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Irritable Bowel Syndrome

What is Irritable Bowel Syndrome:

  Irritable bowel syndrome (IBS) or spastic colon is a symptom-based diagnosis that affects colon (large intestine). It is characterized by chronic abdominal pain, discomfort, bloating, and alteration of bowel habits. Diarrhea or constipation may predominate, or they may alternate.

It’s a functional  gastrointestinal disorder, IBS has no known organic cause.


What happens In IBS:

The most common theory is that IBS is a disorder of the interaction between the brain and the gastrointestinal tract. While the cause of IBS is unknown, a disruption of the brain-gut axis and small intestinal bacterial overgrowth are thought to be important factors

Classification:
IBS can be classified as –
Ø  Diarrhea-predominant (IBS-D)
Ø  Constipation-predominant (IBS-C)
Ø  With alternating stool pattern (IBS-A)
Ø  Pain-predominant.
Ø  Postinfectious IBS (IBS-PI).(In some individuals, IBS may have an acute onset and develop after an infectious illness : fever, vomiting, diarrhea, or positive stool culture).

Symptoms & Signs:
Ø  Abdominal Pain and Discomfort .Pain usually comes and goes. The length of each bout of pain can vary greatly. The pain often eases when you pass stools (faeces) or wind. Many people with IBS describe the pain as a spasm or colic.
Ø  Bloating and distention of abdomen.( Flatulence)
Ø  Changes in stools:
Some people have bouts of diarrhoea, and some have bouts of constipation.Sometimes the stools become small and pellet-like. Sometimes the stools become watery or more loose. At times, mucus may be mixed with the stools.
Ø  There may also be urgency for bowel movements, a feeling of incomplete evacuation( tenesmus)
Ø  Associated complaints :People with IBS, more commonly than others, have gastroesophageal reflux, symptoms relating to the genitourinary system, chronic fatigue syndrome, fibromyalgia, headache, backache
Ø  A strong association with psychiatric symptoms such as depression and anxiety. About a third of men and women who have IBS also report sexual dysfunction typically in the form of a reduction in libido.

What causes IBS:
                While the cause is unknown, there are frequent risk factors viz:
Ø  Post infection- after acute gastrointestinal infection, esp. a possible unrecognized protozoal infection such as blastocystosis as a cause of IBS.
Ø  Young age
Ø  Prolonged fever
Ø  Psychological factors like Anxiety and Depression- The stress response in the body involves the HPA axis and the sympathetic nervous system, both of which have been shown to operate abnormally in IBS patients.
Ø  Antibiotic usage
Ø  Genetic influence– This factor does not follow classic Mendelian but is of the complex/multifactorial variety. 286 genes have been identified that are variably expressed in IBS-D patients
Ø  Other theories: consumption of spicy food, changes in serotonin metabolism.

Changes in the Gut:
There is evidence that abnormalities occur in the gut flora of individuals who suffer from IBS such a loss of diversity with a decrease in Bacteroidetes. The changes in gut flora are most profound in individuals who have diarrhoea predominant IBS. Antibodies against common components (namely flagellin) of the commensal gut flora are a common occurrence in IBS affected individuals. Chronic low-grade inflammation commonly occurs in IBS affected individuals with abnormalities found including increased enterochromaffin cells, intraepithelial lymphocytes, and mast cells resulting in chronic immune mediated inflammation of the gut mucosa

Irritable Bowel Syndrome

Diagnosis:
No specific laboratory or imaging test can be performed to diagnose irritable bowel syndrome. Diagnosis involves excluding conditions that produce IBS-like symptoms, and then following a procedure to categorize the patient’s symptoms. Ruling out parasitic infections, lactose intolerance, small intestinal bacterial overgrowth, and celiac disease is recommended for all patients before a diagnosis of irritable bowel syndrome is made.  The Investigations performed are mentioned below:
Ø  Stool microscopy and culture (to exclude infectious conditions)
Ø  Blood tests: Full blood examination, liver function tests, erythrocyte sedimentation rate.
Ø  Serological testing for coeliac disease
Ø  Abdominal ultrasound (to exclude gallstones and other biliary tract diseases)
Ø  Endoscopy and biopsies (to exclude peptic ulcer disease, coeliac disease, inflammatory bowel disease, and malignancies)
Ø  Hydrogen breath testing (to exclude fructose and lactose malabsorption)

