Irritable Bowel Syndrome Message Boards

Images Show a Snub Really is Like Kick in the Gut
Thu October 09, 2003 01:58 PM ET

By Maggie Fox, Health and Science Correspondent
WASHINGTON (Reuters) - The feeling is familiar to anyone who has been passed over in picking teams or snubbed at a party -- a sickening, almost painful feeling in the stomach.

Well, it turns out that "kicked in the gut" feeling is real, U.S. scientists said on Thursday.

Brain imaging studies show that a social snub affects the brain precisely the way visceral pain does. "

http://www.scn.ucla.edu/labnewsdw/reuters_dw.html

This article is really worth reading also.

""Stress: It's Worse Than You Think

Provided by Psychology Today

Psychological stress doesn't just put your head in a vise. New studies document exactly how it tears away at every body system--including your brain. But get this: The experience of stress in the past magnifies your reactivity to stress in the future. So take a nice deep breath and find a stress-stopping routine this instant. "

http://health.yahoo.com/health/centers/stress/1205.html

and further on stress and the immune system.

and how stress can have a delayed reaction.

http://www.ibsgroup.org/ubb/ultimatebb.php?ubb=get_topic;f=1;t=039331

an why a person with an enteric infection, who is stressed at the time of infection, contributes to PI IBS, after resolution of the intial infection, because stress and the immune system are intricately connected.

and next the role of serotonin and it being majorally impicated in IBS and the brain gut axis communications between the enteric nervous system and the brain.

Serotonin: a neurotransmitter.

The functions of serotonin are numerous and appear to involve control of appetite, sleep, memory and learning, temperature regulation, mood, behavior (including sexual and hallucinogenic behavior), cardiovascular function, muscle contraction, endocrine regulation, and depression. Peripherally, serotonin appears to play a major role in platelet homeostasis, motility of the GI tract"

First its a very important role in gut function, which I will get to next, but it also has a very important role in anxiety, depression and also relaxation.

But its role in gut motility is next, along with brain gut axis communications. It is also involved in pain transmission from the gut to the brain.

Some detailed information on IBS and serotonin.

"IBS: Improving Diagnosis, Serotonin Signaling, and Implications for Treatment"

CME
Authors: Lucinda Harris, MD; Lin Chang, MD

http://www.medscape.com/viewprogram/2750_pnt

95 percent of the serotonin in the body is stored in the gut. The majority of that serotonin is stored in enteroendocrine (or enterochromaffin) cells that line the gut wall. These cells are pressure sensitive to either chemical or mechanical stimulation of the gut mucosa. Once the cells are activated they release serotonin which in turn initiates peristalsis. (gut contractions)

(as a side note these cells have been seen increased in Post infectious IBSers.)

It also signals from the gut to the brain up nerve fibers, the serotonin does not actually go from the gut to the brain, but signals up the nerve fibers to communicate with the brain in a bidirectional communication.

But at the moment this is at the gut level.

Harvard Health

"The Trusted Source
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Harold J. DeMonaco, M.S.

Harold J. DeMonaco, M.S., is senior analyst, Innovative Diagnostics and Therapeutics, and the chair of the Human Research Committee at the Massachusetts General Hospital. He is author of over 20 publications in the pharmacy and medical literature and routinely reviews manuscript submissions for eight medical journals.
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June 19, 2001
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A:

Irritable bowel syndrome is now recognized as a disorder of serotonin activity. Serotonin is a neurotransmitter in the brain that regulates sleep, mood (depression, anxiety), aggression, appetite, temperature, sexual behavior and pain sensation. Serotonin also acts as a neurotransmitter in the gastrointestinal tract.

Excessive serotonin activity in the gastrointestinal system (enteric nervous system) is thought to cause the diarrhea of irritable-bowel syndrome. The enteric nervous system detects bowel distension (expansion) on the basis of pressure-sensitive cells in the bowel lumen (opening). Once activated, these pressure-sensitive cells promote the release of serotonin, which in turn promotes both secretory function and peristaltic function (the contractions of the intestines that force the contents outward). At least four serotonergic receptors have been identified to be participants in the secretory and peristaltic response.

