Research Links Gut Microbiome Changes to Brain Structure in Irritable Bowel Syndrome (IBS)

June 14, 2017

The international gastroenterology conference, Digestive Disease Week, which traditionally takes place annually in mid-to-late May or early June generally brings a wealth of news on state of the science developments in gastroenterology research for a range of conditions, including irritable bowel syndrome (IBS). One of the interesting and groundbreaking articles presented this year,  which has received recent coverage in both scientific and mainstream media, is a collaboration of 14 researchers from UCLA, Texas Children’s Microbiome Center and Baylor College of Medicine,  and the Washington University School of Medicine in St, Louis, Missouri. The authors confirmed the existence of IBS microbiome subgroups as found in various researchers’ past work and made a preliminary identification of some specific microbes and their metabolites that appear to be involved. Also, for the first time, they found that structural differences in the brains of some study volunteers with IBS appear to correlate with gut microbiome composition.

The open access full text of the journal article, “Differences in gut microbial composition correlate with regional brain volumes in irritable bowel syndrome” by J. S. Labus, et al, was published in  Microbiome on May 1, 2017 and is linked above. “Study shows association between gut microbes and brain structure in people with IBS” by Enrique Rivero of the medical news website Medical XPress was published on May 5, 2017 based on information from UCLA. These sources were consulted for the summary below.

International IBS research in past years has previously established that IBS involves disruptions in the brain-gut-microbiome axis in both directions from the brain to the lower GI tract and from the GI tract to the brain. It also has been known that there are structural and functional brain changes in IBS, particularly in the areas controlling sensation and salience (a mechanism of the brain involved in attention to and perception of the relevance of stimuli), and particularly in those with a history of early trauma. Additionally, it has been known that there are changes in microbiome composition in those with IBS compared to healthy controls. However, until now, because of the extremely large number and range of different types of microbes present in the GI tract, it has been challenging to pinpoint specific and consistent microbes or to connect these patterns to the neurological differences. The above study has begun to do so.

The investigators obtained a variety of data from the volunteers including, history, physical exam, numerous standard questionnaires for various aspects of mental health, behavior, diet, and trauma history, if any,  as well as stool samples and brain imaging. The study participants included 29 adults with IBS according to Rome III international diagnostic criteria (in effect at the time, although Rome IV has been in effect since May 2016), about three-quarters of whom were female, representing all of the bowel habit subtypes, diarrhea, constipation, alternating or mixed, and unspecified/unsubtyped. There were 23 control subjects without IBS, all of whom were female. The IBS and control groups were roughly similar in average age. The average length of having IBS for those in the IBS group was 11.3 years, plus or minus 13.2 years.

There were no statistically significant differences in diet. Although a minority of the IBS group showed clinical anxiety and the total trauma history scores were similar between the two groups, those with IBS reported greater anxiety, stress, catastrophizing and trauma history.

The microbiome analyses showed that the participants with IBS fell into two groups. 14 individuals (9 women, 5 men) had a statistically significant altered gut microbiomes while the other 15 (12 women, 3 men) had microbiomes that were essentially indistinguishable from the healthy controls. These differences between groups were not correlated with age, IBS subtype, medication usage, stress, anxiety, depression or catastrophizing. There was some association between history of early life adversity and length of time with IBS and the microbiome alterations in the first group.  Neurological changes in relation to the healthy control group were found in both subgroups of the volunteers with IBS, but were more pronounced and extensive in the group with the microbiome changes.

It should be emphasized that this was a preliminary, exploratory study of a relatively small sample group, and while many details of the findings appeared to the researchers to be consistent with past studies on IBS , some aspects were more surprising, and many unknowns remain, including the causes of these alterations in these individuals with IBS. However, it is hoped that in time, with further research, IBS investigators will be able to identify consistent microbiome patterns in particular subgroups of IBS that will aid in diagnosis and determination of the optimal treatments for  specific individuals.

