# Eric's Compilation about the Psycho-social aspects of IBS information



## administrator (Aug 20, 2004)

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.Also relaxation, distraction and other techniques are KNOWN to help people cope with chronic pain."If your GI doc is telling you to see a psychiatrist for IBS then I'd get a new doctor!"Sophie, this might be a bad suggestion. That maybe for the doctor to decide really in the diagnoses and treatment.Psychology works forIrritable Bowel Syndrome (IBS)"Evaluation studies have typically shown that psychological treatment led to greater improvement than the usual medical treatment. As well, the psychological therapies have long lasting effects months to years after treatment was completed. Medication treatments, in contrast, tend to cease to have an effect when patients stop taking the medicine. Up to 70-80% of people with IBS have reported significant improvements following psychological treatments. Recent research suggested that the amount of improvement relates in part to the effort and time the individual puts in to develop better ways of coping."http://www.apns.ca/prob_IBS.htmlDepression increase pain that is also well known. Part of the brain that processes pain is involved in processing emotions. All pain is processed in the brain and that is very important in regards to IBS and Chronic pain.The Surprising Link Between Mood and Digestion. ..."In the past -- back when scientists believed the mind and the body operated as separate entities -- some physicians wrote off digestive distress with no sign of organic disease as being "all in the head." But in recent years, that wall has crumbled. Doctors now see intricate links between the nervous system and the digestive system. The two realms constantly exchange streams of chemical and electrical messages, and anything that affects one is likely to affect the other. The connections between the two systems are so tight that scientists often refer to them as one entity: the brain-gut axis. (The brain-gut axis is a hot topic in medicine. In the summer of 2001, more than 100 researchers from around the world gathered in Los Angeles for a convention called "2001: A Brain-Gut Odyssey.") For people suffering from persistent digestive troubles unconnected to disease, such research suggests that reducing stress, depression, and anxiety may go a long way toward calming the gut."http://www.ahealthyme.com/article/primer/101186767Merck Manual"In this disorder, the digestive tract is especially sensitive to many stimuli. Stress, diet, drugs, hormones, or minor irritants may cause the digestive tract to contract abnormally, usually leading to diarrhea. Periods of constipation may occur between bouts of diarrhea. Irritable bowel syndrome affects women 3 times more often than men.The brain has enormous control over the digestive system. Stress, anxiety, depression, fear, and virtually any strong emotion can lead to diarrhea, constipation, and other changes in bowel function and can further worsen a flare-up (bout or attack) of irritable bowel syndrome."http://www.merck.com/mmhe/sec09/ch129/ch129d.htmlStress isn't the only triggers though, but its extremely important. Foods, hormones, meds and other things can trigger it as well, even the weather and seasons.The symptoms of d or d/c or c, are symptoms of a bigger disorder. Pain is a must in IBS. There is a lot of research on pain and IBS.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 UCLAhttp://www.aboutibs.org/Publications/VisceralSensations.htmlThey also have good evidence for why there is C and D and d/c which has to do with receptors in the gut and ec cells."Serotonin SignalingOf the putative mechanisms underlying the pathophysiology of IBS, the strongest evidence points to the role of serotonin in the GI tract. The effect of serotonergic mechanisms in the manifestation of IBS symptoms has led to development of a new drug class for the treatment of IBS patients: the GI serotonergic agents.Normal GI function relies on a properly functioning brain-gut axis, which involves the coordinated interplay of the GI musculature, the CNS, the autonomic nervous system, and the enteric nervous system (ENS). The ENS contains millions of neurons embedded in the wall of the digestive tract and functions, at least in part, independently of the CNS. The size, complexity, and independent function of the ENS has resulted in application of the terms "the second brain" and "the mini-brain."[81] Impaired function or coordination of any of these systems, or the communication between these systems and the GI musculature, can lead to symptoms of dysmotility and altered sensory perception, which are characteristic of IBS and select other GI motility disorders.[82]The neurotransmitter serotonin (5-hydroxytryptamine [5-HT]) is a predominant signaling molecule in the ENS. Most (90% to 95%) of the body's serotonin is found in the gut, and smaller amounts are found in the brain (about 3%) and in platelets (about 2%).