IBS

Question 1

Rome II definition of IBS?

Answer 1

IBS can be diagnosed based on at least 12 wks of the preceding 12 mos if there was abd pain or discomfort that had 2 out of 3 features:
relieved w/defecation and/or onset assoc w/change in frequency of stool and/or onset assoc w/change in form of stool

Question 2

sxs that cumulatively support dx of IBS?

Answer 2

abn stool frequency (more than 3 per d or less than 3 per wk)
abn stool form
abn stool passage
bloating or feeling of abd distention

Question 3

5 common misdiagnoses of IBS which could also lead to IBS?

Answer 3

Food allergy/intolerance
ileocecal valve syndrome
parasitic infxn (emotions and sympathetic dominance)
deficiency of secretions: hypochlorhydria, pancreatic insufficiency, BB enzyme deficiency
overgrowth of commensals (SIBO)

Question 4

6 txs for c. diff infxn?

Answer 4

saccharomyces boulardii: 3-6 B TID x 14 d
nutritional or brewer’s yeast: 1 tsp BID x 14 d
cinnamon: 1000-1500 mg/d
metronidazole: 500 mg orally every 6-8 hrs for 10-14 d or alternatively 250 mg every 6 hrs for 10-14 d
vancomycin: 125-500 mg orally every 6 hrs for 10-14 d ($$$)
fecal microbiota transplantation x 5 d

Question 5

5 txs for giardia lamblia infxn?

Answer 5

probiotics (L. casei)
garlic or allicin
pippali rasayana (butea monosperma) and piper longum: 1 gm TID x 15 d
berberine containing herbs
metronidazole: 250 mg orally every 8 hrs for 7 d depending on nature and severity of infxn

Question 6

diet suggestions for someone with giardia infxn? what to avoid specifically?

Answer 6

whole-food based, high-fiber diet low in fat, lactose and refined sugars
additionally add probiotics and wheat germ
avoid vit A supplementation during infxn
beet diet?

Question 7

2 txs for crypto in the immunocompetent pt?

Answer 7

chyawanprash (Ayurvedic herbal combo; base of ghee, may or may not contain silver, honey or sugar, purported to raise SIgA levels): 1/2 tsp BID for 30-60 d
crypto 30X nosode: 15 ggts TID for 1 mo or more

Question 8

7 tx options for treating blastocystis hominis?

Answer 8

broad spectrum antiparasitic formula: 2 TID ic on alternating wks for 10 wks
B. hominus 30X nosode: 15 gtts TID x 10 wks
collodial silver
jackass bitters combo (?)
oregano oil
probiotic
metronidazole (250-750 mg TID x 7 d) or tinidazole or bactrim or iodoquinol (650 mg orally 3x’s/d x 20 d

Question 9

3 tx options for treating dientamoeba fragilis, e. histolytica?

Answer 9

garlic
broad spectrum antiparasitic: 2 TID ic on alternate wks x 10 wks plus E. histolytica 30X or D. fragilis 30X: 15 gtts TID x 60 d
metronidazole for 10 d followed by iodoquinol for 20 d

Question 10

4 tx options for ascaris lumbricoides?

Answer 10

carica papaya: 20 mL of seed blended in honey
1% solution of Artemesia santonica daily for 40 d
chenopodium ambrosiodies (Peruvian herb)
mebendazole: adults and children PO 100 mg tablet AM and PM on 3 consecutive days

Question 11

if SIBO is present what 6 tx options should you consider? 4 diet options, 2 supplements

Answer 11

specific carb diet
SIBO specific foodguide (SCD/ low FODMAPS)
elemental diet
water fast x 2-3 wks
lactobacillus casei 6.5 B ac qd x 6 wks
enteric coated peppermint oil: 25 mg TID x 2-4 wks

Question 12

what does the SCD eliminate? what does it allow? how quickly can you see improvement in sxs after beginning SCD?

Answer 12

eliminates grains and starches, starchy veggies, some beans, oligosaccharides (polysaccharides) 
allows monosaccharides (honey), meat, fat, non-starchy veggies, ripe fruit, nuts/seeds, some beans, lactose-free dairy
can see improvement in sxs in 1-2 d

Question 13

what is the low FODMAPs diet? % success rate?

Answer 13

IBS tx diet that eliminates fermentable carb foods (certain fruits, veggies and grain) and has a success rate of 76% in IBS

Question 14

what does FODMAPs stand for?

