Morbus-Crohn
[Jakob Simmank]
www.zeit.de/wissen/gesundheit/2017-07/psychische-erkrankungen-keime-schaden-therapie/seite
Krankheit: Akut: Bauchbeschwerden.
(Schmerz r./“Wie Blinddarmentzündung“), Durchfall (5x täglich/mit o. ohne
Blut), Gewichtsverlust/Erschöpfung, leichtes Fieber; chronisch:
Augen-/Leber-/Gelenken-/Hautbeschwerden, müde;
Behandlung: Behandlung mit Eier Trichuris suis (= Schweine-Peitschenwurm) lindert o. heilt
vielleicht Morbus-Crohn/Allergien. (Quelle: Ovamed GmbH);
Das heißt, keines der Extreme, übergroße Werttreue (Angst)
oder ihre Missachtung, schützt.
Carbo
Juniperi seems a good medicament for disorders/weakness of life ether in the
abdomen. ‡
Antidotiert von:
‡
Aesc-h cortex ‡ Amoeb-d. Amoeb-h. Antimonit. w
(Ant + S) M.A.P. Stram.
Allerlei:
Weiße Blutkörperchen bilden Leukotrienen/lösen Gelenkrheuma/Morbus Crohn aus.
Immunsystem. ist OVERaktiv, es produziert Antistoffen
gegen körpereigene Darmbakterien
3.545 individuals, who had been immunized against measles at the age of
10 - 24 months included in an immunization study of the Medical Research
Committee (MRC), were compared with 11.407 from the National Child Development
Study (NCDS), who had not been immunized and 90% of whom had measles up to the
age of 11. It was found that the relative risk for immunized individuals to
develop Crohn's disease was 3,01 (95% confidence interval 1.45-7.25; p =
0,004). The odds ratio for ulcerative colitis was 2.53 (95% confidence interval
1.15-5.58; p = 0,03). No risk ratio was found for celiac disease.
In a population of equal size 3x as many of those immunized against
measles would develop Crohn's disease than those not immunized. Remarkably,
this fits in fairly well with incidence evolution.
The incidence for 1960 was 0,8, that for 1980 - 1984, 4,2 per 100.000
people per annum.
[Dr. Farokh Master]
Hoitzia
[Wim Marius Rademan]
http://ir.dut.ac.za/handle/10321/1907
Irritable Bowel Syndrome (= IBS) represents one of the commonest
conditions encountered by gastroenterologists, intemists and general
practitioners.
In the general population, symptoms consistent with IBS are reported by
10 - 20% of persons, and accounts for 20 - 50% of referrals to gastroenterology
clinics.
Extrapolating to the white population of US, the cost were more than $8
billion for IBS yearly, thus making it a costly disorder in the community.
(Talley et al. 1995.)
Essence of IBS.:
Intermittent diarrhea, abdominal colic relieved by bowel action and
'bloated' feeling –due to altered gut motility.
The disease is one of negatives: there is no accepted definition and no
structural pathology. (Hope et al. 1993: 51.8.)
IBS varies in severity hom trivial to incapacitating. The
pathophysiology and epidemiology are gradually being unravelled and it is
becoming more apparent how poor the quality of life of these
patients is. Nowadays its no longer acceptable practice to diagnose the
condition and to discharge the patients on high fiber diets, particularly
because it makes the situation worse. (Francis and Whorwell. 1997.)
IBS consists of a group of symptoms that suggest that there is a
dysfunctional gut for which there is no cure as there is no cure and no organic
cause.
The best lines of defense up to now have been a number of treatments
that provides symptomatic relief of the symptoms of IBS. (Zietsrnan 1997.)
The Manning criteria are widely used for diagnosis and to observe the
major symptoms in IBS. They have a sensitivity and specificity of 67% and 70%
respectively if 3 or more symptoms are positive (Jeong et al. 1993).
All six individual symptoms used in the Manning criteria were found to
be reliable.
These key symptoms are
1. visible abdominal distention,
2. pain relieved by a bowel action,
3. more frequent stools with the onset of pain,
4. looser stools with the onset of pain,
5. rectal passage of mucus,
6. a sensation of incomplete evacuation.
