A Prospective Study On Irritable Bowel Syndrome Occuring In Adults And Its Approach With Homoeopathic Similimum Along With General Management By Abdominal Breathing Techniques
Abstract
Background & Objectives: Irritable bowel syndrome (IBS) is a functional gastrointestinal(GI) disorder characterized by abdominal pain and altered bowel habits in the absence of specific organic pathology. Over the years, the unexplained gastrointestinal symptoms of IBS have been described in various terms, including mucous colitis, spastic colitis, nervous colon, and irritable colon. The symptoms of IBS appear and disappear over time and are often associated with other functional gastrointestinal diseases and non-gastrointestinal somatic pain disorders. The aetiology is poorly understood and many factors are involved altered gastrointestinal motility, visceral hypersensitivity, post infectious reactivity, brain-gut interactions, alteration in faecal micro flora, bacterial overgrowth, food sensitivity, carbohydrate malabsorption, and intestinal inflammation all have been implicated in the pathogenesis of IBS. However, the perceived symptoms from these mechanisms consist of abdominal pain or discomfort, bloating, diarrhoea, and constipation. Diagnosis is made using criteria based on clinical symptoms such as Rome criteria, unless the symptoms are thought to be atypical. According to the updated Rome III criteria, IBS is clinical diagnosis and presents as one of the three predominant subtypes:
(1) IBS with diarrhoea (IBS-D),
(2) IBS with constipation (IBS-C) and
(3) IBS with mixed bowel patterns (IBS-M).
The objective is to study the efficiency of homoeopathy medicine in irritable bowel syndrome and to Evaluate the effectiveness of abdominal breathing in the management of IBS.
Methods: The study was conducted on the patients visiting RVS Homoeopathy Medical College and Hospital, Sulur, Coimbatore, Tamil Nadu. The sample for the study consists of 5 cases. The study duration was from August 2022 to November 2022. Prospective study (along the time) was done for evaluating the effectiveness of similimum along with general management in treatment of IBS.
Results & Interpretation: The cases were selected on the basis of clinical presentation with the assessing parameter of Rome IV criteria and all were prescribed similimum with totality of the case in comparison with Materia medica, repetition was made according to the symptom presentation in the follow up. In a total of 5 cases, 3 cases (60%) had marked improvement, 1 case (20%) had moderate improvement and 1 case (20%) had mild improvement.
Conclusion: From the result we can interpret that the selection of similimum in the treatment of Irritable Bowel Syndrome has better outcomes. It reduces the persons suffering and improves the quality of life (QOL). In conclusion of the study, we can understand that similimum along with general management of the cases has better results.
KEYWORDS: Irritable bowel syndrome, Homoeopathy, Abdominal breathing techniques.
Introduction
Irritable bowel syndrome (IBS) is a chronic, relapsing, remitting and the most prevalent functional disorder of the gastrointestinal tract. This disease is characterized by abdominal pain, bloating, and changes in bowel habits that lack a known structural or anatomic explanation. Since 1960s, attempts were made to make a more positive diagnostic criteria for IBS without the risk of misdiagnosing an organic disease such as ulcerative colitis or colon cancer. A number of diagnostic criteria for IBS are available: the Manning criteria, the Kruis criteria, and the Rome I, II and III criteria.
Incidence: Population-based studies estimate the prevalence of IBS at 10–20% and the incidence of IBS at 1–2% per year. Of people with IBS, approximately 10–20% seek medical care. Rates in women are approximately 1.5- to 3-fold higher than those seen in men. Internationally, the overall prevalence of IBS in women is 67% higher than in men (odds ratio 1.67 [95% CI 1.53–1.82]). IBS occurs in all age groups, including children and the elderly increased incidence seen before 35 years and lower incidence in 50 years.
IBS SUB-CLASSIFICATION: According to the Rome III criteria, IBS may be subtyped or subclassified on the basis of the patient’s stool characteristics, as defined by the Bristol Stool Scale:
IBS-D:
- Loose stools >25% of the time and hard stools <25% of the time.
- Up to one third of cases.
- More common in men.
IBS-C:
- Hard stools >25% of the time and loose stools <25% of the time.
- Up to one third of cases.
- More common in women.
IBS with mixed bowel habits or cyclic pattern (IBS-M):
- Both hard and soft stools >25% of the time.
- One third to one half of cases.
Unsub-typed IBS:
- Insufficient abnormality of stool consistency to meet criteria IBS-C or IBS-M.
