# Lots of Misconceptions Re: IBS Causes, Knowledge, Attitudes - Interesting Reading!



## cookies4marilyn

http://www.newswise.com/articles/view/515548/?sc=rsmnDescriptionSignificant misconceptions about the causes of their condition and mistaken beliefs about its potential progression into other diseases, including cancer, marks the knowledge of a sample of patients with Irritable Bowel Syndrome. Newswise â€" Significant misconceptions about the causes of their condition and mistaken beliefs about its potential progression into other diseases, including cancer, marks the knowledge of a sample of patients with Irritable Bowel Syndrome (IBS) in two recent studies by researchers at Dartmouth-Hitchcock Medical Center in New Hampshire. Presented at the 70th Annual Scientific Meeting of the American College of Gastroenterology, these studies echo findings presented at ACG by Dr. Albena Halpert of Boston Medical Center and colleagues at the University of North Carolina at Chapel Hill on patient perceptions of IBS and their preferences about patient education.Dartmouth-Hitchcock Study Finds Significant Concerns and Misconceptionsâ€œIBS is one of the most common medical conditions, and our study reveals that a lot of people are facing a problem, they donâ€™t feel well, they have significant concerns, and they donâ€™t have enough information,â€ said Brian E. Lacy, Ph.D., M.D., one of the investigators at Dartmouth-Hitchcock who conducted two separate analyses of 261 respondents to study questionnaires. In one analysis, Dr. Lacy and his colleagues found that almost half (42.9 percent) of respondents believed that IBS develops due to food allergy or intolerance, while an even larger percentage (82 percent) reported that a change in their daily routine causes IBS. Significant misconceptions were identified regarding the natural history of IBS, with one-third of respondents believing that once IBS develops it will never resolve, and 16.7 percent expressing the belief that IBS will turn into cancer. Of these patients, 87 percent reported that IBS significantly affects their lives, with daily activities (40.1 percent), work life (19.3 percent) and social life (11.2 percent) being the most frequently affected.In a related study of the same survey respondents, Dr. Lacy and his colleagues found that this sample of patients with IBS did not understand the causes of their condition. A large percentage cited dietary factors (80.7 percent), anxiety (87.9 percent), and depression (68.2) as the most frequent causes of IBS. IBS patients in this study believe that IBS increases the risk of colon cancer (21.5 percent) and increases the risk of Inflammatory Bowel Disease (30.5 percent). IBD is an inflammatory condition of the intestine that can result in bleeding, fever, elevation of the white blood cell count, as well as diarrhea and cramping abdominal pain. IBD includes ulcerative colitis and Crohnâ€™s disease.â€œThis is the first study to assess IBS patientsâ€™ knowledge regarding their disorder. Our findings highlight the need for effective educational programs for IBS patients,â€ concluded Dr. Lacy.National Survey on Patient Education in IBSAlbena Halpert, M.D. of Boston Medical Center and Douglas Drossman, M.D., FACG of the University of North Carolina at Chapel Hill developed and fielded a questionnaire to identify patientsâ€™ perceptions about IBS, their preferences on the type of information they need, as well as educational media and expectations from health care providers. Responses from 200 patients with IBS revealed misperceptions about IBS developing into other conditions, including colitis, malnutrition and cancer. This survey found IBS patients were most interested in learning about foods to avoid (60 percent), causes of IBS (55 percent), medications (58 percent), coping strategies (56 percent), and psychological factors related to IBS (55 percent). The respondents indicated that they wanted their physician to be available via phone or e-mail following a visit (80 percent) and have the ability to listen (80 percent), provide hope (73 percent) and support (63 percent).About Irritable Bowel SyndromeIBS is a functional gastrointestinal (GI) disorder characterized by recurring symptoms of abdominal discomfort or pain associated with an altered bowel habit, either constipation, diarrhea, or both. More than 58 million people suffer from IBS, which affects more women (80%) than men. IBS is a real medical condition, but it is not life threatening, and will not lead to other serious diseases. In IBS, the GI tract may function differently, processing more slowly (or more quickly) than the average person. While the cause of this different â€œpaceâ€ of the GI tract in IBS is not known, and there is no cure, there are usually ways to help manage specific symptoms. Physicians now have more scientific knowledge and an improved range of treatment options that can provide relief for IBS sufferers. The American College of Gastroenterology has resources for patients with IBS online at http://www.ibsrelief.org and free educational materials are available by calling ACGâ€™s toll-free hotline 866-IBS-RELIEF.About the American College of GastroenterologyThe ACG was formed in 1932 to advance the scientific study and medical treatment of disorders of the gastrointestinal (GI) tract. The College promotes the highest standards in medical education and is guided by its commitment to meeting the needs of clinical gastroenterology practitioners. Consumers can get more information on GI diseases through the following ACG-sponsored programs============================================


