# The small bowel controls the colon



## SpAsMaN* (May 11, 2002)

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## SpAsMaN* (May 11, 2002)

http://gut.bmjjournals.com/cgi/content/abstract/29/9/1236Gut, Vol 29, 1236-1243, Copyright Â© 1988 by BMJ Publishing Group -------------------------------------------------------------------------------- PAPERS Dysmotility of the small intestine in irritable bowel syndromeJE Kellow, SF Phillips, LJ Miller and AR Zinsmeister Gastroenterology Unit, Mayo Clinic, Rochester, MN 55905. Though the pathophysiology of the irritable bowel syndrome (IBS) is commonly attributed to dysfunction of the large intestine, evidence exists to incriminate the small bowel. In order to further explore the role of the small bowel in IBS several stimuli were applied, in an attempt to unmask the dysmotility of the jejunum and ileum. These included infusions of cholecystokinin-octapeptide (CCK-OP), a high fat meal, neostigmine and balloon distension of the ileum. Three groups (n = 8) each of age and sex matched healthy volunteers were studied; patients with IBS complained of predominant constipation (n = 8) or diarrhoea (n = 8). Patients with IBS responded excessively to stimulation by CCK-OP, fatty meal, and ileal distension. In general patients with diarrhoea were more sensitive to stimuli than those with constipation. The ileum responded more to stimulation than the jejunum. As in the large bowel, stimuli appear to unmask intestinal dysmotility in patients with IBS. Motor abnormalities were often accompanied by abdominal symptoms, raising the possibility that dysfunction of the small bowel contributes to the symptoms of IBS.


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## SpAsMaN* (May 11, 2002)

Spasman to the rescue:I.S.B.=Irritable small bowel


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## SpAsMaN* (May 11, 2002)

I want to thanks Flux for explaining that gas moves independently from stools.


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## SpAsMaN* (May 11, 2002)

For the newbies,IBS could be associated with the theory of SIBO:SIBO=Small intestine bacterial overgrow


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## 13853 (May 2, 2005)

> quote:Originally posted by SpAsMaN*:I want to thanks Flux for explaining that gas moves independently from stools.This detail is very important to explain why gas moves so quickly.In fact,it can moves from the small bowel to the exit at the speed of ligth.


So now I imagine my bowels are a 6 lane freeway. The gas is taking all 6 lanes thus forcing the poo onto the skinny shoulder where it must travel very slow and isn't allowed to merge with the faster moving traffic.


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## SpAsMaN* (May 11, 2002)

ZZ,you should realize that movement of gas is a serious problem.In other hand,i allow you to use humor.


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## 13364 (Dec 8, 2005)

Spasman - in the abstract it states " patients with IBS responded excessively to stimulation by ...." - but it doesn't say what response was being measured. Subjective pain ? Intraluminal pressure ? Sunspot activity ?Sorry to be so "flux", but without this info, one can't really evaluate the experiment.


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## SpAsMaN* (May 11, 2002)

Mekis,i have to think about what you say,i dosen't understand rigth now.For those interested to participate in clinical research,here few places.There is research on small bowel!!!http://www.ibsgroup.org/main/research.shtml


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## 13364 (Dec 8, 2005)

Spasman, if you were to write in French , I would also not be able to understand. Your English is *much* better than my schoolboy French; but I like to have fun with words, and make jokes, and I'm sorry if I am thus unclear.







Nevertheless, I meant to make a serious point; the abstract was unclear as to what was being measured as a response.


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## flux (Dec 13, 1998)

> quote:" patients with IBS responded excessively to stimulation by ...." - but it doesn't say what response was being measured.


It implies one...


> quote:The ileum responded more to stimulation than the jejunum.


I don't have this article, but my guess is probably something like the motility index. Motility is measured with water-perfused cathethers and the pressure against the water is measured, often expressed as mm of Hg. Then an area under curve measurment is calculated.


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## 13364 (Dec 8, 2005)

QUOTE "it implies one..." UNQUOTE????????????????????????????????????????????????


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## SpAsMaN* (May 11, 2002)




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## 13364 (Dec 8, 2005)

Spasman - My last post was in "fluxish" - maybe I should translate:flux - Your comment "it implies one..." was crass, curt, unhelpful, illogical, unworthy, lazy, unscientific, inaccurate (sic), patronising, specious, irrational, boorish, otiose, discourteous, inelegant, ignoble, and moreover doesn't advance the debate.Try again, without the subtext "look how clever I am".The sad thing is that you probably *could* contribute quite substantially to multipartite discussions; but my bet is that you won't.


