Irritable Bowel Syndrome Message Boards

MikeCA1870

Stress and foods don't cause IBS, just so you know. There is a physical problem. Two cells they believe are highly involved are called enterochromaffin (EC) cells and another mast cells. But they still have work to do on it all.

ec cells and serotonin

http://www.medscape.com/viewarticle/528890_2

serotonin and IBS

Increasingly our understanding of IBS is that it is a heterogeneous disorder � that is, multiple factors contribute to the well defined symptoms of the disorder. One of these suspected underlying dysfunctions involves serotonin, which is a neurotransmitter or messenger to nerves. Most serotonin in the body is in cells that line the gut where it senses what is going on and through receptors signals nerves that stimulate a response. The serotonin must then be reabsorbed (a process called re-uptake) into cells. This process appears to be disrupted in people with IBS.

http://www.aboutibs.org/site/learning-center/video-corner/serotonin

The mast cells can be trigger by both foods and stressors, real or imagined and both physical and mental.

The severity of IBS can be related to psychological issues as well. psychological issues can make it worse, for example depression. Treat the depression and the IBS can get better.

It doesn't have to be severe stress. Eveyday stressors, emotions and thoughts can trigger it as well, but more in moderate to severe IBS. People with mild IBS are not effected as much. So part of this does depend on how bad your IBS symptoms are and how often it effects someone.

Part of the issue here and I don't know if you read that also is the fight or flight responce, which is hardwired to the brain.

What is the "fight or flight response?"

This fundamental physiologic response forms the foundation of modern day stress medicine. The "fight or flight response" is our body's primitive, automatic, inborn response that prepares the body to "fight" or "flee" from perceived attack, harm or threat to our survival.

http://www.thebodysoulconnection.com/EducationCenter/fight.html

So anger, fear, worry, anxiety, stressors, both physical and mental can effect people with IBS. This upsets homeostasis.

The gut brain and the brain develop together at the embryo and are connected by the vagus nerve. There is bidirectional communication between the two going on constantly. Your brain monitors whats happening in your gut, even when your not conciously aware of it and the gut can send signlas to the brain the gut is in distress and effect your thoughts and vise versa.

There is a ton of information on all this and why modern research considers IBS a brain gut axis dysregulation, the two are not communicating together properly.

There is a lot more to all this, like the parasympathetic and sympathetic nervous systems that are also involved.

The parasympathetic and sympathetic nervous systems are also connected to the fight or flight.

The autonomic nervous system is of course conneted to the central nervous system, but runs stuff like heart rate, breathing and importnatly digestion.

The autonomic nervous system is divided into three parts: the sympathetic nervous system, the parasympathetic nervous system and the enteric nervous system. The autonomic nervous system controls smooth muscle of the viscera (internal organs) and glands.

parasympathetic nervous is "rest and digest" and the sympathetic "fight" or take "flight"

http://faculty.washington.edu/chudler/auto.html

Like I said this is all really complex.

another really important part here from brain to gut is the HPA axis: Hypothalamic�pituitary�adrenal axis

This is the bodies stress system. But it also carries out other very important tasks. It can also trigger the gut through mast cells embbed in the colon wall and contribute to pain and d, by releasing the chemical histimine unto the smooth muscle.

"HPA axis, a major part of the neuroendocrine system that controls reactions to stress and regulates many body processes, including digestion, the immune system, mood and emotions, sexuality, and energy storage and expenditure

I have to post some of this information, because the links are dead or it was sent to me personally.

I posted this awhile ago to another bb.

Report from the 6th International Symposium on Functional Gastrointestinal Disorders
By: Douglas A. Drossman, MD and William F. Norton, IFFGD

Some of the major research advances that support the integrated or biopsychosocial approach include:

"Demonstration of post-infectious IBS as a brain-gut disorder"

http://www.iffgd.org/symposium2005report.html

IBS is a brain gut axis disorder. This has been known for some time now.

People can confuse the role of stressors, both physical and mental and IBS. Stress is already known as a contributing factor in Developing IBS and a gastroenteric infection.

This is one reason why IBS is often misunderstood, even by IBSers.

Most people don't understand the Neurobiology of stress and gut functioning.