[83] In the GI tract, serotonin facilitates communication between the ENS and its effector systems (muscles, secretory endothelium, endocrine cells, and vasculature of the GI tract), thus playing a key role in normal GI tract functioning.[84] In addition, serotonin plays a role in the communication between the ENS and the CNS.In the gut, serotonin is synthesized by and stored in the enterochromaffin cells, which are located within the mucosa of the intestinal wall. When material passes through the lumen and the mucosa is stimulated, enterochromaffin cells release serotonin, which then binds to its receptors (primarily 5-HT1P receptors) on intrinsic primary afferent neurons, initiating peristalsis and secretion. Serotonin also binds to 5-HT4 receptors on interneurons, which augments the transmission of signals to motor neurons, resulting in enhanced peristaltic activity. In transgenic mice lacking 5-HT4 receptors, colonic motility is abnormally slow, confirming the role of these receptors in facilitating normal colonic motility.[85] By binding to 5-HT3 receptors on efferent sensory innervations coming from the vagus and the spinal nerves, serotonin mediates signaling between the ENS and the CNS and, thus, modulates pain perception.To regulate the signaling process, excess serotonin must be removed; this is accomplished by the SERT molecule expressed by intestinal epithelial cells.[86] Human studies have shown that defects in serotonin signaling contribute to the pathophysiology of IBS and, potentially, other GI motility disorders. In a recent study by Coates and colleagues,[87] biopsy specimens from patients with IBS showed significantly lower mucosal serotonin concentrations than those from healthy controls, potentially the result of lower mRNA levels for tryptophan hydroxylase (the rate-limiting enzyme in serotonin synthesis), which were also significantly lower in patients with inflammatory bowel disease.[87] There was no significant difference in the number of enterochromaffin cells or in the capacity of these cells to release serotonin under stimulated conditions. In another study, higher serotonin levels were observed in mucosal biopsy samples from patients with IBS with constipation (IBS-C) than in patients with IBS-D or in healthy volunteers.[88]Serotonin levels may also be affected by altering the amount or function of SERT. The study by Coates and colleagues[87] showed a significant decrease in the level of SERT mRNA and SERT protein expressed in the intestinal epithelial cells of IBS patients compared with that of healthy volunteers. In another study,[89] SERT expression and binding capacity in platelets were decreased in women with IBS-D compared with expression and binding capacity in healthy controls. Furthermore, Chen and colleagues[90] showed that mice with a SERT gene deletion had altered colonic motility. It is interesting to note that the mice thrived in laboratory housing conditions, indicating that other transporters could compensate for the lack of SERT. Additional studies have focused on SERT polymorphisms. Yeo and colleagues[91] showed an association between patients with IBS-D and the homozygous short polymorphism of the SERT gene promoter. This mutation results in lower levels of SERT gene transcription and reduced amounts of SERT protein available for reuptake of serotonin. In addition, Camilleri and colleagues[92] showed a possible link between the long promoter polymorphism and patient response to therapy.Thus, a substantially large body of work shows that normal gut physiology is predicated on the interplay between the GI musculature and the ENS, autonomic nervous system, and CNS. One of the central mediators of this complex interplay is the neurotransmitter serotonin. Impairment or imbalance in serotonergic signaling, which can affect GI motility, secretion, and visceral sensitivity, may be affected by defects or deficiencies in serotonin production, specific serotonin receptors, or proteins such as SERT. These changes can manifest in symptoms associated with IBS, including abdominal pain, altered bowel habits (constipation, diarrhea, or alternation between these 2 states), and bloating.http://www.medscape.com/viewarticle/532089_3CBT and HT and meditation are all coping tools.Each has some differences however.It is known now that stress can reinflame previous inflammation in the gut. Part of how this happens in about some of the mechanisms I am pointing out here. If your under stress when you get a gastro infection it increases the risk of developing IBS. Stress effects all peoples guts, especially IBS. In IBS the gut is hypereactive to stimuli. Having IBS is also very stressful. This stress also keep the stress hormones flowing. The vicious cycle in IBS is anxiety=symptoms=anxiety in any order.from the experts."psychophysiological arousal is the core of treating functional gi disorders. There is som much distress, anxiety, antisipatory anxiety, and negative reaction to symptoms, that calming the mind and body often makes a significant difference to symptoms."These aren't "cures" but tools.Its also important that most people with PI IBS who develop IBS have d as their