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IRRITABLE BOWEL SYNDROME- What does the colon do? The colon, which is about five feet long, connects the small intestine to the rectum and anus. The major function of the colon is to absorb water, nutrients, and salts from the partially digested food that enters from the small intestine. Two pints of liquid matter enter the colon from the small intestine each day. Stool volume is a third of a pint. The difference between the amount of fluid entering the colon from the small intestine and the amount of stool in the colon is what the colon absorbs each day. Colon motility—the contraction of the colon muscles and the movement of its contents—is controlled by nerves, hormones, and impulses in the colon muscles. These contractions move the contents inside the colon toward the rectum. During this passage, water and nutrients are absorbed into the body, and what is left over is stool. A few times each day contractions push the stool down the colon, resulting in a bowel movement. However, if the muscles of the colon, sphincters, and pelvis do not contract in the right way, the contents inside the colon do not move correctly, resulting in abdominal pain, cramps, constipation, a sense of incomplete stool movement, or diarrhea. As its name indicates, IBS is a syndrome—a combination of signs and symptoms. IBS has not been shown to lead to a serious disease, including cancer. Through the years, IBS has been called by many names, among them colitis, mucous colitis, spastic colon, or spastic bowel. However, no link has been established between IBS and inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis. There are many possible causes of IBS. For example, there may be a problem with muscles in the intestine, or the intestine may be more sensitive to stretching or movement. There is no problem with the structure of the intestine. It is not clear why patients develop IBS, but in some instances, it occurs after an intestinal infection. It is called post-infectious IBS. There may also be other triggers. Stress can worsen IBS. The colon is connected to the brain through nerves of the autonomic nervous system. These nerves become more active during times of stress, and can cause the intestines to squeeze or contract more. People with IBS may have a colon that is over-responsive to these nerves. IBS can occur at any age, but it often begins in adolescence or early adulthood. It is more common in women. About one in six people in the U.S. have symptoms of IBS. It is the most common intestinal complaint for which patients are referred to a gastroenterologist. Symptoms range from mild to severe. Most people have mild symptoms. Symptoms vary from person to person. Abdominal pain, fullness, gas, and bloating that have been present for at least six months are the main symptoms of IBS. The pain and other symptoms will often: • Occur after meals • Come and go • Be reduced or go away after a bowel movement People with IBS may switch between constipation and diarrhea, or mostly have one or the other. • People with diarrhea will have frequent, loose, watery stools. They will often have an urgent need to have a bowel movement, which is difficult to control. • Those with constipation will have difficulty passing stool, as well as less frequent bowel movements. They will often need to strain and will feel cramping with a bowel movement. Often, they do not eliminate any stool, or only a small amount. For some people, the symptoms may get worse for a few weeks or a month, and then decrease for a while. For other people, symptoms are present most of the time and may even slowly increase. Irritable bowel syndrome is most likely a lifelong condition. For some people, symptoms are disabling and reduce the ability to work, travel, and attend social events. Symptoms can often be improved or relieved through treatment. Symptoms include • Abdominal pain or discomfort for at least 12 weeks out of the previous 12 months. These 12 weeks do not have to be consecutive. • The abdominal pain or discomfort has two of the following three features: It is relieved by having a bowel movement. When it starts, a change occurs in how often a person has a bowel movement. When it starts, a change occurs in the form of the stool or the way it looks. Certain symptoms must also be present, such as: – a change in frequency of bowel movements – a change in appearance of bowel movements – feelings of uncontrollable urgency to have a bowel movement – difficulty or inability to pass stool – mucus in the stool – – bloating Bleeding, fever, weight loss, and persistent severe pain are not symptoms of IBS and may indicate other problems such as inflammation or, rarely, cancer. The following have been associated with a worsening of IBS symptoms: • large meals • bloating from gas in the colon • medicines • wheat, rye, barley, chocolate, milk products, or alcohol • drinks with caffeine, such as coffee, tea, or colas • stress, conflict, or emotional upsets Researchers have found that women with IBS may have more symptoms