Patients with diarrhea-predominant IBS may have higher levels of serotonin after eating than do people without the disorder. This recognition led to the development of the first drug used specifically to treat diarrheal symptoms of IBS, alosetron (also known as Lotronex). Alosetron blocked the specific serotonin receptors responsible for recognizing bowel distention. In doing so, it blocked the effects of serotonin and reduced both bowel secretions and peristalsis. Constipation was the most common side effect seen. (Note: Alosetron was removed from the market by the manufacturer after repeated reports of a dangerous condition known as ischemic colitis became known.) Tegaserod (Zelmac) is another drug under development and under review by the U.S. Food and Drug Administration for approval. Tegaserod is indicated for the treatment of constipation-predominant IBS and works to increase enteric nervous system serotonin activity.

So, increasing serotonin activity in the enteric nervous system produces increased bowel secretions and peristalsis (and potentially diarrhea), whereas depressing serotonin activity produces reduced secretions and reduce peristalsis (and potentially constipation). Increasing serotonin activity in the brain would increase awareness and, in higher doses, produce anxiety, insomnia and restlessness"

They are also working to see if these receptors are malfunctioning and a lot of work has gone into it, from around the world.

However, also to note is that the majority of IBSers presenting to gastroenterologists, have demonstrated effective serotonin dysregulation.

Also to note is an increase in serotonin after eating in d predominate IBS.

"Levels of 5-Hydroxytryptamine Increase After Meals in Women With Irritable Bowel Syndrome

NEW YORK Reuters Health May 05 - Platelet-depleted plasma 5-hydroxytryptamine 5-HT levels increase after meals in women with diarrhea-predominant irritable bowel syndrome d-IBS whose symptoms increase following food ingestion, according to a report in the May issue of Gut.

In small studies, 5-HT concentrations in platelet-poor plasma appear higher in women with d-IBS than in healthy women, the authors explain, suggesting a possible link between 5-HT and postprandial symptom exacerbations or IBS itself.

Dr. L. A. Houghton from University Hospital of South Manchester, UK and colleagues assessed 5-HT and 5-HIAA its metabolite concentrations, 5-HT turnover, and platelet 5-HT stores in 39 women with d-IBS and 20 healthy female volunteers before and after a standard carbohydrate meal.

Although there was no difference in the ratio of postprandial to fasting 5-HT levels between d-IBS patients and healthy controls, the authors report, d-IBS subjects did have higher postprandial concentrations of 5-HT with earlier peak 5-HT levels than did healthy women.

Women with d-IBS who reported symptoms following the meal also tended to have higher 5-HT concentrations and higher peak concentrations than did other women, the report indicates, though there was no difference in the time to peak levels compared with asymptomatic women with d-IBS."

"Our results have shown for the first time that symptom exacerbation following meal ingestion in female subjects with d-IBS is associated with increased levels of plasma 5-HT, together with a reduction in 5-HT turnover," the authors conclude. "In addition, baseline platelet stores of 5-HT are elevated in female subjects with d-IBS compared with healthy subjects, supporting increased exposure of platelets to 5-HT in the systemic circulation.""

Postprandial plasma 5-hydroxytryptamine in diarrhoea predominant irritable bowel syndrome: a pilot study

http://gut.bmjjournals.com/cgi/content/full/42/1/42

There is way more research on serotonin and IBS and its implications however and although majorally implicated the jury is not out yet on all the specifics and IBS, other then they know it is implicated, there are still very important avenues of research still needed to be done. IBS is a very complex condition to research.

This is very complex infromation, but worth familarizing yourself with and there are some important graps to review on this page.

Irritable Bowel Syndrome (IBS): Examining New Findings and Treatments
Authors: Marvin M. Schuster, MD; Michael D. Crowell, PhD; Nicholas J. Talley, MD, PhD