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## SpAsMaN* (May 11, 2002)

Mekis,try to edit your comments,i want my post more "clean".Thanks


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## 13364 (Dec 8, 2005)

Spasman - I reserve the right to repond to flux's "look how clever I am" posts in any manner I deem fit - and my previous reply was not "unclean".He is not what he pretends to be here. A real researcher would not last 5 minutes in the real world with that attitude.But, as you wish, I shall ignore your posts from now on.


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## administrator (Aug 20, 2004)

Just a reminder.If you have a problem with someone elses post, please hit the alert button to let the moderators know about. (the triangle with the ! in it)Now can we get back to the topic "The small bowel controls the colon" rather than how we feel about other poster's posts. Dicsussing each other tends to result in long threads that stray far from the topic at hand. If you disagree with someone's opinion try to discuss the opinion not whatever irks you about the other person. It is a stronger statement when you can refute the opinion rather than dismiss the person who stated it.ThanksThe Moderator Team


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## 13364 (Dec 8, 2005)

I wanted to send this privately, but there is no email address listed for "the moderator team", so publicly it will have to be.You guys know full well that to try to debate on the issues with flux is not possible. He is a hit&run troll, who does not know how to debate rationally or politely - as many other of your long standing residents have recently complained. You tolerate that, yet when I reply in kind, you step in. Illogical, and unfair.The vast majority of us are extremely irritated by the attitude of someone who claims access to knowledge we mere mortals cannot reach, and who occasionally deigns to scatter pearls of wisdom upon us from a great height, yet never justifies his opinions or replies to criticism. I don't want to see him banned - as I said, he *could* contribute constructively, but chooses not to, and is allowed to behave destructively by you.I asked a serious question above in the eighth post to this thread - and got a smart-alec "look how clever I am" reply. It is not me who refuses to discuss opinions rather than "dismiss the person who stated it", but flux who is dismissive of *all* of us to to a point way beyond rudeness. If you are to continue to bend the rules for him, then you must allow me - and others - the right of reply. If you tolerate behaviour from him that you would not from others, on the grounds that he has scientific knowledge, then you delude yourselves on two counts - firstly, he is not as infallible as you may assume; secondly, I, and some others here, have more experience at the sharp end of medical - in my case gastrointestinal - research. And yet he impertinently and imperiously dismisses any opinions other than his own.It is not a solution merely to complain about individual posts by clicking the warning triangle - or we would have to click on 9500-odd posts.The only solution is to make clear that debate is welcomed, but those who act as hit&run trolls are not.However, no doubt you will take the easy option and delete this post of mine - can't have dissent in the ranks.


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## Kathleen M. (Nov 16, 1999)

Um hit the alert button on any post sends an email to the moderators. Contact us link on the bottom of each page is another option.Hope this helpsK.PS, since when does say something about the opinion, show how the opinion is wrong and don't bash other poster or spend post after post after post talking about how much you don't like them means "no dissent is allowed".I mean really.Asking people to respond with reasoned debate, and when they do not alert the mods (which no one here does every single post, and really don't go through someone's past stick to current events, alerting something in the archives from 3 years ago is just being obnoxious







) rather than personal attacks...why is that a BAD thing? Dissenting opinion includes way more than "you jerk"Now reasoned debate may not change the other person's mind. they are just as allowed to believe in whatever they want as you are.


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## 13364 (Dec 8, 2005)

No doubt I'll get bashed for this but...Kathleen, your last post here is rushed, and pretty much incomprehensible. I'd like to reply to it as you're clearly annoyed with me, but it makes no real sense. Please ask one of your co-moderators to check it over before you castigate me for answering back. I take time to compose my posts & put them in clear language; and I suggest the moderators do the same.You might, however, like to clarify your point :"Dissenting opinion includes way more than 'you jerk'".I have not called anyone a jerk; and unless I have missed something, no-one has called me a jerk. Please either clarify, justify, or apologise.You have not answered any of my points - merely responded with a stream of (not very) consciousness. This is disappointing. This is generally a very well moderated, relaxed, *enjoyable*, informative, non-dictatorial board, refereed with a light touch - especially by Kathleen. Goodness knows, I've been on some pretty fascistic ones in the past! You guys are generally pretty good. Seriously. Please take the time to discuss & come up with a plan for the hit&run self-proclaimed expert(s), who, as you are well aware, are not just an irritant to me, but to large numbers of your regular clientele.