during their menstrual periods, suggesting that reproductive hormones can worsen IBS problems. In addition, people with IBS frequently suffer from depression and anxiety, which can worsen symptoms. Similarly, the symptoms associated with IBS can cause a person to feel depressed and anxious. Symtoms range from mild to severe. Most people have mild symptoms. Symptoms vary from person to person. People with IBS may also lose their appetite. Irritable bowel syndrome (IBS, or spastic colon) is a diagnosis of exclusion. It is a functional bowel disorder characterized by chronic abdominal pain, discomfort, bloating, and alteration of bowel habits in the absence of any detectable organic cause. In some cases, the symptoms are relieved by bowel movements. Diarrhea or constipation may predominate, or they may alternate (classified as IBS-D, IBS-C or IBS-A, respectively). IBS may begin after an infection (post-infectious, IBS-PI), a stressful life event, or onset of maturity without any other medical indicators. Although there is no cure for IBS, there are treatments that attempt to relieve symptoms, including dietary adjustments, medication and psychological interventions. Patient education and a good doctor-patient relationship are also important. Several conditions may present as IBS including celiac disease, fructose malabsorption, mild infections, parasitic infections (like giardiasis), several inflammatory bowel diseases, bile acid malabsorption, functional chronic constipation, and chronic functional abdominal pain. In IBS, routine clinical tests yield no abnormalities, although the bowels may be more sensitive to certain stimuli, such as balloon insufflating testing. The exact cause of IBS is unknown. The most common theory is that IBS is a disorder of the interaction between the brain and the gastrointestinal tract (brain-gut), although there may also be abnormalities in the gut flora or the immune system. IBS does not lead to more serious conditions in most patients. However, it is a source of chronic pain, fatigue, and other symptoms and contributes to work absenteeism. Researchers have reported that the high prevalence of IBS, in conjunction with increased costs, produces a disease with a high social cost. It is also regarded as a chronic illness and can dramatically affect the quality of a sufferer's life. Causes The cause of IBS is unknown, but several hypotheses have been proposed. T he risk of developing IBS increases six -fold after acute gastrointestinal infection. Post-infection, further risk factors are young age, prolonged fever, anxiety, and depression. Publications suggesting the role of “ brain-gut “ association appeared in the 1990s, such as a study entitled "Brain-gut" response to stress and cholinergic stimulation in IBS published in the Journal of Clinical Gastroenterology in 1993. A 1997 study published in Gut magazine suggested that IBS was associated with a "derailing of the brain-gut axis." Psychological factors may be important in the etiology of IBS. Prevalence of protozoal infections in industrialized countries (United States and Canada) in 21st century. There is research to support IBS being caused by an as-yet undiscovered active infection. Studies have shown that the nonabsorbed antibiotic Rifaximin can provide sustained relief for some IBS patients. While some researchers see this as evidence that IBS is related to an undiscovered agent, others believe IBS patients suffer from overgrowth of intestinal flora and the antibiotics are effective in reducing the overgrowth (known as small intestinal bacterial overgrowth). Other researchers have focused on an unrecognized protozoal infection as a cause of IBS as certain protozoal infections occur more frequently in IBS patients. Two of the protozoa investigated have a high prevalence in industrialized countries and infect the bowel, but little is known about them as they are recently emerged pathogens. Blastocystis is a single-cell organism that has been reported to produce symptoms of abdominal pain, constipation and diarrhea in patients. Studies from research hospitals in various countries have identified high Blastocystis infection rates in IBS patients, with thirty eight percent being reported from London School of Hygiene & Tropical Medicine, forty seven percent reported from the Department of Gastroenterology at Aga Khan University in Pakistan and eighteen percent reported from the Institute of Diseases and Public Health at University of Ancona in Italy. Reports from all three groups indicate a Blastocystis prevalence of approximately seven percent in non-IBS patients. Researchers have noted that clinical diagnostics fail to identify infection, and Blastocystis may not respond to treatment with common antiprotozoals. Dientamoeba fragilis is a single-cell organism that produces abdominal pain and diarrhea. Studies have reported a high incidence of infection in developed countries, and symptoms of patients resolve following antibiotic treatment. One study reported on a large group of patients with IBS-like symptoms who were found to