Irritable+Bowel+Syndrome

IBS
Irritable Bowel Syndrome (IBS) is a functional GI disorder characterized by abdominal pain/bloating/discomfort and altered bowel habits (diarrhea, constipation, or alternating constipation and diarrhea) in the absence of demonstrable organic pathology.

Conditions That Can Mimic IBS
• Cancer • Dietary factors that impact digestion such as excessive consumption of tea, coffee, carbonated beverages, and simple sugars • Diverticular disease • Infectious enteritis such as amoebiasis and giardiasis • Inflammatory bowel disease • Intestinal candidiasis • Lactose intolerance • Laxative abuse • Malabsorption diseases such as pancreatic insufficiency and celiac disease • Mechanical causes such as fecal impaction • Metabolic disorders such as adrenal insufficiency, diabetes, or hyperthyroidism • Microflora imbalance (dysbiosis) resulting from antibiotic or antacid use or poor diet

Epidemiology of IBS
• Incidence: 10-20% pop. • Most common GI d/o: 30-50% of GI referrals • 2-3:1 female/male • 2nd highest cause of missed work • $2-8 billion in direct medical costs in the US each year

Etiology and Pathogenesis of IBS
Etiology unknown; hypotheses include: • Abnormal gut motility • Visceral hypersensitivity • Enteric infection IBS • Hormonal factors • Psychological factors – depression, anxiety • Symptoms of IBS • Abdominal pain and/or cramping • Diarrhea, constipation, or alternating diarrhea and constipation • Flatulence and bloating • Mucus in stools • Depression, anxiety or stress

Types of IBS
1. Diarrhea-predominant (IBS-D) 2. Constipation-predominant (IBS-C) 3. Alternating diarrhea and constipation

At least 12 weeks or more, which need not be consecutive, in the preceding 12 months, of abdominal discomfort or pain that has 2 out of 3 features: • Relieved by defecation • Onset associated with a change in frequency of stool • Onset associated with a change in form (appearance) of stool

• Onset after age 50 • Weight loss • Fever • Recurrent vomiting

• **Stool studies** - to check for infection or malabsorption problems. Among the tests to rule out other causes for symptoms are the following: • **Flexible sigmoidoscopy** • **Colonoscopy** • **Computerized tomography (CT) scan** • **Lactose intolerance tests** • **Blood tests –** to check for Celiac disease (nontropical sprue) • Screen for Celiac Dz • Incidence in IBS = 5% • Healthy controls <1% • If diarrhea predominant sx - – Antigliadin Ab, antimysial Ab – Upper endoscopy with Bx if suspicious and Abs negative

• Diet (avoidance of known triggers and foods that can increase gas and bloating such as carbonated beverages, salads, raw fruits and vegetables, beans, cabbage, broccoli and cauliflower) • Lifestyle (exercise, stress reduction, counseling) • Medication • Medication • Adjunct only • Avoid chronic use • Use based on predominant sx • Lack of convincing evidence of efficacy

Rx Categories for IBS
• Anticholinergics • Tricyclic antidepressants • SSRIs • Antidiarrheals • Bulking agents • Laxatives • Alosetron* • Pain Sx • Antispasmodics - anticholinergics – Bentyl – Hyoscymine – Levsin, Symax • TCA’s – Low dose – Decrease visceral sensitivity, motility, secretions • Diarrhea predominant IBS • Loperimide (Lomotil) prn • Cholestyramine (Questran) • Ondansetron (Zofran) 5HT3 antagonist • Alosetron (Lotronex) 5HT3 antagonist • Constipation predominant IBS • Fiber (psyllium or methylcellulose) – patients with constipation are more likely to respond • Tegaserod (Zelnorm) HT4 Agonist – Studies valid for efficacy in women only

IBS and TCM
IBD can be categorized in terms of the following TCM disease categories: • Diarrhea (xìe xìe) • Abdominal pain (fù tòng) • Constipation (biàn bí)

