Irritable Bowel Syndrome (IBS) / Colitis and Crohn's Disease (IBD)

Paul L. Reller L.Ac. / Last Updated: August 03, 2017

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Irritable Bowel Syndrome (IBS) affects more than 15 percent of the U.S. population, and is a complex and poorly defined functional disease. Classification as a functional disease is what differentiates it from Inflammatory Bowel Disorders such as Colitis and Crohn's Disease, but many studies have now shown that symptoms associated with Irritable Bowel Syndrome are frequently seen in patients with Inflammatory Bowel Disease as well. In fact, in recent years it has finally become apparent that there is no clear separation between Crohn's Disease, which predominantly affects the upper intestinal tract, and Colitis, which predominantly affects the lower intestinal tract. All of these diseases are not clearly and completely distinct from one another, but represent a more complex spectrum of dysfunction and inflammatory immune processes that are dysfunctional, and thus need a more holistic approach to treatment. Other diseases related to gastrointestinal dysfunction are Gastroesophageal Reflux Disease (GERD) and functional dyspepsia. Research has found that a variety of causes and contributors to this GI dysfunctional disease are important, each to a percentage of patients, and so the treatment strategy must be broad and tailored to the individual. No medication has been found to significantly affect the IBS syndromes, and symptom control is the goal of standard medicine. Zelnorm (tegaserod) was routinely prescribed for IBS, but the FDA issued stern warnings of cardiovascular risk in 2007, and found that benefits were meager. The FDA approved restricted use of Zelnorm only for patients who exhausted other treatment options.

Finally, in 2015, the FDA approved a type of antibiotic for IBS-D, or Irritable Bowel Syndrome with predominant diarrhea, but only in short courses of 10 days, and only because no other standard treatment was available. Since antibiotics and the disruption of the Biome balance are a strong potential cause for IBS, this use of Rifaxim (Xifaxan), or other antibiotics, may be problematic. Another drug approved in 2015, Eluxadoline (Viberzi), for IBS-D, is an agonist of the mu and kappa opioid receptors, and an antagonist of the delta opioid receptor, designed to suppress the nervous system in the bowels. It is well known that acupuncture and electroacupuncture stimulation works largely by modulation of these 3 types of opioid receptors, with low frequency (2 Hz) acting on the mu and delta opioid receptors, and high frequency (100 Hz) acting on the kappa opioid receptors. A combination of short courses of frequent acupuncture stimulation and more prolonged prescription of restorative herbal and nutrient medicine comes with no adverse effects, and can used to either enhance these drugs, or to be tried first before resorting to chronic dependence on pharmaceuticals. The standard treatment for IBD (Inflammatory Bowel Disease) is also very limited and problematic, with significant adverse effects and poor compliance, often involving immune suppression.

Obviously, there is a great need for a better treatment protocol, and research is now demonstrating that integration of Complementary Medicine for these diseases is both effective and without adverse health effects, and in fact is being increasingly integrated in recent years in both Asia and Europe in standard medicine. Most of this article concerns Irritable Bowel Syndrome (IBS), but you may scroll to the section of the article devoted to IBD, and access links to scientific studies in the last section to review current research and treatment of Inflammatory Bowel Disease (Ulcerative Colitis and Crohn's Disease). All of the research points to a need for a more comprehensive treatment strategy, but also for a more intelligent proactive diet and lifestyle protocol on the part of patients. The holistic protocol in Complementary and Integrative Medicine and Traditional Chinese Medicine (CIM/TCM) provides safe and effective therapies that combine many treatment effects, including antibiotic and immune modulating herbal formulas, and these CIM/TCM physicians receive much education in specialized medical schools concerning nutritional medicine, diet and lifestyle changes, an important part of traditional medicine for many thousands of years, and still largely ignored in standard university medical schools. Even if allopathic drugs are used, CIM/TCM offers and array of treatments that can successfully integrate to insure better long term outcomes, and hopefully stop the underlying health problems driving these diseases, to finally achieve a cure, not just a management of symptoms. Hopefully, this article will provide some significant and helpful patient education to further these goals, and help patients with these difficult disease states to take a more proactive and intelligent role in their medical care.