be infected with Dientamoeba fragilis, and experienced resolution of symptoms following treatment. Researchers have noted that methods used clinically may fail to detect some Dientamoeba fragilis infections. Also found in people without IBS. Can changes in diet help IBS? For many people, careful eating reduces IBS symptoms. Before changing the diet, keep a journal noting the foods that seem to cause distress. Then discuss these findings with the doctor. A registered dietitian can help a person make changes to the diet. For instance, if dairy products cause symptoms to flare up, try eating less of those foods. A person might be able to tolerate yogurt better than other dairy products because it contains bacteria that supply the enzyme needed to digest lactose, the sugar found in milk products. Dairy products are an important source of calcium and other nutrients. If a person needs to avoid dairy products, adequate nutrients should be added in foods or supplements should be taken. In many cases, dietary fiber may lessen IBS symptoms, particularly constipation. However, it may not help with lowering pain or decreasing diarrhea. Whole grain breads and cereals, fruits, and vegetables are good sources of fiber. High–fiber diets keep the colon mildly distended, which may help prevent spasms. Some forms of fiber keep water in the stool, thereby preventing hard stools that are difficult to pass. Doctors usually recommend a diet with enough fiber to produce soft, painless bowel movements. High–fiber diets may cause gas and bloating, although some people report that these symptoms go away within a few weeks. Increasing fiber intake by two to three grams per day will help reduce the risk of increased gas and bloating. Drinking six to eight glasses of plain water a day is important, especially if a person has diarrhea. Drinking carbonated beverages, such as sodas, may result in gas and cause discomfort. Chewing gum and eating too quickly can lead to swallowing air, which also leads to gas. Large meals can cause cramping and diarrhea, so eating smaller meals more often, or eating smaller portions, may help IBS symptoms. Eating meals that are low in fat and high in carbohydrates such as pasta; rice; whole–grain breads and cereals, unless a person has celiac disease; fruits; and vegetables may help. How does stress affect IBS? Stress—feeling mentally or emotionally tense, troubled, angry, or overwhelmed—can stimulate colon spasms in people with IBS. The colon has many nerves that connect it to the brain. Like the heart and the lungs, the colon is partly controlled by the autonomic nervous system, which responds to stress. These nerves control the normal contractions of the colon and cause abdominal discomfort at stressful times. People often experience cramps or “butterflies” when they are nervous or upset. In people with IBS, the colon can be overly responsive to even slight conflict or stress. Stress makes the mind more aware of the sensations that arise in the colon, making the person perceive these sensations as unpleasant. Some evidence suggests that IBS is affected by the immune system, which fights infection in the body. The immune system is affected by stress. For all these reasons, stress management is an important part of treatment for IBS. Stress management options include: • stress reduction training and relaxation therapies such as meditation • counseling and support • regular exercise such as walking or yoga • changes to the stressful situations in a person’s life • adequate sleep IBS is a disorder that interferes with the normal functions of the colon. What is the treatment for IBS? Unfortunately, many people suffer from IBS for a long time before seeking medical treatment. Up to seventy percent of people suffering from IBS are not receiving medical care for their symptoms. No cure has been found for IBS, but many options are available to treat the symptoms. The doctor will prescribe the best treatments for a person’s particular symptoms and encourage the person to manage stress and make dietary changes. Medications are an important part of relieving symptoms. The doctor may suggest fiber supplements or laxatives for constipation or medicines to decrease diarrhea, such as diphenoxylate and atropine (Lomotil) or loperamide (Imodium). An antispasmodic is commonly prescribed, which helps control colon muscle spasms and reduce abdominal pain. Antidepressants may relieve some symptoms. However, both antispasmodics and antidepressants can worsen constipation, so some doctors will also prescribe medications that relax muscles in the bladder and intestines, such as belladonna alkaloid combinations and phenobarbital (Donnatal) and chlordiazepoxide and clidinium bromide (Librax). These medications contain a mild sedative, which can be habit forming, so they need to be used under the guidance of a physician. A medication available specifically to treat IBS is alosetron hydrochloride (Lotronex). Lotronex has been re-approved with significant restrictions by the U.S. Food and Drug Administration (FDA) for women with