# Medscape: Inflammatory Bowel Disease and IBS: Separate or Unified?



## Jeffrey Roberts (Apr 15, 1987)

Inflammatory Bowel Disease and Irritable Bowel Syndrome: Separate or Unified?from Current Opinion in GastroenterologyPosted 07/15/2003Sylvie Bradesi, PhD, James A. McRoberts, Ph.D, Peter A. Anton, MD, Emeran A. Mayer, MDAbstract and IntroductionAbstractBoth irritable bowel syndrome and inflammatory bowel diseases share symptoms of altered bowel habits associated with abdominal pain or discomfort. Irritable bowel syndrome has been referred to as a functional bowel disorder, which is diagnosed by a characteristic cluster of symptoms in the absence of detectable structural abnormalities. Inflammatory bowel disease is a heterogeneous group of disorders characterized by various forms of chronic mucosal and/or transmural inflammation of the intestine. In this review, the authors discuss recent evidence suggesting several potential mechanisms that might play a pathophysiologic role in both syndromes. Possible shared pathophysiologic mechanisms include altered mucosal permeability, an altered interaction of luminal flora with the mucosal immune system, persistent mucosal immune activation, alterations in gut motility, and a role of severe, sustained life stressors in symptom modulation. It is proposed that similarities and differences between the two syndromes can best be addressed within the framework of interactions between the central nervous system and the gut immune system. Based on recent reports of low-grade mucosal inflammation in subpopulations of patients meeting current diagnostic criteria for irritable bowel syndrome, therapeutic approaches shown to be effective in inflammatory bowel disease, such as probiotics, antibiotics, and antiinflammatory agents, have been suggested as possible therapies for certain patients with irritable bowel syndrome.Complete article here: http://www.medscape.com/viewarticle/457728_1 Curr Opin Gastroenterol 9(4):336-342, 2003. ï¿½ 2003 Lippincott Williams & Wilkins


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## earthgarden (Jun 3, 2003)

I believe that by administering drugs that we are not attempting to resolve the problems, only mask them. I believe that in many cases of IBS, tho am not sure about IBD (maybe in part), the cause is due to lack of a suitable diet, that is lacking in vitamins and minerals and is too high in fat/sugar and salt.


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## Jupiter119 (Aug 8, 2001)

EarthgardenIBD is an autoimmune disease. No-one knows the cause of it. I am someone who has been very into healthy foods for YEARS, cooking from scratch and ensuring my diet is good.I'm not going to justify myself here as I don't feel the need to.I will say that IBD rarely responds to diet. You won't get remission from diet alone if your IBD is severe although it can bring relief to some symptoms. If you have two feet of bowel severely ulcerated the large intestine can't hold your waste matter. Whatever you eat will affect it.


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## earthgarden (Jun 3, 2003)

Could convenience food, or perhaps food containing pesticides or hormones, or too high in fact,sugar,salt cause ulceration to the intestines? It is possibly that we eat too much, too often and the wrong foods that causes the problems in the first place that then go on to cause IBD and perhaps worse? Possibly, but the truth is not known is it? Possibly because drug companies and food companies don't really want us to know? The fact remains, however, obesity in western world is increasing. As a digestive problem, it cannot hurt, surely, to promote a healthy, balanced and portionately correct diet to those where it is already a problem?


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## Jupiter119 (Aug 8, 2001)

**************************************************Could convenience food, or perhaps food containing pesticides or hormones, or too high in fact,sugar,salt cause ulceration to the intestines? It is possibly that we eat too much, too often and the wrong foods that causes the problems in the first place that then go on to cause IBD and perhaps worse? Possibly, but the truth is not known is it?*************************************************Well then, why don't half, or more of the population have IBD?I refuse to justify myself but if you knew what my lifestyle & diet were like you'd wonder "why has this person got IBD".**************************************************it cannot hurt, surely, to promote a healthy, balanced and portionately correct diet to those where it is already a problem? **************************************************I don 't dispute this. I noticed you're advising people to drink those powdered soups between meals if hungry. Surely this is junk food.. I wouldn't touch them. Also the promotion of peppermint oil capsules. Are these Colpermin? Have you checked out the ingredients? Blue food colouring? Healthy??


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## earthgarden (Jun 3, 2003)

True, the soups aren't good - i have also said that it's better to make your own! And whilst the colpermin isn't ideal, at least it does help when one overeats.No, I don't know what your diet is like. I am only speaking from my own experience and that of other members of my family who are also experiencing digestive disorders of one kind or another.I believe that as we age, our bodies do not work as efficiently as they did when we were younger. They need a little more help and putting a strain on the digestive system, is very unkind to our bodies.I do not speak for half of the population, only myself and offering my suggestions to perhaps ease others problems, is my way of trying to help others. I am not trying to make you angry or upset, dear. The fact of the matter is that eating disorders and obesity are increasing.


