Inflammation: A Possible Cause
Inflammation is an immune response to injury and foreign bodies. Under normal circumstances, the immune system activates and deactivates an inflammatory response at the right times to prevent infection.
Evidence shows in cases of gastrointestinal infection, theres a greater quantity of inflammatory cells within the intestines lining. In healthy patients, inflammation dissipates over time, but in cases of post-infectious IBS, to deactivation times are slower, causing inflammatory cells to;linger around for longer.
Whether inflammation is the true cause behind post-infectious IBS still remains to be seen, but seeing as how inflammation and IBS practically go hand-and-hand, this theory does have a bit of weight.
Cdtb And Its Function In Food Poisoning
Dr. Mark Pimentel Explains:
CdtB is a toxin associated with common food poisoning bacteria like Campylobacter, Shigella, Salmonella, and E. Coli.;
CdtB enters the body through an acute infection , and diarrhea normally occurs immediately.;
Classic IBS symptoms, like bloating, abdominal pain, and chronic diarrhea, may develop after one month.
Epithelial Permeability And Post
The interphase between the gut and the lumen is a sophisticated barrier that keeps the luminal microbes, incompletely digested proteins, and pathogens at bay, while allowing the nutrients to pass through. However, this barrier is vulnerable to adverse stimuli from the lumen as well as from biological/pathological events within the gut wall. An increase in luminal pathogenic load impairs the barrier. The subsequent access of the microbes or their products to the sterile structures in the gut wall initiates an immune response, whose intensity, and profile depend upon the volume and phenotypes of pathogens. To make things worse, the inflammatory mediators might further erode the barrier , setting up a vicious cycle until the anti-inflammatory mechanisms achieve a dynamic equilibrium. Biological events, such as psychological stress, operate from within the gut wall. These events activate resident immunocytes, such as mast cells, whose products impair the barrier to cause influx of luminal pathogens, which might enhance barrier dysfunction until a dynamic equilibrium is achieved. Fortunately, the adverse effects of mucosal inflammatory response are sub-clinical within a wide range of this dynamic equilibrium.
Intestinal inflammation and a systemic response to antigens can develop in the absence of disruption to intestinal permeability .
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How Do I Know If Im At Risk For Post
Anyone can develop post-infectious IBS. According to the CDC, 48 million people get food poisoning every year in America. According to a review conducted at the Mayo Clinic of over 40 research studies, 11% will develop IBS. Thats about 5 million people that will develop post-infectious IBS this year in America alone. This makes food poisoning the leading known cause of IBS.
Patients with post-infectious IBS are four times more likely to contract food poisoning again. Additionally, if you do get food poisoning again, it can significantly worsen the symptoms of your post-infectious IBS. ;
Post-infectious IBS presents itself as IBS-D or IBS-M. Therefore, you might have post-infectious IBS if:
You have chronic diarrhea, travelers diarrhea, or mixed diarrhea and constipation symptoms.
You have abdominal pain and bloating.
You have no other serious symptoms like blood in your stool.;
You have had food poisoning at some point in the past.
Biopsy Supernatants From Pi
As no evidence of low grade inflammation or altered cytokine levels were detected, the potential involvement of mast cell mediators was studied. Recently we reported histamine-mediated sensitization of TRPV1 by IBS supernatants, an effect mediated by activation of histamine 1 receptor . To determine if a similar mechanism is present in PI-IBS, we examined the effect of incubating DRG neurons with PI-IBS supernatants, in the presence of the selective Hrh1 antagonist pyrilamine , or in DRGs from Hrh1 knock-out mice. Pyrilamine normalized the sensitized Ca2+ response to capsaicin in DRGs incubated with PI-IBS biopsy supernatants , and PI-IBS supernatants were not able to potentiate the capsaicin response in DRGs collected from Hrh1 knock-out mice . These data suggest that PI-IBS supernatants contain bioactive compounds, most likely histamine or histamine metabolites that sensitize TRPV1 via Hrh1 activation.