One of the options increasingly popular with patients suffering from IBS is Complementary and Integrative Medicine (CIM), especially the combination of acupuncture, herbal medicine, nutrient prescription, and medical advice with diet and lifestyle (CIM/TCM). This approach provides the time intensive and comprehensive care and guidance needed to correct the dysfunctions, inflammatory problems, and associated symptoms tied to the this complex syndrome. Since IBS affects both the upper and lower intestinal tract, and is affected by dysfunction of the nervous and immune systems, there is no single therapy that is effective. A step-by-step approach with a knowledgeable physician practicing Complementary Medicine, such as a Licensed Acupuncturist and herbalist, is the practical course for the patient. Large studies have shown that up to 75 percent of visits to a medical doctor by patients with IBS relate to comorbid conditions and extra-intestinal symptoms, with both visceral hypersensitivity and psychological disorders, such as anxiety and depressive mood disorders and somatic syndromes seen in more than 90 percent of cases, and a high comorbidity with fibromyalgia (encephelomyopathy), chronic fatigue syndrome (CFS), chronic pelvic pain syndrome, and temporomandibular joint disorder (TMJ/TMD). Obviously, IBS cannot be defined with a simple explanation, and treatment must be broad, individualized, and holistic to accomplish patient goals. Simply taking an antibiotic is not the complete answer to this disease syndrome. To address all of these comorbid conditions more effectively, the MD should integrate with a Complementary Medicine physician to achieve better overall outcomes and quality of life.

Irritable Bowel Syndrome, or IBS, is a complex disease of broad dysfunction in the body, including not only the large intestine, but the upper gastrointestinal tract, autonomic nervous system, and immune reaction. While no specific therapy produces significant cure or control of the syndrome, a comprehensive array of therapies has shown dramatic results. Complementary and Integrative Medicine (CIM) is highly suited to this approach, and should be pursued after an Integrative M.D. has thoroughly evaluated your condition. Standard protocols are now using short courses of antibiotics to decrease imbalances of the gut microbiota, but use of short courses of herbal formulas and prolonged probiotic therapy would seem more sensible and safe, and can be just part of a broader holistic treatment protocol that is individualized and addresses restoration of function, not just suppression.

Irritable Bowel Syndrome (IBS) is defined on the basis of recently modified Rome III criteria as recurrent abdominal pain or discomfort at least 3 days per month in the last 3 months, and that cannot be explained by a structural or biochemical abnormality. Two of three factors are determined necessary for diagnosis, either (1) improvement of symptoms after a bowel movement, (2) onset of the disease associated with a change in frequency of bowel movements, or (3) onset associated with a change in appearance of the stool. Patients with IBS experience a wide variety of symptoms associated with the entire gastrointestinal tract as well as extra-intestinal symptoms. Chronic abdominal pain, usually described as a cramp, may vary in intensity and periodic exacerbation, and is usually located in the lower abdomen. Often, emotional stress aggravates the pain, and often, but not always, the pain or discomfort is relieved by a bowel movement. Periods of frequent bowel movement, and/or constipation, may occur, often alternating and with periods of normal bowel movement. Upper GI symptoms of heartburn, difficulty swallowing, dyspepsia, fullness, nausea, and chest pain are not uncommon. Increased belch and flatulence are also common. Many patients also complain of chronic joint and muscular pain, headache, urinary frequency or urgency, insomnia, periodic sexual dysfunction, and pain with intercourse, although none of the symptoms except for abdominal discomfort and changes in bowel habits need to be apparent to confirm diagnosis. If you have few of the symptoms, the syndrome is probably in an early stage.

