# The Brain in the Gut: Irritable Bowel Syndrome



## JeanG (Oct 20, 1999)

This Article is from CBS Healthwatch, and the url is: http://healthwatch.medscape.com/medscape/p...B=0&Channel=nan The Brain in the Gut: Irritable Bowel SyndromeDebra Galant, Medical WriterAll of the women in Georgia Witkin's family had gut problems. Her grandmother was told that the problems were all in her head and was "sent home with a guilt trip," Witkin says. Her mother was told she had a spastic colon and was "sent home with pain killers." And, at the age of 17, Witkin herself was diagnosed with colitis and "sent home with a heating pad."All wrong. What Witkin suffers from--and what she believes her mother and grandmother probably suffered from--was actually irritable bowel syndrome or IBS. Witkin is a PhD, and director of the Stress Program at the Mt. Sinai School of Medicine. She is the author of The Female Stress Syndrome (Newmarket Press, 1991) and other books about stress.Mysterious IllnessIBS is one of the most common diagnoses in the United States--and one of the least understood. It is estimated to affect one in five American adults, 70% of them women. The confusion about IBS stems from the fact that it is a "functional" disorder, and its diagnosis is based on the presence of certain symptoms rather than on any physical evidence. The diagnosis is often made only after extensive diagnostic testing to rule out other problems, such as Crohn's disease.The symptoms of IBS are painful, and often embarrassing. The primary complaint is abdominal pain (which can sometimes be severe)--often accompanied by an urgent need to go to the bathroom. Not surprisingly, these and other symptoms of the disease (diagnosis is complex and can involve seven or eight other symptoms) can come to dominate a person's life. Sufferers may miss work, avoid outdoor activities, and plan--or perhaps more likely, cancel--trips around the availability of bathrooms. The symptoms of IBS are painful, and often embarrassing. In a recent national survey of 1,014 American women with IBS, two out of three said they were concerned about the availability of a bathroom every time they left the house, and one in three said they avoided group outings. Another 18% said it affected their sex lives.IBS sufferers also report that their condition has enormous impact on their work, including their choice of careers. On average, they had lost 8 days of work due to sickness over the past year. Some 27% said they had to get up much earlier for work, and 24% had to allow extra time for their commute. The survey was underwritten by Glaxo Wellcome, a pharmaceutical company that is developing the drug Lotronex, which is now under Food and Drug Administration review as a treatment for the symptoms of IBS. Gut ReactionsMuch of the mythology involving irritable bowel syndrome concerns the role of stress in the disease. Many sufferers have been told for years that the problem is "in their brain." In fact, this advice is just partially right. While IBS is not caused by stress, stress does seem to make it worse. Says Dr. Lin Chang, co-director of the UCLA/CURE Neuroenteric Disease Program, the problem is that there is a "second brain" located in the gut.This "second brain" is medically known as the "enteric nervous system." But even well outside medical circles, people are familiar with the expressions such as "gut reaction" and "visceral response." These common phrases refer to the fact that the bowels often register an immediate response to stress, often before the brain has figured out quite what's going on. It's theorized that IBS sufferers may simply have oversensitive enteric nervous systems going into overdrive when encountering perceived threats--whether those threats are mild abdominal gas, the lack of a bathroom nearby, or actual physical danger.In fact, Chang reports that studies are currently being conducted on the use of selective serotonin reuptake inhibitors, or SSRIs, in treating IBS. SSRIs (a type of antidepressant) are frequently prescribed for anxiety. If they prove successful in treating problems of the enteric system as well, this might also help to explain why IBS is so much more common in women than in men. Women have lower levels of serotonin, an important component of mood regulation, than men, but their serotonin levels are raised by SSRIs. It has also been noticed that gastric distress often worsens during the premenstrual period--another possible link between mood and women and IBSBiofeedback, a medical technique in which patients are taught how to slow their own heart rates, may also benefit IBS sufferers. Witkin warns, however, that patients shouldn't blame themselves if they try to relax but still suffer from bowel irritation. Many women erroneously believe they can "think their way out" of the condition, she says. When they don't, they feel like they've failed, she adds.One tangible step that women with IBS can take is to keep a food diary, because different foods aggravate different women. Some IBS food triggers include fatty foods, dairy products, and chocolate.And there is hope, even for people from families with notoriously bad digestive tracts. Witkin's daughter--"the lawyer," as her proud mother says with a smile--has broken her family's long chain of IBS suffering, even though she gets plenty of stress. Her gut is just fine--even though she works for New York City's mayor, Rudolph Giuliani.Feel My PainWomen with irritable bowel syndrome say the number 1 symptom of the disease is not bloating or diarrhea, but pain. In a recent national poll, they were asked to rate that pain on a scale of 1 to 10. With 1 being "hardly noticeable" and 10 being "completely incapacitating," IBS sufferers definitely leaned toward excruciating: 6.29 overall. Their doctors, however, estimated their patients' pain considerably lower, at 5.10. Unlike love, pain is apparently not in the eye of the beholder. Measuring the depth of somebody else's pain is one of the age-old riddles of medicine, or parenting for that matter. Mostly we have to rely on reports from the patient herself, whether that means a 1-to-10 rating scale, a color scale for younger patients, or simply a patient's description of pain. But Richard S. Weiner, PhD, executive director of the American Academy of Pain Management, says that astute practitioners can also use direct observation. "Suffering can be deduced by grimaces of the face," he says.Depending on the condition causing pain, other measurements can be used as well. The July issue of the American Journal of Pain Management, for example, contains an article that suggests that range-of-motion measurements can provide an objective tool in treating patients with chronic musculoskeletal pain. Weiner points out that there's a distinction to be made between pain and suffering--with "pain" representing the actual insult to body tissue and "suffering" representing the "learned response" to pain. The learned response begins with one's earliest experiences, such as when a child falls off a bike, he says. "Obviously, there is tissue [damage]. That's the pain," says Weiner. "But the learned response will vary depending on the caregiver's reaction." That could range to a great deal of fussing over the fall to advice to get back in the saddle right away.But Weiner says more objective measurements of pain--based on the levels of chemical endorphins in the blood--are not far off. Soon, he believes, there will be a blood test to confirm what some of us have been telling our dentists for years: that we actually have a low threshold for pain.


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## Guest (Sep 11, 2000)

Jean,Thanks for posting this article! Very interesting!Brandi


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