To confirm that histamine sensitizes TRPV1, DRGs were incubated overnight with HVs supernatant supplemented with 10µM histamine which resulted in an increased Ca2+ response, an effect that was prevented by pyrilamine and absent in Hrh1 knock-out mice . Moreover, as previously reported, incubation of HV submucosal neurons with histamine significantly increased the Ca2+ response to capsaicin, confirming that histamine also sensitizes TRPV1 in humans. Our data indicate that the supernatant of PI-IBS sensitizes TRPV1 via a Hrh1 mediated mechanism.
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Severity Of Bacterial Infection
Not only can the presence of a certain type of bacteria lead to post-infectious IBS, but how long and how hard you suffer from the bacterial attack may also increase the chance of developing it later on. An estimated;10% of such patients will develop the condition at some point during the infection period. The ability to produce toxins like Shiga-like toxin-produce E. Coli .
Different Factors That Aggravate Ibs
Some researchers find that;psychological factors seem to;trigger;the flare-ups and regulate the severity of the IBS, response to medical treatment, and persistence of the syndrome.
In fact, there are 23 unique psychological factors that are;might be associated with IBS symptoms. The most common factors are:
Let’s take a quick look at each one of these.
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Epigenetic Dysregulation And Pi
Early life psychological trauma/stress is a known risk factor for the development of IBS in adulthood . Gut inflammation is another major early life stressful condition . The annual episodes of diarrhea in U.S. children less than 5-year-old ranges from 20 to 35 million . These diarrheal episodes lead to about 22,000 hospitalizations per year, indicating the severity of enteritis. The epigenetic programming of genes begins at the start of fetal development and continues in early life. During these periods, epigenetic mechanisms program the genes for normal health in adulthood. However, in the face of stressful conditions, they reprogram the genes for immediate survival. Unfortunately, the reprogramming of genes might persist in adulthood, resulting in aberrant rates of gene expressions to cause organ dysfunction.
Four mechanisms constitute epigenetic regulation of gene transcription transcription factors, DNA methylation, histone codes , and micro RNAs . The post-translational modification of histone proteins alters the interaction between DNA and chromatin, which regulates the access of transcription factors to their recognition sequences to initiate gene transcription. Epigenetic programming/reprogramming is gene, stimulus and cell-type specific. Unlike mutations/polymorphisms, the epigenetic programming is dynamic it responds to environmental stimuli throughout life, especially during vulnerable stages of fetal and neonatal developments.
What Doctors Know About Post
At this point, no one knows how many people who get COVID-19 will end up with persistent health problems. Reynold Panettieri, MD, professor of medicine at the Rutgers Robert Wood Johnson Medical School in New Jersey, estimates that about 10% of COVID-19 patients will develop a chronic issue. “It’s a minority of patients, but we’re still talking about hundreds of thousands of people,” he tells Health.
Some were extremely sick or had an underlying condition like diabetes or obesity before getting COVID-19, but not everyone. “I’ve seen trained athletes who are experiencing profound fatigue and exhaustion with exercise,” he says. “We don’t fully understand why. They’ve been devastated.” Persistent physical challenges often go hand-in-hand with emotional stress, Dr. Panettieri adds. “Post-illness, people can become depressed, and the isolation and social distancing doesn’t help that,” he says.
The good news is that many long-haulers will not have COVID-related problems for the rest of their lives. “Every patient is a snowflake, but in aggregate most people who have this syndrome appear to be improving,” says Panettieri, who adds that many of his patients who were very ill have been able to return to their normal level of functioning within three or four months.
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Can Ibs Last For Weeks Can Ibs Last For Months
It is not uncommon for IBS symptoms to last for days, but some IBS sufferers report their attacks lasting for weeks.
Other IBS sufferers have had symptoms last for months due to bacterial infections, called post-infective IBS. Side effects can linger long after the bacterial infection and inflammation have subsided.
Real Women Real Symptoms
Berrent, the Survivor Corps founder, is among those who felt fine for a while yet are now dealing with mysterious ailments. She says she has recently developed middle ear pain, headaches, nausea, and blurry vision. “As a photographer for the past 12 years, I’m keenly aware of my eyesight,” she says. “I went to my son’s lacrosse game and could not figure out which player he was.”
