IBS, Irritable Bowel Syndrome

Entity / Miasms

• IBS is a disease which contain two main entities Anxiety + Illeeus and two optional entities Constipation or Diarrhae
• Autonomic nervous system disturbance is the key factor in its pathology.
• If Sympathetic nervous system is over activated, the patient has Diarrhea and in parasympathetic hyperactivity, the patient is constipated.

	PLV	RBS	VZV	EBV
Anxiety	+++	+++	+++	+++
Illeus	+++	+++	+++	+++
Constipation				+++
Diarrhea		+++	+++	+++

So

• IBS-D: RBS, VZV, EBV
• IBS-C: EBV
• IBS-mixed: EBV

IBS, A genuine motility disorder

• I prefer to start IBS with wonderful abstract of Greger Lindberg: "New diagnostic techniques have advanced our knowledge about the IBS. The majority of patients that we believed to have a psychosomatic disorder have received other diagnoses explaining their symptoms. Endoscopy makes it possible to diagnose celiac disease before it leads to malnutrition and allows the detection of microscopic colitis as a cause of watery diarrhea. At the severe end of the symptom spectrum enteric dysmotility marks the border at which IBS ceases to be a functional disorder and becomes a genuine motility disorder.

• Joint hypermobility or Ehlers-Danlos syndrome is present in a substantial proportion of patients with enteric dysmotility.
• CIPO (Chronic intestinal pseudo-obstruction) is the end-stage of a large number of very rare disorders in which failed peristalsis is the common denominator.
• Nutritional needs and symptom control are essential in the management of pseudo-obstruction.
• Home parenteral nutrition is life saving in more than half of patients with chronic intestinal pseudo-obstruction."

• Intestinal motility disorder caused by Sympathetic/ Parasympathetic disorder. The role of interstitial Cajal cells in intestinal peristaltic movement in diseases such as Achalasia, GERD, CIPO and post-infection IBS (PI IBS) has been almost proven.
• The mechanism of IBS disease is the imbalance of the intestinal autonomic system.

Gut dysbiosis

• Disruption of microbiota: Disturbance of the balance of normal intestinal flora microbes causes Leaky Gut Syndrome, which means that the intestine becomes permeable to foreign antigens and as a result the occurrence of autoimmune diseases.
• This issue is so important that some believe in the triangle of genetics, environment and Gut Dysbiosis in the formation of their diseases.

Enteric nervous system

Two nerve networks are responsible for the movement and secretion of enzymes related to food digestion in the intestine:

1. Extrinsic Nervous system = Sympathic / ParaSympathic
2. Enteric nervous system= ENS

• Studies have confirmed the key role of ENS in IBS.
• Extrinsic disorders are divided into two types, LMN and UMN, and occur in diseases such as MS and PD.

• ENS itself has different parts in which serotonin plays the most important role . Therefore the critical role of serotonin in IBS is not accidental.

• Various pathologies can also involve ENS, for example, types of colitis such as Microscopic Colitis, which are divided into two types, (1) Lymphocytic and (2) Collagenic, and are related to IBD and IBS-D diseases, and MTB also plays a role in them.

• But only two diseases specifically involve ENS
  1. Hirschsprung
  2. Ogilvie syndrome

Sign / Symptoms

• Changes in the pattern of defecation
• Abdominal Pain / Discomfort
• Chronic symptoms with Recurrent attacks
• Urgency for stool or Tenesmus (incomplete evacuation) or bloating.
• Symptoms are relieved by dedecation.
• These symptoms are due to changing in the continuity and frequency of bowel movements.

Related disease

• GERD
• Interstitial cystitis/ Bladder pain syndrome
• Fibromyalgia
• Headache, backache, and psychiatric symptoms such as depression and anxiety.
• Sexual dysfunction, typically reduction in libido. (33%)

4 Subtypes

• Diarrhea (IBS-D)
• Constipation (IBS-C)
• Mixed IBS (IBS-M)
• Unspecified (IBS-U)

IBS Subtypes	Entities	Miasms
IBS-D	Ileus Gasteroentritis / Diarrhea	RTV CMV
IBS-C	Ileus Constipation	EBV
IMS-M	Ileus Constipation Diarrhea	EBV

3IFMC Cluster Of Entities

• Here we have one of most famous COD, named 3IFMC which includes IBS, CFS, Fibromyalgia , Impotence, Interstitial cystitis and MDD
• As I mentioned in MDD chapter, its main miasms are EBV, CMV, PLV, HSV-1 and HSV-2.

Remedies

Banerji protocols
First line	Tub C200, one dose daily Nux-v C30 two doses daily
Second line	Ign C200, one dose daily Chel C30 + Merc-v two dose daily
Third line	Aloe C200 one dose daily esp in indigested stool