predominate symptom. There are some psycological differences to the symptoms in d and d/c and c IBS. So some of these things might apply more to different subgroups.also treating the brain in IBS is the top down model and the gut down up model. Its known treating both can be very effective.somethings to look overThe Surprising Link Between Mood and Digestionhttp://www.ahealthyme.com/article/primer/101186767http://www.aboutibs.org/Publications/StressDefined.htmland I emailed some major expert on all this.FYIDr Drossman's comments on foods for IBS Health.Shawn,To say that people with IBS may get symptoms from food intolerances is an acceptable possibility, since the gut will over react to stressors of all types including food (high fat or large volumes of food in particular). Futhermore, there can be specific intolerances. So if you have a lactose intolerance for example, it can exacerbate, or even mimic IBS. Other examples of food substances causing diarrhea would be high consumers of caffeine or alcohol which can stimulate intestinal secretion or with the latter, pull water into the bowel (osmotic diarrhea). The same would be true for overdoing certain poorly absorbed sugars that can cause an osmotic type of diarrhea Sorbitol, found in sugarless gum and sugar substituted foods can also produce such an osmotic diarrhea. Even more naturally, people who consume a large amount of fruits, juices or other processed foods enriched with fructose, can get diarrhea because it is not as easily absorbed by the bowel and goes to the colon where it pulls in water. So if you have IBS, all of these food items would make it worse.However, it is important to separate factors that worsen IBS (e.g., foods as above, stress, hormonal changes, etc.) from the cause or pathophysiology of IBS. Just like stress doesn't cause IBS, (though it can make it worse), foods must be understood as aggravating rather than etiological in nature.The cause of IBS is yet to be determined. However, modern research understands IBS as a disorder of increased reactivity of the bowel, visceral hypersensitivity and dysfunction of the brain-gut axis. There are subgroups being defined as well, including post-infectious IBS which can lead to IBS symptoms. Other work using brain imaging shows that the pain regulation center of the brain (cingulate cortex) can be impaired, as well as good evidence for there being abnormalities in motility which can at least in part explain the diarrhea and constipation. So finding a specific "cause" of IBS has grown out of general interest in place of understanding physiological subgroups that may become amenable to more specific treatments. Hope that helps.Doughttp://www.ibshealth.com/ibs_foods_2.htmhttp://www.ibshealth.com/ibsfoodsinfo.htmDr Wood's comments for me"Dr. Jack Wood, a renowned physiologist at The Ohio State University calls the ENS â€œthe little-brain-in-the-gut.â€"Dear Shawn:Sorry for the delayed reply to your question. I generally agree with Dr. Drosssmanâ€™s response. A subgroup of individuals when they become sensitized to specific molecules in certain foods respond to ingestion of the molecules with symptoms of cramping abdominal pain, fecal urgency and explosive watery diarrhea. These are also the primary symptoms of diarrhea-predominant IBS. Enteric mast cells, by mechanisms we donâ€™t understand, become sensitized to the food molecule and respond to its presence by releasing a signal to the brain-in-the-gut (ENS) which is interpreted as a threat. The ENS responds by â€œrunningâ€ a program which organizes secretion and motility into a behavior pattern of the bowel, which rapidly clears the threat from the lumen. Because to be effective secretion occurs in large volumes and the contractions that accomplish rapid propulsion are strong, running of the program has the side effects of diarrhea and cramping pain. Big brain input to mast cells during stress activates the mast cells to evoke the symptoms resulting from exposure of the mast cells to sensitizing food antigens. Aside from food allergens and mast cells, certain chemicals such as those in hot peppers, stimulate sensory nerves in the ENS and we are beginning to understand how this can also lead to food-related symptoms that might mimic or exacerbate IBS.Hope this helps,Jackie (Jack) D. Wood "FYI"You have two brains: one in your head and another in your gut. Dr. Jackie D. Wood is a renowned physiologist at The Ohio State University. He calls the second brain, "the-little-brain-in-the-gut." This enteric nervous system is part of the autonomic nervous system and contains over one hundred million neurons, which is as many as are in the spinal cord. This complex network of nerves lines the walls of the digestive tract form the esophagus all the way down to the colon. This little brain in the gut is connected to the big brain by the vagus nerves, bundles of nerve fibers running from the GI tract to the head. All neurotransmitters, such as serotonin that are found in the brain are also present in the gut.Dr Wood has discovered that this little-brain-in-the-gut has programs