Answer 14

F: fermentable
O: oligosaccharides
D: disaccharides
M: monosaccharides
A: and
P: polyols

Question 15

what is the elemental diet? absorption occurs where? where can you get it? problems with it? is it successful? cautions?

Answer 15

liquid only diet
predigested nutrients in powder form- vivonex plus (Nestle)
absorbed w/in 1st 2 ft of SI
can get at hospital, OTC, internet
problems: VERY expensive ($450/week); tastes bad
most successful non-drug tx studied for SIBO, 80-85% success during 2-3 wk course
cautions with DM pts and pts on dialysis

Question 16

how long does a water fast last? when to stop? who is this not recommended for? $?

Answer 16

lasts for 2 weeks
some say fast until what looks like the lining of the intestines come out
not suited for underweight pt
cheap (obviously)
no studies done yet

Question 17

what diet is good to help heal the BB? what should it be made from?

Answer 17

SCD
broth made from marrow bones, vit A, L-glutamine, lactose-free colostrum (2-6 g/d), probiotics (sauerkraut juice, lactose-free yogurt), zinc carnosine (75 mg BID), combo formula

Question 18

if a pt has IBS and part of the problem is hypochlorhydria what could you give?

Answer 18

vinegar: 1-2 tsp in water before meals
bitters
betaine HCl: up to 3120 mg per meal

Question 19

what 6 tx options could you try for open ileocecal valve syndrome?

Answer 19

liquid chlorophyll: 1 tbsp TID
betaine HCl
plant or pancreatic enzymes
adrenal tissue
adrenal botanicals (eleutherococcus, glycyrrhiza, rhodiola, holy basil)
adrenal nutrients (B complex, C, Zn, B5)

Question 20

what 4 tx options could you try for closed ileocecal valve syndrome?

Answer 20

calcium (Lowenberg’s test)
choline
pancreatic or plant enzymes
factors to balance high cortisol (ashwaganda, serine phosphate, plant sterols, DHEA)

Question 21

what is the protocol for the ICVS transition diet?

Answer 21

avoid or minimized initially:
high fiber and irritant foods: popcorn, chips, pretzels, nuts, seeds, whole grains
raw fruits and veggies
potent spices: chili, black and cayenne peper
chocolate and alcohol: more than 2 c of coffee/d
dairy, wheat, corn, soy

Question 22

what is the cedars-sinai diet? protocol?

Answer 22

lactose free
sweeteners allowed: glucose, sucrose, aspartame
sweeteners not allowed: corn syrup, mannitol, sorbitol, sucralose, lactose, lactulose, fruit juice
fiber from fruits and non-starchy veggies mostly: limit to 2 servings of fresh fruit/d
limit or eliminate beans, lentils, peas, soy, dairy
adequate water intake: 8 glasses/d
limit potatoes, pasta, rice, bread and cereals to 1/2-1 c at each meal, use white not whole grain products
protocol: diet follows 14 d of antibiotic dosage, 4-5 hrs b/w meals to stimulate MMC, 12 hr fast at night

Question 23

5 botanical tx options for SIBO

Answer 23

allicin extract of garlic: 450 mg BID-TID
berberine herbs: 5 g qd in split dosage
emulsified oregano: 100 mg BID
neem: 300 mg TID
enteric coated peppermint/menthol oil: antibac in vitro for E. coli, can cause heartburn though b/c it is a SM relaxant
30-60 d prior to retesting for all
prolonged die off rxns may occur

Question 24

John’s Hopkins 2 herbal protocols

Answer 24

dysbiocide 2 BID, FC-cidal 2 BID
or
candibactin AR 2 BID, candibactin BR 2 BID
take either for 30 d

Question 25

antibiotic protocol for hydrogen producing SIBO? what happens if you don’t follow one of the SIBO clearing diets w/the abx?

Answer 25

rifaximin 550 mg TID x 10-14 d

if don’t follow one of the 3 diets recurrence rate goes up to 47% w/in 9 mos

Question 26

abx tx for methane producing SIBO? BM picture for these pts? alternative combo?

Answer 26

pts will present w/constipation or alternating constipation and diarrhea
rifaximin 550 mg TID x 14 d w/neomycin 500 mg BID x 14 d
alternative: rifaximin 550 mg TID x 10-14 d plus metronidazole 250 mg TID x 10 d

Question 27

when is rifaximin and concurrent neomycin to tx methane producing SIBO c/i?