IBS Impact looks forward to following the progress of research in this aspect of IBS and hopes to report on more advances in the months and years to come.

 


Representative Pocan of Wisconsin Co-Sponsors HR 1187 for Functional Gastrointestinal and Motility Disorders

May 8, 2017

According to IFFGD and the official Congressional legislative database Congress.gov, Representative Mark Pocan (D-WI-2) recently signed on as the first co-sponsor to the Functional Gastrointestinal and Motility Disorders Research Enhancement Act of 2015.

Representative Pocan is serving his third term in the House of Representatives. His district, the 2nd Congressional District of Wisconsin, encompasses Dane County, Iowa County, Lafayette County, Sauk County and Green County and parts of Richland and Rock Counties, including the state capital of Madison and environs. According to his official House website, Representative Pocan is a member of the House Appropriations Committee where he sits on the Subcommittee on Labor, Health and Human Services and Education, and he supports various health and veterans’ issues. Functional gastrointestinal disorders like IBS disproportionately affect military veterans and service members. He was also a co-sponsor of the most recent previous version of the Act, HR 2311 in 2014-2016, which did not pass.

If you are a constituent of Representative Pocan, please take a few minutes to write or call him with your thanks for his continued  support of the functional gastrointestinal and motility disorders community.

In officially supporting HR 1187, Representative Pocan joins Representative F. James Sensenbrenner, Jr. (R-WI-5) , who is the initial sponsor. If you are a constituent of Representative Sensenbrenner, please thank him as well.

U. S. citizens, if your Member of Congress is not yet a co-sponsor of HR 1187, please see the previous post from March 21, 2017 for links to the bill and more details on how to do so.  Often, it takes multiple attempts to elicit any interest from legislators, so if you do not receive a reply, do not hesitate to try again or to switch contact methods until you attract attention. Keep in mind that your Representative may be different from before because of the 2016 elections, district boundaries that may have been re-drawn, or if you have moved.

Your personal experiences as a person with IBS and/or other functional GI/motility disorders, or as a concerned family member, friend or colleague, are most effective in communicating to legislators and their staff that there are real human beings behind the statistics. However, even general expressions of support are helpful.

HR 1187 is bipartisan legislation (supported by members of both parties) and according to IFFGD discussions with IBS Impact,  is “revenue-neutral,” meaning that there will be no additional taxes or spending added to the current federal deficit if it is enacted. Discretionary funds are available at the National Institutes of Health to be allocated if Congress directs NIH, through this Act, that functional gastrointestinal and motility disorders are a priority. Congress will only do so if we, as a community, are able to show them the importance of the research, education and FDA coordination provided for in HR 1187.

NIH grants funding to researchers throughout the world, not just in the U.S., so in the long run, enactment of this Act may also benefit readers with IBS in other countries. Medical research also sometimes involves multinational teams of scientists, and in any case, study results are usually published globally, adding to the cumulative knowledge worldwide.

It is IBS Impact’s understanding that HR 1187 will not require a debate or vote on the floor of the House of Representatives, and will pass as soon as it reaches 218 sponsor/cosponsors, or a simple majority of the House. In order for this milestone to be accomplished during the current Congress, the 115th,  the necessary number of sponsor/cosponsors must be reached by December 2018. Every two years, the Congressional membership will be different as a result of elections. Thus, if HR 1187 has not passed by that time,  a similar bill will have to be reintroduced and the FGIMD community will have to start the process of gathering co-sponsors anew. This is what occurred with HR 2239 in 2012, HR 842 in 2014 and HR 2311 in 2016. While it is quite common for legislation of various sorts to take several Congresses to pass, our continuing advocacy now can increase awareness, build momentum and perhaps accelerate passage. It is in our hands.

Check back on this blog or join IBS Impact’s Facebook page or Twitter feed for further updates on HR 1187 as they occur. Links to the social media sites can be found on the right sidebar of the blog.


