Irritated gut

We take a look at the most common gastrointestinal complaint patients see doctors for.

MAN HAS been credited (or accused, depending on gender bias) with thinking with more than one head.

This is, of course, not true, otherwise, he would be in double trouble. The fact is, that with each thought, there is emotion; and with each emotion, there is some biological stirring that defies voluntary control.

Crippling habit: Many IBS patients probably wish they could travel with a toilet as they frequently have the urge to empty their bowels.

Aside from the groin, there are the salivary glands that water when one sees, smells, tastes, or even thinks of one’s favourite morsel. The nervous stomach gurgles outside the examination hall, while the fear literally paralyses the speaker in front of a hostile audience.

The mind works on the body. However, when the biological outcome becomes an aberration of what is a “normal” reaction, it transcends into a state of “dys–ease”, or dysfunction. The latter encompasses sensations of illness without obvious underlying physical signs of disease.

The brain-gut axis

In the 1990s, scientists mooted the idea of a “brain–gut axis”. Anatomically, the intestines are rather detached from the brain, and yet, there is the suggestion of a complex highway of nervous communication between them.

Intestinal cellular radar assesses the state of affairs within the gut and sends signals to the higher control centres for information processing.

The brain is thought to regulate certain gut portfolios like appetite, fullness (satiety), digestion, absorption and defecation.

It also co-ordinates waves of muscle contraction and relaxation, known as peristalsis, which moves balls of food along the intestines, squeezing and compacting the digested material, and pushing the resultant faeces towards the rectum, which acts like a temporary storage depot.

The sensors here detect volumetric stretch of the walls and send a message to the brain to evacuate. If the act is postponed due to a variety of factors, the stools in deposit compound interest. Consequently, the waste dries up and hardens, leading to constipation.

Irregular peristalsis, coupled with bacterial fermentation, creates many “pockets” of gas, wreaking havoc with incessant flatulence.

Stress and emotional upheavals can derail the physiological intricacies of this brain–gut axis, paving the way for dysfunctional gut responses, and the physically and emotionally exhausting symptoms of Irritable Bowel Syndrome (or IBS, which affects up to 15% of the population).

A common problem

IBS is the most common gastrointestinal condition presented to doctors.

The diagnosis is made based on the exclusion of a detectable underlying disease, and fitted according to a set of criteria, which hinges on abdominal pain and discomfort that persists for more than 12 weeks out of a year as the main complaint.

In essence, IBS is a state of chronic ill health that robs one of quality of life. Forty percent of sufferers often have anxiety and co-existing psychological adjustment problems.

Various names have been coined for this condition, including nervous colon, spastic colon and irritable colon.

Abdominal pain and discomfort is the primary symptom, and is generally eased somewhat by defecation, which is almost always incomplete.

The stools are squeezed by a “tight” colon and the product is often scanty pencil-like dry faeces, but this does not mean that the storeroom is empty! Each time the wave of spasms comes along, or when the lavatory becomes available, the urge to move the bowels becomes almost a crippling habit, resulting in repeated visits to the loo many times a day.

A frustrating sensation known as “tenesmus” is the need to empty, yet straining with little luck, except milking out a little bit of mucous from the rear.

There is also a change in frequency and form of stools – loose diarrheoa, constipation or an alternation between the two.

As a result of the disturbed movement or motility, there is gaseous build-up with the sensation of bloating and regurgitation of stomach contents, causing heartburn.

Similar symptoms, many causes

IBS is not known to cause any significant long term disease. Conditions that may mimick it have to be excluded, some of which have serious pathology. Similar abdominal complaints, either some or all of the above, may occur in:

> Gastrointestinal infection (bacterial, fungal or parasitic)

> Lactose intolerance

> Sensitivity to gluten in coeliac disease

> The “Leaky Gut Syndrome” (refer to StarTwo, Leaking gut, April 20, 2011) mimicks some or all the symptoms of IBS

> Other more sinister underlying pathologies include Crohn’s disease, ulcerative colitis and cancer

The disturbing attendance of fever, weight loss and bloody stools should trigger alarm bells of a more serious condition.