severe IBS who have not responded to conventional therapy and whose primary symptom is diarrhea. However, even in these patients, Lotronex should be used with great caution because it can have serious side effects such as severe constipation or decreased blood flow to the colon. With any medication, even over–the–counter medications such as laxatives and fiber supplements, it is important to follow the doctor’s instructions. Some people report a worsening in abdominal bloating and gas from increased fiber intake, and laxatives can be habit forming if they are used too frequently. Medications affect people differently, and no one medication or combination of medications will work for everyone with IBS. Working with the doctor to find the best combination of medicine, diet, counseling, and support to control symptoms may be helpful. Due to unsatisfactory results from medical treatments for IBS up to fifty percent of people turn to alternative medicine. Probiotics Probiotics can be beneficial in the treatment of IBS, taking 10 billion to 100 billion beneficial bacteria per day is recommended for beneficial results. However, further research is needed on individual strains of beneficial bacteria for more refined recommendations. A number of probiotics have been found to be effective including: Lactobacillus plantarum and Bifidobacteria infantis; however, one review found that only Bifidobacteria infantis showed efficacy. Some yogurt is made using probiotics that may help ease symptoms of irritable bowel syndrome. Herbal remedies Peppermint oil: Enteric coated peppermint oil capsules have been suggested for IBS symptoms in adults and children. There is evidence of a beneficial effect of these capsules and it is recommended that peppermint be trialed in all irritable bowel syndrome patients. Safety during pregnancy has not been established however and caution is required not to chew or break the enteric coating otherwise gastroesophageal reflux may occur as a result of lower esophageal sphincter relaxation. Occasionally nausea and perianal burning occur as side effects. Iberogast: The multi-herbal extract Iberogast was found to be significantly superior to placebo via both an abdominal pain scale and an IBS symptom score after four weeks of treatment. – Kiwifruit IBS/C – Commiphora mukul – Plantago ovata There is only limited evidence for the effectiveness of other herbal remedies for irritable bowel syndrome. As with all herbs it is wise to be aware of possible drug interactions and adverse effects. Yoga Yoga may be effective for some with irritable bowel syndrome, especially poses which exercise the lower abdomen. Acupuncture Acupuncture may be worth a trial in select patients, but the evidence base for effectiveness is weak. A meta-analysis by the Cochrane Collaboration concluded that most trials are of poor quality and that it is unknown whether acupuncture is more effective than placebo. The goal of treatment is to relieve symptoms. Lifestyle changes can be helpful in some cases of IBS. For example, regular exercise and improved sleep habits may reduce anxiety and help relieve bowel symptoms. Dietary changes can be helpful. However, no specific diet can be recommended for IBS in general, because the condition differs from one person to another. The following changes may help: • Avoid foods and drinks that stimulate the intestines (such as caffeine, tea, or colas) • Avoid large meals • Avoid wheat, rye, barley, chocolate, milk products, and alcohol • Increase dietary fiber Talk with your doctor before taking over-the-counter medications. • Fiber supplements can make symptoms worse Laxatives taken for constipation can become habit forming No one medication will work for everyone. Medications your doctor might prescribe: – Anticholinergic medications (dicyclomine, propantheline, belladonna, and hyoscyamine) taken about a half-hour before eating to control colon muscle spasms – Loperamide to treat diarrhea – Low doses of tricyclic antidepressants to help relieve intestinal pain – Lubiprostone for constipation symptoms – Medications that relax muscles in the intestines Counseling may help in cases of severe anxiety or depression. Most of the time, your doctor can diagnose IBS based on your symptoms, with few or no tests. Eating a lactose-free diet for 2 weeks may help the doctor evaluate for a possible lactase deficiency. There is no test to diagnose IBS, but tests may be done to rule out other problems: Blood tests to see if you have a low blood count (anemia) Stool cultures to rule out an infection Some patients will have sigmoidoscopy or colonoscopy. During these tests, a hollow tube is inserted through the anus. The doctor can see through this tube. You may need these tests if: - Symptoms began later in life (over age 50) - You have symptoms such as weight loss or bloody stools - You have abnormal blood tests (such as a low blood count) Other disorders that can cause similar symptoms include: - Celiac disease (chronic nutritional disturbance) - Colon cancer (although cancer rarely causes typical IBS