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Intestinal motility

Peristalsis is the Movement of the Bowel

Intestinal motility is the other name for the movement of intestinal muscles. The gastrointestinal system moves food from the stomach into the small bowel (small intestine) and eventually into the large bowel (colon). This movement is called peristalsis and is regulated at two levels. The first site of control is located in the intestine and is called the enteric nervous system. The second site of control is located in the brain, and is part of the central nervous system. These two regulatory systems are closely linked through a highway of nerves and the whole system is called the Brain Gut Axis (BGA).

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Intestinal Sensation

When Your Body Feels More Than it Should, You're in Trouble

The increased sensitivity of the bowel can occur due to various problems associated with the BGA. For example irritation of nerve endings in the afferent pathway of the BGA may cause supersensitivity of the system due to release of some chemicals (cytokines and Serotonins) or the hypersensitivity could have its origin from central components of the BGA or the brain.

But why in normal people, the irritant stimuli could result in pain sensation? This is because a pain inhibitory center within the brain can suppress the sensation of pain. This area uses chemicals such as locally made narcotics (Endorphins) and other neurotransmitters to “trick” your mind into thinking that you are not experiencing the pain. In normal people, non-painful (innocuous) stimuli do not result in pain. However, among patients with IBS, the pain center malfunctions. This may result in increased pain sensation with minimal irritant stimuli (hyperalgesia). In severe cases of IBS, even innocuous stimuli can result in pain (alodynia). Thus, even normal motility following a normal meal can result in pain. Emotions, feelings, and stress can modify the function of this inhibitory center and it is not surprising that psychological well-being has an important impact on the magnitude and severity of the perceived pain.

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Brain Gut Axis

Your brain is in constant contact with your gut through a highway of information

Brain Gut Axis: Your brain is in constant contact with your gut through a highway of information. This axis transfers information from brain to gastrointestinal (GI) tract or from GI tract to brain. The first pathway of this connection is called the efferent pathway; the second one is the afferent pathway. (See figure below)

As you can see in the figure, this connection allows exchange of information between the central and gut (enteric) nervous systems. There are receptors in the gut that can sense pain and pressure. When the bowel is irritated, these receptors convey this information to the brain through the afferent pathway of the BGA. The brain also can control the functions of the GI tract, such as digestion, secretion, absorption and movement of the bowel through the efferent pathways of the BGA. Food stimuli usually cause symptoms by affecting the afferent pathways while psychological stimuli do it through affecting the efferent pathways of BGA.

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Stress and Gastrointestinal Tract

Stress Affects Your Gastrointestinal Tract in a Lot of Ways

Stress activates the Brain-Gut Axis and this activation results in release of numerous chemical mediators in the gastrointestinal tract. These mediators change the sensitivity of sensory nerves, intestinal barrier integrity, intestinal immune properties, intestinal motility and many other intestinal functions. Among a wide range of physiological effects of chemicals released from mast cells into the GI tract is an increased sensitivity of sensory terminals of the afferent BGA (BGA input). The increased activity of the afferent sensory nerves could result in increased BGA activity which in turn results in increased output of this system in the form of increased discharge of the efferent nerves of the BGA. The increased discharge of the efferent nerves of the BGA translates into an increase in the release of mast cell mediators. Guess what? This creates a self-amplifying loop or vicious cycle in the IBS. So let me ask you a question. "If you are exposed to stress, is the effect of stress on your body transient or permanent?" Unfortunately, there is no clear answer to this question but even if the chemical or cellular effect of stress fades away the thought and memories of the stressful situation can lingers on. Thus is short answer the effect of stress can persist even in the absence of initiating factors.

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Lactose Intolerance

Do You Get Bloated and Gassy After Drinking Milk? No Surprises. You Are Lactose Intolerant.

Lactose intolerance or lactase deficiency is another disorder that must be seriously considered when diagnosing a patient as having IBS. Indeed, lactose intolerance can be easily confused with IBS. “Lactase” is an enzyme in the beginning portion of the small intestine that digests the milk sugar “lactose”. The intestines of babies typically have a strong capacity to digest this milk sugar. As we get older, the amount and capability of this enzyme declines. This process occurs more quickly in some ethnic groups such as African-Americans and Asians. These problems are especially likely to occur when a large amount of this type of sugar is consumed. Undigested sugar will eventually be consumed by bacteria in the large bowel and produce several gases. One such gas is hydrogen, which is used to diagnose this problem with a Breath Test. Symptoms of IBS are common among people with lactose intolerance, particularly distension and gas following consumption of dairy products.

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Bacterial Overgrowth

When the Bugs Take Over.

We have a large number of bacteria in the mouth and large bowel. Due to the acidic environment of the stomach as well as the digestive enzymes in the small bowel, the environment of the small bowel is almost germ-free. In some instances, this germ-free environment becomes populated with bacteria, which competes with the host (human) to acquire nutritious materials that are supposed to be absorbed across the wall of the small bowel. The bacteria also make a variety of toxins and irritants that can result in bowel inflammation and irritation, creating symptoms of diarrhea, bloating and abdominal pain. This condition is called bacterial overgrowth. Recently, there are several reports that claim that a significant group of IBS patients have bacterial overgrowth as the cause of their symptoms. However, the proof of this fact is still pending.

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