By the way, inflammation cannot be a biological marker because it does not always cause pain.
Irritable Bowel Syndrome: How Far Do You Go in the Workup?
But microscopic inflammation cannot be a diagnostic marker for IBS because it does nor typically produce pain in those who have it. All patients with active celiac disease have microscopic inflammation, but a large proportion do not have abdominal pain, and patients with ulcerative colitis who also have microscopic inflammation when compared with patients with IBS seem to have higher pain thresholds.24 In individuals with these disorders, there may be central nervous system counter-regulatory measures responding to the peripheral pain/inflammatory processes that increase pain thresholds. With regard to IBS, the gut-related effects of microscopic inflammation may be only one component of a dysfunctional brain-gut system. In addition, and often in response to stress, there may be a failure to activate pain inhibition systems that lead to the perception of pain and produce other symptoms that typify this disorder.25 In one prospective study of postinfectious IBS, it was found that those who retained their symptoms 3 months after an enteric infection had not only increased inflammation in the intestinal lining, but also had increased psychosocial distress at the time of the infection. Furthermore, lowered visceral pain thresholds and increased motility were present after the infection regardless of whether or not the patients retained their symptoms.26 Therefore, the microscopic inflammation and its physiologic effects on motility and sensation contribute to, but are not always sufficient for, the clinical expression of IBS pain.
At least for postinfectious IBS, this provides some evidence that psychologic distress alters brain pain regulatory pathways to amplify incoming visceral signals leading to the full clinical expression of this syndrome.27,28
http://www.med.unc.edu/medicine/fgidc/IBS_How_Far_do_you_go_in_the_workup.pdf
-------------------- My website on IBS is www.ibshealth.com
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