Answer 27

w/renal dysfunction, ototoxicity and nephrotoxicity

Question 28

what 3 rxs can you use to tx low motility?

Answer 28

erythromycin compounded to 50 mg qhs x 3 mo (may use 1/4 of 250 mg standard tablet)
LDN nightly for 3 mos, 2.5 mg qhs for diarrhea and 4.5 mg qhs for constipation
prucalopride, potent, selective and specific 5-HT4 receptor agonist: 0.5-2 mg qhs, not available in US

Question 29

what is a prokinetic?

Answer 29

has a (+) effect on the migrating motor complex (motilin receptor agonist)

Question 30

what are 3 antifungals, 2 supplements and a functional problem you need to tx when treating candidiasis/rhodotorula/saprophytic fungi infxn?

Answer 30

antifungals: capryllic acid (800-1200 mg TID cc) or undecylenic acid or nystatin (500,000 units 1-4x’s/d up to 1 yr or fluconazole
supplements: alternate oregano extract (100 mg TID) and garlic (whole herb) or allicin (180 mg QD to TID) along with probiotics (10-15 + billion BID cc)
functional problem: tx hypo/achlorhydria if present

Question 31

if an expanded GI health panel shows an elevated SIgA and trichinella SIgA is also elevated what could really be going on?

Answer 31

trichinella infxn may be elevating food SIgA levels so may just actually need to tx infxn

Question 32

what are the 3 levels of ‘gluten intolerance’?

Answer 32

incomplete digestion of prolamines
wheat or gluten/gliadin allergy or intolerance
celiac dz

Question 33

name a few dzs associated with celiac dz

Answer 33

DM
thyroiditis
osteopenia/porosis
sjogrens dz
primary biliary cirrhosis
adrenocortical deficiency 
IgA nephrosis
RA
Down syndrome
seizure d/os
fibrosing alveolitis
idiopathic pulmonary hemosiderosis 
recurrent pericarditis
myocarditis
dilated cardiomyopathy
splenic atrophy
dementia/schizophrenia
dermatitis herpetiformis 
maltoma

Question 34

labs suggestive of active celiac dz?

Answer 34

hypocalcemia
vit D deficiency
hypoproteinemia
iron deficiency anemia
folate/B12 deficiency anemia
thrombocytosis
prolonged prothrombin time
elevated transaminases or alk phos

Question 35

what could be revealed while taking a hx that could indicate underlying celiac dz?

Answer 35

short stature
anxiety, irritability
chronic fatigue
muscle cramping
tetany
bone/jt/muscle pain
ataxia
neuropathy
paresthesia
migraine/head pain
generalized itching
delayed menarche/puberty
amenorrhea
infertility 
recurrent abortion
night blindness 
chronic anemia
recurrent oral apthae
dental enamel defects
skin pigment changes
follicular hyperkeratosis
vesicular pruritic rash

Question 36

4 screening tests for celiac dz

Answer 36

serum antigliadin IgA/IgG
serum deamidated gliadin peptide IgA, IgG
serum tissue transglutaminase IgA, IgG
esophagogastroduodenoscopy w/ bx of 3rd/4th segment of the duodenum

Question 37

3 screening tests for non-celiac gluten sensitivity

Answer 37

salivary anti-gliadin SIgA
stool anti-gliadin Ab
stool anti-tTG Ab

Question 38

what are 3 typical ASI findings with non-celiac gluten intolerance

Answer 38

depressed morning cortisol
elevated midnight cortisol
depressed total SIgA (salivary or serum)

Question 39

5 key homeopathic IBS remedies?

Answer 39

aloe socratina: diarrhea w/sudden urge for stool 5 am, mucus in stool, jelly-like lumps, insecurity of the rectum, aggravation from oysters or beer
podophyllum: explosive diarrhea, gurgling in the abd precedes stool, yellow, watery, profuse, foul stool, weakness, faintness after stool
gelsemium: diarrhea from fright, anticipation or bad news, dull, dizzy, drowsy, droopy
veratrum album: gastroenteritis, simultaneous vomiting and diarrhea, craves lemon, sour fruit, ice or salt
mercurius cor: dysentery w/constant tenesmus, unrelieved by stool, blood, mucus and burning w/stool