that are designed for our protection and which are very much like computer programs. They respond to perceived threats in the same way that the limbic system or the emotional brain does. So the threat of a gastrointestinal infection can activate the program that increases gut contractions in order to get rid of the infection. The symptoms are abdominal cramping and diarrhea.Dr. Wood has determined that a type of cell found in the body and the gut, called the mast cell, is a key to understanding the connection of the big brain in the head with the little-brain-in-the-gut. Mast cells are involved in defense of the body. In response to certain threats or triggers, such as pollen or infection, mast cells release chemicals, such as histamine, that help to fight off the invader. Histamine is one of the chemicals that causes the symptoms of an allergy or a cold. When an infection of the gut occurs, such as food poisoning or gastroenteritis, the mast cells of the gut release histamine. The little-brain-in-the-gut interprets the mast cell signal of histamine release as a threat and calls up a protective program designed to remove the threat â€" at the expense of symptoms: abdominal pain and diarrhea.The brain to mast cell connection has a direct clinical relevance for irritable bowel syndrome and other functional gastrointestinal syndromes. It implies a mechanism for linking allostasis and the good stress response to irritable states (e.g., abdominal pain and diarrhea) of the gut. Mast cells can be activated to release histamine in response to perceived psychological stress, whether the stressor or trigger is consciously perceived or not. So the end result is the same as if an infection activated the program in the-little-brain-in-the-gut: abdominal pain and diarrhea."http://www.parkviewpub.com/nuggets/n5.htmlBy the way chronic anxiety can contribute to constipation in the activation of the sympathetic nervous system verses the parasympathetic nervous system. Fight or flight or rest and digest.Antisipatory anxiety might be more in d and d/c then C IBSers though for example. C Ibers have more anger they can't go. Although people can have all kinds of emotions to having ibs and to the symptoms.you may not "cure" the underlying disorders, but you can feel better and if you don't have symptoms that s a major plus.also for the info in general, this is on children but it applies."Question--How can you be sure there is no disease?Answer--Worries about the child's health are normal. Repeated explanations may be necessary because the concept of functional symptoms may be new. There are no tests for diagnosis of a functional gastrointestinal disorder, but there are symptom-based diagnostic criteria. Functional gastrointestinal disorders are common; diseases are unusual. If your child's symptoms meet the diagnostic criteria for a functional gastrointestinal disorder, stop worrying that it is something else. Ask your physician to reevaluate the child promptly if the symptoms change.Question--How do you treat the pain in functional disorders?Answer--Conceptually, functional abdominal pain may be treated 1) with education, 2) from the top down, 3) from the bottom up, or 4) with any combination of these.Sometimes getting a diagnosis and learning about a functional disorder is enough to reduce the worries a family has about the health of their child. All parents ask the same four questions when they see a clinician: 1) what is wrong? 2) is it dangerous? 3) will it go away? 4) what can we do about it?In the case of a functional bellyache the answers are: 1) it's a functional bellyache, 2) it is not dangerous, 3) it comes and goes, 4) there are several ways to treat it. If the answers satisfy and the child is not disabled by pain in any way, further treatment may be unnecessary. The goal is to help the child cope with symptoms so that they don't miss daily obligations and activities.Top down treatment--Children can learn to use the thinking parts of their brains to reduce pain. Biofeedback, guided imagery, progressive relaxation, and hypnosis are different ways of training the brain to help control and reduce pain. If these methods are available, the advantage to them is that they teach the child the skills needed to reduce pain without medication.Bottom up treatment--Children may benefit from small doses of chronic pain medicines, or medicine to take away acid or intestinal muscle spasm. These medications are safe and effective in many, but not all, children."http://www.aboutkidsgi.org/Bellyaches.htmlQuestion from a 13-year-old in Oregon -- I have had stomach pains for over one year that make it hard for me to do anything. I have recurring abdominal pain syndrome. My doctor said there is nothing wrong with me and nothing he can do to treat me. Do you have any suggestions?Answer -- We assume that you have been seen by a physician who gave you the diagnosis of "recurring abdominal pain syndrome," (functional recurrent abdominal pain).Tests are done to look for the presence of disease as the cause of symptoms. If the tests find no evidence of