Irritable bowel syndrome (IBS)

Irritable bowel syndrome (IBS) is a gastrointestinal disorder characterized by chronic abdominal pain and altered bowel habits. It is the most commonly diagnosed gastrointestinal condition: the prevalence of IBS in North America is estimated to be approximately 10 to 15 percent Until the advent of culture-independent studies, physicians supposed IBS was a psychosomatic (functional) disorder as there was limited indication of an organic cause, with physicians complaining that patients were unmotivated to seek out cognitive behavioral therapy.¹⁾

However, the notion that IBS is a psychological disorder has come under serious challenge.²⁾ Recent research demonstrates that IBS is characterized by significant alterations in the gut microbiota.³⁾

The Marshall Protocol treats IBS by reactivating the innate immune response. In the course of treatment, patients' disease symptoms may become worse due to a process called immunopathology.

As a matter of course, symptoms of IBS will fluctuate while a patient is on the Marshall Protocol (MP). In addition to the strategies outline in the Managing immunopathology article, the following may also be helpful:

• constipation – MP patients with constipation should have the symptom treated for immediate relief and then measures should be adopted to prevent constipation.
• diarrhea – Patients with diarrhea may wish to increase fluid intake and/or take anti-diarrheal medication. ⁴⁾
• loss of appetite – If nausea is preventing a patient from eating, it's very important to palliate the nausea. Over the counter medications such as Gravol (dramamine) may be helpful. If not, patients should ask their doctor for a prescription antiemetic, such as hydroxyzine.

IBS is characterized by microbial dysbiosis. Electron micrograph of the cytoplasm of an enteroendocrine cell from a patient with IBS showing a structure resembling an intermediate body of Chlamydia (arrow) with characteristic condensed nucleoids. Dark homogenous structures are granules. M = Mitochondria, N = Nucleus, Bar = 0.5 μm. (Source: Dlugosz et al., 2010)

Recent studies provide increasing support for the concept that disturbances in gut flora occur in patients with irritable bowel syndrome and that such abnormalities may contribute to irritable bowel syndrome-type symptoms.

Riordan et al.⁵⁾

Epidemiologic studies have shown that gastrointestinal infection is the strongest environmental risk factor for the development of IBS.^{6) 7)} Although most patients with gastroenteritis become asymptomatic, a small but significant proportion of subjects (7%–31%) develop postinfectious IBS, dyspepsia, or both. A recent systematic review and meta-analysis identified that the incidence for IBS development after infectious gastroenteritis was 10%.⁸⁾

Small intestinal bacterial overgrowth (SIBO) has been documented in a proportion of patients with IBS (10%–84%). For example, in 2012, Greek researchers enrolled patients needing upper gastrointestinal (GI) tract endoscopy. Among 320 subjects SIBO was diagnosed in 62 (19.4%) with 42 of those having IBS (67.7%). Of all IBS sufferers, SIBO was found in 37.5%. Escherichia coli, Enterococcus spp. and Klebsiella pneumoniae were the most common isolates within patients with SIBO. Several researchers have shown that eradicating SIBO results in symptomatic improvement.^{9) 10)}

Accumulating evidence shows that patients with IBS have a higher temporal instability of the bacterial populations and that the microbiota composition is different compared with healthy controls.^{11) 12)}

Free versus total serum 25-hydroxyvitamin D in a murine model of colitis. ¹³⁾

Findings suggest that neither olmesartan nor other ARBs were associated with diarrhea among patients undergoing endoscopy. The spruelike enteropathy recently associated with olmesartan is likely a rare adverse effect and milder presentations are unlikely. ¹⁴⁾

In a methotrexate-induced model of intestinal mucositis, olmesartan reduced inflammation and induced enteropathy characterized by severe diarrhea, weight loss, and reduced sucrose activity. ¹⁵⁾

Mast cell activation syndromes ¹⁶⁾

Gastrointestinal (GI) symptoms are commonly reported in patients with mast cell disease. ¹⁷⁾

Mast cells are located in close proximity to the vasculature, and vasoactive mediators released upon their activation can promote endothelial activation leading to blood brain barrier (BBB) dysfunction. ¹⁸⁾

Mast cell activation plays an important role in stress-mediated disease pathogenesis. ¹⁹⁾

Melinda Stiles

Lyme disease, irritable bowel syndrome/ulcerative colitis, radiculitis

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Chris Eastlund

diabetes, sarcoidosis, irritable bowel syndrome

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Interviews of patients with other diseases are also available.