# A simple statement about IBS - some people can be treated



## betterthroughscience (Jan 13, 2006)

I wanted to create a new post to remove some of the emotion and get to the heart of the matter I am trying to discuss with you all. Rather than a bunch of emotional statements and so forth I will list my assumptions and make clear my logic. If you accept the assumptions and find the logic to be valid, then you will find my conclusion to be true. That is how logic works - if you assumptions are true (accurately describe reality) and your logic valid, then the conclusion is an accurate description of reality.So here it goes, my Assumptions:1. Many people have IBS symptoms as described by the ROME criteria and are diagnosed with IBS. 2. Some people diagnosed with IBS have undiagnosed celiac disease.3. Some people diagnosed with IBS have undiagnosed food allergies. 4. Some people diagnosed with IBS have undiagnosed parasite infections (including giardia).5. Some people diagnosed with IBS have a bacterial mix in their gut that is not optimal.5. Celiac disease can be relatively accurately detected by lab testing. 6. Food Allergies can be identified by measuring the antibodies that react to specific foods by a competant lab using ELISA methods under tight quality control.7. Parasite infections can be detected through stool testing by a competant lab using microscopy under tight quality controls.8. The bacterial mix in the gut can be determined to be sub-optimal through stool testing by a competant lab under tight quality controls.9. A person who has celiac disease will have their health improved by removing glutens from their diet completely, especially if they adjust their diet to ensure that they get all the calories and nutrients they need.10. A person who has food allergies will have their health improved by removing the foods to which they have elevated immune response from their diet completely, especially if they adjust their diet to ensure that they get all the calories and nutrients they need.11. A person who has a parasite infection will have their health improved by treating the infection and ridding their body of the parasite.12. A person who has a sub-optimal bacterial mix in their gut will have their health improved by changing the bacterial mix such that it becomes more optimal.13. Celiac disease, food allergies, parasite infections, and bacterial gut mix have all been studied in terms of their relationship to symptoms of diarrhea, constipation, abdominal pain, and/or changes in bowel habits and/or frequency and have been found to be positively correlated and are suspected to be causal in at least one of those symptoms (even if everything else about the patient is 'normal').My conclusion: Competant detection of and treating celiac disease, food allergies, parasite infections, and suboptimal gut bacteria mix can help some individual patients who have been diagnosed with IBS to improve their health.Please let me know if you think any of my assumtions aren't true or if you think my conclusion is not logically derived from my conclusions. If you think an assumption is not true, please explain why not. If you think my logic is flawed, please explain how it is flawed. If you want I can spell out the logic in "some As are also B", "if B then C", "Therefore Some A are C" form.


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## eric (Jul 8, 1999)

Why not just leave IBS out?A diangnoses of IBS rules out.celiac diseasefood allergiesparasite infections (including giardia).bacterial mix in their gut that is not optimal Whats optimal? There is no concensus on whats optimal?Can a person have the above problems AND IBS, yes.But the above problems ARE NOT considered IBS?Are you just trying to push sales now? Or really interested in understanding IBS better, because you haven't shown you even understand the diagnoses yet or that its a functional GI Disorder.


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## eric (Jul 8, 1999)

By the way all most people can be treated for IBS effectively.


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## betterthroughscience (Jan 13, 2006)

Eric, Please restrict yourself to addressing my specific assumptions. Some people who have been diagnosed with IBS have undiagnosed Celiac disease, right. You can say that those things are not IBS, but some people are diagnosed with IBS and have not been tested for those things. Is the assumption true or not.As regards me pushing sales: Sales of what? I have not mentioned anything for sale. I am trying to increase people's understanding of IBS. IBS is a diagnosis that is given to a huge number of people on the basis of a very simple set of symptoms. Let's stick to what I am saying is true. Please address my specific assumptions.


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## flux (Dec 13, 1998)

> quote:1. Many people have IBS symptoms as described by the ROME criteria and are diagnosed with IBS.


Most.


> quote:2. Some people diagnosed with IBS have undiagnosed celiac disease.


Few.


> quote:3. Some people diagnosed with IBS have undiagnosed food allergies.


Virtually none.


> quote:4. Some people diagnosed with IBS have undiagnosed parasite infections (including giardia).


Few.


> quote:5. Some people diagnosed with IBS have a bacterial mix in their gut that is not optimal.


Since there is no way to measure this, technically it is none, but could be true theoretically.


> quote:5. Celiac disease can be relatively accurately detected by lab testing.


True.


> quote:6. Food Allergies can be identified by measuring the antibodies that react to specific foods by a competant lab using ELISA methods under tight quality control.


True, but generally not relavant since food allergies don't usually GI symptoms.


> quote:7. Parasite infections can be detected through stool testing by a competant lab using microscopy under tight quality controls.


Probably true.


> quote:8. The bacterial mix in the gut can be determined to be sub-optimal through stool testing by a competant lab under tight quality controls.


*False* There is not enough known about the gut bacteria to know what is "sub-optimal". There is no technology capable of culturing most of bacteria in the gut and the little that there is not available clinically anywhere on the planet.


> quote:9. A person who has celiac disease will have their health improved by removing glutens from their diet completely, especially if they adjust their diet to ensure that they get all the calories and nutrients they need.


True, but largely irrelevant to IBSers because they don't have celiac disase.


> quote:10. A person who has food allergies will have their health improved by removing the foods to which they have elevated immune response from their diet completely, especially if they adjust their diet to ensure that they get all the calories and nutrients they need.


Ditoo to 9.


> quote:11. A person who has a parasite infection will have their health improved by treating the infection and ridding their body of the parasite.


Ditto to 9.


> quote:12. A person who has a sub-optimal bacterial mix in their gut will have their health improved by changing the bacterial mix such that it becomes more optimal.


False. See answer to 8.


> quote:13. Celiac disease, food allergies, parasite infections, and bacterial gut mix have all been studied in terms of their relationship to symptoms of diarrhea, constipation, abdominal pain, and/or changes in bowel habits and/or frequency and have been found to be positively correlated and are suspected to be causal in at least one of those symptoms (even if everything else about the patient is 'normal').


I believe this is technically entirely false. Only IBD and IBS have been.


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## eric (Jul 8, 1999)

"Symptoms of these diseases--celiac disease, gastroesophageal reflux disease (GERD), food allergies, lactose intolerance, and eosinophilic gastroenteritis--can sometimes coexist or be confused with a functional GI disorder. *Depending upon the history and symptom presentation, these diseases may need to be considered when making a diagnosis. Significantly, they all have distinguishing characteristics that can differentiate them from functional GI disorders."*http://www.aboutibs.org/Publications/Celiac.html One thing I believe is for sure, doctors should spend more time with patients with IBS and GI disorders of function. Thats one reason some patients are not satisfied with their care."I am trying to increase people's understanding of IBS"You are? Yet you didn't know how IBS is diagnosed or the accuracy of the diagnoses?Your mixing IBS with other conditions."basis of a very simple set of symptoms"That is not entirely true for one.Your not posting the diagnostic criteria or why there is the cluster of symptoms that help diagnose IBS. Your not posting information or questions people can asks their doctors about?Your not taking into account brain gut axis bidirectional communications. Your not covering other problems that can cause the symptoms or recgonizing the ones they ALREADY now about. What about overlapping functional gi disorders?There is nothing wrong with someone getting tested for some of the things your talking about, but I personally think there is a lot of conventional IBS research your leaving out or ignoring or honestly just don't know about perhaps.Lets look at some of the abnormalities they already know about in IBS?


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## betterthroughscience (Jan 13, 2006)

Flux - Thanks for your honest reply.Allow me to provide you with some information of which you might not be aware: Zar, et. al (Am J of Gatroenterol 2005;100:1550-1557) is just one of several articles that demonstrate that food allergies are prevalent among IBS patients at significantly higher rates than control groups and that skin prick testing is ineffective. ELISA testing is effective at uncovering previously undiagnosed food allergies. Once diagnosed, removal of the offending food results in significant reduction of symptoms (compared with controls in blind trials) and re-introduction of the foods to the diet results in resumption of symptom severity. While ELISA food allergy testing is being used at some facilities in the UK and Europe, it is very rare in the US. Because of these studies I am confident that there are many people who have undiagnosed food allergies and that diagnosis and treatment of them would help a significant proportion of IBS patients. You can read the entire report here: http://www.ibstreatmentcenter.com/Articles...BensonKumar.pdf if you have some basis for believing that the report is in error or is invalid, please let me know.Regarding the bacterial mixture in the gut: Numerous labs in the US, including Doctor's Data, and others routinely measure the relative amounts of the major normal bacteria (read about it on their website: http://www.doctorsdata.com/test_info.asp?id=34 including all the references from the journals) - I have no financial interest in this or any other lab. The measurments are simple and easily quality controlled. If a person is deficient in the amounts of Lactobacilli, Bifidobacteria and beneficial E. coli then they have a sub-optimal mix of bacteria in their gut. For this reason I believe that you are mistaken that there is no way to determine if a patient has a sub-optimal bacterial mix in their gut. you don't have to measure all 500 to determine that the big players are not present in normal amounts. Further, Eric has kindly provided many references to the benefits of having re-establishment of the right bacteria in the gut through probiotics. Your statement that not enough is known is in contradiction with those studies. Enough is know to say that probiotics are effective when the patient's levels of the big players is lower than normal.Celiac is not irrelevant. Most patients go decades without being diagnosed. If the estimates that 1% of the population has celiac disease are correct, that means over 3 million people in the US alone have it. For those people, failure to diagnose celiac means years of unnecessary pain. Until celiac screening is routine for IBS patients this will continue to affect many people. Finally you disagree that celiac, etc. have been studied in relationship to IBS symptoms. I think if you refer to the research you will see that all of them have been researched found to be more strongly correlated with IBS patients than symptom free controls. Giardia, a parasite has been extensively studied with regards to diarrhea, for example. Read this if you want information specifically about Giardia and IBS: World J Gastroenterol. 2006 Mar 28;12(12):1941-4. "Giardia lamblia infection in patients with irritable bowel syndrome and dyspepsia: a prospective study." CONCLUSION: In this consecutive series, diagnosis of G. lamblia infection accounted for 6.5% of patients with IBS and dyspepsia. Duodenal biopsies for diagnosis of giardiasis may be unnecessary if stool sample examination is performed.6.5% of the IBS patients!!! That could be a lot of people who could be easily treated for just this one parasite.


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## SophieUK (Dec 18, 2000)

I think you're being a bit unfair to Betterthroughscience - I think most of us on this board know that at the present time there are many areas of IBS where even the top experts disagree. For example, over here in the UK there are a number of IBS experts who have glittering reputations and have worked with IBS patients for years who would agree with the food allergy/intolerance theory, for example. There's a whole clinic that's just based on food intolerance alone, run by some very well-respected doctors. They would not agree that a diagnosis of IBS rules out food allergies/intolerance, because they treat IBS patients only through the use of diets specifically tailored to food allergies or intolerances!Also, for example, the medical advisor to the UK IBS Network, Dr Nick Read, believes strongly that psychological factors are the most important area to look at when looking for IBS causes. I don't agree with him on that, but he's a doctor who has worked with IBS patients for many decades, who has published lots of research on IBS, who keeps up with every new study, and who has heard countless IBS case histories. Should we just dismiss his opinion?The experts disagree - it's not just black and white.


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## 20672 (Jun 1, 2006)

Seems like IBS is in reality the failure to find an 'organic' cause like parasites...of which there are a great many which cannot be detected...In 1994 I detected a negative to side to truth, that being 'anti-truths'...merely simply, a truth that is part of a greater truth that forms a deceptive lie.For example:Stop violence, ignores all the other forms of abuse.(I have edited this because I forgot to include the relevant details to IBS...)It would appear to be that IBS will follow the same historic pattern of ulcers...a causal factor, bacteria/parasites/worms, that has gone undetected, complicated by a variety of other factors...ie food types...I finally treated myself with a wide spectrum herbal anti-parasite formula, i have found that grapefruit seed extract is one of the best stand alone, together with cleanse formulas, high in pysllium and yogurt...(I wish I had tried these earlier, they are a bit expensive, but 16 years of waiting for a suggestion "MAINSTREAM HEALTHCARE" did not know or suggest was the biggest hurdle: THINKING OUTSIDE THEIR BOX.The simplest inexpensive treatment:1. Fresh single slice of garlic with water.2. Bran Flakes.3. Yogurt.Try it and let us know if this helps.


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## Jeffrey Roberts (Apr 15, 1987)

I agree Sophie.I don't think Betterthroughscience's logic is any different than anyone of our own physicians would consider.I hope everyone can back off of the rhetoric (badgering) surrounding every single one of Betterthroughscience's postings. It's getting kind of rediculous.Jeff


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## eric (Jul 8, 1999)

Let me ask a question then Jeff and Sophie, Do you both believe IBS is a brain gut axis disorder?Do yu both believe the brain and the gut are operational to cause the symptoms?Sophie, I agree foods can be triggers. That's not really the issue.Also so we should trust our doctors if they diagnose us with IBS or should we keep 'demanding more testing."? Are we starting to call infectious disease IBS? I believe these are very important issues. Jeff"rhetoric (badgering) surrounding every single one of Betterthroughscience's postings. It's getting kind of rediculous."I personally don't see that way and I don't think its rediculous.


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## Jeffrey Roberts (Apr 15, 1987)

Eric you'll appreciate this if you haven't seen it, because it's just not clear what is causing IBS. Even the experts are confused.Jeff


> quote:Rev Gastroenterol Disord. 2006 Spring;6(2):72-8.A unifying hypothesis for the functional gastrointestinal disorders: really multiple diseases or one irritable gut?Talley NJ.Clinical Enteric Neuroscience Translational and Epidemiological Research Program, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.The functional gastrointestinal disorders are defined by the Rome criteria as a heterogeneous group of symptom-based conditions that have no structural or biochemical explanation. However, this definition now seems outdated, because structural and molecular abnormalities have begun to be recognized in subsets of patients with the irritable bowel syndrome (IBS), the prototypic functional bowel disease. A complex classification system based arbitrarily on symptom criteria does not fit in with a number of emerging facts. For example, the symptom overlap of IBS with gastroesophageal reflux disease is not due to chance, and the emergence of post-infectious IBS, dyspepsia, or both after Salmonella gastroenteritis fits better with a 1-disease model. A new paradigm seems to be needed. All of these disorders may arise after infection or gut inflammation, but the phenotype depends on localized neuromuscular dysfunction in the predisposed human host (the "irritable gut").


