IBS/IBD

IBS/IBD

Digestive disorders such as Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD) together effect up to 20% of Americans (1). Although they have many similar symptoms, they are actually very different. While IBD is a chronic disease that causes inflammation of the colon and small intestine, IBS is a collection of gastrointestinal symptoms with no evidence of the cause, such as inflammation or tumors. However, genetic connections have been found in those who suffer from IBD. The two major types of IBD are Crohn's disease and Ulcerative Colitis. IBS and IBD share the symptoms of cramping, abdominal pain, bloating, diarrhea, constipation and mucous in the stools. More serious IBD symptoms also include: vomiting, bleeding from the colon/intestines, joint pain, fevers and weight loss. The symptoms may worsen or improve from day to day with IBS. However, those with IBD have periods of exacerbating flares and live in fear of a continuous worsening of their symptoms leading to hospitalization and possibly surgery. Living a normal life is difficult for either condition. Eating, sleeping, working and having a normal social life are significantly compromised.

IBS is diagnosis of exclusion, which means that more serious reason for the symptoms, including IBD, needs to be ruled out before this diagnosis can be given. IBD is diagnosed by clinical symptoms as well as imaging, colonoscopy and biopsy results. Some blood tests maybe abnormal from those suffering from IBD, as well. These diagnostic tools help rule out other gastrointestinal disease that can mimic symptoms of IBS/IBD, such as: malabsorption syndromes, lactose intolerance, celiac disease, infectious colitis, colitis related to medications, diverticulitis and colorectal cancer.

Conventional Treatment

Causes remain unclear for IBS; therefore treatment is aimed at symptom management, to prevent symptoms from interfering with daily life. The treatments are aimed at pain management and decreasing diarrhea and constipation. IBD treatment is aimed at getting the patient into remission. There is no conventional cure for IBS and the only “cure” for IBD is removing the part of the intestine that is producing the symptoms. Unfortunately, the medications that are used to treat both IBS and IBD can have dangerous side effects and are not always effective. In fact, no single medication has been shown to have long term lasting effects for the treatment of IBS, specifically.

Anticholinergics are used as the first line therapy for IBS. They slow the spasms of the abdomen and decrease pain, however, not particularly effective. People that can not use this drug are patients with liver or kidney problems, severe ulcerative colitis or GERD, among others. Another common medication that is given for diarrhea in both IBS and IBD is an antidiarrheal. This medication slows the production of diarrhea but can also produce something called a toxic megacolon (a medical emergency) when the bowel becomes paralyzed is unable to excrete feces. This medication should be used with extreme caution in patients with IBD and cannot used if the person exhibits bloody diarrhea. The side effects of both of these drugs include more gastrointestinal problems such as dry mouth, gastrointestinal disturbances, nausea, vomiting, constipation, and diarrhea. Tricylic antidepressants are another medication used in IBS, more specially. It is used to decrease abdominal pain and diarrhea. Since this drug also affects brain chemistry, it can produce side effects of suicidal ideation, insomnia and worsening of depression. It must be used in caution with patients that have cardiovascular risk due to the drug causing symptoms of arrhythmias, heart attack and stroke (in those at risk of heart disease). It also causes weight gain. Other drugs that can be used include: Bile acid binding agents, stimulant laxatives, stool softeners, antispasmodics, antianxiety agents and other antidepressants.

Stronger medications that are reserved for IBD including suppositories, immunosuppressive drugs, steroids and surgical removal of the colon or parts of the small intestine. Sulfasalazine suppositories are used in the treatment of IBD that is particularly flared in the anal area. This is a suppository includes components in aspirin to decrease inflammation in this area. This medication in useful in soothing the area, and can allow those with disease only in this area to go into remission. However, it can produce allergic reactions that are similar to the symptoms of a flares and has side effects include diarrhea, nausea, and rash. Oral and IV steroids are used during flares of IBD to decrease inflammation and bleeding. Although steroids are very useful in the short term treatment of IBD, there are not well tolerated in the long term. They can cause immune suppression, depression, risk of suicide and exacerbate osteoporosis. The side effects of steroid use include: mood changes, diarrhea, nausea, yeast growth, weight gain, hair growth and suppression of growth in pediatric patients. Immunosuppressants are reserved for disease that is not responding to other medications, as they are the most dangerous. These drugs will suppress the immune system as to not allow the body to mount an inflammatory response, thus eliminating inflammation. Patients taking these drugs require weekly blood monitoring due to bone marrow damage and liver damage. Use of these drugs can also increase infection rate, cause hair loss, weight loss, vomiting, mouth ulcers and inflammation of the esophagus. At least 30% of patients with Ulcerative Colitis end up having surgery to remove their colon, or part of it. Some have to live with a colostomy bag while others will have an internal pouch out in place of the colon which is then connected to parts of the small intestine and anus. While this retains fecal function, it commonly becomes inflamed. 60% of people that have this surgery suffer from pouchitits regularly, which causes symptoms of increased stool frequency, infection from bacterial overgrowth, cramping, fever, and rectal bleeding.

