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How to understand the mechanism of chronic diseases of the digestive system?

Messages
92
How to understand the mechanism of occurrence of feelings of stagnation, heaviness and aching pain in the right hypochondrium?
I understand that this may be due to impaired neural regulation, impaired acidity, infection, dysbacteriosis and unhealthy diet. But all these cases are treatable: prokinetics, antispasmodics, antacids, acids, antibiotics, diets. I tried all these tools, and if it’s logical to reason, then one of them should help. But in my case, nothing helps!
How can this be? Or am I missing something?
 

kangaSue

Senior Member
Messages
1,851
Location
Brisbane, Australia
How to understand the mechanism of chronic disease of the digestive system? That's the $64,000 question and I'm sure that if I knew the answer to it, I could easily turn it into a $64,000,000 fortune.

The easy answer here though is that yes, you are missing something if none of these things are getting to a cause and one thing that I'm familiar with that can be the cause of similar symptoms is MALS (Median arcuate ligament syndrome).

This is a physical vascular anomaly (diaphragm compressing the celiac artery) that will not resolve with meds or diets, only surgical intervention. It is also not uncommon for this to go undiagnosed for ten, twenty, thirty years or more as it can chug along with only minor symptoms before it becomes a severe problem.

No doubt there are a number of other possibilities to explore but this is one "known unknown" to start with that may be detected simply by having any doctor listen to your epigastric area for any evidence of a bruit. Not everyone with MALS has this though and the next step is screening with a Doppler ultrasound of the mesentery arteries.
 
Messages
92
@kangaSue, thank you for answer. Unfortunately, I did a dopplerography of the abdominal arteries, and no abnormalities were detected. Phenibut helped me once: I felt healthy tone in my stomach, no discomfort or stagnation. But because of the side effects (headaches, sleep problems and sedation), I had to stop taking it.
I remembered that long before the appearance of CFS and digestive problems, I already had muscle fatigue. When I was in the army service, it was difficult for me to go up the stairs to the second floor, because my legs felt tired. I want to be tested in this direction. Perhaps this will give some useful information.
 

kangaSue

Senior Member
Messages
1,851
Location
Brisbane, Australia
thank you for answer. Unfortunately, I did a dopplerography of the abdominal arteries, and no abnormalities were detected.
It happens all the time where MALS has been consistently missed with a Doppler U/S study until the patient strike a sonographer who actually has experience with testing for this condition and knows the correct technique for finding it, and that is deeply inhaling then sharply exhaling. It is the exhale motion that produces the strongest compression of the celiac artery.

A CT Angiogram can be the best imaging mode to see the celiac artery narrowing but it's also common to require multiple CTA's before someone who knows their stuff picks it up.

With your problems starting out as one of muscle fatigue though, I'd also look down the path of antibody testing in the way of ANA and ENA panels, and consider the Mayo DYS1 panel (Autoimmune Dysautonomia) which tests for a number of antibodies known to affect muscle function.
 

Hip

Senior Member
Messages
17,824
How to understand the mechanism of occurrence of feelings of stagnation, heaviness and aching pain in the right hypochondrium?

Chronic enterovirus can cause pain or tenderness at certain points in the abdomen (see the image half way down this article), but I am not sure about the right hypochondrium (which I believe corresponds to the liver).
 

BeADocToGoTo1

Senior Member
Messages
536
Have your liver, gallbladder, and pancreas been checked properly?

Have you looked at the following tests?

1. MRI MRCP with contrast - Gives a great picture of pancreas and ducts, gallbladder and ducts, liver, stomach, intestines.

2. Genova Diagnostics - FMV - Gives a great overall picture of nutrient deficiencies, microbiome dysbiosis, pancreatic enzyme issues, and many more. Biochemistry and metabolomics in practice. This test should be standard for all primary care and family practice doctors as a regular preventative maintenance test, and for anything chronic or hard to diagnose. Great Plains Laboratories has similar tests. These might be the ones you have already done, as you mentioned OAT.

