IBS is not "all in the mind"

Esther12

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Hi,

Correct me if I'm wrong but hasn't our friend Simon Wessely attempted to reclassify IBS as a mental disorder?
Oh no... he's far too sophisticated for that. It's not that he think IBS is a psychological problem, it's just that he thinks, for pragmatic reasons, it's best to treat it as if it is. Or something. Your mind is a result of the chemical operation of your gut, and it's time to abondon the naive dualism of the past. Something like that. Us lowly patients wouldn't understand.

Wonderful to hear their making progress with IBS though, I know a lot of CFS patients are troubled by it. For those with IBS, I'd have thought it's possible that the cause of the IBS could also be the cause of CFS... constant gut/digestive/etc problems must be a tiring strain upon the body. Hopefully we'll see some things moving foreard more rapidly now.
 

Marco

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Wonderful to hear their making progress with IBS though, I know a lot of CFS patients are troubled by it. For those with IBS, I'd have thought it's possible that the cause of the IBS could also be the cause of CFS... constant gut/digestive/etc problems must be a tiring strain upon the body. Hopefully we'll see some things moving foreard more rapidly now.
Definitely applies here. IBS has been one of the first symptoms and the most constant over the course of the illness. It always feels to me that most if not all the symptoms are aggravated when the IBS is worse (probably just me catastrophising!;)) and I always feel like the constant headaches and brain fog originate there. In fact I usually feel better before or a few hours after a meal once the 'distress' has eased.

I'm pretty sure, at least for a fair proportion of us, that the problems originate in the gut.
 

Enid

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He is just beyond discussion now. Except - catch up with the big wide world. With the help of international collaberation released at last from his grasp - they and we know more. Certain amount of humour in this part of the world - might get another dodgy diagnosis.
 

Mark

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Quote from the article:

Professor Michael Schemann's research team at the TUM Department for Human Biology has managed to demonstrate that micro-inflammations of the mucosa cause sensitization of the enteric nervous system, thereby causing irritable bowel syndrome. Using ultrafast optical measuring methods, the researchers were able to demonstrate that mediators from mast cells and enterochromaffin cells directly activate the nerve cells in the bowel. This hypersensitivity of the enteric nervous system upsets communication between the gut's mucosa and its nervous system, as project leader Prof. Schemann explains: "The irritated mucosa releases increased amounts of neuroactive substances such as serotonin, histamine and protease. This cocktail produced by the body could be the real cause of the unpleasant IBS complaints."
There are those mast cells again...
 

Carrigon

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One of the first symptoms I had in the 80's was IBS. And the first thing the idiot doctors told me was, "it's your nerves, you need to relax". Yeah, right. Prior to getting sick, I was not the nervous type. And I had never had a stomach problem before. Then they said it was a milk allergy and I should cut out all dairy products. Of course, never telling me to take vitamin D supplements or calcium supplements if I did that. Cutting out the dairy did not fix it. It took years for that to get better on its own. Now, what brings it back on me seems to be wheat. If I cut out breads and most wheat things, I don't have stomach problems. Soons as I start up with pizza or other bread based things, bang, I get the IBS symptoms back.
 

Cort

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Professor Michael Schemann's research team at the TUM Department for Human Biology has managed to demonstrate that micro-inflammations of the mucosa cause sensitization of the enteric nervous system, thereby causing irritable bowel syndrome. Using ultrafast optical measuring methods, the researchers were able to demonstrate that mediators from mast cells and enterochromaffin cells directly activate the nerve cells in the bowel. This hypersensitivity of the enteric nervous system upsets communication between the gut's mucosa and its nervous system, as project leader Prof. Schemann explains: "The irritated mucosa releases increased amounts of neuroactive substances such as serotonin, histamine and protease. This cocktail produced by the body could be the real cause of the unpleasant IBS complaints."

Read more: http://www.disabled-world.com/health/digestive/ibs-proof.php#ixzz1AyWxJDPp
That is a big, big study I think......micro-inflammation effecting the nervous system... a 'clean' gut is not clean anymore....(that's what they thought_ and this just cytokines irritating the gut lining; this is the gut lining releasing substances that irritates the nerves under the lining of gut....a whole new look at IBS.....

this is what happens as the technology progresses -the default theory for mysterious disorders (its all in your head) gets exposed....

Will problems with the problems with the micro-blood vessels be demonstrated next?

Love to see this! Glad you dug it up! Thanks...

My gut has only gotten more sensitive over time....first it was dairy, then chocolate, banana's, fruits, sweet things, beans......Dr. Maes says he sees increased gut sensitivity over time in people with ME/CFS quite a bit.
 

