Functional Syndromes

This is supplemental information for this topic marked by the little computer icon in the book, Irritable Bowel Syndrome and the MindBodySpirit Connection, by William B. Salt II, M.D. and Neil F Neimark, M.D. (Columbus: Parkview Publishing, 2002). Click here to learn more about the book and/or to purchase it.

 

Medically unexplained functional symptoms, such as abdominal pain, bowel pattern disturbances (diarrhea, constipation, or both), and widespread muscular pain and fatigue affect most people from time to time. However, when the symptoms become recurrent and chronic, many people consider themselves to be ill with them and consult with doctors. Collections of these medically unexplained symptoms are diagnosed with functional syndromes, such as irritable bowel syndrome and fibromyalgia. The medical term "functional" means that the cause of symptoms cannot be explained by currently available diagnostic studies, including blood tests, x-rays, endoscopy (esophagogastroduodenoscopy and colonoscopy), biopsy, or surgical findings. Instead, there is an altered physiological function (the way the body works)

Doctors Wayne Katon, Mark Sullivan, and Ed Walker, from the University of Washington Medical School, stress that functional medical syndromes without a clearly defined cause are responsible for a high percentage of visits to specialists (Ann Intern Med. 2001;134:917-925). Click here to read an abstract of this medical journal article. There is substantial functional impairment, distress, and costs associated with medical symptoms without identified pathology, which lead to the diagnosis of functional syndromes, such as irritable bowel syndrome and fibromyalgia.

There is considerable scientific evidence that functional symptoms and syndromes commonly overlap and that they share common causes. Examples of functional syndromes include irritable bowel syndrome, fibromyalgia, chronic fatigue syndrome, fibromyalgia, multiple chemical sensitivity, temporomandibular disorder, tension headache, interstitial cystitis, and the post concussion syndrome. You can review two medical journal references regarding this overlap and commonality.

An entire issue of an important medical journal, the Annals of Internal Medicine, has recently been devoted to medically unexplained (functional) symptoms and syndromes (Annals of Internal Medicine, 1 May 2001, volume 134, supplement number 9). Click here to read the abstracts of these issue.

You can review an important medical journal article that calls for a new approach to functional symptoms and syndromes.

 


 

Gastroenterologists

This is supplemental information for this topic marked by the little computer icon in the book, Irritable Bowel Syndrome and the MindBodySpirit Connection, by William B. Salt II, M.D. and Neil F Neimark, M.D. (Columbus: Parkview Publishing, 2002). Click here to learn more about the book and/or to purchase it.

Some gastroenterologists have a special interest in functional gastrointestinal syndromes. We recommend that you contact the International Foundation for Functional Gastrointestinal Disorders to locate such local specialists.

International Foundation for Functional Gastrointestinal Disorders (IFFGD)
Nancy Norton, President and Founder

IFFGD, PO Box 17864, Milwaukee, WI 53217
(888) 964-2001
(414) 964-1799

Click here to visit the website of the IFFGD.

 


 

Healthy Eating

This is supplemental information for this topic marked by the little computer icon in the book, Irritable Bowel Syndrome and the MindBodySpirit Connection, by William B. Salt II, M.D. and Neil F Neimark, M.D. (Columbus: Parkview Publishing, 2002). Click here to learn more about the book and/or to purchase it.

Click here to visit the American Dietetic Association website.

Click here to read Dietary Guidelines For Americans, 2000, 5th Edition, USDA

 


 

Honesty and Health

This is supplemental information for this topic marked by the little computer icon in the book, Irritable Bowel Syndrome and the MindBodySpirit Connection, by William B. Salt II, M.D. and Neil F Neimark, M.D. ((Columbus: Parkview Publishing, 2002). Click here to learn more about the book and/or to purchase it.

Elliott S. Dacher, M.D., a pioneer in the emerging medicine of the future, has developed an innovative and expanded approach to health and healing. His approach evolved from both his personal exploration of these issues and his extensive experience as a practicing internist participating in over 50,000 medical visits. Click here to learn more about Dr. Dacher and his Whole Healing System. He says this about honesty in his book, Intentional Healing (New York: Marlowe & Company, 1996): "Honesty is the cultivation of truth in our words. The yogis say it is ‘the correspondence of speech and mind to fact.’ They also suggest that to cultivate truth, one should initially ‘speak as little as possible or observe silence.’ Honesty does not mean that everything must be said. It means that we must use discrimination when we put into words information that may cause harm rather than good."

In Remarkable Recovery, by Marc Ian Barash and Caryle Hirshberg (New York: Berkley Books, 1995) the authors examined the characteristics of patients who experienced spontaneous remissions from cancer or who lived beyond the expectations of doctors. They found that the one most compelling quality of patients graced by spontaneous remissions was "congruence," which they defined as a way for patients to be "deeply true to themselves, manifesting a set of behaviors growing from the roots of their being."

