As discussed previously, irritable bowel syndrome is believed to be due to the abnormal function (dysfunction) of the muscles of the organs of the gastrointestinal tract or the nerves controlling the organs. The nervous control of the gastrointestinal tract, however, is complex. A system of nerves runs the entire length of the gastrointestinal tract from the esophagus to the anus in the muscular walls of the organs. These nerves communicate with other nerves that travel to and from the spinal cord. Nerves within the spinal cord, in turn, travel to and from the brain. (The gastrointestinal tract is exceeded in the numbers of nerves it contains only by the spinal cord and brain.) Thus, the abnormal function of the nervous system in IBS may occur in a gastrointestinal muscular organ, the spinal cord, or the brain.
In functional diseases of the gastrointestinal tract such as Irritable Bowel Syndrome Symptoms, the grinding, mixing, digestion, and absorption functions are disturbed to only a minor degree. These functions are essentially maintained, perhaps because of a built-in over-capacity of the gastrointestinal tract to perform these functions. The most commonly affected function in these diseases is transportation. In the stomach and small intestine, the symptoms of slowed transportation are nausea, vomiting, abdominal bloating, and abdominal enlargement. The symptom of rapid transportation usually is diarrhea. The interpretation of symptoms, however, may be more complicated than this. For example, let’s say that a person has abnormally rapid emptying of the stomach. The sensing of this rapid emptying by the intestinal sensory nerves normally brings about a motor nerve response to slow emptying of the stomach and transportation through the small intestine. Thus, rapid emptying of the stomach may give rise to symptoms of slowed transportation.
As already mentioned, abnormal function of the nerves of the gastrointestinal organs, at least theoretically, might occur in the organ, spinal cord, or brain. Moreover, the abnormalities might occur in the sensory nerves, the motor nerves, or at processing centers in the intestine, spinal cord, or brain. Some researchers argue that the cause of functional diseases is abnormalities in the function of the sensory nerves. For example, normal activities, such as stretching of the small intestine by food, may give rise to abnormal sensory signals that are sent to the spinal cord and brain, where they are perceived as pain.
Other researchers argue that the cause of functional diseases is abnormalities in the function of the motor nerves. For example, abnormal commands through the motor nerves might produce a painful spasm (contraction) of the muscles. Still others argue that abnormally functioning processing centers are responsible for functional diseases because they misinterpret normal sensations or send abnormal commands to the organ. In fact, some functional diseases may be due to sensory dysfunction, motor dysfunction, or both sensory and motor dysfunction. Still others may be due to abnormalities within the processing centers One area that is receiving a great deal of scientific attention is the potential role of gas produced by intestinal bacteria in patients with IBS. Studies have demonstrated that patients with IBS produce larger amounts of gas than individuals without IBS, and the gas may be retained longer in the small intestine. Among patients with IBS, abdominal size increases over the day, reaching a maximum in the evening and returning to baseline by the following morning. In individuals without IBS, there is no increase in abdominal size during the day.
Slowed transportation of digesting food through the small intestine may be complicated, for example, by bacterial overgrowth. In bacterial overgrowth, gas-producing bacteria that are normally restricted to the colon move up into the small intestine. There, they are exposed to greater amounts of undigested food than in the colon, which they turn into gas. This formation of gas can aggravate bloating and/or abdominal distention and result in increased amounts of flatus (passing gas, or flatulence) and diarrhea.
Dietary fat in healthy individuals causes food as well as gas to move more slowly through the stomach and small intestine. Some patients with IBS may even respond to dietary fat in an exaggerated fashion with greater slowing. Thus, dietary fat could–and probably does–aggravate the symptoms of IBS.
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