Cort

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Some more news on IBS- probably nothing new to many people here - but its great to see researcher prove this....you don't have to have celiac disease to get wiped out by wheat....Hopefully this will pave the way for more research into non-celiac disruptions in the gut..Note that they have no idea what could be happening. Notice they are looking for evidence of immune activation...but what if its something like the article above? What if it's nervous system activation.........they miss it...

Am J Gastroenterol. 2011 Jan 11. [Epub ahead of print]

Gluten Causes Gastrointestinal Symptoms in Subjects Without Celiac Disease: A Double-Blind Randomized Placebo-Controlled Trial.

Biesiekierski JR, Newnham ED, Irving PM, Barrett JS, Haines M, Doecke JD, Shepherd SJ, Muir JG, Gibson PR.

Monash University Department of Medicine and Gastroenterology, Box Hill Hospital, Box Hill, Victoria, Australia.
Abstract
OBJECTIVES: Despite increased prescription of a gluten-free diet for gastrointestinal symptoms in individuals who do not have celiac disease, there is minimal evidence that suggests that gluten is a trigger. The aims of this study were to determine whether gluten ingestion can induce symptoms in non-celiac individuals and to examine the mechanism.

METHODS: A double-blind, randomized, placebo-controlled rechallenge trial was undertaken in patients with irritable bowel syndrome in whom celiac disease was excluded and who were symptomatically controlled on a gluten-free diet. Participants received either gluten or placebo in the form of two bread slices plus one muffin per day with a gluten-free diet for up to 6 weeks. Symptoms were evaluated using a visual analog scale and markers of intestinal inflammation, injury, and immune activation were monitored.

RESULTS: A total of 34 patients (aged 29-59 years, 4 men) completed the study as per protocol. Overall, 56% had human leukocyte antigen (HLA)-DQ2 and/or HLA-DQ8. Adherence to diet and supplements was very high. Of 19 patients (68%) in the gluten group, 13 reported that symptoms were not adequately controlled compared with 6 of 15 (40%) on placebo (P=0.0001; generalized estimating equation). On a visual analog scale, patients were significantly worse with gluten within 1 week for overall symptoms (P=0.047), pain (P=0.016), bloating (P=0.031), satisfaction with stool consistency (P=0.024), and tiredness (P=0.001). Anti-gliadin antibodies were not induced. There were no significant changes in fecal lactoferrin, levels of celiac antibodies, highly sensitive C-reactive protein, or intestinal permeability. There were no differences in any end point in individuals with or without DQ2/DQ8.

CONCLUSIONS: "Non-celiac gluten intolerance" may exist, but no clues to the mechanism were elucidated.Am J Gastroenterol advance online publication, 11 January 2011; doi:10.1038/ajg.2010.487.
 

Cort

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Here - they looked for cytokines....and just didn't find them....which is not dissimilar to CFS...sometimes they find them and sometimes they don't but they don't find the kind of upregulation I think they expect to find....

Its something else.....I love those nervous system findings!

Rev Esp Enferm Dig. 2010 Dec;102(12):711-717.
Irritable bowel syndrome immune hypothesis. Part two: the role of cytokines.
Ortiz Lucas M, Saz Peir P, Sebastin Domingo JJ.

Abstract
Objective: To review the available evidence on the role of interleukins in the etiopathogenesis of Irritable Bowel Syndrome.Methods: Bibliographic retrieval on PubMed including the MeSH terms "Irritable Bowel Syndrome, "Immune System", "Cytokines" and "Interleukins".Results: Sixteen case-control studies and one randomised controlled trial were retrieved. The blood appears to have a high concentration of pro-inflammatory cytokines (TNF- , IL-1 , IL-6, IL-8) and lower concentration of IL-10, an anti-inflammatory cytokine, even though the findings are disparate and heterogeneous. As many as 33 genes were found, each with different expressions, and a diminished expression of cytokines in the colon mucosa of patients with IBS, which have not been previously described in any other pathology.

Conclusions: In patients with IBS, a clear profile of cytokine levels in the blood does not appear to exist, although an imbalance between them can be observed. Moreover, there are indications that give reason to believe that the different subsets of patients with IBS could present cytokine profiles in different blood. On the other hand, in the intestine, high cytokine secretion levels are not detected, contrary to what would be expected. Further studies are required to substantiate these findings.
 

Cort

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Don't feel alone about the early childhood abuse studies in CFS....they've done the same thing in fibromyalgia and IBS, believe it or not...Notice that 50% did not experience abuse and those that did were worse off.

Biol Res Nurs. 2010 Dec 30. [Epub ahead of print]
Is Childhood Abuse or Neglect Associated With Symptom Reports and Physiological Measures in Women With Irritable Bowel Syndrome?
Heitkemper MM, Cain KC, Burr RL, Jun SE, Jarrett ME.