Based on a logistic regression analysis of the discriminatory value of
the Manning criteria it was found that as the number of positive criteria
increased, so did the predicted probability of IBS.
(Talley et al. 1990.)
IBS is a motility disorder that involves the entire hollow
gastrointestinal tract, creating a symptom complex with both upper and lower
gastrointestinal symptoms.
Predominant symptoms include variable degrees of abdominal pain,
constipation or diarrhea, and postprandial distention.
The symptoms nearly always occur in the waking state and are usually triggered
by stress or the indigestion of food.
There are two types of IBS grouped according to the signs and symptoms:
1. the spastic colon type where bowel movements are variable. Most
patients have pain of colonic origin over one or more areas of the colon
associated with periodic constipation or diarrhea.
2. manifests painless diarrhea, usually urgent, precipitous diarrhoea
that occurs immediately upon rising or, more typically, during or immediately
after a meal. (Berkow 1992:842.)
It seems adverse reaction to food is proposed to be a high causative
factor in patients suffering from irritable bowel syndrome.
Thus a diet that eliminates the offending foods is the obvious
treatment for such adverse reactions.
Compliance with a dietetic regimen is often poor and sometimes not
completely free from risks. (Stefanini et al. 1995.)
Research has shown that the people suffering from IBS felt that it
affected all aspects of their lives: work, leisure, travel and relationships.
Sufferers indicated that they felt they would have coped better if they
had been provided with more information about IBS, its possible causes and
treatment, and greater sensitivity from
members of the medical profession in dealing with them. (Dancey and
Backhouse, 1993.)
A control group (n -= 46 patients), a group of patients with irritable
bowel syndrome (IBS) (n = 70) and a group of patients with major depression
(MDE) (n = 60) were interviewed
and compared concerning their family history of psychiatric disorders.
The results showed that both IBS and MDE groups had a similar, higher
prevalence of relatives with psychiatric illness than controls, i.e. there was
a higher prevalence of anxiety and
depressive disorder in the relatives. (Sullivan et al. 1995.)
In treating IBS both the patient and the physician must realize that
the condition is chronic, and that while it may be alleviated, it cannot be
cured.
There should also be an emphasis on the relationship between
psychological stress and the onset of severe symptoms.
Drug treatment is aimed at relieving the disease. With constipation, an
increase in dietary bulk and psyllium bulk laxatives is used.
Troublesome diarrhea may respond to diphenoxylate or loperamide.
Mild sedation with tranquilizers may be indicated, and anticholinergic
drugs such, as dicyclomine is useful in some patients. Unfortunately, no
specific drug (orthodox) or dietary regimen
affords good relief and thus several therapeutic maneuvers need to be
tried. (Isselbacher et al. 1994: 1421.)
There has been no specific research on the effect of Homoeopathy on IBS
but it seems from clinical experience that Homoeopathic treatment may be
effective incl. psychiatric related
bowel disorders (Vickers 1993: 188).
Therefore the aim of the study was to evaluate the efficacy of
Homoeopathic Simillimum treatment in IBS sufferers in terms of the patient's
perception and clinical findings by the researcher
to determine what role the homoeopathic simillimum treatment plays in
the management of spastic colon.
2.1
Introduction
Irritable Bowel Syndrome is one of the commonest disorders in
gastroenterology with a
REVIEW OF THE RELATED LITERATURE
Symptom complex that includes diarrhea, constipation, pain and bloating
(Bonis and Norton 1996).
Although IBS is one of the commonest conditions encountered in clinical practice, it is also one of the
least understood conditions (Kelley 1997:708).
Most individuals do not seek medical attention for their symptoms, and those that do require
limited medical therapy and assurance (Almounajed and Dressman 1996).
This disease is one of negatives: thus there is no accepted definition
and no structural pathology (Hope et al. 1993:518).
In a recent study it was shown that the majority of nurses in 18 London
hospitals hold a very negative attitude towards IBS sufferers, which can be
very detrimental to the treatment
of such patients (Letson and Dancey 1996).
2.1.1
Definition:"Irritable Bowel Syndrome is a combination of chronic
recurrent symptoms of abdominal pain and disturbed defecation not explained by
structural or biochemical abnormalities
of the bowel wall. It is a
localized manifestation of functional gastrointestinal disorders". (Hurst
1996:1532.)