Homeopathy for IBS/IBD

Few people know there are other options to treat IBS and IBD. One of those options is homeopathy. Homeopathic medicines are type of natural medicine that is used to treat disease. They are selected for very particular reasons based on how the symptoms of the individual are expressed. Symptoms that are unique to that person are used to find a specific medication that covers all of the symptoms in the case, both related to the disease condition as well as those related to the individual as a whole. Homeopathic medicine is untimely given to decrease the susceptibility to these diseases and prevent reoccurrences. Homeopathy works by triggering your body to self-heal, therefore treating the underlying predisposition to developing IBD. For example, people who suffer from IBD/IBS may be reactive to different foods and stress. However, this is a symptom of an unbalanced body. With successful homeopathic treatment, over time, the body will be less reactive to stress and foods. With continued homeopathic therapy, the healthier the person becomes, and the less medications, supplements and diet changes are needed to keep them symptom free.

Natural support for IBS/IBD

Other natural support can also be used to treat IBS/IBD. It is used to decrease inflammation, help repair tissue, decrease abdominal spasms/pain and help regulate the stool. Suffers of IBS and IBD usually find that certain foods trigger their symptoms to exacerbate. Many have to make adjustments in their diet, especially in the beginning of treatment. Sometimes people may have sensitivities to unusual foods that can be determined with a simple blood test. Because those with IBD, specifically, have so much inflammation, they also have greater intestinal permeability. In other words, the lining of the gut allows larger proteins and bacteria in and out. This permeability and inflammation of the small intestine or colon, can lead to impaired absorption of important nutrients and vitamins. Outcomes of this problem, such as anemia and nutrient deficiencies (like B1, folic acid and vitamin D) should be evaluated and replacement of those nutrients can be initiated.

Other natural support may be used to modify inflammation such as Probiotics and essential fatty acids, including fish oil. Studies are now also showing that probiotics are as effective as some prescription drugs as treatments for IBD (2) and decrease gas, bloating and abdominal pain in IBS (3). Enteric coated Peppermint Oil can also decrease abdominal pain relating to spasms of the abdomen (4, 5). Additionally, stress and anxiety are triggers that exacerbate symptoms in both diseases. Stress management including therapy, music, reading, meditating and praying can be effective in decreasing the aggravation of symptoms. Hypnotherapy also has evidence in symptom reduction in IBS (6). In patients with constipation predominant IBS, Psyllium fiber can be used to bulk the stool and stimulate activity of the colon. (7)

Case for IBD

I have used Homeopathy to treat both IBS and IBD successfully. “Janet” is a 30 F that came to see me in the middle of a flare of her Ulcerative colitis. She had been diagnosed with this disease 10 years ago via colonoscopy and biopsy. Her most recent colonoscopy was again was showing ulcers and inflammation present in the colon. She was presenting with symptoms of abdominal pain, bloating, diarrhea, blood in the stools and weight loss. She came to see me already on aminosalicylate suppositories and oral steroids. Janet was continuing to have severe symptoms, despite the high dose of steroids she was on. She was desperate to stop the bleeding and return to her normal daily living.

I wanted to decrease the insults that where causing Janet’s inflammation, heal her intestinal tissues, stop the symptoms that she was currently having and decrease her flares from returning. The first thing we did was supportive therapies. I put her on high doses of Probiotics and fish oils as well as putting her on a hypoallergenic diet. Some improvement was seen in a week’s time. Mostly, the frequency of the diarrhea decreased and the stool became more formed.

The following week, I took her homeopathic case. She had some individualizing symptoms that lead me to find the appropriate remedy. Her diarrhea was very specific in that it drove her out of bed every morning at 5AM, and was burning in nature. She also described her abdominal pain as burning. In homeopathy, it is not just the symptoms of that disease that are considered when prescribing a remedy, but all individualizing aspects of that person as well. Therefore, the fact that she was a very warm individual, so warm that she stuck her feet out of the covers at night was useful in prescribing. These symptoms lead to the remedy, Sulphur. Sulphur can be used for many concerns, including eczema, menstrual irregularities, back pain as well as GI problems. Once this remedy was prescribed to Janet she immediately began to see results. One week after this remedy was given, her stools normalized, the bleeding lessened significantly and her abdominal pain was gone! Janet stayed on this remedy for several weeks with increasing improvement.

