancers or serious GI concerns have as yet surfaced, and I know that the background issue still exists. If I hadn't started taking the Provex, I doubt that this would have resolved itself and I would be on some anti-diarrheal or something even more intrusive until the end of time. Assuming that my self-diagnosis of lowered brain circulation is correct (and since that was discovered in the CFS study and I have reversed other circulatory issues as well, that is not an unlikely assumption), who would ever have tested me (or anyone else) for that as a work-up for IBS diagnosis? I would still be FD or IBS-D and no closer to an effective treatment of cause than ever. 20 years later, nothing would have surfaced and there would be no reason to revisit the diagnosis.Mark


----------



## 22997 (Mar 14, 2007)

I felt Dr's just diagnosed IBS if they had no idea...till now. Some do just throw it out there. I thought it was cysts, a hernia and had every test under the sun...even a laporoscopy. There is no way this could be my bowels causing problems. It was too painful I thought, no way. But months later and feeling like a lab rat...IBS


----------



## 14633 (Jan 5, 2007)

Thanks SP for posting this !!I live in Canberra, Australia. This is a small city and every doctor I goto wants to refer me to this GI, Dr Anthony Clarke. So I went to him second time after 4 years and its as if he did not want to see me....He diagnosed me with IBS 4 years back as all the tests he performed came out negative. Finally I asked him what type of IBS am I you think. He told me IBS-D which was totally opposite of what I think the type I am which is IBS-C. He doesn't want to listen to me more than 5 mins and made up his mind already no matter what I am telling him.May be this time I goto different DOctor and see if I can find some other GI.RegardsRSB


----------



## eric (Jul 8, 1999)

Mark, I know you say that a lot about lowered brain blood circulation, but its more complex then that really its areas of the brain that are actiivated or not activated from signals/neurotransmission from the gut nerve fiber to the brain. Those pet scans or fmri's are after they use ballon inflation inserted in the rectum, then they look at what parts of the brain are activated or not activated. I don't believe from what I have read its a circulatory issue, like lack of blood flow.There are a few centers like UCLA who have recently gotten 6 million in NIH money to study the brain more in IBS, so new info will come out on it. The UNC received 6 million to study the gut and both centers are collaborating the information, along with other research centers, mayo, John Hopkins, Vanderbuilts, cleveland clinic and others.Which ties into another issue as well and that is in the research about 80% of IBSers have rectal sensivity. At one time they were wondfering if that could be a marker, but it maybe one more item just help to establish a diagnoses.Another issue is they may diagnose based on the specific cluster of symptoms and then intiate treatments. Then look at a person six months later to see if the treatments are helping. It is and has been a concern of the lead researchers, that other gastroenterologists and md's use the criteria which have been out for a while now and are being updated and modified to diagnose, which doesn't always happen. So yes asking your doctor if they are using them is a good idea. There is a new system being created also for the major centers around the US in creating a computer database between them all to share information.


----------



## eric (Jul 8, 1999)

Some info on the brain and IBShttp://mindbodydigestive.com/themindb1920/...-Mind-Body.htmlhttp://ibs.med.ucla.edu/Articles/PatientArticleSp97Sens.htm"Evaluation of Visceral Sensation in IBS Patients Using Subliminal StimulationLawal A, Kern M, Sidhu H, Hofmann C, Shaker R. Novel evidence for hypersensitivity of visceral sensory neural circuitry in irritable bowel syndrome patients. Gastroenterology. 2006;130:26-33.The pathophysiology of IBS involves multiple underlying factors, including abnormalities in visceral sensation, disturbances in gut motility, and differences in the central nervous system (CNS) processing of visceral pain.[1] Many investigators now believe that visceral hypersensitivity is the most important pathophysiologic abnormality in IBS patients. The mechanism that leads to visceral hypersensitivity in patients with IBS is unknown, although current theories postulate the presence of abnormal sensory receptors and sensory afferents, deficient descending modulating factors, and a hypervigilant CNS. This latter component has been demonstrated in studies using functional magnetic resonance imaging (fMRI) and positron emission tomography scans.[2,3] The end result is that IBS patients sense abdominal discomfort at lower levels than normal individuals and often misinterpret normal sensations as painful (allodynia).[4] This has been demonstrated in a number of studies that typically involve distending the lumen of the gastrointestinal tract with a balloon.[5] One concern is that these studies may be influenced by cognitive processes associated with perceived sensory stimulation. Stated another way, anticipation of a possibly unpleasant sensation (balloon distention of the rectum) may alter cortical activity and thus change fMRI findings. Lawal and colleagues[6] addressed this potentially confounding factor by evaluating visceral sensation in IBS patients using subliminal stimulation.""This well-designed, novel study is the first to show that very low levels of distention in the gastrointestinal tract, without any related cognitive processes typically associated with perceived distention, lead to increased CNS activity in IBS patients compared with healthy volunteers. In addition, patients with IBS demonstrated a maximum response to subliminal distention, as compared with the graded response seen in healthy volunteers. *These findings are important for a number of reasons. One, it confirms the now widely accepted view that the brain-gut axis is a critical component in IBS. Two, it emphasizes that hypersensitivity is a key underlying pathophysiologic mechanism in the generation of symptoms in IBS patients. * And finally, although not evaluated in this study, these findings point out that therapeutic options for patients with IBS should focus on treating both the hypersensitive gut and the hypersensitive CNS.http://www.medscape.com/viewarticle/544018_printThere is a lot more, if you search ballon distension studies and IBS.


----------



## 22319 (Mar 15, 2007)

When my Doctor told me I had Post Infection IBS, he told me IBS was a Blanket Label for gut issues. He went on to say years from now they will be able to take 100 cases of so called IBS by todayâ€™s standard and divide them into smaller groups.When it comes right down to it I donâ€™t care what the call it, I just want it gone from my system.


----------



## eric (Jul 8, 1999)

I am not so sure its a blanket label for already known gut issues, but perhaps ones they haven't defined yet. Already post infectious IBS is a subgroup and the problem in d IBS verses C or d/c IBS are probably different probelms, although they are related to serotonin release from the gut. But different histopathological alterations in irritable bowel syndrome and strutural problems are already emerging and its looking like different biochemical dyregulation is occuring." Aliment Pharmacol Ther. 2006 Apr 15;23(8):1067-76. Links Review article: intestinal serotonin signalling in irritable bowel syndrome.Mawe GM, Coates MD, Moses PL. Department of Anatomy and Neurobiology, University of Vermont College of Medicine, Burlington, VT 05405, USA. gary.mawe###uvm.eduAlterations in motility, secretion and visceral sensation are hallmarks of irritable bowel syndrome. As all of these aspects of gastrointestinal function involve serotonin signalling between enterochromaffin cells and sensory nerve fibres in the mucosal layer of the gut, potential alterations in mucosal serotonin signalling have been explored as a possible mechanism of altered function and sensation in irritable bowel syndrome. Literature related to intestinal serotonin signalling in normal and pathophysiological conditions has been searched and summarized. Elements of serotonin signalling that are altered in irritable bowel syndrome include: enterochromaffin cell numbers, serotonin content, tryptophan hydroxylase message levels, 5-hydroxyindoleacedic acid levels, serum serotonin levels and expression of the serotonin-selective reuptake transporter. Both genetic and epigenetic factors could contribute to decreased serotonin-selective reuptake transporter in irritable bowel syndrome. A serotonin-selective reuptake transporter gene promoter polymorphism may cause a genetic predisposition, and inflammatory mediators can induce serotonin-selective reuptake transporter downregulation. While a psychiatric co-morbidity exists with IBS, changes in mucosal serotonin handling support the concept that there is a gastrointestinal component to the aetiology of irritable bowel syndrome. Additional studies will be required to gain a more complete understanding of changes in serotonin signalling that are occurring, their cause and effect relationship, and which of these changes have pathophysiological consequences.PMID: 16611266and just for the infoIBS Beyond the Bowel:The Meaning of Co-existing Medical Problems"Table 1. Non-gastrointestinal symptoms more common in irritable bowel syndromepatients than in comparison groups(5).1. Headache2. Dizziness3. Heart palpitations or racing heart4. Back pain5. Shortness of breath6. Muscle ache7. Frequent urinating8. Difficulty urinating9. Sensitivity to heat or cold10. Constant tiredness11. Pain during intercourse (sex)12. Trembling hands13. Sleeping difficulties14. Bad breath/unpleasant taste inmouth15. Grinding your teeth16. Jaw pain17. Flushing of your face and neck18. Dry mouth19. Weak or wobbly legs20. Scratchy throat21. Tightness or pressure in chest22. Low sex drive23. Poor appetite24. Eye pain25. Stiff muscles26. Eye twitchingOVERLAP WITH OTHER MEDICAL CONDITIONSResults from numerous studies (reviewed by Whitehead, Palsson & Jones, 2002(5)) alsoindicate that IBS overlaps or co-exists more often than would be expected with othermedical conditions that appear to have little logical connection with the gut. The mostresearched example of such an overlap is the co-existence of IBS with fibromyalgia, adisorder characterized by widespread muscle pain. Fibromyalgia affects an estimated 2%of the general population, but 28-65% of IBS patients have the disorder. Similar resultsare obtained when this overlap is examined the opposite way, by studying fibromyalgiapatients and looking for IBS -- 32-77% of fibromyalgia patients have IBS.Chronic fatigue syndrome (CFS) is another medical condition that has been found to havemany times the expected co-occurrence with IBS. CFS is thought to affect only 0.4% ofthe general population, but it has been reported in 14% of IBS patients. Conversely, 35-92% of chronic fatigue syndrome patients have IBS. Other conditions documented inmultiple studies to have excess overlap with IBS are temporomandibular joint disorder(TMJ), found in 16-25% of IBS patients(2,6), and chronic pelvic pain (35% of IBSpatients(7)."http://ibsgroup.org/groupee/forums/a/tpc/f...610974#86610974


