It often begins after a gastrointestinal infection or after taking antibiotics. Suddenly the digestion becomes sensitive. Food is less well tolerated, there is stinging and bloating, diarrhea and/or constipation.
A gastroscopy or colonoscopy reveals no abnormal findings, and a blood test reveals nothing abnormal either.
- What is it?
- What is the background?
- What should be done?
What is irritable bowel syndrome?
Irritable bowel syndrome (IBS) is present if the following 3 points are fulfilled.
- Chronic complaints (e.g., abdominal pain, flatulence), i.e., lasting longer than 3 months, which the patient and physician relate to the bowel and are usually accompanied by changes in bowel movements.
- The complaints should justify the patient seeking help and/or worrying about them and be so severe that their quality of life is relevantly affected.
- The prerequisite is that there are no changes characteristic of other clinical pictures which are probably responsible for these symptoms.
According to Layer P et al. S3 guideline on the definition,... Z Gastroenterol 2011; 49: 237 - 293.
Definition according to ROME II (1999)
Here main criteria were distinguished from secondary criteria
Complaints or pain in the abdomen during a period of at least 12 weeks within the last year. These 12 weeks do not have to be related.
The complaints are characterized by at least 2 of 3 things:
1. improvement in discomfort after bowel movements2. Bowel movements are sometimes more frequent, sometimes less frequent3. Bowel movements are sometimes harder, sometimes softer, or diarrhea-like
1. the shape of the stool changes2. There is a feeling of incomplete evacuation3. Mucus is mixed with the stool4. Flatulence is present.
- Irritable colon
- Spastic colon
- Mucous colitis
- Functional diarrhea
- Spastic colon
- Irritable colon syndrome
1. diarrhea-affected IBS (med.: diarrhea-affected IBS) - about 1/3 of cases
2. constipation-affected IBS (med.: constipation-affected IBS - about 1/3 of cases)
3. Mixed form -(alternation of diarrhea and constipation) - about 1/3 of cases.
Irritable bowel syndrome (IBS) is a common disorder. It is estimated that between 6.6-25% (!) of the population suffer from it.
At the gastroenterologist (gastrointestinal specialist) between 40-60% of all patients fall under this diagnosis.
The majority of patients have resigned themselves to the disease, or do not hope for medical help. Only 20% seek medical attention for their symptoms.
In the USA, the diagnosis is more frequent than in our country (perhaps more people are affected there as well).
Women and men
Especially at younger ages (20-30), women predominate in a ratio of 2:1. This is ultimately the case for all functional disorders. In older age, the ratio is less different.
Patients with IBS also very often suffer from other complaints that are not directly related to the gastrointestinal tract. Here there is a smooth transition to other functional complaints.
- dullness, sleep disturbances
- Back pain
- Bladder complaints: e.g. irritable bladder
- In women: Menstrual cramps, period pain
- palpitations, heart pain
Likewise, the following are common complaints:
- Anxiety disorder
- Panic disorder
- Post-traumatic stress disorder
- Eating disorders
Regarding the prognosis, there is good news and bad news:
The bad: The symptoms do not get better. Only 5% become symptom-free with the usual, mostly drug therapy.
The good news: The symptoms do not get much worse, however, and it is very rare for a new, severe disease of the gastrointestinal tract to develop, and of course people with IBS live just as long as those without.
IBS is an expensive disease. The follow-up costs (lost working hours, retirement) are many times higher than the pure treatment costs.
In principle, overdiagnosis should not be made! Once the diagnosis has been clarified, no unnecessary further and repeated examinations should take place unless the complaints change significantly. In particular, it does not make sense to have repeated gastroscopy or colonoscopy if no pathological findings were found.
The most important thing is the symptoms. This can be clarified, for example, in a medical consultation.