According to the "Rome criteria" IBS can be defined as chronic
abdominal pain for at least 3 months and present for several days a week
(Louvel et a11996).
2.2
Epidemiology
In the general population, symptoms consistent with IBS are reported by
15 - 20 % of patients. 75% of patients seen by physicians with IBS in Western
countries are female.
Male patients predominate in countries such as India and Sri Lanka.
(Rakel1996: 347.)
Although very common in early adulthood, it can also have an onset
after the age of 45 (Bennett and Plum 1996:686).
In medical practice, 25 - 50% of referrals to
"gastroenterologists” are patients suffering from IBS (Hurst 1996: 1534).
The prevalence of IBS is much higher in females, primarily because of a
higher prevalence of constipation – predominant IBS. Females have a higher
number of Manning's symptom criteria.
(Talley et al. 199\)
2.3
Aetiology
No anatomical aetiology has been found up to now. Factors like
emotions, diet, drugs, and hormones can precipitate and aggravate GI motility.
Patients with IBS are more neurotic, anxious,
and depressed than patients in a similar age group. Stressful and
emotional conflict may result in the onset and recurrence of the syndrome.
Some psychosocial precipitating symptoms involve marital discord,
anxiety related to children, loss of a loved one, and obsessional worries over
trivial everyday problem. (Berkow 1995:842.)
There arc several theories about the aetiology of IBS.
1. it is possible that there may be a generalized alteration of the
visceral receptors throughout the gut.
2. there may be an increased perception due to altered central
processing.
3. there may be an imbalanced autonomic nervous system. (Hurst 1996:
1532.)
The latest beliefs are that the main causes of IBS are stress, poor
eating habits, a lack of exercise, gut smooth muscle spasms and hiatus hernia
(Zietsman 1997).
2.4
Pathophysiology
Patients with IBS have certain motility and sensory abnormalities,
which distinguish them:
~ Stimuli like stress, meals and peptides alter colocnic and small
intestinal motor response
Pain symptoms in patients with IBS are due to hyperactivity of gut
muscle. IBS patients also have reduced Sensory thresholds for stimuli such as
rectal and ileal distention. (Rakel. 1996:347.)
Small bowel and sigmoid colon circular and longitudinal muscles arc
particularly susceptible to motor abnormalities. Pain of IBS is either due to
abnormally strong contraction of the intestinal
smooth muscle or to undo sensitivity of the intestine to distention.
Hypersensitivity to the hormones gastrin and cholecystokinin may also be
present. (Berkow 1992:842.)
Investigations have failed to detect any histological, microbiological,
or biochemical abnormalities but have suggested abnormal myoelectric and motor
activity in the gut.
Measuring myoelectric activity as well as slow wave and spike
potentials it was found that patients with IBS have a 3 cycles per minute (cpm)
motor activity in contrast with the 6 cpm found
in normal control subjects. Emotional stress alters colonic motility
with inhibition of motility with depression, whilst stimulation occurs with
hostility and anger.
IBS patients also show selective hypersensitivity of internal
mechanosensitive pathways associated with a nonspecific and central dysfunction
ofviscerosomatic referral. (Kelley 1997:709.)
Neuropeptides like motilin and cholecystokinin are partly responsible
for initiating intestinal dysmotility in IBS patients due to disrupted motilin
and cholecystokinin release in the system.
Motilin has been proposed to initiate the peristaltic reflex in the small
intestine and cholecystokinin the gastrocolic reflex. (Sjolund et al. 1996.)
Patients with IBS show a deviation from normal brain activity patterns
both during noxious rectal distention and during anticipation of rectal pain
(Silverman et al. 1997).
Repetitive sigmoid contractions may induce rectosigmoid hyperalgesia in
patients with IBS, i.e. if the sigmoid splanchnic afferents get repetitive
stimulated, central sensitization develops which
is manifested as hyperalgesia and increased viserosematie referral
during rectal distention and spontaneous rectosigmoidal hyperalgesia in the
absence of applied stimuli. (Munakata et a1.1997.)
Motor abnormalities in all parts of the gastrointestinal tract have
been found, viz. esophageal, gastric, upper small bowel, ileac and colonic
(Kumar and Gustavsson 1988:402).