IBS Awareness Month 2017: Approaching a Decade of IBS.

April 30, 2017

by Nina Pan, IBS Impact founder and primary blogger for IBS Impact.

Four years ago, on April 24, 2013, I wrote a post for IBS Awareness Month that began with some reflections on my personal experiences with IBS, as well as my motivations for IBS Impact. At that time, I had been living with IBS for over five years, and 2013 marked my sixth April with IBS. I observed how for many of us, dealing with the numerous actual or potential effects on a day to day basis often makes it difficult to recognize when progress is being made, either for us as individuals, or for the IBS community as a whole. I stated that it is only with the passage of time that I had begun to realize how some things are indeed changing, albeit slowly, for the better. In the rest of the post, I pointed out numerous areas in IBS research, IBS treatment, understanding of the impact of IBS on quality of life, increased societal support and advocacy that had seen concrete, positive change in just the five years and six IBS Awareness Months I had personally experienced.

 On April 10, 2014 ,  April  14, 2015, and April 29, 2016, I reported in a similar vein on progress for the IBS community in each respective year. Now, continuing the tradition during my own ninth year and tenth IBS Awareness Month, once again, I can observe small steps forward in just a single year.

Progress in the science of IBS:

In the past year, the science of IBS has continued to expand in many areas, from diet, to gut microbiota, to understanding of the visceral hypersensitivity responsible for pain, to stigma, and the effect of parental response on children with functional abdominal pain  and many other topics. These varied endeavors are taking place in or with the involvement of many scientists from many countries. See other posts in the Research category of the blog sidebar or our Facebook or Twitter feeds to see the range of research news and clinical trial opportunities publicized over the most recent several months. The annual Digestive Disease Week international gastroenterology conference taking place shortly in May traditionally provides even more state of the science research news each year.

Progress in the diagnosis and treatment of IBS:

 Over the past two and a half years, this blog has often reported on the development of Rome IV criteria, the latest update to the international symptom-based diagnostic criteria for functional gastrointestinal disorders like IBS, which was officially published and presented to the international gastroenterology community in May 2016.  This latest update reportedly involved over 100 experts from numerous countries. The Rome criteria, which are said by leading IBS researchers to be 98% accurate for most people with IBS symptoms, have been in existence in some form for 26 years, although research shows that many people with IBS and medical professionals who do not specialize in IBS remain unaware of this.

In addition to some changes in symptom criteria, Update on Rome Criteria for Colorectal Disorders: Implications for Clinical Practice,” by Magnus Simren, MD of the University of Gothenburg in Sweden, Olafur Palsson, PsyD and William Whitehead, PhD of the University of North Carolina Center for Functional GI and Motility Disorders in the U.S., published this month in Current Gastroenterology Reports, notes that the Rome IV is attempting to encourage a transition from the more stigmatizing “functional GI disorders” to a “disorders of gut-brain interaction,” which is more reflective of current understanding of IBS and related disorders, some of which include functional diarrhea, functional constipation and  centrally mediated abdominal pain (functional/recurrent abdominal pain) among others affecting the lower or upper GI tract.  In addition, the authors state that, “Therefore, in Rome IV it is emphasized that functional bowel disorders constitute a spectrum of GI disorders rather than isolated entities. It is acknowledged that, even though they are characterized as distinct disorders based on diagnostic criteria, significant overlap exists, and occasionally, it may be difficult to distinguish them as distinct entities. Furthermore, it is also highlighted that transition from one functional bowel disorder to another, or from one predominant symptom to another, is frequently seen, and this may occur as part of the natural course of the disorder, as a response to therapy, or both.”

As this blog reported on October 11, 2015,  Rome IV guidance also includes a new Multidimensional Clinical Profile which, for the first time, takes into account common extraintestinal (non-GI) symptoms and other psychological and social factors that may influence care. It is hoped that all of these changes will provide better diagnosis and treatment for people with IBS worldwide, and new opportunities for education of medical professionals in disorders of gut-brain interaction.