symptoms, unless symptoms such as weight loss, blood in the stools or abnormal blood tests are present) - Crohn's disease or ulcerative colitis Cannabinoids Treat IBS Symptoms Cannabinoid receptor 1 gene polymorphism and irritable bowel syndrome in the Korean population: a hypothesis-generating study. OBJECTIVE: The cannabinoids affect gastrointestinal function and are thought to be involved in the pathogenesis of irritable bowel syndrome (IBS). We hypothesized that genetic variants of the cannabinoid receptor 1 gene (CNR1) might be associated with IBS. The role of the endocannabinoid system in the pathophysiology and treatment of irritable bowel syndrome Abstract Irritable bowel syndrome (IBS) is a spectrum of disorders characterized by abdominal discomfort and pain, associated with altered bowel habits. Through gut motility, secretion and sensation may be altered in patients with IBS, the pathophysiology of this condition remains to be fully understood. The endocannabinoid system is involved in the regulation of numerous gastrointestinal functions including motility, sensation and secretion under both physiological and pathophysiological conditions. Activation of cannabinoid (CB)1 and CB2 receptors under various circumstances reduces motility, limits secretion and decreases hypersensitivity in the gut. Drugs that alter the levels of endocannabinoids in the gut also reduce motility and attenuate in?ammation. In this review, we discuss the role of the endocannabinoid system in gastrointestinal physiology. We go on to consider the involvement of the endocannabinoid system in the context of symptoms associated with IBS and a possible role of this system in the pathophysiology and treatment of IBS. Anecdotal evidence suggests that use of cannabis/marijuana reduces symptoms associated with Irritable Bowel Syndrome (IBS). Irritable Bowel Syndrome Irritable bowel syndrome (IBS) is a common disorder that affects the large intestine (colon). Irritable bowel syndrome commonly causes cramping, abdominal pain, bloating gas, diarrhea and constipation. Unlike intestinal diseases such as celiac disease, ulcerative colitis and Crohn’s disease, irritable bowel syndrome does not cause inflammation or changes in bowel tissue or increase the risk of colorectal cancer. Marijuana can be used to treat many of the symptoms of irritable bowel syndrome that are qualifying medical conditions under state medical marijuana laws. Marijuana “cools the gut.” It slows down the muscle contractions that move food through the stomach and intestines and reduces the secretion of liquid into the intestines associated with diarrhea . Marijuana also controls the muscle spasms associated with diarrhea. Mayo Clinic, Irritable Bowel Syndrome Constituents in marijuana called cannabinoids interact with receptors (called CB1 receptors) in the enteric nervous system (the part of the nervous system that directly controls the gastrointestinal system) and with CB1 receptors in the brain. The cannabinoids in marijuana that contribute to its ability to treat the symptoms of irritable bowel syndrome include tetrahydrocannabinol (THC) and, possibly, cannabidiol (CBD). People with irritable bowel syndrome should use marijuana strains that contain a relatively high concentration of THC. THC binds to CB1 receptors on cells in the gut and brain and acts as an agonist to inhibit emptying of the stomach and transit of food through the intestines . CBD appears to have little effect on intestinal motility on its own, but it synergizes the effect of THC . Cannabinoids that activate CB2 receptors (agonists) like CBD may alter intestinal mobility under pathophysiological conditions . "Indica strains of the plant are most beneficial for Treating symptoms of IBS due to their muscle relaxing properties". Strains: Auntie Em, Blackberry, Black Domina, Bluberry, Chemo, Blue Fruit, G13, Mandala No. 1, Purple Kush, Ultimate Indica, Santa Maria, Super Silver Haze. Medical Marijuana relieves IBS symptoms Many IBS patients have found that the cramping, abdominal pain, and irregularity of bowel movements are relieved with marijuana. Marijuana has been shown to decrease intestinal muscle spasms, decrease nausea, and increase appetite. There are also reports that marijuana works well as an anti-inflammatory, helping to alleviate inflammation in the bowel. Marijuana is well known to help relieve anxiety and induce a relaxed state for most people; this relief of anxiety has been reported by some patients to help calm the symptoms of IBS triggered by stress. Many patients use a combined natural approach of dietary changes, stress-reducing activities like yoga or meditation, and marijuana with good improvement in most if not all their symptoms. Cannabinoids and the gastrointestinal tract -Department of Physiological Chemistry, Johannes Gutenberg-University Mainz, 55099 Mainz, Germany. In the past centuries, different preparations of marijuana have been used for the treatment of gastrointestinal (GI) disorders, such as GI pain, gastroenteritis and diarrhea. Delta9-tetrahydrocannabinol (THC; the