----------



## eric (Jul 8, 1999)

FYIThe 18-Second DoctorBy Nancy ShutePosted 3/18/07http://www.usnews.com/usnews/news/articles/070318/26qa.htmMedicine Has Become aBusiness, But What Isthe Cost?"I have seen a great deal of changes inthe practice of medicine. I grew upin the 50s and 60s, when MarcusWelby and James Kildare were rolemodels for physicians. At that time, aphysician would sit at the bedside,hold hands, take a pulse, and talk tofamilies and the patients expected it."http://ibsgroup.org/groupee/forums/a/tpc/f...410974#63410974


----------



## eric (Jul 8, 1999)

FYI"Neuromuscular Dysfunction and IBS: Clinical Implications Previous Page Next Page In This Article IntroductionPathophysiology of IBSTreatment Options for IBSConclusion Pathophysiology of IBSClassically, the pathophysiology of IBS has been thought to involve an interplay between psychosocial stressors and abnormalities in gut motility and visceral sensation. A variety of motility abnormalities have been described in IBS, *including more frequent and prominent colonic contractions in response to meals in patients with IBS and diarrhea (IBS-D)*, *and delayed colonic motility or abnormal colonic propulsive activity in patients with IBS and constipation (IBS-C).[1]* Additionally, disorders of evacuation, as seen with puborectalis dysfunction or a rectocele, may also play a role, either alone or in conjunction with abnormal motility, in some IBS patients.Visceral hypersensitivity has long been accepted as an important feature in a subset of IBS patients and has even been suggested by some to be a biological marker of the condition.[2] Until recently, the concept of visceral hypersensitivity was based largely upon studies that identified differences in patient pain response or cortical activation measured by brain imaging techniques following painful visceral distention. An interesting recent study using functional magnetic resonance imaging (fMRI) found that subliminal rectal distention resulted in a greater volume of cortical activation in IBS patients than in controls. By eliminating the effects of stimulus-related cognitive processes through the use of subliminal stimuli, *this study more definitively established the hypersensitivity of neural circuitry involved in visceral sensation in IBS patients.*[3]The enteric nervous system (ENS) regulates motor, secretory, and sensory functions through an extensive neural network contained within the GI tract. *It functions semiautonomously, but is influenced by bidirectional communication with the central nervous system (CNS) through the autonomic nervous system (ANS).* Numerous neurotransmitters and neuropeptides have been identified in the ENS, including calcitonin-gene receptor protein, substance P (SP), vasoactive intestinal peptide, nitric oxide, adenosine triphosphate, acetylcholine, and serotonin (5-hydroxytryptamine [5-HT]). *Current understanding of the compex interaction between the nerves and muscles of the GI tract with the various neurohormones and peptides serves as the basis for much of the discussion on emerging therapeutic options for IBS.*http://www.medscape.com/viewarticle/548600_2


----------



## eric (Jul 8, 1999)

FYI Biopsychosoc Med. 2007 Jan 10;1:3.Temporomandibular disorder is associated with a serotonin transporter gene polymorphism in the Japanese population.Ojima K, Watanabe N, Narita N, Narita M. Graduate School Human Sciences, University of Tsukuba, Ibaraki, Japan. narita_m###doc.medic.mie-u.ac.jp.ABSTRACT: AIMS: Recent genetic studies have linked serotonin-related genetic polymorphisms with diverse disorders characterized by functional somatic symptoms, including chronic fatigue syndrome, irritable bowel syndrome, and premenstrual dysphoric disorder. METHODS: We investigated three serotonin-related genetic polymorphisms by screening genomic DNA of 36 temporomandibular disorder (TMD) patients. RESULTS: A significant increase of longer alleles (l and xl) was found in the TMD patients compared to the controls both by the genotype-wise and the allele-wise analyses (both p < 0.01 by chi2 test and Fisher's exact test). CONCLUSION: Genetic factors that involve the serotonergic system may play a role in the pathogenesis of TMD.PMID: 17371573


----------



## 19865 (Mar 17, 2007)

Eric, With all do respect Eric. You seem like a very smart person and know alot and read alot on this and many GI issues. (you could pass for a commonly seen gastroenterologist who reads too much into an OLD ROME CRITERIA which in reality no one trully follows 100%) Please dont take affense but. I tend to disagree with you on alot of issues and believe you have been brainwashed by the current Gastroenterologists' you may know. #1) Dont read into much on all the motility studies. Most are done by supporters of the use of IBS diagnosis more often. #2) You had picked a perfect example of in my opinion a (half as; MD-Gastroenterologist who loves the IBS diagnosis and has made so much money publiziing it over the years-she has written many books and has backing from Antimotility DRUG companies) ( She is one of the many on my ::Shi::List) Very Bad Example of a Fraud in my opinion. She missed alot of red flags on me and Doped me Up on high doses of Anidepresants when i DID not know anybetter many years ago for approx 13 months and masked my true symptoms which delayed my True diagnoses. She is clueless, Aragant, and a Know it all--about IBS and loves the diagnosis and makes alot of money off it.(in my opinion from meeting other Former patients of hers , more than half of her patients have another issue being masked) #3) THE OLD As: ROME CRITERIA NEEDS ALOT OF REVAMPING ! (it was probably from the rome days) Unfortunatley not many docs will even notice many of the RED FLAGS you mention over & over. Unfortunatley the GI-Field of medicine is (outdated, too many dummys, too many showoffs, dont read updated material, and dont look outside the box. ( Gastros look at you like --Horses LOOK through the SIDE BLINDERS so they only see straight ) One Example: CgA=Chromogranin A a very vague but stable neuroendocrine marker. Mine was elevated back in 2000.2001,2002 1st GI didnt even notice it. 2nd GI asked me what it meant.(while i hadnt a clue back then) 3rd GI (I asked him what it meant and HE HAD NO CLUE and ignored it) 4th GI said well, you should see an Endocrinologist because im not too farmiliar with Cga ""Its not related to your GI-IBS problems at all, it just means you have a secondary problem" ( MOST GIs ARE CLUELESS UNLESS THET ARE ACADEMIC GIs)( and even then ,alot are still much in a hurry to call it IBS::unless your bleeding from the A hole in front of them)<form of expression. #4) You say RED FLAGS alot. Another Example: You made a comment about Malabsorption. 48HR FECAL FAT STUDY & 24 HR FECAL FAT STUDY. < im sure all of you are farmiliar with) 1st GI says to me ""yeah you must have a bacterial infection along with your IBS. kept blindly giving me antibiotics for approx 6 months.(killed more time) 2nd GI says --no problem ,,we will repeat it in a couple months to see if its still HIGH. ( i respond, in couple months, and he says ,,,yeah its ok ,,your not dying yet making a joke of it) 3rd GI says -Im sending you to another specialist GI to figure this one out You seem to be malabsorbing. ( I go to the specialist and he labeled me as IBS with malabsorption) ( He basically created his own IBS catagory) SOME RED FLAGS DO NOT APEAR FULLY UNTIL THE ACTUAL PROBLEM HAS GOTTEN WORSE. BY THAT TIME ,, MORE DAMAGE HAS TAKEN AFFECT. GIs HAVE A TENDENCY TO LOOK AT YOU LIKE YOU ARE CRAZY WHEN YOU TELL THEM TOO MANY SYMPTOMS AND IMMEDIATLEY LABEL YOU AS IBS-PHYC-GUT PROBLEM IN THIER MIND EVEN BEFORE THEY DO ANY STUDIES OR TESTS.Eric , I hope you are not affened by my form of expressions. You are a very inteligent person- I know this by your posts. But please dont get caught up with focusing too much on the much fabricated and too publizied motility-IBS studies. like i said before. IBS --MOTILITY --IBS DOES EXIST. IT IS NOOOOOOOOOOOOOOTTTTT in the amount # of people that is STATED and publisized by the corupt GI fied--my opinion.