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## Kathleen M. (Nov 16, 1999)

Hopefully this won't be to stream of conciousnes for you, but I wanted to reply sooner rather than later. (FWIW, the whole unclean post thing was a big part of the problem. That things didn't get back on track after that also needed to be addressed. Moderator responses are usually done in the general sense rather than specific...and sometimes we don't find things until several posts have gone by. One of the reasons we want people to hit that alert button. We can't read every post as it is posted. I'd rather catch something when it happens than try to put a fire out two days later. Do not assume that these requests only refer to the post immediately above the Mod. Team post. Just because you can see yourself in the request doesn't mean that you were the only one that it refers to. If something applies to you, please take what you can from them, but try not to assume you are the problem, or the only problem.)I'm sorry it wasn't clear. (I did email Jeff and popped a message to the other mods to check it out even before you replied. They are more than welcome to edit my comments however they see fit. They wanna do something with it, they can. I have no problems with anything they do with it. I always do that, BTW)The point I believed you were in part making and that I was replying to, was that dissent on this board is not allowed. Perhaps you were not making that point, but that is the point I was refering to. (the last part of your post)I thought it was clear "you jerk" was merely an example of the sort of thing that is about how much a person irks you, rather than discussing the topic at hand. I never meant to imply those exact words were posted on this thread, and I am sorry if it came off that way to you. All too often that is the point of a post, which is why I used it as an example. I generally avoid doing point by point analysis of other people's viewpoints of other posters. Firstly, because that is not productive or about the topic at hand. Secondly, all it usually does is get me stuck in the middle of a flame war without protective gear. Thirdly, it violates the exact thing that we shouldn't be doing here. Also, I usually don't talk about moderation issues in public, but just so you know Flux has altered aspects of his posting style when we have asked it of him. I wish more people were willing to do that. Believe it or not, Flux's posts do get reviewed on a fairly regular basis. I will make the following commentary, but I really would prefer this thread get back on topic and not be "let's all bash Flux" free-for-all, which historically is what happens whenever this sort of thing comes up.Flux can present himself however he wants, as can you, and everyone else. He shouldn't be required to do something different from every other poster on this board. Yes, he is abrupt and opinionated. On the other hand, his posts almost always address the points people make and are not personal attacks (because they are abrupt people may feel attacked, but what he said didn't say anything about them as a person) He never gets involved in the flame wars about him, either. Could he be more diplomatic, yes. Do I wish he was, a lot of the time, yes. I won't make hiim change who he is to post here. Just like I do not think I have to stop being random to post here (I've been evaluated for it, after graduate school I found out I never should have finished high school because random people like me rarely finish high school)That he is allowed to speak here doesn't mean anyone believes he is infallible. Why you think I, or Jeff, or the mods. believe that I have no idea. He is allowed to believe whatever he wants to, as is every other person on the board. We can't make him agree with you. We can't require him to see your point. We can let you make your point, but we do require that once it is clear that two people are not going to ever agree they need to walk away. Make your point and move on. Do not argue over and over. We have found over time that it only hurts the people here looking for information and support when there are too many of these endless fights. A fair number of the posting guidelines were put in place to address behaviors that lead to the endless fights. It can be very hard to just drop it. However, people will read both sides and may very well agree with you, even when the person you are argueing with won't change their mind.Can we now get back to the topic that started this thread?K.


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## 13364 (Dec 8, 2005)

Kathleen - thank you for replying. I think this needs sorting out once & for all, and I hope you will allow further public discussion. I think that you still miss my two main points. Firstly, you say "We can't make him agree with you. We can't require him to see your point." Agreed. But my point is, he is unpersuadable. He is a hit&run merchant, doesn't debate, and in that guise, is not a constructive contributor. I could do that, too. I could make unsupported assertions, and not respond to reasoned criticism. We all could. How does that help ? Who learns from that ? I want to discuss treatments & science (as I tried to do on the eighth post of this debate), and if I am wrong, or persuaded otherwise, I will admit it (sometimes through gritted teeth, but you can't have everything