2.5
Clinical Manifestation
Dysregulated intestinal motor function, sensory functions and central
nervous system functions are currently believed to be the basis for IBS (Dalton
and Drossman 1997).
And the hallmarks of IDS are cramping abdominal pain of colonic origin
and an altered bowel habit.
Symptoms arc intermittent with variable periods of remission. (Bennett
and Plum 1996: 686.)
The most predominant symptoms are a history of chronic constipation,
diarrhea, or both occurring intermittently for months or years.
The diarrhoea < morning or after breakfast.
There are usually 2 – 4 bouts of loose stools then the patient will
start feeling better for the remainder of the day,
Some describe the stools to be "pencil-like" pasty stools
rather than diarrhea.
In rare cases some patients may develop a severe, painless diarrhea in
which a watery bowel movement is present every day.
Chronic abdominal pain with constipation or with constipation #
diarrhea is another presentation in patients with IBS.
These patients have bouts of intermittent crampy lower abdominal pain,
often over the sigmoid colon, which is usually > passage of flatus or stool.
Abdominal bloating is also commonly found in patients with IBS,
(Isselbacher et al. 1994:1421.)
Continuous recurrent symptoms will be present for at least 3 months
which consist of abdominal pain > by defecation or associated with changes
in frequency or consistency of stools.
Defecation is disturbed and involves altered stool characteristics with
a feeling of bloating and abdominal distention. (Kelley 1997:708.)
IBS is often accompanied by passage of an excessive amount of mucus,
which might be interpreted as pus or as a worm by some patients.
Other presentations of IBS include epigastric fullness, abdominal
discomfort after a meal, nausea, and occasional bilious vomiting.
These patients frequently complain of bloating, distention, and pain in
the upper abdomen. (Bouchier et al. 1993:270.)
Symptoms may occur for several years before patients seek medical
advice.
Precipitating factors that can set off an acute attack include
(1) acute illness,
(2) increased work demands and stress,
(3) severe financial pressure,
(4) loss of a job,
(5) family crises,
(6) death of a close friend or loved one. (Cohen and Soloway 1987:71.)
Patients with short symptom duration and fewer psychological symptoms
have a better prognosis than patients with long histories of IBS and related
psychological distress (Lembo at al 1996).
Some new findings has indicated that IBS is extremely prevalent in
patients seeking treatment for dysthymia and is often undiagnosed and untreated
(Masand at al 1997).
A high prevalence rate of major depression, current panic disorders,
and childhood sexual abuse is found in patients with IBS.
It was also found that patients with IBS have a significant number of
medically unexplained physical symptoms and disability ratings which are equal
or higher than those of patients with
severe organic gastrointestinal disease. (Walker et al 1995.)
When posttraumatic stress disorder was investigated in relation to IBS
a high prevalence was found.
These findings suggest that IBS is often associated with psychiatric
disorders, indicating that assessment and treatment of psychiatric disorders
may be important in the treatment of IBS.
(Irwin et aI.1996.)
Clinical Findings:
In most patients with IBS the physical examination is generally normal.
Physical examination may reveal tenderness in the areaof the colon.
The majority of patients with IBS are between the ages of 20 and 50.
IBS patients have a past history of multiple illnesses such allergies,
headaches, kidney disease, joint symptoms, and in women dyspareunia. (Rakel.
1996: 347.)
2.6
Diagnosis and Physical Examination
Laboratory studies are generally all negative in IBS.
The diagnoses should be suspected based on the patient's symptoms
picture and by excluding organic disease.
A minimal evaluation of complete blood count, stool sample and
urinalysis must: be obtained.
Sigmoidoscopy is normal (Rakel1996: 347.)
Unless symptoms change, it will not be necessary to undergo the
laboratory tests again (Rees and Willey 1993: 332).
Clinical features supportive of the diagnosis of IBS:
(1) lower abdominal pain that recurs with altered
bowel habits over a period of time without progressive
deterioration,
(2) symptom onset during periods of stress or
emotional upset,
(3) absence of fever or loss of weight,
(4) small volume stools without any evidence of blood
(Kelley 1997:709).
