# Non gi complaints and IBS



## eric (Jul 8, 1999)

FYIIBS ï¿½ Beyond the Bowel: The Meaning of Co-existing Medical ProblemsOlafur S. Palsson, Psy.D.William E. Whitehead, Ph.D. http://www.med.unc.edu/wrkunits/2depts/med...the%20bowel.pdf article is available in PDF format and you may click on the appropriate star to bring up the PDF version. If you do not already have Adobe Acrobat Reader on your computer which is needed to read these files, you may download it for free by clicking the button below. http://www.adobe.com/products/acrobat/readstep2.html


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## mdonbru (Oct 15, 2003)

Thanks, Eric. Interesting article. I have often thought about this very issue, and wondered if there is a connection between some of my other chronic complaints and IBS. (I am newly diagnosed with IBS after years of symptoms). Sounds like they may be making some sort of progress in this area - but of course no real answers yet. I was surprised to find that I can honestly say I have 9 of the non-bowel symptoms on that list - never really thought too much about them as a group - just figured they were all unrelated. And perhaps they are.The stuff about somatization makes some sense to me - I think I have a tendency to do that. I also believe I have a tendency to be overly aware of what's going on in my body. I always figured that was a good thing, and has served me well in many circumstances. But perhaps it would be better to be less aware and worried about body signals. I'll have to give it more thought.Previous experiences with psychotherapy have not been helpful for my physical symptoms, with the exception of biofeedback for headaches. (is that considered psychotherapy?) But possibly with a therapist trained in specifically focusing on pain I could make some progress. I am not interested in trying a bunch of drugs until I have tried some other things first. My doctor wants to send me to a gastro, but I'm putting it off.This article gives me food for thought.Thanks again.Marty


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## kel1059 (Feb 28, 2003)

I give these guys some credit for recognizing that there might be "SOMETHING BIOLOGICALLY WRONG". You got that right --gentlemen!there is something "biologically wrong".It may very well pertain to fatty acids, prostaglandins, and leukotrienes. What else can have such a profound impact over so many different areas of the body?Why else would so many people see so many of their problems shriveling away after taking Ibsacol. Ibsacol has a profound effect on prostaglandins. Prostaglandins have a profound effect on the lower brain, immune system, nervous system....Palsson, Whitehead-- read the works of one of your colleagues -Dr Douglas Hunt. he claims that a very likely "unifying" factor in so many illnesses has to do with our fatty acids. --could there be a 'fatty acid metabolic disorder' -- maybe. He thinks that esters --such as those found in Ibsacol-- can be unbelievably powerful in correcting some basic dysfunction. He is dead on correct.***********ibsnewbie, don't fall for that psychobabble about somatization. you are NOT somatizing!!! your problems are 100% FOR REAL!!!! None of us are "somatizing" --- we all experience everything that we state. In fact, most of us have symptoms that we are not even discussing because other symptoms DROWN the minor ones out.eric, are you exagerating your symptoms??? I did NOT think so.****************all of these disorders are going to come down to a few factors such as:1. *overconsumption of sugar and junk food* 2. genetic weaknesses3. altered bowel flora (dysbiosis)4. essential fatty acid deficiencies (corrected with ESTERS and fish oil)5. certain food intolerances (wheat, dairy, corn, etc)6. women NOT breastfeeding their kids (this is the most foolish practice that Westerners have ever committed.)7. stress (stress which is part of the Western culture --specifically... being drilled that we must conform to some hollywood standard...or that we must buy product 'X' or we are not good enough.....or the stress that comes from a hard-driving culture based on money and production)8. fill in the blank


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## eric (Jul 8, 1999)