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## eric (Jul 8, 1999)

Jeff, I have seen that, although not read the whole paper yet. Research is moving forward.and "Some of the major research advances that support the integrated or biopsychosocial approach include: "Demonstration of post-infectious IBS as a brain-gut disorder"http://www.iffgd.org/symposium2005report.htmlI am wondering still if we can all agree IBS is a motility, viceral hypersenitivty and brain gut axis disorder? Even though molecular abnormalities exist in the gut is subgroups of IBS. Do you agree both the brain and the gut are operational to cause the symptoms.Also why not talk about the abnormalities they have found?You and I also both know a lot of these researchers work together and share information.also did you watch this?Integrated Approach to Irritable Bowel SyndromeThis is an online CME course featuring Dr. Drossman http://www.ja-online.com/dukeibs/#


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## eric (Jul 8, 1999)

Jeff, have you seen this?I know you know DR Chang."It's really a brain-gut disorder," said Dr. Lin Chang, an associate professor at the University of California, Los Angeles' Division of Digestive Diseases and School of Medicine. "We're gaining more information from many different aspects, but I don't think we have the whole story down yet."'and'Researchers have not discovered any specific cause for IBS, but several theories have gained some traction."Chang said it appears that IBS could be initially triggered by some sort of serious physical or psychological problem, such as a runaway infection, a major surgery, or a deep depression.The sufferer's colon grows particularly sensitive, and reacts violently to certain foods and stress.Once IBS has been triggered, a number of mental and physical occurrences have been associated with a worsening of symptoms, according to the NIH. http://www.healthscout.com/news/1/533054/main.html


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## betterthroughscience (Jan 13, 2006)

Sophie, Caesarjbsquitti, and Jeffrey,Thanks for chiming in. IBS is complex. There are many things that can be examined and, if found to be non-normal, can be treated. Treating problems can significanly reduce suffering. I got started on this thread (and my previous one) because the standard practice of many, many doctors is to diagnose IBS and then to try to dissuade the patient from investigating further. The diagnosis is nothing more than telling the patient 'you have these symptoms and I am not sure what the cause is'. It seems quite logical to then do a few easy tests (blood and stool are very simple to collect) and find out if the patient has celiac, or giardia, or food allergies, or abnormal amounts of the most common, normal gut flora. If you then find a problem the patient can be helped, often to the point where their symptoms are so reduced that they don't qualify as an IBS patient anymore.These are obviously not the only ways to address IBS, but given the rates at which these problems are found, and that the treatments are so easy and have practically no side effects, it seems like a no-brainer to go down this route.


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## SophieUK (Dec 18, 2000)

> quote:Originally posted by eric:Let me ask a question then Jeff and Sophie, Do you both believe IBS is a brain gut axis disorder?Do yu both believe the brain and the gut are operational to cause the symptoms?


If I say "I don't know" do you promise not to try to convince me otherwise?


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## Gutguy22 (Jul 6, 2004)

Like others I'd disagree with.. I think it was number 9, the one concerning the bacterial makeup of the flora in the colon. Seems like there is a paucity of knowledge in this area. As for the rest, who knows. It seems that the gut has certian similarities to the brain, and that the brain (CNS) is as well involved in IBS, so it would seem that any explanation for IBS is going to be very (hopelessly?) complex. I think much like depression, we'll find many treatments long before we have any definitive explanation. Science requires humility and skepticism, and given the current state of knowledge of IBS I'd say anyone with a strong opinion as to what really is going on with IBS is lacking in those two areas. But what do I know.


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## flux (Dec 13, 1998)

> quote:Also, for example, the medical advisor to the UK IBS Network, Dr Nick Read, believes strongly that psychological factors are the most important area to look at when looking for IBS causes. I don't agree with him on that, but he's a doctor who has worked with IBS patients for many decades, who has published lots of research on IBS, who keeps up with every new study, and who has heard countless IBS case histories. Should we just dismiss his opinion?


Yes. Read *was* an expert on IBS in the past and he did great research, but somewhere along the way he fell off the boat. *Now* believes IBS is purely a psychosomatic condition. I don't know what make of _his_ IBS case histories. Consider one of his recent article: http://gut.bmjjournals.com/cgi/content/full/51/suppl_1/i50


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## eric (Jul 8, 1999)

"If I say "I don't know" do you promise not to try to convince me otherwise? "Is it something you want to know about in regards to modern state of the art IBS research?


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## eric (Jul 8, 1999)

You know Jeff, I was thinking about what you posted there from DR Talley?"A unifying hypothesis for the functional gastrointestinal disorders: really multiple diseases or one irritable gut?"And was reading the ULCA website and wondered about what you posted and this?"One particular focus of Center research is how the brain and the internal organs, in particular the digestive system communicate with each other, and how alterations in this communication results in chronic abdominal pain and discomfort. Medical problems resulting from such altered brain visceral communication are often more common in women, and include IBS, functional heartburn and dyspepsia, and chronic pelvic pain syndromes. Center investigators study sex-related differences in the pathophysiology and in the treatment response of these disorders. A major research focus is on neurobiological mechanisms underlying the greater vulnerability of women to develop common affective, chronic pain and stress-related disorders."http://www.ibs.med.ucla.edu/CenterAbout.htmWhy more women?


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## SophieUK (Dec 18, 2000)

> quote:Originally posted by eric:"If I say "I don't know" do you promise not to try to convince me otherwise? "Is it something you want to know about in regards to modern state of the art IBS research?


No thanks Eric - the point I was trying to make is that I have a right to be undecided if I want to be, just as you have the right to be decided. I read the new research studies and the new books and the Pubmed archives and all the rest of it too, I just don't see such a black and white conclusion as you.I think Flux has kind of made my point for me as well - Dr Read, as I said, is the medical advisor to the IBS Network over here, the only charity and organisation dedicated to IBS sufferers. Like I said I don't agree with his opinion, but you're arguing that we should just listen to the IBS experts who agree with us and fit in with our particular notion of what IBS is about. Why is Dr Read's opinion less valuable than Flux's?


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## Talissa (Apr 10, 2004)

I'm biased, because of my own experience.When I first got IBS, I was not only going to the bathroom 12-18 xs/day, but I was a mental wreck too. It changed my personality...Then I got the D under control, by treating it as a bacterial imbalance. All products, plus eating -0- processed foods, also help lower inflammation & this did 3 things:1. I became outgoing again. Un-afraid of social interactions again. Stopped obsessing. Etc.2. Got rid of all food reactivities(over time).3. No more pain....& so, I believe the serotonin problems as well as food sensitivites stem from the flora imbalance & the inflammation.It starts in the gut.Fix the gut & you fix the brain...


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## flux (Dec 13, 1998)

> quote:but you're arguing that we should just listen to the IBS experts who agree with us and fit in with our particular notion of what IBS


No, it's not they agree with us. They are doing the research that lets them come up with opinons they have. It is their research that speaks for them. We don't have the option of disagreeing with them because they are the sole source of our information.


> quote:Why is Dr Read's opinion less valuable than Flux's?


Because his opinion contradicts the research, even his own past research! He's an example of a scientist who "lost" it. There are others out there in this category. For example, Kary Mullis is a Nobel-prize winning biochemist whose opinion is that HIV does not cause AIDS. We disregard this opinion because the research shows it to be false.


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## eric (Jul 8, 1999)

Sophie, I am not talking about a particular doctor, and I am very much aware of DR Reed and the IBS network.I also talk to Flux on the phone quite a bit.







The IFFGD, the UNC, John's Hopkins, the Center for Neurovisceral Sciences & Women's Health, Vanderbuilts University, Cleveland clinic and Mayo, the American Gastroenterology Association and the Bristish society of Gastroenterology all recognize IBS as a brain gut axis disorder now, as well as other centers around the world.I am pointing out a consensus here.That does mean its all in the head or there are not abnormalities in the gut either.These center have recently receive together from the NIH 6 million dollars each to set up computer networs to share information. The UNC focus will be on the gut for the most part and ULCA center will focus on brain gut axis communications. They are sharing research with other centers. Then specialists from many fields all the centers, even from the UK and other places around the world get together for DDW and the IFFGD international symposium, among other symposiums.There is basic science in brain gut axis communications. All pain is processed in the brain as well. The abnormalities found in IBS recently all have to do with brain gut axis communications. It doesn't matter if were Personally undecided. That's how modern research on IBS is understood now.The speciality of neurogastroenterology is an extremly important area of IBS research.Neurogenic inflammation and stressors are important as well as the basic science of brain gut interactions. Especially since stress can re inflame tissue in the gut. Or that serotonin is the neurotransmitter responsible for gut function and for signaling sensation(pain) to the brain. Or that the pain gate is lost in IBS.Or that the HPA axis plays a role in IBS.I am not talking about all the causes of IBS here, I am talking about how research is needed to understand all the problems. I am talking about the basic science to understand how the brain and the gut function and that they develop together. I personally feel this is very important to understand. Especially because of the abnormalities found recenlty are directly connected to brain gut axis communications.http://www.iffgd.org/symposium2003brain-gut.htmlOr that the majority of treatments that do work for IBS are based on brain gut axis communications. They have just recently demonstrated."Demonstration of post-infectious IBS as a brain-gut disorder"and"Newer research relating to altered neuroimmune function, cytokine (cell molecules involved in the immune system response) activation, and brain-gut interactions"http://www.iffgd.org/symposium2005report.htmlI am not going to say anymore on this thread. Just pointing it out.


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## betterthroughscience (Jan 13, 2006)

Talissa, It is interesting that the research on cytokines and probiotics that eric repeatedly cites fits in with what you say very well. I have tried to discuss that there is a cycle and it is not entirely clear where it begins or if it can begin at any point or be affected from any point. The gut affects the nervous system (Wood's article in Gut lays out the specific ways in which histamine released as part of immune response affects nerves in specific ways) and the nervous system affects the gut. The research on probiotics clearly and repeatedly (in blind controlled tests) demonstrates that some people with IBS can have their symptoms alleviated without any psychological counseling or hypnotherapy or whatever. What is laking from these studies so far is that they include a group of Rome criteria IBS patients without eliminating those who have food allergies, without specifically determining their gut bacteria (the big three) populations, and other problems. I look forward to the study of hundreds of IBS patients who have been tested and found to not have any of the other problems (celiac, food allergies, parasites, porphyria, etc.) but who do have a deficiency of one of the big three bacteria. Treat half with probiotics and half with placebo in a double blind study and then you will have some useful data. Without it there is too much noise in the data, but the indications are positive. Some IBS patients benefit from probiotics and we even know that it restores cytokines, so there is every reason to be hopeful that a really focussed study will be pretty darned definitive. However, some people will still point to the fact that there is altered nervous system chemistry in most IBS patients and deny that probiotics could possibly be the solution for patients who don't have any other problem, or part of the solution for patients who also have another symptom generating condition. You can't convince people who are invested in their belief.


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## eric (Jul 8, 1999)

You want to compare probiotic studies with Hypnotherapy studies for IBS?The difference in HT in IBS is the treatment has shown to continue to work five years after treatment. Probiotics you have to keep taking.Its already a very effective treatment for most people with IBS. That's now a done deal. Its a shame you don't really recognize these things. Mast cells in the gut that your talking about, because major inflammtion in IBS has not been seen, can be inflammed by neurogenic inflammation. Which is also one connection to why some people have bladder problems and IBS.A major amount of research has been done on mast cells and still is being done. Your not up to date on it however.The brain is in charge of the autonomic nervous system, the sympathetic and parasympathetic nervous sytem and the enteric nervous system and brain in the gut. When you talk about the Central nervous system your are in part talking about the brain.So treating this along with the gut means nothing?UNC chat with the experts."psychophysiological arousal is a major part of treating functional gi disorders. There is some much distress, anxiety, antisipatory anxiety, and negative reaction to symptoms, that calming the mind and body often makes a significant difference to symptoms."


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## betterthroughscience (Jan 13, 2006)

Please don't try to claim that others are not 'up on the research', just because they don't share your opinons. I thought I was quite clear that there is a cylce between the nervous system and the gut. Evidence is that it can be affected from either side. However, given that the right bacteria populations are necessary, not only for avoiding IBS, but to maximize digestive efficiency, it seems that it is appropriate to re-populate the gut with the right bacteria when they are deficient. I am not saying that there is no benefit to hypnotherapy.I am open minded about psychological techniques for dealing with IBS. It is clear that there are gains to be had. However, it is also helpful to acknowledge that there are other ways to affect the system. Individual people have individual situations. Some people find that when they stop eating foods to which their immune system is responding they notice a dramatic decrease in headaches, anxiety attacks and general anxiety/stress. Talissa reported feeling psychologically different when her gut bacteria were addressed. It would seem that both approaches provide some benefits.Eric, we know you have done the hypnotherapy thing. Are you IBS free? Would you ever consider getting tested for bacterial balance, celiac, parasites, or food allergies? Why or why not?


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## 14416 (Jun 21, 2005)

I always feel a lot better when I am taking a good probiotic supplement. I tried cognitive behavioral therapy to help with the IBS and anxiety, and it did not improve either AT ALL. I know it's not the same as hypnotheraphy, but it's just a point that everyone is individual. There are people that have had their IBS diminish and even completely eliminated with CBT...didn't mean that it would work for me, and it didn't (unfortunately). My IBS seems to be the best when I'm taking an anti-depressant, fiber, and a probiotic. Some people wouldn't touch an anti-depressant because it affected them in the wrong way and didn't improve their symptoms; however, I believe it's one of the "key" parts of my IBS journey.No two people are exactly the same. What works for me might not work for you...but, don't let what doesn't work for me make you not do something because you think it won't work for you. It's a simple statement, but it's very true when it comes to pretty much anything (definitely IBS








).


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## 22813 (Jun 7, 2006)

Betterthroughscience I totally agree with you. My IBS cleared up a treat with 1 tablet of mebendazole. The doctor told me that it was unlikely to be parasites but a vet friend told me what I needed to take, he said it was whipworm. Well be x


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## eric (Jul 8, 1999)

FYI"Frequency: In the US: Prevalence of whipworm infestation is less than 0.1%. The most common areas of infection are the southern Appalachian range and Gulf coast states. Internationally: Whipworm infections are among the most common of all human parasites, with an estimated 750-800 million infections worldwide. The most affected regions are rural areas with poor sanitation and tropical climates, including Southeast Asia, Africa, the Caribbean, and Central and South America. Prevalence rates as high as 80% exist in these regions. In contrast, prevalence in areas of Western Europe and Japan is similar to that in the United States."http://www.emedicine.com/ped/topic2436.htm


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## 22813 (Jun 7, 2006)

EricAnd people dont travel? If anybody can learn anything through my experiences I will gladly help. There is also a great deal of information available on the internet about how parasitic disease may well be one of the most misdiagnosed and underdiagnosed problems of our time. I understand scientific jargon and statistics more than you may ever know and I am not convinced by those statistics.P.S I am outside the US.Well be x


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## eric (Jul 8, 1999)

Truthseeker Glad you found the suspected cause of your gastrointestinal symptoms. This is interesting on whipworm"Worm Eggs Ease Stomach ProblemsSwallowing live worm eggs? The thought may turn your stomach. But the eggs may safely relieve the abdominal distress caused by inflammatory bowel disease (IBD). Crohn's disease and ulcerative colitis are two major components of IBD that cause inflammation and ulcers in the lining of the digestive tract.In underdeveloped countries with poor sanitary conditions, IBD is practically nonexistent. Researchers have speculated that it's because parasitic worms are abundant, living in the intestines of humans and animals. Even in the U.S., before plumbing and sanitation improved, there was little IBD. In one recent study, seven people with IBD swallowed a solution containing thousands of eggs of Trichuris suis, which is known as a "whipworm." Every two weeks, they got doses of the solution -- with great results, reports lead researcher Robert W. Summers, MD, a gastroenterologist with the University of Iowa College of Medicine. Some of the patients have been taking the worm egg solution "for years now and are doing well," Summers says.He says he believes the worm eggs secrete a substance that calms the overactive immune system response that causes IBD and other autoimmune disorders like lupus, multiple sclerosis, and psoriasis.If it makes you queasy, try to get past it. "These worms have been around for 3 million years," says Summers. "And one-third of the world's population is walking around with them in their digestive tracts today and apparently having no problems." Read on for the complete story on whipworms and IBD. Published Oct. 4, 2004.http://www.medicinenet.com/script/main/art...rticlekey=50381


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## betterthroughscience (Jan 13, 2006)

Keep adding up all the parasites, all the people who have bacterial issues, celiac disease, and the food allergy folks and pretty soon you have a substantial portion of the people who are diagnosed can actually be treated for an identifiable condition. Not all IBS patients, but what is it worth to be sure that you can't be easily treated? Testing runs under a $1000. For many people that is far too much, but for many others, that is nothing compared to suffering with IBS. My philosophy - get tested and treat what you can find.