3. Genova Diagnostics - Comprehensive Digestive Stool Analysis 2.0 with Parasitology (microbiome dysbiosis indicators), Fecal Fat Distribution (checks if you have issues with different types of fat intake and digestion), Elastase (for EPI, pancreas enzyme marker)and Chymotrypsin (for EPI, pancreas enzyme marker). Doctor's Data has similar tests.

4. 24 hour fecal fat test - Simple, cheap and tests if you are breaking down fat properly, which can indicate pancreas dysfunction.
 

Wayne

Senior Member
Messages
4,300
Location
Ashland, Oregon
There's bugger all else left in life when humour and obvious parody gets censored too.
Since this is being commented on, I thought I'd let everybody know that I was the one who reported the post. I did so because sudden and unexpected movements on my screen are fairly painful for me. I do my best to avoid these things online, and look at this forum as a safe place to come to. I had thought the policy here at PR is to not have these kinds of "movements", so I reported the post. Can't remember exactly what I said, but I seem to recall inquiring what PR policy is on this. -- Sorry to be a debbiedowner. :oops:
 

Wayne

Senior Member
Messages
4,300
Location
Ashland, Oregon
this is going to seem like a real radical suggestion but why not just scroll past it … takes oh one second
Hey @prioris -- Sorry that this still does not seem to be sitting well with you. -- To answer your question, the reason scrolling past it in one second doesn't work for me is because a "startle reflex" has already set in. Depending on the severity, a startle reflex can take a few minutes to several hours to recover from. Which is often a relatively painful recovery process. Sensory processing disorder is not an easy one to live with.
how does one even get on the internet without seeing moving images especially ads
I do my best to avoid moving images the best I can, and use ad blockers when I'm online. It doesn't always work obviously, but when I'm on other sites, I kind of go into a "geared up" mode--which takes a lot of energy--to help me withstand unexpected things popping up. Sometimes I just can't do it, and have to come back later if it's something really important.

When I come to Phoenix Rising, I generally go into a mode of relaxation, and attentiveness, looking for little gems that may be applicable to help me improve things for myself. I suppose it could even be described as going into somewhat of a contemplative mode. So when I get relaxed and feeling safe from regular online "commotion", it can be quite jarring for me when something pops up out of nowhere--so to speak.

I've been under the impression PR had a policy of now allowing these kinds of moving images, as I know many with ME/CFS have very similar problems. I still don't know what the official policy is. -- But just to assure you, I'm not trying to censor humor. I'm just hoping to be able to come to PR and relax, and even enjoy myself.

All the Best...
 
Messages
92
Recently I tried Lamotrigine and noticed that it works wonders with my gastrointestinal tract: a pleasant rumbling begins in my stomach, and the annoying discomfort gradually disappears. I feel much better!
Unfortunately, Lamotrigine also has a sedative effect for me and somewhat worsens sleep (a strange combination). But despite this, I am very glad that for the first time in recent years I discovered a new medicine that alleviates my problems with digestion.
But how? How does epilepsy medicine treat the gastrointestinal tract, despite the fact that I do not have epilepsy? If I figure this out, then maybe I can understand the mechanism of my gastrointestinal illness. Any ideas?
 

Wayne

Senior Member
Messages
4,300
Location
Ashland, Oregon
If I figure this out, then maybe I can understand the mechanism of my gastrointestinal illness. Any ideas?

Hi @yurybx -- Congratulations on finding something that alleviates some of your problems with digestion. As far as the mechanism, it likely has to do with the fact that this medication is a very strong anticholinergic drug. I just did a quick google search and came up with the following:

Commonly prescribed as an anti-epileptic/anti-seizure medication, carbamazepine has strong anticholinergic properties. Alternatives include lamotrigine (Lamictal) and gabapentin (Neurontin). Divalproex (Depakote) is another option for the prevention of seizures and has fewer anticholinergic effects.May 15, 2018​
Just to mention, anticholinergic drugs have been in the news lately, and have been highlighted as causing dementia and Alzheimer's disease. The reason being is that these drugs inhbit the acetylholine receptors in the body. These receptors are particularly concentrated in the brain and the brain. But they're also located throughout the body.