Common complaints are:
- Alternating pain in the abdomen- Diarrhea- Constipation- Alternating diarrhea/constipation- Pappy stools mostly in the morning or immediately after a meal- Bowel movements that can hardly be held back- Flatulence, women usually complain of a swelling of the abdomen towards evening ("5th month pregnant").
There are no laboratory abnormalities in RDS. Laboratory diagnostics only serve to exclude other diseases (e.g. diseases of the pancreas, biliary diseases, thyroid diseases, etc.).
Colonoscopy (colonoscopy) shows most clearly whether there is a different disease of the intestine. It is important if there is a family history of colon cancer.
You will need to check with your doctor to see if a colonoscopy is appropriate in a particular case. Sometimes it is performed to make sure that there is nothing malignant behind the symptoms.
Many people are afraid of a colonoscopy. However, if it is performed by a trained physician, it is not a stressful examination.
X-ray examinations are not part of the diagnosis of irritable bowel syndrome. In rare cases, a special imaging of the small intestine (small intestinal passage according to Sellink) or a capsule endoscopy may be useful. However, this is a relatively complex examination.
Differential- and Misdiagnosis
Everyone is allowed to have a little rumbling without immediately becoming ill. If you only feel a twinge after eating too much, then this is not irritable bowel syndrome, but a completely normal disturbance of your state of mind.
Probable organic disease
Irritable bowel syndrome may be contraindicated by any of the following symptoms:
- Weight loss
- Blood in the stool
- Increasing intensity of complaints
- Onset of symptoms after the age of 50
- Disturbance of sleep due to diarrhea
If you have one of these complaints, you should be examined more closely, i.e. you should consult a specialist (gastroenterologist).
Depending on the individual case, the following - in part rare - diseases, among others, must be excluded:
- Chronic inflammatory bowel disease (especially Crohn's disease and ulcerative colitis)-.
- Other forms of colitis- Colorectal carcinoma
- Drug side effects
- Malabsorption: sprue, pancreatic insufficiency.
- Infectious diseases: Lambliasis, amebiasis, yersinia
- Lactase deficiency
- Fructose intolerance
- Histamine intolerance
- Superinfection of the small intestine
- Endocrine metabolic disorders: Diabetes mellitus, thyroid dysfunction
- Chronic idiopathic pseudo-obstruction
- Neuroendocrine tumors
Many people cannot tolerate milk sugar (med.: lactose). In order to absorb lactose, which is contained in milk and in many finished products, we need the enzyme lactase, which is found in the intestinal mucosa.
About 10% (according to other estimates up to 25%) of people in Northern Europe lack this completely or do not have sufficient amounts of the enzyme. The lactose then remains in the intestine and triggers considerable bacterial growth there. The result: flatulence, swelling of the abdomen, pain and diarrhea.
The majority of people in the world do not have lactase and therefore cannot tolerate dairy products containing lactose. 60% of Asians, 90% of Chinese and most Africans as well as the majority of Mediterranean people belong to this group.
Accordingly, people in Asian countries and Africa do not drink milk. In the case of acidified milk products such as sour milk, yogurt or lassie, bacteria have already broken down the lactose so that they can be tolerated even by people without lactase.
However, small amounts of milk (a shot in the coffee) usually do not cause discomfort. In addition, the passage speed of the (small) intestine plays an essential role.
Whether a lactose intolerance is present can be reliably determined with the help of a breath test or blood test.
Also common is the inability to absorb fructose properly in the small intestine. About one in three (!) people in Central Europe are said to be affected.
This intolerance also leads to flatulence, diarrhea or malaise after eating foods rich in fructose. As can be assumed, these are mainly fruits, fruit drinks, honey, fruit teas, etc. As with lactose intolerance, the passage speed of the (small) intestine is essential.
In cereal products, dairy products, meat, but also in numerous vegetables, the proportion of fructose is significantly lower.
By the way: Fructose intolerance is also increased by artificial sweeteners such as sorbitol, mannitol or xylitol, as these hinder the absorption of fructose.