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## eric (Jul 8, 1999)

Truth seeker, the weight loss should have been a red flag symptoms that requires further investigations.How long have you been feeling better?did you have any of these symptoms along with weight loss?"Bloody stools Diarrhea Weight loss Bloody diarrhea Rectal prolapse "http://www.wrongdiagnosis.com/w/whipworm/symptoms.htm


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## 20250 (Jul 14, 2005)

This brings back memories as a kid, maybe 4 or 5 years old. I had worms and mom had to hold me down and force water down my throat to get me to swallow a little red round pill. I wonder if these were the same worms you are talking about? I have to call mom on this one. May have been a different worm invading me.


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## 20250 (Jul 14, 2005)

My bad... I had pin worms as a child. Red pills were because I had anemia(low Iron) and had to take Feosol spanules(sp)? Sorry to interrupt your friendly debate.


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## flux (Dec 13, 1998)

> quote:Keep adding up all the parasites, all the people who have bacterial issues, celiac disease, and the food allergy folks and pretty soon you have a substantial portion


1%?


> quote:My bad... I had pin worms as a child.


Pinworm does not GI symptoms.


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## 14416 (Jun 21, 2005)

> quoteinworm does not GI symptoms


What?


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## flux (Dec 13, 1998)

> quote:What?


GI symptoms include diarrhea, abdominal pain, nausea, vomiting. Pinworm does not cause them.


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## 22813 (Jun 7, 2006)

EricThe weight loss worried me quite alot as I love my food and usually have to watch what I eat. Along with the weight loss I had diarrhea, no blood but lots of mucus, bloating, cramping, pain which was mostly in my right side. I have been totally symptom free 8 weeks today. The doctors attitude was eat more fibre and take some painkillers if necessary. They probably thought because I am female that I had an eating disorder and even my periods stopped. In the past 8 weeks I have regained most of the 20LBS or so that I lost much of which is muscle tissue.Well be x


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## Kathleen M. (Nov 16, 1999)

Pinworm symptoms


> quoteinworm Symptoms & Signsintense itching around the anus irritability (usually due to itching and interruption of sleep at night) sleep disturbance (usually due to itching that occurs during the night when the adult worms migrate out through the anus to lay their eggs) decreased appetite and weight loss (this is uncommon but can occur in severe infections) vaginal irritation or discomfort in young girls (if an adult worm enters the vagina rather than the anus) excoriation, irritation or infection of the skin around the anus from constant scratching


http://health.allrefer.com/health/pinworm-symptoms.html


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## 20250 (Jul 14, 2005)

> quote:Originally posted by flux:
> 
> 
> > quote:What?
> ...


Hence the reply "My Bad"


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## flux (Dec 13, 1998)

> quote:Hence the reply "My Bad"


Looks like I doubled the bad







, but at least everyone else learned how pinworms are different.


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## phillipm2 (Sep 24, 2004)

Whatever the cause of IBS could be it still remains the same. You go to the doctors they find nothing seriously wrong but tell you to go on a diet. No matter how many diets and treatments you try the problem is still there. It very well could be a brain-gut ordeal or germ acquired somewhere. I wish more was known about the variables. Its good to see the science and the analytical minds at work turning the mental gears.


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## eric (Jul 8, 1999)

While the EXACT cause of IBS is not known, researchers are not totally clueless."History of Functional DisordersIn the 1990 it was found"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 recurrent abdominal 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, where motility disturbances do not exist.""BRAIN-GUT AXISThe concept of brain-gut interactions brings together observations relating to motility andvisceral hypersensitivity and their modulation by psychosocial factors. By integrating intestinal and CNS central nervous system activity, the brain-gut axis explains the symptoms relating to functional GI disorders. In other words, senses such as vision and smell, as well as enteroceptiveinformation (i.e. emotion and thought) have the capability to affect gastrointestinal sensation,motility, secretion, and inflammation."http://ibsgroup.org/groupee/forums/a/tpc/f...710974#19710974


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## eric (Jul 8, 1999)

FYI"Irritable bowel syndrome and mind-body interactions"Brain-gut interactions are increasingly recognized as underlying pathomechanisms of functional gastrointestinal disorders. Bi-directional communication between the central nervous system and the enteric nervous system occurs both in health and disease. Various central nervous system and gut-directed stressors stimulate the brain-gut axis, involving processes which modulate responsiveness to the stressors. Disturbances at every level of neural control of the gastrointestinal tract can affect modulation of gastrointestinal motility, secretion and immune functions, as well as perception and emotional response to visceral events. Gut neural function, CNS processing, and autonomic regulation play an important role in the brain-gut dialogue. Stress and emotions commonly trigger neuroimmunoendocrine reactions via the brain-gut axis. Various non-site-specific neurotransmitters influence gastrointestinal, endocrinological and immunological function, as well as human behavior and emotional state, depending on their location. The physiology of the digestive tract, the subjective experience of symptom, health behavior, and treatment outcome are strongly affected by psychosocial factors. Recently, a biopsychosocial [holistic] model of IBS including physiological, emotional, cognitive and behavioral components has been proposed to explain a greater portion of observable phenomena."http://www.findarticles.com/p/articles/mi_...252/ai_n6132398In regards to stressors mentioned above, its both physical and mental stressors.


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## eric (Jul 8, 1999)

FYI"Meats implicated as IBS triggers""Researchers found no link between elevated IgG4 antibody titers and patients' symptoms."http://www.findarticles.com/p/articles/mi_...60/ai_n15734478


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## betterthroughscience (Jan 13, 2006)

Flux: 1%? Obviously much higher. The percentage of people with IBS in the population is estimated (depending on the study your read) to be between 10 and 20% of all people in the US. The percentage of people with IBS who were found to have Giardia was 6% in one study. Other studies have show that food allergies are extremely common and may be as high as 5% of the general population and between 20 and 65% of the IBS population.As for the giardia study, Eric argued that conclusions of the study were not worthy of consideration because the water in Italy, where the study was done, must be poor. But he himself got giardia here in the states. The estimate for the number of people affected by giardia in western countries is between 2 and 4%, and much higher for the third world. Many people in the US travel to Mexico and etc. Intestingly thouse found to have giardia were also found not to have any consistent set of identifiable symptoms that could reliably distinguish them from other IBS patients. So if 10% of all people have IBS and 4% of all people have undiagnosed giardia that presents as IBS, then almost half of all IBS is really just undiagnosed Giardia. (yes I recognize that I am using the low number for IBS prevalence, high number for Giardia, and assuming that all Giardia is undiagnosed is not valid - however, the degree to which my analysis holds is a matter for debate. It could be that high, but likely is not, but some IBS is due to undiagnosed Giardia and it is likely higher than 1%). Remember that cryptosporidium outbreak in Milwaukee a few years back. How many smaller outbreaks are there that are simply not caught because the number of people is small and the testing is not done. The moral of the story is you can't be sure you don't have it until you get tested. And why not get tested anyway? Even if the chance of having one of the identifiable treatable problems is only 1% (though we know it is much much higher) why not find out if you are one of the lucky that can get an easy effective treatment for your IBS? Especially since there is evidence that it is disturbance of the immune system that is thought to be one of the factors that might initiate IBS that then affects the nervous system in such a way that just addressing the infection may no longer be enough. Logic would say that as soon as you are diagnosed with IBS you should be tested for all the things that cause it so you can reduce the chance that you will initiate a cycle of effects that will be very hard to reverseI am not sure why you seem to diminish the value of testing by implying that only 1% could have these problems. Are you opposed to laboratory testing for some reason? I am just trying to understand your seeming opposition to testing for things. Perhaps I am reading too much into your statement and you are simply unaware of the high prevelance of these problems.


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## betterthroughscience (Jan 13, 2006)

Eric: Dr. Kumar's statement is that the food allergy specifally mitigated by IgG4 for a specific food doesn't seem to be related to which symptoms of IBS the patient has. The overall conclusion of the report is that IBS patients often have food allergies, specifically to meat. His study group did not seem to have significant numbers of dairy allergic patients. Other studies have found that dairy allergies were present among IBS patiens so it may just be that his 108 patients were not representative of the larger population. But the conclusion, the lesson to take away, is that some people with IBS have food allergies and respond positively to removing that food from their diet. I don't want anyone to misunderstand the quote you cited as meaning something entirely different.


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## betterthroughscience (Jan 13, 2006)

Oh, and your reference is to a summary of the orginal article. To read the original, including the conclusions you can find it here: http://www.ibstreatmentcenter.com/Articles...BensonKumar.pdfThe conclusion in the abstract is:Serum IgG4 antibodies to common foods like wheat, beef, pork, and lamb are elevated in IBS patients. In keeping with the observation in other atopic conditions, this finding suggests that possibility of a similar pathophysiological role for IgG4 antibodies in IBS.


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## Talissa (Apr 10, 2004)

> quote: why not find out if you are one of the lucky that can get an easy effective treatment for your IBS?


Unfortunately, you can't use Giardia as an example here.As I posted earlier, a study found that peeps infected w/ Giardia who are symptomatic(w/ "IBS" symptoms showing) *ARE NOT helped by anti-parasitic treatment* but are instead worsened by it.This is exactly what happened to me:J Infect. 2002 OctI've also talked to others here with the same experience. Giardia damages the intestinal lining. The flagyl makes it worse, due to further destruction of the protective probiotic-type bacteria, allowing for further inflammation..."*Recent insights into the mucosal reactions associated with Giardia lamblia infections*.""...This phenomenon(increased epithelial permeability) as well as other Giardia-induced intestinal abnormalities such as loss of intestinal brush border surface area, villus flattening, inhibition of disaccharidase activities, and eventually also overgrowth of the enteric bacterial flora seem to be involved in the pathophysiology of giardiasis." Int J Parasitol. 2005 Nov


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## eric (Jul 8, 1999)

Hey that's what it said"Researchers found no link between elevated IgG4 antibody titers and patients' symptoms."If what you say is truely the case, then they certainly have their work cut out for them?So they don't know?Are you saying they don't know how IgG4 cause symptoms and what symptoms they can cause in IBS?What about people who have allergies and IBS?Food allergies are well known for there effect on mast cells. Mast cells are KEY players in food allergy.They have also been found in increase numbers in some IBS patients, especially after and enteric infection. There are many very well know researchers studying mast cells.Chronic stress and activation of the fight or flight system also effects and degrandulates mast cells through the Hypothalamic-Pituitary-Adrenal Axis. There is evidence for a role in the HPA axis and IBS. "It also sensitises the gut, producing allergies to certain foodstuffs. "So what comes first? The fight or flight goes off around two hundred times a day in normal people. In IBS how often does antisipatory anxiety, 'perceived or actual" threat of pain, or "where the bathrooms are" or other psychophsiological arousal activate the fight or flight in IBS which in turn can degradulate masts cells and sensitize them to "certain foodstuffs?Are you familar with Psychoneuroimmunology?A Lot of work has been done on mast cells in IBS over the years. While macroscopic inflamation of mast cells contributes to pain in IBS, inflammtion is not sufficent to explain chronic pain and viceral hypersensitivity in IBS.


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## eric (Jul 8, 1999)

FYI"It has been suggested that mast cell degranulation is a possible link between psychological stress, enteric infection, food allergy and gut hypersensitivity in IBS. [55] This could occur through various mediators acting on enteric neurons and smooth muscle cells. Psychological stress may trigger this sensitive alarm system via the brain-gut axis, a process described as neurogenic inflammation and involving the neurotransmitter substance P. Bladder and colon biopsies of a female patient with both interstitial cystitis (which may involve neurogenic inflammation) and IBS found high levels of degranulated mast cells in her bladder and colon."http://www.findarticles.com/p/articles/mi_...i_75178703/pg_6


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## betterthroughscience (Jan 13, 2006)

eric: Perhaps I can clarify the language a bit for you. "No link between elevated IgG4 antibody titers and patient symptoms" means that they couldn't find a statistical correlation between the amount of the antibody that is reacting to the specific food and a specific symptom, like diarrhea. In other words, if a person has a huge quantity of the antibodies that are reactive to beef protiens in their blood that doesn't help predict if the patient has constipation, diahrrea, gas, bloating, abdominal pain, or whatever. The specific patient may have all of the symptoms, or may be IBS-D or IBS-C. The report includes much more detail if you read the whole thing. The important point is that having elevated IgG4 antibodies *does* predict that the patient will have some type of IBS symptoms. Removing the offending food from the diet results in significant decrease or complete reduction of symptoms (shown in other studies).Perhaps your understanding of the science is limiting your ability to correctly interpret the article. Scientists use language in a way that is slightly different than common english. They are very careful to be very specific about what their data shows (the good ones, anyway). This article is a report on a study of the statistical relationship between measurable food allergies as defined as IgG4 and IgE type antibodies in the blood. What they showed was that IBS patients are significantly more likely than controls to have eleveted levels of these antibodies. They also noted that there were some problems with their measurements, specifically for dairy-related antibodies and thus their conclusions in that regard are suspect. Incidentally, they also showed that skin-prick testing - the allergy testing used by practically all of the allergists in America, is useless in measuring these food allergies.The fact is that having a specific allergy, mediated by a specific type of antibody does not mean that the patient will have a specific symptom at a specific time. This can be confusing for people who are not used to working with complex systems that exhibit multimodal effects and are sensitive to very small variation. One might think that since you can't tie a specific allergy to a specific symptom in all IBS patients that there is no causal relationship. But this is not the case. The reaction to immune challenge in any specific patient is quite complex and subject to many other factors. This report shows that some patients, at least some of the time, have constipation reactions, some have diarrhea reactions, and some have combo reactions. The severity of these reactions is also not correlated with the quantity of the antibodies present in the blood, which is interesting. It suggests that there are additional factors that affect severity.You ask: Which comes first? (in relation to stress and allergies) I don't know of any study that has produced data that would illuminate that for us. They would have to study a particular patient who doesn't have IBS and follow them through the development of IBS while constantly measuring a whole host of factors. Not theoretically impossible, but probably not practical at this time.Many people live with high levels of stress and never develop IBS. Stress has been a part of the human experience since we developed our modern genetic form, about a million years ago. We have only been consuming some of the foods that are now very common in our diets for about 10,000 years, in many cases far less. Just hypothesizing from an evolutionary perspective one might suspect that the food allergies are the first step in the process. Perhaps they alert the body that it should change behavior (avoid those foods) by causing increased anxiety, etc. It is harder to come up with a similar hypothesis for why stress should cause immune response to not only increase (makes sense), but add new protiens to the group interpreted as 'bad'. It might be the case. Only more study will tell.Just because we don't have all the information doesn't mean we can't make use of what we do have. What we do have is that food allergies can be identified. And patients who stop eating foods to which they are allergic decrease or end their IBS symptoms.


