Irritable Bowel Syndrome

KEYWORDS: Irritable bowel syndrome (IBS), case report, homeopathic therapy

BACKGROUND

Irritable bowel syndrome (IBS) is one of the gastro-intestinal disorders widely accepted to have no known underlying organic pathology. Though a prevalent condition, the pathophysiology of IBS still remains unclear and is generally attributed to the gut-brain axis dysfunction, where the synchronized functions between the gut microbiota and the autonomous nervous system is disrupted.¹

The recent studies suggest that persistent low grade inflammation of the gut mucosa might play a role in the development of IBS, which eventually leads to epithelial and neuromuscular dysfunction resulting in altered peristalsis of the gut; this challenges the proposal that IBS is purely a functional disorder, but is multifactorial involving potential factors like genetic predisposition and psychological stress.²

The prevalence of IBS differs with each country, but IBS globally affects 9-23% of the population, involving middle aged groups and commonly more among females than in males.^3,4

IBS is diagnosed using the Rome IV criteria^5,6, which is the gold standard method even in assessing the clinical course; this includes the sub-types viz. IBS-D (diarrhea predominant), IBS-C (constipation predominant), IBS-M (mixed diarrhea and constipation) and IBS-U (unclassified).³ While the serological tests are carried out to exclude the probability of celiac disease only.

Conventionally IBS is managed through dietary modifications, pharmacological and psychological therapies. According to the guidelines on management of IBS^7,8, the cases are to be intervened with the Low FODMAP (Fermentable Oligo-, Di-, Mono-saccharides, And Polyols) Diet (LFD), although compared to the cases on gluten-free diet or non-dietary interventions, LFD is proved to be effective.

But various studies have revealed that approximately 30% of the cases do not respond to LFD and long-term application of such diet might result in significant lack of micronutrients.^9–11 While the administration of probiotics are highly recognized, there are still on-going conflicts regarding the same.¹² Psychological therapies for IBS focus on cognitive behavioral therapy and or hypnosis, but provide little evidence on the long-term efficacy of such interventions.^13,14

Formerly, there have been studies published under homeopathic treatment for IBS, but have failed to deliver its evidence of efficacy due to the disease specific administration of the remedies¹⁵ rather than individualization.^16,17  We present a case of a 43 year old female diagnosed of IBS using the Rome IV diagnostic criteria⁶, treated with individualized classical homeopathic therapy.

CASE REPORT

Female, 43 years old

Initial consultation – 21.09.2020

Main complaint: stomach complaints: diarrhea, vomiting, distension; agg. after eating, when acting against conscience, when anxious.

Background information:

Throughout her youth she’s suffered recurring renal colic.

Annual flu (with high fever) usually transforms into cough which lasts for months.

Tonsils and adenoids removed in childhood.

In recent years, the symptoms of IBS got worse, which makes it very difficult for her to work. She is a physiotherapist and when working with a patient she cannot be taking breaks to relieve herself. The anxiety related to talking to people brings on the abdominal pain and strong urges to go to the toilet.

Currently:

Fears: “Everything”. Heights, drowning, narrow spaces, accidents (she is very nervous while driving).

Anxiety, anxious when talking to people. Feels like she may not understand them, or they won’t understand her.

Food-Desire: Bread & butter, cheese, nuts, tomato, eggs soft; Aversion: raw meat; Agg: Bread, chocolate, meat

Thirstless

Sleep: nightmares (can’t make it to the toilet, or public toilet too dirty)

Sleep position: abdomen can’t, covered, desires fresh air

Perspires when anxious

Motion sickness.

Uterine growth.

Cough during winter.

Bladder stones.

Breast sore at the beginning of menses.

Diarrhea at the beginning of menses.

Difficult breathing when ascending.

Abdominal pains after eating, which can be followed by diarrhea and vomiting.

Abdominal pains when anxious; when feels pressured to do what she doesn’t want to do; in conflicting situations.