(These ultimately rather harmless complaints should not be confused with fructose intolerance, which is much rarer. Here, the fructose cannot be broken down).
Whether a fructose intolerance is present can be reliably determined with the help of a breath test or blood test.
Caution false alarm
Not every fructose intolerance diagnosed in the breath test actually plays a role in everyday life. The absorption of fructose depends on the ratio of glucose (dextrose) to fructose. The more glucose in the food, the more easily the fructose is absorbed. Because pure fructose is rarely absorbed under real-life conditions, many people therefore tolerate fruit excellently, even if fructose intolerance has been diagnosed in a breath test.
For many other sufferers, there is a simple therapy: a little dextrose (household sugar if necessary) over the fruit, and it is better tolerated.
Caution IgG4 test!
Causes and background
There are numerous theories regarding IBS. Confirmed by research is above all the hypersensitivity (lowering of the stimulus threshold) of the gastrointestinal tract.
In addition, psychological influences, disturbances of the movement of the intestine and the control of the autonomic nervous system of the intestine are largely secured.
Less well established are disturbances of the intestinal flora, the immune system, genetic influences or environmental influences.
Finally, lactase deficiency (absence of the enzyme that absorbs lactose) may also contribute to IBS.
If one lists the various types of complaints of functional diseases, one finds, despite all the differences, that disorders in the area of the gastrointestinal tract are associated with many clinical pictures. It almost seems as if digestive disorders run like a red thread through the life story of all patients who suffer from chronic functional diseases.
Sometimes those affected are only slightly aware of this. However, physical examination of the abdomen reveals the following picture. The upper abdomen is painful, the lower abdomen is distended, and at certain points the physician can elicit a sharp pressure pain during the examination.
Interesting facts - according to guideline
- IBS patients have disturbances of intestinal barrier, motility, secretion and/or visceral sensitivity.
- Various molecular and cellular mechanisms, individually and in combination, are relevant to the development of IBS, although their frequencies and specificities are partly unclear.
- IBS is often associated with intestinal immune imbalance.
- IBS symptoms may be triggered by an infection in the gastrointestinal tract and may persist for weeks, months, and years.
- In IBS patients, alterations in serotonergic mechanisms are found.
- Increased innervation of the mucosa is found.
- Altered mucosal mediator profile in IBS leads to activation of the enteric nervous system and primary afferent (nociceptive) nerves.
- A genetic predisposition to IBS exists.
- Sympathetic-parasympathetic activation is altered in RDS.
- IBS is associated with an altered microbiota (gut flora).
- IBS patients differ from controls in terms of individual assessment of visceral sensations and willingness to report them.
- The transmission of intestinal stimuli in the spinal cord may be increased in patients with IBS.
- In IBS patients, intestinal pain stimuli lead to activation of different and larger brain regions than in controls.
- Learned illnes behavior is more frequently detectable in IBS patients compared to healthy controls.
- In humans, acute and chronic stress has an impact on gastrointestinal functions. Individual studies also suggest that acute stressors alter functions that may be related to the development of IBS.
- Acute and chronic stress alters gastrointestinal functions in animal models that may play a role in the pathogenesis of IBS.
It is not uncommon for IBS to be triggered by a viral or bacterial infection.
In studies, between 25-38% of those affected report that their symptoms were triggered by a gastrointestinal infection.
The germs responsible were more frequently found to be: campylobacter, shigella and the notorious salmonella.
Approximately 100 million nerve cells envelop the human digestive tract in two gossamer layers, in the middle of which is the intestinal musculature. They ensure the smooth running of the complicated process of breaking down and absorbing food.
In no part of the body is there a larger collection of nerve cells with the exception of the brain. Even the spinal cord, which is composed practically entirely of nerve cells, does not come close in number to the intestinal control system. Between the nerve cells of the brain and the intestine, there is such a high degree of correspondence that scientists spoke of a second brain, the "intestinal brain".