In the brain, acetylcholine is critical for creating memories, so if these acetylcholine receptors are blocked, it's pretty easy to see how it could lead to memory problems of all sorts. These drugs can also cause a number of other serious "side effects" which you may want to familiarize yourself with. I myself got a very serious case of tinnitus from taking just a single dose of an anticholinergic drug called Promethazine (also known as Phenergen).

As I did some research on it, I discovered that there's a condition called, "Anticholinergic Syndrome". Here's a quick definition:

Anticholinergic syndrome results from competitive antagonism of acetylcholine at central and peripheral muscarinic receptors. Central inhibition leads to an agitated (hyperactive) delirium - typically including confusion, restlessness and picking at imaginary objects - which characterises this toxidrome.​
I'm not sure why these drugs seem to give temporary relief for things like nausea, and perhaps other GI issues. I do know they're used in most cold medicines, and are also in asthma medications. This is also a primary mechanism in most anti-phsychotic drugs. Unfortunately, some people can end up having psychotic-like episodes from taking them, which obviously can be very serious.

Given how sensitive most people with ME/CFS are to drugs, I thought it would be a good idea to alert you to some of the potential downsides. Not to try to unduly influence you, but it may be worth considering other options, or to consider keeping your use of this drug to a minimum.

All the Best...
 
Last edited:

ljimbo423

Senior Member
Messages
4,705
Location
United States, New Hampshire
Recently I tried Lamotrigine and noticed that it works wonders with my gastrointestinal tract: a pleasant rumbling begins in my stomach, and the annoying discomfort gradually disappears. I feel much better!
Unfortunately, Lamotrigine also has a sedative effect for me and somewhat worsens sleep (a strange combination). But despite this, I am very glad that for the first time in recent years I discovered a new medicine that alleviates my problems with digestion.
But how? How does epilepsy medicine treat the gastrointestinal tract, despite the fact that I do not have epilepsy? If I figure this out, then maybe I can understand the mechanism of my gastrointestinal illness. Any ideas?


These might be possible reasons-

Anticonvulsants/mood stabilisers

Lamotrigine

In vitro

Good antibacterial activity against Gram-positive bacteria B. subtilis, S. aureus and S. faecalis. Inhibition of bacterial ribosome biogenesis
https://link.springer.com/article/10.1007/s00213-019-5185-8

Synthesis, antimicrobial activity of lamotrigine and its ammonium derivatives

All these complexes were tested in vitro for their antibacterial activity (Bacillus subtilis, Staphylococcus aureus, Enterococus faecalis, Escherichia coli, Pseudomonas aeruginosa and Enterobacter cloacae).

The results indicated that most of the complexes showed good antibacterial activity against Gram-positive (B. subtilis, S. aureus and S. faecalis), but showed mild, even inactive against Gram-negative bacterial strains.
https://link.springer.com/article/10.1007/s12039-009-0055-2
 

kangaSue

Senior Member
Messages
1,851
Location
Brisbane, Australia
But how? How does epilepsy medicine treat the gastrointestinal tract, despite the fact that I do not have epilepsy? If I figure this out, then maybe I can understand the mechanism of my gastrointestinal illness. Any ideas?
As with many meds, the mechanisms of action aren't fully elucidated and there are a number of anti-convulsant meds that have been found to alleviate symptoms in gastroparesis, but only in some cases, so I'd say that you just got lucky finding one that fitted with the cause of your particular GI dysfunction issue.

GI dysfunction can involve alteration in various ion channels (chloride, calcium and sodium) so maybe Lamotrigine, in being a sodium channel blocker, is addressing an issue there as a reason why it works for you.

Alternatively, there is evidence that Lamotrigine could have some clinical efficacy in some neuropathic pain conditions so maybe it's easing inflammation in the vagus nerve to let it work more efficiently on autonomic function?
https://www.drugbank.ca/drugs/DB00555