As functional disorders of the gut continue to increase in occurrence and develop in frequency across all population groups, a broad based review in the Journal Digestive Disorders published in Feb 2018 is a welcome chance to tease out elements of discord and dysbiosis that present opportunities for personalised intervention.[1]

Background and Summary: Traditionally, functional gastro­intestinal disorders (FGID), including functional dyspepsia or irritable bowel syndrome (IBS), are defined by more or less specific symptoms and the absence of structural or bio­chemical abnormalities that cause these symptoms. This concept is now considered to be outdated; if appropriate tests are applied, structural or biochemical abnormalities that explain or cause the symptoms may be found in many patients. Another feature of FGID are the highly prevalent psychiatric comorbidities, such as depression and anxiety.

A summary of key points.

In this mini update, learn more about possible contributors to IBS, and how simple diet or supplemental interventions may improve it. There’s a lot more than just probiotics to try!

Learn about:

• The importance of the pancreas and digestive enzyme secretion,
• Support for improving constipation,
• And how mealtime habits can be a simple solution!

Unless you have been hiding away from all published materials you will be aware that Monash University in Australia have proposed and others have supported that for people with irritable bowel syndrome, that following a diet low in FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols content will result in symptom resolution.

Yet here at Clinical Education we have stressed that following this diet has risks of key nutrient insufficiencies and in particular those foods rich in aryl hydrocarbon receptor agonists, which are vital for gut mucosal immune balance and competence. In effect the use of a low FODMAP diet for long term health is not justified, but short term intervention may be helpful.

A paper in the American Journal of Gastroenterology looks at various markers to see if it is possible to use them to differentiate between IBS and IBD.[1]

Objectives:

Irritable bowel syndrome (IBS) is viewed as a diagnosis of exclusion by most providers. The aim of our study was to perform a systematic review and meta-analysis to evaluate the utility of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), faecal calprotectin, and faecal lactoferrin to distinguish between patients with IBS and inflammatory bowel disease (IBD) and healthy controls (HCs).

The remedies for gastrointestinal complaints are legion and stretch back far in human history. Ancient Chinese physicians prescribed anise for flatulence, while Dioscorides, chief physician for the Roman army, recommended garlic for parasites. Many are effective and stand the test of time, but contemporary scientific research on novel extracts offers up surprising new finds. The Asian plant, Perilla (Perilla frutescens) for example, offers valuable assistance in the management of functional gut problems.

A study published in the BMC Complementary and Alternative Medicine Journal identifies a number of benefits and improved function, achieved in people with IBS ( a functional loss of tolerance in the GI Tract) when consuming a 300mg daily dose of Perilla Extract.[1]

Conclusions Patients complaining of flatulence have a poor tolerance of intestinal gas, which is associated with instability of the microbial ecosystem.[1]

Significance of this study

What is already known on this subject?

• Some patients specifically complain of excessive evacuation of gas per anus.
• Intestinal gas content depends by-and-large on gas production by bacterial fermentation of unabsorbed substrates.
• Diet influences anal gas evacuation and gut microbial composition.
• A proportion of patients complaining of flatulence have increased number of gas evacuations, but the net volume of gas evacuated is within the normal range.
• Flatulence is associated with abdominal symptoms.

The use of faecal transplantation as a therapeutic tool for not only Clostridium Difficile Infection but as a mechanism for changing the composition of colonic microbiota for the purpose of resolving numerous persistent inflammatory conditions is starting to gain increased interest in the research and medical communities.

Medscape recently published a summary of many of the key areas and I have extracted and edited a small section for peoples review.

I have explored the role of appropriate transplantation in the resolution of MRSA infection that fails to resolve with antibiotic therapy, and have intimated that other conditions of the bowel and linked tissues may also benefit. The model is: that loss of mucosal tolerance underlies the pathology of inflammatory bowel disease and is also linked to irritable bowel syndrome. These altered states of function reflect a combination of environmental, genetic and emotional events that coalesce into a wide range of conditions.