----------



## eric (Jul 8, 1999)

SP, no offence and I can sense and understand your frustrations, although perhaps not totally because what happened to you did not happen to me.I however don't view the entire medical profession or GI's as a bunch of villans out to harm people and ALL the researchers fabricating information for money or for other reasons. In science the research has to be tested by different researchers with the same outcomes and results, so there are checks and balances incorporated into the system in all the sciences. I also don't follow just one doc, but the whole body of basic science and research from around the world in many different specialities, neurogastroenterology, Gastroenterology and many others. I have spent and enormous amount of my own time looking at all the IBS research over the years. I did this for myself and my own IBS issues of over 40 years.Unlike your situation, it was the education and help from certain doctors, this bb and my own research that has greatly helped my IBS and basically put me into remission for the most part, although I am not cured I am 85 percent better. I have also seen hundreds if not thousands on the bb here helped by the information. The treatments that have helped people can also be clues to the problems in IBS. Two of those things that have really helped IBSers in the research and what I have witnessed on the bb here is dietary modification and stress reduction along with education. Also HT and CBT are valid and effective treatments for IBS, not because IBS is a psycological disorder, but because of the psychophysiology of how the gut and brain operate. Its a total misconception when a doc suggests a form of treatment like that and the patient thinks they are doing that, because they think its all in my head. HT is one of the most effective treatments in IBS to date and importantly can work long term, up to five years in one of the studies looking at how long it can help for, which is important, because drugs with drugs the symptoms will return when you stop taking them. Its also important because its a safe treatment. There is 20 years of research behind it as well.IBS is probably under diagnosed because a lot of people don't want to talk about bowel issues and some don't go see doctors.The doctors I am following are major academics and researchers in IBS. IBS is also not studied in a vacuum. Researchers apply what they learn about all gi conditions including diseases and GI disorders of function.So there is a substanial body of research that has happened over the last 20 years. I agree they don't know everything of course. But there is fundemental Basic science research and then there are theories.Have you looked at the new rome criteria?http://www.romecriteria.org/GastroIssue.htmHave you read all these."Report from the 6th International Symposium on Functional Gastrointestinal DisordersBy: Douglas A. Drossman, MD and William F. Norton, IFFGDThe 6th International Symposium on Functional Gastrointestinal Disorders was hosted by IFFGD on April 7-10, 2005. The biennial meeting was jointly sponsored by the Office of Continuing Medical Education, University of Wisconsin Medical School and the International Foundation for Functional Gastrointestinal Disorders (IFFGD) in cooperation with the Functional Brain-Gut Research Group (FBG). The program, a culmination of two years planning was both stimulating and informative. In fact, our knowledge of the functional gastrointestinal (GI) disorders continues to evolve, and these symposia are in many ways a barometer of the many changes occurring in the field. Nearly 400 persons from around the world attended representing a variety of health care disciplines. Over 80 experts in the field of functional GI disorders presented their work in general sessions, multiple symposia directed toward specialties, and mini-workshops. The attendees included gastroenterologists, other medical physicians, nurses, physician assistants, lab technicians, and related allied health personnel, as well as representatives from the U.S. National Institutes of Health (NIH), the U.S. Food and Drug Administration (FDA), and the pharmaceutical and medical device industry. The summary that follows highlights several of the important aspects presented in the general sessions, including:"http://www.iffgd.org/symposium2005report.htmlClick to view reports from the previous Symposiums: 5th International Symposium on Functional GI Disorders, 2003 4th International Symposium on Functional GI Disorders, 20013rd International Symposium on Functional GI Disorders, 19992nd International Symposium on Functional GI Disorders, 19971st International Symposium on Functional GI Disorders, 1995http://www.aboutibs.org/Publications/symposium.htmlIf you go into pubmed, you can view all the studies on who gets IBS (more women then men)and that is important, how prevalant IBS in different countries, genetics, how prevalant IBS is in the US, IBS in different ethnic groups, and a huge body of research like that from all over the world in every country and from major research centers, John Hopkin's, mayo, UNC, UCLA, Cleveland clinic, Vanderbuilts and others around the world. The real concensus from all these centers at this point is IBS is a brain gut axis disorder, they have not toally figured out yet. They have also moved from dualism, sepration of mind and body in disease, to a more holistic approach looking at the person has a whole. This approach has been much more effective, because they are seeing and realizing in order to help more people and in order to understand the way the body physically functions they have to incorporates the mind and body which generate the symptoms.There is a lot of research here I have not posted.That they have made some substantial progress in IBS in recent years, shouldn't be overlooked or dismissed, but perhaps better understood with all do respect.While there maybe bad GI's out there and I have run into a few over the years, there are many truely excellent, caring and dedicated people working on these problems. I don't view doctors as any kind of gods either, they are human and humans make mistakes. This is also a very difficult and complex disorder, made even more so by people that have comorbid disorders. I hope we can agree though there needs to be more education, and more research done. Not all research either comes from pharm companies, there is NIH money and support money as well. Some of the drugs have helped people.I am sorry to hear you have had such bad experiences though. Its understandable your upset at the way your were treated and diagnosed.I hope that someone is helping you now and you have found a better doctor who listens to you and can treat and help you. I personally was suicidal with IBS and I am glad I didn't go that route, because I am much better now and a lot of that came from education and help from the medical establishement and doing my own research and homework. I have to ask though if they don't use the Rome criteria, which at this point is the "gold Standard" and is constantly being updated, as a framework for the diagnoses, how should they diagnose someone.


----------



## David LA (Dec 21, 2005)

SP: You've probably seen a number of these "Brain Scans" PostedI've spoke with Dr. Pimentel about this, In his opinion,their totally useless & basically mean nothing.Here's a scenario how they would mean something:Have three groups of People: Say 300 in each Group:Group A: Has been diagnosed with "IBS" for more than 2 YearsGroup B: Never or Rarely have any Digestive ProblemsGroup C: Has some sort of other pain in their Body(Other than GI Problemss) Back Pain as an Example)Conduct the "Brain Scan" for all Three Groups.For this test to mean anything the Dr. Conducting it, should be able to pick out the 300 people that have "IBS Symptoms"Than,this would become a great diagnostic tool & the Brain Scan would be something.But....the reality is their is NO WAY in H..they would achieve this. They probably would have 100 or so people that Don't even have IBS Symptoms and another 100 or so people that have some sort of other pain....The TEST would be Useless--Which of course it is!!!!! And..if anybody on this board believes that they could sucessfully pick out the "IBS Group"I have some great property on Pluto I'd like to sell to them....


----------



## 18110 (Jan 3, 2007)

So am I to take from this discussion that when I finally have a colonscopy my diagnosis of exclusion (hopefully) dosent rule me out from colon cancer?All my tests are leading me to beleive IBD or IBS. Why all of a sudden should I accept someones (non-qualified) opinion that I suddenly have a tumour?Maybe I do, who knows. I'll tell you this though, ordering all the most advanced tests in the world will only just label you as a hypchondriac.