Readers' Exchange
Defining Stress in IBS
Fall 2003

From Arizona -- Thank you so much for your efforts and support for those of us with GI disorders. Your first issue (Spring 2003) of Digestive Health Matters is both professional and informative. I would like to comment on one of the articles - "The CNS: Center for Neurovisceral Sciences and Women's Health at UCLA." I am encouraged to know that steps are being taken for funding research of IBS and interstitial cystitis. However, it is discouraging that researchers are still expending time and money to research "neurobiological mechanisms by which stress modulates brain-visceral interaction." I realize that stress is a popular theory in the discussion of IBS triggers, however, I believe this is completely backward and it is the chronic pain and totally unreliable bowel function of an IBS sufferer which causes the greatest stress. If research would focus on "fixing" the bowel, no doubt the panic and fear of IBS would be greatly alleviated.

Comment from Emeran A. Mayer, M.D. -- In contrast to the common interpretation of the term "stress" as a psychological phenomenon, it should be understood as any real or perceived perturbation of an organism's homeostasis, or state of harmony or balance. For example, in this viewpoint a severe hemorrhage, starvation, extreme temperature, or worry about the unpredictable onset of abdominal pain all qualify as stressors -- some as "physical" stressors, others as "psychological" stressors. The fear to leave the house in the morning without knowing if one can make it to work without having to stop on the freeway because of an uncontrollable bowel movement, or the fear of experiencing uncontrollable abdominal discomfort during an important business meeting are sufficient stressors to activate the central stress system.

The central stress system involves the release of chemical stress mediators in the brain (such as corticotropin releasing factor), which in turn orchestrate an integrated autonomic, behavioral, neuroendocrine, and pain modulatory response. This biological response in turn will alter the way the brain and the viscera interact, and this altered brain-gut interaction can result in worsening of IBS symptoms. Thus, pain and discomfort, fear of these symptoms, activation of the stress response, and modulation of the brain-gut interactions by stress mediators are part of a vicious cycle which need to be interrupted to produce symptom relief.

The neurobiology of stress is not a theory, but a topic that can be studied in animal models, and one of the hottest topics in drug development for treatment of IBS (e.g., substance P antagonists, corticotropin releasing factor antagonists).

The Neurobiology of Stress and Emotions
By: Emeran A. Mayer, M.D., UCLA Mind Body Collaborative Research Center, UCLA School of Medicine, California

We often hear the term "stress" associated with functional gastrointestinal (GI) disorders, such as irritable bowel syndrome (IBS). Many patients experience a worsening of symptoms during times of severely stressful life events. But what is stress? How often does it occur? How does our body respond to stress? This article explores the mechanisms that link stress and emotions to responses that have evolved to ensure survival and that, in the modern world, affect health�"including gastrointestinal function.

Introduction
Stress is an adaptive response that is not unusual or unique to only certain individuals. In humans and animals, internal mechanisms have developed throughout evolution, which allow the individual to maximize their chances of survival when confronted with a stressor. A stressor in this context is any situation that represents an actual or perceived threat to the balance (homeostasis) of the organism. In a wide variety of real, life threatening situations -- such as an actual physical assault or a natural disaster -- stress induces a coordinated biological, behavioral, and psychological response. "

Stress and Irritable Bowel Syndrome: Unraveling the Code
By: Yvette Taché, Ph.D., Center for Neurovisceral Sciences and Women Health, Digestive Diseases Center, Department of Medicine, Digestive Diseases Division, University of California at Los Angeles and VA Greater Los Angeles Health Care System, California

Dr. Taché was the recipient of the IFFGD 2005 Research Award to Senior Investigator, Basic Science. Her early publications put the "brain-gut axis" on the map. Since then, she has been one of the pioneers in this field. In many ways, it has been her energy and enthusiasm that has ensured the continued vibrancy of the field. Her identification of the role of corticotrophin-releasing factor (CRF) signaling pathways in stress-related alterations of gut motor function and visceral pain are of major and lasting importance.

http://www.giresearch.org/Tache.html

also the actual phyiscal abnormalities like serotonin are also connected to stress and anxiety as are mast cells in the gut, both EC cells and Mast cells are increased in PI IBSers embedded in the gut wall.