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## stavros (Nov 24, 2002)

In some patients there is both IBD and IBS, I had inconclusive biopsies , many tests etc, finally I was treated with a 5ASA compound, Pentasa. It was slow , months but I am alive again, not cured, but much better. I can now tolerate soluble fibre, nothing helped before Pentasa. This drug has few side effects, slow dose increases at the start. The hardest thing was to get my Doctor to try it without a certain diagnosis. You have to push and persist, there is overlap patients with IBD and IBS. Even if biopsies aren't Conclusive. Remember Much of small bowel can't be got at to biopsy.


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## Caroleenie (Nov 5, 2003)

I have both IBS and Crohns disease. The "wonderful" medical profession told me I had IBS 6 years ago. After two years of suffering terribly and about 5 doctors later they found Crohns. I had surgery 4 years ago as I could no longer function and I am STILL waiting to feel better! Now they are telling me again after all the tests that it is IBS AGAIN and that you can have both at the same time. Tell me I am not confused at this point. "we found no regrowth of crohns......... so .........er ........um .......you have IBS.....yeah that's it.........OY I say. I am looking into a parasitic theory and have really never been the same since a trip to Mexico years ago. Didn't they think ulcers were stress related and then they found a bacterial cause and they are now treated with antibiotics!!??Thanks for listening Carolyn


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## Mike NoLomotil (Jun 6, 2000)

"Could convenience food, or perhaps food containing pesticides or hormones, or too high in fact,sugar,salt cause ulceration to the intestines?"Actually the abnormal inflammatory response seen in IBS diarrheics is termed loss of oral oelrance or, by some who have done in vivo food provocation studies of this in Sweden, "intestinal allergy".This is because similar inflammatory mediators are released in repsonse to chaklenge of the small bowel mucosal and cellular immune system as are seen in food allergy, but no circualtin IgE antibodies to the foods are detectible.There ar about (8) pathways related to these cell mediated reactions which result from oral tolerance dysfunction...but each regardless has a common end point and common origin: end point is release of an array of proinflammatory mediators which affect gut and systemic functions creating symptoms...and origin is a breakdown in the oral tolerance system (ability of the immune system to differentiate safe food from unsafe pathogens...but it is a delayed dose dependent reaction as opposed to sudden and sever and non-dose dependet reaction as occurs in food allergy).There is actually much more in the worldwide medical literature about this phenomenon than has been read by most in the USA as which physician can read everything....and/or there is selection-bias employed as to what to include and not include in trying to understand IBS.Many clinicians, academicians, researchers, therapists, and lay people alike tend to focus on and adopt the findings of those investigations which fit our preconceived notions or personally espoused theories, and reject those which do not.Inclusivity and objectivity however, reveal that the whole IBS pathop[hysiology is much different than has been presumed for years and is far from being some mystical "functaional" disease.In fact the term is way past obsolete but is so ingrained in dogma it weill take some years for it to be shed. Espeially when opinion leadetrs coin such a phrase...it takes time to make it quietly go away without self-refutation.This is irrelvant as symantics do not define disease...the body reveals the facts sooner or later when our ability to see them catches up.The pathways to this weird abnormal immune response seen now in IBS, linking in in some ways to IBD's...whose definition may need to be expanded...seem to be dysbiosis in its many forms (wghich will disrupt proper digestive funtion and as a consequence disrupt the oral tolerance mechanisms balance) as well as indeed your suggestion concerning additives and such is apt.Brostoff has pionted out that the chemical load in the Americn diet has io=ncreased dramatically within one generation...as much as 40 POUNDS of chemcials by solid weight must be processed and deroxified per year by the liver and related enzymes...have we been able to adpat that quickly? Doubtful.Tw books, one for patients and one for doctors, can shed some light on such thingsï¿½FOOD ALLERGIES AND FOOD INTOLERANCE: THE COMPLETE GUIDE TO THEIR IDENTIFICTION AND TREATMENTï¿½, Professor Jonathan Brostoff , M.D.. Allergy, Immunology and Environmental Medicine, Kingsï¿½ College, London http://www.amazon.com/exec/obidos/ASIN/089...6487508-3420903 FOOD ALLERGY AND INTOLERANCE, Professor Jonathan Brostoff, MD, Stephen Challacombe, MD (NEW 2002) http://www.amazon.com/exec/obidos/ASIN/070...product-details ...as can an extensive study of all the research published over the last 30 years realted to immuen repsonse to food, bowel dysfunction in absence of allergy, IBS, and digresive studies such as systemic aberrent immune response to food antigens.When you do this you get a much different picture than you get if you just read the main GI journals....a broader perspective.Some threads from this community on the subject with rousing discussions from days gone by http://www.ibsgroup.org/ubb/ultimatebb.php...ic;f=1;t=033220 http://www.ibsgroup.org/ubb/ultimatebb.php...ic;f=4;t=000616 MNL


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## catlady (Feb 22, 2005)

Has anyone looked at possible correlations between allergy (ige protein missing from blood) and IBD or IBS?I think there is a correlation that is observable in my own family...CATLADY


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