active component of marijuana), as well as endogenous and synthetic cannabinoids, exert their biological functions on the gastrointestinal tract by activating two types of cannabinoid receptors, cannabinoid type 1 receptor (CB1 receptor) and cannabinoid type 2 receptor (CB2 receptor). While CB1 receptors are located in the enteric nervous system and in sensory terminals of vagal and spinal neurons and regulate neurotransmitter release, CB2 receptors are mostly distributed in the immune system, with a role presently still difficult to establish. Under pathophysiological conditions, the endocannabinoid system conveys protection to the GI tract, eg from inflammation and abnormally high gastric and enteric secretion. For such protective activities, the endocannabinoid system may represent a new promising therapeutic target against different GI disorders, including frankly inflammatory bowel diseases (eg, Crohn's disease), functional bowel diseases (eg, irritable bowel syndrome), and secretion- and motility-related disorders. Irritable Bowel Syndrome (IBS) is a common syndrome that affects the large intestine. The most common symptoms are cramping, abdominal pain, bloating gas, constipation and diarrhea. Although the symptoms can be severe, there appears to be no long term permanent damage to the bowel. Many patients with IBS find that emotional stress worsens their symptoms. IBS is usually a chronic condition where symptoms can come and go, depending on diet and stress factors. IBS is different from Inflammatory Bowel Disease (IBD) which includes Crohn’s Disease and Ulcerative Colitis. These diseases cause permanent changes in the bowel that can be severe and can even increase the risk of colorectal cancer. This is why it is very important to get the correct diagnosis from your doctor before you make any decisions on how to proceed with treatment. Conventional treatment for IBS includes dietary changes, stool softeners, anti-spasmotic medications, laxatives, and anti-depressants. Many patients find that these treatments don’t work or have unwanted side effects. Many patients have opted to try a more natural approach to their treatment and have found herbal medication (including marijuana) to be helpful. Many IBS patients have found that the cramping, abdominal pain, and irregularity of bowel movements are relieved with marijuana. Marijuana has been shown to decrease intestinal muscle spasms, decrease nausea, and increase appetite. There are also reports that marijuana works well as an anti-inflammatory, helping to alleviate inflammation in the bowel. Marijuana is well known to help relieve anxiety and induce a relaxed state for most people; this relief of anxiety has been reported by some patients to help calm the symptoms of IBS triggered by stress. Many patients use a combined natural approach of dietary changes, stress-reducing activities like yoga or meditation, and marijuana with good improvement in quality of life. Marijuana and IBS Find relief from the pain associated with IBS - Irritable Bowel Syndrome with medical marijuana. IBS is an enigmatic problem with no known cause and no effective cure or remedy. IBS is sometimes referred to as spastic colon. IBS symptoms include stomach pain, constipation, diarrhea, bloody stools, nausea, nervousness and loss of appetite. The pain and nausea from having IBS are daily. Prescription drug therapy is often not very useful; the drugs most commonly used are Bentyl and Imodium and have even caused intolerable side effects. Those who have IBS claim using marijuana reduces the pain, is effective in curbing abdominal cramps and eliminates nausea. Marijuana also improves their appetite, and reduces emotional stress, itself being a strong suspect in the cause of IBS. Marijuana has been described as being the best of all treatments in relieving the symptoms of IBS. IBS relief using CBD rich Sour Tsunami strain “I am a IBD & IBS patient that has been doing the high CBD sour tsunami hemp oil treatment now since march 4th along with my other diet and supplement regiment. Within a few days great relief to spasms, pain, bleeding and bowel incontinence had been seen. Now up to full dosage and a few weeks into treatment I have much greater relief. Down to one bowl movement a day (from 10-20), and stools are now formed and solid. I have fully adjusted to meds. and now have energy during day, more stamina, and sleep unbelievably well at night. Some nights I can get eight to ten hours straight of real REM sleep which has helped healing tremendously. The other effects worth noting are the emotional effects. The oil also keeps any stress and anxiety so common with IBD and IBS under control better than any other meds. out there and totally safe. The high CBD medicine makes it possible to have great relief, healing and still function during the day with no restrictive effects. I can now leave my bathroom and house and get things done and feel human again! So far, I cannot say enough about the effectiveness of this treatment. I still have a few weeks to go. J, Northern California Recommendation: Use whole plant extracts. Indica x hybrid or Indica x Sativa hybrid {you want high CBD/ THC medicine} Teas, Tinctures, Vaporizer, Edibles , Cannabutter, Suppositories. Strains for IBS symptoms: Sour Tsunami, Super Skunk, Super Lemon Skunk, Pure OG Kush, GDP, Trainwreck, OG Kush, Aurora, Blueberry, Green Crack, Cripple Creek. Talley NJ. Irritable bowel syndrome. