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Flashcards in IBS Deck (39)
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1
Q

Rome II definition of IBS?

A

IBS can be diagnosed based on at least 12 wks of the preceding 12 mos if there was abd pain or discomfort that had 2 out of 3 features:
relieved w/defecation and/or onset assoc w/change in frequency of stool and/or onset assoc w/change in form of stool

2
Q

sxs that cumulatively support dx of IBS?

A

abn stool frequency (more than 3 per d or less than 3 per wk)
abn stool form
abn stool passage
bloating or feeling of abd distention

3
Q

5 common misdiagnoses of IBS which could also lead to IBS?

A

Food allergy/intolerance
ileocecal valve syndrome
parasitic infxn (emotions and sympathetic dominance)
deficiency of secretions: hypochlorhydria, pancreatic insufficiency, BB enzyme deficiency
overgrowth of commensals (SIBO)

4
Q

6 txs for c. diff infxn?

A

saccharomyces boulardii: 3-6 B TID x 14 d
nutritional or brewer’s yeast: 1 tsp BID x 14 d
cinnamon: 1000-1500 mg/d
metronidazole: 500 mg orally every 6-8 hrs for 10-14 d or alternatively 250 mg every 6 hrs for 10-14 d
vancomycin: 125-500 mg orally every 6 hrs for 10-14 d ($$$)
fecal microbiota transplantation x 5 d

5
Q

5 txs for giardia lamblia infxn?

A

probiotics (L. casei)
garlic or allicin
pippali rasayana (butea monosperma) and piper longum: 1 gm TID x 15 d
berberine containing herbs
metronidazole: 250 mg orally every 8 hrs for 7 d depending on nature and severity of infxn

6
Q

diet suggestions for someone with giardia infxn? what to avoid specifically?

A

whole-food based, high-fiber diet low in fat, lactose and refined sugars
additionally add probiotics and wheat germ
avoid vit A supplementation during infxn
beet diet?

7
Q

2 txs for crypto in the immunocompetent pt?

A

chyawanprash (Ayurvedic herbal combo; base of ghee, may or may not contain silver, honey or sugar, purported to raise SIgA levels): 1/2 tsp BID for 30-60 d
crypto 30X nosode: 15 ggts TID for 1 mo or more

8
Q

7 tx options for treating blastocystis hominis?

A

broad spectrum antiparasitic formula: 2 TID ic on alternating wks for 10 wks
B. hominus 30X nosode: 15 gtts TID x 10 wks
collodial silver
jackass bitters combo (?)
oregano oil
probiotic
metronidazole (250-750 mg TID x 7 d) or tinidazole or bactrim or iodoquinol (650 mg orally 3x’s/d x 20 d

9
Q

3 tx options for treating dientamoeba fragilis, e. histolytica?

A

garlic
broad spectrum antiparasitic: 2 TID ic on alternate wks x 10 wks plus E. histolytica 30X or D. fragilis 30X: 15 gtts TID x 60 d
metronidazole for 10 d followed by iodoquinol for 20 d

10
Q

4 tx options for ascaris lumbricoides?

A

carica papaya: 20 mL of seed blended in honey
1% solution of Artemesia santonica daily for 40 d
chenopodium ambrosiodies (Peruvian herb)
mebendazole: adults and children PO 100 mg tablet AM and PM on 3 consecutive days

11
Q

if SIBO is present what 6 tx options should you consider? 4 diet options, 2 supplements

A

specific carb diet
SIBO specific foodguide (SCD/ low FODMAPS)
elemental diet
water fast x 2-3 wks
lactobacillus casei 6.5 B ac qd x 6 wks
enteric coated peppermint oil: 25 mg TID x 2-4 wks

12
Q

what does the SCD eliminate? what does it allow? how quickly can you see improvement in sxs after beginning SCD?

A
eliminates grains and starches, starchy veggies, some beans, oligosaccharides (polysaccharides) 
allows monosaccharides (honey), meat, fat, non-starchy veggies, ripe fruit, nuts/seeds, some beans, lactose-free dairy
can see improvement in sxs in 1-2 d
13
Q

what is the low FODMAPs diet? % success rate?

A

IBS tx diet that eliminates fermentable carb foods (certain fruits, veggies and grain) and has a success rate of 76% in IBS

14
Q

what does FODMAPs stand for?