The Manning criteria is widely used for diagnosing patients with IBS
related symptoms because the six cardinal symptoms used in this criteria were
found to be very reliable.
These key symptoms are:
1. pain > with defecation,
2. onset of pain associated with more frequent
defecation,
3. onset of pain associated with looser stools,
4. visible distention of the abdomen,
5. a feeling of incomplete evacuation,
6. the passage of mucus per rectum.
The more of these symptoms present in a patient the more likely it is
that they have irritable bowel syndrome. IBS can be diagnosed if a patient
presents with abdominal pain and
any three of these six symptoms. (Talley el al. 1990.)
All six Manning symptoms were rigorously tested for their diagnostic
value at the Mayo-clinic in a large study and were found to be reliable
(Pounder 1992: 51).
Most patients show no abnormalities on their physical examination and
laboratory tests with a case history suggestive of IBS (Levine1992:346).
A combination of two or more symptoms of the Manning criteria may lead
to a positive diagnosis for IBS, obviating the requirement for invasive
investigations (Barrison et al 1992:7.3).
2.7
DD.: In making an accurate differential: quality, location, and timing
of pain must be considered which will be very helpful for the diagnosis. IBS in
the epigastric region: biliary tract
disease, peptic ulcer, intestinal ischemia, and carcinoma of the
stomach or pancreas. Pain mainly in the lower abdomen: diverticular disease,
inflanunatory bowel disease, and carcinoma
of colon. Postprandial pain + bloating, nausea, and vomiting suggest
gastroparesis or partial obstruction.
If diarrhea is the major complaint: lactose deficiency, laxative abuse,
malabsorption, hyperthyroidism, inflammatory bowel.
2.8
Allopathic treatment
IBS is a very hard disease to treat but worthwhile responses can be
achieved by carefully targeting the therapy to the many different facets of the
disorder (Francis and Whorwell.1997).
Drugs are unproved in the global treatment of IBS, but certain drugs
will certainly benefit specific symptoms of the syndrome (Thompson and Giek.
1996).
Loperamide is such a drug and has shown beneficial in some cases of IBS
with these symptoms but there was an increase of pain during the night (Efskind
et al. 1996).
The use of placebo can be used advantageously for some patients
(Thompson and Giek. 1996).
The treatment of IBS must be individualized due to fact that it has a
multifactorial aetiology (Efskind et al. 1996).
The goal is to modify the factors that caused the exacerbation of
symptoms and the patient's response to them.
Lots of reassurance must be given to the patient because it is not a
life threatening disease and cure is not likely.
The first line of control is a dietary approach in which food allergies
and intolerance to certain foods must be considered. (Hurst 1996:1533.)
The next step is to introduce drugs for the different problems related
to this syndrome.
Drugs such as anticholinergic agents, antispasmodic agents,
antidiarrheal agents, antiflatulance therapy, antidepressant and anxiolitic
agents, and anti afferent agents are used. (Kelley 1997:710.)
IBS is a very hard disease to treat but worthwhile responses can be
achieved by carefully targeting the therapy to the many different facets of the
disorder (Francis and Whorwell. 1997).
Drugs are unproved in the global treatment of IBS, but certain drugs
will certainly benefit specific symptoms of the syndrome (Thompson and
Giek.1996).
Loperamide is such a drug and has shown beneficial in some cases of IBS
with these symptoms but there was an increase of pain during the night (Efskind
et al. 1996).
The use of placebo can be used advantageously for some patients
(Thompson and Giek. 1996).
The treatment of IBS must be individualized due to the fact that it has
a multifactorial aetiology (Efskind et al. 1996).
The goal is to modify the factors that caused the exacerbation of
symptoms and the patient's response to them.
Lots of reassurance must be
given to the patient because it
is not a life threatening disease
and cure is not likely.
1st line of control is
a dietary approach in which food allergies and intolerance to certain
foods must be considered. (Hurst 1996:1533.)
2. Introduce drugs for the different problems related to the syndrome.
Drugs such as anticholinergic agents, antispasmodic agents,
antidiarrheal agents, antiflatulance therapy, antidepressant and anxiolitic
agents, and anti afferent agents are used. (Kelley 1997:710.)
