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

Entities	PLV	RBS	VZV	EBV
Anxiety	+++	+++	+++	+++
Illeus	+++	+++	+++	+++
Constipation				+++
Diarrhea		+++	+++	+++
Subtypes
IBS-D		+++	+++	+++
IBS-C				+++
IBS- mixed				+++

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 defecation.
• 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%)

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.

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

Documented Remedies

• Asaf, Lyc, Nat-m, Ars, Nux-v
  • One of the studies in the 2019 review also used Asaf as a homeopathic treatment.
  • A 2019 meta-analysis Trusted Source found that asaf was effective in reducing global IBS symptoms.
  • Another homeopathic remedy that the 2021 study.

Remedies

		Modalites
Lyc	IBS with food intolerances The inflamed digestive tract struggles to get enough nutrition from food, so there can be loss of weight + Abdomen Fullness / Bloating Appetite is very changeable and can go from being ravenous to very full after a few mouthfuls.	Onions, Oysters, Cabbage and beans. Pains agg in the evening, typically from 4- 8 pm Pain amel by passing wind.
Coloc	Terrible stomach cramps Pains are Short / Sharp / Pinching and Pains extend to Lower back / Buttocks	Amel with doubling up Agg from anger or indignation. Agg after eating esp fruits Heat & pressure amel pain
Nux-v	Their stressful lifestyle disturbs their digestive system Severe stomach cramps and acid reflux Hiccups, belching, fullness and indigestion There can also be a lot of nausea and feelings of being sea-sick.	Agg after coffee, spicy foods Agg with smoking. agg by mental exertion.
Ars	Stomach cramps that agg after taking cold. They always feel chilly, Agg with cold food such as ice cream Diarrhea after Alcohol whilst moving around makes everything worse.	Amel with taking regular sips of a warm drink Amel with lying down to rest
Arg-n	A lot of wind, with very loud and forceful belching or flatulence. Nausea and indigestion in Nervous / Anxious, esp when	Agg in anticipating a stressful event.
Sul	Stomach cramps agg by touch Burning pains agg in Morning / Night Increased Appetite esp around 11am + All-gone sensation. Heavy Stomach immediately after eating.
Bry	Thirsty Stomach may feel so heavy, like a stone Belching amel the pain and tastes of undigested food.	Agg after eating bread Agg after Tight clothing Agg after walking about
Carb-v	Older people or those suffering from general fatigue with stomach pains Stomach burning, sore or pressing. Stomach cramps / Being contracted with Dyspepsia + Weakness or Faintness.	A lot of bloating after eating (Flatulence) Butter/ Fats/ Rich foods cause belching, heartburn and indigestion
Chin	Stomach acidity with a great deal of bloating & bitter or sour belching. The appetite swings from being ravenous to being completely off food + Feeling of fullness after eating a small amount. Slow Digestion Pains are pressing or sore.	Fruit and milk agg and the
Nat-m	Indigestion after too much starchy food with sour belching & terrible hiccough. Painful stomach cramps, agg by touch.	Strong emotions such as grief or stewing on the past can agg