Several investigational medications and other non-pharmaceutical treatment options are always in the research pipeline in various parts of the world. Eluxadoline (brand name Viberzi), already in use in the United States, was approved by Health Canada in March 2017. According to Canadian contacts, the timeline for availability depends on provincial decisions.

 Progress in understanding the impact of IBS and the barriers that remain:

As this blog reported on January 29, 2017, in December 2016, the Gastrointestinal Society released its report on a year-long survey on experiences and opinions and needs of adults with IBS and parents of children with IBS across Canada. The results are intended to shape future GI Society programs and to advocate and educate health care providers, policymakers and community members about IBS. A five-question followup survey, open to previous and new participants, is still accepting responses at this time. The link to both the report and the follow-up are in the linked January post.

Progress in societal supports for people with IBS:

The IBS Network in the United Kingdom made great progress this past year in its ongoing efforts to support and expand the availability of local, in-person self-help/support groups for people with IBS in the UK. as reported by this blog on October 23, 2016 and January 13, 2017.

Although the Irritable Bowel Information and Support Association (IBIS) in Australia closed this year, the administrators of the IBS Support Facebook group, of which I am one, were pleased to be recognized as one of the two alternative resources IBIS suggested on its remaining web page. This international, evidence-based educational group is currently administered by 9 individuals from 4 countries, all of whom have had IBS for many years, and are highly knowledgeable from formal professional education and experience and/or many years active in the IBS community. At this time, membership is over 27,000 and grows by about 1000 members each month.

Monash University in Australia, developers of the low-FODMAP diet that is effective for reducing symptoms for many people with IBS, continues to test specific foods and product brands in several countries, in some cases, leading to revision of its previous recommendations.  It also adds new countries as research and resources permit. In late March of this year, Dutch foods were added to the app, allowing those in the Netherlands to use it more easily. Monash also has a low-FODMAP certification program, whereby food product manufacturers whose products have been tested by Monash as appropriate for the diet, may display an official certification symbol to alert consumers. The number of products currently certified is small, but growing Previously, the only manufacturers listed were in Australia or New Zealand, but there have been recent additions in the U.S. and Canada as well.

Progress in advocacy and awareness:

The International Foundation for Functional Gastrointestinal Disorders has  continued to shepherd the Functional GI and Motility Disorders Research Enhancement Act through its fourth attempt at passage by the U.S. House of Representatives, with the support of IBS Impact and other groups and individuals. After three previous attempts in the three previous Congresses,  it  was reintroduced in the the current 115th Congress under a different Act number, HR 1187, in March 2017 and has received bipartisan support from Representative.  See the Legislation category, HR 1187,   HR 2311 HR 842 and HR 2239 subcategories in the right sidebar of this blog for more on this history of this important Act.  IFFGD has also been an ongoing advocate for veterans, who are disproportionately at risk for functional gastrointestinal disorders like IBS.

IBS Impact once again completely redesigned and updated its main website in December 2016 and continues to make incremental updates and improvements several times a year.  The number of followers of this blog and our social media accounts continues to increase. Largely due to the release of the Rome IV criteria in May 2016, overall hit counts average 300-400% higher than prior to Rome IV and have remained in the new range almost one year later. A Rome IV post has now displaced the August 12, 2011 post on IBS being added to service-connected disabilities for Gulf-era U.S. veterans as the most popular post in the history of this blog, a status the previous post held from 2011-2015. Cumulatively, IBS Impact now reaches readers in over 130 different countries and territories on every continent of the globe.

These are just a handful of examples of progress for the IBS community in the past year. Cumulatively, there are many more. Obviously, we still have very far to go before all people with IBS have all the medical and social supports that we need for fully productive lives, with or without IBS,  but we have come far as well. There are reasons for hope, especially if more of us do our part for self-advocacy and awareness in the years and IBS Awareness Months to come.