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## eric (Jul 8, 1999)

What relavance and clinical eveidence is there with the 5ht 3 receptor and d and c and d/c in IBS?This is not the mast cell.


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## eric (Jul 8, 1999)

FYINew drugsâ€"and some respectâ€"for IBS"But as many gastroenterologists are quick to point out, much of the progress being made on IBS has been lost on general practitioners. Rapid advances have created a "very big gap between primary care and gastroenterology," said Douglas A. Drossman, FACP, co-director of the University of North Carolina Center for Functional Gastrointestinal and Motility Disorders at Chapel Hill. "Primary care doctors are not up to speed."To help close that gap, here is an overview of the latest developments in IBS research and treatment.""There's also preliminary evidence that many IBS patients have a heightened immune response in the gut that includes a boosted number of mast cells, natural killer cells, lymphocytes and serotonin-laden enterochromaffin cells. Interestingly, between 10% and 30% of patients who recover from food poisoning develop IBS, especially if they were under undue psychological stress at the time they developed acute gastroenteritis."There's one theory that the infection and stress alter the permeability of the gut mucosa so that bacteria or viruses invade the gut where they don't belong," Dr. Lacy said. "This leads to chronic inflammation that could result in disordered motility and sensation by injuring nerves in the gut." The excessive numbers of enterochromaffin cells in some IBS patients could cause many IBS symptoms just by releasing their granules of serotonin."http://www.acponline.org/journals/news/sep03/ibs.htm#body


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## eric (Jul 8, 1999)

"Perhaps your understanding of the science is limiting your ability to correctly interpret the article. "I am not the one calling infectious disease or celiac, or food allergies IBS.An example of how important the brain to mast cell connection is that I have personally seen.At one of our IBS support groups a hypnotherapist was guiding patients through the process and had them imagine they were in a beautiful garden. One of the people there with allergies started having allegy symptoms.A perceived threat of an allergy can set the reaction off.I know you know now who DR Wood is and that he is the one that coined a brain in the gut and also the first one too "Dr. Wood is internationally recognized for his pioneering work on the neural control of gastrointestinal function. He was the first to record electrical behavior of enteric neurons with microelectrodes and has continued to study the function of the enteric nervous system or the "little brain in the gut", a phase that he has popularized. "You might want to read this at the middle of the page. Its an excerpt from the bood the Mind Body Connection by DR Salt."The Little Brain in the Gut"The brain to mast cell connection has a direct clinical relevance for irritable bowel syndrome and other functional gastrointestinal syndromes." http://www.parkviewpub.com/nuggets/n5.html#pg0083Not to mentionStress May Lead To Food Allergieshttp://www.thebostonchannel.com/news/1406559/detail.htmlThe "The brain to mast cell connection has a direct clinical relevance" also to Post infectious IBS and people under stressors at the time of an enteric infection and later going on to develop IBS after resolution of intial infection. Where as some do not. It is also connected to how stress can re-inflame tissue.


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## flux (Dec 13, 1998)

> quote: Other studies have show that food allergies are extremely common and may be as high as 5% of the general population and between 20 and 65% of the IBS population.[/.quote]No, it' s probably less than 3% and that applies to the IBS population.
> 
> 
> > estimate for the number of people affected by giardia in western countries is between 2 and 4%, and much higher for the third world. Many people in the US travel to Mexico and etc. Intestingly thouse found to have giardia were also found not to have any consistent set of identifiable symptoms that could reliably distinguish them from other IBS patients.
> ...


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## 14416 (Jun 21, 2005)

> quoteinworm does not GI symptoms





> quote:What? GI symptoms include diarrhea, abdominal pain, nausea, vomiting. Pinworm does not cause them.


 Sorry Flux; I didn't understand what you meant. The grammatical error took me by surprise."Pinworm does not GI symptoms"I think you meant... Pinworm does not CAUSE GI symptoms.







Maybe?


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## Gutguy22 (Jul 6, 2004)

Eric, The Mind-Body Connection is a good book, but it was written by Dr. Sarno







I'm only kidding, I know you meant a different book with a similar title, but if you haven't read it yet I think you might like Sarno's book.So, what are the chances PI-IBS is the result of irreversible changes/damage? I'm curious as to people's opinions about why many people see major benefits from a lot of things, but few seem to find a total cure using those same treatments. In PI-IBS things seem to come on quickly, yet reversing this utilizing the plasticity of the NS seems to take a long time or not be possible. Seems almost similar to PTSD in some ways.


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## flux (Dec 13, 1998)

> quote:Sorry Flux; I didn't understand what you meant. The grammatical error took me by surprise.


Holy smokes!


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## betterthroughscience (Jan 13, 2006)

Flux and Eric, One of the reasons that we have trouble communicating is that when we talk about patient with IBS you have a different idea in mind than I do. You (flux) say IBSers don't have food allergies. Eric seems to acknowledge that some IBS patients have food allergies but then seems to indicate that they must be completely caused by a psychological process so only psychological means to address them are appropriate. Both of you say Giardia is not IBS.When I talk about IBS, I am talking about patients who have been diagnosed by a board certified, state licensed physician as having IBS under the ROME criteria. As has been demonstrated in study after study some of those patients have food allergies, some have parasites (which Talissa is correct in pointing our do not always respond well to standard treatments), some have celiac disease, some have infectious diseases like salmonella that aren't correctly diagnosed, and etc.You can say that those things are not IBS. When I talk about IBS, I am referring to the entire population of people who are diagnosed. That is part of the reason that we are seeming to disagree a lot. In any case, the fact remains that there are some treatable physically measurable maladies that are associated with IBS symptoms that are frequently overlooked for a variety of reasons. In the case of food allergies, the number of people who have been tested by the ELISA method under tight quality controls is pretty small. The York labs in the UK are having great success, as reported in various articles. Sophie can probably provide more information. In the US the physicians testing for food allergies are almost all using skin prick testing, which is fine for anaphylactic response, but, as demonstrated in the article mentioned above, useless for the food allergies that cause IBS symptoms. To say that people with food allergies are not IBSers is to deny a host of studies to the contrary.Most people believe things because they want to, not because they have made a rational, calculated analysis of the facts and have formed a conclusion based on the evidence. But they often rationalize to themselves that they have been rational. Makes a person feel better and more confident in their beliefs, especially when they have that nagging feeling in the back of their head that something is not quite right.(Flux - if 4% of the total is 4% and 10% of the total is 10% and the 4% is a subset of the 10% then 'nearly half' (40% to be precise) of the 10% is represented by the 4%.)


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## flux (Dec 13, 1998)

> quote: When I talk about IBS, I am talking about patients who have been diagnosed by a board certified, state licensed physician as having IBS under the ROME criteria.


That's IBS. No food allergies, no celiac, no giardia. Just IBS.


> quote:As has been demonstrated in study after study some of those patients have food allergies, some have parasites


Some? Nope, a few.


> quote: he fact remains that there are some treatable physically measurable maladies that are associated with IBS symptoms that are frequently overlooked for a variety of reasons.


Some? Nope, a few.


> quote: To say that people with food allergies are not IBSers is to deny a host of studies to the contrary.


People with food allergies may have IBS independently of IBS, but very few IBSers have food allergies.


> quote: if 4% of the total is 4% and 10% of the total is 10% and the 4% is a subset of the 10% then 'nearly half' (40% to be precise) of the 10% is represented by the 4%.)


4% is 4%. Period.


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## 17807 (Feb 27, 2006)

> quote:Originally posted by flux:Besides, IBSers do not have food allergies.


This is a strange statement when phrased this way. Of course people with IBS can have food allergies.Should I/we assume you mean to say something more like, "IBS symptoms are not caused by food allergies." ?


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## betterthroughscience (Jan 13, 2006)

It is hard to argue with someone who just says 'No it isn't'. Reminds me of an old monty python sketch.Repeated studies of patients who meet the ROME criteria (Zar, Benson, and Kumar, 2005, etc.)and were screened for IBD etc. have been demonstrated to have much higher rates of food allergies than controls. In addition, many people with celiac disease are not diagnosed for years, often more than a decade as having celiac, but instead are diagnosed with IBS. As long as the medical community continues to use the ROME criteria and not do testing for celiac, food allergies, etc. it is simply wrong to claim that IBS patients do not have these problems. IBS is not a disease. It is a collection of symptoms that are seen across a variety of conditions. The biggest fallacy I see on this post is that IBS is a specific, single condition. Dr. Drossman and the rest all acknowledge that it is a complex set of circumstances and we are a long way from completely isolating all the reasons why the collection of symptoms develop. Jeffrey Roberts (founder of this post) had a nice quote about this recently.


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## 14416 (Jun 21, 2005)

> quote:Holy smokes!










HOLY SMOKES TO YOU, TOO! Flux, be kind







!


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## eric (Jul 8, 1999)

There is a reason they don't call IBS food allergies.There is a reason they don't call IBS celiac.There is a reason they don't call IBS giardia."It is a collection of symptoms"IBS IS A "SPECIFIC CLUSTER OF SYMPTOMS." That "ring true for a diagnoses of IBS."The Criteria to diagnose IBS is a SECURE Diagnoses.The misdiagnoses rate is low when used. Less then 5 percent."is that when we talk about patient with IBS you have a different idea in mind than I do. "IBS is NO LONGER a wastepaper diagnoses.IBS is a legitimate diagnoses.IBS is one of 25 GI disorders of Function, not an infectious disease. "How the digestive system functions." There is great overlap of functional disorders. Not one person has ever transmitted IBS to someone else.To call IBS food allergy and celiac and giardia IBS is flat out wrong. First off your missing how IBS is even classified as a medical condition. Your missing how its diagnoed and how accurate the diagnoses is when used. Or the difference between IBS and other comorbid conditions. Do you do biopsies at your clinic for celiac?You should also be very specific when you talk about food allergies and what kind of food reactions.


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## eric (Jul 8, 1999)

FYI"A food allergy is an immune system response by which the body creates antibodies as a reaction to certain food. Symptoms *similar* to those of IBS include diarrhea and abdominal pain. Other symptoms can include vomiting, hives, itching, swelling of the lips, tightness in the throat, and wheezing. Allergic symptoms usually occur within a few minutes to an hour after ingesting the causative food. Eight foods cause 90% of all allergic reactions: milk, egg, wheat, peanut, soy, tree nuts (almonds, walnuts, pecans, etc.), fish, and shellfish.In response to a mailed consumer questionnaire that surveyed 5,000 representative Americans, 16% reported conditions that they felt were food allergies. *However, studies show that true food allergies are present in only 1-2% of adults. In people with IBS, reactions to food are rarely allergic reactions. "*"Editor's response--In the Fall 1998 issue of Participate, we published an article by Jarol Knowles, MD that reviewed five diseases that affect the gastrointestinal (GI) system. (IFFGD Fact Sheet No. 148, Dietary Factors in Gastrointestinal Diseases). Symptoms of these diseases--celiac disease, gastroesophageal reflux disease (GERD), food allergies, lactose intolerance, and eosinophilic gastroenteritis--can sometimes coexist or be confused with a functional GI disorder. Depending upon the history and symptom presentation, these diseases may need to be considered when making a diagnosis. *Significantly, they all have distinguishing characteristics that can differentiate them from functional GI disorders. * http://www.iffgd.org/GIDisorders/GImain.html


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## betterthroughscience (Jan 13, 2006)

Eric: You say "IBS is a SECURE Diagnoses". And yet the article you quote in your very next post says: "A functional disorder does not show any evidence of an organic or physical disease, and the cause of a functional GI disorder doesn't show up in a blood test or an x-ray. The disorders are diagnosed based on symptoms, and often require tests to rule out the likelihood of another disease." and "Much remains unknown about these disorders, resulting in a great deal of confusion and misunderstanding, among patients and physicians alike. This lack of understanding can lead to misdiagnosis and misguided treatment."If the doctors can admit that there is a lot of confusion, that people are being diagnosed with IBS without testing for celiac, food allergies, bacterial problems and parasites, why do you insist that IBS is something well defined? Sure there are ways to differentiate these things from other IBS cases. I am merely advocating that patients get tested so they can do so.The ROME criteria are far from comprehensive. They rule things out, but leave a lot untested. The criteria are simple and not definitive of any cause or group of causes. See the criteria from the latest ROME conference below. (from GASTROENTEROLOGY 2006;130:1480â€“1491) If you read the article you see that they are even uncomfortable with subclassification ('is controversial')and note that patients change subtype frequently. The fact is that functional disorders are simply a description of the problem, not an identification of the cause. You say that calling celiac and food allergies IBS is wrong. And yet, people are diagnosed by physicians around the world with IBS and are later found to have celiac, food allergies, etc. You say that giardia is not IBS and that no one has ever 'caught' IBS from someone else. Yet there have been several people on this very post who were diagnosed with IBS and yet later were successfully treated for an infection or parasite. They all met the criteria. It is possible to differentiate them, but very few doctors are doing it and the criteria even recommend against doing testing.I am not saying that all IBS patients have these conditions. I am saying that some do. Some do not and cannot be successfully treated by addressing these conditions.A note about prevalence of food allergies. The studies referred to (mostly pre-1998) used skin prick testing as the gold standard (which is still the rule for 99.9% of physicians in the US) despite the fact that skin prick testing has been shown to be incapable of reliably measuring immune response to foods in the gut. Studies that used the (much more expensive and complex) ELISA testing have found that food allergies are very common in IBS patients. One of the reasons that the information isn't better is that doing these studies is very expensive. To quote the article you reference: "There is a pressing need to support more research. Gastrointestinal disorder research remains severely underfunded."C1. Diagnostic Criteria* for Irritable BowelSyndrome Recurrent abdominal pain or discomfort** at least 3 days per month in the last 3 months associated with 2 or more of the following:1. Improvement with defecation2. Onset associated with a change in frequency of stool3. Onset associated with a change in form (appearance) of stool*Criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis.**Discomfort means an uncomfortable sensation not described as pain. In pathophysiology research and clinical trials, a pain/discomfort frequency of at least 2 days a week during screening evaluation for subject eligibility.