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## legbuh

What a wonderful way to say "we don't know what this is!" lolIt's like saying "people have sore feet. We're not sure if it's from walking all day, tight shoes, sand in their socks, or if they simply walk on coals all day..."Once they grasp the concept we're all different (at least in a few different categories of "causes") then they can hanker down and figure out what's best for each person with IBS instead of one "cure all"!Sorry, felt like ranting. I know pointless BS when I hear it... as they'd say in the tech business "just reboot, and if that doesn't work, reinstall windows..." LOL!


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## karoe

The IBS section of the American College of Gastroenterologists is...........just absolutely STUNNING in its fabulous waste of time and space to say NOTHING. Message to patients: there are no remedies and we don't know what it is. Message to doctors: tell patients there is nothing serious wrong with them and basically no therapy we have works. There, I did it in two sentences!!!!!!!!!!


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## eric

FYI"But it turns out that irritable bowel syndrome, like depression, is at least in part a function of changes in the serotonin system. In this case, it is too much serotonin rather than too little.In a healthy person, after serotonin is released into the gut and initiates an intestinal reflex, it is whisked out of the bowel by a molecule known as the serotonin transporter, or SERT, found in the cells that line the gut wall.People with irritable bowel syndrome do not have enough SERT, so they wind up with too much serotonin floating around, causing diarrhea. The excess serotonin then overwhelms the receptors in the gut, shutting them down and causing constipation."http://ibsgroup.org/eve/forums/a/tpc/f/71210261/m/369100861


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## Talissa

(Another) FYI~Canadian Journal of Gastroenterology"Recent studies are identifying a basis for these neural changes â€" low grade inflammation in the gut â€" which may play a key role in IBS....IBS therefore may begin as an inciting event injuring the bowel followed by an inability to down-regulate the subsequent inflammation. The reason for this ongoing inflammation is not clear, but interestingly, patients with IBS are less likely to have high-producer IL-10 gene alleles (40), similar to patients with inflammatory bowel disease. IL-10 plays a significant anti-inflammatory role; if IL-10 were produced in low levels, mild inflammation could persist.Other potential causes of continued low-level inflammation in the GI tract include food allergies and changes in bacterial microflora. Allergic reactions can evoke inflammatory cell infiltration in the GI tract (41), but the prevalence of food allergies in IBS is unclear (42). Gut microflora may be altered in patients with IBS (43); some findings suggest that IBS patients may have intestinal bacterial overgrowth (44) and increased colonic fermentation (45). Further information is needed to elucidate the role of these environmental factors in promoting and perpetuating the putative low-grade inflammatory process...."http://www.pulsus.com/Gastro/18_10/andr_ed.htmSerotonin?...."...Inflammation appears to downregulate SERT,[56] although whether this is selective remains to be determined...." http://www.medscape.com/viewarticle/514413_6American Journal of Gastroenterology Nov 05"Commensal bacteria inhabiting the human intestine (i.e., intestinal microflora) participate in the development and maintenance of gut sensory and motor functions, including the promotion of intestinal propulsive activity....Recent interest has also been directed to the potential role of intestinal microflora in the pathogenesis of the irritable bowel syndrome. Although the status of intestinal microflora in the irritable bowel syndrome remains unsettled, small intestinal bacterial overgrowth (as detected with breath testing) and increased fermentation of foods with gas production, provide indirect evidence that microflora may contribute to symptom generation in irritable bowel syndrome..."http://www.ncbi.nlm.nih.gov/entrez/query.f...9914&query_hl=3