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier;2010:chap 118. Irritable bowel syndrome. NIH Publication No. 07-693. September 2007. The National Digestive Diseases Information Clearinghouse (NDDIC). ^ "irritable bowel syndrome" at Dorland's Medical Dictionary ^ a b Mayer EA (April 2008). "Clinical practice. Irritable bowel syndrome". Engl. Med. ^ Ledochowski M et al.: Fruktosemalabsorption. Journal für Ernährungsmedizin, 2001 (German) ^ Intestinal Infection^ Yang CM, Li YQ (2007). "[The therapeutic effects of eliminating allergic foods according to food-specific IgG antibodies in irritable bowel syndrome]" (in Chinese). Zhonghua Nei Ke Za Zhi 46 (8): 641–3. ^ a b c Stark D, van Hal S, Marriott D, Ellis J, Harkness J (2007). "Irritable bowel syndrome: a review on the role of intestinal protozoa and the importance of their detection and diagnosis". Int. Parasitol. ^ a b Bercik P, Verdu EF, Collins SM (2005). "Is irritable bowel syndrome a low-grade inflammatory bowel disease?". Gastroenterol. Clin. North Am.34 (2): 235–45, vi-vii. ^ a b Quigley EM (2005). "Irritable bowel syndrome and inflammatory bowel disease: interrelated diseases?". Chinese journal of digestive diseases 6(3): 122–32. ^ a b Simrén M, Axelsson J, Gillberg R, Abrahamsson H, Svedlund J, Björnsson ES (2002). "Quality of life in inflammatory bowel disease in remission: the impact of IBS-like symptoms and associated psychological factors". Gastroenterol. ^ a b Minderhoud IM, Oldenburg B, Wismeijer JA, van Berge Henegouwen GP, Smout AJ (2004). "IBS-like symptoms in patients with inflammatory bowel disease in remission; relationships with quality of life and coping behavior". Dig. Dis. Sci. ^ a b García Rodríguez LA, Ruigómez A, Wallander MA, Johansson S, Olbe L (2000). "Detection of colorectal tumor and inflammatory bowel disease during follow-up of patients with initial diagnosis of irritable bowel syndrome". Scand. Gastroenterol. ^ a b Paré P, Gray J, Lam S, et al. (2006). "Health-related quality of life, work productivity, and health care resource utilization of subjects with irritable bowel syndrome: baseline results from LOGIC (Longitudinal Outcomes Study of Gastrointestinal Symptoms in Canada), a naturalistic study". Clinical therapeutics 28 (10): 1726–35; discussion 1710–1. ^ Maxion-Bergemann S, Thielecke F, Abel F, Bergemann R (2006). "Costs of irritable bowel syndrome in the UK and US". PharmacoEconomics 24(1): 21–37. ^ a b c Boivin M (October 2001). "Socioeconomic impact of irritable bowel syndrome in Canada". Can. Gastroenterol. ^ a b Wilson S, Roberts L, Roalfe A, Bridge P, Singh S (July 2004). "Prevalence of irritable bowel syndrome: a community survey". 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"Eradication of Dientamoeba fragilis can resolve IBS-like symptoms". J Gastroenterol Hepatol 17(Suppl; pages=A103). ^ Windsor JJ, Macfarlane L (May 2005). "Irritable bowel syndrome: the need to exclude Dientamoeba fragilis". Trop. Med. Hyg. 72 (5): 501; author reply 501–2. ^ a b Yawn BP, Lydick E, Locke GR, Wollan PC, Bertram SL, Kurland MJ (2001). "Do published guidelines for evaluation of irritable bowel syndrome reflect practice?". BMC gastroenterology 1: 11. ^ C. Hauser (29 August 2005). Mayo Clinic Gastroenterology and Hepatology Board Review. CRC Press. Retrieved 24 October 2010. ^ a b Fass R, Longstreth GF, Pimentel M, et al. (2001). "Evidence- and consensus-based practice guidelines for the diagnosis of irritable bowel syndrome". Arch. Intern. Med. ^ Talley NJ (2006). "A unifying hypothesis for the functional gastrointestinal disorders: really multiple diseases or one irritable gut?". Reviews in gastroenterological disorders 6 (2): 72–8. ^ Spiegel BM, DeRosa VP, Gralnek IM, Wang V, Dulai GS (2004). "Testing for celiac sprue in irritable bowel syndrome with predominant diarrhea: a cost-effectiveness analysis". Gastroenterology 126 (7): 1721–32. ^ Su YC, Wang WM, Wang SY, et al. (August 2000). "The association between Helicobacter pylori infection and functional dyspepsia in patients with irritable bowel syndrome". Gastroenterol. ^ Gerards C, Leodolter A, Glasbrenner B, Malfertheiner P (2001). pylori infection and visceral hypersensitivity in patients with irritable bowel syndrome". ^ Grazioli B, Matera G, Laratta C, et al. (March 2006). "Giardia lamblia infection in patients with irritable bowel syndrome and dyspepsia: a prospective study". World J. Gastroenterol. ^ Vernia P, Ricciardi MR, Frandina C, Bilotta T, Frieri G (1995). "Lactose malabsorption and irritable bowel syndrome. Effect of a long-term lactose-free diet". 