TCM Etiology of IBS
• Emotional stress • Improper diet • Constitutional weakness, chronic illness, or aging leading to SP/ST vacuity
 * LV/SP disharmony is the core disease mechanism of this disease

IBS Manifesting as Liver Qi Attacking the Spleen
**Herbal Treatment:** __ Tong ____ Xie ____ Yao Fang ____ Jia ____ Wei ____ (Pain and Diarrhea Formula with Additional Flavors) __ [Bai Zhu (10g.), Bai Shao (15g.), Chen Pi (10g.), Fang Feng (10g.), Chai Hu (10g.), Zhi Ke (10g.), Mu Xiang (6g.), Gan Cao (6g.)]
 * Signs ** : recurrent, painful diarrhea and borborygmus induced by anger, frustration or depression, abdominal pain is somewhat relieved after diarrhea
 * Symptoms: ** stuffiness or distention in the chest, epigastrium, and hypochondrium, depression, anger/irritability, moodiness, belching, poor appetite, gas
 * Tongue: ** thin, white coat
 * Pulse: ** wiry
 * Treatment Principle: ** Soothe the Liver, regulate Qi, strengthen the Spleen
 * Acupuncture Treatment:**

** Signs ** : alternating diarrhea and constipation, diarrhea with sensation of incomplete defecation, mucus in stools, distention and pain in the abdomen, borborygmus **Herbal Treatment:** __ Wu Mei Wan ____ Jia ____ Wei __ __ ( ____ Mume ____ Pill with additional flavors) __ [Wu Mei (12g.), Zhi Fu Zi (3g.), Gan Jiang (6g.), Hua/Chuan Jiao (1.5g.), Gui Zhi (6g.), Xi Xin (1.5g.), Dang Shen (15g.), Dang Gui (10g.), Huang Lian (10g.), Huang Bai (6g.), Mu Xiang (6g.), Bai Zhu (10g.), Fu Ling (10g.)]
 * Symptoms: ** poor appetite, dry mouth, restlessness, cold abdomen
 * Tongue: ** red with greasy coating
 * Pulse: ** wiry, slippery
 * Treatment Principle: ** Harmonize the Stomach and Intestines

** Signs ** : dry stool with decreased frequency of bowel movements, straining required to defecate **Herbal Treatment**: __ Zeng ____ Ye Tang ____ (Increasing Fluids Decoction) + Ma Zi Ren Tang __ [Xuan Shen (15g.), Sheng Di Huang (10g.), Mai Men Dong (15g.)] + [Ma Zi Ren (15g.), Da Huang (3g.), Xing Ren (10g.), Bai Shao (10g.), Zhi Shi (6g.), Hou Po (10g.)]
 * Symptoms: ** abdominal distention and fullness, palpable “mass” (i.e., stool) in LLQ in severe cases, thirst, irritability, headache, insomnia, sweating in hands and feet
 * Tongue: ** red with scanty or dry coating
 * Pulse: ** wiry
 * Treatment Principle: ** Nourish Yin, moisten the intestines, clear Heat, and promote bowel movement.

• Alternate Rx for IBS Manifesting as Stomach and Intestine Fluid Deficiency __ Yi Guan ____ Jian __ __ Jia __ __ Jian ____ (All-the-Way Through Brew ____ with additions and subtractions) __ [Mai Men Dong (10g.), Sha Shen (10g.), Sheng Di Huang (10g.), Dang Gui (10g.), Chuan Lian Zi (10g.), Bai Shao (10g.), Suan Zao Ren (10g.)]