 


 

IBS Differential Diagnosis

This is supplemental information for this topic marked by the little computer icon in the book, Irritable Bowel Syndrome and the MindBodySpirit Connection, by William B. Salt II, M.D. and Neil F Neimark, M.D. (Columbus: Parkview Publishing, 2002). Click here to learn more about the book and/or to purchase it.

 

It is important to realize that there are several diseases and disorders that must be distinguished from irritable bowel syndrome (IBS). The most common and important differential diagnoses for irritable bowel syndrome are listed here:

Inflammatory bowel disease (ulcerative colitis and Crohn’s disease)

Colon polyps and colon cancer

Diverticulosis

Celiac sprue

Index of celiac related sites

Kenneth Fine, MD is an expert in celiac sprue who provides educational information on his web site.

University of Maryland Center for Celiac Research

Murray Joseph A. Review article: the widening spectrum of celiac disease American Journal of Clinical Nutrition, Vol. 69, No. 3, 354-365, March 1999.

Click here to read the entire medical journal article.

Gluten-free diet

Medications affecting bowel pattern (constipating or diarrhea-causing agents)

Gastrointestinal infections

Post-infectious irritable bowel syndrome

Lactose intolerance

Lactose-free low-lactose diet

Endocrine disorders and tumors (thyroid disorders most commonly)

Microscopic colitis

Collagenous colitis

Bacterial overgrowth

Comments by

Comments by Douglas A. Drossman, M.D.

Comments by William E. Whitehead, Ph.D.

Clostridium difficile infection

Wisconsin Department of Health & Family Services

IFFGD (International Foundation for Functional Gastrointestinal Disorders)

Click here to learn more about the diagnosis of IBS.

 


 

Increasing Dietary Fiber

This is supplemental information for this topic marked by the little computer icon in the book, Irritable Bowel Syndrome and the MindBodySpirit Connection, by William B. Salt II, M.D. and Neil F Neimark, M.D. (Columbus: Parkview Publishing, 2002). Click here to learn more about the book and/or to purchase it.

 

Click here for a high fiber diet.

Click here to learn more about fiber supplements:

Calcium polycarbophil

FiberCon (brand name)

Methylcellulose

Citrucel (brand name)

Psyllium

Konsyl (brand name)

Metamucil (brand name)

 


 

Journaling

This is supplemental information for this topic marked by the little computer icon in the book, Irritable Bowel Syndrome and the MindBodySpirit Connection, by William B. Salt II, M.D. and Neil F Neimark, M.D. (Columbus: Parkview Publishing, 2002). Click here to learn more about the book and/or to purchase it.

Here are several resources for journaling:

 


 

Metabolic Syndrome X

This is supplemental information for this topic marked by the little computer icon in the book, Irritable Bowel Syndrome and the MindBodySpirit Connection, by William B. Salt II, M.D. and Neil F Neimark, M.D. (Columbus: Parkview Publishing, 2002). Click here to learn more about the book and/or to purchase it.

In 1988, Stanford’s Gerald Reaven M.D. first described a symptom cluster associated with high risk of heart disease and stroke. Many medical experts now refer to it as Metabolic Syndrome X, which is the association of:

Dr. Bruce McEwen, a stress researcher at Rockefeller University in New York, emphasizes that allostatic load and the bad stress response contribute to Metabolic Syndrome X. Click here to learn more.

Learn more about Metabolic Syndrome X:

 


 

Negative Expectancy

This is supplemental information for this topic marked by the little computer icon in the book, Irritable Bowel Syndrome and the MindBodySpirit Connection, by William B. Salt II, M.D. and Neil F Neimark, M.D. (Columbus: Parkview Publishing, 2002). Click here to learn more about the book and/or to purchase it.

 

Howard Brody, M.D. is a physician from Michigan State University who is an expert on the expectancy model, the conditioning model and the placebo/nocebo effect.

Click here to learn more about his book (with Daralyn Brody), How You Can Release the Body's Inner Pharmacy for Better Health (New York: HarperCollins, 2000). Click here to visit Dr. Brody’s web site.

 


 

New Drugs for IBS

A discussion of IBS, including treatment is available on the Internet in the Patient Resource Center at UpToDate's home page where it will be updated as needed every four months. Click here to review patient treatment information on IBS.

Click here to read an abstract from a medical journal article on management of irritable bowel syndrome by Arnold Wald, M.D.

We recommend visiting Jeffrey D. Roberts' web site, Irritable Bowel Syndrome (IBS) Self-Help Group for timely information about new drugs for IBS.

5HT (5-hydroxytryptamine) Drugs

There are 5HT (5-hydroxytryptamine) receptors of the gut, which are involved in intestinal motility (contraction) and sensation. Drugs that stimulate the 5HT4 receptor (5-HT4 agonists) are helpful with constipation predominant IBS. One such drug is currently available: Zelnorm. Drugs that block the 5-HT3 receptor can be beneficial with the diarrhea predominant form of IBS. One drug is currently available: Lotronex. New drugs that affect 5HT receptors are currently under development.