Most patients with chronic disease need to change remedies several times until they are healed. Janet was no exception. After about a month on this remedy, the improvements began to plateau. Janet’s symptoms in her case also began to change. She no longer had the diarrhea that drove her out of bed in the morning; in fact she was not having diarrhea at all anymore. She was still having bouts of minimal bleeding, which was bright red in color. She also suddenly became more thirsty that usual, especially for ice cold beverages. She also began to worry about her condition much more that than she had in the past despite the fact that her symptoms where much less. Finally, Janet no longer wanted to be alone. She stated that she felt much better physically and emotionally when she was around her boyfriend. These new symptoms lead to the new remedy prescription of Phosphorus, which I gave her in daily doses. By the next follow up, her bleeding cleared up for good and she had no residual symptoms of the flare. After her symptoms cleared up, Janet went in for a follow up colonoscopy. It showed that the ulcers had healed and there was much less inflammation. This was 2 years ago. Janet has been on increasing potencies of Phosphorus since this time. Because Ulcerative colitis comes in “flares”, you always want to be on the lookout for any worsening of symptoms. Only 3 times in that 2 year period did she exhibit some abdominal pain, which cleared up with increasing the potency of her remedy. Janet is forever grateful that she gave homeopathy a chance.

If you or someone you know suffers from IBS or IBD, there are some things that they can start to do, which may help:

1. Make sure you are not suffering from Lactose in tolerance. Lactose intolerance can mimic the symptoms of IBS and can be treated entire with dietary modification. Try eliminating all dairy products and see if symptoms abate.

2. Stress management: Managing stress appropriately can decrease symptoms of IBS and help reduce flares of IBD. Some was to manage stress include calming exercises such a stretching, walking and yoga. Relaxation techniques, like deep breathing exercises, guided imagery and meditation can also be used. Take time out of your day to check in with yourself. Take a bath, listen to music or read. The purpose is to allow your mind to decompress, decreasing the biochemical responses to stress that lead to increase in symptoms.

3. Maintaining a healthy diet: Having a clean diet avoids adding insult to injury. Because those that suffer from IBS and IBD are predisposed to gastrointestinal symptoms, they have to be much more careful in their diet than the average person. Eating organic, unprocessed foods is a key to reducing symptoms. Avoid exacerbating foods such as dairy, wheat, artificial sweeteners, fatty, fried foods, caffeine and alcohol. In flares of IBD however, it is common to eat very bald foods to avoid additional stomach upset.

4. Exercising regularly: Low impact exercise, especially in IBS is important from the reduction of symptoms. This provides an outlet for stress as well as overall wellbeing. During flares of IBD, however, exercise should remain minimal as to avoid added stress on the body.

5. Avoid NSAIDS, such as ibuprofen. As it may decrease pain, using these medications will put undue stress on the stomach and will exacerbate symptoms in the long term.

 

References 1. http://www.womenshealth.gov/faq/irritable-bowel-syndrome.cfm

2. ("Maintaining remission of ulcerative colitis with the probiotic Escherichia coli Nissle 1917 is as effective as with standard mesalazine".)

3. (Moayyedi P, Ford AC, Talley NJ, et al. The efficacy of probiotics in the treatment of irritable bowel syndrome: a systematic review. Gut. 2010;59:325-32)

4. (Lesbros-Pantoflickova D, Michetti P, Fried M, Beglinger C, Blum AL. Meta-analysis: The treatment of irritable bowel syndrome. AlimentPharmacolTher.2004;20:1253-69PubMed CrossRef)

5. Quartero AO, Meineche-Schmidt V, Muris J, Rubin G, de Wit N. Cochrane DatabaseSystRev.2005:CD003460CrossRef ) Bulking agents, antispasmodic and antidepressant medication for the treatment of irritable bowel syndrome.

6. Hypnotherapy for functional gastrointestinal disorders. DrugTherBull.2005;43:45-8PubMed

7. (Bijkerk CJ, Muris JW, Knottnerus JA, Hoes AW, de Wit NJ. Systematic review: the role of different types of fibre in the treatment of irritable bowel syndrome. Aliment Pharmacol Ther. 2004;19:245- 51PubMed CrossRef)