----------



## 19865 (Mar 17, 2007)

David LA, You have picked a terrific doctor Who is very open minded and Who thinks OUTSIDE THE BOX. He is a perfect example of one of the few GOOD -GI= Gastroenterologists. and a Gentlemen. Dr Pimintel and his group from Cedar Sinai CA. Are a perfect example of how the GI community should shink. I can also vouch for Dr Conklin who is also in his group. They are great careing and open minded people. I agree very much on the Brain Scan opinion.


----------



## 19865 (Mar 17, 2007)

I would also like to make a statement that I am not physician and dont want anybody on here to think that they all may have any type of cancer. This is not true. Most immediate threats are caught on time. I have been just stating my opinion from my own experiences as well as others i know.My opinion simply ---dont let the doctor not rule out everything else. Minor or Major in findings before coming to the conclussion it is a IBS motility issue.you must feel confident with your diagnosis 100%even if that means you go see another 5 Docs without telling them or showing them the previous GIs diagnosis of IBS. Since most get very influenced by each other and are afraid of going against one another even if they dont know eachother.DO NOT THINK IT IS CANCER.JUST DONT BE AFRAID TO GET ANOTHER BLIND OPINION BEFORE BELEIVING THE IBS AS A LAST RESOURT.I tend to beleive most have some type of Small Bowel Bacteria Overgrowth and or a rare form of IBD such as Microscopic or Lymphocytic or even minor Crohns or Ulc-Colitis before getting acuaratley diagnosed since it sometimes takes years before they fully show themselves or occasionally FC-DNA-PCR on the Biopsys are needed which are not routineley done.Another smaller group has problems like mineSuch as Carcinoid or GastrinomasThat have not fully shown themselves since they take many years to fully grow.IBS-MOTILITY DOES EXIST --IT IS MEARLY NOT IN AS MANY PEOPLE.


----------



## eric (Jul 8, 1999)

"I've spoke with Dr. Pimentel about this, In his opinion,their totally useless & basically mean nothing."I highly doubt he put it that way for one. Also he is not a neurogastroenterologist.Do you know why there is a specailty called neurogastroenterology?Also the pet and fmri scans are DIFFERENT in IBS, Normals and in colitus?People with colitus have HIGHER pain thresholds.In IBS the brain may not be sending signals for the release of endorphines back down to the gut so you don't feel anything like normals.All pain is processed in the brain. THIS IS REALLY IMPORTANT!!!!These are ballon distension studies. They don't just pet or fmri scan someone, they insert a ballon and look at the brains reaction and at what point the inflation of the ballon causes pain in IBS or in normals. It is different in IBS then controls, so why is that?They may mean nothing to him personally if he said that which I somehow doubt, but it means a lot in IBS research.Already they know the pain gate in IBS is lost and viceral sensations that should not conciously reach the brain, because the brain is not designed to get those signals.gets them.This is part of pain reporting in IBS and viceral sensations and brain gut mechanisms.In a couple weeks new SIBO and IBS information will be released. Then after a couple months more will be released. You may believe SIBO is the root cause of IBS, but that is not the case so far in the slightestest, only that some IBSers have both at this point.You two are throwing out twenty years of solid basic IBS research on one speculation, it isn't really even a theory yet. Other centers ARE NOT reporting what cedar is in there studies. The test is not accurate they use and it has not explained a ton of other solid IBS research and people without IBS can have sibo and people with IBS may or maynot have sibo.Studies already done have highly questioned sibo as a "cause" of IBS.By the way Pimental wrote a book and makes money on it, he designed and patented a home test kit for the market, is associated with the drug companies that make the antibiotic. Basically things you are accusing other doctors of? So what gives with that?There are hunders of researchers, Dr Gershon the father of neurogastroenterology, Dr Wood, Dr Drossman, DR Spiller, a leading expert on PI IBS, Dr Ester Sternberg and expert on the brain and immune system, Dr Whitehead an expert on IBS and consitpation and many many others I have not named.Dr Pimental will be attending the new IFFGD sympoisium on functional gi disorders in April.I don't think you both have really spent any time looking at the bigger picture, before thinking outside the box. There are a lot of people thinking outside the box. There are many researchers studying bacteria in IBS right now as well and have been for many years.AT THIS TIME IBS and SIBO are seperate conditions.Again I remind you to get and read these articles."Gut Bacteria and Irritable Bowel Syndrome By: Eamonn, M. M. Quigley M.D., Alimentary Pharmabiotic Centre, University College Cork, Cork, IrelandBacteria are present in the normal gut (intestines) and in large numbers the lower parts of the intestine. These "normal" bacteria have important functions in life. A variety of factors may disturb the mutually beneficial relationship between the flora and its host, and disease may result. The possibility that gut bacteria could have a role in irritable bowel syndrome (IBS) may surprise some; there is indeed, now quite substantial evidence to support the idea that disturbances in the bacteria that populate the intestine may have a role in at least some patients with IBS. This article presents a discussion of the possible role of bacteria in IBS and various treatment approaches."Do bacteria play a role in IBS?The possibility that gut bacteria could have a role Irritable Bowel Syndrome (IBS) may surprize some; there is indeed, now quite substantial evidence to support the idea that distrubances in the bacteria that populate the intestines may have a role in at least some patients with IBS. What is this evidence? It can be summarized as follows:1. surveys which found that antibiotic use, well known to distrub flora, may predispose individuals to IBS.2. The observation that some individuals may develop IBS suddenly, and for the first time, following an episode of stomach or intestinal infection (gatroenteritis) caused by a bacterial infection.3. recent evidence that a very low level of inflammation may be present in the bowel wall of some IBS patients, a degree of inflammation that could well have resulted from abnormal interactions with bacteria in the gut.4. The Suggestion that IBS maybe Associated with the abnormal presents, , in the small intestines, of types and numbers; a condition termed small bacterial overgrowth (SIBO)>5. Accumaliting evidence to indicate that altering the bacteria in the gut, by antibiotics or probiotics, may improve symptoms in IBS.For some time, various studies have suggested the presence of changes in the kind of colonic flora in IBS patients. The most consistent finding is a relative decrease in the population of one species of 'good' bacteria, bifidobacteria.However, the methods employed in these studies have been subject to question and other studies have not always reproduced these finding. Nevertheless, these changes in the flora, maybe primary or secondary, could lead to the increase of bacterial species that produce more gas and other products of their metabolism. These could CONTRIBUTE to symptoms such as gas, bloating and diarrhea.""We still don't know the exact role bacteria has in IBS. More research is needed."http://www.aboutibs.org/Publications/currentParticipate.htmlDoes Bacterial Overgrowth Play a Role in IBS?Bacterial Overgrowth & IBS: Too Soon To TellBy Philip Schoenfeld, MD, MSEd, MSc (Epi)Associate Professor of Medicine, University of Michigan School of Medicine Chief, Division of Gastroenterology, VA Ann Arbor Healthcare System http://www.gastro.org/wmspage.cfm?parm1=2721I don't think either of you understand sibo very well either, because SIBO is a motility disorder and is probably caused by something else. YOu might have to take antibiotics the rest of your life to keep it in check.It is bacteria (not really bad bacteria) in the samll bowel, which is basically in the wrong place. It usally causes D.Dr Drossman on SIBO"IT IS AN OVERSTATEMENT TO SAY THEY ARE "IRRITATING" SUBSTANCES AT LEAST IN THE SENSE OF BEING SOME TYPE OF TOXIN. THEY ARE NATURAL BYPRODUCTS OF DEGRADATION OF FOOD SUBSTANCES BY BACTERIA WHICH DON'T NORMALLY OCCUR IN THE SMALL BOWEL. SO WITH INCREASED BACTERIA IN THE SMALL BOWEL, THE BACTERIA ARE ABLE TO DIGEST SUGARS FOR EXAMPLE PRODUCING H2 AND CO2 FROM THE SUGARS WHICH ARE GASEOUS BUT WHICH ALSO HAVE OSMOTIC PROPERTIES, I.E. INCREASED PARTICLES THAT CAUSE SECRETION OF FLUID INTO THE BOWEL THUS CAUSING DIARRHEA. IT'S THE SAME PRINCIPLE AS USING NON ABSORBABLE SUGARS LIKE LACTULOSE OR SORBITAL TO TREAT CONSIPATION BY INCREASING FLUID IN THE BOWEL. IT'S JUST THAT WITHOUT BACTERIA IN THE SMALL BOWEL, IT DOESN'T HAPPEN AND THE FOOD SUBSTANCES GET ABSORBED. WITH INCREASED BACTERIA IT COMPETES FOR THE FOOD SUBSTANCES AND PRODUCES THE GAS AND DIARRHEA."*This means these are just in the wrong place and not specific or multiple pathogens?*CORRECT. HOWEVER, THERE IS GROWING INTEREST NOT IN THE AMOUNT OF BACTERIA BUT THE TYPE OF BACTERIA. CERTAIN BACTERIA CAN CAUSE SOME MILD INFLAMMATION OF THE BOWEL AND OTHERS PROTECT THE BOWEL FROM THAT POSSIBILITY. SO THERE IS "GOOD" AND "BAD" BACTERIA. POSSIBLY WHEN PEOPLE ARE TREATING PRESUMED SIBO (WHICH MIGHT NOT ACTUALLY BE HAPPENNING, BECAUSE THE TEST MAY BE INACCURATE) ANTIBIOTICS MAY HELP TO GET RID OF THE BAD BACTERIA AND THAT MAY BE WHY THEY ARE GETTING BETTER. THIS IS WHY SOME PEOPLE GET BETTER AFTER ANTIBIOTIC TREATMENT. BUT IT CAN ALSO GO THE OTHER WAY, I.E., ANTIBIOTICS HAVE BEEN SHOWN TO MAKE IBS WORSE AS WELL. THE OTHER IDEA IS TO USE PROBIOTICS WHICH CONTAIN "GOOD" BACTERIA (E.G., LACTOBACILLUS OR BIFIDOBACTERIA) WHICH REPLACE THE BAD BACTERIA, POSSIBLY REDUCE THE INFLAMMATION AND IMPROVE SYMPTOMS. SO THE ISSUE OF BACTERIA IN THE BOWEL IS MUCH MORE COMPLICATED THAN SIMPLE SIBO, BUT SIBO CAN BE A PART OF THE WHOLE PICTURE (THOUGH NOT THE WHOLE PICTURE FOR IBS).http://ibsgroup.org/groupee/forums/a/tpc/f...322/m/380104372


