Research & Education

The Latest on IBS


Inflammatory bowel disorders which include conditions such as IBS and IBD Crohn's and colitis  like many modern day ailments continue to rise. It is estimated that as many as 1.4 million persons in the United States suffer from these types of diseases.

There are of course subtle yet significant differences between these various inflammatory gut disorders. For example the main difference between Crohn's disease and ulcerative colitis is the location and nature of the inflammatory changes. Crohn's can affect any part of the gastrointestinal tract from mouth to anus although a majority of the cases start in the terminal ileum. Ulcerative colitis in contrast is restricted to the colon and the rectum. Additionally while it appears that gastroesophageal reflux disease (GERD) and colitis are unrelated conditions new evidence is showing that the prevalence of IBS-like symptoms is very high in patients with GERD and vice versa.  This may suggest that some systemic component underlies the pathophysiology of both of these disorders. Also at the risk of making the issue even more complicated research shows that adults with allergy symptoms report a high incidence of IBS suggesting a link between atopic disorders and IBS.

Getting the diagnosis right

Diagnostically new biomarkers are continually being discovered to help more accurately diagnose these conditions. Granins (chromogranin A) which are primarily generated by cells of the pancreas have previously been shown to serve as biomarkers for other inflammatory diseases in the gut such as ulcerous colitis and Crohn's disease. The present study looked at the variants secretogranin II and chromogranin B and found that IBS patients have high levels of the former and low levels of the latter.

Until very recently specifics regarding the pathophysiology of the condition were vague and undefined. Researchers have now detailed certain key aspects of the diseases progression by discovering a relationship between the enteric nervous system and signaling pathways in the gastrointestinal mucosa where irritated mucosa releases increased amounts of neuroactive substances that include histamine and protease. Increased release of these agents could be at least partially responsible for IBS's symptomatology.

Soothing with cooling compounds

Therapeutically alternative practitioners have for many years used cooling compounds like peppermint to soothe the GI tract. It was recently discovered that peppermint and certain other cooling agents activated the transient receptor potential melastatin-8 (TRPM8) channels reducing the pain-sensing ability of associate pain fibers. TRPM8 a cationic ion channel is involved in the detection of normal cooling-sensation in mammals and is found in nerves throughout the lining of the large intestine essentially acts as an anti-pain channel. 

Of course the chicken and egg question arises as to what is or are the initiating factors surrounding this condition. Is it genetic?  Is it diet related?  Is there an emotional/psychological component to inflammatory bowel diseases as once thought by many allopathic physicians?

Or is the condition itself dictating the gastrointestinal hypersensitivity and subsequent symptoms?

Perhaps this is simply a matter of shades of grey with various triggers and genotypes contributing to inflammatory bowel diseases. As the number of individuals suffering with these conditions continues to rise I anticipate the science becoming much more detailed specific and clinically relevant.

by Michael Fuhrman D.C.