IBSnewbie, here is some more for you.Also, have you tried HT?Anyway, more of the picture.From Medscape GastroenterologyMEDLINE Abstracts: Serotonin Signaling and Visceral Hypersensitivity in IBSPosted 10/23/2003 What's new concerning the role of serotonin signaling and mechanisms of visceral hypersensitivity in the pathophysiology of irritable bowel syndrome IBS? Find out in this easy-to-navigate collection of recent MEDLINE abstracts compiled by the editors at Medscape Gastroenterology.--------------------------------------------------------------------------------Serotonin and Its Implication for the Management of Irritable Bowel SyndromeGershon MDRev Gastroenterol Disord. 2003;3suppl 2:S25-S34Our understanding of the enteric nervous system ENS has evolved from the "classical" view, in which the brain controls all enteric behavior, to the current view, which holds that enteric innervation is one of local control within the bowel, modified by a bidirectional "dialogue" with the brain. The ENS independently controls enteric reflexes through intrinsic primary afferent neurons, which monitor intraluminal conditions. This monitoring is accomplished through the use of enteroendocrine cells in the mucosa, the best known of which are the serotonin-containing enterochromaffin cells. This article describes the roles that serotonin, specific serotonin-receptor subtypes, and the serotonin reuptake transporter play in the ENS and in the communication between the ENS and central nervous system. The way in which these findings have implicated serotonin in irritable bowel syndrome is discussed.Systematic Review: Serotonergic Modulators in the Treatment of Irritable Bowel Syndrome--Influence on Psychiatric and Gastrointestinal SymptomsKilkens TO, Honig A, Rozendaal N, Van Nieuwenhoven MA, Brummer RJAliment Pharmacol Ther. 2003 ;17:43-51Background: Both central and peripheral serotonergic modulators are used in the treatment of irritable bowel syndrome. The majority of patients with irritable bowel syndrome presenting to a gastroenterologist demonstrate affective dysregulation. Serotonin may play a regulatory role in both gastrointestinal motility and sensitivity, as well as in affective dysregulation, in irritable bowel syndrome.Aim: To analyse, systematically, randomized controlled trials studying the influence of serotonergic modulators on both gastrointestinal and psychiatric symptoms in irritable bowel syndrome, in order to elucidate baseline irritable bowel syndrome symptomatology and possible differential effects of serotonergic modulation on this symptomatology.Methods: A standardized qualitative analysis was performed of studies investigating the influence of serotonergic modulators on both gastrointestinal and psychiatric symptoms in irritable bowel syndrome using a blind review approach. The studies were ranked according to their total quality score maximum 100 points.Results: Eleven studies fulfilled the entry criteria, six of which scored above 55 points. An association between gastroenterological and psychiatric changes was present in five of the six studies.Conclusions: The results strengthen the serotonergic association between gastroenterological and psychiatric symptoms. Adjusted guidelines for combined gastrointestinal and psychiatric assessments are recommended in order to further elucidate the serotonergic interaction between gastrointestinal and psychiatric symptoms.Tegaserod and Other Serotonergic Agents: What Is the Evidence?Chey WDRev Gastroenterol Disord. 2003;3suppl 2:S35-S40Through effects on gastrointestinal motor and secretory function as well as visceral sensation, serotonin 5-HT plays a key role in the pathogenesis of irritable bowel syndrome IBS. In particular, 5-HT3 and 5-HT4 receptors appear to be very important in IBS. This article critically appraises the evidence supporting the use of the 5-HT3 receptor antagonist alosetron in the treatment of women with diarrhea-predominant IBS. The safety profile and restricted-use program for alosetron is also reviewed. This discussion is followed by a comprehensive review of the efficacy and safety data in support of tegaserod for women with constipation-predominant IBS.Sex Differences of Brain Serotonin Synthesis in Patients With Irritable Bowel Syndrome Using Alpha-11CMethyl-L-Tryptophan, Positron Emission Tomography and Statistical Parametric MappingNakai A, Kumakura Y, Boivin M, et alCan J Gastroenterol. 2003;17:191-196Background: Irritable bowel syndrome IBS is the most common functional bowel disorder and has a strong predominance in women. Recent data suggest that the brain may play an important role in the pathophysiology of IBS in the brain-gut axis. It is strongly suspected that serotonin 5-HT, a neurotransmitter found in the brain and gut, may be related to the pathophysiology of IBS. It is reported that a 5-HT3 antagonist is effective only in female patients with diarrhea-predominant IBS.Objective: In the present study, 5-HT synthesis was measured using positron emission tomography, with alpha-11Cmethyl-L-tryptophan as the tracer, in patients with IBS. The aim of the present study was to compare 5-HT synthesis in the IBS patients with that in the controls, and to compare 5-HT synthesis between male and female IBS patients.Methods: Six male and six female nonconstipated IBS patients were scanned. Age-matched healthy volunteers were scanned as controls. Eighty minute dynamic scans were performed. Functional 5-HT synthesis images were analyzed using statistical parametric mapping.Results: 5-HT synthesis was greater only in the female IBS patients in the right medial temporal gyrus multimodal sensory association cortex compared with the female controls P<0.001.Conclusions: The greater brain 5-HT synthesis in the female IBS patients than in the controls may be related to the pathological visceral pain processing of the IBS patients, a larger female predominance of the disorder, and the sex difference of the efficacy of the 5-HT3 antagonist in treatment.Sex-Related Differences in IBS Patients: Central Processing of Visceral StimuliNaliboff BD, Berman S, Chang L, et alGastroenterology. 