Developmentally, the intestinal brain is explained by a simple fact. The human being is born immature. Therefore, at birth, the human brain cannot yet take over large areas of its later tasks. That is why, unlike animals, we can neither walk nor stand after birth, for example. The reason for the functional immaturity is the disproportionately large brain compared to other mammals and thus the large head of humans. With such a large skull, we can only pass through the narrow birth canal if we are born very prematurely. In this sense, all humans are premature even after nine months of gestation.
Functions essential for survival, such as feeding, must function immediately after birth. By outsourcing control to the abdomen, they are freed from spatial restriction in the immature brain. We can thus eat and digest without help from above.
Intestine and immune system
The gastrointestinal tract, it has certainly become clear, is much more than a pipe that runs through the body once, gaining energy in the process. The digestive tract is closely connected with our nervous system and even our emotional life. But the intestine has another important function: it is the center of our immune system.
This may sound surprising. Digestion and the immune system - the two terms seem to go together poorly. But they are closely linked for good reason.
Our intestines are not only filled with food. It is also the habitat for bacteria. And these live here in large numbers. We take in around 100 billion new germs with our food every day. Between one and a thousand trillion microorganisms are said to populate the intestine. Or, to make the dimensions clear: the intestine is home to about one hundred times more germs than our body has cells. We ourselves are in the minority!
The comparison may cause slight vertigo. How can it be that we do not perceive anything of this condition? Why does our inside consist of such a fermenting vat of foreign germs?
We need these microorganisms. In fact, we are desperately dependent on them to break down food and digest it properly. And, we live in peace with them, even though many a potential pest hides among the approximately 500 species of bacteria strains.
The immune system of the intestine continuously watches over the bacterial flora and ensures that nothing gets out of hand in terms of bacterial growth. For this reason, about 70% of all immune cells are located along the intestine: Lymph nodes, lymphatic channels and about 70 billion plasma cells that cover the inside of the intestine with a protective film of defense substances (immunoglobulin A). However, such concentrated defense is also necessary, otherwise we would lose out to our fellow inhabitants.
Fungi - mycoses
In every healthy intestine there are not only billions and billions of bacteria but also other microorganisms such as fungi. Most of them are harmless, some are even useful. However, there are also pests, most importantly Candida albicans, a yeast fungus.
Without going into details, it should only be mentioned here that this fungus likes to multiply when the immune system of the intestine is restricted, the diet consists unilaterally of sweet things or antibiotics have been taken more frequently.
The importance of fungi in medicine was underestimated for a long time. Then came a phase in which they were held responsible for countless ailments. Today, a more realistic assessment is being made. Candida albicans can occur in a healthy intestine without causing any damage. However, if the intestine is irritated or the immune system is weakened, fungi can considerably aggravate the complaints. Our medical ancestors put it this way: Fungi are a disease of the sick!
Fungi can be detected by a simple stool test or by a mouth/nose swab. What the findings mean in each case and whether treatment should be given must then be decided by the doctor.
Irritations of the intestine make the body susceptible to pain.
- Continuous impulses from the intestinal brain lower the pain threshold. Inflammation in the intestine lowers the level of the anti-pain hormone serotonin. Overloading of the lymphatic tissue leads to edema, which promotes pain.
Our pain fibers are not one-way roads toward the brain. Via a "side road" the excitation is conducted back to the affected tissue. There, the pain impulse can lead to inflammation and swelling, which is medically termed "neurogenic" inflammation. This mechanism may explain some of the swelling in fibromyalgia patients.
The therapy of irritable bowel syndrome is often as complex as the multitude of complaints. Irritable bowel syndrome is usually much more than just a little rumbling in the stomach!
Of course, it is not necessary to always treat it to the maximum. In mild cases, simple dietary changes and a few lifestyle tips are sufficient, but depending on the extent of the symptoms, more extensive measures may be necessary.
It has proven very effective to approach the complaints from several sides and to do this simultaneously.