disease, the symptoms are termed "functional." Diagnosis of this functional gastrointestinal disorder is based on the symptoms, after ruling out the presence of disease or tissue damage. These symptoms are defined as abdominal pain severe enough to disrupt routine activities three or more times during a three-month period. Studies show that it is pretty common, affecting 10%-15% of school-aged kids.So if it is not a disease that is causing these symptoms (you are not sick and that is good news), what is causing it? The answer is not entirely clear. Ongoing research is looking for the explanation.Recent studies point to an increased sensitivity of the sensory nerves in the intestines. Normal movements of your intestines may be perceived as cramps or other discomfort.The intestines share nerve pathways with the brain. In many situations, when the brain reacts to something -- like the sound of a dentist's drill -- the intestines, or gut, pick up the same signals and react.The majority of people will ultimately have some kind of gastrointestinal (GI) symptom when exposed to stressful situations. If your GI system is a bit too reactive, you will experience symptoms in more types of stressful situations than someone else will whose gut is not quite as reactive. What is stressful for one person may not be stressful to another, and lots of people don't even realize it when they get stressed -- they just feel sick.Finally, there is the "gate theory" of how pain is experienced. When pain originates at some point, nerve messages pass through something like a gate on their way to the brain. The wider open the gate is, the more pain that is experienced. By thinking about and focusing on the pain site, we open the gate. Plus, feelings of anger or worry or sadness can open the gate.However, we can also help close the gate. Turning attention away from the site or feeling of pain, through relaxation or focusing on some other activity, can help close the gate and lessen or even eliminate pain.A well-known phenomenon that demonstrates this is that of the athlete who plays a game while injured, oblivious to the pain. The athlete is completely focused on the game and does not feel pain. Then, after the game is over, the athlete turns attention to the injury and feels pain.Whatever the cause, you can do something about it! It takes some effort but there a number of ways that you can help yourself.First, think about this example. Have you ever experienced a muscle cramp or a side-ache during strenuous running or exercise? You feel real pain in muscles that are not diseased. But they have been stressed beyond some point that in you causes discomfort. What do you do to avoid it in the future? You might think about what you were doing that resulted in the muscle pain. Maybe next time you do more warm-up exercises, or start out slower, or don't run as far.The first time you felt a side-ache, you might have felt concerned and stopped running. After you learned that it was nothing to be concerned about, you may have barely taken notice the next time it happened, perhaps slowed down a bit, but then kept right on going.This is the same type of thing that happens with functional recurrent abdominal pain. Your intestinal muscles may be causing you to feel pain. To get it under control, try this:1) While the pain you feel is very real, do not worry that you are sick. You are not. Your body is reacting to events in a way that is causing you discomfort but is not cause for alarm.2) Try to figure out if your symptoms are connected with anything else that may be triggering them. Do symptoms flare at certain times, before certain events, on weekdays, on weekends, etc? If you can identify triggering factors (like certain foods or activities) you can try to avoid them, or if that is not possible, try to deal with them in different ways.3) Are you missing school because of this? Worry over missing school can make symptoms worse. Try to keep going.4) Are you doing too much-school plus lots of outside activities? If so, take some time off to relax. Too much of anything can be stressful.5) The next time you feel the pain, don't let it stop you. Keep on going. Practice focusing your thoughts on what it is you want to do next and then go ahead and do it. Don't let pain take your awareness hostage.http://www.aboutkidsgi.org/questionsandanswers.html#schoolI know I posted a lot here and will refrain, but I think its very important info.yiUNC Digest fall 2006Ask the expertStephan R. Weinland PhDWhy see a psychologists when the diagnoses is IBS?"many people experience distress and anxiety when their doctor makes a recomendation that they see a psychologist. This reaction often comes from the belief that a referal to a psychologist carries with it the assumptions about symptoms being "all in the head" or the result of "mental illness."These are two of the biggest MISCONCEPTIONS about the practice of psychology in a medical setting, and they often stand in the way of patients achieving a meningful reduction in symptoms. In this column, I hope to dispel some of these