Table 1: Repertorisation of symptoms 21.09.2020

Symptoms
Mental/emotional	Physical	Generalities
MIND ­ STUPEFACTION ++ MIND ­ FEAR ­ high places, of ++ MIND ­ FEAR ­ animals, of ++ MIND ­ FEAR ­ narrow places, in ++ MIND ­ FEAR ­ crowd ­ in a ++ MIND ­ CONTRADICTION ­ is intolerant of +++ MIND ­ FEAR +++	ABDOMEN ­ PAIN ­ menses ­ beginning of +++ RECTUM ­ DIARRHOEA ­ menses, at beginning of + BLADDER ­ CALCULI ++ STOMACH ­ NAUSEA ­ motion ­ on +++ STOMACH ­ THIRSTLESS ++ SLEEP ­ DREAMS ­ nightmare ++ PERSPIRATION ­ ANXIETY ­ during +++ RESPIRATION ­ DIFFICULT (Dyspnoea) ­ ascending +++ CHEST ­ PAIN ­ Mammae (Mastodynia) ­ menses ­ before +++ GENITALIA­FEMALE ­ POLYPUS ­ Uterus +++	EATING – after – agg. +++ FOOD and DRINKS ­ sweets ­ agg. ++ FOOD and DRINKS ­ bread ­ agg. +++ FOOD and DRINKS ­ meat ­ agg. ++ FOOD and DRINKS ­ bread and butter ­ desire +++ FOOD and DRINKS ­ cheese ­ desire ++ FOOD and DRINKS ­ eggs ­ desire ­ boiled ­ soft +++ BATHING ­ hot bath ­ amel. ++

Figure 1: Results based on repertorisation of symptoms in Table 1

Level of health – 5-6 (the organism is able to bring up high fevers, which indicate higher level of health. However, her acutes are severe and long-lasting.)

Prescription: Calc carb 30C (even though the patient is in a higher level of health and can be prescribed higher potency, she is very sensitive, hence the 30C was chosen as starting point.)

Table 2: Follow ups

Date	Follow up	Prescription
14.10.2020	Two days after taking the remedy the patient had stomachache and diarrhea. Less anxiety driving on freeway. Less brain-fag. Mind feels clearer. Can understand people better in conversation and is less stressed about not being able to understand. Thirst increased. New dreams during sleep. Enjoying her femininity – “it feels good to be a girl”. At the time of the follow up no diarrhea due to anxiety. No perspiration due to anxiety. “I feel like a princess in a fairy-tale that was under a spell until a fairy came and took it off… I feel like I lived in a zip-lock bag all my life and now I feel free.  I’m trying to remember when I felt this way and I go as far as kindergarten. I think I can smell better too now.  I noticed today that I don’t even hate flies anymore.  I used to hate them and try to kill them. Since my grandma told me long ago that they bring disease. It feels like I lived by fears and restrictions of all my relatives and now I can finally decide what to keep and what to let go.”	Nil
22.10.2020	The patient reported complete relapse which started a few days prior when she remembered that she shouldn’t have had coffee. She had coffee few times during the period.	She was asked to repeat the remedy for antidoting.
23.10.2020	She felt nauseous and had flu like symptoms.  Recovered after a day. But the anxiety comes and goes	Nil
29.11.2020	After the initial relapse, the patient didn’t feel that she managed to return to that good feeling she had when she first took Calc Carb 30C.  While the anxiety was not as bad as it was before, it still weighed her down and affected her thinking. She felt she lack clarity, which she now knew she could attain. The abdominal symptoms would occasionally return. That would affect her energy level and ability to perform well in her duties.	Calc Carb 200C
18.12.2020	Flu-like symptoms – high fever, muscle pain, chills, cough. Feeling very weak. Suffocating cough worse at night, during sleep. After taking the remedy, the patient immediately felt better.  She perspired a lot. She regained her energy. The cough became productive and started to improve in intensity and frequency.	Calc Carb 30C
25.12.2020	After feeling better, the patient started to attend to her family members who were sick with COVID 19. Caring for her family day and night, she became exhausted, and her cough became worse. She lost her sense of smell. Despite the great demand that was placed on her, she had enough energy to continue with her duties.	On her own accord, when her cough would get very bad, she would take a dose of Calc Carb 200C and the cough would get better, but once overworked it would return.
30.5.2021	The patient complained of not having enough energy. Her IBS was back and was bothering her a lot. Her anxiety while driving returned. She felt uneasy while talking to people. Her general symptoms were the same as before.	Calc Carb 1M
2.07.2021	After taking Calc Carb 1M, the patient felt emotionally better, but the symptoms of IBS became increasingly worse.  Her old fears were gone but were replaced with a deep sense of inadequacy. Few weeks ago, she went to a dance class and all of a sudden, she felt that she was “not good enough”. She felt very insecure within herself, and it bothered her a lot. When describing how she felt she sounded very confident. It was pointed out to her, to which she explained that she is very good at making herself look confident, but that’s not how she feels. (See repertorization in Table 3)	Lycopodium 30C
1.08.2021	The patient reported, “I am better on all levels.” She observed gradual improvement. In her own words, “Comparing to the first remedy that I took [Calc. Carb.] and that brought me tremendous relief overnight this one started to work slowly. Over a few days after taking, I started to feel calmer and more relaxed. I was not worried all the time what might go wrong. The foggy feeling or being stuck under the dirty foggy glass jar slowly disappeared. I am able to communicate with other people without a fear of what I’m saying wrong or what they think that I’m saying wrong. This made me hear more clearly what people are saying to me and be able to express more freely what I want to say to them. Without worrying of being constantly judged. It’s an amazing feeling of clarity and freedom. Before I had moments like this and then it would fall back into stupor and fogginess. So, I was worried that it will happen again this time. But as of now the state of comfort does not leave me. It’s hard to explain to people who never felt this way how it feels. But almost like I was stuck in the emotional jail. And after taking the remedy being free from this emotional jail.” Her memory has improved significantly.  In the past she would intend to do something and then forget all about it.  That would cause her a lot of embarrassment.  Now, she remembers her commitments. As the anxiety settled, her IBS symptoms started to disappear. No abdominal pains, no diarrhea, no vomiting. Energy level is good.	Nil