We carry out such therapy programs for patients with pronounced irritable bowel complaints (so-called multimodular therapy). Ultimately, these aim at raising the irritability threshold of the intestine.
Depending on the individual case, they consist of different elements:
- A basic measure is the change of nutrition. Restoring restful sleep is also central, since it is usually significantly disturbed. Drug therapy has its place, but should not be overestimated.- Psychotherapeutic procedures and relaxation methods are equally helpful, provided they are not used as the sole therapy.- Massages, e.g. colon massage, are extremely pleasant to reduce the hypersensitivity of the abdominal region. - Often, in addition to the discomfort and pain in the abdomen, there is also pain in the muscles and joints. We treat these equally as well. Vitalizing therapies such as cold and heat applications can also be beneficial. Acupuncture is a good method of reducing tension and pain, as numerous studies on this subject have shown. The lowered threshold must be raised again in this clinical picture. This can be achieved by movement exercises, muscle building and exercises to increase mobility, as well as training of the pelvic floor with the Galileo system, among other things: Menstrual cramps, edema, migraine, tension headaches, irritable bladder, etc.
Many of these measures are also used for other functional clinical pictures, as they are non-specific in their effect. Ultimately, the goal here is also to raise a lowered threshold of irritation again. Here I ask you to look especially at the pages on fibromyalgia and CFS syndrome.
Some of the more specific therapy components are described here. In particular, the diet, the medications, and the psychotherapeutic procedures.
Medication: limited help
A purely drug-based therapy is usually not successful. However, a strong placebo effect is known in IBS. Up to 50% of patients respond with an improvement in symptoms even to a placebo. Unfortunately, this effect does not usually last long. After some time the success evaporates and now one tries it with the next preparation...
Although medications are not fundamentally helpful, they can alleviate individual symptoms.
Basically, one should not treat for too long and specifically for certain symptoms: No schematic permanent therapy
The following preparations are more frequently used and recommended. Of course, this is only an overview. Please talk to your doctor before taking any preparation.
Various plant substances are used for treatment.
It is difficult to predict which ones are effective in individual cases:
- Peppermint oil (also available as a ready-to-use drug e.g. Medacalm®).
- Chamomile- Caraway
- Asa foetida
- Ginger root (against nausea) e.g. prepared as tea.
- Bitters: We like to use a tea ("Biovent"), which tastes very bitter but does a lot of good.
Anticonvulsant preparations: They help against acute symptoms. (Example of the active ingredients contained in different commercial preparations: Mebeverine, butylscopolamine, hyoscine).
On the subject of flatulence, you will find the essential therapeutic tips on the corresponding pages.
Antidepressants: As described in detail, serotonin metabolism plays a major role in the disease. Accordingly, drugs that increase the serotonin content of the blood are beneficial. This can be achieved by so-called tricyclic antidepressants. The main representatives are very proven substances such as amitriptyline and trimipramine. In high dose (about 75-150 mg) they are effective against depression.
I prefer very low dosages in IBS, where the substance is taken drop by drop. Patients start with one drop of amitriptyline (contains 2 mg) in the evening and then increase until they feel a positive effect.
This refers first to a deepening of sleep, while the effect on the bowel often comes later. The first target dose (usually between 3-10 drops) is the one where sleep is restful and no daytime sleepiness is noticeable.
At low doses, side effects are very low and the medication can be taken for many months or longer.
Important: Antidepressants also act directly on the nerves of the gastrointestinal tract. That is, they also act independently of their effect on the psyche. This means two things:
- You can make a trial with these preparations even if you do not feel depressed at all.
- If the antidepressants work, it is not proof that you were depressed "in reality".
Means against diarrhea
Loperamide, a classic treatment for acute diarrhea. It can also be taken in fixed doses for chronic diarrhea. Loperamide is actually an opiate but acts only peripherally, i.e. has no effect on the brain. Thus, there is also no risk of dependence.
