Uncovering the Hidden Causes of Recurrent GI Distress
The Gut-Brain Connection
The gut and brain have a powerful, bidirectional relationship. Stress and emotions can clearly impact gastrointestinal function. However, the opposite effect also holds true – gastrointestinal issues can directly affect mood, anxiety levels, cognition, and energy.
For example, conditions like small intestinal bacterial overgrowth (SIBO) and hiatal hernia syndrome allow bacterial byproducts and food particles to enter areas of the gut they should not populate. This can lead to production of neurotransmitters and other neuroactive compounds that influence processes in the brain.
Restoring GI Motility to Calm the Nerves
Prokinetic agents can help improve gastrointestinal motility to flush out problematic organisms and metabolites. Herbal prokinetics like ginger, artichoke, and Iberogast can provide relief for some. Others with severe lifelong constipation may need prescription prokinetics like low-dose erythromycin or the newly approved drug Motegrity (prucalopride).
In addition to pharmaceuticals, gastrointestinal physical medicine offers hands-on techniques to get the bowels moving. Methods like myofascial release and soft tissue mobilization applied to regions like the ileocecal valve and stomach can work wonders.
When Good Bugs Go Bad
Dysbiosis refers to any imbalance in the gut’s microbiome – be it undergrowth, overgrowth, or shifts in diversity. Small intestinal bacterial overgrowth (SIBO) is one common form of microbial imbalance whereby bacteria meant to primarily reside in the large intestine take up residence proximal to the ileocecal valve.
In some cases, infection clearly precedes indolent SIBO. Both bacterial and viral gastroenteritis often graduate to post-infectious IBS. Traveler’s diarrhea and food poisoning can leave patients with chronically unsettled abdomens.
However, slow, innocuous, and seemingly disconnected events also set the stage for SIBO. Gradual nerve damage from years of high blood sugar characteristic of diabetes frequently blankets the intestines in a paralytic state of pseudo-obstruction.
Stealthy Sources of GI Slowdown
Adhesions stealthily strangle the abdominal organs like pythons, impeding their gentle waltz. Ruptured appendixes or ectopic pregnancies generate significant scar tissue. Endometriosis also seeds the pelvis with adhesions.
Certain medications hammer the digestive track too. Chronic proton pump inhibitor use hampers nutrient absorption critical for microbial balance and gut immunity. Repeat antibiotic exposure sweeps away commensal microbes while selecting for drug-resistant species.
Even traumatic brain injury alters gastrointestinal motility and microvilli structure within hours, initiating gradual digestive decline.
Breaking the Cycle of Recurrent SIBO
Identifying and addressing the root causes of impaired motility provides the missing link for resolving chronic SIBO in difficult cases. Treatments must encompass gut-level interventions like prokinetics and adhesion release as well as host-level approaches such as weaning off problematic medications, modulating blood sugar, and providing neurological support.
For post-infectious IBS, prokinetic cocktails taken for 3-5 years can help manage autoantibodies against intestinal pacemaker cells that would otherwise guarantee relapse. Supporting a robust population of commensal microbes also allows less opportunity for pathogenic species to gain footholds when infections strike.
Stomach Acid – Friend or Foe?
Debate stirs around whether to supplement hydrochloric acid (HCL) for recurring SIBO accompanied by hypochlorhydria. Some argue excess HCL introduces additional hydrogen gas to feed SIBO microbes. However, others counter that insufficient stomach acid paves the way for overgrowth by hampering a natural barrier to migration.
When hypochlorhydria is identified via clinical presentation or testing, HCL replacement can profoundly improve digestive function. Those with histories of gastritis or erosive esophagitis may need closer monitoring when first introducing HCL. Gentler alternatives like bitters or digestive enzymes can prime the gastrointestinal tract to eventually tolerate HCL supplementation.