"The Role of Serotonin in the Pathophysiology of IBS

The Brain-Gut Interaction
The enteric nervous system (ENS) functions semi-autonomously.[3] It acts directly upon effector systems such as smooth muscles, endocrine cells and blood vessels, facilitating serotonin (5-HT) -mediated secretion and motility. However, the parasympathetic and sympathetic nervous systems have a pivotal role in GI function through autonomic integrative processes that facilitate the brain-gut interaction. Neuronal interactions that involve numerous neurotransmitters (eg, 5-HT, norepinephrine [NE], dopamine [DA], acetylcholine [ACh], glutamate), neuropeptides (eg, substance P, vasointestinal peptide, calcitonin gene-related peptide [CGRP]), and other neuromodulators (eg, neurotrophic factors) occur in both the brain and the gut.
Whereas short reflex pathways include a circuit of local and spinal cord neurons, long reflexes involve vagal and spinal pathways. Visceral pain information, for instance, traverses A-delta and C fibers and synapse in the dorsal horn of the spinal cord (specifically laminae I and II). The neural signal ascends through the contralateral spinothalamic tract to the brain where pain is perceived. The processing of pain information within the CNS varies between normal individuals and those with IBS. The CNS-processed information is sent to the effector through descending pathways traversing brainstem nuclei (eg, periaqueductal gray, raph� nucleus, and locus coeruleus) -- pathways that use 5-HT and NE."

"Serotonin influences motility, visceral perception, and secretion in the gut. The pervasive role of 5-HT in normal and pathological GI conditions is apparent in its pattern of distribution -- 95% of 5-HT in the body is in the GI tract and approximately 5% is localized in the brain.[3] Serotonin is released primarily by enterochromaffin cells, but also by neuronal and mast cells."

http://www.medscape.com/viewprogram/725_pnt

Mentioned above are mast cells which are also connected to the HPA axis and immune system.

I will come back to that however.

New news on serotonin which may at a later date have possible ramifications for IBS.

"UI sheds new light on behavior-affecting chemical

By GREG KLINE
� 2004 THE NEWS-GAZETTE
Published Online October 4, 2004

Serotonin plays a powerful role in the function of the brain and elsewhere in the body.
When it's working properly, it makes us content or happy, scientists believe, while a glitch in the amount or processing of the chemical can stimulate depression, anxiety or aggressive behavior, even when they're unwarranted.
"It's one of the central organizing factors in behavior," University of Illinois Professor Rhanor Gillette said recently.
The illegal drug Ecstasy releases massive amounts of serotonin, making the user feel great, at the eventual cost of what amounts to overloading and burning out the cells in the area of the brain affected.
Problems with serotonin also may contribute to sudden infant death syndrome, attention deficit hyperactivity disorder and irritable bowel syndrome, among other things."

http://www.news-gazette.com/story.cfm?Number=16857

AlphaMale
, Like K, said different drugs effect people differently, but some are more known to cause certain side effects perhaps.

Also, like K said they can help block pain transmission, because serotonin is also used as a singaling transmitter for pain.

There are also newer drugs being tested on some of these issues, that target stress hormones and a different approach. Although this study was preliminary, its results were promicing. There are others as well.

Tmar, keep at it and its good your trying the CBT. IBS is still a physical problem and there can be issues that account for people taking longer for the HT or CBT to take effect. If you start getting more rleaxed as you go, try the tapes again at a later date, also.

But importantly trying to learn this information and its effect on the gut, for normals even, but very importantly for IBS will help in a variety of ways, some of which I will keep posting about.

However, these things do take time and a lot of persistence, dedication and focus on the IBSers part to keep at it and learn about it all. The it will start to help and a person will start feeling and seeing the connections. Part of this involveds moods states and the distress the condition causes in and of it self.

CRH Antagonist Reduces IBS Responses to Stress

June 30, 2004 � Peripheral administration of the nonselective corticotropin-releasing hormone (CRH) antagonist α-helical CRH9-41 (αhCRH) improves gastrointestinal motility, visceral perception, and negative mood in response to gut stimulation without affecting the hypothalamo-pituitary-adrenal axis in patients with irritable bowel syndrome (IBS), according to the results of a preliminary study published in the July issue of Gut.

"IBS is presumed to be a disorder of the brain-gut link associated with an exaggerated response to stress," write Y. Sagami, MD, and colleagues of the Department of Psychosomatic Medicine at the Tohoku University School of Medicine in Sendai, Japan. "CRH is considered to be a major mediator of stress responses in the brain-gut axis."

The investigators enrolled 10 healthy subjects and 10 subjects diagnosed with diarrhea-predominant IBS according to the Rome II criteria. IBS medication was discontinued one week prior to the study.

A barostat bag and three transducers were inserted into the proximal portion of the descending colon of each subject and connected to an analog-digital converter and a visceral stimulator. An electrode catheter was set in the rectum for electrical stimulation of the mucosa.