Opium tincture or codeine more effective than loperamide. However, there is a risk of dependence. These substances are therefore only considered in individual cases.
Cholestyramine: An ion exchanger, is often poorly tolerated.
Psyllium (psyllium): Natural swelling agent when needed and can also be used on a long-term basis. It may be confusing that psyllium is effective for both diarrhea and constipation. The effect is explained by the high ability to bind water and the numerous mucilages contained in psyllium. It is necessary to pay attention to sufficient dosage (9-18 g). Most common side effect: flatulence. If there is a history of intestinal constriction, psyllium should not be taken.
Means against constipation
Lactulose, lactitol and macrogol are more commonly used. The first two usually cause flatulence. (Change of diet usually works very effectively after a while of getting used to the diet).
Irritants (rhizinus type) should not be used.
It almost goes without saying: The soul has a considerable influence on the gastrointestinal tract. As a rule of thumb, one can say that the gastrointestinal tract values safety and security above all. Anxiety, permanent stress leads increasingly to an acceleration of the intestinal passage and thus to "shittiness", as is known from animal experiments.
The more depressed a patient is, the slower the massage and constipation is the result.
It is known from various studies that affected patients are somewhat more anxious or depressed than healthy controls. But considering the large number of affected people and the fact that only 20% of all IBS patients go to the doctor, one has to assume that only the anxious and depressed find their way to the doctor. However, it seems to be the case that severe symptoms of illness go hand in hand with more pronounced psychological complaints.
Does psychotherapy help against diarrhea or constipation? This may be possible in individual cases. However, in our view, psychotherapy alone is often not sufficiently effective. Other complementary procedures are necessary, which can be carried out, for example, as part of a multimodal therapy.
Which therapy method should be chosen (behavioral therapy, depth psychology, systemic therapy, etc.) probably depends more on the therapist than on the therapy direction. Whenever possible, it is favorable to have preliminary discussions with different psychotherapists - even if this is difficult in view of the supply situation.
In principle, psychotherapy is recommended if there are unresolved life conflicts in addition to the abdominal complaints.
Relaxation procedures (e.g. progressive muscle relaxation according to Jakobson) is certainly a good, simple procedure that can be easily performed at home.
In the few studies on this, the procedure showed to be favorable and effective after about 10 sessions.
Up to 25% of the population suffers from irritable bowel syndrome, 20% from constipation, 40% at least occasionally from heartburn. In addition, there are inflammations of the esophagus, diverticula of the colon, rectal problems, stomach and intestinal ulcers, tumors and much more. Who, one wonders, then has a truly healthy digestive tract?
Indeed, ailments and diseases of this organ are currently the rule rather than the exception. What does this have to do with our lifestyles and diets?
There is no doubt that eating habits in the rich countries of this world have changed over the last hundred years. But a hundred years is a long time and many things have become so natural to us that we hardly think about them.
Our body, however, is older. It has existed in its present form for about three million years. Certainly, today we have less hair than our ancestors, our chin is no longer quite as strong, but with regard to our internal organs, practically everything has remained the same.
How did we feed ourselves in the past millions of years? - Extremely modestly! 99% of the time, which humans populate the earth, concern the hunter and collector epoch. One must not get romantic ideas about this phase. In the morning some gazelle, at noon pheasant and in the evening a hearty bear ham - far from it!
The hunting methods were ineffective. In the longest period people used only primitive throwing tools. Stones, wooden sticks and later spears. Bow and arrow is a relatively young weapon technology. With these tools tasty game was difficult to hunt. Therefore, sick or weakened animals often had to be pursued for days, and they did not shy away from carrion. Much more important than meat was therefore the vegetable food, which probably formed the largest part of the daily meals. Roots, finer leaves, fruit, mushrooms and seeds were the most important foods. In addition, there were also "lower game" such as snails, worms and insects. Pleasures that we would not necessarily put on the menu today.
