# UNC Study Investigating factors causing IBS



## Kathleen M. (Nov 16, 1999)

The UNC Center for Functional GI & Motility Disorders is conducting aresearch study investigating a broad range of factors that may cause IBS.Participation will include filling out various health questionnaires andphysiological testing.Â Individuals who meet the study criteria will berequired to spend one overnight visit in the General Clinical Research Center at UNC Hospital.Benefits include free medical screenings for disorders such as bacterial overgrowth, lactose malabsorption and celiac disease, and up to $250 compensation.To be eligible, you must be* 18 years or older* diagnosed with irritable bowel syndrome by a physicianIf you are interested in the study, please reply toibsresearch###med.unc.edu or contact Lenore at 919-966-8329.Â You can alsolog on to the Center website at www.med.unc.edu/ibs for more details.


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## 19277 (Mar 26, 2007)

Kathleen, I appreciate this post and hope they find something good. I also read your story of beating IBS...nice. You can read mine if you are so inclined.Here is my opinion about research conducted by MD's on IBS:I don't have any faith that they will get anywhere because I believe they look at the disorder from the wrong perspective.IBS is a disorder that has huge variation in it's manifestation over individuals. This is because there is no systematic disease process that produces IBS and IBS symptoms.Thus it is entirely possible that the root cause of my IBS is different from the root cause of another individual's IBS.What MD's will do at UNC and across the nation is "Investigate a broad range of factor's that may cause IBS".This approach (in my opinion) is fundamentally flawed, here is why:I believe it is entirely possible that these "co-factors" they see when they examine multiple IBS patients are not all possible causes. (the next part is in caps for emphasis, I am not yelling.)IT MAY BE ENTIRELY POSSIBLE THAT THESE SO-CALLED "CO-FACTORS" ARE NOT ALL POSSIBLE CAUSES, BUT RATHER ARE ALL, ALL OF THEM, POSSIBLE C0-SYMPTOMS OF THE TRUE UNDERLYING ROOT CAUSE OF IBS.Take a second to ingest the above statement and give it some good contemplations. Perhaps viewing the co-symptoms as co-factors that contribute to cause of IBS, and then treating the co-factors IS WHY the Medical Community has been largely unsuccessful in treating IBS.What I would call for is a complete philosophical shift...get to the root of how your body functions chemically and it may be revealed what underlying process caused your IBS as well as all of the co-symptoms.Under this idea, it is possible to view patients as individuals, analyze their individual biochemistries that govern their bodily processes, identify problems with said biochemistry...and then try to fix it.Medical doctors are not taught to think, analyze, or treat under such a model.The proposed philosophy, if it has some truth, has far reaching implications. Among these are1.) Why I can suffer from a similar disorder as another individual but conventional treatments affect us differently.2.) Why the root cause of my IBS is different from the root cause of yours.3.) Why one treatment may cure my IBS, but you will require different treatment to cure yours.I found a pioneer in this field, Nutritional Biochemistry...you can read my story on my home website or visit this doctor's website atwww.montanaim.comI would like to emphasize that I am not trying to sell or solicit and that I have no vested interest in the success of this man's business.I too have an advanced degree and the above diatribe is an attempt to show that I can think analytically and support my position.This doctor was the first in 10 MD's to diagnose me correctly and then improve my symptoms.Good luck all,


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## 17890 (Mar 11, 2007)

questforhealing- Well written, I agree with your logic.


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## Kathleen M. (Nov 16, 1999)

> quote:IBS is a disorder that has huge variation in it's manifestation over individuals. This is because there is no systematic disease process that produces IBS and IBS symptoms.


As defined by researcher it really does not have that much variation in manifestation. Pain or discomfor with altered bowel habit is the one symptom we should all have.IBS is sometimes used too broadly by medical people, but that doesn't mean that is the way researchers work. They will make sure the people in the study actually have IBS as defined not any other GI disease or any other non-GI disease.Now a lot of people with IBS have other problems as well, but that doesn't mean fibromyalgia, TMJ, or any other disease or disorder is IBS. They are a person that has BOTH.Researchers are not the same as medical doctors. They are trained to be research scientists so they don't have the same limited view that a doctor in a clinic might have.