CLINICAL FEATURES OF IBS
Pain is a key symptom for the diagnosis of IBS. This symptom should be associated with defecation and/or have its onset associated with a change in frequency or form of stool. The common symptoms of the IBS are
- Abdominal Pain
- Altered Bowel Habits
- Gas and Flatulence
- Upper GI Symptoms
Symptom-based criteria have been developed for the purpose of differentiating patients with IBS from those with organic diseases. These include the Manning, Rome I, Rome II, Rome III, and Rome IV criteria. Rome IV criteria for the diagnosis of IBS were published in 2016. Table 5 Comparison of the Manning and Rome diagnostic criteria frequently used in epidemiological studies for case ascertainment.
Manning (1978) | 2 or more of the following symptoms: 1.Abdominal distension 2.Pain relief with defecation 3.Frequent stools with pain 4.Looser stools with pain 5.Passage of mucus 6.Sensation of incomplete evacuation | |||||||||||||||||||||||||||||||||||||||
Rome I (1989) | 1. At least 3 months of continuous or recurrent abdominal pain. Relieved with defecation (or) Associated with change in stool consistency. With at least 2 of the following on at least 25% of days: 1.Altered stool frequency 2.Altered stool form 3.Altered stool passage 4.Passage of mucus 5.Bloating or abdominal distension | |||||||||||||||||||||||||||||||||||||||
Rome II (1999) | At least 12 weeks in past 12 months of continuous or recurrent abdominal pain or discomfort With at least 2 of the following: 1.Relief with defecation 2.Altered stool frequency 3.Altered stool form Onset of symptoms more than 12 months before diagnosis | |||||||||||||||||||||||||||||||||||||||
Rome III (2006) | At least 3 days per month in past 12 weeks of continuous or recurrent abdominal pain or discomfort With at least 2 of the following: 1.Relief with defecation 2.Altered stool frequency 3.Altered stool form Onset of symptoms more than 6 months before diagnosis | |||||||||||||||||||||||||||||||||||||||
Rome IV (2016) | Recurrent abdominal pain, on average, at least 1 day per week in the last 3 months, associated with ≥2 of the following criteria: 1. Related to defecation 2. Associated with a change in frequency of stool 3. Associated with a change in form (appearance) of stool *Criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis. ABDOMINAL BREATHING TECHNIQUE: Generally, standard medical treatments (reassurance, dietary manipulation, and pharmacological therapy) are often ineffective in reducing abdominal IBS and other abdominal symptoms, whereas complementary and alternative approaches such as relaxation and cognitive therapy are more effective than traditional medical treatment. Activating the diaphragm creates a gentle massaging action felt by internal organs like the intestines and stomach, which can reduce abdominal pain, urgency, bloating and constipation. Diaphragmatic breathing can help in specific GI-related situations: Diarrhoea and urgency: Diaphragmatic breathing can help calm the digestive track and ease those moments of panic (i.e. I MUST get to the bathroom immediately!”). Constipation: Diaphragmatic breathing can be used while sitting on the toilet attempting to have a bowel movement to calm and massage the system. The result may be a more complete bowel movement. OBJECTIVES: The objective is to study the efficiency of homoeopathy medicine in irritable bowel syndrome and to Evaluate the effectiveness of abdominal breathing in the management of IBS. MATERIAL AND METHODS: Study Design: The study was undertaken at OPD, IPD & POPD of RVS Homoeopathy Medical College & Hospital. The study duration was from August 2022 to November 2022. Prospective study (along the time) was done for evaluating the effectiveness of similimum along with general management in treatment of IBS. The diagnosis of the cases was made on the basis of Rome IV criteria. The cases were selected for the study after fulfilling the inclusion and exclusion criteria. A total 5 cases were selected and followed for a period of 2 to 3 months. Selected cases were diagnosed based on clinical presentation. All the cases were selected with Rome IV criteria and the arrived similimum based on the totality of each individual case was prescribed and repetition was done according to the symptoms. Cases were reviewed once in a 1-3weeks for 2-3months or till the symptoms got reduced intensity and frequency. Study Participants: Cases of both sexes and age limit of 18 to 39 are included in this study. Cases having other systemic illness, cases under treatment of others system of medicine and cases above 39 years of age are excluded from the study. Selection of tools:
Outcome Assessment: Case history of the patients was taken and recorded in a standardized case format with all the details like preliminary data, presenting complaints and its details, general examination, systemic examination, Provisional diagnosis, analysis and evaluation, totality, general management, prescription. Total duration of study was 4months. The prominent clinical features were pain in the lower abdomen, eructation, loose stools, constipation and the intensity of symptoms is variable in each case. The selection of similimum in the treatment of Irritable Bowel Syndrome has better outcomes. It reduces the persons suffering and improves the quality of life (QOL). A MODEL CASE FROM STUDY Case Presentation Ms. A a 26years old student from Peelamedu (Reg no: OP2022/ 1778) presented herself at RVS Homoeopathic Medical College and Hospital, Kannampalayam, Sulur, Coimbatore, Tamil Nadu on 30/09/2022 for treatment of pain in the lower abdomen since 6 months on & off. Pain as of weight in the stomach with fullness of abdomen < after eating, > bending2+, passing stool with internal heat feeling and external chills and foul smell in mouth at morning . Patient also complaints of loose stools since 5 months on & off stool frequency of 2-3 times/ day. Stool character – semisolid, offensive < oily food, anxiety. Past history and Treatment history Took allopathic treatment for menstrual irregularities and got better. No history of typhoid, malaria, dengue, mumps, chicken pox, covid and other systemic illness. Family history No history of diabetes mellitus, hypertension, bronchial asthma and other systemic illness. Personal history Mixed diet. Mental general Anxious because of talks about her marriage in the house , and she is against the idea of marriage because she would like to pursue higher studies (but doesn’t fight for it). Desires company. Physical generals Appetite: Reduced, 2times/ day Thirst: 1-2 L/ day Desire: Cold drinks Bladder habit: 4-5 times/ day, 1time/ night Bowel habit: 2-3 times/ day, slimy, offensive Perspiration: On exertion, offensive foot sweat Thermal relation: Chilly Prescription Rx
Follow up
Result and Discussion In this study 5 cases were selected from RVS Homoeopathy medical college and hospital based on the inclusion criteria. Out of 5 cases the patients are in between 18 – 39 years of age including both the sexes. The cases were selected on the bases of clinical presentation with the assessing parameter of Rome IV criteria and all were prescribed similimum with totality of the case in comparison with Materia medica, repetition was made according to the symptom presentation in the follow up. Table 1: Distribution cases of IBS according to sex In this study of 5 cases of Irritable Bowel Syndrome, Female 3 (60%) more affected than Males 2 (40%). Table 2: Distribution of cases according to types of IBS
|
Among the 5 cases, 3 cases were IBS-diarrhoea dominant (60%), 1 case was IBS – mixed type (20%) and 1case was IBS – constipation dominant.
Table 3: Outcome of cases based on similimum and general management
RESULT | NUMBER OF CASES | PERCENTAGE |
MARKEDLY IMPROVED | 3 | 60% |
MODERATELY IMPROVED | 1 | 20% |
MILD IMPROVEMENT | 1 | 20% |
NO IMPROVEMENT | — | — |
In a total of 5 cases, 3 cases (60%) had marked improvement, 1 case (20%) had moderate improvement and 1 case (20%) had mild improvement.
Limitations
- As only limited number of cases were taken for the study, the conclusion made may not be accurate.
- The accuracy of results cannot be relied due to limited time period for the study.
- Developing the habit of abdominal breathing as a daily routine is limited as it differs from person to person.
Table 4: Remedies prescribed for IBS
CASE | PRESCRIPTION |
CASE 1 | Lycopodium |
CASE 2 | Arsenicum album |
CASE 3 | Sulphur |
CASE 4 | Pulsatilla |
CASE 5 | Lycopodium |
Conclusion
The result of this study shows that females (60%) are more affected than the male (40%) counterpart. Of 5 cases, 3 cases (60%) had marked improvement, 1 case (20%) had moderate improvement and 1 case (20%) had mild improvement. From the result we can interpret that the selection of similimum in the treatment of Irritable Bowel Syndrome has better outcomes. It reduces the persons suffering and improves the quality of life (QOL). In conclusion of the study, we can understand that similimum along with general management of the cases has better results.