So I would encourage people to try to understand stress, anxiety and even emotions in regards to IBS and it being a physical problem.

Also relaxation, distraction and other techniques are KNOWN to help people cope with chronic pain.

Psychology works for
Irritable Bowel Syndrome (IBS)

"Evaluation studies have typically shown that psychological treatment led to greater improvement than the usual medical treatment. As well, the psychological therapies have long lasting effects months to years after treatment was completed. Medication treatments, in contrast, tend to cease to have an effect when patients stop taking the medicine. Up to 70-80% of people with IBS have reported significant improvements following psychological treatments. Recent research suggested that the amount of improvement relates in part to the effort and time the individual puts in to develop better ways of coping."

http://www.apns.ca/prob_IBS.html

Depression increase pain that is also well known. Part of the brain that processes pain is involved in processing emotions. All pain is processed in the brain and that is very important in regards to IBS and Chronic pain.

Merck Manual

"In this disorder, the digestive tract is especially sensitive to many stimuli. Stress, diet, drugs, hormones, or minor irritants may cause the digestive tract to contract abnormally, usually leading to diarrhea. Periods of constipation may occur between bouts of diarrhea. Irritable bowel syndrome affects women 3 times more often than men.

The brain has enormous control over the digestive system. Stress, anxiety, depression, fear, and virtually any strong emotion can lead to diarrhea, constipation, and other changes in bowel function and can further worsen a flare-up (bout or attack) of irritable bowel syndrome."

http://www.merck.com/mmhe/sec09/ch129/ch129d.html

Stress isn't the only triggers though, but its extremely important. Foods, hormones, meds and other things can trigger it as well, even the weather and seasons.

The symptoms of d or d/c or c, are symptoms of a bigger disorder. Pain is a must in IBS. There is a lot of research on pain and IBS.

Visceral Sensations and Brain-Gut Mechanisms
By: Emeran A. Mayer, M.D., Professor of Medicine, Physiology and Psychiatry; Director, Center for Neurovisceral Sciences & Women's Health, David Geffen School of Medicine at UCLA

http://www.aboutibs.org/Publications/VisceralSensations.html

They also have good evidence for why there is C and D and d/c which has to do with receptors in the gut and ec cells.

CBT and HT and meditation are all coping tools.

Each has some differences however.

It is known now that stress can reinflame previous inflammation in the gut. Part of how this happens in about some of the mechanisms I am pointing out here. If your under stress when you get a gastro infection it increases the risk of developing IBS. Stress effects all peoples guts, especially IBS. In IBS the gut is hypereactive to stimuli. Having IBS is also very stressful. This stress also keep the stress hormones flowing. The vicious cycle in IBS is anxiety=symptoms=anxiety in any order.

from the experts.

"psychophysiological arousal is the core of treating functional gi disorders. There is som much distress, anxiety, antisipatory anxiety, and negative reaction to symptoms, that calming the mind and body often makes a significant difference to symptoms."

These aren't "cures" but tools.
Its also important that most people with PI IBS who develop IBS have d as their predominate symptom. There are some psycological differences to the symptoms in d and d/c and c IBS. So some of these things might apply more to different subgroups.

also treating the brain in IBS is the top down model and the gut down up model. Its known treating both can be very effective.

Dr Drossman's comments on foods for IBS Health.

Shawn,
To say that people with IBS may get symptoms from food intolerances is an acceptable possibility, since the gut will over react to stressors of all types including food (high fat or large volumes of food in particular). Futhermore, there can be specific intolerances. So if you have a lactose intolerance for example, it can exacerbate, or even mimic IBS. Other examples of food substances causing diarrhea would be high consumers of caffeine or alcohol which can stimulate intestinal secretion or with the latter, pull water into the bowel (osmotic diarrhea). The same would be true for overdoing certain poorly absorbed sugars that can cause an osmotic type of diarrhea Sorbitol, found in sugarless gum and sugar substituted foods can also produce such an osmotic diarrhea. Even more naturally, people who consume a large amount of fruits, juices or other processed foods enriched with fructose, can get diarrhea because it is not as easily absorbed by the bowel and goes to the colon where it pulls in water. So if you have IBS, all of these food items would make it worse.