> quote:1.) Why I can suffer from a similar disorder as another individual but conventional treatments affect us differently.


This is true of every single disease or disorder on the planet. What works for my high blood pressure may not work for you, etc.


> quote:2.) Why the root cause of my IBS is different from the root cause of yours.


They are looking at that with things that make some scientific sense based on all the decades of research that have happened up until now.They are looking for horses when they hear the hoofbeats, not unicorns or zebras.If they find a subset that are inexplicable they may then do more research into them. You don't look for unicorns first, no scientist does.


> quote:3.) Why one treatment may cure my IBS, but you will require different treatment to cure yours.


Again this is true for everyone for every disease. Why can my friend control her diabetes with diet and other peole need insulin. Doesn't mean thesse two people have completely different diseases.I am glad you found something that works.I am confused as why you seem to be so negative, while you start with maybe they will find sometihng at the begining the rest of the post seems to be very much against them doing this study.After all celiac and SIBO are two very logical things to test people with IBS symptoms for, and it would be good to have solid numbers as to what % of IBSers that have these in systematic testing. If for no other reason than to increase the number of doctors in the clinic that will do these tests when people need them.I just can't see this as completely flawed.And any study has to limit it's scope. Science, by definition, does look "outside the box" as you are always looking to what we don't know. They do always go from what we do know. Otherwise you are just doing random things with little chance of finding anything useful.K.


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## 19277 (Mar 26, 2007)

Kathleen, thank you for responding, here is my rebuttal.As a statistician, I understand full well how science works. I understood all of your diatribe on the horses and unicorns.Let me elaborate on my point so that you can better understand my perspective._quote:___________________________________________________________________________They are looking at that with things that make some scientific sense based on all the decades of research that have happened up until now.They are looking for horses when they hear the hoofbeats, not unicorns or zebras.If they find a subset that are inexplicable they may then do more research into them. You don't look for unicorns first, no scientist does.-----------------------------------------------------------------------------------based on all the research over the last decades...Most of the research over the last decades into all disorders are done under the same Medical-research minded scope. I believe that the core of this philosophy has reached it's limit in explaining disease processes and causes. A bold statement, I know. I would argue that this area too often scientifically identifies co-symptoms as causes and then treats the symptom. This is why medical doctors can't heal people...there scope does not allow them to identify the true cause of the majority of diseases.What I propose is a complete paradigm shift. Yes, research disease, but under a different philosophy...more on this later.quote:------------------------------------------------------------------------------------Now a lot of people with IBS have other problems as well, but that doesn't mean fibromyalgia, TMJ, or any other disease or disorder is IBS. They are a person that has BOTH.------------------------------------------------------------------------------------I agree with the first sentence in the above statement. I whole heartedly disagree with the second statement. In fact, I no longer consider the labeling of my symptoms and then grouping me into a disease category beneficial to the improvement of my disease state and conducive to my return to a state of health.What I would argue is that a person who has been given both "IBS" and "Fibromyalgia" diagnoses (or perhaps labels is a better word) has some underlying dysfunction in their bodily processes that contributes to a state of ill health. So whatever the the dysfunction is, it is currently manifesting itself on the macro scale as symptoms consistent with the "IBS" and "Fibromyalgia" diagnoses. If this underlying dysfunction can be identified and then altered...the individual may have a chance to return to health.I call for a complete paradigm shift in the way that we view all disease states.quote:------------------------------------------------------------------------------------Again this is true for everyone for every disease. Why can my friend control her diabetes with diet and other peole need insulin. Doesn't mean thesse two people have completely different diseases.------------------------------------------------------------------------------------Possible answer: Your friend can control her diabetes with diet because the dysfunction that hinders her insulin production is not as severe as a diabetic who required complete insulin replacement. I never made the claim that people with different manifestations of similar disease states have different disease. I claim that the dysfunctions that cause the disease states in two individuals may be different but manifest themselves similarly.____________________________________________________________________________________ My quote: 1.) Why I can suffer from a similar disorder as another individual but conventional treatments affect us differently. Your reply:This is true of every single disease or disorder on the planet. What works for my high blood pressure may not work for you, etc.____________________________________________________________________________________My response: What works for your high blood pressure does not work for mine because, while our high blood pressure problems appear to be similar on many levels, somewhere beneath it all is a fundamental view of what is causing our high blood pressures. If the fundamental cause of mine differs from your fundamental cause, then similar treatments may also have different effects because we are functioning differently on these fundamental levels and hence respond to the treatment differently.I do not retract my statement that research based out of the current paradigm for diseases states is fundamentally flawed. I argue that the scope that medical researcher's operate under is wrong. If you have false prior assumptions then the implications that follow may also be false. This is reflected in the complete failure of conventional medicine to reduce and eradicate chronic degenerative diseases. They had reasonable theory and science when it came to micro-organisms and physiology, which did lead to the near eradication of most infectious diseases through antibiotics and vaccinations. They can also save my life if I am in a traumatic accident. But they are supremely insufficient at treating and improving chronic conditions such as IBS.I appreciate all research, but science does not necessarily take one "outside the box" as you state it. Science only works if you remain "inside a specific box that contains a specific set of rules". Then under those rules you see what truths may be found.When I say I want research scientists to "think outside the box" when it comes to IBS...I want them to work from a completely different paradigm for how a chronic disease state may be created and maintained. They do not adequately address this question. Thus, again, they are insufficient.Luckily I found a completely different paradigm that addresses all of my above concerns. This doctor has helped many people, myself included, drastically improve their health when conventional medicine has failed to even control symptoms with the standard treatments. In searching for answers I even had referral to the Mayo Clinic, but no solutions were offered for me. Then Dr. Neustadt improved my condition so drastically that my PCP and my GI doc were utterly amazed at the progress I made after years of suffering. They even didn't really believe it even though I was sitting right in front of them cured.So in short have a very negative view of the medical world because subscribing to their philosophy kept me ill for many years, offered me little hope of improvement, incorrectly diagnosed me every time (because they don't understand most disease processes), and then applied the science lacking conclusion that THE cause of ALL my problems must be Stress. This is how I justify the claim that they are fundamentally flawed in their philosophy, and there are thousands upon thousands of people every day that are told that there is no hope for eradicating their symptoms and it is very sad.If you are interested in the philosophy that potentially saved my life, you can read my story on my homesite or start email diatribe with me atquest.for.healing###gmail.comThank you for the lively debate,


