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BPS model redundant in IBS

Demepivo

Dolores Abernathy
Messages
411
Interesting spot by @Keith Geraghty in the New England Journal of Medicine. Looks at change from BPS model to physiological one. Looking at infection, inflammation, gut biome & nervous system

http://www.nejm.org/doi/full/10.1056/NEJMra1607547

Irritable Bowel Syndrome
Alexander C. Ford, M.D., Brian E. Lacy, M.D., and Nicholas J. Talley, M.D., Ph.D.

N Engl J Med 2017; 376:2566-2578June 29, 2017DOI: 10.1056/NEJMra1607547

SOURCE INFORMATION
From the Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, and the Leeds Gastroenterology Institute, St. James’s University Hospital, Leeds, United Kingdom (A.C.F.); the Section of Gastroenterology and Hepatology, Dartmouth–Hitchcock Medical Center, Lebanon, NH (B.E.L.); the Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia (N.J.T.); the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (N.J.T.); and Karolinska Institute, Stockholm (N.J.T.).

Old BPS model

Old BPS model.JPG


Newer physiological one

Newer physiological one.JPG


The full paper is available from Sci Hub

https://sci-hub.cc/10.1056/NEJMra1607547
 
Last edited:

Demepivo

Dolores Abernathy
Messages
411
IBS has traditionally been thought of as a brain–gut disorder . In susceptible persons (e.g., those with a genetic predisposition or exposure to environmental factors), an abnormal stress response, in combination with psychological distress (e.g., anxiety, depression, or somatization), and an infectious or inflammatory response may alter intestinal permeability and initiate a cascade of events (e.g., infiltration of inflammatory cells, localized edema, and release of cytokines or chemokines) that results in the development of IBS symptoms.

Recent data show that immunocytes may play an important role in some patients. Coexisting depression, somatization, and catastrophization may also mediate changes in gut permeability, the immune system, and the microbiome, leading to the development of IBS symptoms.

The presence of IBS symptoms may exacerbate symptoms of anxiety, depression, or somatization, further intensifying the gastrointestinal symptoms. Emerging data show that in up to half of patients with IBS, gastrointestinal symptoms develop first, with subsequent development of mood disorders (Panel B).

Changes in the gut microbiome and the release of inflammatory mediators may be responsible for the central nervous system (CNS) disorders that arise after the development of IBS symptoms.22 The ensuing psychological distress may further exacerbate IBS symptoms.
 

ljimbo423

Senior Member
Messages
4,705
Location
United States, New Hampshire
Interesting thread! I did a search and couldn't find this study posted. It found exhausted T cells in IBS.

Exhausted Immune Cells Linked To Irritable Bowel Syndrome

All patients with diarrhea-predominant irritable bowel syndrome (IBS-D) were found to have the same kind of exhaustion in their T-cells.

“For the first time, we’ve discovered that in patients with irritable bowel syndrome associated with diarrhoea, their T-cells seem to be ‘out of puff’ or run down,” Dr Hughes says.

“These normally active immune cells are less responsive to stimulation, secreting fewer mediators and dividing less. This type of response is often observed in chronic infections.

link
 

Demepivo

Dolores Abernathy
Messages
411
A refreshing change, I'd almost forgotten what it felt like!

There are similar models to this IBS one are being developed by Mady Horning & Flute & Mella for ME.

Infection, inflammation, gut biome, nervous system, the brain... It's incredibly complicated piecing everything together but the links are slowly coming together.

I guess scientists are working on similar models across the range of autoimmune & inflammatory conditions.

It's all there in the scientist literature.... It's Saturday evening, so leave it until Monday.... Have a beer if you can tolerate it :)
 

ljimbo423

Senior Member
Messages
4,705
Location
United States, New Hampshire
There are similar models to this IBS one are being developed by Mady Horning & Flute & Mella for ME.

Infection, inflammation, gut biome, nervous system, the brain... It's incredibly complicated piecing everything together but the links are slowly coming together.

I guess scientists are working on similar models across the range of autoimmune & inflammatory conditions.

It's all there in the scientist literature.... It's Saturday evening, so leave it until Monday.... Have a beer if you can tolerate it :)

This is really good news! I'm very much looking forward to more researchers making "the connections"!