Free Online Webinar for IBS, Functional GI Disorders with Dr. Drossman, “Achieving Effective Patient-Provider Communication” on April 24, 2017

April 17, 2017

The American College of Gastroenterology has announced that for IBS Awareness Month, it will be sponsoring a free online webinar presented by Douglas Drossman, MD, MACG  and one of his patients, Katie Errico on “Achieving Effective Patient-Provider Communication.” The webinar will take place on Monday, April 24, 2017 from 8:00-9:00 p.m. Eastern time. The webinar is designed specifically for people with irritable bowel syndrome and/or other functional gastrointestinal disorders.

Dr. Drossman, a leading, internationally-known expert on IBS, functional gastrointestinal disorders, doctor-patient relationships and the biopsychosocial approach to medical care, is President of the Drossman Center for the Education and Practice of Biospsychosocial Care, President of the Rome Foundation, Professor Emeritus of Medicine and Psychiatry at the University of North Carolina at Chapel Hill, retired co-director of the University of North Carolina Center for Functional GI and Motility Disorders and a longtime board member of the International Foundation for Functional Gastrointestinal Disorders,  along with many other pivotal roles in the development of the field of functional gastrointestinal disorders like IBS over his 40+ year career.

To participate in the webinar, please use the link to register. You will need to provide ACG with your full name and email address so that instructions for accessing the webinar on the scheduled date can be sent to you. It is open to anyone in any geographical location who has Internet access fast enough to handle streaming video, audio and chat technology. You will be able to ask questions after the presentation. Please keep in mind that Dr. Drossman cannot diagnose or treat anyone over the Internet, and depending on the number of participants and questions, he and Ms. Errico may or may not be able to get to every question.

“Achieving Effective Patient-Provider Communication” online webinar with Dr. Drossman, April 24, 2017

This is a tremendous and rare opportunity, especially for people with IBS or their loved ones to hear from and communicate directly with one of the world authorities and pioneers in the research, education and treatment of IBS. IBS Impact thanks ACG for making this webinar possible. We also thank Dr. Drossman for taking time out of his busy schedule to make himself available to the general public, and for his long decades of commitment to making functional gastrointestinal disorders like IBS a serious field of medical research and to supporting and treating many who live with these complex conditions.

 

 


ACTION ALERT: Functional Gastrointestinal and Motility Disorders Research Enhancement Act of 2017 (HR 1187)

March 21, 2017

In early March 2017,  the International Foundation for Functional Gastrointestinal Disorders (IFFGD) publicly made known that the Functional Gastrointestinal and Motility Disorders Research Enhancement Act of 2017, also known as HR 1187 was introduced in the United States House of Representatives on February 16, 2017.  HR 1187 addresses public awareness efforts and research funding for functional gastrointestinal and motility disorders like IBS, as well as improved efforts at coordination of research efforts and prescription drug approval among federal entities and the functional GI and motility disorder community.

This is similar to the bill that was known in the 112th Congress in 2011-2012 as HR 2239, in the 113th Congress in 2013-2014 as HR 842 and in the 114th Congress as HR 2311. Because the composition of Congress changes with each federal election, it is not unusual for legislation that does not pass to be reintroduced in future sessions under different bill numbers depending on the date of introduction.

IBS Impact thanks IFFGD  for its ongoing work of many years in bringing this bill to fruition, and urges readers who are U.S. citizens to advocate for this landmark legislation on behalf of people with IBS and related disorders. As with the previous versions of the Act, HR 1187, was introduced by Representative F. James Sensenbrenner, Jr. (R-WI-5) as the initial sponsor. On March 13, 2017, Representative Mark Pocan (D-WI-2), a co-sponsor of HR 2311 in the previous Congress, became the first co-sponsor of HR 1187.