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## eric (Jul 8, 1999)

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


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## Kathleen M. (Nov 16, 1999)

To drag this thread kicking and screaming back on topic.The POINT of posting the study at UNC was not to debate the philosophy of science, or the nature of IBS.The POINT was to let people with IBS who may be in the UNC area who would like to get tested for celiac and SIBO and other things that may be going on that they may want to check with the study coordinator.All the tests will be free and you get paid for your time and trouble.A lot of patients do not get these tests from their regular doctor, and a lot of them would like to get these tests, so there may be some who would like to participate.K.


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## Popp (May 31, 2004)

If I only lived closer to NC.


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## 19282 (Jul 19, 2005)

Two years ago, I went down to UNC and participated as a volunteer in this exact study. I HIGHLY recommend the experience to anybody who might even be considering it. The doctors and nurses were unbelievably knowledgeable and friendly. Besides getting a $250 check, I came away from those two days with a ton of new information about IBS and a stack of helpful test results that I was able to share with my gastroenterologist back home. (For all of you who want to get tested for SIBO, this is your chance to do it...and for free!)And obviously, the more people that volunteer for studies like this, the closer the researchers will be to really understanding IBS and the sooner we'll all be able to benefit from better treatments.Tim


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## Kathleen M. (Nov 16, 1999)

I'm glad to hear you had a good experience.I've been on both sides and I will say those running the study will do everything they can to be supportive. K.


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## 19277 (Mar 26, 2007)

Kathleen, Do you have a response to my last statement, I understand that you want people to be aware of the UNC research group.Suggest arguing through email?thanks


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## 14416 (Jun 21, 2005)

I would ask that the thread remain on topic; Kathleen presented a study so people would be informed of the work these experts at UNC are doing for the IBS community.No need for arguing, here or through email.


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