** Signs ** : loose or watery stools that may contain undigested food, increased frequency of bowel movement after after eating rich and greasy foods **Herbal Treatment:** __ Shen ____ Ling ____ Bai ____ Zhu San ____ Jia __ __ Jian ____ (Ginseng, ____ Poria ____, and ____ Atractylodes ____ Powder ____ with additions and subtractions) __ [Dang Shen (10g.), Bai Zhu (10g.), Fu Ling (10g.), Bai Bian Dou (10g.), Yi Yi Ren (15g.), Shan Yao (10g.), Lian Zi (10g.), Zhi Gan Cao (3g.), Sha Ren (6g.), Chen Pi (10g.), Mu Xiang (10g.)]
 * Symptoms: ** epigastric and abdominal fullness and distention (particularly after eating), poor appetite, sallow complexion, lassitude, fatigue
 * Tongue: ** pale with white coating
 * Pulse: ** thin, weak
 * Treatment Principle: ** Strengthen the Spleen and boost the Qi

A multifactorial disease like IBS requires a multifaceted approach to treatment to be successful: 1. Diet: it important to identify and eliminate any food sensitivities or allergies. ELISA, a blood test, is considered by many nutritionally oriented physicians be the best test for food allergies as it tests for a wide range of antibodies. Elimination diet and food challenge can be employed in lieu of laboratory methods, but it requires motivation on the part of the patient.

2. Diet (cont’d.): Elimination of refined sugars and highly processed foods is crucial to the treatment of this disease.

3. Exercise: daily, moderate exercise such as biking or walking can, in some cases, improve symptoms significantly all by itself.

4. Stress reduction: yoga, tai chi, and/or meditation should be strongly encouraged with this population.

5. Probiotics: supplementation with a high-quality probiotic (e.g., Jarrow Formulas) can be helpful to re-establish a healthy intestinal floral balance. 6. Counseling: in some cases, counseling and medication may be necessary as this population is highly prone to depression and anxiety.

The intestine is hypersensitive; as the passing of alimentary bolus brings about painful sensations and discomfort. This results in spasmodic and uncoordinated contractions of the intestinal muscles. And often leads to diarrhea or constipation accompanied by abdominal pain.

"In this biopathy, the patient experiences periodic attacks of abdominal pain, gas, and diarrhea or constipation. The condition is characterized by an abnormal irritability of the bowel with resultant abdominal distress. In most cases, the syndrome causes frequent but not debilitating discomfort. In a minority of cases, however, it causes severe enough pain to dominate the patient’s life. It is a fairly common illness, accounting for as many as 40% of all visits to gastroenterologists. In one study, it was estimated as much as 15-17% of the general population has symptoms related to this biopathy . The symptoms vary in severity from fullness and discomfort induced by the ingestion of food or drink to severe, cramp-like abdominal pain. This tends to be generalized over the abdomen, may shift from point to point, and usually is more noticeable in the lower than the upper abdomen."[|1]

It DOES NOT cause inflammation or alter the structure of the intestinal mucous membrane; nor does it increase the risk of colorectal cancer. It DOES NOT get worse over time, but can get in the way of life and impoverish quality of life.

=Causes= -Anger and stress linked to what is "retained" in the abdomen; in women, often following sexual abuse -Antibiotics -Intestinal permeability

Orgonomic Perspective of Etiology
The symptoms are based on a parasympathetic reaction to an underlying sympathetic excitation of the nerves serving the intestine, primarily the colon. Emotional stress or certain specific foods may trigger the appearance of symptoms. [|1]

=Solutions= Eliminate: -Alchohol -Caffeine -Artificial sweeteners (splenda, aspartame, sorbitol, mannitol, ect.) -Very fatty foods -Excessive consumption of simple carbohydrates -Raw fruits and cruciferious vegetables (in the case of diarrhea or gas)

=Treatment= -Enzymes -Pro- and prebiotics -Enteric capsules of peppermint oil -NAG (n-acetyl-glucosamine) -Eliminate allergenic food -Hypnosis -Psycho-energetic medicine, such as homeopathy or acupuncture

Orthomolecular Treatment
-Omega-6 - Arabinogalactan -Active Lb.