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## eric

The first paper is again on PI IBS.Talissa, what does this really mean. "inability to down-regulate the subsequent inflammation."?"Another mechanism that lends credence to physiology as the source of intestinal dysfunctions is the system of mast cells in the gut that have an important role in immune response."During stress, trauma or 'fight or flight' reactions, the barrier between the lumen, the interior of the gut where food is digested, and the rest of the bowel could be broken, and bad stuff could get across," Dr. Wood said. "So the big brain calls in more immune surveillance at the gut wall by activating mast cells." These mast cells release histamines and other inflammatory agents, mobilizing the enteric nervous system to expel the perceived intruders, and causing diarrhea. Inflammation induced by mast cells may turn out to be crucial in understanding and treating GI disorders. Inflamed tissue becomes tender. A gut under stress, with chronic mast cell production and consequent inflammation, may become tender, as well. In animals, Dr. Mawe said, inflammation makes the sensory neurons in the gut fire more often, causing a kind of sensory hyperactivity. "I have a theory that some chronic disorders may be caused by something like attention deficit disorder in the gut," he said."http://ibsgroup.org/eve/forums/a/tpc/f/71210261/m/369100861 "Jack Wood, PhDProfessor of Physiology and Internal MedicineChairman Emeritus, Department of PhysiologyThe Ohio State University College of Medicine Dr. Wood was the first to use microelectrodes to record the electrical and synaptic behavior of neurons in the enteric nervous system. He coined the term "brain-in-the-gut" in view of emerging evidence that the enteric nervous system had neurophysiological properties like the brain and spinal cord. In recent years he has focused on signaling interactions between the enteric immune system and the brain-in-the-gut during infectious enteritis and food allergy. In this lecture he shows how the central nervous system, enteric nervous system and intestinal immune system are integrated during physical and emotional stress to produce irritable bowel symptoms of diarrhea and abdominal pain and discomfort."http://www.conference-cast.com/ibs/GUIs/bios.cfmand"Serotonin?...."...Inflammation appears to downregulate SERT,[56] although whether this is selective remains to be determined...."They are working on this and it has to do with the brain and the immune responce."Recent research has shown that the cascade of signals in the proinflammatory immune response tend to cause the amino acid tryptophan to break down into kynurenic acid rather than serotonin, a brain chemical that influences mood. â€œThatâ€™s extremely interesting,â€says Fallon, â€œbecause serotonin depletion seems to be involved in depression. So you can see a very clear mechanism whereby people with chronic immune activation can become depressed.â€"Recent interest has also been directed to the potential role of intestinal microflora in the pathogenesis of the irritable bowel syndrome. Although the status of intestinal microflora in the irritable bowel syndrome remains unsettled"Newer""Anti-inflammatory Effect of ProbioticsNumerous studies have shown an anti-inflammatory effect but the study by McCarthy et al.[30] is of particular interest since it showed a benefit in the interleukin-10-knockout mouse model of colitis using two probiotic bacteria, Lactobillus salivaris and Bifidobacterium infantis, which have since been used in IBS patients (see below). The same group also demonstrated that bacteria did not need to be living to be effective. Nor did they need to be administered orally but could be effective when given subcutaneously,[31] showing that the anti-inflammatory *effect is systemic * with a generalized decrease in proinflammatory cytokines.""L. salivaris and B. infantis, as McCarthy et al..[30] Only B. infantis was demonstrated to improve composite symptom scores as well as abdominal pain, bloating and distension.[33**] Like previous studies, this showed a small improvement in symptoms but, unlike previous studies, they also demonstrated a mechanism by measuring the release of cytokines by peripheral blood lymphocytes. "http://ibsgroup.org/eve/forums/a/tpc/f/431...m/596105671/p/6 "small intestinal bacterial overgrowth (as detected with breath testing) ""Another diagnostic test that has increasingly gained interest in this setting is the breath test to detect small intestinal bacterial overgrowth (SIBO). It has been proposed that many IBS patients have symptoms due to the presence of SIBO, as measured by the lactulose breath test, which has been detected in as much as 78% to 84% of patients.[39,40] Harris and colleagues[41] presented a retrospective chart review assessing the presence of GI symptoms, in particular those associated with IBS, in patients referred for glucose hydrogen breath tests for SIBO. *They predicted that lactulose breath testing overpredicted the actual prevalence of SIBO in IBS.* Glucose hydrogen breath testing has a sensitivity of 75% for SIBO[42] compared with the sensitivity of 39% with lactulose breath testing for the "double-peak" phenomenon characteristic of SIBO.[43] There has been considerable debate regarding the accuracy of the lactulose breath test compared with small bowel aspirates to detect the number of bacteria, which has been considered the gold standard for diagnosing SIBO.[44] Of the 182 patient charts reviewed, 113 patients (88 women; mean age, 58 years) met the Rome II criteria for IBS (IBS-D, 56%; IBS-C, 32%; and IBS-A, 12%).[41] *Only 11% of these patients had a positive breath test for SIBO.* The study authors concluded that etiologic factors other than SIBO are likely involved in the pathophysiology of IBS. Despite the standard use of the Rome II diagnostic criteria for IBS, the prevalence of SIBO in these patients appears to vary widely depending on the patient population and type of methodology used."http://www.medscape.com/viewarticle/517739"increased fermentation of foods with gas production"One of the reasons for this is food gets trapped behind in these areas.