A
F: fermentable
O: oligosaccharides
D: disaccharides
M: monosaccharides
A: and
P: polyols
15
Q

what is the elemental diet? absorption occurs where? where can you get it? problems with it? is it successful? cautions?

A

liquid only diet
predigested nutrients in powder form- vivonex plus (Nestle)
absorbed w/in 1st 2 ft of SI
can get at hospital, OTC, internet
problems: VERY expensive ($450/week); tastes bad
most successful non-drug tx studied for SIBO, 80-85% success during 2-3 wk course
cautions with DM pts and pts on dialysis

16
Q

how long does a water fast last? when to stop? who is this not recommended for? $?

A
lasts for 2 weeks
some say fast until what looks like the lining of the intestines come out
not suited for underweight pt
cheap (obviously)
no studies done yet
17
Q

what diet is good to help heal the BB? what should it be made from?

A

SCD
broth made from marrow bones, vit A, L-glutamine, lactose-free colostrum (2-6 g/d), probiotics (sauerkraut juice, lactose-free yogurt), zinc carnosine (75 mg BID), combo formula

18
Q

if a pt has IBS and part of the problem is hypochlorhydria what could you give?

A

vinegar: 1-2 tsp in water before meals
bitters
betaine HCl: up to 3120 mg per meal

19
Q

what 6 tx options could you try for open ileocecal valve syndrome?

A
liquid chlorophyll: 1 tbsp TID
betaine HCl
plant or pancreatic enzymes
adrenal tissue
adrenal botanicals (eleutherococcus, glycyrrhiza, rhodiola, holy basil)
adrenal nutrients (B complex, C, Zn, B5)
20
Q

what 4 tx options could you try for closed ileocecal valve syndrome?

A

calcium (Lowenberg’s test)
choline
pancreatic or plant enzymes
factors to balance high cortisol (ashwaganda, serine phosphate, plant sterols, DHEA)

21
Q

what is the protocol for the ICVS transition diet?

A

avoid or minimized initially:
high fiber and irritant foods: popcorn, chips, pretzels, nuts, seeds, whole grains
raw fruits and veggies
potent spices: chili, black and cayenne peper
chocolate and alcohol: more than 2 c of coffee/d
dairy, wheat, corn, soy

22
Q

what is the cedars-sinai diet? protocol?

A

lactose free
sweeteners allowed: glucose, sucrose, aspartame
sweeteners not allowed: corn syrup, mannitol, sorbitol, sucralose, lactose, lactulose, fruit juice
fiber from fruits and non-starchy veggies mostly: limit to 2 servings of fresh fruit/d
limit or eliminate beans, lentils, peas, soy, dairy
adequate water intake: 8 glasses/d
limit potatoes, pasta, rice, bread and cereals to 1/2-1 c at each meal, use white not whole grain products
protocol: diet follows 14 d of antibiotic dosage, 4-5 hrs b/w meals to stimulate MMC, 12 hr fast at night

23
Q

5 botanical tx options for SIBO

A

allicin extract of garlic: 450 mg BID-TID
berberine herbs: 5 g qd in split dosage
emulsified oregano: 100 mg BID
neem: 300 mg TID
enteric coated peppermint/menthol oil: antibac in vitro for E. coli, can cause heartburn though b/c it is a SM relaxant
30-60 d prior to retesting for all
prolonged die off rxns may occur

24
Q

John’s Hopkins 2 herbal protocols

A

dysbiocide 2 BID, FC-cidal 2 BID
or
candibactin AR 2 BID, candibactin BR 2 BID
take either for 30 d

25
Q

antibiotic protocol for hydrogen producing SIBO? what happens if you don’t follow one of the SIBO clearing diets w/the abx?

A

rifaximin 550 mg TID x 10-14 d

if don’t follow one of the 3 diets recurrence rate goes up to 47% w/in 9 mos

26
Q

abx tx for methane producing SIBO? BM picture for these pts? alternative combo?

A

pts will present w/constipation or alternating constipation and diarrhea
rifaximin 550 mg TID x 14 d w/neomycin 500 mg BID x 14 d
alternative: rifaximin 550 mg TID x 10-14 d plus metronidazole 250 mg TID x 10 d

27
Q

when is rifaximin and concurrent neomycin to tx methane producing SIBO c/i?