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## eric (Jul 8, 1999)

"*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.htm" Curr Gastroenterol Rep. 2005 Aug;7(4):264-71. Related Articles, Links Symptom overlap and comorbidity of irritable bowel syndrome with other conditions.Frissora CL, Koch KL.Department of Medicine, The Weill Medical College of Cornell University, 520 E. 70th Street, Suite J-314, New York, NY 10021, USA. cfrissor###med.cornell.eduIrritable bowel syndrome (IBS) is one of several highly prevalent, multi-symptom gastrointestinal motility disorders that have a wide clinical spectrum and are associated with symptoms of gastrointestinal dysmotility and visceral hypersensitivity. Symptom overlap and comorbidity between IBS and other gastrointestinal motility disorders (eg, chronic constipation, functional dyspepsia, gastroesophageal reflux disease), *with gastrointestinal disorders that are not related to motility (eg, celiac disease, lactose intolerance),* and with somatic conditions (eg, fibromyalgia, chronic fatigue syndrome), are frequent. The clinical associations and pathophysiologic links between IBS and these disorders continue to be explored. This review discusses overlapping symptoms and comorbidity of IBS with select gastrointestinal and non-gastrointestinal disorders and attempts to identify commonalities among these conditions.Publication Types: Betterthroughscience, please explain to us what is visceral hypersensitivity?Please explain to us what are rectal distension studies in IBS and what have they found?


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## Gutguy22 (Jul 6, 2004)

Just curious about something. Unless you're some wacked-out cartesian dualist how can the term "functional disorder" be considered as anything other than a statement of ignorance? I don't mean that in a negative way, just that It doesn't say what something is, it is telling you what they can't find. To treat it otherwise seems to me to be some kind of reification error. Eric, please explain how something can stop functioning properly, yet down to the cellular (i.e. structural) level remain unchanged. IBS, mind-body axis, blah blah blah, who cares, these are terms to use to help discuss the problems, they aren't black and white and operationaly defined in any truly meaningful way that I've seen. I agree that celiac, food allergies, etc don't seem to be correlated enough with IBS symptoms, so therefor are not IBS (although I'm not so sure about food intolerance issues, however you can define that). Lets say though, for the sake of discussion, that it turns out that 90 percent of IBS is caused by nuerotransmitter abnormalities of some kind or something, so then what... most of us never had IBS I guess by your logic. Or what if it is mast cells, etc. Is it me or is this discussion way too simplistic? Whatever IBS is, it seems far more complex than people here seem to want to admit. I've been reading this board for years now and while I agree you need to challenge the allergy quacks, etc, I think some of you shoot yourself in the foot by claiming you know much more about the inner workings of IBS than you actually do.


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## Kathleen M. (Nov 16, 1999)

Well, there are abnormalities seen in research, just nothing to where we can to tests in the clinic at this point. SERT for one example.I did like one doctor's explaination of functional diseases that seems to explain most of them (IBS included) and explains why you don't actually find anything wrong, but it isn't functioning right. Also why all this mind-body stuff works so well for so many of them and may explain why antidepressants and other drugs that target nerves work.Everything in the body is supposed to work in concert with everything else. In a functional disorder the communication breaks down. Each part can do things on it's own, but it only does the right thing at the right time in the right way when all the communications functions properly. Some communication is chemcial and hormonal but a lot of it involves the unconcious parts of the nervous system.When there is an injury or infection or other issue sometimes the lines of communication get messed up. The part still does all the same functions it always has, and you can't see anything wrong with it, but it is now doing all the right things at the wrong times or in the wrong order, etc.If test to see if does A, it does A. but it may not be doing A when it should be, or for as long as should be or too long when it should stop, etc.For me the "mind body" stuff was all about how to get the feedback systems working again so when the colon went off doing the best it could, but in a way that messed things up it finally was able to get the feedback it needed to be able to stop doing the right things at the wrong times and stopped doing things that caused symptoms.K.


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## 20250 (Jul 14, 2005)

Finally, something I can understand.


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## eric (Jul 8, 1999)

A couple things.They have now found structural abnormalities in PI IBS and IBS. Mast cells and EC cells, the ec cells store the most serotonin and are involed in sensation and importantly gut contractions, but it has other roles as well.They also know now there is biochemical dysregulation.But not an exact biological marker for all IBSers.But there is more too it all then that, because they don't know how all the systems work together or everything about the complexities of the enteric nervous system and the central nervous system and how they communicate exactly.I personally don't go into the really technical because I can post that much material, just the links. Most of which people can get lost in. Its all in the research forum though, years and years of it.They no longer view IBS in black and white, that is called dualism, seperation of mind and body. They know view IBS in the a biopsychosocial [holistic] model. That there is no seperation of mind and body. The brain and the gut communicate constantly.Which is one reason I posted this above."Irritable bowel syndrome and mind-body interactions"Brain-gut interactions are increasingly recognized as underlying pathomechanisms of functional gastrointestinal disorders. Bi-directional communication between the central nervous system and the enteric nervous system occurs both in health and disease. Various central nervous system and gut-directed stressors stimulate the brain-gut axis, involving processes which modulate responsiveness to the stressors. Disturbances at every level of neural control of the gastrointestinal tract can affect modulation of gastrointestinal motility, secretion and immune functions, as well as perception and emotional response to visceral events. Gut neural function, CNS processing, and autonomic regulation play an important role in the brain-gut dialogue. Stress and emotions commonly trigger neuroimmunoendocrine reactions via the brain-gut axis. Various non-site-specific neurotransmitters influence gastrointestinal, endocrinological and immunological function, as well as human behavior and emotional state, depending on their location. The physiology of the digestive tract, the subjective experience of symptom, health behavior, and treatment outcome are strongly affected by psychosocial factors. Recently, a biopsychosocial [holistic] model of IBS including physiological, emotional, cognitive and behavioral components has been proposed to explain a greater portion of observable phenomena."http://www.findarticles.com/p/articles/mi_...252/ai_n6132398However, most new IBSer probaly think of it as one thing wrong and more its food or parasites or bacteria. Because that would be most people's first assumptions.They don't know the exact cause for one, because they have not figured out the entire complex system. They know where there are problems though and what those problems can cause and how they can cause IBS symptoms.As Katleen also mentioned, if you look at what really works for IBS and the treatments she mentioned and even other, that also gives them clues.To complicate it, many people have comorbid conditions.Yes even food triggers.







There are a lot of ways foods can trigger IBS. Even the act of eating itself.


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## Gutguy22 (Jul 6, 2004)

Kathleen, I've heard those explanations, and they seem reasonable I suppose, but what I was getting at is all the "mind-body", "lines of communication", "unconscious", etc, etc,etc might be nice for treatment but on a deeper operational level seems insufficent as an explanation. Such loosely defined words/ideas on such a complex system seems almost meaningless. If a neuron isn't firing right presumably there is something wrong with the neuron, or the NT's, or whatever. To me "the right thing at the wrong time" is still the wrong thing, since presumably something of a physical sort must be controlling the timing, unless you are a dualist. I understand the need to use terms like these, my point was just that repeating them the way some people do (not you) doesn't necessarily provide anymore insight into what is going on in such a complex system. For me anyway. I've mentioned the analogy to depression before in previous posts. Much like that, we have treatments w/o definitive explanations. The system is simply too complex it would seem for easy answers.


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## Kathleen M. (Nov 16, 1999)

It is very difficult to find one neuron that is firing too much or not firing enough. It is hard enough to Pet Scan or EEG or other measure of the brain to find a whole clump that is misbehaving.The neural net that controls digestion is complex enough to be considered a second brain. Just not one we conciously communicate with (from what I understand of the unconcious part of the nervous system you don't want to know what it is doing. After all if you had to conciously figure out which muscles to move to take a step, each step none of us would get anywhere very fast. You can train and use the unconcious systems, when athletes are "in the zone" often it is because they let the unconcious but well trained part of the nervous system take over and they don't think so much about what they want to do)For me it is all physical, nerves and part A telling part B X or Y is all of the body. The mind has some ability to interact with things that are normally not controlled, like during a biathalon when they can quickly get the heart rate back down after skiing to get the shot off accurately. For me it isn't something mystical or psychological it is how do I interact with my body in ways to help it do what I want.What I was getting at with "right thing wrong time" was that their isn't any gross abnormalities. All the parts are there, they all do what they should so there isn't a whole lot to find on the tests. Maybe eventually we will be able to pinpoint the exact nerve that is not listening (like when my nervous system got the nerve in my finger that grew back to *SHUT UP* in a day or two. When it first started having touch back I wanted it numb again. It was screaming in pain with every little touch, but since it got the right feedback from the system it learned to report in correctly.)It wasn't because I had a psychological "in my head" issue or anything that it hurt like hell the first couple of days. Now I can understand how in phantom limb when the system could be messed up enough that feedback can't act how something that isn't there could hurt like hell without relief.I don't think IBS or any other functional problem is non-physical. It is just we have some ability to interact with our physical selves in ways that can alter function. And I think that is both for good and for bad. Sometimes we react in ways that only make things worse. I have a heart rhythm issue myself (why the biathalon stuff interests me so much) and depending on how I react to it makes a big difference on whether I can pop the heart back into normal beating again. Any sort of stresss or need to fix it now thoughts will make it all the harder to get it back as those reactions send signals that tend to increase the heart rate and reinforce it misbehaving. Now it wasn't all the way to bad, but after I had a near accident on the way to the doctor the adreniline was so high that my heart rate and blood pressure were a bit scary. The nurse was shocked at how quickly I could get it under control, but that only worked if I really focused, as soon as I stopped trying to control it the hormones took over and right back up everything went until I finally got all the released hormones out of my system.To me IBS and all the mind-body stuff is no different than what I can do with my heartrate.K.


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## Eric Extreme (Jul 7, 2001)

My IBS litteraly almost killed me in 2001. Through several years of taking foods that bothered me out of my diet, switching to a healthier lifestyle, and staying fit I have pretty much no symptoms of IBS.In 2001 when I first had IBS and just got out of been in the hospital for 2 weeks I looked like this...







and now I look like this...







My IBS severely limits my diet to a number of items I can count on my fingers. If I have come this far through dedication and determination and taking control of the IBS and not letting it control me... than so could many people on this board.


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## eric (Jul 8, 1999)

Gutguy22 These are more technical.Have you watched this?Integrated Approach to Irritable Bowel SyndromeThis is an online CME course featuring Dr. Drossman http://www.ja-online.com/dukeibs/#and read theseGastroenterology April 2006 Issue: Rome III http://www.romecriteria.org/GastroIssue.htmReport from the 6th International Symposium on Functional Gastrointestinal DisordersBy: Douglas A. Drossman, MD and William F. Norton, IFFGDThe 6th International Symposium on Functional Gastrointestinal Disorders was hosted by IFFGD on April 7-10, 2005. The biennial meeting was jointly sponsored by the Office of Continuing Medical Education, University of Wisconsin Medical School and the International Foundation for Functional Gastrointestinal Disorders (IFFGD) in cooperation with the Functional Brain-Gut Research Group (FBG). The program, a culmination of two years planning was both stimulating and informative. In fact, our knowledge of the functional gastrointestinal (GI) disorders continues to evolve, and these symposia are in many ways a barometer of the many changes occurring in the field. http://www.iffgd.org/symposium2005report.htmlEric Extreme Goldberg Glad to hear your doing well.A lot of people feel better when they"Through several years of taking foods that bothered me out of my diet, switching to a healthier lifestyle, and staying fit I have pretty much no symptoms of IBS."Good for you.


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## Popp (May 31, 2004)

Eric Xtreme,What foods can you eat? Definitely looks like your diet does you good.Are you able to tolerate whole grains and such.You could post on a new thread, hate to hijack this pissin' contest.Thanks


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## eric (Jul 8, 1999)

This I believe is pertinent to this thread in many ways.Is It All in My Head? http://www.psychologytoday.com/articles/pt...503-000002.html


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## betterthroughscience (Jan 13, 2006)

I started this post with a list of assumptions and a conclusion based on those assumption. My assumptions were attacked using various techniques, but mostly just denial and misdirection. I will reassert here that some patients that are diagnosed by physicians according to the ROME criteria (II or as modified in the more recent publications) with IBS have an identifiable and treatable condition such as celiac disease, parasite infection, food allergy, or deficit in the bacteria in their gut that they need to properly digest.I think this assertion is pretty self evident. People on this very post have identified parasite infections, treated themm, and found relief from their IBS. People with Celiac disease are often not diagnosed correctly for many years. In the US, the rate at which IBS patients are tested for food allergies using the only proven technology to do so is practically zero (but studies using these techniques show that IBS patients often have food allergies and can be successfully treated). Probiotics is being studied and found to be helpful to many IBS patients. And all of these stand to reason: If you don't test for these conditions you will not know if they are the cause of a particular patient's IBS. If you do, you can find, and treat these conditions. Studies show that treating these conditions improves health. Pretty simple logic.Note: The above statements do not exclude the possibility that there are other ways to address IBS or that there are other causes to IBS such that some patients with IBS cannot be helped by addressing the aforementioned issues.


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## 21683 (May 7, 2006)

Im ceratin in my own mind that many, maybe even most diagnoses of IBs are actualy misdiagnoses. Certainly, me. Looks liek that although I was diagnosed with IBS some years ago, the real reasn is adhesions. And doesn't matter how many antidepressants you take, how many probiotic, pills of all sorts, hypnotherpy, reiki, whatever, you wont cure adhesions. Only surgery!!!!!!!!!!!!!!