).Secondly, I object that flux implies through his signature and his general demeanour that he is a medical researcher. You know, and I know, that he is not; he is a computer programmer. I know, and you know, his real name. It is unfair, and misleading that he is allowed to continue to misrepresent himself on such a BB, where sometimes desperate and impressionable people come for advice. He had the impertinence, with no evidence whatsoever, when I first posted here, to suggest that my history of many years in medical research was a fiction. This attack was permitted to continue. (By the way, you continue you think that a clicking of the warning triangle is an adequate way of dealing with unsuitable posts. My point in mentioning 9500-odd posts was not to threaten retrospective action, but to point out that since *all* of his posts are equally abrupt, patronising and offensive (give or take a half dozen, maybe), then we would be flagging up *all* of his posts.)He has killed this thread, to the chagrin of Spasman & myself, who both wished to understand the significance of the paper originally posted, by his "look how clever I am" reply. He has recently killed another thread, on the connection between blood types and IBS, by similar methods. That was, in my opinion, a pretty silly thread - but what was gained by his aggressive approach? No-one was persuaded - and no-one would have been the worse off had the thread quietly died. I see daily numerous scientifically dubious claims on this BB - should I agressively & peremptorally challenge each one ? I could. Who would gain ? Only my ego - look how clever I am !I urge you to clamp down on hit&run posters who are not prepared to engage in constructive debate; and to warn those people who pretend to have authority they are not qualified to express.


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## SpAsMaN* (May 11, 2002)

Mekis,what kind of research are you doing?


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## Kathleen M. (Nov 16, 1999)

Why you and spas can't discuss the paper just because flux posted a comment I don't understand. So he might make another comment. I don't see why it stopped you. It might be worth starting a new thread on this so it can be all about that, and not about who posted what to whom.Everyone has their own posting style. Trying to regulate that is much more into the grey areas than most of the rules we have (that is why we came up with a guideline for what is too long of a cut and paste, it isn't based on what it is, it is based on length). We try to make it so there is little interference in what people discuss (which you acknowledged) but that has the down-side as well. I understand how much he frustrates you, but to regulate what you don't like about his behavior could get us into heavy-handed moderation mode. Something we don't want, nor do most of the posters. Also I try not to take people's posting styles personally. It doesn't always work, but usually what they posted says volumes about them, rather than anything about me. I don't need to try to out-do them. This isn't a competition. How much I let them effect me is up to me.I generally recommend if someone on here posts in a way that drives you nuts, just ignore them. Don't try to change them (the cat isn't going to bark...don't try to teach a pig to sing, it won't work and you only annoy the pig, and any other folksy sayings that apply). Don't let them effect how you post, either. Really, I'm pretty done with this conversation. Why not get back to the topic Spas started either here or on a new thread?K.


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## flux (Dec 13, 1998)

> quote:flux posted a comment I don't understand.


Hmm, can I ask what exactly you (or mekis) didn't understand of my previous answer?







I thought the answer in that post, that follows the ellipsis in "It implies one..." was clear.Perhaps "pressure against the water" was not clear. That's the intraluminal pressure, from the gut wall contracting against the water-infused catheter. All these contractions are added together to get a motility index. I'm not saying this is the response they measured, but it's the "implied" one







, at least based on my reading of the abstract.


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## SpAsMaN* (May 11, 2002)