misconceptions around psycology in a medical setting, and in doing so communicatee a few of the benefits you might be able to achieve in working with a psycologists to address your IBS symptoms."http://www.med.unc.edu/wrkunits/2depts/med...gidc/digest.htmThe whole article has not been posted yet.the autonomic nervous sytem runs digestion."The autonomic nervous system (ANS) is the portion of the nervous system that controls the body's visceral functions, including, but not limited to action of the heart, movement of the gastrointestinal tract and secretion by different glands, among many other vital activities.To summarize:Thoughts and even subtle emotions influence the activity and balance of the autonomic nervous system (ANS).The ANS interacts with our digestive, cardiovascular,immune and hormonal systems and is therefore ideally suited to translate mind states into organ functions/dysfunctionsNegative reactions create disorder and imbalance in the ANS.Positive feelings such as appreciation and a state of relaxation create increased order and balance in the ANS, resulting in increased hormonal and immune system balance and more efficient brain function.It has been shown in a number of studies that during mental or emotional stress and physical stress, there is an increase in sympathetic activity and a decrease in parasympathetic activity. "The increase in sympathetic tone can contribute to constipation in IBS or in normal people.http://ibs.med.ucla.edu/Articles/PatientArticleSm02ANS.htmalso importantly"By using sophisticated imaging techniques that allow us to visualize the activity of the living human brain (see â€œLooking Into the Living Human Brainâ€), researchers at the UCLA Neuroenteric Disease Section have recently identified for the first time the regions within the brain that are involved in the perception and modulation of visceral sensations, including visceral pain. In addition, by comparing brain responses to an acute intestinal stimulus between healthy control subjects, patients suffering from IBS, and patients with ulcerative colitis, they were able to identify specific alterations in how the brains of IBS patients process and respond to acute colonic pain."http://ibs.med.ucla.edu/Articles/PatientAr...eakthroughs.htmSerotonin is also the neurotransmitter in the gut that signals sensations from the gut to the brain.FYI from Harvard.The Trusted Source..Harold J. DeMonaco, M.S.Harold J. DeMonaco, M.S., is senior analyst, Innovative Diagnostics and Therapeutics, and the chair of the Human Research Committee at the Massachusetts General Hospital. He is author of over 20 publications in the pharmacy and medical literature and routinely reviews manuscript submissions for eight medical journals...June 19, 2001.A:Irritable bowel syndrome is now recognized as a disorder of serotonin activity. Serotonin is a neurotransmitter in the brain that regulates sleep, mood (depression, anxiety), aggression, appetite, temperature, sexual behavior and pain sensation. Serotonin also acts as a neurotransmitter in the gastrointestinal tract.Excessive serotonin activity in the gastrointestinal system (enteric nervous system) is thought to cause the diarrhea of irritable-bowel syndrome. The enteric nervous system detects bowel distension (expansion) on the basis of pressure-sensitive cells in the bowel lumen (opening). Once activated, these pressure-sensitive cells promote the release of serotonin, which in turn promotes both secretory function and peristaltic function (the contractions of the intestines that force the contents outward). At least four serotonergic receptors have been identified to be participants in the secretory and peristaltic response.Patients with diarrhea-predominant IBS may have higher levels of serotonin after eating than do people without the disorder. This recognition led to the development of the first drug used specifically to treat diarrheal symptoms of IBS, alosetron (also known as Lotronex). Alosetron blocked the specific serotonin receptors responsible for recognizing bowel distention. In doing so, it blocked the effects of serotonin and reduced both bowel secretions and peristalsis. Constipation was the most common side effect seen. (Note: Alosetron was removed from the market by the manufacturer after repeated reports of a dangerous condition known as ischemic colitis became known.) Tegaserod (Zelmac) is another drug under development and under review by the U.S. Food and Drug Administration for approval. Tegaserod is indicated for the treatment of constipation-predominant IBS and works to increase enteric nervous system serotonin activity.So, increasing serotonin activity in the enteric nervous system produces increased bowel secretions and peristalsis (and potentially diarrhea), whereas depressing serotonin activity produces reduced secretions and reduce peristalsis (and potentially constipation). Increasing serotonin activity in the brain would increase awareness and, in higher doses, produce anxiety, insomnia and restlessness."almost all if not all IBSers demonstrate an alter serotonin system.