Past versions of the Act have been supported by both political parties and it is a revenue-neutral bill, meaning no new spending or taxes are involved. However, through this legislation, Congress can direct the National Institutes of Health to allocate existing discretionary resources specifically to IBS and other functional gastrointestinal and motility disorders, such as GERD, gastroparesis, chronic idiopathic psuedo-obstruction, functional dyspepsia, short bowel syndrome, Hirschsprung’s disease, cyclic vomiting syndrome, chronic bowel incontinence from various causes, and many others, which collectively affect about 25% of Americans. Irritable bowel syndrome is the most common of these. NIH grants funding to researchers throughout the world, not just in the U.S., so in the long run, enactment of this Act may also benefit readers with IBS in other countries. Medical research often involves multinational teams of scientists, and in any case, study results are usually published globally, adding to cumulative scientific knowledge among professionals and public awareness of various conditions worldwide.

In order to pass the House of Representatives in this Congress, HR 1187 needs support from 218 Representatives, a majority of the House, by the end of the current 115th Congress in December 2018. During 2011-2012, the previous bill received sponsorship or co-sponsorship from 17 Representatives in 12 states and both political parties, in 2013-2014, 20 Representatives from 13 states and both political parties, and in 2015-2016, 13 Representatives from 7 states and both political parties. Some are no longer members of the House of Representatives, but IBS Impact hopes that previous cosponsors who are still in office will continue their support and encourage their colleagues to sign on as well. Now affected people and our supporters must show Congress that this is important enough to pass and enact.

For more information, see IFFGD’s link at: https://iffgd.org/advocacy-activities/congressional-bill.html
The text of the bill, the current status and cosponsors can also be accessed directly at any time through its official Congressional database entry at Congress.gov. If you do not know who your Representative is, you can look up this information by entering your zipcode in the “Find Your Representative” search box with the white U.S. map graphic near the top right corner of your screen at house.gov. In some zipcodes, different areas fall into two or more different Congressional districts, in which case you will then be prompted to enter your exact street address to determine the correct district.

Clicking on your Representative’s name will take you to his or her official House website, which will have contact forms, links or details. If you already know who your Representative is, you can generally find the website by typing his or her name into any Internet search engine. Because modern security procedures for postal mail may result in significant delays, legislators generally prefer to hear from constituents through email/website contact forms or telephone. If you choose to call, it is preferable to ask for the staff person in charge of health issues, but if he or she is not available, you may leave a message or speak to the person who answers your call. Many legislators also have social media accounts.

Your specific personal experiences as a person with IBS and/or other functional gastrointestinal disorder or a family member, friend or professional who supports us, and how HR 1187 is needed are most effective in communicating that we are real people behind the statistics. However, even a polite general request can demonstrate to your Member of Congress that there are many constituents interested in the swift passage of this Act.

When writing and/or calling, be sure to state your name, where you live in the Congressional district and that you are a constituent. Tell briefly why you are interested in HR 1187 so they know who you are and why the bill is important– such as have had IBS for X years, have had difficulty finding adequate relief or have a family member with IBS, etc. If you are prepared with a few reputable facts and details about IBS in general to show that this is a widespread issue, not just your personal problem, these also help in showing credibility on the issue. The IFFGD link above has some suggested talking points.  Familiarity with your Representative’s record on or interest in other health issues may also help,  but if you do not know these things, telling your own experience is fine. Be sure to say thank you. Then pass the word to family, friends, coworkers or classmates who have been supportive of you with your IBS. Keep in mind that because of the 2016 elections and redistricting, you may have a different Representative than before, even if you have not changed your residence.

Please sign your real full name, physical address and email address if you choose to write,  or give this information to the staff member you speak to you choose to call on the telephone. Most offices will request it near the end of the call so that they have a record of callers and issues discussed. This is important so that Congressional staff members know that you are actually a constituent and potential voter in their district. Many legislators do not accept communications from those outside their own districts. They may also wish to respond to you, although it may take several attempts to attract attention or some time to receive a reply. Please contact only your member of the U.S. House of Representatives at this time. The President, Senators, Governors or other state or local officials do not have any control over this part of the legislative process.