http://72.14.207.104/search?q=cache:06kB-0...r&ct=clnk&cd=29INTESTINAL GAS AND BLOATINGFernando Azpiroz, Digestive System Research Unit, University Hospital Vall dâ€™Hebron, Barcelona, Spain. Abdominal bloating is a common and significant clinical problem without properclinical classification, known pathophysiology or effective treatment, that remains to be scientifically addressed. Bloating is one the most common and bothersome complaints in a large proportion of patients with various functionalgut disorders, but in the current standard classification abdominal bloating is merely regarded as a secondary descriptor. Four factors are included in thepathophysiology of bloating: subjective sensation abdominal bloating, objectiveabdominal distension, volume of intraabdominal contents and muscular activity of the abdominal wall. The primer to elicit subjective bloating may be any of theother three factors, or else, the sensation may be related to distortedperception, and these mechanisms may play and independent role or may be interrelated. Bloating probably represents a heterogeneous condition producedby a combination of pathophysiological mechanism, that differ among individual patients, and that in most cases are subtle and undetectable by conventional methods.Several studies measuring girth changes with either tape measure, computedtomography or inductance pletismography, have shown that, indeed, thesubjective sensation is associated to objective abdominal distension. Gasproduction was initially measured by Levittâ€™s group using a wash-out technique, and was found to be normal in patients. Hydrogen, which accounts for a large proportion of colonic gas production, is partly absorbed into the blood and excreted by breath. A more recent study measured gas excretion (breath plus--------------------------------------------------------------------------------Page 2 anal) by indirect calorimetry in IBS patients on a standard diet, and showed that hydrogen excreted was increased, but the total gas volume excreted (hydrogenplus methane) was not different than in healthy controls. Indirect evaluation of hydrogen production by breath tests has shown either normal production or increased production, attributed to various causes, such as hyperactive gasproducing colonic flora, small bowel bacterial overgrowth or small bowel malabsorption. The level of evidence supporting these interpretations is questionable. Nevertheless, it seems that the total volume of gas produced inthese patients is not much larger than in healthy subjects. Three independent studies showed that the gas surface in plain abdominal radiographs was somewhat larger in IBS patients than in controls, but the extragas volume would hardly justify the symptoms. Furthermore, other studies using computed tomography or the wash-out technique, could not detect differences between patients complaining of bloating and healthy controls. Gas transit studies have evidenced that patients with bloating have impairedhandling of gut contents. Scintigraphic studies using gas labelled withradioactive xenon, indicate that the small bowel is responsible for impaired gastransit in these patients, in contrast to the common idea of gas being retained inthe colon. The ileocecal region is an area with sphinteric function likelyimplicated in this dysfunction. However,*very elaborate studies with gas infusionat various levels of the gut showed that gas retention is due to impaired propulsion in more proximal parts of the small bowel*, because while jejunal gas loads were retained, clearance of gas directly infused into the distal ileum or the cecum was normal. Impaired gas clearance in these patients is related to abnormal gut reflexes: the prokinetic effect of gut distension is impaired and the --------------------------------------------------------------------------------Page 3 inhibitory effect of intestinal lipids are up-regulated, and both effects, reduced stimulation and increased inhibition, contribute to delayed gas transit and retention. Hence, segmental pooling, either or gas or alternatively of solid/liquid components, may induce bloating sensation, particularly in patients with alteredgut perception. It has been recently shown that an intraabdominal volume load, produced bycolonic gas infusion, induces in healthy subjects an increment in tonic activity of the abdominal muscles, that can be measured by electromyography, and thisresponse is probably mediated via viscerosomatic reflexes. This adaptation ofthe abdominal wall to intraabdominal volume loads is impaired in patients complaining of bloating, who fail to contract their abdominal muscles, and this abnormal response is associated to exaggerated abdominal distension andbloating. Hence, altered viscerosomatic reflexes, may contribute to abdominal wall protrusion and objective distension, even without net intraabdominal volume increments. The combination of the interacting pathophysiological factors may determine theclinical presentation of bloating and related symptoms. A more preciseknowledge of the pathophysiology and clinical forms of bloating may allow thedevelopment of mechanistic rather than the currently empiric treatment strategies, for a comprehensive and effective management of thisheterogeneous problem. --------------------------------------------------------------------------------Page 4 SELECTED REFERENCESâ€¢ Levitt MD, Bond JH, Levitt DG. Gastrointestinal


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## 13364 (Dec 8, 2005)

That's a lot of info, mostly very useful, & consistent with the way bloating *feels*, to me at least. Thanks.ps. One can't help laughing, however, at the comment "...patients complaining of bloating, who fail to contract their abdominal muscles..." - this suggests a simple answer to IBS : a regiment of sergeant majors (or drill instructors) hollering "Shoulders back !!! Chests out !!! Stomachs in !!!!"If only we had known it was so simple....


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## SpAsMaN* (May 11, 2002)

Characteristics of small bowel motility inpatients with irritable bowel syndrome:http://www.clinsci.org/cs/095/0165/0950165.pdf


> quoteISCUSSIONOur study mainly indicated that delayed small boweltransit time was found in the constipation-predominantpatients with IBS, whereas accelerated transit characterizeddiarrhoea-predominant patients with IBS. Theseobservations are very compatible with the reports onOccidental subjects [8,9]. In addition, our study indicatedthat orocaecal transit times manifested a negative correlationwith the frequencies of weekly bowel habits.Perhaps this observation suggests that small boweldysmotility *produces the predominant symptoms * inpatients with IBS...


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## SpAsMaN* (May 11, 2002)

Zigzag,never too late,i just get your humor.


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