The study was conducted in two segments, one using a 20-mL saline bolus followed by continuous infusion, and the other using a 2 �g/kg αhCRH bolus followed by 8 �g/kg continuous infusion. Both segments included baseline, rectal electrical stimulation, recovery, and tracking phases. Colonic tone was evaluated by noting the lowest volume in the barostat bag at which the subject felt pressure. Subjective symptoms were self-assessed by subjects on an ordinate scale.

Basal bag volume tended to be lower in IBS subjects than controls, indicating higher colonic tone. Administration of αhCRH resulted in significantly increased baseline barostat bag volume in control subjects (from a mean standard error of the mean (SEM) of 105.8 30.5 mL to 148.3 37.4; P = .004) but not IBS subjects. IBS subjects responded to electrical stimulation with significantly decreased bag volume both in the first segment (P = .01) and after the αhCRH infusion (P = .004). Electrical stimulation did not reduce bag volume in the control subjects.

"Colonic tone in IBS patients increased throughout our experiment and was even exaggerated by electrical stimulation of the rectum," the authors note. "The increased sensitivity of the gut to CRH in IBS patients may account for this phenomenon."

Motility indices of the colon induced by electrical stimulation were significantly higher in IBS patients compared with control subjects (mean SEM, 421.5 171.6 vs. 124.5 46.5; P = .04). This exaggerated motility response in IBS subjects was significantly attenuated by αhCRH (P .05).

In IBS subjects, αhCRH significantly decreased evaluations of abdominal pain (P = .02) and anxiety (P< .0001) resulting from electrical stimulation.

Administration of αhCRH had no inhibitory effects on the hypothalamo-pituitary-adrenal axis; levels of plasma adrenocorticotropic hormone and serum cortisol were not reduced.

"Because of the small number of subjects included in the study, this initial clinical investigation warrants replication in a larger group of IBS patients and further assessment using a placebo control group," comments Y. Tach�, MD, from the Digestive Diseases Research Center in Los Angeles, California, in an accompanying editorial, adding that the findings also support the testing of more potent CRH antagonists.

The authors report no pertinent financial disclosures.

Gut. 2004;53:919-921, 958-964

It should be noted, that regardless of how complex all this is, some basic approaches really make a huge difference in IBS symptoms for the vast majority of IBSers.

Its not needed to understand this all in serious depth, although that helps too, but to just learn the basics.

This is on the bigger picture of IBS and IBS research in general, it is quite in depth. And actually save me some time.

Irritable Bowel Syndrome: Taking Concepts Into Clinical Practice

Chairperson: Michael D. Gershon, MD; Faculty: Kevin W. Olden, MD; Walter L. Peterson, MD; Nicholas J. Talley, MD, PhD; Gervais Tougas, MD, CM, FRCPC

Copyright � 2002 CME Consultants, Inc.
This CME activity is based on transcripts and slides of presentations as delivered by the faculty at the "Irritable Bowel Syndrome: Taking Concepts Into Clinical Practice" symposium held at the Palace Hotel in San Francisco, California on May 20, 2002.

http://www.medscape.com/viewprogram/1985_pnt

You often see cortisol or ACTH or Histimine and other stress hormones in IBS research and IBS education. This helps even more to explain what I have been talking about on this thread and how very important it is in IBS and psycophysiological brain gut intereactions.

Mayo
Stress: Why you have it and how it hurts your health

"Often referred to as the "fight-or-flight" reaction, the stress response occurs automatically when you feel threatened. Your pituitary gland, located at the base of your brain, responds to a perceived threat by stepping up its release of adrenocorticotropic hormone (ACTH), which signals other glands to produce additional hormones. When the pituitary sends out a burst of ACTH, it's like an alarm system going off deep in your brain. This alarm tells your adrenal glands, situated atop your kidneys, to release a flood of stress hormones into your bloodstream. These hormones � including cortisol and adrenaline � focus your concentration, speed your reaction time, and increase your strength and agility.

How stress affects your body

After you've fought, fled or otherwise escaped your stressful situation, the levels of cortisol and adrenaline in your bloodstream decline. As a result, your heart rate and blood pressure return to normal and your digestion and metabolism resume a regular pace. But if stressful situations pile up one after another, your body has no chance to recover. This long-term activation of the stress-response system can disrupt almost all your body's processes, increasing your risk of obesity, insomnia, digestive complaints, heart disease and depression.