However, it is important to separate factors that worsen IBS (e.g., foods as above, stress, hormonal changes, etc.) from the cause or pathophysiology of IBS. Just like stress doesn't cause IBS, (though it can make it worse), foods must be understood as aggravating rather than etiological in nature.

The cause of IBS is yet to be determined. However, modern research understands IBS as a disorder of increased reactivity of the bowel, visceral hypersensitivity and dysfunction of the brain-gut axis. There are subgroups being defined as well, including post-infectious IBS which can lead to IBS symptoms. Other work using brain imaging shows that the pain regulation center of the brain (cingulate cortex) can be impaired, as well as good evidence for there being abnormalities in motility which can at least in part explain the diarrhea and constipation. So finding a specific "cause" of IBS has grown out of general interest in place of understanding physiological subgroups that may become amenable to more specific treatments. Hope that helps.
Doug

http://www.ibshealth.com/ibs_foods_2.htm

http://www.ibshealth.com/ibsfoodsinfo.htm

Dr Wood's comments for me

"Dr. Jack Wood, a renowned physiologist at The Ohio State University calls the ENS “the little-brain-in-the-gut.”

"Dear Shawn:

Sorry for the delayed reply to your question. I generally agree with Dr. Drosssman’s response. A subgroup of individuals when they become sensitized to specific molecules in certain foods respond to ingestion of the molecules with symptoms of cramping abdominal pain, fecal urgency and explosive watery diarrhea. These are also the primary symptoms of diarrhea-predominant IBS. Enteric mast cells, by mechanisms we don’t understand, become sensitized to the food molecule and respond to its presence by releasing a signal to the brain-in-the-gut (ENS) which is interpreted as a threat. The ENS responds by “running” a program which organizes secretion and motility into a behavior pattern of the bowel, which rapidly clears the threat from the lumen. Because to be effective secretion occurs in large volumes and the contractions that accomplish rapid propulsion are strong, running of the program has the side effects of diarrhea and cramping pain. Big brain input to mast cells during stress activates the mast cells to evoke the symptoms resulting from exposure of the mast cells to sensitizing food antigens. Aside from food allergens and mast cells, certain chemicals such as those in hot peppers, stimulate sensory nerves in the ENS and we are beginning to understand how this can also lead to food-related symptoms that might mimic or exacerbate IBS.

Hope this helps,

Jackie (Jack) D. Wood "

FYI

"You have two brains: one in your head and another in your gut. Dr. Jackie D. Wood is a renowned physiologist at The Ohio State University. He calls the second brain, "the-little-brain-in-the-gut." This enteric nervous system is part of the autonomic nervous system and contains over one hundred million neurons, which is as many as are in the spinal cord. This complex network of nerves lines the walls of the digestive tract form the esophagus all the way down to the colon. This little brain in the gut is connected to the big brain by the vagus nerves, bundles of nerve fibers running from the GI tract to the head. All neurotransmitters, such as serotonin that are found in the brain are also present in the gut.

Dr Wood has discovered that this little-brain-in-the-gut has programs that are designed for our protection and which are very much like computer programs. They respond to perceived threats in the same way that the limbic system or the emotional brain does. So the threat of a gastrointestinal infection can activate the program that increases gut contractions in order to get rid of the infection. The symptoms are abdominal cramping and diarrhea.

Dr. Wood has determined that a type of cell found in the body and the gut, called the mast cell, is a key to understanding the connection of the big brain in the head with the little-brain-in-the-gut. Mast cells are involved in defense of the body. In response to certain threats or triggers, such as pollen or infection, mast cells release chemicals, such as histamine, that help to fight off the invader. Histamine is one of the chemicals that causes the symptoms of an allergy or a cold. When an infection of the gut occurs, such as food poisoning or gastroenteritis, the mast cells of the gut release histamine. The little-brain-in-the-gut interprets the mast cell signal of histamine release as a threat and calls up a protective program designed to remove the threat �" at the expense of symptoms: abdominal pain and diarrhea.