----------



## 19865 (Mar 17, 2007)

Eric,Even though we dont see eye to eye on many issues.I have basically agreed with certain things.Such as the PET-Brain Scan Being useless for IBS. <I agree with that from DR Pimitel.I also agree that SBBO-Small Bowel Bacteria Overgrowth are not IBS but I agree with DR Pimintel that there are alot of people for some strange unknown reason have Bacteria Overgrowth of certain FLORA which dominate on certain people which needs to be pursued as to WHY?.I Dont want you to think i havent read most of your articles you show us already.As far as the Field of NeuroGastroenterology gettting involved with the overabundance of IBS diagnoses the past 15 years (which has multiplied thousand fold ))((very coincidentally) I will not comment on the field of NeuroGastros since you will not like my response.SP.


----------



## 19865 (Mar 17, 2007)

Dr Pimintel and His group of Colleages are a terrifc group of OPEN MINDED people who always think OUTSIDE THE BOX.Dr Conklin who is also in the same building who specializes in other Gastric issues.I have met many years ago prior to him being in CA. He is a very low-key person who does not look for any recognition and enjoys figuring out dificult problems and enjoys helping people.He is also a very open minded caring person who doesnt leave stones unturned. Unfortunaltey at that time due to Travel distance , Illness -fear of travel and $ from NJ to CA where he ended up going i was unable to follow up with him. I wish i had.I am confident if i had followed up with him. I would have gotten correct answers many years ago with the correct diagnoses.Unfortunatley i did not.I usually do not like to recomend people.But in my opinion I encourage anybody able not confident with thier IBS diagnoses and are able to travel to see someone in Dr Conklin's & Dr Pimintel's group or them themselves.To do so. IBSrs need Doctors who always think OUTSIDE THE BOX such as they do. They have opened the eyes of the Gastro Field on the possobilities that Many IBS patients actually have Small Bowel Bacteria Overgrowth.For reasons unknown yet. Certain people tend to get an overabundance of certain FLORA not usually dominant in Health NON SBBO-IBS people.


----------



## eric (Jul 8, 1999)

You guys ask me to think outside the box, yet David here believes only in bacteria as the root cause of IBS. I have no opinion on the cause of IBS myself, as I don't do real research. I also keep the opinions I do have to basic research and science not on single new theories, until they are confirmed.I also have studied as much OF the box as possible before thinking outside the box.Stress, the fight or flight and emotions plays a big role in IBS and the bodies stress system is the HPA axis, so even in order to understand stress the gut and the brain it all has to be looked at for one.They also look at drugs and there effect on the brain in IBS and responce to treatments. Like lotronex they did pet scans for one, but also others, to see if they were reducing pain activation in the brain.You can state your opinion on neurogastroenterology, but its a fact the brain and the gut connected by the vagus nerve continually communicate to each other, They even develop "from the same part of the human embryo. So it is not surprising that the intestinal tract has such a rich nerve supply that it is sometimes referred to as "the little brain." The gut shares many of the same kinds of nerve endings and chemical transmitters as the brain to which it remains linked through a large nucleus. This collection of nerve cells is partly responsible for controlling anxiety and fear, which explains why these emotions can sometimes be associated with bowel function."So the study of neurogastroenterology is very important. The mind and body are not sperate entities." Dig Dis. 2006;24(3-4):278-85. Links New directions in brain imaging research in functional gastrointestinal disorders.Ringel Y.UNC School of Medicine, Department of Medicine, Division of Digestive and Liver Diseases, Chapel Hill, NC 27599-7080, USA. ringel###med.unc.edu*Functional brain imaging has greatly enhanced the ability to investigate brain-gut interactions and to assess the central nervous system role on visceral pain perception.* *The results of studies using brain imaging in irritable bowel syndrome (IBS) have demonstrated differences in brain activation between patients with IBS and healthy controls. * In addition, the more recent studies are starting to shed light on pathophysiological mechanisms that underlie the generation of functional gastrointestinal (GI) symptoms as well as the response to treatment. These studies highlight the potential of functional brain imaging to become an important and exciting investigative tool in research of functional GI disorders. However, the multifactorial, multideterminant nature of these disorders, the current limitations in the understanding of the pathophysiology of the disorders, and the heterogeneous patient population make brain imaging research in this field difficult and require caution in the interpretation of the data. The continued development of brain imaging techniques provides not only exciting opportunities but also significant challenges to the field. This article focuses on brain imaging research in functional GI disorders. It describes some of the recent developments in the use of brain imaging in research of the brain-gut axis and provides an overview of the current data. Copyright 2006 S. Karger AG, BaselPMID: 16849855Differences between UC and IBS Pain. 2005 Jun;115(3):398-409. Links Comment in: Pain. 2005 Aug;116(3):173-4. Differences in brain responses to visceral pain between patients with irritable bowel syndrome and ulcerative colitis.Mayer EA, Berman S, Suyenobu B, Labus J, Mandelkern MA, Naliboff BD, Chang L. Center for Neurovisceral Sciences and Women's Health, David Geffen School of Medicine, University of California, Los Angeles, CA 90073, USA. emayer###ucla.eduPatients with mild chronic inflammation of the rectum or ileum have reduced perceptual responses to rectosigmoid distension compared to patients with irritable bowel syndrome (IBS). The current study sought to identify differences in regional cerebral blood flow (rCBF) during rectal distension, which might correspond to these perceptual differences. In 8 male ulcerative colitis (UC) patients with quiescent disease, 7 male IBS patients and 7 healthy male controls, rCBF was assessed using 15O-water positron emission tomography at baseline and during actual and anticipated but undelivered rectal distensions. No group differences were seen in anterior insula and dorsal anterior cingulate cortex (dACC), two regions consistently activated by painful intestinal stimuli. However, IBS patients showed greater activation of the amygdala, rostroventral ACC, and dorsomedial frontal cortical regions. In contrast, no significant differences were observed between UC and controls. When these two non-IBS groups were combined, functional connectivity analyses showed that right lateral frontal cortex (RLFC) activation positively correlated with activation of the dorsal pons/periaqueductal gray, a key region involved in endogenous pain inhibition. According to the connectivity analysis, this effect was mediated by inhibition of medial frontal cortex by the RLFC. Chronic colonic inflammation is not necessarily associated with increased visceral afferent input to the brain during rectal distension. In the sample studied, the primary difference between functional and quiescent inflammatory disease of the colon was in terms of greater activation of limbic/paralimbic circuits in IBS, and inhibition of these circuits in UC and controls by the RLFC.PMID: 15911167Have you both ever looked at the HPA axis and IBS research? You guys also might want to read all the validation studies on using the Rome Criteria for an IBS diagnoses.This was a single case study yet very important one. Gastroenterology. 2003 Mar;124(3):754-61. Links Alterations of brain activity associated with resolution of emotional distress and pain in a case of severe irritable bowel syndrome.Drossman DA, Ringel Y, Vogt BA, Leserman J, Lin W, Smith JK, Whitehead W. UNC Center for Functional GI and Motility Disorders, Division of Digestive Diseases and Department of Radiology and Biomedical Engineering, University of North Carolina, Chapel Hill, North Carolina 27599, USA. Drossman###med.unc.eduBACKGROUND & AIMS: The association of psychosocial disturbances with more severe irritable bowel syndrome (IBS) is well recognized. However, there is no evidence as to how these associations might be mediated. Functional magnetic resonance imaging (fMRI) offers an opportunity to study whether activation of the cingulate cortex, an area involved with the affective and pain intensity coding might be linked to poorer clinical status with IBS. In this case report, we found an association between the severity of a patient's clinical symptoms and psychosocial state, with activation of the cingulate cortex. We also found that clinical and psychosocial improvement was associated with reduced cingulate activation. METHODS: Observational case report of a young woman observed for 16 years with a history of sexual abuse, psychosocial distress, and functional GI complaints. Psychosocial, clinical, and fMRI assessment was performed when the patient experienced severe symptoms and again 8 months later when clinically improved. RESULTS: During severe illness, the patient had major psychosocial impairment, high life stress, a low visceral pain threshold, and activation of the midcingulate cortex (MCC), prefrontal area 6/44, and the somatosensory cortex, areas associated with pain intensity encoding. When clinically improved, there was resolution in activation of these 3 areas, and this was associated with psychosocial improvement and an increased threshold to rectal distention. CONCLUSIONS: Activation of the MCC and related areas involved with visceral pain encoding are associated with poor clinical status in patients with severe IBS and psychosocial distress and appear to be responsive to clinical improvement.PMID: 12612913


