IBS - Here we go again

www.ncbi.nlm.nih.gov/pmc/articles/PMC3444908/

Sorry, had some extra time on my hands. From the above link:

The association between IBS and IBD is well-recognized; however, the mechanism(s) underlying this association is a source of ongoing research. Some have argued that IBS and IBD represent clinical presentations on a pathophysiologic spectrum of disease given the considerable overlap between symptoms in patients with IBS and IBD, whereby IBS symptoms represent sub-clinical inflammation and immune activation that progress in severity towards the expression of IBD [4,13]. Increased mucosal barrier defects in some patients with IBS may also contribute to the increase passage of luminal antigens of dietary and bacterial origin into the sub-mucosal which may result in the further activation of mucosal immune responses involved in the genesis of IBD [14].

I guess I'm not the only one who thinks there is a connection between IBS & IBD and that they are not two totally different unrelated things. This article is from 2012.

NCOT, not necessarily. In the same way that IBD presents with very different levels of severity and very different progressions there's no reason to think that just because IBS is milder than IBD it naturally always leads to IBD if they are related. Quite the contrary, it could be a milder response to some low level disbyosis or another environmental trigger and could be what people who aren't genetically predisposed to IBD develop (to posit one theory).

One of the lead pediatric celiac researchers in the US thinks celiac and IBD are related, albeit different. No reason not to think IBS and IBD might have some relationship, whether from initial causes or aspects of the resultant response.

EDIT:  Or it could lead to it.  That doesn't, however, explain those of us who got IBD and now are left with IBS type symptoms but in remission.

Interesting discussion. I seem to be one of the lucky ones who have ibs and ibd concurrently. I had the ibs symptoms about ten years prior to being scoped and diagnosed with ibd. Now, even with the inflammation controlled I suffer from the ibs. For me it seems the ibs came first and carries on doing its thing regardless of my inflammation. For others they have no ibs begore their first ibd episode. So it seems ibs can come before, during or after ibd rears its ugly head, which makes it even more difficult to pin down!!

When a doctor says "congrats you're in clinical remission, but since you have food tolerance issues still you must have underlying IBS" - I think this is a way of them saying the inflammatory disorder in finally under control, but the functional (and sub-clinical) disorder (of IBD) remains and we have no idea why at the moment - so deal with it and adjust your diet accordingly and we're just going to call it IBS... Immense Bull $hit, haha.

My mother and aunt (on dad's side) both have irritable bowel syndrome, but nobody with uc or crohn's (lucky me, I'm the first). I think I had undiagnosed ibs with constipation, before uc for most of my life. I'd poop 2 times a week at most, dense stuff that splashed me in the butt lol. Now with uc, I've made up for missed poops

My uc is in remission, with 1 bm a day. No signs of ibs now.

Hi Gary. Now that I have a moment this weekend I wanted to post link for you to read.

In regards to the connection between IBS and IBD there are a few doctors and researchers that think this very thing. Especially due to the microscopic nerve inflammation. Tim Bull and Herman Taylor are the MAP guys - and the vaccine developers. Here is a paper they co-wrote with a few others.

Mycobacterium avium Subspecies paratuberculosis Infection in Cases of Irritable Bowel Syndrome and Comparison with Crohn’s Disease and Johne’s Disease: Common Neural and Immune Pathogenicities: jcm.asm.org/content/45/12/3883.full.pdf+html

Keep in mind this: It states that MAP was detected in 75% of patients with IBS, 15% of healthy controls, and 87% of patients with Crohn's - Now here is the thing. Back then they did testing on mucosal biopsies, so this is the upper portion on the intestines. What has since been realized is that if you test tissue from resection - the deep tissues that have been 'cut' out during operation, detection increases to 97%+ in crohns patients. Not sure what it would be in IBS as they don't do resection for this. Now they seem to be at 99% detection rate in Crohn's according to Professor Taylor with their new blood test and visualization method.

This is why Professor Herman Taylor feels that their vaccine may also help people with UC - He thinks a portion (those with IBS like symptoms) have an immune defect of some sort causing Ulcerative Colitis and a concurrent MAP infection (IBS portion). If this turns out to be the case, no one knows at the moment, but he is pretty sure of himself both in relation to Crohn's, IBS and as a co-factor in UC. Time will tell.

Side note: I spoke with the research company that is now testing for MAP in the US. My niece has severe IBS (no prior infection other than antibiotics for a pneumonia) which is when hers set in. I have Crohn's-Colitis. He has agreed to test both myself, my niece and maybe my mom for the presence of MAP in blood (culture), PCR (DNA detection) and Antibodies to MAP antigen. So all three tests for the three of us. Super interested to find out the results.

Anyway - I link the above article for you so you can see there are a few researchers that questions the connection especially in regards to nerve inflammation. Also there is the MAIT cell researcher that thinks the same. There is a few papers on nerve inflammation in IBS cited in the paper that you might like to read.

Post Edited (Canada Mark) : 5/23/2015 10:35:18 AM (GMT-6)

I have never seen the serious and legitimate expression of the opinion that IBS and IBD have NOTHING to do with each other, so this appears to be a straw-man Gary has manufactured.

The questions is to the form of the association. Some association can come from incorrect initial diagnosis, and some association can come form each mutually predisposing increased chances of the other. Both have obvious impact/interaction on the gut microbiome. Additionally, as cited in the article, some suggest they are two points on a single pathology spectrum. I want to see more evidence of this because one is a motility disease and the other is an immune disease.

I realize patients and the public cannot always discuss matters under active scientific investigation with the exact correct words and definitions. However, the straw-man and either/or positions being flung out (by some) here are not helpful. In fact the confusion and misinformation spread could even be harmful.

DBwithUC said...
I have never seen the serious and legitimate expression of the opinion that IBS and IBD have NOTHING to do with each other, so this appears to be a straw-man Gary has manufactured.

The questions is to the form of the association. Some association can come from incorrect initial diagnosis, and some association can come form each mutually predisposing increased chances of the other. Both have obvious impact/interaction on the gut microbiome. Additionally, as cited in the article, some suggest they are two points on a single pathology spectrum. I want to see more evidence of this because one is a motility disease and the other is an immune disease.

I realize patients and the public cannot always discuss matters under active scientific investigation with the exact correct words and definitions. However, the straw-man and either/or positions being flung out (by some) here are not helpful. In fact the confusion and misinformation spread could even be harmful.

Exactly, and well put!!

Thanks Mark. I can't wait to see those test results! I'm shaking my head here in regards to some of the other comments. I'm the one who has posted many times that I think both IBD and IBS are related in some way even if distantly or indirectly and a few others post on here in response claiming they are two separate issues and not related in any way shape or form. I'm beginning to think more and more that for those patients who never had IBS, got diagnosed with IBD, and then were later diagnosed with IBS due to still having symptoms while in "clinical remission", that their IBD (colon inflammation) actually caused their IBS (inflammation of the colon nerves). I totally agree with NCOT. I've been thinking this very same thing.