IBS, Irritable Bowel Syndrome: Difference between revisions

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=== 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.
{| class="wikitable"
|+
!
!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. <ref>Karolinska Institutet, Department of Medicine, Huddinge and Karolinska University Hospital Huddinge, Patient Area Gastroenterology, Dermatology, and Rheumatology, SE-14186, Stockholm, Sweden. Electronic address: greger.lindberg@ki.se.</ref>
 
* Joint hypermobility or Ehlers-Danlos syndrome is present in a substantial proportion of patients with enteric dysmotility.
* [[CIPO, Chronic idiopathic intestinal pseudo obstruction entities|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." <ref>Lindberg G. Pseudo-obstruction, enteric dysmotility and irritable bowel syndrome. Best Pract Res Clin Gastroenterol. 2019 Jun-Aug;40-41:101635. doi: 10.1016/j.bpg.2019.101635. Epub 2019 Jul 22. PMID: 31594655.</ref>
 
* Intestinal motility disorder caused by Sympathetic/ Parasympathetic disorder. The role of interstitial Cajal cells in intestinal peristaltic movement in diseases such as [[Achalasia]], [[GERD, Gastroesophageal Reflux Disease|GERD]], [[CIPO, Chronic idiopathic intestinal pseudo obstruction entities|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 miams|Gut Dysbiosis]] in the formation of their diseases. <ref>Autoimmunity and the Gut Andrew W. Campbell<sup>*</sup> Autoimmune Dis. 2014; 2014: 152428.</ref>
 
 
=== Enteric nervous system ===
Two nerve networks are responsible for the movement and secretion of enzymes related to food digestion in the intestine:
 
# Extrinsic Nervous system = Sympathic / ParaSympathic
# Enteric nervous system= ENS
 
* Studies have confirmed the key role of ENS in IBS.
* Extrinsic disorders are divided into two types, [[LMN, Lower motor neuron entities|LMN]] and [[UMNS, Upper Motor Neuron Syndrome entities|UMN]], and occur in diseases such as [[MS, Multiple Sclerosis|MS]] and [[Parkinson disease|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, Mycobacterium tuberculosis|MTB]] also plays a role in them.
 
* But only two diseases specifically involve ENS
*# [[Hirschsprung disease entities|Hirschsprung]]
*# [[Ogilvie syndrome miasms|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, Gastroesophageal Reflux Disease|GERD]]
* [[Interstitial cystitis]]/ Bladder pain syndrome <ref>Chang KM, Lee MH, Lin HH, Wu SL, Wu HC. Does irritable bowel syndrome increase the risk of interstitial cystitis/bladder pain syndrome? A cohort study of long term follow-up. Int Urogynecol J. 2021 May;32(5):1307-1312. doi: 10.1007/s00192-021-04711-3. Epub 2021 Feb 23. PMID: 33620539.</ref>
* [[Fibromyalgia]] <ref>The Association of Irritable Bowel Syndrome and Fibromyalgia Lin Chang, MD Associate Professor of Medicine, Co-Director of the UCLA/CURE Neuroenteric Disease Program, Director of the UCLA Motility Unit</ref>
* Headache, backache, and psychiatric symptoms such as [[Major depressive disorder|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)
 
{| class="wikitable"
|+
!IBS Subtypes
!Entities
!Miasms
|-
|IBS-D
|
* Ileus
* Gasteroentritis / Diarrhea
|
* RTV
* CMV
|-
|IBS-C
|
* Ileus
* Constipation
|EBV
|-
|IMS-M
|
* Ileus
* Constipation
* Diarrhea
|EBV
|}
 
=== [[3IFMC COE|3IFMC]] [[Cluster Of Entities]] ===
 
* Here we have one of most famous COD, named 3IFMC which includes IBS, [[CFS, Chronic Fatigue syndrome|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.

Revision as of 23:45, 4 November 2023

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. [1]
  • 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." [2]
  • 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. [3]


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.


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

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.
  1. ↑ Karolinska Institutet, Department of Medicine, Huddinge and Karolinska University Hospital Huddinge, Patient Area Gastroenterology, Dermatology, and Rheumatology, SE-14186, Stockholm, Sweden. Electronic address: greger.lindberg@ki.se.
  2. ↑ Lindberg G. Pseudo-obstruction, enteric dysmotility and irritable bowel syndrome. Best Pract Res Clin Gastroenterol. 2019 Jun-Aug;40-41:101635. doi: 10.1016/j.bpg.2019.101635. Epub 2019 Jul 22. PMID: 31594655.
  3. ↑ Autoimmunity and the Gut Andrew W. Campbell* Autoimmune Dis. 2014; 2014: 152428.
  4. ↑ Chang KM, Lee MH, Lin HH, Wu SL, Wu HC. Does irritable bowel syndrome increase the risk of interstitial cystitis/bladder pain syndrome? A cohort study of long term follow-up. Int Urogynecol J. 2021 May;32(5):1307-1312. doi: 10.1007/s00192-021-04711-3. Epub 2021 Feb 23. PMID: 33620539.
  5. ↑ The Association of Irritable Bowel Syndrome and Fibromyalgia Lin Chang, MD Associate Professor of Medicine, Co-Director of the UCLA/CURE Neuroenteric Disease Program, Director of the UCLA Motility Unit
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