----------



## 19865 (Mar 17, 2007)

The Point of The Tryptophan and other Hormone releases and or Serotonin.There is whole lot of overlapping problems since Tryptophan and Serotonin and many other similar reasearch in Motility-IBSARE ALSO MENTIONED & MARKERS FOR CARCINOID & GASTRINOMAS.Another example of failure of the currentley used ROME CRITERIA.THERE ARE APPROX 37 or more VARIOUS KNOWN HORMONES THAT CARCINOID & OR GASTRINOMAS COULD PRODUCE.Most of the 37 are not routineley done at local QUEST & LABCORP LABS except commomnly seen ones.(such as Serotonin,Cga 5-HIAA,gASTRIN and a couple others.)Plus an Octreoscan & PET scan which are not routineley done for IBS patients.BEFORE A DOCTOR COMES TO THE CONCLUSSION YOU MAY HAVE IBS.DO YOU ACTUALLY THINK HE WILL SEND YOU FOR NON-COMMON TESTING TO COMPLETELEY RULE OUT ANYTING ELSE?COMMON --GET REAL-!--I AM NOT STATING THAT IBS PEOPLE HAVE CARCINOID ---I AM JUST SHOWING YOU ANOTHER EXAMPLE JUST ANOTHER SMALL EXAMPLE OF A FAILED ROME CRITERIA AND COMMON GASTROENTEROLOGY PRACTICES.


----------



## 19865 (Mar 17, 2007)

As far as the group of Small Bowel Bacteria Overgrowth patients.FOCUS in the next couple years will be on IMMUNE system links not keeping certain flora IN CHECK> WHY?is THERE AN Immune LINK ? such as a Variant of CVID ?that has not shown itself in many YET since it has not shown full Immune deficeicny --on whole body yet?. CVID- COMMON VARIABLE IMMUNE DEFICIENCY. AS YOU COULD SEE (ERIC ) THERE ARE MANY MANY OVERLAPPING ISSUES IN --RULLING OUT 100% BEFORE A GI-COULD GIVE YOU A SECURE CONFIDENT DIAGNOSES OF IBS. AND UNFORTUNATLEY --THE MAJORITY SEE YOU ARE NOT DYING YET IN FRONT OF THEM --DONT TAKE YOU SERIOUSLY --AND ARE AFRAID FOR UNKOWN REASONS--WHETHER IT BE RESOURCES - KNOWELDGE --INSURANCE OR OTHER REASONS UNKNONW TO --THINK OUTSIDE COMMMON-GI ISSUES-TO COMPLETLEY RULE OUT EVERYTHING 100% BEFORE COMMINING TO THE CONCLUSSION OF IBS-MOTILITY AS A DIAGNOSES.


----------



## 19865 (Mar 17, 2007)

think in reality---think about what you are saying.OF COURSE YOUR BRAIN WILL SHOW ACTIVITY.::YOU ARE IN PAIN:::OF COURSE STRESS WILL MAKE IT WORSE.When you are sick or have the RUNS doesnt it get worse when you are stressed?THEY ARE NOT CAUSES THOUGH!THEY ARE MERELEY A SECONDARY REACTION OF THE DOMINO CHAIN.


----------



## Kathleen M. (Nov 16, 1999)

In some of the studies they do the same stimulus in normals and IBSers to see the differences.The ones they have done here both are stimulated until they are in pain even if the amount needed for that pain is different.K.


----------



## 19865 (Mar 17, 2007)

another example of what you are saying: CORRETLY DIAGNOSES PEOPLE WITH EITHER CROHNS OR UC NOTICE THIER SYMPTOMS WORSE WHEN THEY ARE STRESSED!DOES THAT MEAN THAT THE STRESS CAUSED THIER CROHNS OR ULCERATIVE COLITIS?NOTHAT JUST MEANS THAT IT GETS WORSE WITH THE STRESS OF COURSE.WHEN ANYBODY HAS ANY KIND OF STRESS RESPONSE ANY MEDICAL CONDITION WILL GET WORSE.Such as but not limited to GI issues.But Cardiac Problems,Prostate problems,gallbladder problems etc.did the stress cause those problems Most of the time NO The stress simply agravates the situation.


----------



## Kathleen M. (Nov 16, 1999)

No one who knows what they are talking about says IBS is only and solely caused by stress.It, like everything else, as you have noted gets worse when you are stressed out.GI infections are known to be an initiating trigger for IBS. That doesn't fit with the IBS is just stress hypothesis that most people abandoned quite some time ago.Seeing differences in the brain IS NOT saying it is *just* stress. FWIW.The complex nervous system in the gut does talk to the central nervous system. Things that effect that communication (chemical or mental) can be used to make IBS a lot better for a lot of people. (the study I was in about 70% of people with clear IBS diagnosis and no depression got better).K.


----------



## 19865 (Mar 17, 2007)

The stress excuses and brain activity as being the Causes most times are BULL and easy COP OUT excuses to quickly come up with a diagnoses of IBS-Motlity caued by stress.Another Overly used excuse --""its your stress causing it """Common!


----------



## Kathleen M. (Nov 16, 1999)

Now I'm lucky I go to one of the world's experts in IBS.He never says "it's your stress causing it"He is working hard to get that message out. Unfortunately not all doctors have caught up.Don't assume the bad doctors are the only opinion about IBS in the medical community.


----------



## 19865 (Mar 17, 2007)

Another example ERIC :THE LISTED CONDITIONS OF OVERLAPPING.Table 1. Non-gastrointestinal symptoms more common in irritable bowel syndromepatients than in comparison groups(5).1. Headache2. Dizziness3. Heart palpitations or racing heart4. Back pain5. Shortness of breath6. Muscle ache7. Frequent urinating8. Difficulty urinating9. Sensitivity to heat or cold10. Constant tiredness11. Pain during intercourse (sex)12. Trembling hands13. Sleeping difficulties14. Bad breath/unpleasant taste inmouth15. Grinding your teeth16. Jaw pain17. Flushing of your face and neck18. Dry mouth19. Weak or wobbly legs20. Scratchy throat21. Tightness or pressure in chest22. Low sex drive23. Poor appetite24. Eye pain25. Stiff muscles26. Eye twitchingIF YOU GO TO A LOCAL GASTROENTOLOGIST AND TELL HIM YOU HAD ANY HALF OF THESE ABOVE SYMPTOMS MENTIONED.LETS BE REAL::MOST GIs will definetley either THINK YOU ARE NUTS OR A HYPOCONDRIAC.