Management:
A number of treatments have been found to be effective including: fiber, talk therapy antispasmodic and antidepressant medication, and peppermint oil.
Ø  Diet: Some people with IBS have food intolerances. A low FODMAP diet has been shown to reduce symptoms in functional gastrointestinal disorders (such as IBS) by 60-80%. This diet restricts various carbohydrates which are poorly absorbed in the small intestine, as well as fructose( for fructose intolerance) and lactose( for  lactose intolerance).
Ø  FODMAPs diet: A diet restricted in fermentable oligo- di- and monosaccharides and polyols (FODMAPs) now has an evidence base sufficiently strong to recommend its widespread application in conditions such as IBS and IBD.
Ø  Fiber: Some evidence suggests soluble fiber supplementation (e.g., psyllium/ispagula husk) is effective. It acts as a bulking agent, and for many IBS-D patients, allows for a more consistent stool. However, insoluble fiber (e.g., bran) has not been found to be effective for IBS.
Ø  Probiotics.
Medication:
·         Antidiarrheals (e.g., opiate, opioid, or opioid analogs such as loperamide, codeine, diphenoxylate) in IBS-D.
·         Medications may consist of stool softeners and laxatives in IBS-C.( osmotic laxatives such as polyethylene glycol, sorbitol, and lactulose can help avoid “cathartic colon” which has been associated with stimulant laxatives.)
·         Serotonin antagonists such as ondansetron are effective in postinfectious IBS and diarrhoea-dominant IBS due to their blockade of serotonin on 5HT3 receptors in the gut
·         Atypical antipsychotic medications, such as clozapine and olanzapine,
·         Selective serotonin reuptake inhibitor antidepressants
·         Antispasmodics: The use of antispasmodic drugs (e.g., anticholinergics such as hyoscyamine or dicyclomine) may help patients, especially those with cramps or diarrhea
·         Seratonin Agonists(Tegaserod (Zelnorm)).
·         Rifaximin can be used as an effective treatment for abdominal bloating and flatulence
·         Domperidone, a dopamine receptor blocker and a parasympathomimetic
Psychological therapies:

The mind-body or brain-gut interactions has been proposed for IBS, and is gaining increasing research attention. Hypnosis can improve mental well-being, and cognitive behavioural therapy can provide psychological coping strategies for dealing with distressing symptoms
Stress relief:
Reducing stress may reduce the frequency and severity of IBS symptoms. Techniques that may be helpful include:
    • Relaxation techniques such as meditation
    • Physical activities such as yoga or tai chi
    • Regular exercise such as swimming, walking, or running

The following case describes a young 22 year old female, a student diagnosed with IBS, who was unable to get relief elsewhere.
Get yourself treated by Dr Rashmi Chandwani

     

    Successful Treatment Of Interstitial Lung Disease By Homoeopathy

     

    The totality of the patient guided towards the selection of Arsenicum Album.  She was prescribed Arsenicum Album on 8/1/2013.

    15/1/13- Patient reported improvement generally. Her cough, breathlessness and weakness were better. Appetite improved. Cough < lying on right side. Same medicine continued.


    1/2/13- cough better but troubles off and on. Same medicine continued.

    5/3/13- Patient was much better with arsenicum album.

    4/4/13 – The complaints recurred off and on. The case was reanalysed and patient was advised deep breathing exercises. Sulphur was given as recurring and relapsing nature of complaints was there.

    5/5/13- Patient felt much better this time. This time she felt as if she is free from illness, her strength returned. She was leading normal life after many years and was regularly doing deep breathing exercises. Same medicine continued.

    20/5/13- Patient developed paroxysmal sneezing, watery nasal discharge, headache, sore throat after eating sour mango seeds. Patient was fond of mangoes. She was prescribed Aconite. Sulphur was given as SOS for cough.

    25/5/13- Patient recovered nicely and didn’t need sulphur. She felt better again.
    Patient continued homoeopathic treatment for another 6 months and came to clinic every month for check-up. She had occasional knee pain and right shoulder pain for which Rhus tox or Bryonia were prescribed off and on.

    5/1/14- Patient came with severe cough and breathlessness after exposure to cold draft of wind while she was attending a wedding. She was prescribed Sulphur 30.

    10/1/14- Not much improvement. She required nebulisation with Asthelin. Sulphur 200 was prescribed. ( As sulphur 30 gave her lasting relief earlier, hence it was given in higher potency this time).

    13/1/14- General condition much better. Cough was much better.

                    Patient is reviewed every month for chest examination and general check-up. She is doing well and improvement is lasting with occasional sneezing and sore throat and knee pain.

    The case again reinforces that the patient should be treated holistically and not merely based on diagnosis. 

    The seemingly resistant and incurable ILD is cured with mild homoeopathic treatment where the aggressive multiplex of antibiotics and other medications failed. The homoeopathic concept of disease being nothing but a disturbance in the vital force individual to the sick person is true to the best and hence can only be corrected when the derangement of the vital force ( life energy) is rectified by homoeopathic patient specific medicine.
    Reports attached below.