----------



## tummyrumbles (Aug 14, 2005)

I think Sophie is right.Saying that stress leads to IBS is a sweeping statement, and doesnâ€™t take into consideration the myriad of problems here. IBS would certainly lead to stress though. In my case, IBS was caused by both a physical problem and a combination of things I was doing wrong, which Iâ€™ve now corrected. The physical problem I canâ€™t cure, but I can work around it. This problem has nothing to do with stress. Stress can amplify symptoms, but so can depression, isolation and loneliness. I think a great many people here have suffered in the past, maybe more so than the average person. Underlying issues like abuse or alienation can lead to IBS because of the helplessness the person feels. A colic pain can easily become exaggerated in the mind of a lonely person. People can also get in a rut, and find themselves powerless to change their habits. Therapy may help, if people can afford this, but any kind words would help. A good friend would be even better, but these arenâ€™t always easy to come by, especially with IBS. Anyone taking an interest in you would help. This is a far cry from saying that IBSers need psychiatry. It isnâ€™t easy for people who have suffered in the past to approach IBS with the single-minded determination thatâ€™s probably necessary to really tackle IBS. There needs to be a totally honest appraisal of issues like diet, lifestyle and self-discipline. IBSers rarely divulge this information, neither here on the board, nor to their doctors. This helps perpetuate the myth that IBS is a mystery. It is if people arenâ€™t honest about what theyâ€™re doing in their lives, and this should be acknowledged if anyone is serious about treating IBS. Perhaps the board could help by encouraging IBSers to be a little more forthright.


----------



## eric (Jul 8, 1999)

TummmyrumblesNo Where in the above information does it say stress causes IBS!!!! IT is however WELLKNOWN stress can conttribute to Developing Post Infectious IBS.The reason is the stress system also helps to fight infections.you might want to read thisStress and Disease: New Perspectives By Harrison Wein, Ph.D.http://www.medicinenet.com/script/main/art...rticlekey=60918 also*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.*"This problem has nothing to do with stress."IBS is embedded in the central and autonomic and enteric nervous systems. I think you maybe only looking at stress as a psycological stress issue, but it is a whole lot more then that really."Underlying issues like abuse or alienation can lead to IBS"Abuse doesn't cause IBS but it can make it worse.Emotional Abuse and IBSStudy found link to severity -- but not causality By: Douglas A. Drossman, M.D., Co-Director, Center for Functional GI & Motility Disorders Center; Professor of Medicine and Psychiatry, University of North Carolina, Chapel Hill http://www.aboutibs.org/Publications/abuse.htmldepression, isolation, loneliness, helplessness, worry, anger, anxiety, distress, antispatory anxiety, negative reaction to symptomsare all forms of stressors to the organism. "This is a far cry from saying that IBSers need psychiatry. "again psychiatry in a medical setting for IBSWhy see a psychologists when the diagnoses is IBS?"many people experience distress and anxiety when their doctor makes a recomendation that they see a psychologist. This reaction often comes from the belief that a referal to a psychologist carries with it the assumptions about symptoms being "all in the head" or the result of "mental illness."These are two of the biggest MISCONCEPTIONS about the practice of psychology in a medical setting, and they often stand in the way of patients achieving a meningful reduction in symptoms. In this column, I hope to dispel some of these misconceptions around psycology in a medical setting, and in doing so communicatee a few of the benefits you might be able to achieve in working with a psycologists to address your IBS symptoms."http://www.med.unc.edu/wrkunits/2depts/med...gidc/digest.htm"There needs to be a totally honest appraisal of issues like diet, lifestyle and self-discipline."I agree with this very muchI would add IBS education and a good doctor who takes time,listens and works with the patient.


----------



## eric (Jul 8, 1999)

Evaluation of Visceral Sensation in IBS Patients Using Subliminal Stimulation"From Medscape GastroenterologyLiterature Review -- Select Topics in IBS and Chronic ConstipationLatest From the Literature in IBS and Chronic Constipation: September 2006Posted 09/07/2006Brian E. Lacy, MD, PhD IntroductionIn this second installment in our quarterly literature review series on topical issues in irritable bowel syndrome (IBS) and chronic constipation, 3 original research studies are reviewed. These reports describe new information regarding the pathophysiology of IBS, the role of alternative therapies in the treatment of IBS, and the treatment of constipation.""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.[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_2


----------



## 18855 (Feb 15, 2007)

Hi, I don't post much,but I wanted to say that this has been one of my favorite and most useful posts I have read! Thank you so much for all this info! Lori


----------