It is important to remember that almost everything was eaten raw. Only with the control of fire was roasting possible and cooking has only been common for a few tens of thousands of years.
One may find this type of cuisine unappealing, but one thing is certain: our digestive tract is built for this type of food.
Almost the entire time that humans have lived on Earth, food has been extremely plain. And it was very hard. A challenge for dentition and digestion.
Undoubtedly, it was not a gourmet cuisine. But it also had its advantages: The inhabitants of Earth at that time ate virtually no sugar, only half as much fat, almost ten times as much fiber, only one-tenth as much table salt, five times as much vitamin C and three times as much highly unsaturated fatty acids as a contemporary inhabitant of the civilized world. Cholesterol problems were thus unknown.
In the course of a relatively short period of time, the diet changed drastically.
A first major step began with agriculture and animal husbandry about 10,000 years ago. But truly revolutionary changes have occurred in the last 100 years, especially since World War 2.
Humans are adaptable. Our digestive tract can also adapt to a wide variety of foods. But the adaptability that is demanded of it today is clearly beyond its capabilities. Sugar, fat, meat, alcohol in hitherto unknown quantities lead to a permanent strain and irritation of the intestinal walls. Lack of exercise, prolonged mental stress, work stress, etc. push the body to the limits of its capacity. It is highly probable that the increase in chronic functional diseases is related to these stress factors.
Some of these factors are difficult or impossible to influence. Food, on the other hand, very much can. Of course, no one can or should return to a "Stone Age diet," although this would be theoretically possible. But you don't have to go that far to create healthy conditions for the intestines. Basically, you only have to follow a few principles to fulfill the basic needs of the digestive tract and thus effectively prevent diseases and ailments.
You may have read the above advice and thought to yourself, "well, I've heard that sort of thing before and I'm not living quite so wrong after all". Or: "I'm doing everything right and yet I feel bad"! Or: "When I eat all the coarse, healthy things like wholemeal bread, my stomach feels much worse than when I eat white bread or toast".
Indeed, the above dietary suggestions are not very original. Even worse, if a patient with intestinal problems were to follow them, he would actually feel worse! Raw fruits, raw grains, cereals and salads are extremely reliable in worsening the symptoms of irritated bowels!
Many patients with digestive problems do not tolerate healthy food. Low-fiber concentrates initially cause far less discomfort than "healthy" food. But this can lead to a vicious circle: If you avoid the "healthy" stuff because you can't tolerate it, your intestines lose more and more muscle, making it even harder for them to digest coarse and fresh foods. This leads to a spiral of deprivation, at the end of which we tolerate less and less food.
It is like healthy sport. But it is not at all good to do long runs when muscles and joints are untrained or diseases have affected the musculoskeletal system.
If the digestive tract is irritated, it cannot cope with a healthy diet. However, if one spares the gastrointestinal tract with white bread and toast, then one suffers from less discomfort, but at the same time perpetuates the disorder, since the intestinal muscles are not built up.
Similar to sports, the solution lies in a gradual loading of the intestines. After a phase of healing, the effort is gradually increased, thus slowly bringing the intestine to normal function. Eventually, the digestive tract should be in such good condition that it is able to digest healthy food, which will itself contribute to intestinal health.
Stool transplantation is increasingly coming into focus as another therapeutic option. Once the "disgust factor" has been overcome, this therapy may be an interesting extension of the treatment spectrum.
Here is some basic information.
- The human body has approximately 10 trillion cells.
- The number of germs in the intestine is about 10 times higher: 100 trillion bacteria.
- There are between 500 and 2000 different species per person in the intestine.
- A total of 40,000 different species have been found to thrive in the intestine.
- Hardly any other habitat is as densely populated as the gastrointestinal tract.
- How this life takes place inside us, what influence the bacteria have on the body, how they communicate with it is practically unknown. The only thing that is clear is that these bacteria influence to a great extent.