The newest therapies are based on reducing high-amplitude GI
contractions with nonselective muscarinic antagonists, but due the typical
muscarinic. side effects and its failure to relieve pain
their efficacy is limited (Mitch ct al. 1997).
Other new aspects of treatment for IBS are a biopsychosocial approach
with attention to the doctor-patient relationship as being the basis of the
treatment (Almounajed and Drossman 1996).
Hypnotherapy has shown that in addition to relieving the symptoms of
IBS it is capable of profoundly improving the patient's quality of life and
reduced absenteeism from work.
Although it: is relatively expensive to provide it might be a good
long-term investment. (Houghton et al. 1996.)
2.9.3
Homoeopathic remedies are non-toxic due to successive dilution's.
These remedies do not act chemically but according to a particular
physical state and have the capacity of making the ill patient react to his
disease. (Jouanny 1991:91..)
Some commonly used remedies for IBS and indications for them:
Alum.:
Ant-t.:
Arg-n.:
One of its main functions is on the nervous system: it
is a remedy that work on anxiety and fear of a patient.
GIT: Lots of frequent and loud eructations, Abdominal
distention that mayor may not be relieved by eructations.
Marked flatus, which is passed with or without relief,
Diarrhea is one of the leading symptoms and can
usually due to panic attacks or anticipation.
Clinically well indicated IBS (Morrison 1993:35.)
Coloc.:
Should always be considered if there is lots of colic present.
The pains are severe and cramping, > strong
pressure.
These pains < anger and excitement.
Abdominal pain < before diarrhoea whereas diarrhoea
and colic is made < eating.
Also indicated in IBS. (Morrison 1993: 139.)
Lyc.:
Digestive disturbance is the main problem (Boericke
1991: 411).
Bloated abdomen > eructation and flatus, feeling
< after eating even small amounts of food.
Lots of pyrosis with sour eructations.
Constipation # diarrhoea, the stool can begin hard
Nux-v.:
This remedies pathology largely centered around the
gastrointestinal tract which makes it a good remedy for IBS.
Cramping and sharp pain in the abdomen, which gets
< eating, tight clothes; > warmth/warm drinks;
Constipated with constant ineffectual urging for
stool, small round stools passed which give temporary relief.
Incomplete sensation in the rectum with constipation #
diarrhoea, (Morrison 1993:274.)
Puls.:
Symptoms are always changing, thus one day a patient can
have constipation and next he can have a bout of diarrhoea, which is often the
case in IBS.
Pain and discomfort in the abdomen after eating with
flatulence.
Bloating of the abdomen with loud rumbling.
No two stools are the same, thus it can constipation #
diarrhea, (Boericke 1991:517.)
Sep.:
Tends to be depressed and very irritable.
There is an empty feeling in the abdomen.
Usually constipated without urging and rectal depressed and very irritable.
There is an empty feeling in the abdomen.
Usually constipated without urging and there is a
rectal dissatisfaction, it feels as if there is a lump in the rectum. Well
indicated for a female over the age of forty and who starting to have
menopausal problems (Morrison 1993:345).
It is vital that there is a good doctor-patient relationship for any
treatment to be successful and effective and especially in IBS (Dalton and
Dressman 1997). Concluded that there was LI
significant
Difference in patients suffering from IBS if they got treated with the homoeopathic simillimum
treatment compared to the patients that received the placebo treatment.
Phytologie: Olib-sac. (= Weihrauchöl)
Diät
Wann Würmer helfen!!
Die meiste Erfahrung hat die Arbeitsgruppe von Joel
Weinberg am Tufts Medical Center in Boston in der Therapie von
chronisch-entzündlichen Darmerkrankungen. Die Würmer sind vor allem
an Patienten mit Morbus Crohn erprobt worden. Die ersten
Studienergebnisse waren positiv und zeigten bei einem Großteil der Patienten
verminderte Symptome. In Freiburg findet im Moment
eine Studie mit 300 Patienten statt, um die Sicherheit
der Therapie zu überprüfen, bevor sie weitläufig angewendet werden kann.
Daneben untersucht Weinberg die Therapie mit Wurminfektionen
bei der Darmentzündung Colitis Ulcerosa, bei Diabetes Typ
1, bei der Hautkrankheit Schuppenflechte und bei MS.