----------



## 19865 (Mar 17, 2007)

KATHLEEN M.Sorry about my comments prior.My comments were mostley directed to another member on here who is convinced of other things.and my responses where for his responses.


----------



## Kathleen M. (Nov 16, 1999)

Still the brain studies are not used as proof that IBS is simply caused by stress.From everything I've read from Eric he doesn't think IBS is simply stress, either. I just want people to be clear about that.IBS is not caused by stress. Anyone who doctors you from that position needs to be left for a doctor that is up to date on what IBS is and how to treat it.Yep, mind-body medicine can be used for IBS as it can be used for any disease. Psychosocial issues are just as problematic for people recovering from a heart attack. That they look at that aspect doesn't mean IBS isn't something physical.K.


----------



## Kathleen M. (Nov 16, 1999)

> quote:AND TELL HIM YOU HAD ANY HALF OF THESE ABOVE SYMPTOMS MENTIONED.


No IBSer has that whole list.That is a list of every single thing any IBSer also had.You'd have a similar list if you asked people with asthma or antyhing else to list every other symptoms they have.Each one of those will be found in a very small number of IBSers. Since IBS is so common you expect that pretty much every other disease known to man will have a significant number of IBSers in the group.Really.There is a very small list of symptoms that define IBS. Yep, a lot of people have other problems as well as IBS, but you can't use every symptom that any IBSer ever had to define the syndrome especially since most of those are symptoms of other clearly defined diseases and syndromes. TMJ is not IBS. Fibromyalgia is not IBS, etc. etc.K.


----------



## 19865 (Mar 17, 2007)

Eric,You had made a comment about David or Dr Pimintel beleiveing that IBS is caused by SBBO.That is simply not true and taken out of context. THOUGH NOT THE CASE FOR ALL-IBSrs.THE BELEIFS AND PROOF IS REAL.""A LARGE PORTION OF IBS-DIAGNOSED PEOPLE --DO ACTUALLY HAVE SMALL BOWEL BACTERIA OVERGROWTH.falsley labled as IBS.Ask an IBSr who noticed a large releif to thier diarrhea -even if it be a temporary releif who has taken Antibiotics who noticed a difference.The FLORA & BACTRIA link is definatley a good start to a large portion of IBS diagnosed people.NOT ALL --BUT MANY !IT IS NOT THE problem FOR EVERYONE.BUT IT HAS BEEN PROVEN TO BE A TERRIFIC QUESTION RAISED BY REASEARCH AND BY SELF-WITNESSES.( MANY WHO I KNOW PERSONALLY)Dr Pimintel made a larger point with his Small Bowel Bacteria Overgrowth & IBS link.The POINT IS dont settle so easy on IBS-MOTILITY as a diagnosis. KEEP LOOKING AND YOU WILL FIND ANOTHER NON-TRADITIONAL CAUSE AND SOLUTION. IN HIS OWN SEARCH & REASEARCH HE CAME UP WITH HIS BELEIEFS OF SMALL BOWEL BACTERIA OVERGROWTH AS A LINK TO ALOT OF IBSrs PROBLEM.


----------



## 19865 (Mar 17, 2007)

the only reason i posted the large symptom list was for the member who originally posted them.to show him how vague symptoms are and how they are different in every case and can easily be overlooked.


----------



## eric (Jul 8, 1999)

There is going to be a new paper out on bacteria and IBS soon in regards to gas and bloating. Like I mentioned earlier there is going to be ore out in a couple wekks, that will explain things better.Other research centers are NOT getting the same reults as Cedar, nor is the test they use for a diagnoses of IBS very accurate. Perhaps we should discuss that, how accurate is lactulose breath testing for SIBO?Gut flora are important, but as of yet there is no proof they cause IBS, other then the development of IBS AFTER a bacterial infection. But they have also seen IBS develop out of a viral infection recently. The intial infection is RESOLVED, but changes persist in the digestive system. Celluar and structual changes. Again those changes are very important.There is no specific bacteria as of yet found to cause IBS and there are some problems with bacteria being the root cause of IBS. For example does this bacteria effect more women then men? And Why? But that is just one I could list quite a few of them for sure.Everyone has bacteria in there gut and it is crucial to be there. Not everyone has IBS though. There has been no overgrowth found, no single pathogen, no overt inflammation in IBS ect.. The major body of research on serotonin and the motility of IBS the d and c and d/c is SUBSTANTIAL. But motility alone doesn't explain Chornic pain. For that matter either does inflammation as I have already pointed out.IBS is not caused by stress, it is well known, lots of people have stress and don't have IBS. However stress is a very important factor. The hpa axis is connected to cells in the gut to help fight infection, so the stress system has a dual role, fighting infection and alerting the person to dangers. The fight or flight happens faster then a person can think about it.Its also stressors both mental and physical.Stress is define in this way as a "Threat to the organsims either real or perceieved, which activate the stress ystem and the end reult can be the release of histimine from mast cell unto the smooth muslce and that can cause macroscopic inflammation and contribute to pain in IBS. You might want to read this entire thread.but"Report from the 6th International Symposium on Functional Gastrointestinal DisordersBy: Douglas A. Drossman, MD and William F. Norton, IFFGDSome 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.htmlIBS is a brain gut axis disorder. This has been known for some time now.People can confuse the role of stressors, both physical and mental and IBS. Stress is already known as a contributing factor in Developing IBS and a gastroenteric infection.This is one reason why IBS is often misunderstood, even by IBSers.Most people don't understand the Neurobiology of stress and gut functioning.Readers' ExchangeDefining Stress in IBSFall 2003From Arizona -- Thank you so much for your efforts and support for those of us with GI disorders. Your first issue (Spring 2003) of Digestive Health Matters is both professional and informative. I would like to comment on one of the articles - "The CNS: Center for Neurovisceral Sciences and Women's Health at UCLA." I am encouraged to know that steps are being taken for funding research of IBS and interstitial cystitis. However, it is discouraging that researchers are still expending time and money to research "neurobiological mechanisms by which stress modulates brain-visceral interaction." I realize that stress is a popular theory in the discussion of IBS triggers, however, I believe this is completely backward and it is the chronic pain and totally unreliable bowel function of an IBS sufferer which causes the greatest stress. If research would focus on "fixing" the bowel, no doubt the panic and fear of IBS would be greatly alleviated.Comment from Emeran A. Mayer, M.D. -- In contrast to the common interpretation of the term "stress" as a psychological phenomenon, it should be understood as any real or perceived perturbation of an organism's homeostasis, or state of harmony or balance. For example, in this viewpoint a severe hemorrhage, starvation, extreme temperature, or worry about the unpredictable onset of abdominal pain all qualify as stressors -- some as "physical" stressors, others as "psychological" stressors. The fear to leave the house in the morning without knowing if one can make it to work without having to stop on the freeway because of an uncontrollable bowel movement, or the fear of experiencing uncontrollable abdominal discomfort during an important business meeting are sufficient stressors to activate the central stress system.The central stress system involves the release of chemical stress mediators in the brain (such as corticotropin releasing factor), which in turn orchestrate an integrated autonomic, behavioral, neuroendocrine, and pain modulatory response. This biological response in turn will alter the way the brain and the viscera interact, and this altered brain-gut interaction can result in worsening of IBS symptoms. Thus, pain and discomfort, fear of these symptoms, activation of the stress response, and modulation of the brain-gut interactions by stress mediators are part of a vicious cycle which need to be interrupted to produce symptom relief.The neurobiology of stress is not a theory, but a topic that can be studied in animal models, and one of the hottest topics in drug development for treatment of IBS (e.g., substance P antagonists, corticotropin releasing factor antagonists).The Neurobiology of Stress and EmotionsBy: Emeran A. Mayer, M.D., UCLA Mind Body Collaborative Research Center, UCLA School of Medicine, CaliforniaWe often hear the term "stress" associated with functional gastrointestinal (GI) disorders, such as irritable bowel syndrome (IBS). Many patients experience a worsening of symptoms during times of severely stressful life events. But what is stress? How often does it occur? How does our body respond to stress? This article explores the mechanisms that link stress and emotions to responses that have evolved to ensure survival and that, in the modern world, affect healthâ€"including gastrointestinal function.IntroductionStress is an adaptive response that is not unusual or unique to only certain individuals. In humans and animals, internal mechanisms have developed throughout evolution, which allow the individual to maximize their chances of survival when confronted with a stressor. A stressor in this context is any situation that represents an actual or perceived threat to the balance (homeostasis) of the organism. In a wide variety of real, life threatening situations -- such as an actual physical assault or a natural disaster -- stress induces a coordinated biological, behavioral, and psychological response. "Stress and Irritable Bowel Syndrome: Unraveling the CodeBy: Yvette TachÃ©, Ph.D., Center for Neurovisceral Sciences and Women Health, Digestive Diseases Center, Department of Medicine, Digestive Diseases Division, University of California at Los Angeles and VA Greater Los Angeles Health Care System, CaliforniaDr. TachÃ© was the recipient of the IFFGD 2005 Research Award to Senior Investigator, Basic Science. Her early publications put the "brain-gut axis" on the map. Since then, she has been one of the pioneers in this field. In many ways, it has been her energy and enthusiasm that has ensured the continued vibrancy of the field. Her identification of the role of corticotrophin-releasing factor (CRF) signaling pathways in stress-related alterations of gut motor function and visceral pain are of major and lasting importance.http://www.giresearch.org/Tache.htmlalso the actual phyiscal abnormalities like serotonin are also connected to stress and anxiety as are mast cells in the gut, both EC cells and Mast cells are increased in PI IBSers embedded in the gut wall.So I would encourage people to try to understand stress, anxiety and even emotions in regards to IBS and it being a physical problem."http://ibsgroup.org/groupee/forums/a/tpc/f...261/m/906107392If your going to talk about the immune system and there is a TON of research on it as well then you need to incorporate stress as well.Your are also continuing to say IBS are things it is NOT. The bacteria issues and IBS has been around for a long time and have been researched and are still being researched.You are really not looking at sibo and IBS research to make those comments. In fact a lot of them are inaccurate, even you posted earlier a thread that contradicts what your saying here.SIBO and IBS research is a good thing. Just like fructose and lactose malabsorbtion studies and IBS and studies on PI IBS and celiac and IBS and all the information and research.I began this with pointing out physical and structural problems in IBS and now you think I say IBS is caused by stress. Take your time and read through this complex information more carefully and you will perhaps see a bigger picture. Validation studies of diagnosing IBS which have been done and are being done and with large groups of IBSers and years later after the diagnoses to check to see if they missed organic disease or misdiagnoed ect..Some more info on SIBO. One notice it is called Small Bowel Bacterial SYNDROME.First Prinicples of Gastroenterology online"Bacterial Overgrowth Syndrome page 251 The bacterial overgrowth syndrome can result from any disease that interferes with the normal balance (ecosystem) of the small intestinal flora and brings about loss of gastric acidity; alteration in small bowel motility or lesions predisposing to luminal stasis; loss of the ileocecal valve; or overwhelming contamination of the intestinal lumen (Table 16). "http://gastroresource.com/GITextbook/en/Chapter7/7-17.htm