Symptoms presentation may vary widely with IBS, and patients without the classic symptom presentation are common. The prevalence of alternating periods of constipation and diarrhea imply that the disease mechanisms are also varied. Patients may present with just chronic diarrhea and no constipation. Differential diagnosis is important, and sometimes this is a prolonged process. Standard medicine will often first test for more threatening underlying diseases, and usually, and hopefully, these tests will be negative. This does not mean that the patient should give up on testing or further diagnosis. A diligent pursuit of sound objective diagnostic data is recommended, although often this is a difficult and prolonged process. With symptoms of chronic diarrhea, Giardia or other protozoal, or even low-grade viral infection, may be present, and testing and evaluation with an experienced physician is needed. Current research is confirming the efficacy of various Chinese herbs, such as Curcuma, to treat Giardia, other protozoal infections, and persistent viral pathologies (see links below in additional information). Concurrent problems may also exist, making the actual diagnosis in chronic cases more difficult and complex. Standard medicine wants to narrow the diagnosis to one specific problem, but often a variety of concurrent problems exist. Knowing more of the underlying conditions helps the Complementary Medicine physician design a more thorough and comprehensive treatment plan. The failure to design such comprehensive individualized treatment plans is the main reason that so many IBS patients are frustrated with the results of care.

There are no completely definitive tests for IBS, and so the diagnosis is one of exclusion, meaning that if you meet the above criteria, and no other disease is proven to account for your symptoms, we assume that IBS is the diagnosis. Tests are useful to both rule out other potential causes and to help guide the therapeutic protocol. Once a diagnosis of IBS is made, further testing is needed to complete the diagnostic assessment. Initial testing by your M.D. specialist should include a complete blood count, chemistry panel including tests for antigliadin and antiendomysial IgA, thyroid function studies where appropriate, and stool analysis. Copies of the test results should be obtained, and brought to the Licensed Acupuncturist, so that treatment strategy reflects proof of problems, especially where celiac disease and chronic intestinal infections are concerned. Older patients, or any patient with apparent blood in the stool, feces that are becoming thin in shape, or with significant weight loss or diarrhea, may want to have a colonscopy to rule out cancer or other structural colon pathology. Sigmoidoscopy is generally not recommended as useful in diagnosis, but development of video capsule endoscope has revolutionized imaging of the small bowel mucosa and facilitated evaluation, helping to differentiate IBS from Crohn's disease, other inflammatory disorders, cancer and various tissue growth and bleeding pathologies.

As studies of IBS pathology increase, testing procedures are also being refined, although standard medicine often does not keep pace. Pathogenic protozoal parasites are increasingly found to be associated with chronic IBS-D, or diarrhea-dominant IBS. In 2010, the University of Technology Sydney, in Australia, found that a newer test, mutiplex tandem PCR (MT-PCR) was much more accurate for detection of the 4 common pathogenic protozoan parasites found in urban populations, Giardia intestinalis, Cryptosproridium spp., Entamoeba histolytica, and Dientamoeba fragilis. The study of MT-PCR demonstrated that this test was able to provide "rapid, sensitive and specific simultaneous detection and identification of the four most important diarrhoea causing protozoan parasites that infect humans", and pointed out the lack of sensitivity demonstrated in standard microscopic evaluation of stool samples. Often, this type of evaluation is dismissed in current testing and assessment of IBS. Some now common parasitic diseases are more associated with chronic or acute constipation than diarrhea, and studies in Thailand and Turkey (cited below in additional information) show that Blastocystis infection is more associated with constipation than diarrhea, with studies noting Blastocystis in about 17 percent of consecutive patients studied with a diagnosis of Irritable Bowel Syndrome or Inflammatory Bowel Disease, and that Blastocystis subtype 3 is most prevalent, a parasitic subtype found in feedlot animals, but not in rodents and wild birds. The Australian studies of protozoal infections also implicated large feedlot animal farming as the probable route of infection. These studies are turning past assumptions about parasitic overgrowths and bowel disease on their head, and showing that unhealthy corporate meat production, overuse of antibiotics, and poor regulation of feedlot waste and runoff into waterways are indeed major public health problems associated with Irritable Bowel Syndrome and Inflammatory Bowel Disease. These studies help find the most effective and comprehensive holistic therapy. With more specific information, the holistic therapy may target the most important aspects of the disease and increase efficiency.