    Successful Treatment Of Interstitial Lung disase By Homoeopathy

    To treat your disease contact Dr Rashmi Chandwani.

     


    CASE STUDY OF INTERSTITIAL LUNG DISEASE AND TUBERCULOSIS

    The following is the case narration of an elderly female who consulted for sever cough and breathlessness was diagnosed as Interstitial Lung Disease on HRCT.

    A 65 year old female, consulted for  treatment of her Interstitial Lung Disease, after taking endless allopathic treatment for her illness.
    The patient visited on 8th January 2013, complained of severe breathlessness, cough , great weakness and loss of appetite since last 4 months. The breathlessness was so severe that walking a few steps caused shortness of breath, oppression of chest and the patient was compelled to rest.

            The illness dates back to 1992, when the patient suffered from Bilateral Pulmonary Koch’s ( Tuberculosis), for which she took 7 months of Anti-Tubercular Treatment ( ATT, with or without Pyrazinamide). The tuberculosis was treated adequately with aggressive allopathic medicinal regime, but the patient never recovered completely. She had episode of POST TUBERCULAR ACUTE EXACERBATION?? BRONCHIECTASIS(??) in 1996. The patient was again treated with strong antibiotics. She was not investigated and the attack recurred in 1999. 
    homeopathic treatment of tuberculosis


    This time the attack was so severe, the patient was miserable from cough, breathlessness. She was treated with antibiotics and bronchodilators. She also suffered from Allergic rhinitis in the past.

            Although the acute attack subsided, but the patient developed a tendency for recurrent coughs and colds since last 12 years.  No significant family history.

            The patient consulted a leading Pulmonologist, on 17/11/2011. The doctor advised Chest X-ray. The X-ray showed Tuberculosis. There was infiltration/ fibrosis and calcification in both upper and mid zones. The doctor further advised High Resolution CT scan on 18/11/2011.  The HRCT confirmed the diagnosis of post tubercular sequel with patchy areas of “ GROUND GLASS” appearance in lungs, likely overlying Interstitial Lung Disease. She was diagnosed with ILD with Post Tubercular Bronchiectasis, and prescribed the following treatment regimen for 10 days:
    ·         Tab Mucinac 600mg/ BD ( antibiotic)
    ·         Tab. Gudcef-CV 200 mg/BD ( antibiotic)
    ·         Tab ZI/ Azibact 500mg/ before lunch
    ·         Syrup Asthakind / TDS ( bronchodilator)
    ·         Capsule Flora B.C./ BD
    ·         Tab Telekast 10 mg/ post dinner.

    This treatment was continued for a month with additions of Syrup Lupituss for the relentless cough and capsule Corcium plus for calcium supplement.

    The patient was not at all relieved by the above treatment, rather she was driven out of her mind by consumption of a maze of tablets capsules and syrups. The sweet elderly was so bewildered by this multiplex of tablets that she had little appetite for the food that will nourish her health. In this situation she came to the refuge of mild and soothing homoeopathic treatment.

    The patient was in great trouble due to her tormenting cough, with expectoration, severe breathlessness, aggravation on right side. The thermal reaction was chilly (2+), her appetite was normal but she was unable to eat because of plethora of medications. She had thirst but used to consume warm water only for precaution. She complained of great weakness. Stools and urine were normal. She desired sweets(2+), mangoes(3+), sweet porridge, warm food and drinks, although she was not able to eat because of side effects of allopathic medicines and antibiotics.

    The patient was a very amiable and sweet natured woman, friendly, pleasant, good listener. She was a gracious and genial lady who liked to help others. Her entire life was dedicated to help others. She was always helpful and tried her level best to be conducive to her family. She worked hard at home and help her daughter-in-law, used to cook and clean house for the family. She served and cared so much for her ill husband, who survived 5-7 yrs after kidney transplant operation. She struggled very hard for him. Her husband died in 2003. There after she devoted herself to her kids, worked very hard. She had been a very diligent and laborious woman throughout her life. Presently she was unhappy about her daughter as she was not settled yet.

     To Know About The Detailed Homeopathic Treatment of the patient- Click Here

    To Know All About Interstitial Lung Disease Visit- What is Interstitial Lung Disease


    What is Interstitial Lung Disease

    INTERSTITIAL LUNG DISEASE

     What is Insterstitial Lung Disease?

     Interstitial lung disease (ILD), also known as diffuse parenchymal lung disease (DPLD), refers to a group of lung diseases affecting the interstitium (the tissue and space around the air sacs of the lungs), that inflame or scar the lungs. It concerns alveolar epithelium, pulmonary capillary endothelium, basement membrane, perivascular and perilymphatic tissues.

