Jully 21, 2017


Abdominal Pain by Microbubble in IBS

 


 

Office Uno Column: Yoshiharu Uno, MD, PhD

 


 

1.   Questions and Answers: Abdominal Pain

 

Symptoms of IBS are related to diet.

Abdominal pain occurs in IBS.

 

So why do IBS get abdominal pain?

 

In IBS, high FODMAP increases intestinal gas and water contents. Increases in their physical factors and intestinal hypersensitivity lead to abdominal pain.

 

Then, why does abdominal pain occur in IBS - D in which the intestinal tract is not expanded?

 

In the case of IBS - D, intestinal hypersensitivity is strong so that abdominal pain occurs even if intestinal pressure is not high.

 

Why it is that abdominal pain does not occur in non-IBS even if colonic gas increases?

 

In cases without IBS, absence of intestinal hypersensitivity does not cause abdominal pain.

 

So, do IBS reduce abdominal pain with low FODMAP diet?

 

The amount of gas and the water contents are reduced.

 

If intestinal hypersensitivity exists, does not it feel abdominal pain?

 

Short chain fatty acid (SCFA) produced by high FODMAP fermentation may be related to intestinal hypersensitivity. Low FODMAP diet not only reduces gas and water but also SCFA.

 

If so, in IBS, can IBS abdominal pain disappear by a decrease in SCFA?

 
No answer


 

2.   Questions and Answers: Chest Pain in angina

 

Why causes angina pectoris chest pain?

 

In angina with intermittent hypoxia, pain inducing substances, such as PGE2, histamine and serotonin are involved.

 

 

3.   Abdominal pain in IBS and chest pain in angina pectoris

 

If IBS is concerned with intermittent hypoxia, PGE 2, histamine and serotonin will be involved.

 

So, what is the mechanism?

 

Microbubbles may be involved.

Fermentation occurs by high FODMAP, but at that point many microbubbles are produced.

Small bubbles join with the passage of time and the diameter increases.

To some extent, the volume increases as the diameter increases.

For example, like watermelon fermented by anaerobic bacteria.

 １０２

However, microbubbles do not increase in volume but have energy.

In addition, microbubbles have the ability to wash skin contamination.

Namely, microbubble might be remove the mucosal barrier and mucine barrier (biofilm) in the intestine. Its size is small like red blood cells.

Therefore, there is a possibility of entering the capillary directly.

The increase in microbubbles in fermentation can cause ischemia in the mucosa and submucosa, due to large amounts of hydrogen and carbon dioxide.



uno


This mechanism can also be applied to SIBO.


This is a hypothesis by Yoshiharu Uno and is not proven.




<Reference>

Lam C, Chaddock G, Laurea LM, Costigan C, Cox E, Hoad C, Pritchard S, Gowland P, Spiller R. Response to Uno

Am J Gastroenterol. 2017 Jul;112(7):1167.

・・・・・・・・・・・・・・・・・

Revision

333


Revision 2


４４４図1


Revision 3


555


////////////////

Jully 23, 2017


11


＜References＞

 

Journal of Neurogastroenterology and Motility 2017; 23(3): 341-348 

Targeting Histamine Receptors in Irritable Bowel Syndrome: A Critical Appraisal

 

Gut. 2017 Jul;66(7):1241-1251.

FODMAPs alter symptoms and the metabolome of patients with IBS: a randomised controlled trial.

 

J Physiol. 2011 Aug 1;589(Pt 15):3867-82.

Mast cells drive mesenteric afferent signalling during acute intestinal ischaemia.






２２図1



＜References＞

Hervé S, Beaugerie L, Bouhnik Y, et al. Irritable bowel syndrome is more frequent in patients hospitalized for ischaemic colitis: results of a case-control study. Neurogastroenterol Motil 2009;21:1170-e102.


・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・



333


////////////////

Jully 24, 2017

Revision 4


111

・・・・・・・・・・・・・

http://www.ncbi.nlm.nih.gov/pubmed/26976734


  2016 Mar 14. pii: gutjnl-2015-311339. doi: 10.1136/gutjnl-2015-311339. [Epub ahead of print]

FODMAPs alter symptoms and the metabolome of patients with IBS: a randomised controlled trial.

McIntosh K1, Reed DE2, Schneider T2, Dang F2, Keshteli AH3, De Palma G4, Madsen K3, Bercik P4, Vanner S2.

Author information

  • 1GI Diseases Research Unit, Queen's University, Kingston General Hospital, Kingston, Ontario, Canada St. Joseph's Hospital, Western University, London, Ontario, Canada.
  • 2GI Diseases Research Unit, Queen's University, Kingston General Hospital, Kingston, Ontario, Canada.
  • 3University of Alberta, Edmonton, Alberta, Canada.
  • 4Farmcombe Institute, McMaster University, Hamilton, Ontario, Canada.

Abstract

OBJECTIVE:

To gain mechanistic insights, we compared effects of low fermentable oligosaccharides, disaccharides and monosaccharides and polyols (FODMAP) and high FODMAP diets on symptoms, the metabolome and the microbiome of patients with IBS.

DESIGN:

We performed a controlled, single blind study of patients with IBS (Rome III criteria) randomised to a low (n=20) or high (n=20) FODMAPdiet for 3 weeks. Symptoms were assessed using the IBS symptom severity scoring (IBS-SSS). The metabolome was evaluated using the lactulose breath test (LBT) and metabolic profiling in urine using mass spectrometry. Stool microbiota composition was analysed by 16S rRNA gene profiling.

RESULTS:

Thirty-seven patients (19 low FODMAP; 18 high FODMAP) completed the 3-week diet. The IBS-SSS was reduced in the low FODMAPdiet group (p<0.001) but not the high FODMAP group. LBTs showed a minor decrease in H2 production in the low FODMAP compared with the highFODMAP group. Metabolic profiling of urine showed groups of patients with IBS differed significantly after the diet (p<0.01), with three metabolites (histamine, p-hydroxybenzoic acid, azelaic acid) being primarily responsible for discrimination between the two groups. Histamine, a measure of immune activation, was reduced eightfold in the low FODMAP group (p<0.05). Low FODMAP diet increased Actinobacteria richness and diversity, and high FODMAP diet decreased the relative abundance of bacteria involved in gas consumption.

CONCLUSIONS:

IBS symptoms are linked to FODMAP content and associated with alterations in the metabolome. In subsets of patients, FODMAPs modulate histamine levels and the microbiota, both of which could alter symptoms.