Although the causes of IBS are largely unknown, this chaotic basket of symptoms can be triggered by diverse factors.

It has been observed to be set off by bacterial intestinal infections. There are some indications that a yet-to-be-identified chronic gut infection may be a contributory factor. An imbalance in bacterial population within the gut is also a suspect.

A lot of interest has been generated by the concept of the brain–gut axis. Stress, anxiety and other psychological derangements alter the sensitivity of the intestinal sensor cells to over-react to otherwise innocuous stimuli.

These cells release chemical signals that set the stage for further heightened sensitivity.

The brain falls in tandem with the gut and becomes extremely aware of intestinal sensations, feeding the stress–pain–anxiety cycle.

Investigations do not yield positive results. Blood and stool tests are normal. Many patients end up having either, or both – gastroscopy (viewing the upper gut) or colonoscopy (viewing the lower gut).

These procedures are like “a hammer looking for a nail”, and truly in IBS, nothing is found.

No effective treatment

Treatment of IBS is as disheartening as the symptoms. So much research and yet so little achieved. The wide array of drugs continuously being introduced illustrates the complex nature of this condition.

Ultimately, however, all pharmacological treatments merely manage the symptoms – antispasmodics, anti-diarrhoeals, laxatives, motility drugs, dyspeptic agents, etc, have all been used with just adequate results.

Targeting the brain–gut axis, various anti–anxiety and anti-depressants have been on trial with limited success.

Some of the side effects actually add to the patient’s misery. A drug targets a specific pathway and treats only a particular symptom, necessitating a potpourri of prescriptions for the plethora of varied complaints, with less than robust results.

A more holistic approach involves smoothening the edges of anxiety and stress, and resolving underlying internal conflicts.

Healthy lifestyle practices include taking up regular exercises, and having adequate rest and sleep. Adopting relaxation techniques like breathing exercises, yoga, qigong, etc, are helpful.

Since the trouble originates from the gut, it should not surprise the thinking individual that a large part of the reversal of this syndrome lies with nutritional intervention.

One should avoid large meals (beware buffets!) and “trigger” foods.

A trial of milk and wheat products avoidance may offer relief among some. Foods known to trigger allergies and intolerance should be omitted from the diet.

Taking smaller and more frequent meals certainly helps. Complete chewing and avoidance of large volumes of fluid with meals reduces some of the coexisting symptoms such as heartburn.

Spicy foods, caffeine, tea and alcohol may add more to the torment. Carbonated beverages, beans, sprouts, cabbages, fatty foods, etc, are examples of foodstuff that promote gaseous distention, compounding the abdominal discomfort.

Health supplements that purportedly help to reduce the symptoms of IBS have not been extensively studied.

From limited information, some probiotics containing certain strains of the Lactobacillus and Bifidobacterium groups confer some benefits for sufferers.

Taking the required amount of soluble fibre can ease constipation. However, the daily dosage is titrated according to symptoms as too much fibre can ironically cause more abdominal distention.

Peppermint oil (pure therapeutic grade essential oil) offers temporary relief.

As normal peristalsis is disordered in IBS, a well-crafted calcium and magnesium supplement may aid the restoration of motility. Magnesium has the added benefit of exerting a mild laxative effect, which is a welcome aid for IBS patients with predominant constipation.

As the discomfort follows regular food ingestion, a balanced replacement meal once or twice a day offers some relief from the overloaded diet.

While scientists debate over classification, causes and treatments, it is prudent for one to seek the key that opens the combination lock on the door of true health.

Unfortunately, as is often the case, it remains locked as the “easy not to do” (regular exercise), “hard to do” (dietary control), and “will not do” (taking optimal cellular and digestive supplements) complex, which ultimately cheats us of optimal health, leading us from one medical syndrome to another.

Sumber

Irritated gut