IBS Flashcards
Rome II definition of IBS?
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
sxs that cumulatively support dx of IBS?
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
5 common misdiagnoses of IBS which could also lead to IBS?
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)
6 txs for c. diff infxn?
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
5 txs for giardia lamblia infxn?
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
diet suggestions for someone with giardia infxn? what to avoid specifically?
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?
2 txs for crypto in the immunocompetent pt?
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
7 tx options for treating blastocystis hominis?
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
3 tx options for treating dientamoeba fragilis, e. histolytica?
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
4 tx options for ascaris lumbricoides?
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
if SIBO is present what 6 tx options should you consider? 4 diet options, 2 supplements
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
what does the SCD eliminate? what does it allow? how quickly can you see improvement in sxs after beginning SCD?
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
what is the low FODMAPs diet? % success rate?
IBS tx diet that eliminates fermentable carb foods (certain fruits, veggies and grain) and has a success rate of 76% in IBS
what does FODMAPs stand for?
F: fermentable O: oligosaccharides D: disaccharides M: monosaccharides A: and P: polyols
what is the elemental diet? absorption occurs where? where can you get it? problems with it? is it successful? cautions?
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
how long does a water fast last? when to stop? who is this not recommended for? $?
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
what diet is good to help heal the BB? what should it be made from?
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
if a pt has IBS and part of the problem is hypochlorhydria what could you give?
vinegar: 1-2 tsp in water before meals
bitters
betaine HCl: up to 3120 mg per meal
what 6 tx options could you try for open ileocecal valve syndrome?
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)
what 4 tx options could you try for closed ileocecal valve syndrome?
calcium (Lowenberg’s test)
choline
pancreatic or plant enzymes
factors to balance high cortisol (ashwaganda, serine phosphate, plant sterols, DHEA)
what is the protocol for the ICVS transition diet?
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
what is the cedars-sinai diet? protocol?
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
5 botanical tx options for SIBO
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
John’s Hopkins 2 herbal protocols
dysbiocide 2 BID, FC-cidal 2 BID
or
candibactin AR 2 BID, candibactin BR 2 BID
take either for 30 d
antibiotic protocol for hydrogen producing SIBO? what happens if you don’t follow one of the SIBO clearing diets w/the abx?
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
abx tx for methane producing SIBO? BM picture for these pts? alternative combo?
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
when is rifaximin and concurrent neomycin to tx methane producing SIBO c/i?
w/renal dysfunction, ototoxicity and nephrotoxicity
what 3 rxs can you use to tx low motility?
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
what is a prokinetic?
has a (+) effect on the migrating motor complex (motilin receptor agonist)
what are 3 antifungals, 2 supplements and a functional problem you need to tx when treating candidiasis/rhodotorula/saprophytic fungi infxn?
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
if an expanded GI health panel shows an elevated SIgA and trichinella SIgA is also elevated what could really be going on?
trichinella infxn may be elevating food SIgA levels so may just actually need to tx infxn
what are the 3 levels of ‘gluten intolerance’?
incomplete digestion of prolamines
wheat or gluten/gliadin allergy or intolerance
celiac dz
name a few dzs associated with celiac dz
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
labs suggestive of active celiac dz?
hypocalcemia vit D deficiency hypoproteinemia iron deficiency anemia folate/B12 deficiency anemia thrombocytosis prolonged prothrombin time elevated transaminases or alk phos
what could be revealed while taking a hx that could indicate underlying celiac dz?
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
4 screening tests for celiac dz
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
3 screening tests for non-celiac gluten sensitivity
salivary anti-gliadin SIgA
stool anti-gliadin Ab
stool anti-tTG Ab
what are 3 typical ASI findings with non-celiac gluten intolerance
depressed morning cortisol
elevated midnight cortisol
depressed total SIgA (salivary or serum)
5 key homeopathic IBS remedies?
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