Ruby Engel, a Westchester, New York resident who has spent the last few months in Colorado visiting Keith’s clinic, had an extremely mild case of COVID-19 in March. “Ninety-nine percent of my colds are worse,” she tells Health. Since then, however, she’s had bouts of breathlessness, palpitations, and chest pain. She was recently diagnosed with cardiomyopathy .
Engel has also experienced flare-ups of asthma and reflux, ailments she had pre-COVID but were well under control. “It’s almost like this virus reactivated previous health problems,” she says.
That’s completely possible, believes Dr. Keith: “Say you had a chronic cough for years related to nasal drainage or reflux and it was controlled. If COVID exacerbated your upper airway sensitivity, we may need to go back and treat those underlying problems again. We have to step back and look at the whole patient.”
From a research perspective, “the trick will be to tease out which are ongoing health issues that could have been exacerbated by any viral illness from those that are related to COVID itself,” she explains. Either way, patients need help.
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Persistent Diarrhea In Returned Travelers
Although most cases of travelers diarrhea are acute and self-limited, a certain percentage of travelers will develop persistent gastrointestinal symptoms . The pathogenesis of persistent diarrhea in returned travelers generally falls into one of the following broad categories: 1) ongoing infection or coinfection with a second organism not targeted by initial therapy, 2) previously undiagnosed gastrointestinal disease unmasked by the enteric infection, or 3) a postinfectious phenomenon.
How Long Can Post
Heres a scenario that may sound familiar.; You go out to eat, and you eat some meat that maybe looked a little undercooked or some bad shellfish.; You get home, and six hours later youre throwing up in the bathroom.; Maybe someone else you know who had the same food gets sick as well.; But whereas youre used to recovering from food poisoning within a couple of days, a week later, you still feel pretty sick.; A month later, you still dont feel good.; Youve stopped vomiting, but you still feel queasy or nauseous every day, have cramps in your abdomen, and difficulty with your digestive cycle.; You look at food and you dont want it.; You go to the doctor and your tests come up clear.; Apparently youre not even sick anymore.; Whats going on and when will it go away?
This describes a situation where you may have post-infectious irritable bowel syndrome .; While IBS is poorly understood, this is what happens when you get a sickness, get over it, but still have echoes of your original sickness for an extended time period which follows.; You may still think youre sick, but if you have post-infectious IBS, youre not.; Your body has beaten the illness, but its left a long shadow following behind it.; Of course, its important to make sure that nothing else is wrong, but for most people this is the most likely explanation when there is an identifiable infection and your tests for pathogens come up clear.
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Ca2+ Imaging Of Murine Dorsal Root Ganglia Neurons
Lumbosacral DRG neurons from 3 to 4 adult wild type or Hrh1 knock-out mice were bilaterally excised under a dissection microscope, digested and cultured in complete medium on poly-D-lysine/laminin-coated glass coverslips as previously described. Supernatants derived from either HVs or PI-IBS patients, combined or not with 10µM histamine and/or 1µM Hrh1 antagonist pyrilamine , was added overnight. Cultured DRG neurons were subsequently loaded with 2µM Fura-2AM for 20minutes at 37°C.
Intracellular Ca2+ concentration was measured and quantified as previously described,. Neurons were identified by a Krebsbased solution in which the KCl concentration was increased to 45mM by iso-osmotic substitution of NaCl. The baseline was monitored for 120s and the chamber was thereafter perfused with 10nM capsaicin . TRPV1 positive DRG neurons were identified by a high dose of capsaicin .
Enterochromaffin Cell Hyperplasia And Motility Dysfunction In Pi
The findings of EC cell hyperplasia in the mucosa of PI-IBS/NI-IBS patients are divergent some found a significant, but modest, increase others did not . The hyperplasia of a cell type does not necessarily mean that it will release more of its contents, which depends on complex cell signaling and microenvironment this is one of the reasons that immunohistochemical staining alone is insufficient to establish a cause and effect relationship. EC cell hyperplasia, if it is present, does not translate into an increase in the release of 5-HT in the mucosa of IBS patients . Paradoxically, the mucosal serotonin decreases in IBS patients even though the plasma serotonin increases . The source of increase plasma serotonin is unknown and there is no evidence that it has a significant effect on colonic motility or VHS. The serotonin transporter mRNA expression also does not change in IBS patients . Recent studies show that the mucosal release of 5-HT is not required to stimulate GMCs in response to distention in the guinea pig and mouse colons . Overall, the available evidence weighs heavily against a potential role of EC cell hyperplasia in causing motility dysfunction or VHS in PI-IBS or NI-IBS patients.