You do not have to be an excellent writer or speaker, just one that your Representative and his or her staff will see as a real person with real issues and real needs, not a “canned” request copied and pasted from somebody else’s letter. Keep your message short– one page or less in writing, or a phone message or conversation of a couple minutes.

This is a major opportunity for the IBS community and its various websites, groups and organizations to come together, regardless of political or philosophical differences, make our needs known, and do something to make our lives better in the future. Self-advocacy to get legislation enacted takes time, effort and patience, but it is possible if more people are willing to make noise publicly, as other health and disability groups do.

For all those with IBS who complain that nobody understands and nobody wants to do anything for us, now is your chance to make yourself heard. Some people want to understand and help. Congress has the power to make this bill happen. Each of us has the power to make it happen by coming out of the closet, getting over the embarrassment and asking publicly and persistently for this very specific help. It only takes a few minutes to write an email or pick up the phone. Please do it.


GERD Awareness Week: November 20-26, 2016

November 21, 2016

This week is the annual GERD Awareness Week. Gastroesophageal reflux disease, like IBS, falls under the broad category of functional gastrointestinal and motility disorders, and many people with IBS also have GERD. According to About.com IBS Guide Barbara Bradley Bolen, PhD, some studies show that over 70% of people with IBS report some symptoms of GERD and vice versa, but that among those with actual diagnoses, the overlap rate ranges from about one-quarter to one-third. GERD occurs when the lower esophageal sphincter, the valve connecting the esophagus to the stomach, fails to close completely and consistently when needed, and stomach acids and digested food inappropriately back up into the esophagus on a recurring basis. GERD is estimated to affect at least 20% of American adults, both men and women. GERD also commonly affects children of all ages, including infants. A wide variety of lifestyle factors, medical conditions and medication side effects are thought to be possible factors in causing or exacerbating GERD.

Symptoms vary from person to person and are not restricted to heartburn. Some people may not have noticeable symptoms at all until they experience complications. Some other possible symptoms of GERD are: belching, coughing, hoarseness, difficulty or pain in swallowing, excessive saliva, the sensation of food sticking in the esophagus,  chronically sore or irritated throat, laryngitis, inflammation of the gums, erosion of tooth enamel, bitter taste in the mouth, and bad breath. Chest pain may also be a symptom of GERD, but should receive immediate medical attention to rule out the possibility of cardiac problems or other serious conditions. Other possible symptoms of GERD occurring more than once a week or the need to use non-prescription heartburn/reflux medications for more than two weeks without resolution should be discussed with a doctor.

Relative to other functional gastrointestinal and motility disorders, GERD is generally considered by physicians and many affected people to be quite treatable by a variety of lifestyle and diet modifications, prescription medications and/or surgery. Many people have mild GERD and, with appropriate medical care, are at low risk of serious complications, but untreated GERD can lead to inflammation, erosion or narrowing of the esophagus or, in a small percentage of cases, Barrett’s esophagus, cell changes that heighten the risk of esophageal cancer. According to a brief extract of a longer IFFGD publication by Carlo DiLorenzo, M.D. of Children’s Hospital of Columbus and Ohio State University, Dr. Mark Glassman, MD of Sound Shore Medical Center in New Rochelle, New York, and Paul Hyman, M.D. of Children’s Hospital in New Orleans, Louisiana, some children with GERD and other conditions such as asthma, cystic fibrosis, abnormal lung development due to premature birth, muscle or nerve disorders affecting swallowing, or esophageal dysplasia, are at risk of GERD complicating those conditions.

Please see the following links for further information and resources and the original source for Drs. DiLorenzo, Glassman and Hyman’s work mentioned above.  IFFGD also offers downloadable GERD, IBS and functional GI and motility disorder awareness brochures and posters for anyone to hang or distribute in his or her own community, that are accessible from the IFFGD links posted here. As American Thanksgiving is approaching this week, readers may find IFFGD’s holiday GERD-reducing tips to be particularly useful.

