IBS and IBD Flashcards
IBS solutions
- 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.
IBS Key Symptoms
- Abdominal pain and cramping relieved by passing a stool.
- Diarrhoea, constipation or mixed.
- Bloating and flatulence.
- Incomplete emptying of bowels.
IBS Sub-types
IBS-C: Constipation
IBS- D: Diarrhoea
IBS-M: Mixed
IBS-U: Unclassified
IBS- C Treatment
- ↑ 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).
IBS-D Treatment
- ↑ 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)
IBD
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
IBD: Key symptoms
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).
IBD: Key complications
Colorectal cancer, osteoporosis, anaemia e.g. iron, folate, B12).
Crohn’s region affected
Any part of the GIT but mostly the terminal ileum.
Crohn’s Distribution
Skip lesions
Crohn’s disease: Layers affected
All layers
Crohn’s Complications
Fistulas, abscess, obstruction, malabsorption - B12 deficiency
UC Regions
Colon and rectum
UC Distribution
Proximally continuous
UC Layers
Mucosa only
UC: Key symptoms
Abdominal pain (left side), Bloody diarrhoea
UC: Complications
Haemorrhage -> anaemia
Crohn’s: Key symptoms
Crampy, abdominal pain (right). Loose semi-solid stools.
IBD aetiology and pathophysiology
- 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
Bacterial patterns commonly seen in IBD
- 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.
IBD Triggers
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.
Dietary strategies for IBD:
- 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).
Other natural approaches for IBD:
- 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