Additional evidence that speaks against a potential role of EC cell hyperplasia as a causative factor for motility dysfunction or VHS in IBS patients is:
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Whatsymptoms To Watch For
Post-infectious IBS is a constellation of symptoms that resemble irritable bowel syndrome, Dr. Kirsh says.
Symptoms are usually lesssevere than the original infection and may include:
- Abdominal cramping.
- In some cases, constipation.
Overtime people do tend to get better, he says. For most of them, this is notgoing to be lifelong IBS.
The symptoms of post-infectious IBS develop after an infectious GI bug such as viral gastroenteritis or a bacterial infection like E. coli or Salmonella or even C. difficile. Patients may suspect this condition if they had a documented GI infection that resolved, but their digestive function wont go back to normal. That should tip them off that they should seek out help.
Clinical Presentations Of Ibs Following Enteric Infection: Altered Intestinal Motility And Hypersensitivity
Abnormal bowel habits and abdominal hypersensitivity, or reduced threshold of pain, are the hallmark clinical signs of IBS. The classification of IBS as a functional disorder stems from a lack of determinant histopathological, or structural biomarkers in afflicted patients. The Rome criteria requires the incidence of abdominal pain, accompanied by alterations in bowel habit for complete IBS diagnosis.
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Lessons Learnt From Post
- 1 Enteric Neuromuscular Disorders and Visceral Pain Center, Division of Gastroenterology, Department of Internal Medicine, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
- 2 Department of Neuroscience and Cell Biology, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
IBS is a complex disorder its origins are unknown and the conventional diagnostic approaches are unable to identify an organic cause. The absence of an identifiable abnormality frustrates physicians they cannot respond satisfactorily to provide relief of symptoms; it frustrates patients they see no end to morbidity the disorder carries; it frustrates pharmaceutical companies their attempts to develop therapeutic agents have repeatedly fallen short; it frustrates scientists they are unable to pinpoint the cellular and system wide mechanisms of organ dysfunction. Is it possible that an open-minded look at post-infectious IBS will give a new sense of direction that would move us forward in managing a disorder that causes significant morbidity and carries huge socio-economic burden?
How Common Is Pi
Between 617% of individuals with IBS who had a previously normal bowel habit believe their illness began suddenly in association with an infectious illness. Although estimates vary, studies suggest that around 10% of people who suffer bacterial gastroenteritis develop IBS.
Most cases reported are of the diarrhea predominant or mixed subtype of IBS. Fewer cases are reported in the constipation predominant subtype of IBS.
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How Does Irritable Bowel Syndrome Start How Long It Last
IBS , also called as spastic colon is a collection of symptoms such as constipation, diarrhea, gas, bloating, abdominal discomfort & pain, and cramping. Though many experts say that it is less severe than other serious digestive diseases but it can be a very frustrating condition. How does it start and how long it last?
In general, spastic colon is not categorized into serious health condition. Even there is no specific test to help doctor diagnose it. It also doesnt cause other serious health conditions, such as permanent damage to the bowel or colon cancer. But it takes attention since it can be very bothersome.
How does IBS start What are the risk factors?
Unfortunately, experts still dont have a clearly answer for the exact cause of this digestive problem. In other words, it is still not clear yet why it occurs.
In a few cases of this syndrome, it occurs after certain infection affecting the intestines. In such case, this is also called as post-infectious IBS.
It seems there are a number of reasons that can lead to the development of ;irritable bowel syndrome.
Studies have confirmed that there is a link between the gut /intestines and the brain. Probably, there is the wrong way of message from the brain sent to the intestines. This malfunction message may affect the way of the bowel to work.
How long does irritable bowel syndrome last?