References
- Upadhyay Rajesh, Singh Aesha, Irritable bowel syndrome: The Indian scenario [Internet].[cited 2013] Available from: https://apiindia.org/Medicine-Update-2013-Contents
- Canavan Caroline, West Joe, Card Timothy, The epidemiology of irritable bowel syndrome [Internet]. [cited 2014 February 4] Available from : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3921083/#b16-clep-6-071
- Patel Nicholas, Shackelford Karen, Irritable Bowel Syndrome [Internet]. [cited 2022 July 4] Available from: https://www.ncbi.nlm.nih.gov/books/NBK534810/
- Enck Paul, Aziz Qasim, Barbara Giovanni, Farmer D. Adam, Fukudo Shin, Mayer A. Emeran, Niesler Beate, Quigley M. M Eamonn., Stojanović -Rajilić Mirjana, Schemann Michael, Kiuntke-Schwille Juliane, Simren Magnus, Zipfel Stephan, and Spiller C.Robin, Irritable bowel syndrome [Internet]. [cited 2016 March 24] Available from : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5001845/
- Sembulingam K, Sembulingam Prema, Essentials of Medical Physiology, 6thedition, New Delhi, Jaypee Brothers Medical Publishers, 2012,.p.277-283
- Barett E. Kim, Brooks L. Heddwen, Barman M. Susan, Yuan J.X. Jason Ganong’s Review of Medical Physiology, 26th edition, New Delhi, McGraw-Hill Education, 2019,.p.1060-100, 1135-1145
- Loscalzo Joseph, Fauci S. Anthony, Kasper L. Dennis, Hauser L.Stephen , Longo L. Dan, Jameson Larry J., Harrison’s Principles of Internal Medicine, 21stedition, New Delhi, McGraw Hill LLC., 2022.p. 2490-2496
- Raltson H. Stuart, Penman D. Ian, Strachan W.J. Mark, Hobson P. Richard, Davidson’s Principles and Practice of Medicine, 23rddition, China, Elsevier Ltd., 2018,.p.824-825
- Hungin A P, Chang L, Locke G R, Dennis E H, Barghout V. Irritable bowel syndrome in the United States: prevalence, symptom patterns and impact.[Internet]. [cited 2005 June 1] Available from : https://pubmed.ncbi.nlm.nih.gov/15932367/
- Canavan Caroline, West Joe, Card Timothy, The epidemiology of irritable bowel syndrome [Internet]. [cited 2014 February 4] Available from : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3921083/#b16-clep-6-071
- Rasquin A, Di Lorenzo C, Forbes D, Guiraldes E, Hyams JS, Staiano A, et al. Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology. 2006;130(5):1527-37.
- Holloway Beth RN How Do You Know If You Have IBS-C (Irritable Bowel Syndrome with Constipation)? [Internet]. [cited 2021 July 29] Available from : https://www.goodpath.com/learn/know-you-have-ibs-c
- Peper Erik, Mason Lauren, Huey Cindy, Healing Irritable Bowel Syndrome with Diaphragmatic Breathing. Biofeedback, Winter 2017, 45(4):83-87
- Diaphragmatic Breathing for GI Patients [Internet]. [cited 2018 January 23] Available from:https://www.uofmhealth.org/conditions-treatments/digestive-and-liver-health/diaphragmatic-breathing-gi-patients
- Diaphragmatic Breathing for IBS [Internet]. [cited 2021 January 14] Available from: https://www.ibspatient.org/treatment/hypnotherapy-for-ibs/diaphragmatic-breathing/
- Allen’s H.C., Keynotes Rearranged and Classified with Leading Remedies of the Materia Medica and Bowel Nosodes including Repertorial Index, 10thedition, New Delhi, B. Jain Publishers (P) Ltd., 2017.p.37,42,85,109,135,177,180-298
- Kent J. James, Lectures on Homoeopathic Materia Medica Together with Kent’s ‘New Remedies’ incorporated and arranged in alphabetical order, 2nd Rearranged edition, New Delhi, B. Jain Publishers (P) Ltd,2019. p.136,148,183-976
- Boericke William, Boericke’s New Manual of Homoeopathic Materia Medica with Repertory including Indian Drugs, Nosodes, Uncommon Rare Remedies, Mother Tinctures, Relationships, Sides of the Body, Drug Affinities & List of Abrevations, 3rd Revisied and Augmented edition, New Delhi,2016,.p.66,72,81,151,200-548
R.R. Karthikeyan1, S. Gopika2, R. Darshini3
1 Professor and HOD, Community Medicine, RVS Homoeopathic Medical College and Hospital, Sulur, Coimbatore, Tamil Nadu
2 CRRI RVS Homoeopathic Medical College and Hospital, Sulur, Coimbatore, Tamil Nadu
3 CRRI RVS Homoeopathic Medical College and Hospital, Sulur, Coimbatore, Tamil Nadu
Address for correspondence:
Prof. (Dr)R.R. Karthikeyan1
RVS Homoeopathic Medical College and Hospital, Sulur, Coimbatore, Tamil Nadu
