Posted 11/3/2009 11:29 AM (GMT -6)
Worried Doug, keep reading the articles and I do understand what your saying, but there needs to be more education to new medical students and to doctors on the condition and they need to help explain things to their patients better, I believe.
The experts are trying hard to educate primary care, gi doctors and the public that it is a REAL Psychophysiological disorder. Hence one reason I was showing you the article. But also the one on pain.
"Psychophysiology is the branch of physiology that is concerned with the relationship between mental (psyche) and physical (physiological) processes; it is the scientific study of the interaction between mind and body. The field of psychophysiology draws upon the work of physicians, psychologists, biochemists, neurologists, engineers, and other scientists.
A psychophysiological disorder is characterized by physical symptoms that are partly induced by emotional factors. Some of the more common emotional states responsible in forming illness include anxiety, stress, and fear. Common psychosomatic ailments include migraine headaches, attention deficit hyperactivity disorder (ADHD), arthritis, ulcerative colitis, and heart disease."
There has been this seperation in the past and it has hindered very important research, now they are moving to holitic and there is no seperation between mind and body, or brain and body.
Stress and foods don't cause IBS, but can be major factors in generating symptoms for most IBSers, especially those with moderate to severe IBS. Even the act of eating which is in part a neurological mechanism.
When they poll IBSers on stress and symptoms the statistical numbers are very high. I don't think many doctors that have even slightly studied IBS, believe anymore its not real disorder or someone is making it up, maybe a few. But they also don't have time to explain all the connections in short visits. I have seen a lot of doctors and have had two bad experiences out of perhaps ten doctors or more. The two bad experience was with one, a RN Nurse who are now doing more doctor type practices and one primary care doctor. None with any gi specialists personally.
A good doctor-patient relationship is very important in helping someone treat there IBS.
I agree with you in finding physical abnormalities and they are looking both in the brain and in the gut and how they both communicate. There are bottom up models and top down models.
There are also impairments to the brain seen in IBSers with pet and fmri scans being studied.
Funny you should mention "inflammatory cytokines", because they too
"A chain of events that begins with stress and/or depression can lead to increased production of proinflammatory cytokines, thus raising the risk for certain diseases and conditions linked to inflammation."
Hence one reason why I mentioned neurogenic inflammation stress can cause or reactivate inflammation. The stress system helps fight infections and can effect the immune system.
Proinflammatory Cytokine Gene Polymorphisms in Irritable Bowel Syndrome.
anti-anxiety medications are not just because of anxiety, but as I mentioned before serotonin is the neurotransmitter from the gut that signals to the brain pain, so altering it can have an effect both on the gut and the brain. I agree sometimes they are given out to quickly to people.
The Use of Antidepressants in the Treatment of IBS and Other Functional GI Disorders - C. Dalton and D. Drossman
Also like I said psychological treatments have shown to be very effective for IBS, specifically Gut directed hypnotherapy and CBT as well as a few others. So they might not cure someone completely, but they can majorally reduce the symptoms and help a person quality of life and management. For example and this was done and has been done for the last 20 years by a senior GI doctor in England.
"New York Times - Let the Mind Help Tame An Irritable Bowel
The brain has the ability to inhibit sensations from the gut. But, as Dr. Gerson put it, ”I.B.S. patients tend to be hypervigilant — too aware of what is going on in their gut.” Through techniques like hypnotherapy and cognitive-behavioral therapy, it is possible to change how the brain perceives what is happening in the body.
In hypnotherapy, patients learn to visualize their colon as functioning more normally. In cognitive-behavioral therapy or short-term psychotherapy, patients can learn to change symptom-provoking beliefs, like thinking that their colon will always be abnormal or that a given circumstance will provoke symptoms.
In a British study of 204 patients in which more than two-thirds of them were initially helped by hypnotherapy, 81 percent of those maintained the improvement up to five years after the treatment. Learning to practice stress-reduction and relaxation techniques can be as helpful as learning which foods to avoid.
New York Times, Sep 2nd 2008
Five years after treatment and a big study with 81 percent helped.
There are three primary features of FGIDs - motility, sensation, and brain-gut dysfunction:
Motility is the muscular activity of the GI tract. Normal motility (e.g., peristalsis) is an orderly sequence of muscular contractions from the top to the bottom. In FGIDs, the motility is abnormal - there can be muscular spasms that can cause pain, and the contractions can be very rapid (fast motility is diarrhea) or very slow (slow motility is constipation).
Sensation is how the nerves of the GI tract respond to stimuli (for example, digesting a meal). In FGIDs, the nerves are sometimes so sensitive that even normal contractions can bring on pain or discomfort.
Brain-gut dysfunction relates to the disharmony in the way the brain and GI system communicate. With FGIDs, the regulatory conduit between the brain and gut function may be impaired and this can lead to increased pain and bowel difficulties which can be worsened by stress.