IBS and IBD

Question 1

IBS solutions

Answer 1

• Slow down, chew thoroughly, eat mindfully, don’t overeat (or too late within 3 hours of bed), do not drink with meals.
• Avoid lying down post meals; when sleeping elevate the head of the bed (by up to 20 cm).
• Address stress and anxiety. Lose weight if applicable.
• Visceral manipulation of hiatus hernia. Also ↑ fibre to ↓ straining.

Question 2

IBS Key Symptoms

Answer 2

• Abdominal pain and cramping relieved by passing a stool.
• Diarrhoea, constipation or mixed.
• Bloating and flatulence.
• Incomplete emptying of bowels.

Question 3

IBS Sub-types

Answer 3

IBS-C: Constipation
IBS- D: Diarrhoea
IBS-M: Mixed
IBS-U: Unclassified

Question 4

IBS- C Treatment

Answer 4

• ↑ dietary fibre and stay hydrated.
• Magnesium (e.g., magnesium citrate increase dosage from 250 mg gradually until tolerance).
• Vitamin B5 and ginger ((↑ peristalsis).
• Psyllium husk or ground flaxseed (15-30 g / day). 5-HTP (for some).
• Natural laxatives e.g., prunes, figs. Pour prune juice over freshly ground flaxseeds (leave it in the fridge).

Question 5

IBS-D Treatment

Answer 5

• ↑ soluble fibre to help bulk stool e.g. apple pectin.
• Enteric-coated peppermint oil.
• Digestive enzymes.
• S. boulardii ((↑ sIgA)
• Electrolyte replacement , juices and broths to account for fluid / electrolyte losses.
• Marshmallow root, slippery elm, meadowsweet (powder)

Question 6

IBD

Answer 6

A group of autoimmune conditions of the colon and small intestine. Crohn’s disease (CD) and ulcerative colitis (UC) are the principal types of IBD

Question 7

IBD: Key symptoms

Answer 7

Key symptoms (peaks 15 35 years):
– Abdominal pain and diarrhoea
– Urgency to pass stools.
– Rectal bleeding (more so in UC)
– Weight loss.
– Fatigue (blood loss and malabsorption).

Question 8

IBD: Key complications

Answer 8

Colorectal cancer, osteoporosis, anaemia e.g. iron, folate, B12).

Question 9

Crohn’s region affected

Answer 9

Any part of the GIT but mostly the terminal ileum.

Question 10

Crohn’s Distribution

Answer 10

Skip lesions

Question 11

Crohn’s disease: Layers affected

Answer 11

All layers

Question 12

Crohn’s Complications

Answer 12

Fistulas, abscess, obstruction, malabsorption - B12 deficiency

Question 13

UC Regions

Answer 13

Colon and rectum

Question 14

UC Distribution

Answer 14

Proximally continuous

Question 15

UC Layers

Answer 15

Mucosa only

Question 16

UC: Key symptoms

Answer 16

Abdominal pain (left side), Bloody diarrhoea

Question 17

UC: Complications

Answer 17

Haemorrhage -> anaemia

Question 18

Crohn’s: Key symptoms

Answer 18

Crampy, abdominal pain (right). Loose semi-solid stools.

Question 19

IBD aetiology and pathophysiology

Answer 19

• IBD is characterised by the interaction between a genetically susceptible individual and environmental factors , which have an impact on gut microbiota composition, triggering overly aggressive T cell responses.
• Genetics there are at least 163 genes involved in IBD. Many are shared between UC and CD but some are unique to each.
• Damage to the mucosal lining is very much associated with IBD

Question 20

Bacterial patterns commonly seen in IBD

Answer 20

• Very low / missing Akkermansia spp., ↑ R. gnavus and R. torques  mucus degradation .
• Raised gram negative bacteria (e.g., Fusobacterium nucleatum ) create a high LPS load, which in itself ↑ immune response.
• Bacteroides fragilis (enterotoxigenic) has also been associated as a trigger for IBD (its toxins destroy intestinal tight junctions).
• A lack of commensal bacteria diversity (especially the SCFA producers) necessary in times of mucosal tissue repair. Lower numbers of F. prausnitzii , a bacterium that generates anti-inflammatory metabolic by products, e.g., SCFAs incl. butyrate.

Question 21

IBD Triggers

Answer 21

Certain environmental factors alter mucosal barrier integrity, the immune response, or GI ecology
* Medication use: Antibiotics, NSAIDs, oral contraception.
* Smoking (particularly CD)
* Stress.
* Infections (e.g., viral)
* Poor diet (e.g., ↓ fibre = ↓ commensal substrates and ↓ SCFAs ; omega 3’s, ↑ arachidonic acid, ↑ refined sugars ). Also, food additives such as carrageenan.

Question 22

Dietary strategies for IBD:

Answer 22

• Remove inflammatory foods / beverages (e.g., dairy, gluten, refined sugars, coffee, alcohol, damaged oils).
• Consider a low reactive dietary model such as SCD (especially for CD) or low FODMAP.
• Include well cooked foods (slow cooked at a low temperature) as well as soups, stews and broths that are easy to digest and nourishing.
• Consider an elimination diet to identify problematic foods.
• Optimise omega 3 to 6 ratio (e.g., skinless oily fish ) can also be addressed via supplementation.
• Fresh green juices (chlorophyll rich, anti- inflammatory).

Question 23

Other natural approaches for IBD:

Answer 23

• Vitamin D
• Fish oils
• Supporting the mucosal / epithelial barrier:
  – Demulcent herbs
  – Green tea catechins and epicatechins
  – Vitamin A, N acetyl glucosamine, zinc carnosine, L glutamine.
• Ginger
• Turmeric
• Quercetin
• Aloe vera
• Bowellia serrata (frankincense)
• Chamomile
• Lion’s mane mushroom
• Probiotics
• Prebiotics
• Prioritise nutrient deficiencies