- Intestinal wall and bacteria seem to be in a constant "dialogue" and among other things it is probably so that the intestinal bacteria can communicate their wishes - e.g. for certain nutrients.
It is also interesting that the intestinal wall and the bacteria are not in direct contact in a healthy state but are separated by a layer of mucus. In intestinal inflammation, this mucus layer is probably not fully intact. The intestinal wall comes into greater contact with bacteria and begins to fight them.
Actually not so new
In veterinary medicine, this method has long been used as "transfaunation", e.g. for sick cows. Stool transplants are also said to have been performed in China in the 4th century. So it seems to be rather a rediscovery.
This method has been particularly successful in the treatment of intestinal infections with clostridia. The success rate is significantly higher than with antibiotic therapy, and the side effect rate is considerably lower. There are numerous studies on this, which show very impressive efficacy.
Less certain, however, is the use of the method in other diseases. A beneficial effect is most likely in other forms of intestinal disease, e.g. ulcerative colitis or Crohn's disease. But there are also serious indications of effectiveness for irritable bowel syndrome.
In addition, other clinical pictures are also mentioned, in which an effect is supposed to be shown:
- Metabolic syndrome (obesity, fatty liver, high blood pressure, diabetes).
- Chronic fatigue syndrome (CFS)
- and others.
- Ultimately, it is about influencing the gut-brain communication.
Side effects must be expected with any effective therapy. This also applies in principle to stool transplantation. So far, experience with the "new" method has been surprisingly positive. Nevertheless, as with any new therapy, caution should be exercised as long as no comprehensive controlled double-blind studies are available that provide clear figures.
The question is, above all, could diseases not also be transmitted? There are still no generally accepted rules for what is required of a donor. It is also still unclear what characterizes a "perfect donor."
For the most part, the following applies: Persons without chronic diseases, without cancer, especially no autoimmune diseases or even intestinal diseases, diarrhea or antibiotic therapies in the last 6 months.
Furthermore, laboratory tests should be done regarding general abnormalities and especially hepatitis, CMV, syphilis and AIDS. Stool should be examined for worm eggs, parasites and of course Clostridium difficile.
As donors, people living in the same household or relatives are usually preferred.
The questions of medical liability are also unresolved. Therefore, many colleagues (we as well) are reluctant to perform it, although it is practically easy.
Since stool transplantation is technically easy to perform, some affected persons have performed this procedure in self-help. The reports are naturally very sporadic. Nevertheless, there are reports of success here as well. However, here, too, it is essential that the donor has undergone sufficient preliminary examination. Probably the chances of success increase with closer relationship.
In the case of minor complaints, individual procedures described can often help quite well. With pronounced or chronic symptoms, this is often not enough. Then more comprehensive procedures are necessary.
In this context, we speak of multimodal (multi=many, mode=way) therapy.
As already outlined, the therapy is primarily aimed at overcoming the increased sensitivity of the gastrointestinal tract.
An initial "gentle" diet is again an indispensable part of the therapy. But many more steps may be necessary to achieve lasting success.
We have developed a program for this purpose, through which we guide our patients step by step. It begins with close-meshed therapy: During the first 2-3 weeks, depending on the symptoms, we treat patients as frequently as possible, often on a daily basis.
In most cases, the multimodal therapy already improves the symptoms in the first few weeks. Once this has been achieved, the intervals between treatments are rapidly extended. Our goal is then to emphasize self-help and thus contribute to greater independence and inner security.
For patients who live further away, we offer 2-3 weeks of intensive therapy. Here you can stay in apartments in the immediate vicinity of the practice clinic. Twice a day we carry out 2-3 hour treatment cycles. Of course, we provide detailed introduction to dietary changes.
We have detailed recipes for the light diet. In our small patient kitchen it is possible to warm up the sparing food.
After the therapy we train our patients in self-help and further therapy procedures, which can then be carried out at home. With this procedure we have very satisfying treatment results - not only with irritable bowel syndrome.
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