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Çok çeşitli adları olan bu hastalığın günümüzün tıp biliminde benimsenen adı irritabl bağırsak sendromudur (İBS), eskiden ‘spastik kolon’ adı kullanılırdı. Huzursuz bağırsak sendromu, hassas bağırsak sendromu, mutsuz bağırsak sendromu, daha çok hastalara anlatılırken tercih edilen diğer adlarıdır. Hastalarda ishal veya kabızlık, karın ağrısı, karında şişkinlik, aşırı gaz çıkarma, acil tuvalet gereksinimi gibi yakınmalar vardır. Bazı hastalarda dışkı sert küçük parçalar şeklinde olup keçi pisliğine benzetilir, dışkıda müküs (sümüksü sıvı) fazladır. Bazı hastalarda ishal ve kabızlık dönüşümlü olarak gözlenir. Kimi hastada dışkılama güçtür ve hasta her gün dışkıladığı halde kendini kabız sanır, bazıları da parmağının yardımıyla dışkılamaya çalışır. Bir grup hastada da dışkı kaçırması olur. Genelde saklanan bu durum ishalli hastalarda %60, kabız olanlarda %30 civarındadır (1). Yapılan incelemelerde bağırsakta yapısal bir bozukluk saptanmaz. Bir grup hastada yakınmalar çok şiddetlidir ve bu yaşam kalitesini düşürdüğü gibi hastalarda anlaşılamamış çok ciddi bir hastalığı olduğu korkusunu doğurur. Üstelik yakın çevrelerindeki akrabaları da, yapılan tüm tetkiklerin normal çıkmasıyla hastaların durumunu bağdaştıramaz ve onları, hastalık hastası olduklarını, hastalıklarını abarttıklarını düşünerek suçlar. Hastalığın nedeni tam olarak bilinmediğinden, uygulanan tedaviler de çoğu hastada başarılı olmaz. İrritabl Bağırsak Sendromu ve Gıdalar Hastaların yarısından fazlasında yakınmalar yemekten sonra başladığı veya arttığı için öncelikle gıdalar üzerinde durulur. Hastaların bir bölümü dokunduğunu hissettikleri gıdaları kısıtlayarak daha rahat yaşamaya çalışır hatta bu nedenle bazılarının yediklerinin sayısı bir elin parmaklarını geçmez. Tıp biliminde de IBS ile gıdaların ilişkisini araştıran çalışmalar yapılmıştır. Bunların bir bölümünde, hastalara her gün yeni bir gıda yedirilip yakınmaları değerlendirilmiştir (2, 3). En fazla dokunan gıda olarak buğday, süt ve ürünleri, mısır, kahve, çay ve meyve suları bulunmuştur. Bu gıdalar diyetten uzaklaştırılınca hastalar iyileşmiş, yenmeye başlandığında da yakınmalarında tekrarlama olmuştur. Çalışmaların birinde hastaların yarısında uygun diyetle bir yılı geçen iyilikler saptanmıştır (3). Gıdalarla ilgili diğer çalışmalar, İBS ile IgE– aracılı gıda alerjisi araştırması şeklinde yapılmış ve sonuç alınamamıştır (4,5). Bu yüzyılın başından beri gıdalara karşı oluşmuş IgG antikorlarının miktarı ölçülüp (gıda duyarlılık testi), yüksek çıkan gıdaların kısıtlanmasıyla yapılan uygulamalarda başarılı sonuçlar alınmaktadır ve bildirilen çalışma sayısı dörde ulaşmıştır (6-9). Bu arada benzer uygulamayla 2005 yılından beri IBS’li hastalarımın çoğunda iyi sonuçlar aldığımı, hastalarımın rahatladığını bildirmek isterim. Bu hastalara ait IgG testinin sonuçlarını ve hastalara önerilerimi kitapta bulabilirsiniz (bk., Kitap, s. 130-132). Web sitemin mektuplar bölümündeki son üç mektup da onlara aittir. Mast hücreleri Son yıllarda İBS ve mast hücrelerinin ilişkisi üzerinde yapılan çalışmalar, hastalığın, mast hücrelerinin aktivasyonuna bağlı olduğunu göstermektedir (10). Sonuç olarak; duyarlılık yapan gıdaların seçimi ve bunların kısıtlanması yanında, çeşme suyu, gıda katkıları, naylon su ve gıda saklama kapları, aşırı stres, aşırı soğuk ve sıcak yiyecekler gibi mast hücrelerini uyaran etmenlerden uzaklaşılmasının bu hastalara yararı olacaktır. Kitap: Artık Hastalığımla Baş Edebiliyorum (Mast Hücrelerinin Gizi), Nobel Tıp Kitabevleri. 1. Atarodi S, Rafieian S, Whorwell PJ. Faecal incontinence-the hidden scourge of irritable bowel syndrome: a cross-sectional study. BMJ Open Gastroenterol. 2015 Feb 6;1(1):e000002. 2. Jones VA, McLaughlan P, Shorthouse M, Workman E, Hunter JO. Food intolerance: a major factor in the pathogenesis of irritable bowel syndrome. Lancet 1982; 2: 1115±7. 3. Nanda R, James R, Smith H, Dudley CR, Jewell DP. Food intolerance and the irritable bowel syndrome. Gut 1989; 30:1099-104. 4. Karamanolis G, Tack J. Nutrition and motility disorders. Best Pract Res Clin Gastroenterol.2006;20:485–505. 5. Zuo XL1, Li YQ, Li WJ, et al. Alterations of food antigen-specific serum immunoglobulins G and E antibodies in patients with irritable bowel syndrome and functional dyspepsia. Clin Exp Allergy. 2007;37:823-30. 6. Atkinson W, Sheldon TA, Shaath N, Whorwell PJ. Food elimination based on IgG antibodies in irritable bowel syndrome: a randomized controlled trial. Gut. 2004;53:1459–1464. 7. Yang CM, Li YQ. The therapeutic effects of elimination allergic foods according to food-specific IgG antibodies in irritable bowel syndrome. Zhonghua Nei Ke Za Zhi. 2007; 46:641-3. 8. Guo H, Jiang T, Wang J, Chang Y, Guo H, Zhang W. The value of eliminating foods according to food specific immunoglobulin G antibodies in irritable bowel syndrome with diarrhea. J Int Med Res. 2012;40:204-10. 9. Aydinlar EI, Dikmen PY, Tiftikci A, Saruc M, Aksu M, et al. IgG-based elimination diet in migraine plus irritable bowel syndrome. Headache. 2013;53:514-25. 10. Kang Nyeong Lee, Oh Young Lee. The Role of Mast Cells in Irritable Bowel Syndrome. Gastroenterol Res Pract. 2016; 2016: 2031480