Table 3: Repertorisation of symptoms 2.07.2021

Symptoms
Mental/emotional	Physical	Generalities
MIND ­ CONFIDENCE ­ want of self­confidence (low) +++ MIND ­ COWARDICE +++ MIND ­ RESPONSIBILITY ­ aversion, to ++ MIND ­ ANXIETY +++ STOMACH ­ ANXIETY +++ MIND ­ ANXIETY ­ company ­ when in ++ MIND ­ FEAR ­ crowd ­ in a ++ MIND ­ MEMORY ­ weakness of +++	BLADDER ­ CALCULI ++ ABDOMEN ­ PAIN ­ menses ­ beginning of +++ RECTUM ­ DIARRHOEA ­ menses, at beginning of + PERSPIRATION ­ ANXIETY ­ during +++ CHEST ­ PAIN ­ Mammae (Mastodynia) ­ menses ­ before ++ GENITALIA­FEMALE ­ POLYPUS ­ Uterus +++ STOMACH ­ NAUSEA ­ riding in a carriage or car, while +++ RECTUM ­ DIARRHOEA ­ anxiety, after ++ STOMACH ­ DISTENTION +++	FOOD and DRINKS ­ olives ­ desire ++ FOOD and DRINKS ­ eggs ­ desire ­ boiled ­ soft ++ FOOD and DRINKS ­ cheese ­ desire ++ FOOD and DRINKS ­ sweets ­ agg. ++ FOOD and DRINKS ­ bread ­ agg. ++ EATING – after – agg. +++

Outcome:

The patient experienced improvement in order of priorities – with every prescription she first regained her mental-emotional balance, with physical health to follow. Calc carb has cleared many of her fears and in time exposed the underlying feeling of inadequacy, which led to Lycopodium prescription.

Once at peace with herself, her body was able to calm down and let go of the IBS symptoms. We still have some way to go with this case when the next remedial picture may erupt at a more superficial level, and then we can claim cure here.

DISCUSSION

Homeopathic system of medicine has gained popularity over the past few decades, specially known for its individualized treatment of the patients irrespective of the underlying disease conditions they endure.

To achieve even slight improvement in cases like IBS, it is very essential to strictly adhere to the laws and principles of homeopathy and the same has been demonstrated in the case presented here. History of tonsillectomy has been established as a  risk factor for developing IBS¹⁸ later in life, indicating that the homeopathic perspective of ‘driving in’ of disease is indeed correct. In this case we see an example of this.

Along with the pathological symptoms of IBS, the patient deeply suffered from vivid fears accompanied with an unexplained anxiety which served as triggers for her IBS symptoms. The remedy was prescribed based on totality, purely individualistic to this particular case.

The changes were recorded in just two days after the remedy Calc carb, where the psychological states of phobia and anxiety dramatically reduced. But the patient was exposed to her family with covid19 infection, and she developed mild symptoms similar to the infection.

At this point the patient required a new remedy, but the patient repeated the remedy on her own accord, which might have caused a relapse of her chronic issue. This could have been avoided if the infection was treated right there.

After this infection subsided, patient required a higher dose of the same remedy. This led to an over-all improvement of her psychological state and evolved to a degree where she feels an inner freedom. The patient eventually developed acutes with flu like symptoms, which are milestones in homeopathic treatment, because acute inflammatory states are important for the immune system to cross over the chronic pathological state as propounded in the “continuum” of a unified theory of diseases¹⁹ by prof. George Vithoulkas.

These acutes need to be treated homeopathically, so that the immune system is not compromised. This can be evidenced by the shift of the psychological state of the patient from anxiety to lack of self-confidence after the development of the acutes. According to the hierarchical levels of emotions, lack of self-confidence is of lower order compared to anxiety and phobias¹⁷. Further, by addressing this state with Lycopodium, the case beautifully recovered from IBS.

CONCLUSION

The patient reported here benefited from classical homeopathic treatment for her IBS. Further studies are required to assess the usefulness of homeopathy in such fields.

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