The brain to mast cell connection has a direct clinical relevance for irritable bowel syndrome and other functional gastrointestinal syndromes. It implies a mechanism for linking allostasis and the good stress response to irritable states (e.g., abdominal pain and diarrhea) of the gut. Mast cells can be activated to release histamine in response to perceived psychological stress, whether the stressor or trigger is consciously perceived or not. So the end result is the same as if an infection activated the program in the-little-brain-in-the-gut: abdominal pain and diarrhea."

http://www.parkviewpub.com/nuggets/n5.html

By the way chronic anxiety can contribute to constipation in the activation of the sympathetic nervous system verses the parasympathetic nervous system. Fight or flight or rest and digest.

Antisipatory anxiety might be more in d and d/c then C IBSers though for example. C Ibers have more anger they can't go. Although people can have all kinds of emotions to having ibs and to the symptoms.

you may not "cure" the underlying disorders, but you can feel better and if you don't have symptoms that s a major plus.

also for the info in general, this is on children but it applies.

"Question--How can you be sure there is no disease?
Answer--Worries about the child's health are normal. Repeated explanations may be necessary because the concept of functional symptoms may be new. There are no tests for diagnosis of a functional gastrointestinal disorder, but there are symptom-based diagnostic criteria. Functional gastrointestinal disorders are common; diseases are unusual. If your child's symptoms meet the diagnostic criteria for a functional gastrointestinal disorder, stop worrying that it is something else. Ask your physician to reevaluate the child promptly if the symptoms change.

Question--How do you treat the pain in functional disorders?
Answer--Conceptually, functional abdominal pain may be treated 1) with education, 2) from the top down, 3) from the bottom up, or 4) with any combination of these.

Sometimes getting a diagnosis and learning about a functional disorder is enough to reduce the worries a family has about the health of their child. All parents ask the same four questions when they see a clinician: 1) what is wrong? 2) is it dangerous? 3) will it go away? 4) what can we do about it?

In the case of a functional bellyache the answers are: 1) it's a functional bellyache, 2) it is not dangerous, 3) it comes and goes, 4) there are several ways to treat it. If the answers satisfy and the child is not disabled by pain in any way, further treatment may be unnecessary. The goal is to help the child cope with symptoms so that they don't miss daily obligations and activities.

Top down treatment--Children can learn to use the thinking parts of their brains to reduce pain. Biofeedback, guided imagery, progressive relaxation, and hypnosis are different ways of training the brain to help control and reduce pain. If these methods are available, the advantage to them is that they teach the child the skills needed to reduce pain without medication.

Bottom up treatment--Children may benefit from small doses of chronic pain medicines, or medicine to take away acid or intestinal muscle spasm. These medications are safe and effective in many, but not all, children."

http://www.aboutkidsgi.org/Bellyaches.html

Question from a 13-year-old in Oregon -- I have had stomach pains for over one year that make it hard for me to do anything. I have recurring abdominal pain syndrome. My doctor said there is nothing wrong with me and nothing he can do to treat me. Do you have any suggestions?
Answer -- We assume that you have been seen by a physician who gave you the diagnosis of "recurring abdominal pain syndrome," (functional recurrent abdominal pain).

Tests are done to look for the presence of disease as the cause of symptoms. If the tests find no evidence of disease, the symptoms are termed "functional." Diagnosis of this functional gastrointestinal disorder is based on the symptoms, after ruling out the presence of disease or tissue damage. These symptoms are defined as abdominal pain severe enough to disrupt routine activities three or more times during a three-month period. Studies show that it is pretty common, affecting 10%-15% of school-aged kids.

So if it is not a disease that is causing these symptoms (you are not sick and that is good news), what is causing it? The answer is not entirely clear. Ongoing research is looking for the explanation.

Recent studies point to an increased sensitivity of the sensory nerves in the intestines. Normal movements of your intestines may be perceived as cramps or other discomfort.

The intestines share nerve pathways with the brain. In many situations, when the brain reacts to something -- like the sound of a dentist's drill -- the intestines, or gut, pick up the same signals and react.

The majority of people will ultimately have some kind of gastrointestinal (GI) symptom when exposed to stressful situations. If your GI system is a bit too reactive, you will experience symptoms in more types of stressful situations than someone else will whose gut is not quite as reactive. What is stressful for one person may not be stressful to another, and lots of people don't even realize it when they get stressed -- they just feel sick.