Abstract
Purpose. Early childhood traumatic experiences (e.g., abuse or neglect) may contribute to sleep disturbances as well as to other indicators of arousal in patients with irritable bowel syndrome (IBS). This study compared women with IBS positive for a history of childhood abuse and/or neglect to women with IBS without this history on daily gastrointestinal (GI), sleep, somatic, and psychological symptom distress, polysomnographic sleep, urine catecholamines (CAs) and cortisol, and nocturnal heart rate variability (HRV).

Methods. Adult women with IBS recruited from the community were divided into two groups: 21 with abuse/neglect and 19 without abuse/neglect based on responses to the Childhood Trauma Questionnaire (CTQ; physical, emotional, sexual abuse, or neglect). Women were interviewed, maintained a 30-day symptom diary, and slept in a sleep laboratory. Polysomnographic and nocturnal HRV data were obtained. First-voided urine samples were assayed for cortisol and CA levels.

Results. Women with IBS positive for abuse/neglect history were older than women without this history. Among GI symptoms, only heartburn and nausea were significantly higher in women with abuse/neglect. Sleep, somatic, and psychological symptoms were significantly higher in women in the abuse/neglect group. With the exception of percentage of time in rapid eye movement (REM) sleep, there were few differences in sleep-stage variables and urine hormone levels. Mean heart rate interval and the natural log of the standard deviation of RR intervals for the entire sleep interval (Ln SDNN) values were lower in those who experienced childhood abuse/neglect.

Conclusion. Women with IBS who self-report childhood abuse/neglect are more likely to report disturbed sleep, somatic symptoms, and psychological distress. Women with IBS should be screened for adverse childhood events including abuse/neglect.
 
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New placebo-controlled trial shows antibiotic reduces ibs symptoms

More evidence that IBS is not all in the mind, here from the prestigious New England Journal of Medicine, Jan 2011.

Rifaximin Therapy for Patients with Irritable Bowel Syndrome without Constipation

Background
Evidence suggests that gut flora may play an important role in the pathophysiology
of the irritable bowel syndrome (IBS). We evaluated rifaximin, a minimally absorbed
antibiotic, as treatment for IBS.

Methods
In two identically designed, phase 3, double-blind, placebo-controlled trials
(TARGET 1 and TARGET 2), patients who had IBS without constipation were randomly
assigned to either rifaximin at a dose of 550 mg or placebo, three times
daily for 2 weeks, and were followed for an additional 10 weeks. The primary end
point, the proportion of patients who had adequate relief of global IBS symptoms,
and the key secondary end point, the proportion of patients who had adequate relief
of IBS-related bloating, were assessed weekly. Adequate relief was defined as selfreported
relief of symptoms for at least 2 of the first 4 weeks after treatment.
Other secondary end points included the percentage of patients who had a response
to treatment as assessed by daily self-ratings of global IBS symptoms and individual
symptoms of bloating, abdominal pain, and stool consistency during the 4 weeks
after treatment and during the entire 3 months of the study.

Results
Significantly more patients in the rifaximin group than in the placebo group had
adequate relief of global IBS symptoms during the first 4 weeks after treatment
(40.8% vs. 31.2%, P = 0.01, in TARGET 1; 40.6% vs. 32.2%, P = 0.03, in TARGET 2;
40.7% vs. 31.7%, P<0.001, in the two studies combined). Similarly, more patients in
the rifaximin group than in the placebo group had adequate relief of bloating
(39.5% vs. 28.7%, P = 0.005, in TARGET 1; 41.0% vs. 31.9%, P = 0.02, in TARGET 2;
40.2% vs. 30.3%, P<0.001, in the two studies combined). In addition, significantly
more patients in the rifaximin group had a response to treatment as assessed by
daily ratings of IBS symptoms, bloating, abdominal pain, and stool consistency.
The incidence of adverse events was similar in the two groups.

Conclusions
Among patients who had IBS without constipation, treatment with rifaximin for
2 weeks provided significant relief of IBS symptoms, bloating, abdominal pain, and
loose or watery stools.
Incidentally, Peter White also provided some relevant evidence, showing that gastroenteritis is a risk factor for IBS but not CFS (which he cited in his Splitters vs Lumpers debate with Simon Wessely).

All in all, it looks like the somatisation model of IBS is falling apart.
 
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One caveat to this discussion. "IBS not all in the mind" implies some of it is. But that claim is untenable, based on the usual discrepancies in psychogenic explanations. The phrase "all in the mind" gets over-used, so that people don't even realise that saying something is "not all in the mind" means something is being described as at least partly "in the mind".

This sort of sleight of hand goes on all the time in ME/CFS, and even the charities have allowed that to propagate.
 