2003;124:1738-1747Background & Aims: Women have a higher prevalence of irritable bowel syndrome IBS and possible differences in response to treatment, suggesting sex-related differences in underlying pathophysiology. The aim of this study was to determine possible sex-related differences in brain responses to a visceral and a psychological stressor in IBS.Methods: Regional cerebral blood flow measurements using H 2 15 O positron emission tomography were compared across 23 female and 19 male nonconstipated patients with IBS during a visceral stimulus moderate rectal inflation and a psychological stimulus anticipation of a visceral stimulus.Results: In response to the visceral stimulus, women showed greater activation in the ventromedial prefrontal cortex, right anterior cingulate cortex, and left amygdala, whereas men showed greater activation of the right dorsolateral prefrontal cortex, insula, and dorsal pons/periaqueductal gray. Similar differences were observed during the anticipation condition. Men also reported higher arousal and lower fatigue.Conclusions: Male and female patients with IBS differ in activation of brain networks concerned with cognitive, autonomic, and antinociceptive responses to delivered and anticipated aversive visceral stimuli.Functional Brain Imaging in Irritable Bowel Syndrome With Rectal Balloon-Distention by Using fMRIYuan YZ, Tao RJ, Xu B, et alWorld J Gastroenterol. 2003;9:1356-1360Aim: Irritable bowel syndrome IBS is characterized by abdominal pain and changes in stool habits. Visceral hypersensitivity is a key factor in the pathophysiology of IBS. The aim of this study was to examine the effect of rectal balloon-distention stimulus by blood oxygenation level-dependent functional magnetic resonance imaging BOLD-fMRI in visceral pain center and to compare the distribution, extent, and intensity of activated areas between IBS patients and normal controls.Methods: Twenty-six patients with IBS and eleven normal controls were tested for rectal sensation, and the subjective pain intensity at 90 ml and 120 ml rectal balloon-distention was reported by using Visual Analogue Scale. Then, BOLD-fMRI was performed at 30 ml, 60 ml, 90 ml, and 120 ml rectal balloon-distention in all subjects.Results: Rectal distention stimulation increased the activity of anterior cingulate cortex 35/37, insular cortex 37/37, prefrontal cortex 37/37, and thalamus 35/37 in most cases. At 120 ml of rectal balloon-distention, the activation area and percentage change in MR signal intensity of the regions of interest ROI at IC, PFC, and THAL were significantly greater in patients with IBS than that in controls. Score of pain sensation at 90 ml and 120 ml rectal balloon-distention was significantly higher in patients with IBS than that in controls.Conclusion: Using fMRI, some patients with IBS can be detected having visceral hypersensitivity in response to painful rectal balloon-distention. fMRI is an objective brain imaging technique to measure the change in regional cerebral activation more precisely. In this study, IC and PFC of the IBS patients were the major loci of the CNS processing of visceral perception.Role of Visceral Sensitivity in the Pathophysiology of Irritable Bowel SyndromeDelvaux MGut. 2002;51 suppl 1:i67-i71Visceral hypersensitivity has been recognised as a characteristic of patients with irritable bowel syndrome IBS. It may be involved in the pathogenesis of abdominal pain/discomfort, and seems to result from the sensitisation of nerve afferent pathways originating from the gastrointestinal tract. From a clinical point of view, hypersensitivity, although frequent, is not a constant finding among patients with IBS and cannot therefore be considered as a diagnostic marker of the condition. The advances made in understanding visceral hypersensitivity in patients with IBS are reviewed: the factors that influence abdominal distension are defined and different therapeutic perspectives are examined.www.medscape.com/viewarti...02/7001/-1


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## eric (Jul 8, 1999)

FYIIrritable Bowel Syndrome:How Far Do You Go in the Workup? http://www.med.unc.edu/wrkunits/2depts/med..._the_workup.htm


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## Guest (Nov 7, 2003)

I answered this on the hypno forum too.... I can vouch for the benefits of CBT and psychotherapy.It's often a matter of how we are able to look at things. And we can re-train ouselves to view things from different perspectives as long as the "think machine" is well-oiled and in good condition... if it isn't... there's always a pill or two that can help.Evie


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