The Rome IV: Irritable bowel syndrome - A functional disorder, 2019, Hellstrom and Benno

Paywall, https://www.sciencedirect.com/science/article/abs/pii/S152169181930037X
Scihub, https://sci-hub.se/10.1016/j.bpg.2019.101634

 

This is all so back to front. From experience with family members I accept that some people have bowel problems when under stress. The "fight or flight" mechanism is obviously involved but what are the implications?

The functional view is that a healthy system (no genuine bodily system disorder) is going wrong because of emotional problems.

A more likely scenario is that normal emotions are causing the body to overreact.

Now working on the thing you can reach may be useful - like changing your diet when you have coeliac disease because we have no treatment for what is wrong in the body. So dampening down emotions by psychological or pharmaceutical methods could lead to better way for patients to live with their disease. I have no problem with that.

I also have no problem with a vicious cycle of disease. Anyone who knows they will have diarrhoea as soon as they get excited will become more anxious about life so psychological medicine may help a bit.

But none of this is evidence for the body systems being normal. All it does is prevent research that would help the problem at source, the bowel.

What we are learning about microflora and our ignorance of their role in our biology should stop any scientist or doctor from claiming "medically unexplained" as an answer.

 

Another weird paper that argues more BPS would be useful because reasons. Essentially boils down to "we can't explain their problems" with some woo about gut-brain and the existence of eating disorders, therefore emotions may play some role. I'm not even sure there's actually a point being argued here. I read it all, it's pretty short, ironically while my lunch is tormenting my gut, and I cannot really find any other point than BPS exists for things we can't explain therefore BPS would be useful, as usual only a proxy term for psychosomatic.

At best I would describe this as yet another piece of useless commentary that simply sprinkles BPS woo in order to build up the evidence base for BPS, by serving as a possible citation for why more BPS could be useful. There is a bizarre note about how people with digestive pain will eat less and that's weird, because somehow avoiding touching the hot stove is abnormal when you believe it's room temperature.

 

I had IBS symptoms all my life that tipped over into gastritis in my late 40s - caused I believe in part by diet plus hypothyroidism that was not well treated by the standard Thyroxine care.

I recovered from the gastritis but ended up with chronic digestive issues caused I believe in part by long term use of PPIs. I got over that issue by weaning off the PPIs (my idea not the GP), and changing my diet and using various herbs and supplements, and kefir. That was mostly in the lower gut where I used to get the worst problems then.

As if all that wasn't enough I developed a new symptom in my upper gut following whooping cough in my mid 50s. I didn't know then, but found out later that I had a small hiatus hernia. When I finally got to see a Gastro she was very dismissive and promptly diagnosed me with non-ulcer or 'functional dypepsia'. The pain when I ate certain foods was horrible, and this went on for years as the NHS had no ideas to help, other than more PPIs or a drug that I discovered was not being used in the EU due to possible heart issues. I did my own investigations and a year ago realised that if I avoided acidic foods and even used an alkali water filter for some of my water, that I slowly improved. How can that be functional? More likely due to the Hiatus Hernia though I was told it was a small one and couldn't cause my symptoms. Today I have been able to reintroduce some fruits with care, and apart from very acidic foods, and avoiding processed foods, sugar and gluten, plus some other foods I don't care to eat, I have a much wider diet than for 10 years.

So, as you can see from my own story, most of my worst symptoms have developed because of the standard care, and most of my improvements have happened by my own hand.

I would agree that stress can worsen some of my symptoms like diarrhoea, or I sometimes get a gut spasm if I am under stress, but they are not daily problems.