on the last one you posted you left this out, did you do that purposely?"On the other hand, intestinal motility represents one of the major control systems of gut microflora, through the sweeping of excessive bacteria from the lumen."


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## Talissa

Hey Eric,Debated whether to respond to the above post because, well, I really don't have the time or the inclination anymore to debate w/ you. Peace & love...I just want to say, concisely, that I didn't "purposely" leave anything out. I wanted to be concise & to the point--a concept you may want to try on for size...For ex, I could've included the following sentence that you mentioned AS WELL AS its following sentence..."On the other hand, intestinal motility represents one of the major control systems of gut microflora, through the sweeping of excessive bacteria from the lumen. There is emerging evidence indicating that changes in *this bidirectional interplay * contribute to the pathogenesis of gut diseases..."ORThe sentence that preceeded the medscape citation..."However, *recent evidence suggests that this promoter, which determines SERT production in the brain and platelets, may not determine production in the gut*, because in both human and mice intestine there is a novel promoter 12.6 base pairs downstream.[61] Inflammation appears to downregulate SERT,[56] although whether this is selective remains to be determined...."So after all, it doesn't necessarily mean its like depression...it can start in the gut...I could've included those & more. But I wanted to be clear. Peace & love, T-


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## eric

"There is emerging evidence indicating that changes in this bidirectional interplay contribute to the pathogenesis of gut diseases..."This does not surprize me at all. "contribute"This is a picture of problem in the gut of IBS they KNOW is malfunctioning. The 5ht3 receptor is malfunctioning. Which explains d and c and d/c. There arte in the process of figuring out why that happens. However, they KNOW it is happening. The vast majority of IBSers exhibit serotonin dysregulation of the serotonin system.


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## eric

FYI on IL-10 Interleukin 10 genotypes in irritable bowel syndrome: evidence for an inflammatory component?Gonsalkorale WM, Perrey C, Pravica V, et al.Gut. 2003 Jan; 52(1):91-3.BACKGROUND AND AIMS: Inflammation may play a role in the pathogenesis of irritable bowel syndrome in some individuals, such as in those who develop symptoms following a dysenteric illness. Persisting inflammation, resulting from an imbalance of cytokines regulating the inflammatory response, is one possible mechanism. As the elaboration of cytokines is under genetic control, this study was designed to establish whether there might be a genetic predisposition to an altered pattern of anti-inflammatory cytokine production in patients with irritable bowel syndrome. SUBJECTS: A total of 230 unselected patients with irritable bowel syndrome and 450 healthy, ethnically matched controls were studied. METHODS: DNA was extracted from peripheral blood leucocytes of subjects. Allele and genotype frequencies were determined for the anti-inflammatory cytokine interleukin 10 at the site (-1082) concerned with production in lymphocytes. Transforming growth factor beta(1) (codons 10 and 25) genotypes were also examined in a smaller group of subjects. RESULTS: Patients with irritable bowel syndrome had significantly reduced frequencies of the high producer genotype for interleukin 10 than controls (21% v 32%; p=0.003). There was no apparent relationship with any particular bowel habit subtype. Genotypes for transforming growth factor beta(1) were not altered. CONCLUSIONS: These preliminary results suggest that at least some patients with irritable bowel syndrome may be genetically predisposed to produce lower amounts of the anti-inflammatory cytokine interleukin 10. This lends some support to the hypothesis that there may be an inflammatory or genetic component in some cases of this condition and that further studies in specific irritable bowel syndrome subgroups are justified


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## administrator

Before the "battle of the abstracts" goes any further this thread is being locked.This is the behavior that tends to lead to the endless debate problem that we keep asking people to avoid engaging in. While good information is important long threads consisting mostly of abstracts does little to support people who are suffering.Thank you for your attention.


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