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## eric (Jul 8, 1999)

One problem here are they are your "personal assumptions" and your not even a doctor or an expert studying and researching IBS. Your assumptions contradict the REAL research on IBS." Curr Gastroenterol Rep. 2005 Aug;7(4):264-71. Related Articles, Links Symptom overlap and comorbidity of irritable bowel syndrome with other conditions.Frissora CL, Koch KL.Department of Medicine, The Weill Medical College of Cornell University, 520 E. 70th Street, Suite J-314, New York, NY 10021, USA. cfrissor###med.cornell.eduIrritable bowel syndrome (IBS) is one of several highly prevalent, multi-symptom gastrointestinal motility disorders that have a wide clinical spectrum and are associated with symptoms of gastrointestinal dysmotility and visceral hypersensitivity. Symptom overlap and comorbidity between IBS and other gastrointestinal motility disorders (eg, chronic constipation, functional dyspepsia, gastroesophageal reflux disease), *with gastrointestinal disorders that are not related to motility (eg, celiac disease, lactose intolerance),* and with somatic conditions (eg, fibromyalgia, chronic fatigue syndrome), are frequent. The clinical associations and pathophysiologic links between IBS and these disorders continue to be explored. This review discusses overlapping symptoms and comorbidity of IBS with select gastrointestinal and non-gastrointestinal disorders and attempts to identify commonalities among these conditions.Publication Types: Celiac is not a motility disorder and modern research understand IBS as a motility disorder, viceral hypersensitvity and brain gut axis dysfuntion.Mayo Clin Proc. 2004 Apr;79(4):476-82. Related Articles, Links Celiac disease serology in irritable bowel syndrome and dyspepsia: a population-based case-control study.Locke GR 3rd, Murray JA, Zinsmeister AR, Melton LJ 3rd, Talley NJ.Division of Gastroenterology and Hepatology and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA. locke.giles###mayo.eduOBJECTIVE: To determine whether undiagnosed celiac disease is associated with irritable bowel syndrome (IBS) or dyspepsia in the community. SUBJECTS AND METHODS: A self-report bowel disease questionnaire was mailed to a random sample of Olmsted County, Minnesota, residents aged 20 to 50 years. All respondents who reported symptoms of dyspepsia or IBS (cases) and all respondents without notable gastrointestinal symptoms (controls) were invited to participate (260 eligible subjects; 150 58% were studied). Each respondent was examined by a physician, and the medical records of each were reviewed (3 subjects did not meet the criteria for dyspepsia or IBS at the time of the physician interview). Serum was obtained to measure antiendomysial antibodies and tissue transglutaminase (TTg) IgA antibodies using validated assays. RESULTS: A total of 34 subjects had dyspepsia (20 had ulcerlike dyspepsia), 50 had IBS (19 had diarrhea-predominant IBS), and 15 met criteria for both dyspepsia and IBS; 78 were asymptomatic healthy controls. The overall prevalence of positive TTg serology was 4% (95% confidence interval CI, 1.5%-8.5%). The number of subjects who were seropositive for TTg was 2 of 34 (5.9%) with dyspepsia (95% CI, 0.7%-19.7%), 2 of 50 (4.0%) with IBS (95% CI, 0.5%-13.7%), and 2 of 78 (2.6%) of asymptomatic controls (95% CI, 03%-9.0%) (P = .64 IBS vs controls; P = .58 dyspepsia vs controls). No subjects had positive antiendomysial antibodies. CONCLUSION: *In this community, celiac disease did not explain the presence of either IBS or dyspepsia.*PMID: 15065612No Link Found Between Celiac Disease and Irritable Bowel Syndrome""Irritable Bowel Syndrome: Does it Cause other Disease? By: W. Grant Thompson MD, Emeritus Professor of Medicine, University of Ottawa, Ontario, Canada There are many discussions of the plausible causes of the irritable bowel syndrome (IBS), but the question of whether IBS causes other diseases receives less attention. It is a further paradox that we know little about the cause of IBS, yet can be confident that it causes no serious intestinal disease. The syndrome can be very troublesome and disruptive, *but it is incorrect to blame it for structural gut diseases. A discussion of IBS and colon cancer, diverticular disease, inflammatory bowel disease, celiac disease, and other functional gastrointestinal disorders follows." * "Celiac disease Doctors in the north of England and ireland report that many patients with a diagnoses of IBS have celiac disease, a chronic small intestinal malabsorbtion state due to sensitvity to wheat protein. These reports are from areas where the prevalance of Celiac disease is relatively high. While the dat have less relavance elsewhere, they do underline your doctors need to consider a person's ethnicity, and other personal characteristics when making a diagnoses. As in the above diseases, the association with IBS is likely coincidental, even in England and ireland. Nevertheless, it would be foolish not to considered seriously a disease that is common in a community or ethnic group. As with IBD, IBS symptoms may accompany celiac disease, but no evidence supports the notion that IBS makes one prone to aquire it." http://www.aboutibs.org/Publications/currentParticipate.htmlCeliac can cause malabsorption and weight loss red flags in IBS.However gastroenterologist will perform tests if they suspect the patient has it.Now your probably going to say well then those patients have food allergy or bacteria or parasites. Except there are no elavated white blood cell counts that in IBS the cells are fighting any kind of infection for one or that it in any way is infectious. However the only connection so far to IBS and its still speculation and food allergy is the IgG4 triggering symptoms. NOT CAUSING IT.I also am slightly at a loss why since you don't have IBS, only that you work for an "IBS Treatment center" that specifically tests for parasites, bacteria and food allergies that you would continue to talk ONLY about those avenues of IBS and miss so much more they have already researched. You can assume all you want, but the very real fact is, IBS is already considered and has been for years an altered motility, viceral hypersensivity and brain gut axis dysfunction.Those are based on Clinical evidence and rigourous scientific study and control experiments and not your assumptions. Rectal distension tests have shown altered pain thresholds of the nerves in the gut of IBSers and brain gut axis dysfunction. So while some people might be helped by food allergy testing and bacteria and parasites, many more will not be, because they have IBS or IBS and other functional disorders and other comorbid conditions. Also because the prevalance of those issues in IBS is very low.


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## betterthroughscience (Jan 13, 2006)

eric: You wrote:


> quote:"Celiac diseaseDoctors in the north of England and ireland report that many patients with a diagnoses of IBS have celiac disease, a chronic small intestinal malabsorbtion state due to sensitvity to wheat protein. These reports are from areas where the prevalance of Celiac disease is relatively high. While the data have less relavance elsewhere, they do underline your doctors need to consider a person's ethnicity, and other personal characteristics when making a diagnoses. As in the above diseases, the association with IBS is likely coincidental, even in England and ireland. Nevertheless, it would be foolish not to considered seriously a disease that is common in a community or ethnic group. As with IBD, IBS symptoms may accompany celiac disease, but no evidence supports the notion that IBS makes one prone to aquire it."


So basically IBS doesn't cause Celiac, but Celiac is often diagnosed as IBS. Your other references say basically the same thing, except that in some locations the prevalence of celiac is low. Your data confirms my statement. Who I am is irrelevant. The fact remains that celiac is often diagnosed as IBS -according to the report you cite. So I really don't understand your argument.I have never said that IBS doesn't result in alterations of the enteric nervous system, altered pain thresholds, etc. But that is not the basis of the IBS diagnosis. The diagnosis is based on symptoms of altered bowel habits and associated discomfort (new word in the new standards!) or pain relieved or decreased upon defecation.Some patients with celiac disease exhibit red flag symptoms in addition to the standard IBS symptoms. Those are easier to diagnose. Some do not, as the study you cite found.It is nice that there are many ways to address IBS. I encourage patients to get facts, based on actual measurement of their own body and body processes. There are conditions that have been shown to cause IBS symptoms. Fix those things and see what it does to your symptoms.Perhaps it was a poor choice to use the word assumption. Perhaps assertion (based on research) would have been a better term. But if you want to argue, perhaps a better method would be to cite a study that refutes, rather than reinforces my assertion.


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## Arnie W (Oct 22, 2003)

Eric, it is difficult to ascertain whether you think that testing for celiac disease, SIBO, food intolerances, parasites, etc, is not a viable option.I really do believe that a lot of people fall through the cracks when they visit a doctor because they get a catch-all diagnosis of IBS for what could be something different. Sure, the symptoms are examined, then there is a process of elimination to determine whether it could be something more serious. However, the conditions which I have outlined above and which BTS has mentioned tend not to be considered.By the way, it is only since I have joined this board that I have discovered that I don't actually have a diagnosis of IBS and I know that, judging by the symptoms described by many people on this board, I am not alone.


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## flux (Dec 13, 1998)

> quoteerhaps a better method would be to cite a study that refutes, rather than reinforces my assertion.


It doesn't really. It's a special case, same with someone who traveled outside the US.


> quote:judging by the symptoms described by many people on this board, I am not alone.


I had the opposite impression.


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## eric (Jul 8, 1999)

> quote:Eric, it is difficult to ascertain whether you think that testing for celiac disease, SIBO, food intolerances, parasites, etc, is not a viable option.


Yes people are tested for them all the time. All our recgonized medical problems. That is not the problem, its calling them IBS is the problem. The symptoms can already seperate those conditions out. Doesn't mean someone can't be misdiagnosed either or have more then one condition, more are misdiagnosed because those criteria aren't not being met.So I can ask you Betterthrough science what is the accuracy of using the manning, rome 1 and rome II and rome III criteria? What is the accuracy of rome ll?Try answering that question with real studies? Not that people are misdiagnosed or any of that but just how accurate those criteria are when used in IBS.Arnie, so you were rediagnosed with something else by a doctor, or your now self diagnosing yourself with something else?"By the way, it is only since I have joined this board that I have discovered that I don't actually have a diagnosis of IBS and I know that,"


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## betterthroughscience (Jan 13, 2006)

The label IBS is confusing to people. They think that it describes a discreate disease with a (perhaps not yet know) singlular nature. Unfortunately this is not the case. IBS merely describes a group of symptoms. It is interesting that many of the people who have this group of symptoms can be reliably predicted to have other symptoms (like viseral hypersensitivity). But IBS is not like the diagnoses that you might get that actually define the situation, for example, scurvy - which is a deficiency of vitamin C, or chickenpox, an infection by a specific organism.The real benefit of the diagnosis is that it allows the insurance company to stop paying for testing and treatment. Once diagnosed with IBS, the insurance company can point to the recommendations and tell the patient that the 'state of the art' for IBS is to stop testing and just learn to live with it, since it will not be fatal. If there wasn't this nice label to apply to people then patients might keep insisting different testing and treatment. This is not good for a financial model that relies on predictability of costs. Not that I think the insurance companies got together and told the ROME conference to come up with a catch-all diagnosis. But if you understand how medical charting works there simply has to be an ICD-9 code to get reimbursed so doctors basically have to have one to get paid.Fortunately for us doctors in countries with public medicine have some financial incentive to actually cure (or stop the symptoms) of patients because they pay for treatment and for losses to the economy when a worker is not able to perform due to irritated bowels. Research there is directed at finding things to treat, and is not limited to the drug or surgery mentality our system fosters.If you think that parasites don't effect people in the US, just remember the outbreaks we have had in major municipal water supplies and think about all the small water supply systems and private systems that never get tested at all.No individual knows if they have a particular condition until they test for it. If you have IBS symptoms you should get tested for the things that can cause those symptoms.


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## betterthroughscience (Jan 13, 2006)

> quoteoctors in the north of England and ireland report that many patients with a diagnoses of IBS have celiac disease


Eric - Doctors diagnose IBS based on symptoms. IBS is not exclusive of these conditions. It is simply a broad 'diagnosis' that doesn't define what it is, just what it isn't. Further testing can identify causes of the symptoms. You cure those things and you cure the person of their 'IBS'.


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## eric (Jul 8, 1999)

> quote:The label IBS is confusing to people.


You are confusing people more. Calling infectious diseases IBS and disease process they already know the cause of and calling celiac IBS which isn't even a motility disorder. Its amazing how you personally Interpret these things as you go."ROME conference to come up with a ROME conference to come up with a catch-all diagnosis"Is that how you interpret the rome criteira as a "ROME conference to come up with a catch-all diagnosis'?Or come up with more accurate ways to diagnose people with IBS and functional GI disorders. Your not even talking about functional gi disorders? There are 25 of them and you are not even talking about there major overlap.What your doing its putting fear in people who's IBS can react to fear, that they have parasites "infectious diseases" and so forth and don't have an accurate diagnoses if they have been diagnosed using The Rome critieria and a SPECIFIC SET OF SYMPTOMs, that is a secure diagnoses you have IBS.IBS HAS NEVER BEEN CLASSIFIED AN INFECTIOUS DISEASE!!! only you are doing calling it this and that is flat out WRONG!!!!Symptoms discriminate irritable bowel syndrome from organic gastrointestinal diseases and food allergy.http://www.ncbi.nlm.nih.gov/entrez/query.f...l=pubmed_docsumThis test discriminates IBS from Inflammation in the gi tract.Fecal leukocyte proteins in inflammatory bowel disease and irritable bowel syndrome.http://www.ncbi.nlm.nih.gov/entrez/query.f...l=pubmed_docsumThe diagnoses for IBS continues to GET BETTER not worse."Durability of DiagnosisA number of studies conducted in community-based and specialty-based clinics *over the past 3 decades have demonstrated that once the diagnosis of IBS is made, only a small percentage (0.7% to 6.5%) of patients subsequently receive a diagnosis of organic disease*. *These studies provide evidence that once the diagnosis of IBS is established, additional studies are not necessary unless the clinical symptoms change."*Irritable bowel syndrome (IBS) is the most common disorder seen in gastroenterology practice. It is also a large component of primary care practices. Although the classic IBS symptoms of lower abdominal pain, bloating, and alteration of bowel habits is easily recognizable to most physicians, diagnosing IBS remains a challenge. This is in part caused by the absence of anatomic or physiologic markers. For this reason, the diagnosis of IBS currently needs to be made on clinical grounds. A number of symptom-based diagnostic criteria have been proposed over the last 15 years. The most recent of these, the Rome II criteria, seem to show reasonable sensitivity and specificity in diagnosing IBS. However, the role of the Rome II criteria in clinical practice remains ill defined. A* review of the literature shows that, in patients with no alarm symptoms, the Rome criteria have a positive predictive value of approximately 98%, and that additional diagnostic tests have a yield of 2% or less. * Diagnostic evaluation should also include a psychosocial assessment specifically addressing any history of sexual or physical abuse because these issues significantly influence management strategies and treatment success.Diagnosis of IBSSymptom-Based Diagnostic CriteriaDue to the lack of a diagnostic biologic marker for IBS, the diagnosis is made using symptom-based criteria. A number of symptom-based criteria have been used in the past; however, the currently accepted criteria are those that have been developed by the Rome II committee, a group comprised of experts specializing in functional gastrointestinal disorders.[2] IBS is most recently defined as abdominal pain or discomfort not explained by biochemical or structural abnormalities that is present for at least 12 weeks (not necessarily consecutive) over the past 12 months and associated with at least 2 of the following features: (1) relief with defecation; (2) a change in stool consistency (eg, watery/loose or hard/lumpy); and/or (3) a change in stool frequency.The Rome II criteria are a simplification of the Rome I Criteria.[12] The Rome I criteria were similar to the above indicated features, but also stated that 2 or more of the following features must be present as least 25% of the time: (1) abnormal stool form; (2) passage of mucus; (3) bloating or distension; (4) abnormal stool passage (feeling of incomplete evacuation, straining, or urgency); and (5) altered stool frequency (> 3 bowel movements/day or < 3 bowel movements/week). These symptoms are presently used as supportive symptoms for the diagnosis of IBS.Because patients may present with diarrhea and/or constipation, patients are often subgrouped by predominant bowel habit. However, GI symptoms may fluctuate over time and, therefore, a special task force of the American College of Gastroenterology has suggested that patients with IBS be identified using the following designations: IBS associated with abdominal pain, fecal urgency, and diarrhea; IBS associated with abdominal discomfort, bloating, and constipation; and IBS associated with alternating diarrhea and constipation.[11]Diagnostic ConsiderationsOnce a dominant symptom complex is identified in the patient, it is also useful to exclude possible "red flags" that might be indicative of an organic disorder. Table 1 outlines the potential "alarm" symptoms that need to be considered when evaluating a patient with IBS.Table 1. Alarm Symptoms Suggestive of Organic DiseaseHistoryWeight loss > 10 lbs Nocturnal symptoms Initial onset at age > 50 years Significant travel history Severe diarrhea or constipation Rectal bleeding Arthritis/rashes Family HistoryColon cancer Inflammatory bowel disease Celiac disease Physical FindingsFever Oral ulcers Palpable abdominal mass Guaiac-positive stool Other physical finding (eg, abdominal mass, distension) Rectal bleeding or obstruction Laboratory EvaluationIncreased white blood cell count Anemia Abnormal chemistry Increased thyroid-stimulating hormone Elevated erythrocyte sedimentation rate or C-reactive protein Once a thorough medical history and physical examination are performed, a variety of laboratory tests that have been advocated in the literature may be considered.[1,13] These diagnostic tests include: (1) complete blood count (CBC); (2) thyroid-stimulating hormone (TSH) level; (3) erythrocyte sedimentation rate (ESR); (4) complete metabolic profile; (5) stool for ova and parasites (O&P); (6) stool culture and examination; (7) fecal occult blood testing; and (8) celiac sprue panel. Other diagnostic tests include flexible sigmoidoscopy, colonoscopy, or barium enema, and hydrogen breath tests, which should be considered on an individual basis. It is generally recommended that clinicians take an evidence-based medicine approach in their medical evaluation and consider the pretest probability of a test for diagnosing another medical condition (eg, colon cancer, inflammatory bowel disease, celiac sprue) before ordering it. The presence of alarm symptoms would suggest a higher pretest probability of an organic disorder that needs to be ruled out. The differential diagnosis of IBS often depends on the predominant symptom (eg, diarrhea or constipation), as outlined in Table 2.Table 2. Differential Diagnosis of IBS*Malabsorption Dietary Factors Intestinal disorders Lactose intolerance Pancreatic insufficiency Alcohol/caffeine Postgastrectomy Sorbitol/high fructose corn syrup Gas-producing foods Infection High-fat foods Bacteria Wheat (celiac disease) Parasites HIV and associated infections Psychological Disorders Inflammatory Bowel Disease Panic disorder Crohn's disease Somatization Ulcerative colitis Depression Microscopic/collagenous colitis Gynecologic Disorders Endometriosis Malignancies Dysmenorrhea Endocrine tumors Ovarian cancer Colon cancer Neurologic Disorders Parkinson's disease Medicationsâ€ Multiple sclerosis Antibiotics Spinal cord lesions Nonsteroidal anti-inflammatory drugs Chemotherapy Endocrine/Metabolic Disorders Opiates Diabetes Calcium-channel blockers Hypo/hyperthyroidism Antidepressants Hypercalcemia *Consider dominant bowel symptomâ€ Not an all-inclusive listStudies of reasonably good quality have suggested that the diagnostic yield associated with performing most of these tests is not very high -- for many, in fact, less than 2%.[14,15] However, there are a few exceptions. One exception is lactose intolerance, which is present in approximately 25% of the population. However, lactose intolerance is often coexistent with IBS and, when treated, the patient still has symptoms of IBS. The other exception is celiac sprue. The pretest probability in the patient with IBS is significantly higher than that found in the general population (4.67% vs 0.25% to 0.50%).[16,17] Therefore, screening with endomysial antibody, among other such screening tests, may be indicated, particularly if the patient has failed to respond to treatment. Seven percent of patients with celiac disease are IgA deficient and, therefore, the clinician may want to measure the IgA level as well when celiac disease is a diagnostic consideration.Although the pretest probability of finding an etiology for symptoms by colonoscopy is not high, most gastroenterologists would agree that patients >/= 50 years of age should undergo this examination (or, alternatively, a flexible sigmoidoscopy and barium enema) if a previous screening examination has not been done. This age threshold should be lowered to 40 years if there is a significant family history of colon cancer.Another condition to consider excluding from the differential diagnosis when managing a patient with symptoms of IBS is bacterial overgrowth. Two studies from the same research group found that 78% to 84% of patients with IBS had bacterial overgrowth.[18,19] In patients with evidence of bacterial overgrowth, those treated with neomycin had a >/= 35% reduction in clinical response (ie, improvement) compared with an 11% reduction in patients on placebo.[19] Although these data are extremely intriguing, there are some methodologic limitations in these studies and, therefore, the use of widespread hydrogen breath testing for bacterial overgrowth is still not generally advocated.The diagnosis of IBS is primarily symptom-based, and the literature suggests that once made, the clinician can be confident of his/her diagnosis. *Retrospective views of patients have suggested that the diagnosis is an enduring one, with 92% to 97% of the individuals maintaining the same diagnosis over 2-13 years*http://www.medscape.com/viewarticle/463521_2