     Prolonged ILD may result in pulmonary fibrosis which make it hard to get enough oxygen. The term Idiopathic pulmonary fibrosis is used to describe interstitial lung disease for which no obvious cause can be identified , and is associated with typical radiographic (basal and pleural based fibrosis with honeycombing) and pathologic (temporally and spatially heterogeneous fibrosis, histopathologic honeycombing and fibroblastic foci) findings.

    What is Interstitium?

    The interstitium is a lace-like network of tissue that extends throughout both lungs. The interstitium provides support to the lungs’ microscopic air sacs (alveoli). Tiny blood vessels travel through the interstitium, allowing gas exchange between blood and the air in the lungs. Normally, the interstitium is so thin it can’t be seen on chest X-rays or CT scans.

    THEALVEOLI

    What causes ILD?

    Classification of ILD according to causes:
    1 Inhaled substances
    ·         Inorganic:
    v  Silicosis
    v  Asbestosis
    v  Berylliosis
    ·         Organic:
    v  Hypersensitivity pneumonitis
    2 Drug induced
    ·         Antibiotics
    ·         Chemotherapeutic drugs
    ·         Antiarrhythmic agents
    ·         Statins
    3 Connective tissue disease
    ·         Systemic sclerosis
    ·         Polymyositis
    ·         Dermatomyositis
    ·         Systemic lupus erythematosus
    ·         Rheumatoid arthritis
    4 Infection
    ·         Atypical pneumonia
    ·         Pneumocystis pneumonia (PCP)
    ·         Tuberculosis
    ·         Chlamydia trachomatis
    ·         Respiratory Syncytial Virus
    ·         Interstitial Pneumonia: Bacteria, viruses, or fungi may infect the interstitium of the lung. A bacterium called Mycoplasma pneumonia is the most common cause.

    5 Idiopathic
    ·         Sarcoidosis
    ·         Idiopathic pulmonary fibrosis
    ·         Hamman-Rich syndrome

    ·         Antisynthetase syndrome
    6 Malignancy
    ·         Lymphangitic carcinomatosis

    Diagnosis of ILD:
    pneumocystis pneumonia treatment by homoeopathy

    Patients with pneumocystis pneumonia can present with ILD, as seen in the reticular markings on this AP chest x-ray.

    Investigation is customized towards the symptoms and signs. People with interstitial lung disease usually come to see a doctor due to concern about shortness of breath or cough.  A proper and detailed history looking for the occupational exposure, and for signs of conditions listed above is the first and probably the most important part of the workup in patients with interstitial lung disease.

    Pulmonary function tests :

    These usually show a restrictive defectwith decreased diffusion capacity (DLCO) .
    X-rays
    v  Chest radiography is usually the first test to detect interstitial lung diseases, but the chest radiograph can be normal in up to 10% of patients.
    v  High resolution CT of the chest is the preferred modality
    v  Radiologic appearance alone however is not adequate and should be interpreted in the clinical context, keeping in mind the temporal profile of the disease process.

    Interstitial lung diseases can be classified according to radiologic patterns

    Pattern of opacities

    ·         Consolidation
    ·         Linear or reticular opacities
    ·         Small nodules
    ·         Cystic airspaces

    ·         Ground glass opacities
    ·         Thickened alveolar septa
    Associated findings:
    ·         Pleural effusion or thickening
    ·         Lymphadenopathy
    Lung Biopsy:
    A lung biopsy is required if the clinical history and imaging are not clearly suggestive of a specific diagnosis or malignancy cannot otherwise be ruled out. A surgical lung biopsy is often required.

    Treatment:
    ILD is not a single disease, but encompasses many different pathological processes. Hence treatment is different for each disease.

    v  If a specific occupational exposure cause is found, the person should avoid that environment. If a drug cause is suspected, that drug should be discontinued.

    v  Many cases due to unknown or connective tissue-based causes are treated with corticosteroids, such as prednisolone. Some people respond to immunosuppressant treatment
    .
    v  Esbriet (pirfenidone) and Ofev (nintedanib): These drugs are FDA-approved to treat idiopathic pulmonary fibrosis. They act on multiple pathways that may be involved in the scarring of lung tissue. Studies show both medications slow decline in patients when measured by breathing tests.

    v  Patients with hypoxemia may be given supplemental oxygen.

    v  Pulmonary rehabilitation appears to be useful.

    v   Lung transplantation is an option if the ILD progresses despite therapy in appropriately selected patients with no other contraindications.

    To study a case study regarding the successful treatment of ILD by homoeopathy, CLICK HERE

    FIGHT YOUR DISEASE BY CONSULTING Dr Rashmi Chandwani