A

w/renal dysfunction, ototoxicity and nephrotoxicity

28
Q

what 3 rxs can you use to tx low motility?

A

erythromycin compounded to 50 mg qhs x 3 mo (may use 1/4 of 250 mg standard tablet)
LDN nightly for 3 mos, 2.5 mg qhs for diarrhea and 4.5 mg qhs for constipation
prucalopride, potent, selective and specific 5-HT4 receptor agonist: 0.5-2 mg qhs, not available in US

29
Q

what is a prokinetic?

A

has a (+) effect on the migrating motor complex (motilin receptor agonist)

30
Q

what are 3 antifungals, 2 supplements and a functional problem you need to tx when treating candidiasis/rhodotorula/saprophytic fungi infxn?

A

antifungals: capryllic acid (800-1200 mg TID cc) or undecylenic acid or nystatin (500,000 units 1-4x’s/d up to 1 yr or fluconazole
supplements: alternate oregano extract (100 mg TID) and garlic (whole herb) or allicin (180 mg QD to TID) along with probiotics (10-15 + billion BID cc)
functional problem: tx hypo/achlorhydria if present

31
Q

if an expanded GI health panel shows an elevated SIgA and trichinella SIgA is also elevated what could really be going on?

A

trichinella infxn may be elevating food SIgA levels so may just actually need to tx infxn

32
Q

what are the 3 levels of ‘gluten intolerance’?

A

incomplete digestion of prolamines
wheat or gluten/gliadin allergy or intolerance
celiac dz

33
Q

name a few dzs associated with celiac dz

A
DM
thyroiditis
osteopenia/porosis
sjogrens dz
primary biliary cirrhosis
adrenocortical deficiency 
IgA nephrosis
RA
Down syndrome
seizure d/os
fibrosing alveolitis
idiopathic pulmonary hemosiderosis 
recurrent pericarditis
myocarditis
dilated cardiomyopathy
splenic atrophy
dementia/schizophrenia
dermatitis herpetiformis 
maltoma
34
Q

labs suggestive of active celiac dz?

A
hypocalcemia
vit D deficiency
hypoproteinemia
iron deficiency anemia
folate/B12 deficiency anemia
thrombocytosis
prolonged prothrombin time
elevated transaminases or alk phos
35
Q

what could be revealed while taking a hx that could indicate underlying celiac dz?

A
short stature
anxiety, irritability
chronic fatigue
muscle cramping
tetany
bone/jt/muscle pain
ataxia
neuropathy
paresthesia
migraine/head pain
generalized itching
delayed menarche/puberty
amenorrhea
infertility 
recurrent abortion
night blindness 
chronic anemia
recurrent oral apthae
dental enamel defects
skin pigment changes
follicular hyperkeratosis
vesicular pruritic rash
36
Q

4 screening tests for celiac dz

A

serum antigliadin IgA/IgG
serum deamidated gliadin peptide IgA, IgG
serum tissue transglutaminase IgA, IgG
esophagogastroduodenoscopy w/ bx of 3rd/4th segment of the duodenum

37
Q

3 screening tests for non-celiac gluten sensitivity

A

salivary anti-gliadin SIgA
stool anti-gliadin Ab
stool anti-tTG Ab

38
Q

what are 3 typical ASI findings with non-celiac gluten intolerance

A

depressed morning cortisol
elevated midnight cortisol
depressed total SIgA (salivary or serum)

39
Q

5 key homeopathic IBS remedies?

A

aloe socratina: diarrhea w/sudden urge for stool 5 am, mucus in stool, jelly-like lumps, insecurity of the rectum, aggravation from oysters or beer
podophyllum: explosive diarrhea, gurgling in the abd precedes stool, yellow, watery, profuse, foul stool, weakness, faintness after stool
gelsemium: diarrhea from fright, anticipation or bad news, dull, dizzy, drowsy, droopy
veratrum album: gastroenteritis, simultaneous vomiting and diarrhea, craves lemon, sour fruit, ice or salt
mercurius cor: dysentery w/constant tenesmus, unrelieved by stool, blood, mucus and burning w/stool