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One caveat to this discussion. "IBS not all in the mind" implies some of it is.
I have no problem with some role for psychological factors in illness. Various forms of heart disease are the classic example where personality traits and states have a significant impact on, for example, the risk of subsequent heart attacks - but no one seems to mind that in the least; maybe because if you die of heart failure there is a pretty clear physical cause. Charles Shepard of the M.E Association made an interesting and relevant point about the slide from mind-and-body to just mind with ME: CBT, he agreed, was used as a helpful therapy a range of physical illnesses including cancer, but ME was the only illness where it was promoted as treating the underlying cause.
 
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I have no problem with some role for psychological factors in illness. Various forms of heart disease are the classic example where personality traits and states have a significant impact on, for example, the risk of subsequent heart attacks - but no one seems to mind that in the least; maybe because if you die of heart failure there is a pretty clear physical cause. Charles Shepard of the M.E Association made an interesting and relevant point about the slide from mind-and-body to just mind with ME: CBT, he agreed, was used as a helpful therapy a range of physical illnesses including cancer, but ME was the only illness where it was promoted as treating the underlying cause.
Well I agree about the special pleading with regard to ME/CFS. However, the claims that 'personality traits and states have a significant impact on, for example, the risk of subsequent heart attacks' are actually very unsafe for many reasons around the instabilities of diagnosing 'personality traits', weak correlations etc. etc. Indeed this is the case for many illnesses where 'personality traits' are alleged to cause or perpetuate them.
 
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I have no problem with some role for psychological factors in illness. Various forms of heart disease are the classic example where personality traits and states have a significant impact on, for example, the risk of subsequent heart attacks - but no one seems to mind that in the least; maybe because if you die of heart failure there is a pretty clear physical cause. Charles Shepard of the M.E Association made an interesting and relevant point about the slide from mind-and-body to just mind with ME: CBT, he agreed, was used as a helpful therapy a range of physical illnesses including cancer, but ME was the only illness where it was promoted as treating the underlying cause.
Actuall- this points the the problem that there are TWO rationales for CBT - one is as a therapy to help cope with illness, the second is the belief the person is wrong-headed in believing they have a physcial illness. This is discussed in Carruthers et al, for example.

Two completely different approaches. The first is not claiming 'mind OVER body' interaction. The second is. Impact of illness is different to claiming psychogenic causation or perpetuation.
 
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Actually, I wasn't aware that the science linking stress with illness in general was in any doubt. We're getting way off topic but here, for example, is one study where they measured psychological factors before inoculating with the common cold and found that stress was a risk factor for getting a cold. With a prospective design like this there is less danger of confounding factors giving false results.
 
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Actually, I wasn't aware that the science linking stress with illness in general was in any doubt. We're getting way off topic but here, for example, is one study where they measured psychological factors before inoculating with the common cold and found that stress was a risk factor for getting a cold. With a prospective design like this there is less danger of confounding factors giving false results.
Actually, there were various confounding problems in the 'cold and stress' research: Defining 'stress', for one thing... Defining 'cold' was another. That the scientists don't mention these don't mean these problems are not present.

Yes. The claims of 'stress' causing illness IS problematic, and is criticised.

AND- this is SO NOT 'off topic'!

Just one example of various critiques of claims around stress and health is this:

Jones, F. Bright, J. Stress : myth, theory and research (2001) Pearson Education, Harlow.

This book contains various critiques, but is not exhaustive.
 

Dolphin

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Firstly, can this thread be moved to:
Other Health News and Research
Find health news/research on another topic that you feel has implications for PWCs? Post it here.
http://forums.aboutmecfs.org/forumdisplay.php?55-Other-Health-News-and-Research
I don't want this sub-forum to get overrun with non-ME/CFS threads. I've given up asking for threads to be moved in the nuts and bolts section.

Thanks to everyone for interesting posts.

Is Childhood Abuse or Neglect Associated With Symptom Reports and Physiological Measures in Women With Irritable Bowel Syndrome?
I'm afraid this didn't convince me that Childhood Abuse or Neglect caused a specific illness or a worse illness.
IBS, I think is a particularly problematic condition is this regard. Let me first say that I know something physically go wrong (I have had IBS-D but it's much more under control now).

However, so much about IBS is subjective in terms of severity. Some people can focus more on abdominal pain more than others. If there were objective differences it would be more interesting.

This reminds me of when I read that hypnotherapy could effectively treat IBS. I looked it up: what they found was that hypnotherapy could reduced the pain. Saying hypnotherapy can effectively treat IBS makes out that it was having some sort of physical effect; saying it can treat pain may mean that the person may focus less on the bowel, be able to cope with more pain to report the same "level"/similar.