 GERD Awareness Week section from the IFFGD About GERD website

Pediatric GERD section from the IFFGD About Kids  GI website

Medline Plus page on GERD  (subunit of the U.S. National Institutes of Health)

In addition to encouraging accurate awareness of irritable bowel syndrome, IBS Impact encourages awareness of related conditions that are known to often overlap with IBS, as improvement in symptom management, treatment options, public awareness and social resources may have overlapping positive effects that improve quality of life for some people with IBS. With the high prevalence of GERD in the general public, many people who are not otherwise aware of or who do not take particular interest in functional gastrointestinal and motility disorders may actually have GERD or be close to someone who does. This is another opportunity to educate them about GERD and about FGIMDs in general as issues that do indeed involve them.


Veterans with IBS and Functional Gastrointestinal Disorders 2016

November 11, 2016

Today, November 11, is Veterans Day in the U.S., and a good time to highlight veterans’ issues. U.S. veterans  and current military service members who have been deployed in the Persian Gulf/Southwest Asia region at any time since 1990 have been shown by multiple studies to be at even higher risk of IBS and other functional GI disorders than the general population. Conservative estimates put the incidence of functional GI disorders in the general population as 25%, most commonly irritable bowel syndrome. For veterans and military service members of the Persian Gulf era, the estimate may reach as high as 40%. This appears to be in part because of the high incidence of known functional GI risk factors during active duty, such as severe stress or trauma and/or food or water contamination that results in post-infectious IBS  (IBS-PI) or other post-infectious functional GI and motility disorders.

Here is IBS Impact’s August 12, 2011 post on the recognition four years ago by the U.S. Department of Veterans Affairs of irritable bowel syndrome and functional gastrointestinal disorders as presumptive service connected disabilities for Gulf War veterans.

IFFGD has done considerable work in the past several years in advocating for federal funding and other legislative needs specific to veterans, conducting outreach to service members and veterans and encouraging those affected by functional GI and motility disorders to participate in veteran-specific self-advocacy efforts. Since fiscal year 2012, functional GI disorders have been included in the Department of Defense Gulf War Illness Research Program, which is part of the Congressionally Directed Medical Research Program. However, advocacy from the veteran community and supporters must occur on an ongoing basis for funding to be continued each fiscal year. Interest in veteran issues has been one reason for Congressional support of the Functional Gastrointestinal and Motility Disorders Research Enhancement Act of 2015, HR 2311, currently in the House of Representatives, aimed toward improving the lives of affected veterans and civilians alike, and must continue to build.

As this blog reported on January 20, 2014, the depth of need for further awareness, services, support, and research in the veteran community is not necessarily well known even within the Department of Defense or other military entities, the media or the general public. The post linked in the second paragraph of this post about the recognition of IBS and other functional GI disorders as presumptive service-connected disabilities, more than five years after original publication, has continued to receive consistent hits from readers nearly every day. By an extremely wide margin, from the inception of this blog in mid-2011 through 2015, it was the #1 most read individual post, of over 200 cumulative posts on this blog. It was also the #1 most read post for each individual year.  Not until the release of the Rome IV international diagnostic criteria in late May of this year, did it drop to #2 on the all-time and 2016-to-date lists.Clearly, a very strong need exists for information and resources on this topic. It is hoped that given the relatively higher impact of functional GI disorders among veterans and service members, and their relatively higher profile as a constituent group, any advances on behalf of the affected veterans and service members will eventually carry over to people with functional GI disorders in general.

IBS Impact encourages veterans, service members and families in the IBS and functional GI community, as well as those who support them,  to familiarize themselves with the issues and resources, and to consider participating in self-advocacy activities. We look forward to feedback from readers as to how IBS Impact may be able to support such efforts further.