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## eric (Jul 8, 1999)

Betterthrough science, please explain the rise of white blood cells and infectious diseases?ThenPlease explain why there is NOT elevated white blood cells in IBSERS from infection?


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## betterthroughscience (Jan 13, 2006)

Eric: Yes, many people diagnosed with IBS still have the symptoms for years. Since most are never tested for celiac, food allergies (by a valid method), bacterial imbalance, etc. it is not surprising that most still have IBS over time.I am not sure what you are getting at when you mention infectious disease and white blood cell count. People with bacterial or viral infections often have increased white blood cell count. If the physician does a CBC and notes this then he may try to determine the type of infection. But some bacteria and other microorganisms can establish huge colonies in the gut, displacing normally present bacteria, and still not result in increased white blood cell count. You have posted lots of research on probiotics, I would hope that means that you are familiar with it. The studies seem to indicate that some cases of IBS can be resolved by restoring the proper balance of the right strains of bacteria in the gut. But such testing is still not recommended by the ROME conference. One paper indicated that it is worthy of continued study.One reason it is challenging is that not all people with IBS (as diagnosed) have a bacterial problem. Some have food allergies. Some have both. Some have celiac disease. Some have parasites (that have evolved specifically to be able to inhabit the gut without killing the host or arousing the immune system too much). Some have none of these things. Some (although very rarely) have all of them. But you can't know if you don't test. I am not trying to make people afraid. I am trying to give them information that they can use to end their suffering. One should not be afraid of having more information. IBS is complex. I am not the one diagnosing people with IBS without doing a complete set of testing. Doctors around the US are doing that. Many people on this post have been able to find a solution to their IBS. That is what I advocate - don't give up just because you were diagnosed. Get more info and try to find a solution.


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## 17409 (Jun 6, 2006)

Betterthroughscience, I agree I have just yesterday got food intolerance test results though and found I am extremely allergic to Yeast and moderately allergic to Gluten, egg white, and cows milk. I have had IBS Symptoms for as long as I can remember and was diagnosed 3 years ago (I am 24) My diet was based around foods that contained the above ingrediants as I thought that as bread and pasta is plain and the only thing that was 'safe' for me to eat. Boy was I wrong, today I have cut out all bread, pasta, cows milk and eggs which I used to consume at least daily and I can't believe that I have not had any discomfort! I hope that this is the root of my problems ,i guess I will find out in the coming few days.


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## eric (Jul 8, 1999)

Katie who did the testing for you and how was it done?A food allergy and a food intolerence are two different problems."Food allergies or food intolerances affect nearly everyone at some point. People often have an unpleasant reaction to something they ate and wonder if they have a food allergy. One out of three people either say that they have a food allergy or that they modify the family diet because a family member is suspected of having a food allergy. But only about three percent of children have clinically proven allergic reactions to foods. In adults, the prevalence of food allergy drops to about one percent of the total population.This difference between the clinically proven prevalence of food allergy and the public perception of the problem is in part due to reactions called "food intolerances" rather than food allergies. *A food allergy, or hypersensitivity, is an abnormal response to a food that is triggered by the immune system. The immune system is not responsible for the symptoms of a food intolerance, even though these symptoms can resemble those of a food allergy.*It is extremely important for people who have true food allergies to identify them and prevent allergic reactions to food because these reactions can cause devastating illness and, in some cases, be fatal."http://www.webmd.com/content/article/5/1680_50303One is an immune responce (allergy) the other is not(intolerence.)


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## 17409 (Jun 6, 2006)

Slip of the tongue, I ment food intolerance, which in my case said I was extremly intolerant to the items I mentioned. The people that carried out my test are here in the U.K they are called York Testing. I am not familiar with your past postings and im sorry for being a little clueless, do you believe there could be a link between what people who are intolerant to certain foods and IBS? I ask this question because a past doctor told me that IBS tends to be diagnosed when no other diagnosis can be found? I have only just started to really research IBS and am trying to take on board the arguements for and against all the relevant issues. Any feedback would be welcomed.


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## betterthroughscience (Jan 13, 2006)

Katie: Are you sure it wasn't an ELISA type test for immune system response to foods (IgG and/or IgE)? The York labs are famous for ELISA allergy testing.


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## 17409 (Jun 6, 2006)

No I do not know, could you tell me the diffrence and I will find out.


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## betterthroughscience (Jan 13, 2006)

Food allergy testing (ELISA - based methodologies) measures the antibodies present in your blood serum by taking a sample of your blood, applying the serum to concentrated purified samples of the food you want to challenge and then measuring the quantity of antibodies that reacted to the food. I strongly suspect this is your situation. The docs in the UK have been using this technique for some time and are getting great results. Food allergies are simply your immune system reacting to a food protien in the same way that it would react to a protien on a bacterium or virus. The antibodies have a physical structure that matches a particular protein like a lock and key. When the key fits in the lock it triggers a whole series of responses, including histamine release, etc. that results in symptoms.Some confusion exists between intolerances and allergies, even among doctors. Fortunately what learned may help you end your suffering. I hope so.


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## 17409 (Jun 6, 2006)

thanks betterthroughscience, I did give a blood sample. I am hoping that the results will maybe help my symptoms. But as I mentioned I only got the results yesterday so I will have to wait and see I suppose.


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## onyx (Jan 13, 2006)

> quote:Originally posted by katie tattie:Betterthroughscience, I agree I have just yesterday got food intolerance test results though and found I am extremely allergic to Yeast and moderately allergic to Gluten, egg white, and cows milk. I have had IBS Symptoms for as long as I can remember and was diagnosed 3 years ago (I am 24) My diet was based around foods that contained the above ingrediants as I thought that as bread and pasta is plain and the only thing that was 'safe' for me to eat. Boy was I wrong, today I have cut out all bread, pasta, cows milk and eggs which I used to consume at least daily and I can't believe that I have not had any discomfort! I hope that this is the root of my problems ,i guess I will find out in the coming few days.


Hi Katie. I took the same test through York about a year ago and had similar results. It said I had +3 reactions to egg and milk and a whole bunch of +1 reactions to other things. I tried going on a pretty strict diet cutting most of these foods out for about a month but didn't notice any difference in my IBS symptoms (mainly cramping and D). Would be interested to see if you or anyone else really experiences a continued benefit to avoiding certain foods that came back positive on that test. Maybe I'll give it another shot with a new diet.


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## flux (Dec 13, 1998)

> quote:Some have food allergies. Some have both. Some have celiac disease. Some have parasites (that have evolved specifically to be able to inhabit the gut without killing the host or arousing the immune system too much). Some have none of these things. Some (although very rarely) have all of them.


None of these statements are true.


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## betterthroughscience (Jan 13, 2006)

Flux: Please support your contention with some evidence. There is a significant amount of research, some cited in this very post by Eric, that contradicts your statement. Why do you think that it is not the case that some people diagnosed with IBS have, for example, celiac disease? Please share your evidence with us.


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## eric (Jul 8, 1999)

The mast cell







This cell is best known for IgE food allergy.What betterthrough science is failing to mention is this cell has been and continues to be researched in IBS and has been for the last five years IN DEPTH.In post Infectious IBS they have found and increase in mast cells in the gut as well as serotonin-containing enterochromaffin (EC) cells. These are Distinctive histological features of postinfective irritable bowel. Structural changes in the gut after an enteric infection which resolves. Both cells are very important, serotonin-containing enterochromaffin (EC) cells which store the majority of serotonin in the body in the gut 95 percent. Serotonin intiates gut contractions and is majorally implicated in D and c and d/c in IBS, there is altered serotonin release from the cells in IBS. It is also the neurotransmitter that signals gut sensations to the brain. Harvard Health"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. "Hence the newer drugs specifically for IBS.Next and very importantly the mast cellMany researchers are studying the mast cell in IBS, but DR Wood is also an expert on food allergy as well as IBS."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."*This is why the stress of "what if I am not near a bathroom, or the fear of getting into a car, or a PERCEIVED threat as well as an actual threat can trigger IBS. OR chronic activation of the system by chronic stress, or the fight or flight responce. IT does not have to be consciously perceived, but is a neurobiological and psychophysiological responce in all humans.The fight or flight responce goes off around 200 times in normal people with out IBS. Perceived pain as in will I have a pain attack or or perceived d will I have an accident, am I close to a bathroom can activate the system and degrandulate the mast cell. This is one reason why people under stress at the time of an enteric infection can develop Post infectious IBS. The HPA axis or Hypothalamic-Pituitary-Adrenal Axis the bodies stress system activates the mast cell in the gut and degrandulates them. The cell then release histimine and serotonin. "The hypothalamic-pituitary-adrenal axis (HPA axis) is a major part of the neuroendocrine system that controls reactions to stress and has important functions in regulating various body processes such as digestion, the immune system and energy usage."Here is a regular mast cell







and a degranulation







The release of histimine is toxix to the surrounding smooth muslce and causes macroscopic inflammation. This is the type of inflammation talked about in IBS. There is no overt inflammation seen in IBS. Again the inflammation is MACROSCOPIC.It should be noted that the author of the article below is not taking into consideration other aspect of mast cells and IBS that I have posted above.Food allergy and irritable bowel syndrome"It should be emphasized, however, that IgG food anti-bodies were not compared between healthy control individuals and irritable bowel syndrome patients in the study by Atkinson et al.[15â€¢â€¢]. A previous study with healthyinfants suggests that food-specific IgG antibodies arephysiologic and indicate only earlier exposure to these foods [16]. It may thus be possible that there is not any significant increase in IgG food antibodies in patients with irritable bowel syndrome, as was suggested by a previoussmall study [14]. Alternatively, the gut permeability defect found in patients with inflammatory bowel syndrome leads to increased intake of dietary antigens to laminapropria that ultimately may result in raised IgG antibody production [17]." http://66.218.69.11/search/cache?p=mast+ce...&icp=1&.intl=us


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## Arnie W (Oct 22, 2003)

It seems to me, flux and eric, that whenever somebody suggests that there could be grounds for considering alternative treatments to look at (eg parasites, celiac), you immediately stand up and proclaim "but that ISN'T IBS." I don't think for one moment that BTS has even remotely suggested that celiac, parasites, etc, are IBS. They are options which can be considered when a diagnosis of IBS is unsure or when treatment for IBS is not resulting in improvement.Regarding youir response to me on the preceding page, eric, when you asked about how I knew that I am not diagnosed as having IBS, I did put 2 and 2 together when I realised, after having read pertinent material on this site, that Rome did not cover my condition, because I don't have pain. This was confirmed by a GI last year, who said that I have a functional bowel disorder. And I cannot agree that doctors test for celiac, etc, 'ALL THE TIME'. I was not offered these tests, but had to seek out doctors who practised alternative therapies or I visited natural therapists.


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## eric (Jul 8, 1999)

Arnie, the Rome criteria covers functional D, but I think your trying to say pain or discomfort is a must for a diagnoses of IBS. The rome criteria covers all the function gi disorders.http://ibsgroup.org/groupee/forums/a/tpc/f...261/m/397106832Some doctors will test for celiac in all their IBS patients and some will test if they have the symptoms and if the doctor believes the person has celiac, I have already posted a lot of information on testing for celiac in IBS or celiac in general.