----------



## eric (Jul 8, 1999)

PS I am done with this thread.


----------



## 16229 (Jan 28, 2006)

The best way it's been explained to me is this. The problem is not in the head. It's believed to be more in the nerve centers that relay info from the gut to the head.These nerve centers may do one of several things, of which that has not been determined. a) The signals get confused and the wrong directions are sent to the brain.







The directions are sent but get amplified or de-amplified in the process.c) The nerves send signals even though the gut did not send them.d) Signals intended to go to a certain area are accidentally sent to another.Rome is not perfect, but it is solid and when used properly is correct most of the time. You can be out of the box and have extensive testing, but to what point? Not everyone can have $200,000 worth of testing done. And not everyone's body can handle all that testing even if somehow the financial end worked out.In the end there needs to be a way that is efficient and effective. A way to properly diagnose symptoms and do testing to confirm or deny the possible causes of those symptoms. A bunch of testing just for the sake of testing does no one good.I should know. I've gone through more tests than I would want anyone to go through. I finally called it quits after two years because I couldn't take it and it was not helping me get better or find a cause. In the end it was someone performing and interpreting a more basic test more effectively that gave me a small breakthrough.I do have a problem with GI's. People should shop around and find a capable one. Even capable one's have problems. They want to have an answer and too many times they don't. I've found that too many docs dx IBS too often and/or attribute symptoms to IBS that have nothing to do with it. But there are good GI's out there. It's wise to find one if you have problems.


----------



## 19865 (Mar 17, 2007)

> quote:Emeran A. Mayer, M.D.,


You mentioned ->Emeran A. Mayer, M.D., study.thats JUST terrific.(HOW COINCIDENTAL)?Emeran A. Mayer, M.D., A Doctor who has a conflict of interest since he is one of the Main Doc Pushers of Antimotility medications such as Lotronex and also works for the DRUG company on thier private studys and pushes the motlity seretonin stuff..NOT TO BE CONFUSED WITH LYOYD MAYER WHO IS A MASTERMIND EXPERT IN THE MUCOSAL IMMUNITY .HE IS IN NO WAY AFILIATED WITH THE OTHER MAYER.----------------------------------------As far as the SMall Bowel Bacteria Syndrome.It is not to be confused with other common forms of SMall Bowel Bacteria overgrowth that had been caused by things such as Intestinal Surgery ,removal or part of the Gastric tract or other medical problems that had caused the bacteria to overgrow.Very Similar problem to (Healthy NON surgery people getting bacteria overgrowth)>but with more pronounced reasoning as to why the overgrowth such as removal of sections of the Terminal Ileum Etc.ERIC. Why must you end this thread?we cant have a friendly disagreement and AGREE TO DISAGREE?Please dont take affense.Like i said --you see things one way and i see them another way.My forms of expression may not be the greatest , ""I m from Jersey""and had been given the run around by many Gastros for many years.I AM IN NO WAY A PHYSICIAN AND DO NOT WANT TO GIVE ENYBODY THE FALSE IMPRESSION THAT ANY OF THE IBSrs HAVE ANY MORE SERIOUS ILLNESS.DO NOT REPLACE YOUR OWN PHYSICIANS ADVICE.JUST KEEP IT MORE OPEN MINDED WITH HIM OR HER.MOST OF ALL STAY HEALTH .DO TO LET OTHERS (doctor or non doctor )EASILY DISMISS CERTAIN THINGS YOU FEEL A DOCTOR SHOULD KNOW.THEY MIGHT BE DISMISSED AS NON SERIOUS. BUT LET A DOCTOR DECIDE. DONT BE AFRAID TO BE PORTRAYED AS A HYPOCONDRIAC.IF YOU ARE NOT CONFIDENT WITH YOUR DIAGNOSIS OR MEDICAL TREATMENT , JUST FIND ANOTHER DOCTOR WHO WILL TRULLY LISTEN TO YOU AND THINK MORE CLEARLY WITHOUT THE --RUSH TO BLAME IT ALL ON IBS THEORYS.I BASE ANY INFORMATION AS INFORMATION PURPOSES ONLY AS MY OWN PERSONAL OPINION AND EXPERIENCESI AM NOT A MEDICAL DOCTOR JUST A TOSSED AROUND PATIENT WHO WAS TOLD HE HAD IBS FOR MANY YEARS PRIOR TO GETTING THE CORRECT DIAGNOSIS.MANY OTHERS I PERSONALLY KNOW HAVE HAD VERY SIMILAR PROBLEMS AND HAD GOTTEN BLANKETED BY BEING LABLED AN IBSr when in reality they had something else wrong.IBS -MOLITY DOES EXHIST. IT HAS INCREASED THOUSANDS-FOLD IN THE PAST 15 YEARS. COME TO YOUR OWN CONCLUSSION.


----------



## Jannybitt (Oct 13, 2006)

Just my opinion, because everyone has one, but I believe Eric probably is done with this thread because it has been talked to DEATH!!!!!!! God help a new person that happened to step into this thread looking for support or information. A conversation can be beat into the ground and this one is on it's way to China! Don't mean to sound nasty, but Whoa! Rein it in please!


----------