Finally, there is the "gate theory" of how pain is experienced. When pain originates at some point, nerve messages pass through something like a gate on their way to the brain. The wider open the gate is, the more pain that is experienced. By thinking about and focusing on the pain site, we open the gate. Plus, feelings of anger or worry or sadness can open the gate.

However, we can also help close the gate. Turning attention away from the site or feeling of pain, through relaxation or focusing on some other activity, can help close the gate and lessen or even eliminate pain.

A well-known phenomenon that demonstrates this is that of the athlete who plays a game while injured, oblivious to the pain. The athlete is completely focused on the game and does not feel pain. Then, after the game is over, the athlete turns attention to the injury and feels pain.

Whatever the cause, you can do something about it! It takes some effort but there a number of ways that you can help yourself.

First, think about this example. Have you ever experienced a muscle cramp or a side-ache during strenuous running or exercise? You feel real pain in muscles that are not diseased. But they have been stressed beyond some point that in you causes discomfort. What do you do to avoid it in the future? You might think about what you were doing that resulted in the muscle pain. Maybe next time you do more warm-up exercises, or start out slower, or don't run as far.

The first time you felt a side-ache, you might have felt concerned and stopped running. After you learned that it was nothing to be concerned about, you may have barely taken notice the next time it happened, perhaps slowed down a bit, but then kept right on going.

This is the same type of thing that happens with functional recurrent abdominal pain. Your intestinal muscles may be causing you to feel pain. To get it under control, try this:

1) While the pain you feel is very real, do not worry that you are sick. You are not. Your body is reacting to events in a way that is causing you discomfort but is not cause for alarm.

2) Try to figure out if your symptoms are connected with anything else that may be triggering them. Do symptoms flare at certain times, before certain events, on weekdays, on weekends, etc? If you can identify triggering factors (like certain foods or activities) you can try to avoid them, or if that is not possible, try to deal with them in different ways.

3) Are you missing school because of this? Worry over missing school can make symptoms worse. Try to keep going.

4) Are you doing too much-school plus lots of outside activities? If so, take some time off to relax. Too much of anything can be stressful.

5) The next time you feel the pain, don't let it stop you. Keep on going. Practice focusing your thoughts on what it is you want to do next and then go ahead and do it. Don't let pain take your awareness hostage.

http://www.aboutkidsgi.org/questionsandanswers.html#school

I know I posted a lot here and will refrain, but I think its very important info.

yi

UNC Digest fall 2006

Ask the expert

Stephan R. Weinland PhD

Why see a psychologists when the diagnoses is IBS?

"many people experience distress and anxiety when their doctor makes a recomendation that they see a psychologist. This reaction often comes from the belief that a referal to a psychologist carries with it the assumptions about symptoms being "all in the head" or the result of "mental illness."

These are two of the biggest MISCONCEPTIONS about the practice of psychology in a medical setting, and they often stand in the way of patients achieving a meningful reduction in symptoms. In this column, I hope to dispel some of these misconceptions around psycology in a medical setting, and in doing so communicatee a few of the benefits you might be able to achieve in working with a psycologists to address your IBS symptoms."

http://www.med.unc.edu/wrkunits/2depts/med...gidc/digest.htm

The whole article has not been posted yet.

the autonomic nervous sytem runs digestion.

"The autonomic nervous system (ANS) is the portion of the nervous system that controls the body's visceral functions, including, but not limited to action of the heart, movement of the gastrointestinal tract and secretion by different glands, among many other vital activities.

To summarize:

Thoughts and even subtle emotions influence the activity and balance of the autonomic nervous system (ANS).

The ANS interacts with our digestive, cardiovascular,immune and hormonal systems and is therefore ideally suited to translate mind states into organ functions/dysfunctions
Negative reactions create disorder and imbalance in the ANS.
Positive feelings such as appreciation and a state of relaxation create increased order and balance in the ANS, resulting in increased hormonal and immune system balance and more efficient brain function.
It has been shown in a number of studies that during mental or emotional stress and physical stress, there is an increase in sympathetic activity and a decrease in parasympathetic activity. "

The increase in sympathetic tone can contribute to constipation in IBS or in normal people.