Digestive system. It's common to have a stomachache or diarrhea when you're stressed. This happens because stress hormones slow the release of stomach acid and the emptying of the stomach. The same hormones also stimulate the colon, which speeds the passage of its contents. Chronic stress can also lead to continuously high levels of cortisol. This hormone can increase appetite and cause weight gain.
Immune system. Chronic stress tends to dampen your immune system, making you more susceptible to colds and other infections. Typically, your immune system responds to infection by releasing several substances that cause inflammation. In response, the adrenal glands produce cortisol, which switches off the immune and inflammatory responses once the infection is cleared. However, prolonged stress keeps your cortisol levels continuously elevated, so your immune system remains suppressed.
In some cases, stress can have the opposite effect, making your immune system overactive. The result is an increased risk of autoimmune diseases, in which your immune system attacks your body's own cells. Stress can also worsen the symptoms of autoimmune diseases. For example, stress is one of the triggers for the sporadic flare-ups of symptoms in lupus.

Nervous system. If your fight-or-flight response never shuts off, stress hormones produce persistent feelings of anxiety, helplessness and impending doom. Oversensitivity to stress has been linked with severe depression, possibly because depressed people have a harder time adapting to the negative effects of cortisol. The byproducts of cortisol act as sedatives, which contribute to the overall feeling of depression. Excessive amounts of cortisol can cause sleep disturbances, loss of sex drive and loss of appetite.
Cardiovascular system. High levels of cortisol can also raise your heart rate and increase your blood pressure and blood lipid (cholesterol and triglyceride) levels. These are risk factors for both heart attacks and strokes. Cortisol levels also appear to play a role in the accumulation of abdominal fat, which gives some people an "apple" shape. People with apple body shapes have a higher risk of heart disease and diabetes than do people with "pear" body shapes, where weight is more concentrated in the hips.
Other systems. Stress worsens many skin conditions � such as psoriasis, eczema, hives and acne � and can be a trigger for asthma attacks."

http://www.mayoclinic.com/invoke.cfm?objectid=76F75B48-39C9-42CE-AC10563A6FFB68E8

IBS � Beyond the Bowel:
The Meaning of Co-existing Medical Problems
Olafur S. Palsson, Psy.D. and William E. Whitehead, Ph.D.
UNC Center for Functional GI & Motility Disorders
SYMPTOMS ALL OVER THE BODY IN IBS
Several research reports have established that IBS patients report non-bowel symptoms
more frequently than other GI patients and general medical patients. For example, four
studies that have asked IBS patients about a wide variety of body symptoms(1-4) all found
headaches (reported by 23-45% of IBS patients), back pain (28-81%), and frequent
urination (20-56%) to be unusually common in individuals with IBS compared to other
people. Fatigue (36-63%) and bad breath or unpleasant taste in the mouth (16-63%) were
found in three of these four studies to be more common among IBS patients, as well.
Furthermore, a large number of other symptoms have been reported to occur with
unusually high frequency in single studies. In our recent systematic review of the medical
literature(5), we found a total 26 different symptoms, listed in Table 1, that are reported to
be more common in IBS patients than comparison groups in at least one study.
Table 1. Non-gastrointestinal symptoms more common in irritable bowel syndrome
patients than in comparison groups(5).
1. Headache
2. Dizziness
3. Heart palpitations or racing heart
4. Back pain
5. Shortness of breath
6. Muscle ache
7. Frequent urinating
8. Difficulty urinating
9. Sensitivity to heat or cold
10. Constant tiredness
11. Pain during intercourse (sex)
12. Trembling hands
13. Sleeping difficulties
14. Bad breath/unpleasant taste in
mouth
15. Grinding your teeth
16. Jaw pain
17. Flushing of your face and neck
18. Dry mouth
19. Weak or wobbly legs
20. Scratchy throat
21. Tightness or pressure in chest
22. Low sex drive
23. Poor appetite
24. Eye pain
25. Stiff muscles
26. Eye twitching

http://www.med.unc.edu/medicine/fgidc/beyond_the_bowel.htm

See any similarities?

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My website on IBS is www.ibshealth.com

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