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## betterthroughscience (Jan 13, 2006)

It is interesting to note that the criteria for subtyping are now considered suspect. The ROME III report (Gastoenterology, May, 2006) says this: Current evidence indicates that bowel pattern subtyping is best done according to stool form rather than bowel frequency,[9â€"13,18] particularly IBS-M[15]; however, weemphasize that bowel pattern subtypes are highly unstable. In a patient population with approximately 33% prevalence rates of IBS-D, IBS-C, and IBS-M, 75% of patients change subtypes and 29% switch between IBS-C and IBS-D over 1year.[14] Other investigators report the IBS-M subtype in about 50% of referred patients according to 3 sets of criteria, [15] and IBS-M is the most prevalent group in primary care.16 In addition, a majority of patients have rapidlyfluctuating symptoms lasting from <1hour to 1<1 week.[15,16] Therefore, the rate of documented bowel pattern change is a function of the data collection frequency, and there are insufficient data upon which to recommend a timeperiod for defining IBS-A. ANDAlthough the committee recommends a change in subtyping from the multisymptom Rome II classification to one based on stool form only, there are insufficient data to exclude either classification at this time. Further validation studies are needed. What this means is that all those people thought they had a definitive diagnosis of IBS-D found that their symptoms changed over time and thus subtyping depends on when and how often the patient's symptoms are measured.There is huge variability in even individual IBS patients. Eric: Yes, it is possible to influence the immune system through psychological means. But that doesn't mean that the regular, simple biochemical reactions driven by simple chemistry don't also occur. If you challenge a person who has antibodies to a specific protien, their system will respond. The timing, degree, etc. are all variable and have many influencing factors.


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## overitnow (Nov 25, 2001)

IBS-M? I used to use that to refer to my recovery period when I went through a period of IBS-Mud. What does it really stand for?Mark


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## flux (Dec 13, 1998)

> quote:There is a significant amount of research, some cited in this very post by Eric, that contradicts your statement. Why do you think that it is not the case that some people diagnosed with IBS have, for example, celiac disease?


That's the evidence I'm using. You have just misinterpreted it.


> quote:I don't think for one moment that BTS has even remotely suggested that celiac, parasites, etc, are IBS


Yes, he has. That's the point. He's claiming--falsely--that *some* people with IBS really have other conditions. In reality, the misdiagnosis is rare.


> quote:I was not offered these tests, but had to seek out doctors who practised alternative therapies or I visited natural therapists.


Not everyone needs these tests. What's alternative/natural have to do with this?


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## betterthroughscience (Jan 13, 2006)

I will simply point out that there is no misinterpreting the statement in Eric's citation. IBS patients were diagnosed with IBS, then later found to have celiac disease. There is no way to know if you have celiac disease unless you test for it.There is no way to know if you have any of these problems unless you test for them. To say that IBS is a diagnosis of a condition is the problem. IBS is not a condition, it is a collection of symptoms not explained by any particular cause. Further exploration can reveal the cause.It frustrates me that telling people they have these symptoms (which is identical to the IBS diagnosis) is somehow considered sufficient. It is ridiculous to not pursue the situation further, unless you believe that IBS is really just 'all in your head'.


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## 14416 (Jun 21, 2005)

> quote:He's claiming--falsely--that some people with IBS really have other conditions. In reality, the misdiagnosis is rare.


I'm sorry Flux; the statement you just made is really... well how should I say it- how about I just say, you just made his point.Yeah, he's claiming some- rare or not, some could be 3 out of 1,000. That constitutes "some". So, how is he falsely claiming something?He's not.


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## Arnie W (Oct 22, 2003)

In your reply to me, eric, you stated that Rome covers functional D. I do not regularly have D.I have in front of me a letter given to my doctor by my GI. I quote:"Whilst his sensation of incomplete evacuation is functional in nature, he does not in fact have irritable bowel syndrome principally due to the lack of abdominal pain."Remember this is written by a GI who, I imagine, is up with the play. And herein lies the difficulty in making a diagnosis, and maybe having to look for alternatives. I think this is where BTS's suggestions have some merit.


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## eric (Jul 8, 1999)

Arnie,FUNCTIONAL BOWEL DISORDERSContributed by the International Foundation for Functional Gastrointestinal Disorders (IFFGD) and edited by the Patient Care Committee of the ACG.INTRODUCTION"People with functional diarrhea donâ€™t necessarily have it all the time. They can still have normal bowel movements or even constipation between bouts of diarrhea.http://www.acg.gi.org/patients/gihealth/functional.aspBetterthroughscience, stool patterns do not define IBS. Altered motility in IBS are symptoms of a bigger disorder.Altered motiltyviceral hypersensivityaltered brain gut axis dysfunction"MOTILITYIn healthy subjects, stress can increase motility in the esophagus, stomach, small and large intestine and colon. Abnormal motility can generate a variety of GI symptoms includingvomiting, diarrhea, constipation, acute abdominal pain, and fecal incontinence. Functional GI patients have even greater increased motility in response to stressors in comparison to normal subjects. *While abnormal motility plays a vital role in understanding many of the functional GI disorders and their symptoms, it is not sufficient to explain reports of chronic or recurrent abdominal 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, where motility disturbances do not exist. Patients suffering from visceral hypersensitivity have a lower pain threshold with balloon distension of the bowel or have increased sensitivity to even normalintestinal function. Additionally, there may be an increased or unusual area of somatic referral of visceral pain. Recently it has been concluded that visceral hypersensitivity may be induced in response to rectal or colonic distension in normal subjects, and to a greater degree, in persons with IBS. Therefore, it is possible that the pain of functional GI disorders may relate to sensitization resulting from chronic abnormal motor hyperactivity, GI infection, or trauma/injury to the viscera.5BRAIN-GUT AXISThe concept of brain-gut interactions brings together observations relating to motility andvisceral hypersensitivity and their modulation by psychosocial factors. By integrating intestinal and CNS central nervous system activity, the brain-gut axis explains the symptoms relating to functional GI disorders. In other words, senses such as vision and smell, as well as enteroceptiveinformation (i.e. emotion and thought) have the capability to affect gastrointestinal sensation,motility, secretion, and inflammation. Conversely, viscerotopic effects reciprocally affect central pain perception, mood, and behavior. For example, spontaneously induced contractions of the colon in rats leads to activation of the locus coeruleus in the pons, an area closely connected to pain and emotional centers in the brain. Jointly, the increased arousal or anxiety is associatedwith a decrease in the frequency of MMC activity of the small bowel possibly mediated by stress hormones in the brain. *Based on these observations, it is no longer rational to try to discriminate whether physiological or psychological factors produce pain or other bowel symptoms.* Instead, the Functional GI disorders are understood in terms of dysregulation of brain-gut function, 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."http://ibsgroup.org/groupee/forums/a/tpc/f...710974#19710974


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## Arnie W (Oct 22, 2003)

Sorry, I did not explain myself well obviously. In the scale of digestive problems, D is not a problem for me. I do NOT have functional D. And apparently I don't have IBS.


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## eric (Jul 8, 1999)

So Arnie, what do you have? What is your main symptom/symptoms?IF you don't have pain or functional d or functional c or IBS or a functional bowel disorder? ETC.. What functional disorder do you have?Yet you said "This was confirmed by a GI last year, who said that I have a functional bowel disorder. "In regards to the mast cells and food reactions, here are some other things that activate the mast cells.Its is not all inclusive"What Causes Degranulation?Theoharides has identified an extensive list of compounds and activities that can cause mast cells to degranulate. These include: bacteria, free radicals, hormones (estradiol, estrogen), IgE and antigen (autoimmune reaction), neuropeptides (Substance P), neurotransmitters (acetylcholine), physical stresses (cold, exercise, pressure, cysto/hydro distension), emotional stress, radiation (including solar), toxins (bacterial, insect, jellyfish, plants, seafood), and viruses (measles, Para influenza), contrast media used in radiology, drugs (local anesthetics, morphine, high doses of non steroidal anti-inflammatory /NSAIDS, high doses of antihistamines, opioids), Bacille Calmette-Guerin (BCG), and 50% DMSO (RIMSO)."http://www.b-p-s-a.org.uk/mast_cells_and_ic.htm


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## betterthroughscience (Jan 13, 2006)

> quote:Betterthroughscience, stool patterns do not define IBS. Altered motility in IBS are symptoms of a bigger disorder.Altered motiltyviceral hypersensivityaltered brain gut axis dysfunction


ROME III contradits you:C1. Irritable Bowel SyndromeDefinitionIBS is a functional bowel disorder in which abdominal pain or discomfort is associated with defecation or a change in bowel habit, and with features of disordered defecation.C1. Diagnostic Criteria* for Irritable Bowel SyndromeRecurrent abdominal pain or discomfort** at least 3 days per month in the last 3 months associated with 2 or more of the following:1. Improvement with defecation2. Onset associated with a change in frequency of stool3. Onset associated with a change in form (appearance) of stool*Criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis.**Discomfort means an uncomfortable sensation not described as pain. In pathophysiology research and clinical trials, a pain/discomfort frequency of at least 2 days a week during screening evaluation for subject eligibility.Gastroenterology 2006;130:1480â€"1491The definition of IBS is pain (or discomfort) associated with a change in bowel habit. Not altered motility, not visceral hypersensitivty. The patient that meets these criteria (and the exclusions) has IBS. By definition. These are the diagnostic criteria.


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## eric (Jul 8, 1999)

"Gastrointestinal motility is defined by the movements of the digestive system, and the transit of the contents within it. When nerves or muscles in any portion of the digestive tract do not function in a strong coordinated fashion, a person develops symptoms related to motility problems. These symptoms may range from heartburn to constipation. Other symptoms may also include abdominal distention, nausea, vomiting, and diarrhea." http://www.iffgd.org/GIDisorders/GImain.htmlBelow


> quote:defecation or a change in bowel habit, and with features of disordered defecation.


IS altered motility"Visceral hypersensitivity helps to account for disorders associated with chronic or recurrent pain, which are not well correlated with changes in gastrointestinal motility, and in some cases, where motility disturbances do not exist."IS abdominal pain or discomfort*The above I posted was written by Douglas Drossman, MD President Rome Foundation*he also wrote this"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.htmYou need to look at the whole disorder as well as testing for it.


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## Arnie W (Oct 22, 2003)

As I said previously, according to my GI, I have a functional bowel disorder, but he has definitely ruled out IBS. I have it in print!My symptoms? Most vexing is gas, because of the social implications. Now here follows the gross part, but dirty laundry gets aired here all the time. I also suffer from incomplete evacuations, meaning that there is always a remnant of stool in the rectal area. I have frequent bm's every day - 3 usually within the first hour of the day, which evacuate readily. Frequent urges for the remainder of the day, but generally not urgent. Often it's a matter of I should go, but if I'm not handy to a toilet, don't need to go and will probably end up just passing gas. BM's can be runny but not enough to be called D much of the time. Later in the day the urges remain, but the bm's are smaller, pebbly or sludgy, and more difficult to pass. Well, I probably gave you a lot more info than you bargained for. Now if someone can digest all that and send me a cure, I'll be most grateful.


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## eric (Jul 8, 1999)

You suffer from " incomplete evacuations", but you go every day enough.So that is "sensations of incomplete" evacuations?which can happen in IBS as just a note that the probelems over lap. This more a clue this isn't caused by food allery or a bacteria.Sounds like a lower anal rectum problem perhaps where those nerves are sending signals to the brain that they should not be doing. Tell us what the doc says again.Did he give you any treatment plan?"Current Approach to the Diagnosis of Irritable Bowel Syndrome""Summary A knowledgeable physician can diagnose IBS by careful review of the patient's symptoms, a physical examination, and selected diagnostic procedures that are often limited to a few basic tests. Such a diagnosis is quite secure, as follow-up for many years of confidently diagnosed patients seldom discloses another cause for their symptoms. With an unequivocal diagnosis, both patient and physician can work together on the most effective management."Lets agree to disagree Betterthrough science and leave it up to the experts and the doctors.


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## betterthroughscience (Jan 13, 2006)

> quote:"SummaryA knowledgeable physician can diagnose IBS by careful review of the patient's symptoms, a physical examination, and selected diagnostic procedures that are often limited to a few basic tests. Such a diagnosis is quite secure, as follow-up for many years of confidently diagnosed patients seldom discloses another cause for their symptoms. With an unequivocal diagnosis, both patient and physician can work together on the most effective management."


I guess you and I can disagree. I will continue to try to recommend to people who have been diagnosed with IBS that they get tested for things that generally are not tested for. The diagnosis is 'secure' as long as practically none of the doctors test for these things. While I am not a doctor, there are those that find and fix problems in the vast majority of their patients. I recommend anyone with IBS find a doctor that won't just be happy to let them suffer.I know you recommend hypnotherapy, and if that works, great. But if you don't find relief there, then try the range of other things that have been shown to be treatable with respect to the symptoms of IBS.


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## Arnie W (Oct 22, 2003)

I believe that doctors are certainly not infallible when it comes to diagnosing IBS, and there has been research to this vein. I am not considering visiting my doctor for a while, but when I do, I will be most interested to find out what his knowledge of Rome is and the yardsticks for diagnosing IBS.There has been research indicating that errors are being made (and for that reason it could pay to check for celiac, etc.) I've never been offered that test by the way.http://www.ncbi.nlm.nih.gov/entrez/query.f...l=pubmed_docsumI feel that I've highjacked this thread now, but it does show the difficulties in making an accurate diagnosis.No, eric, it is definitely not a sensation. IE is for real in my instance. Firstly, I often find that I need more than toilet paper to wipe up after bms (flannel cloths or baby wipes). Secondly, if I put toilet paper round my finger and insert it in the anus, I can feel the stool remnant.You asked what the GI recommended for treatment, eric. He wrote that my beliefs are now maladaptive, having had them for several yearsa. He thinks anal tone is good because I have no history of incontinence. There is little evidence to support bacterial overgrowth. He also feels that there is an obsessive or paranoid component. BTW, I am a psychiatric nurse and am not overly worried about the last comment. I only started becoming 'obsessed' aboutl my bowels when they started going haywire. Before that, I never even remotely worried about them.He suggeste amitriptyline for visceral insensitivity, but that stuff knocks me out and makes me a zombie. I've tried it twice - that's enough. He also suggested seeing a psycholgist to learn to tolerate the sensation of rectal fulness. Hey, he sounds like you. But it's not just a sensation. He even noted that there was some stool present during his examination, although there wasn't much at the time. I have not been able to talk with him since then about the letter.The thing is that he was an extremely nice guy, gave me an incredibly long session, apologised for the length of the letter to the doctor and even said that I was an interesting chap. I think he said that because I had done my research (thanks principally to this group) and explored different options and he enjoyed the challenge of considering my 'interesting' case.It is important to say too that, although, I don't seem to have adverse reactions to most of the food groups, what I eat definitely has a great impact on my digestion and I am on a self-imposed restricted dietary regime.


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## Jeffrey Roberts (Apr 15, 1987)

I have been wading through this long thread and it seems that everyone is trying to post accurate and non-anecdotal information, which is very helpful. It's pretty clear that there is a grey area in this illness and perhaps symptoms don't necessarily meet each and every criteria.That being said, I think this thread has gone as long and as far as it's going to go and and I urge the participants to be as helpful and constructive in other discussions on the BB.Jeff


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