Irritable Bowel Syndrome (IBS)

The term “colitis” comprises several types of inflammatory intestinal disorders, as distinguished from Irritable Bowel Syndrome (IBS), a “functional” disorder of motility in which inflammation is not apparent. The main types of colitis are ulcerative colitis (UC) and Crohn’s Disease (CD), which have different characteristic appearances and radiological and blood testing presentations. They are collectively referred to as Inflammatory Bowel Disease (IBD).

While CD and UC have not generally been thought of as infectious diseases, one form of colitis, pseudomembranous colitis, is known to be caused by a bacterium, clostridium difficult.

More researchers are coming to believe that imbalances in intestinal flora may be at the root of IBD. Immune cells in the walls of the intestinal tract are engaged in continual “cross-talk” with the trillions of bacteria that inhabit our gut. When beneficial bacteria are suppressed, and harmful bacteria  proliferate, that intestinal defense system =may go into “overdrive”, resulting in and over-exuberant immune response, triggering autoimmunity and consequent inflammation.

This disorder state of intestinal microbes is sometimes referred to as “dysbiosis”. Evidence that dysbiosis might be a contributing factor in IBD comes from several sources. Frequent administration of antibiotics is known to be a risk factor for IBD, and UC and CD patients sometimes suffer exacerbations of their disease after antibiotics are prescribed for other conditions.

Also, use of powerful acid-blocking medications increases the risk for IBD, probably because it alters the intestinal flora. Breastfeeding, perhaps because of its “priming” effects on the intestinal immune system, appears to be protective against IBD.

In some studies, probiotics appear to ameliorate the symptoms of IBS, but no one is yet sure which probiotics work best, or in what form or dosage. Promising research suggests that fecal flora harvested from healthy donors can help sufferers of IBD, but human trials are carefully regulated by the FDA.

Whether because of over-dependency on pharmacological drugs, refined foods, or other factors, IBD incidence is on the rise in developed countries, affecting as many as 1.4 million Americans, or nearly 1/2% of the population. Some point to the “Hygiene Hypothesis”, wherein it is thought that our conquest over unsanitary conditions has increased the likelihood that our idle immune systems will inappropriately target our own tissues in a misguided attack. Supporting this notion is research showing that introduction of harmless parasites into the GI tracts of IBD sufferers can induce remission by “decoying” the immune system to fight an invader instead of attaching the intestinal tissue.

While there is evidence that administration of a wide variety of oral supplements and nutraceuticals may be justified in IBD, caution must be exercised. Many patients suffer from chronic diarrhea, cramping and abdominal pain, or may have narrowing of segments of the intestine. A gradual introduction may be warranted, with supplements added only as tolerated.

By Ronald L. Hoffman, MD, CNS

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