http://ibs.med.ucla.edu/Articles/PatientArticleSm02ANS.htm

also importantly

"By using sophisticated imaging techniques that allow us to visualize the activity of the living human brain (see “Looking Into the Living Human Brain”), researchers at the UCLA Neuroenteric Disease Section have recently identified for the first time the regions within the brain that are involved in the perception and modulation of visceral sensations, including visceral pain. In addition, by comparing brain responses to an acute intestinal stimulus between healthy control subjects, patients suffering from IBS, and patients with ulcerative colitis, they were able to identify specific alterations in how the brains of IBS patients process and respond to acute colonic pain."

http://ibs.med.ucla.edu/Articles/PatientAr...eakthroughs.htm

Serotonin is also the neurotransmitter in the gut that signals sensations from the gut to the brain.

FYI from Harvard.

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."

almost all if not all IBSers demonstrate an altered serotonin system.

Evaluation of Visceral Sensation in IBS Patients Using Subliminal Stimulation

"From Medscape Gastroenterology

Literature Review -- Select Topics in IBS and Chronic Constipation
Latest From the Literature in IBS and Chronic Constipation: September 2006
Posted 09/07/2006

Brian E. Lacy, MD, PhD

Introduction
In this second installment in our quarterly literature review series on topical issues in irritable bowel syndrome (IBS) and chronic constipation, 3 original research studies are reviewed. These reports describe new information regarding the pathophysiology of IBS, the role of alternative therapies in the treatment of IBS, and the treatment of constipation."

"Lawal A, Kern M, Sidhu H, Hofmann C, Shaker R. Novel evidence for hypersensitivity of visceral sensory neural circuitry in irritable bowel syndrome patients. Gastroenterology. 2006;130:26-33.

The pathophysiology of IBS involves multiple underlying factors, including abnormalities in visceral sensation, disturbances in gut motility, and differences in the central nervous system (CNS) processing of visceral pain.[1] Many investigators now believe that visceral hypersensitivity is the most important pathophysiologic abnormality in IBS patients. The mechanism that leads to visceral hypersensitivity in patients with IBS is unknown, although current theories postulate the presence of abnormal sensory receptors and sensory afferents, deficient descending modulating factors, and a hypervigilant CNS. This latter component has been demonstrated in studies using functional magnetic resonance imaging (fMRI) and positron emission tomography scans.[2,3] The end result is that IBS patients sense abdominal discomfort at lower levels than normal individuals and often misinterpret normal sensations as painful (allodynia).[4] This has been demonstrated in a number of studies that typically involve distending the lumen of the gastrointestinal tract with a balloon.[5] One concern is that these studies may be influenced by cognitive processes associated with perceived sensory stimulation. Stated another way, anticipation of a possibly unpleasant sensation (balloon distention of the rectum) may alter cortical activity and thus change fMRI findings. Lawal and colleagues[6] addressed this potentially confounding factor by evaluating visceral sensation in IBS patients using subliminal stimulation."

"This well-designed, novel study is the first to show that very low levels of distention in the gastrointestinal tract, without any related cognitive processes typically associated with perceived distention, lead to increased CNS activity in IBS patients compared with healthy volunteers. In addition, patients with IBS demonstrated a maximum response to subliminal distention, as compared with the graded response seen in healthy volunteers. These findings are important for a number of reasons. One, it confirms the now widely accepted view that the brain-gut axis is a critical component in IBS. Two, it emphasizes that hypersensitivity is a key underlying pathophysiologic mechanism in the generation of symptoms in IBS patients. And finally, although not evaluated in this study, these findings point out that therapeutic options for patients with IBS should focus on treating both the hypersensitive gut and the hypersensitive CNS."

http://www.medscape.com/viewarticle/544018_2

I hope all this helps some, but this is really important and from one of the top doctors studying IBS, Emeran A. Mayer, M.D.

In contrast to the common interpretation of the term "stress" as a psychological phenomenon, it should be understood as ANY real or perceived perturbation of an organism's homeostasis, or state of harmony or balance.

http://www.ibsgroup.org/forums/index.php?showtopic=52329

So they no longer look at it as just the gut or just the brain, its both as they are so closely connected and you can treat both, which is one reason why things like CBT and hypnotherapy have also been so successful in treating IBS.

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My website on IBS is www.ibshealth.com

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